Systemic Anticancer Therapy

Question 1

What does systemic anticancer therapy (SACT) refer to?

Answer 1

Treatment of cancer using drugs that act throughout the body to destroy or control malignant cells.

Question 2

What are the four main classes of systemic anticancer therapy?

Answer 2

1. Cytotoxic agents – damage DNA and induce apoptosis
2. Hormonal therapies – e.g. Tamoxifen
3. Immunotherapy – e.g. Herceptin (trastuzumab)
4. Targeted therapies – e.g. receptor tyrosine kinase inhibitors

Question 3

How do cytotoxic drugs generally work?

Answer 3

By damaging DNA and triggering programmed cell death (apoptosis).

Question 4

What are the four main clinical uses of chemotherapy?

Answer 4

1. Adjuvant – after surgery to destroy residual microscopic disease
2. Neoadjuvant – before surgery to shrink tumours
3. Curative – as the main or sole treatment for cure
4. Palliative – to relieve symptoms and improve quality of life

Question 5

What is the goal of adjuvant chemotherapy?

Answer 5

To eliminate micrometastatic disease post-surgery and improve survival (e.g. in breast, lung, colorectal cancers).

Question 6

What is the goal of neoadjuvant chemotherapy?

Answer 6

To downstage a tumour before surgery (e.g. in oesophageal or rectal cancers).

Question 7

When is curative chemotherapy used?

Answer 7

As the primary treatment in potentially curable cancers such as testicular tumours, lymphomas, leukaemias, and many paediatric malignancies.

Question 8

What is the role of palliative chemotherapy?

Answer 8

To improve symptoms, enhance quality of life, and modestly prolong survival (e.g. in small cell lung cancer).

Question 9

What are the two broad categories of chemotherapy toxicities?

Answer 9

• Acute (generally reversible)
• Late (usually irreversible)

Question 10

List examples of acute toxicities.

Answer 10

• Myelosuppression
• Nausea and vomiting
• Diarrhoea
• Alopecia
• Skin and nail changes
• Local reactions

Question 11

List examples of late toxicities.

Answer 11

• Peripheral neuropathies
• Sterility
• Cardiovascular toxicity
• Pulmonary fibrosis
• Renal insufficiency

Question 12

What is myelosuppression?

Answer 12

Suppression of bone marrow function leading to decreased production of red cells, white cells, and platelets.

Question 13

What are the clinical effects of red cell suppression?

Answer 13

Lethargy and dyspnoea (from anaemia).

Question 14

What are the effects of white cell suppression?

Answer 14

Increased susceptibility to infections (neutropenia).

Question 15

What are the effects of platelet suppression?

Answer 15

Purpura and bleeding due to thrombocytopenia.

Question 16

What types of infections are seen in chemotherapy patients?

Answer 16

• Localized - bacterial, viral (e.g. herpes zoster), fungal
• Systemic - febrile neutropenia, septic shock

Question 17

Define febrile neutropenia.

Answer 17

Neutrophil count <1.0 × 10⁹/L and temperature >38°C.

Question 18

How is neutropenic sepsis managed?

Answer 18

• Prompt IV fluids
• Broad-spectrum IV antibiotics

Question 19

What is mucositis?

Answer 19

Inflammation and ulceration of the mucous membranes (oral, GI) due to chemotherapy-induced epithelial damage.

Question 20

What are the three types of CINV?

Answer 20

1. Acute – within 24 hours
2. Delayed – after 24 hours
3. Anticipatory – Pavlovian response before treatment due to prior experiences

Question 21

What has reduced the occurrence of anticipatory emesis?

Answer 21

Improved use of modern antiemetic regimens.

Question 22

Name high-risk drugs for chemotherapy-induced emesis.

Answer 22

Cisplatin, dacarbazine, doxorubicin, epirubicin, ifosfamide, streptozocin.

Question 23

Name moderate-risk drugs for emesis.

Answer 23

Cyclophosphamide and carboplatin

Question 24

Name low-risk drugs for emesis.

Answer 24

Methotrexate, 5-fluorouracil, taxanes, topotecan.

Question 25

Name minimal-risk drugs for emesis.

Answer 25

Vincristine and bleomycin.

Question 26

Which chemotherapy drugs most commonly cause alopecia?

Answer 26

Anthracyclines and taxanes.

Question 27

Which drugs rarely cause alopecia?

Answer 27

5-fluorouracil (5-FU) and vincristine.

Question 28

Is chemotherapy-induced alopecia reversible?

Answer 28

Yes — always reversible.

Question 29

How can alopecia be minimized during chemotherapy?

Answer 29

Scalp cooling during chemotherapy administration.

Question 30

Which drug commonly cause peripheral neuropathy?

Answer 30

Cisplatin

Question 31

Which areas are most affected by chemotherapy-induced neuropathy?

Answer 31

Hands and feet, and sometimes autonomic nerves.

Question 32

Describe the time course of chemotherapy neuropathy.

Answer 32

- Cumulative (worsens with total dose) - Often irreversible

Question 33

Which agents most commonly cause sterility?

Answer 33

Alkylating agents.

Question 34

Is recovery from chemotherapy-induced sterility possible?

Answer 34

Yes — spontaneous recovery may occur, especially in younger patients.

Question 35

What fertility preservation options are available?

Answer 35

- Men - sperm storage - Women - experimental ovarian or oocyte tissue storage

Question 36

Which cytotoxic drugs are most cardiotoxic?

Answer 36

Anthracyclines (e.g. doxorubicin, epirubicin).

Question 37

What cardiac effect do anthracyclines most commonly cause?

Answer 37

Congestive heart failure (dose-related).

Question 38

How can anthracycline-induced heart failure be minimized?

Answer 38

By keeping cumulative doses below the safe threshold.

Question 39

Which drugs can cause cardiac arrhythmias?

Answer 39

Taxanes and anthracyclines.