Fundamentals of Chemotherapy Immunotherapy Administration

Fundamentals of Chemotherapy Immunotherapy Administration Paclitaxel -plant alkaloid -common in combo with cisplatin -treats: ovarian, breast, lung CA no surgery, AIDS related kaposi sarcoma -admin IV only in filter -anaphylaxis, pre-medicate w/pepcid, benadryl, dex Etoposide -Plant alkaloids -treats: testicular and small cell Lung, off-labels too -IV only, (30-60 min) -can cause anaphylaxis and hypotension Vincristine -plant alkaloid -treat: lymphoma, leukemia, neuroblastoma, rhabdomyosarcoma -vesicant -IV push or rapid infusion (15 min) -FATAL IF INTRATHECALLY -may develop ileus Hydroxyurea -antimetabolite/miscellaneous -treats: leukemia, melanoma, inoperable ovarian, with radiation for head/neck, prophylaxis of sickle-cell -ORAL ONLY -consider risks with gout Hormone therapy -treatment that adds, blocks, removes hormones -hormones can cause cancers (ovarian, prostate) -surgery may remove gland that produces hormone -synthetic hormones may block natural hormones Prostate cancer (hormone therapy) -androgen (testosterone) cause prostate cell growth -androgen suppression decreases testosterone -castration resistant (less effective over time) Breast cancer (hormone therapy) -hormone receptor-positive (HR+) - most common -goal: decrease estrogens/progestins -treatment depends on (pre/post menopause) Hormone receptor positive -cells with proteins that bind to specific hormones -need estrogen or progesterone to grow -can affect treatment Tamoxifen -estrogen receptor antagonist & receptor modulator -HR+ breast CA -binds to estrogen receptors, alters estrogen genes -ORAL ONLY -can increase ovulation (birth control) Leuprolide -breast and prostate CA -block LHRH from hypothalamus, block hormone from anterior pituitary gland -Breast=IM q4w ---- Prostate=SC or IM q4-24w -only FDA approved for prostate Targeted therapy -identify/attack specific cancer cells, less harm to normal -block action or deliver toxic substances to cancer cell -fewer side effects to other treatments Small molecule inhibitors -tyrosine kinase inhibitors (TKIs) -Mammalian target of rapamycin (mTOR) inhibitors Tyrosine kinase inhibitors (TKIs) TK = direct cell growth, signaling and division -inhibiting them stops cancer cell growth -drug-drug interaction - TKIs metabolized by CYP Imatinib -TKI -leukemia -ORAL ONLY -monitor GI upset, and weight gain Lapatinib -targeted therapy -breast CA