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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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
1

Cardiomyopathy

90%

(2429/2691)

2

Pulmonary fibrosis

5%

(129/2691)

3

Myelosuppression

3%

(84/2691)

4

Encephalopathy

0%

(11/2691)

5

Urotoxicity

1%

(31/2691)

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
1

Paget's disease

15%

(417/2804)

2

Osteogenesis imperfecta

3%

(96/2804)

3

Cancer

70%

(1970/2804)

4

Osteoporosis

3%

(91/2804)

5

Osteopetrosis

8%

(224/2804)

L 3 D

Select Answer to see Preferred Response

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

QID: 659
1

neuropathy

4%

(107/2392)

2

hearing loss

3%

(67/2392)

3

pulmonary fibrosis

4%

(103/2392)

4

cardiac toxicity

87%

(2081/2392)

5

liver cirrhosis

1%

(21/2392)

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
1

Phenol adjuvant resection bed therapy in giant cell tumors

11%

(215/1884)

2

TNF-alpha inhibitor treatment in rheumatoid arthritis

6%

(112/1884)

3

Colchicine treatment for gout

2%

(41/1884)

4

Vancomycin therapy for MRSA infection

2%

(36/1884)

5

Doxorubicin neoadjuvant chemotherapy for cancer

78%

(1471/1884)

L 2 C

Select Answer to see Preferred Response

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

QID: 987
1

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

78%

(986/1263)

2

It is the primary mechanism by which cancer metastasis occurs

2%

(19/1263)

3

It is the primary mechanism by which cancer causes organ failure

1%

(14/1263)

4

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

3%

(34/1263)

5

None of the above

16%

(204/1263)

L 2 D

Select Answer to see Preferred Response

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