Ep. 64 – Chemo & Biological Therapy: Corissa makes it easy!

It can be easy to get lost in all the different cancer treatments & side effects. “What does what again?” Good thing Corissa Decker, BSN, RN, BMTCN is back to teach us about common side effects, mechanisms, & other things to know about chemotherapy & biological therapy, but don’t worry: she makes it easy to follow & understand, so you’ll walk away with exactly what you need to know! I’ve listed some of our favorite resources to reference about these treatments below:

Resources

chemocare.com

cancer.gov

drugs.com

Chemotherapy 

Technically, every medication is a form of chemotherapy.  However, we’ll refer to chemotherapy in the rest of this episode as medication known as anti-neoplastic therapy or anti-cancer drugs designed to cure or treat cancer.  Chemotherapy can be used alone or in conjunction with other treatments, before or after surgery.  Patients can undergo chemotherapy for curative purposes, to treat cancer, or for palliative purposes.

Alkylating Agents

• Cell-cycle non-specific (attacks cells no matter the phase they are in), most active in resting phase.  
• Sub-groups: mustard gas derivatives, nitrosureas, metal salts
• Examples: carboplatin, carmustine, thiotepa, busulfan
• Because they are non-specific to cell cycle, they cause major damage, including immunosuppression, N/V, mucositis, alopecia, bone marrow suppression.
• Nitrosureas can cross the blood-brain barrier, useful because of “sanctuary sites” (places cancer cells can “hide out”)

Plant Alkaloids

• Cell-cycle specific (wait for certain times when the cells are in a particular phase to attack), derived from plants (examples: periwinkle, pacific yew tree)
• Vinca alkaloids, Taxanes
• Common side effects: peripheral neuropathies

Antimetabolites

• Cell-cycle specific, classified by which substance in the body they are interfering with (Folic acid, purine, adenosine)
• Examples: 5-FU, methotrexate, cytarabine, 
• Alopecia, N/V, bone marrow suppression, change in taste, mucositis

Antitumor antibiotics

• Cell-cycle specific
• Examples: doxorubicin (Adriamycin, “red devil”), daunorubicin, idarubicin; dactinomycin, mitomycin
• Vesicant – means that it can damage surrounding tissue
• Side effects: pain*, n/v, bone marrow suppression, alopecia

Miscellaneous Antineoplastics

• Various classes & mechanisms of action
• Retinoids, enzymes, ribonucleotide reductase inhibitors
• Common side effects: alopecia, N/V/D, mucositis

Biological Therapies

Immunotherapy

• Manipulates the immune system to create a hostile environment for the growth of cancer
• Mobilizes immune system to fight cancer (making it more efficient or triggering it to indirectly affect tumor cells.
• *Flu-like symptoms: fever, chills, nausea
• Colony-stimulating factors – neupogen, procrit,
  • Can cause bone pain, fever, fatigue
• Tumor vaccines – help immune system recognize cancer – provenge
  • Not the same as vaccines to prevent cancer, such as HPV vaccine
• Non-specific active immunotherapy – creates general immune response to activate wide variety of immune cells – interleukins, BCG
• Passive immunotherapy/adoptive immunotherapy – providing antibodies to create immune response, can be specific (monoclonal antibodies, “-mab”) or non-specific (remove T-cells to culture in lab, then return to patient)
• Alternate approach to activate lymphocytes from patient’s tumor to crate tumor-infiltrating lymphocytes.

Cytotoxic therapy (tumor cell modulation)

• Changes cell biology so cancer cells weaken & die
• Uses cytoxins produced by body to attack cancerous cells
• Some agents make cancer cell antigens more recognizable or “stickier” so our body’s defenses will attach more easily, or will cause interference with ability to metastasize. 

Don’t forget to check out my Facebook Live series happening on Mondays – we’re discussing how to make your oncology evals easier & more efficient. You don’t want to miss it here!