Chemotherapy Biotherapy Certification

Resources - LESSON 1: Cell cycle - g1- increase in size s- dna replicated g2- cell enlarge and ready to divide m phase- 2 hours mitosis - 4 stages, prophase, metaphase, anaphase, telophase -chemo targets certain points in the process apoptosis - programmed cell death hematopoiesis - formation of blood cells & how cells differentiate -myeloid: pre cells mature into RBCs, platelets and WBCs -lymphoid: pre cells- mature into WBCS Principles of Biotherapy: p51-95 immunology - -defense against foreign organisms, homeostasis (destroy aged cells), surveillance immune responses - innate: primary line of defense, non specific, no memory adaptive: secondary line of defence with specific memry cytokines - -effect growth and differentiation of WBC -interferons, tumor necrosis factors, growth factos and interleukins -small protein molecules released by cells throughout body providing comunication between cells of the immune system -regular antiboddy production and function of b cells vaccines for cancer prevention - -hep B prevents hepatitis and hepatocellular carcinoma -hpv vaccine filgrastim aka neupogen - SC or IV to derease infection in patients with neutropenic fever associated with myelosuppressive anticancer treatments for nonmyeloid malignancies tbo-filgramstim/ pegfilgrastim - reduce duration of neutroenia in patients with non myeloid malignancies palifermin - IV to dec incidence of oral mucositis in patients with hem malignanies before BMT sargramostim - aka leukine - patients with AML following chemo to shorten neutrophil recovery and reduce incidence of infection IFN gamma - reduce frequency and severity o infections related to granulomatous disease aldeleukin - treat renal cell carcinoma and metastatic melanoma oprevelkin - prevent severe thrombocytopenia and refuce need for platelet transfusions in patients with nonmyeloid malig plerixafor - with filgrastim to mobilize hematopoeitc stem cells for collection from peripheral blood of patients sipuleucel - castrate resistant prostate cancer rituximab - rituxan- treatment of relapsed or refractory low grade follicular b cell NHL_ first line traetment in combo with chemo in patients with response -can treat severe rheumatoid arthritis -can have severe reactions (hypotension, urticaria, angiodema, hypoxia, rigors, dyspnea, chills, fever, nausea, rash, renal tox) -premed with tylenol and benadryl -slow infusion to resolve some side effects, side effects reduce with each infusion immune system - 1st line: skin , ucous membrane, gut flora second line: phagocytes: 3rd line antibodies, t and b cells malignant tumor (cancer) - cell strcuture different from parent tissue, cell division uncontrolled, loosely adherent, invade neighboring tissue, establish blood vessels Approaches to treatment - cure: prolonged absence of disease control: no further growth and palliation : comfort neoadjuvant - therapy in the first step to shrink a tumor before the main treatment) surgery is given -chemo, radiation, hormone therapy adjuvant - therapy given afer primary treatment to lower risk of cancer coming back -chemo, radiation, hormone, targeted and biologic therapy myeloblation - obliteration of bone marrow with chemo in prep for blood stem cell or bone marrow trasnplant to destroy blood forming cells in the marrow and reduce tumor burden - destroy immune system so it cannot attack donated cells after transplant nonmyeloblative - not as intense, chemo doses are not as intense LESSON 2: Alkylating Agents - -cytoxan -ifosframide -bendamustine platinum based chemo - consideration on age, kidney function, and concurrent use of radiation. both can cause nausea, vomiting, hearting loss, kidney function damage, electrlyte disturb. CBC chem panel and mag checked -cisplatin: admin over longer period of time. nausea can last over a week -carboplatin- risk with age 65, harder on kidney function. over shorter period of time, nausea within first 24 hours. neuro tox cyclophasmide - hair loss 10-14 days post treatment -can be given peripherally -hemmorhagic cystitis - hydration is key, high dose may need bladder protection -easier to give than iphosphamide iphosphamide - neuro changes can occur- personality changes can occur, neuro checks before central line only -need a bladder protective agent 100% of the time nitrosureas - cross blood brain barrier - can treat brain tumors. alkylating agents -pulmonary monitoring Lesson 3: Antimetabolites - -azacitidine -capacitabine -fluorouracil -cytarabine -decitabine -methotrexate inhibit DNA and RNA synthesis - can cause myelosuppression, GI toxicities, phospotsensitiivty, hand foot syndrome, vigorous I V hydration to prevent tumor lysis 5 fluorouracil (5 FU) - -IV oral topic and opthalmic formalation -can cause hyperpigmentation, increased mucositis, photosensitivity, diarrhea -capcytobine is the oral form - needs to be taken 2x day, hand foot syndrome can occur -INR monitoring methotrexate - antimetabolite, cell cycle specific to S phase -cleared in kidneys - effects: hepatotox, renal tox, mucositis, nausea, myelosuppression, pneumonitis, photosensitivity, neurotoxicity, infertility