I have just passed my FRCR part 1 in clinical oncology and want to help others do the same. I hope over time you will find this a useful blog. Each week I will post advice, revision notes, helpful suggestions and links to helpful resources. This is an independent resource for trainees sitting the FRCR part 1 in clinical oncology.
I've just got started with this blog. Give it time and I hope to create a really helpful resource for everyone out there sitting the exam. Please feel free to e-mail suggestions and 'killer' revision notes. Thanks. I would love to hear from you about this blog. Please post a comment.
A little disclaimer: I am doing this blog to hopefully help you when revising due to the very little available information about this exam. I am not affiliated with any organisation in doing this, completely unfunded and not being sponsored. I can not guarantee the accuracy of the information, but will do my best. If you think something is incorrect please let me know so we can all learn. Thanks
Tuesday, 22 November 2011
My Colleague today brought to my attention a couple of websites that have many helpful resources for revising. They cover Physics particularly well and some radiobiology. The links are:
Cisplatin can lead to renal damage which can therefore reduce the renal clearance of methotrexate
If cisplatin is given before topotecan, exposue to topotecan increases, due to reduced renal clearance of topotecan
Allopurinol reduces the metabolic inactivation of 6-mercaptopurine and increases its toxicity.
Penicillins, Probenacid and sulfonamides and NSAIDs reduce the renal clearance of Methotrexate. Compete for the tubular secretion pathway
If Carboplatin/Cisplatin are administered simultaneously with paclitaxel there is less myelosuppression compared to when platinum preceeds paclitaxel.
There is increased neurotoxicity when cisplatin ans paclitaxel are administered together. This interaction is worse when paclitaxel infusion has along duration.
Methotrexate can be displaced from Albumin by 1.sulphonamides 2.tetracycline 3.chloramphenicol 4.phenytoin 5.NSAIDs. This will increase the plasma concentration, causing more side effects such as mucositis and myelosuppression
I never realised people from so many countries are all gearing up for the FRCR. In the last few months this page has been going, people from every continent have been visiting. I am so excited and can't wait to do more to help you in any way I can. Twesi was telling me how difficult it is knowing where to start with revision. I also found the FRCR very frustrating, with little available to help me through. That is why I set this up. I will do my best to be helpful.
Recently I have been on-call and generally busy at work as an oncology registrar, so not added much. In the next few weeks I will be adding alot more to the blog as I have some time off work. Keep in touch. Good Luck. Stephen
Hi. Just a thank you to everyone who has taken a look at the blog so far. Really good to see people all over the world are taking a look. I have not been putting too much on this last month. as I have been busy at work and having fun sailing. I hope these notes on Drug development and trials helps. I remember this being asked about quite a bit. What's great is it is very easy to understand -so easy marks there.
Hope your studying is going well. Remember is now 3 months to go!
Phase 3: Therapeutic action Confirmed and compared to standard
Phase 4 : Post launch
For classical Cytotoxics
Dose escalation Phase 1 to determine Dose Limiting Toxicity (DLT) & Max Tolerated Dose (MTD)
No-randomised Phase 2 to determine efficacy
Phase 3 - for comparative effficacy
DLT -for example
neutrophil count <0.5 for 5 days associated with fever or infection
Platelet count <10 or bleeding
Other Grade 3 toxicity
Dose at which < or = 33% patients experience an unacceptable toxicity
Characteristics of a Phase 1 trial
Usually in patients with an advanced malignancy, refractory to standard therapies
Patients usually otherwise well
Start with a very cautious dose as determined from pre-clinical studies.
Starting dose (mg/M2) 1/10th of the LD10 (dose at which 10% of rodents die)
1/3rd of minimal toxic dose in large animal studies
Minimise number of patients treated with sub-therapeutic doses. Escalate dose quickly if toxicity absent. Escalate slowly if toxicity present.
Example: Treat 3 pts with safe starting dose (as described above), increase dose if no toxicity. If toxicity in 1 patient add 3 more. Stop escalation when more than 33% pts have an unacceptable toxicity.
Modified Fibomaci Scheme: Start at 1/10th of LD10, then increase by 100% then 67%, then 50%, then 40%, then 33% thereafter (100--67--50--40--33). If the LD10 is accurate, should be 5-6 dose incriments.
PURPOSE: Estimate the recommended dose for later trials, study drug metabolism, elimination and side effects
LIMITATIONS: Chronic/cumulative toxicities not well assessed, uncommon toxicities missed, dose for Phase 2 may be conservative as Phase 1 patients often heavily pre-treated.
PHASE 1 ETHICS
- Pt benefit is not the primary goal, but the trial dose need to have a therapeutic intent
- Low probability of response expected - approx 5%