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Updated: 6/18/2021

Chemotherapy

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Questions
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Evidence
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Videos / Pods
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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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Flashcards (5)
Cards
1 of 5
Questions (5)

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

QID: 3598

Cardiomyopathy

90%

(2742/3050)

Pulmonary fibrosis

5%

(147/3050)

Myelosuppression

3%

(102/3050)

Encephalopathy

0%

(14/3050)

Urotoxicity

1%

(35/3050)

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?

QID: 2980

Paget's disease

15%

(443/3042)

Osteogenesis imperfecta

3%

(104/3042)

Cancer

71%

(2153/3042)

Osteoporosis

3%

(100/3042)

Osteopetrosis

8%

(234/3042)

L 1 D

Select Answer to see Preferred Response

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

QID: 659

neuropathy

4%

(117/2674)

hearing loss

3%

(69/2674)

pulmonary fibrosis

4%

(111/2674)

cardiac toxicity

88%

(2340/2674)

liver cirrhosis

1%

(21/2674)

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?

QID: 311

Phenol adjuvant resection bed therapy in giant cell tumors

12%

(241/2094)

TNF-alpha inhibitor treatment in rheumatoid arthritis

6%

(124/2094)

Colchicine treatment for gout

2%

(50/2094)

Vancomycin therapy for MRSA infection

2%

(38/2094)

Doxorubicin neoadjuvant chemotherapy for cancer

78%

(1632/2094)

L 2 C

Select Answer to see Preferred Response

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

QID: 987

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

77%

(1153/1491)

It is the primary mechanism by which cancer metastasis occurs

1%

(22/1491)

It is the primary mechanism by which cancer causes organ failure

1%

(20/1491)

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

3%

(45/1491)

None of the above

16%

(245/1491)

L 2 D

Select Answer to see Preferred Response

Evidence (9)
VIDEOS & PODCASTS (5)
EXPERT COMMENTS (2)
Private Note