Drugs Used to Treat Cancer
Plant Alkaloids (Vinca Alkaloids)
vincristine (Oncovin) Uses: lymphomas, acute leukemia, neuroblastoma, Wilms' tumor AE: peripheral neuropathy, extravasation may lead to tissue necrosis
Minimization of Indirect Contact
--PPE use (gown, gloves, etc) --Double flush toilets for 48 hours following hazardous drug administration with lid down --Place linen with contaminated body fluid in specially marked laundry bags placed inside an impervious (and labeled) bag
Goals of Anti-Cancer Treatment
1. Cure--try to achieve a cure or produce remission 2. Control--to control tumor growth, shrink the mass (tumor) 3. Palliation--relieve pain, improve quality of life
General Adverse Reaction to Anti-Cancer Drugs
1. Hematologic (anemia, neutopenia, thrombocytopenia) 2. Gastrointestinal (NVD, decreased app., change in taste) 3. Skin and Hair (rash, alopecia) 4. Reproductive (infertility--not gender specific)
Factors Affecting Response to Chemotherapeutic Agent----(Characteristics of the tumor)
1. Location 2. Size/tumor burden (# of cancer cells) 3. Growth rate/fraction 4. Presence of resistant cells 5. Ratio of sensitivity of malignant cells to normal target cells 6. Adequate blood supply with adequate drug uptake
Potential AE of Chemotherapy: Gastrointestinal System
AE: Anorexia, Taste changes, N/V/D, Mucositis, Stomatitis, Constipation
Potential AE of Chemotherapy: Integumentary System
AE: Dermatitis, Hyperpigmentation, Alopecia, Nail changes (brittle), Rash, Urticaria, Pruritus
Potential AE of All Chemotherapy: Hematopoietic System
AE: Neutropenia, Thrombocytopenia, Anemia
Cardotoxicity (potential organ toxicity related to chemotherapy)
Adriamycin
Cell cycle non-specific drugs (CCNS)
Alkylating agents Antitumor Antibodies Hormone inhibitors
Hormonal Inhibitor Agents (CCNS)
Antiestrogen: tamoxifen (Novaldex) Used to treat estrogen dependent breast cancers AE: hot flashes, N/V, vaginal discharge **only effective in treatment of tumors with estrogen receptors
Cell cycle specific drugs
Antimetabolites Plant alkaoids
Pulmonary toxicity (potential organ toxicity related to chemotherapy)
Bleomycin
Factors Affecting Response to Chemotherapeutic Agents----Psychological Status
Can affect how well you tolerate treatment
Cancer treatments: Systemic
Chemotherapy Hormonal therapy Biologic response modifiers
Neurotoxicity, Ototoxicity, and Nephrotoxicity (potential organ toxicity related to chemotherapy)
Cisplatin
Hemorrhagic cystitis (potential organ toxicity related to chemotherapy)
Cytoxan
Plant Alkaloids (Taxanes)
Ex) Taxol, Taxotere Uses: Advanced breast cancer and non-small cell lung cancer AE: Bone marrow depression, N/V, peripheral neuropathy
Hyperplasia
Excessive growth (higher production)
Cancer Influences
Genetic (tumor suppressor gene) Infective (HPV, HIV) Environmental (chemicals, radiation) Dietary (high fat and sugar foods) Lifestyle (alcohol, tanning bed, multiple sex partners Immune suppression (patients with HIV)
Local therapies
Impact that area only, not the entire body
Systemic therapies
Impact the whole body
Neutropenia
Low neutrophil count ***Need to advocate to patients the EXTREME importance of wearing masks out in public, frequent hand washing, etc. is when they have neutropenia
Antiandrogens: bicalutamide (Casodex)
MOA: Bind to androgen receptors in cells of the prostate gland and blocks the effects of testosterone on the malignant prostate cell growth ***Used for advanced prostate cancer
Bleomycin (Blenoxane)
MOA: Inhibits DNA and RNA synthesis Uses: Squamous cell, lymphomas, testicular cancer AE: Pulmonary toxicity, mucositis, alopecia, N/V
Aromatase inhibitors: anastrazole (Arimidex)
MOA: blocks estrogen production **Used for breast cancer in postmenopausal women AE: nausea, hot flashes, edema
Anti-tumor antibiotics (CCNS)
MOA: kill cancer cells by stopping the synthesis of RNA, DNA, or proteins Ex) Blenoxane, Actinomycin D, Adriamycin
Platinol
Route: IV Uses: advanced carcinomas of testes, bladder, and ovary AE: Nephrotoxicity, Ototoxicity, etc. Nursing Interventions: monitor I&O, BUN, CREA, watch for tinnitus and hearing loss
Dysplasia
More growth, see abnormalities
Factors Affecting Response to Chemotherapeutic Agents-----Social Support
Need to have stability and support, helps them deal with their diagnoses
Factors Affecting Response to Chemotherapeutic Agents----Socioeconomic Issues
Nutrition, living environment, expensive treatment
How many cells are there in a 1 cm tumor?
One billion
Factors Affecting Response to Chemotherapeutic Agent----Physical Status
Performance status, age, co-morbidities (other diseases patient may have on top of this), prior therapies
Wilms' tumor (nephroblastoma)
Rare kidney cancer that predominantly affects children (most common cancer of kidneys in children)
Cytoxan
Route: Oral or IV ***Hydration is imperative to prevent hemorrhagic cystitis Administer in the a.m. Can give MESNA as a cytoprotectant to prevent hemorrhagic cystitis AE: N/V, bone marrow depression, alopecia
Folic acid antagonists: Methotrexate
S-phase specifc Antimetabolite (CCS) MOA: interferes with DNA synthesis, repair, and cellular replication **Uses: colorectal cancer, topical for basal cell carcinomas, leukemias, osteosarcoma AE: Bone marrow suppression, NVD, mucositis, alopecia
FluoroUracil (5FU)
S-phase specific Antimetabolite (CCS) MOA: Affects DNA and RNA synthesis ***Uses: colon cancer, pancreatic cancer, topical for basal cell carcinoma AE: Stomatitis (early sign of toxicity), bone marrow depression, NV, etc. **60%-80% of drug excreted by lungs as CO2
In situ-
Small "theoretically can remove and achieve a cure"
Neoplasm
Solid tumors on your organ
Plant Alkaloids (CCS)
Stop cell division during mitosis (M-phase)
Cancer treatments: Local
Surgery and Radiation
Invasive CA:
Through layers of tissue to blood and lymph vessels---metastasis occurs at this point
Adriamycin (Doxorubicin)
Uses: acute leukemia, lymphoma, breast cancer, lung cancer, ovarian cancer AE: **Cardiotoxicity**, bone marrow depression, N/V, alopecia, etc. Let patients know their urine will be red for a short period of time