Chapter 45 Antineoplastic Drugs Part 1: Cancer Overview and Cell Cycle–Specific Drugs Copyright ©...
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Transcript of Chapter 45 Antineoplastic Drugs Part 1: Cancer Overview and Cell Cycle–Specific Drugs Copyright ©...
Chapter 45
Antineoplastic Drugs Part 1:Cancer Overview and Cell
Cycle–Specific Drugs
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Cellular transformation Uncontrolled and rapid cellular growth Invasion into surrounding tissue Metastasis to other tissues or organs
Cancer
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Cancerous cells do not have: Growth control mechanisms Positive physiologic function
Cancer cells either: Grow and invade adjacent tissues, or Break away from original tumor mass and travel by
means of blood or lymphatic system to distant sites
Cancer (cont’d)
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Primary lesion Original site of growth
Metastasis Uncontrolled cell growth Secondary lesion, in a new and remote part of the
body Neoplasm (“new tissue”)
Mass of new cells; tumor Tumor
Benign Malignant (cancer)
Cancer (cont’d)
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Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 5
Carcinomas Sarcomas Lymphomas and leukemias
Also known as circulating tumors or hematologic malignancies
Cancer: Tissues of Origin
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Various group of symptoms that cannot be directly attributed to the spread of a cancerous tumor
May be the first sign of malignancy Cachexia (most common) Fatigue, fever, weight loss Others
Paraneoplastic Syndromes
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Age- and sex-related differences Genetic factors Ethnic factors Oncogenic viruses Occupational and environmental carcinogens Radiation Immunologic factors
Etiology of Cancer
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G0: resting phase
G1: first gap phase S: synthesis phase G2: second gap phase M: mitosis phase (cell reproduction)
Cell Growth Cycle
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Pharmacologic treatment of cancer Antineoplastic drugs Divided into two groups based on where in the
cellular life cycle they work Cell cycle–nonspecific (CCNS) Cell cycle–specific (CCS)
Some drugs have characteristics of both
Chemotherapy
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Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 12
Cell cycle–specific drugs Drugs that are cytotoxic during a specific cell-cycle
phase Used to treat a variety of solid and/or circulating
tumors• Antimetabolites
• Mitotic inhibitors
• Alkaloid topoisomerase II inhibitors
• Topoisomerase I inhibitors
• Antineoplastic enzymes
Cancer Drugs:Antineoplastic Medications
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Cell cycle–nonspecific drugs Cytotoxic during any cell-cycle stage
Cancer Drugs:Antineoplastic Medications (cont’d)
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Miscellaneous cell cycle–specific drugs Miscellaneous antineoplastics (cell-cycle
specificity unclear) Hormonal agents Radioactive antineoplastics
Cancer Drugs:Antineoplastic Medications (cont’d)
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Drugs have a narrow therapeutic index Combination of drugs is usually more effective
than single-drug therapy Drug resistance Nearly all drugs cause adverse effects Dose-limiting adverse effects
Chemotherapy (cont’d)
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Harmful to all rapidly growing cells Harmful cancer cells Healthy, normal human cells
• Hair follicles
• GI tract cells
• Bone marrow cells
Chemotherapy (cont’d)
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Dose-limiting adverse effects GI tract and bone marrow
Alopecia Emetic potential Myelosuppression
Bone marrow suppression (BMS) Bone marrow depression (BMD)
Nadir Extravasation Targeted drug therapy
Chemotherapy Terms
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Folate (folic acid) antagonists methotrexate (MTX), pemetrexed, palatrexate
Purine antagonists fludarabine (F-AMP),mercaptopurine (6-MP),
thioguanine (6-TG), cladribine, pentostatin Pyrimidine antagonists
fluorouracil (5-FU), cytarabine (ara-C), capecitabine, floxuridine (FUDR), gemcitabine
Antimetabolites
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Folic acid antagonism Interferes with the use of folic acid As a result, DNA is not produced, and the cell dies
Antimetabolites (cont’d)
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Purine antagonism Interrupts metabolic pathways of purine nucleotides Results in interruption of DNA and RNA synthesis Tumor lysis syndrome
Antimetabolites (cont’d)
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Pyrimidine antagonism Interrupts metabolic pathways of pyrimidine bases Results in interruption of DNA and RNA synthesis
Antimetabolites (cont’d)
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Used in combination with other drugs to treat various types of cancer, such as solid tumors and some hematologic cancers Acute and chronic lymphocytic leukemias Leukemias (several types) Colon, rectal, breast, stomach, lung, pancreatic
cancers
Antimetabolites: Indications
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Oral and topical forms may be used for low-dose maintenance and palliative cancer therapy
Often used in combination chemotherapy regimens
Methotrexate is also used to treat severe cases of psoriasis and rheumatoid arthritis
Antimetabolites: Indications (cont’d)
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Hair loss, nausea and vomiting, myelosuppression
Neurologic, cardiovascular, pulmonary, hepatobiliary, GI, genitourinary, dermatologic, ocular, otic, and metabolic toxicity
Tumor lysis syndrome Palmar-plantar dysesthesia (also called hand-
foot syndrome), Stevens-Johnson syndrome, toxic epidermal necrolysis
Antimetabolites: Adverse Effects
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Classroom Response Question
Which condition does the nurse anticipate when assessing a patient with tumor lysis syndrome?
A.Hyperuricemia
B.Hypophosphatemia
C.Hypokalemia
D.Hypercalcemia
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Classroom Response Question
A patient who is receiving high-dose chemotherapy with methotrexate is also receiving leucovorin. The purpose of the leucovorin is to:
A.produce an additive effect with the methotrexate by increasing its potency against the cancer cells.
B.reduce the incidence of cardiomyopathy caused by the methotrexate.
C.add its antiinflammatory effects to the treatment regimen.
D.reduce the bone marrow suppression caused by the methotrexate.
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Natural products obtained from the periwinkle plant Vinca alkaloids
Semisynthetic drugs obtained from the mandrake (mayapple) plant
Drugs obtained from the yew tree
Mitotic Inhibitors
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Vinca alkaloids (periwinkle) vinblastine, vincristine, vinorelbine
Taxanes docetaxel (European yew tree: needles) paclitaxel (western yew tree: bark) cabazitaxel eribulin
Mitotic Inhibitors (cont’d)
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Can work in various phases of the cell cycle (late S phase, throughout G2 phase, and M phase)
All work shortly before or during mitosis and thus retard cell division
Each different subclass inhibits mitosis in a unique way
Mitotic Inhibitors: Mechanism of Action
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Often used in combination therapies Used to treat a variety of solid tumors and some
hematologic malignancies Testicular, small cell lung, breast, ovarian, non–small
cell lung cancers Kaposi’s sarcoma Acute leukemia
Mitotic Inhibitors: Indications
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Hair loss, nausea and vomiting, myelosuppression
Liver, kidney, lung toxicities Convulsions Extravasation
Several specific antidotes can be used
Mitotic Inhibitors: Adverse Effects
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Derived from mandrake plants Used to treat small cell lung cancer and
testicular cancer Not used as much now because of significant
toxicities without therapeutic benefit etoposide teniposide
Alkaloid Topoisomerase II Inhibitors
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Classroom Response Question
The nurse identifies which of the following as the most significant neurotoxin of the cytotoxic drug class?
A.paclitaxel (Taxol)
B.docetaxel (Taxotere)
C.vincristine (Vincasar PFS)
D.etoposide (Toposar)
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Derived from camptothecin, a substance taken from a Chinese shrub topotecan (Hycamtin) irinotecan (CPT-11, Camptosar)
Topoisomerase 1 Inhibitors (Camptothecins)
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Cell cycle–specific drugs Inhibit proper DNA function in the S phase Prevent DNA relegation
Topoisomerase 1 Inhibitors (Camptothecins) (cont’d)
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Indications Ovarian and colorectal cancer Small cell lung cancer Other tumors
Topoisomerase 1 Inhibitors (Camptothecins) (cont’d)
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Adverse effects Bone marrow suppression (predictable, reversible,
noncumulative, manageable) GI effects (nausea, vomiting, diarrhea) Irinotecan causes cholinergic diarrhea (delayed,
occurring 2 to 10 days after dosage)
Topoisomerase 1 Inhibitors (Camptothecins) (cont’d)
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Synthesized using cultures of bacteria and recombinant DNA technology
As a result, an enzyme is produced This enzyme is isolated and purified for clinical
use asparaginase (Elspar): used to treat acute
lymphocytic leukemia pegaspargase (Oncaspar)
Antineoplastic Enzymes
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Assess baseline blood counts before administering antineoplastic drugs
Follow specific administration guidelines for each antineoplastic drug
Nursing Implications
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Classroom Response Question
A pregnant woman has been diagnosed with cancer and is meeting with her oncologist to plan treatment. Which statement about chemotherapy and pregnancy is true?A.She will have to wait until the baby is born before starting chemotherapy.B.The greatest risk of fetal harm from chemotherapy is during the third trimester.C.Chemotherapy treatment during the second or third trimester poses less risk to the fetus.D.Chemotherapy is unsafe during pregnancy, but radiation therapy is safe in low doses.
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Remember that all rapidly dividing cells (both normal and cancer cells) are affected Mucous membranes Hair follicles Bone marrow component
Monitor for effects on these tissues or complications
Nursing Implications (cont’d)
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Monitor for complications GI mucous membranes: stomatitis, altered bowel
function with high risk for poor appetite, nausea, vomiting, diarrhea, and inflammation and possible ulcerations of GI mucosa
Nursing Implications (cont’d)
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Monitor for complications Hair follicles: loss of hair (alopecia) Bone marrow components: dangerously low (life-
threatening) blood cell counts Monitor for adverse effects specific to the type of
antineoplastic drug given
Nursing Implications (cont’d)
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Implement measures to monitor for and prevent infection in patients with neutropenia or leukopenia
Implement measures to monitor for and prevent bleeding in patients with thrombocytopenia and anemia
Keep in mind that anemia may result in severe fatigue
Nursing Implications (cont’d)
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Classroom Response Question
The nurse is caring for a patient who received chemotherapy 24 hours ago. The patient’s white blood cell count is 4,400 mcL. Which symptom, if experienced by the patient, should the nurse report to the prescriber immediately?
A.Fatigue
B.Diarrhea
C.Fever
D.Nausea and vomiting
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Monitor for stomatitis (oral inflammation and ulcerations), and implement measures to reduce the effects if it occurs
Anticipate nausea and vomiting, and implement measures to reduce these effects
Antiemetics often work better if given 30 to 60 minutes before chemotherapy is started
Nursing Implications (cont’d)
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Women of childbearing age will need to use a nondrug form of contraception during therapy
In addition to physical measures, keep in mind the need for emotional support during this time for both the patient and family
Monitor for therapeutic responses to antineoplastic therapies and the many possible adverse effects
Nursing Implications (cont’d)
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Classroom Response Question
When working with a patient who is neutropenic, the nurse identifies which as the most effective measure to prevent the patient from developing an infection? A.Administer prophylactic antibioticsB.Stop administration of the chemotherapeutic drugC.Perform hand hygieneD.Vaccinate the patient to prevent bacterial infection
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