Principles of systemic therapy

From Oncology for Medical Students
Ideal oncology curriculum > Principles of systemic therapy

Objective 5.4

At graduation, the student should be able to:

a) outline the principles of systemic therapy including chemotherapy, hormone and immunotherapy biological therapies (including immunomodulators, signal transduction inhibitors and monoclonal antibodies) and (prospectively) gene therapy
b) recognise clinical indications for use of systemic therapy in early and advanced disease
c) evaluate the outcomes of systemic therapy including efficacy, short and long-term sideeffects, financial costs and quality of life
d) demonstrate ability to assess response to systemic therapy both clinically and radiologically
e) recognise the common complications of systemic therapy and understand their management
f) demonstrate ability to manage toxicities and adverse reactions to systemic therapy e.g. emesis, febrile neutropenia
g) discuss the integration of systemic therapy with other modalities.

Representative questions that suggest the required depth of knowledge

1. Describe some of the important toxicities associated with a course of systemic chemotherapy for lymphoma (support your answer with possible mechanisms).

Essential in answer:

  • Haematological (bone marrow toxicity) – Ø WCC (impaired immunity, risk of secondary infection), Ø Hb, Ø platelets
  • Hair loss – hair follicle synchronisation
  • Nausea and vomiting
  • Cardiomyopathy – anthracycline toxicity after certain dose levels

2. What are the aims of systemic adjuvant therapy (treatment given after definitive surgery) in breast cancer and what are some of the recognised indications for consideration of such therapy?

Essential in answer:

  • Aims – to reduce risk of death or recurrence or to delay these events in women with breast cancer
  • Indications – node positive BC, large primary tumours, women considered at “high” risk of recurrence. More detail than this would be considered of greater than required standard (ie. high-grade tumours, pre-menopausal, vascular invasion)