Updated: 10/4/2016

Chemotherapy

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Evidence
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Introduction
  • Mechanism
    • induces apoptosis  
    • may target specific proteins over-expressed in cancer cells
      • e.g. tyrosine kinase inhibitors 
        • imatinib (Gleevec) for chronic myelogenous leukemia
        • gefitinib (EGFR inhibitor, Iressa) for lung, breast cancer
        • erlotinib (EGFR inhibitor, Tarceva) for NSCLC and pancreatic cancer
    • eliminates micrometastasis in lungs
    • >98% necrosis with chemotherapy is good prognostic sign
  • Resistance
    • expression of multi-drug resistance (MDR) gene portends very poor prognosis
      • cells can pump chemotherapy out of cell
      • present in 25% of primary lesions and 50% of metastatic lesions
Indications
  • Integral component of treatment along with surgical resection in
    • osteosarcoma (intramedullary and periosteal)
    • Ewing's sarcoma/primative neuroectodermal tumor
    • malignant fibrous histiocytoma
    • dedifferentiated chondrosarcoma
    • chemotherapy for soft tissue sarcoma is controversial 
Administration
  • Preoperative chemotherapy given for 8-12 weeks
  • Maintenance chemotherapy for 6-12 months
Specific Agents & Antidotes
  • Doxorubicin (Adriamycin)
    • mechanism
      • doxorubicin is an anthracycline antibiotic commonly used in oncological protocols
      • functions as a cytostatic agent
    • side effects
      • cardiac toxicity  
        • leads to congestive heart failure
        • dexrazoxane used to mitigate toxicity
  • Agents and Antidotes  
    • mechlorethamine/cisplatin - give sodium thiosulfate
    • doxorubicin/epirubicin - give dexrazoxane
    • vinca alkaloids (vincristine/vinblastine) - give hot compress and hyaluronidase
      • give cold compress for all other vesicants
 
 

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Questions (5)

(OBQ11.175) Doxorubicin, a common chemotherapeutic agent used in the treatment of osteosarcoma, has which of the following major dose-limiting toxicities? Tested Concept

QID: 3598
1

Cardiomyopathy

91%

(2329/2567)

2

Pulmonary fibrosis

5%

(117/2567)

3

Myelosuppression

3%

(76/2567)

4

Encephalopathy

0%

(10/2567)

5

Urotoxicity

1%

(28/2567)

L 1 C

Select Answer to see Preferred Response

(OBQ09.167) Tyrosine kinase inhibitors are currently used in the medical treatment of which of the following? Tested Concept

QID: 2980
1

Paget's disease

15%

(402/2729)

2

Osteogenesis imperfecta

3%

(95/2729)

3

Cancer

71%

(1924/2729)

4

Osteoporosis

3%

(90/2729)

5

Osteopetrosis

8%

(213/2729)

L 3 D

Select Answer to see Preferred Response

(OBQ08.273) What is the major side-effect of doxorubicin? Tested Concept

QID: 659
1

neuropathy

4%

(105/2352)

2

hearing loss

3%

(67/2352)

3

pulmonary fibrosis

4%

(102/2352)

4

cardiac toxicity

87%

(2044/2352)

5

liver cirrhosis

1%

(21/2352)

L 1 C

Select Answer to see Preferred Response

(OBQ06.125) Pharmacologically induced apoptosis occurs during the medical therapy of which of the following disorders? Tested Concept

QID: 311
1

Phenol adjuvant resection bed therapy in giant cell tumors

11%

(208/1809)

2

TNF-alpha inhibitor treatment in rheumatoid arthritis

6%

(105/1809)

3

Colchicine treatment for gout

2%

(40/1809)

4

Vancomycin therapy for MRSA infection

2%

(34/1809)

5

Doxorubicin neoadjuvant chemotherapy for cancer

78%

(1413/1809)

L 2 C

Select Answer to see Preferred Response

(OBQ05.101) Which of the following is true regarding apoptosis? Tested Concept

QID: 987
1

It is the primary mechanism by which conventional chemotherapy kills cancer cells

79%

(947/1192)

2

It is the primary mechanism by which cancer metastasis occurs

1%

(16/1192)

3

It is the primary mechanism by which cancer causes organ failure

1%

(13/1192)

4

It is the primary mechanism by which cancer forms lytic lesions in bone

2%

(28/1192)

5

None of the above

15%

(182/1192)

L 2 D

Select Answer to see Preferred Response

Evidence (9)
POSTS (1)
VIDEOS (4)
Topic COMMENTS (2)
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