NUR231 Case Study: Chemotherapy for Lung Cancer Management

This case study focuses on Nigel, a 78-year-old male with stage 4 non-small cell lung cancer and liver metastases, who experiences shortness of breath and chest pain. The case explores the pathophysiology of lung cancer, particularly how it affects breathing, and the impact of liver metastases on chemotherapy drug pharmacokinetics. It discusses the effectiveness of cisplatin and docetaxel in treating lung cancer, detailing their mechanisms of action and potential side effects like nausea and vomiting. The case also touches on alternative treatments like Nivolumab and the importance of managing chemotherapy-induced nausea and vomiting through understanding the underlying hormonal and neurological mechanisms. This comprehensive analysis provides insights into the complexities of lung cancer treatment and patient care strategies.

CASE STUDY 1
Case Study
Name of Author
Institution of Affiliation
Date of Submission

CASE STUDY 2
Case Study
Question One
The shortness of breathing or difficulty in breath is a common condition to individuals with
lung cancer like in the case of Nigel. In this case, one feels uncomfortable and cannot get enough
oxygen into the lungs (Noble and Pasi, 2010). It is because of lung cancer that makes Nigel
experience difficulty in breathing. Lung cancer affects breathing by interfering with the normal
functions of the lungs in different ways. The first process involves a tumor cell grows rapidly,
thereby blocking off or narrowing the airway taking the piece of lung out of commission. With
the airway blocked, no fresh air can get into the airway for its transportation into the blood,
which leads to mild or severe issues with breathing (Dupoiron et al., 2015). In this case, the
person experiences shortness of breathing since the airway of the lung cannot transport oxygen
from the lungs into the blood. The other case almost similar the first case where the airway is
obstructed by the cancerous cell which puts pressure on structures around the aviation route, the
bodily fluid caught inside the lung get contaminated coming about into a development of
discharge noticeable all around sacs of the lungs. The process is otherwise called obstructive
pneumonia and prompts trouble in breathing as well as prompts chills and fever.
Furthermore, lung cancer can affect breathing systems by blocking the free flow of fluids that
are found in the spaces of the lungs and the ribs. This leads to accumulation of fluids in the
spaces of the lung a condition referred to as pleural effusion. As a result, the lung becomes soft
and spongy, whereas the chest wall remains solid and composed by the bones and the muscles.
The accumulation of the fluid compresses the spongy and soft lung together with air sacs making
the lung to collapse. This leads to insufficient oxygen into air sacs, thereby making the patient

CASE STUDY 3
experience difficulty in breathing. The rapid growth of the tumor cell may also put the pressure
on the lungs by making them small, thereby collecting insufficient oxygen, which in turn results
in breathing difficulties (Mercadante, 2010).
Nigel is in stage IV of non-small cell lung cancer, which means that he is in the most
advanced form of cancer. This means that most of the cancerous cell spread beyond the lungs to
other parts of the body, including the brain, the heart, and in the blood, the process referred to as
metastasis (Afsharimani, Cabot and Parat, 2011). The cancerous cells can spread into the
blood, thereby leading to anemia. Anemia is a condition of low red blood count in the blood,
which may lead to shortness of breath. Also, the tumor can also spread to the heart, thereby
leading to building up of fluid around the heart, also known as pericardial effusion (Temel et al.,
2010).
Question Two
The administration of chemotherapy drugs to patients with secondary liver cancer needs
careful consideration. This is because having secondary liver cancer means the patient has
hepatic dysfunction thus liver impairment the condition that affects drug kinetics including
altering of the biliary excretion of drugs, the changes of the intrinsic hepatic clearance of drugs
and the reduction of hepatic metabolic capacity (Hellmann et al., 2017).
Metastases, also referred to as secondary liver cancer results in hepatic dysfunction, which
influences the pharmacokinetics of chemotherapy drugs used. In this scenario, Nigel’s secondary
cancer will lead to hepatic dysfunction, which will then influence the pharmacokinetic effects of
chemotherapy drugs that Nigel has been administered, namely Docetaxel and Cisplatin. Besides,
the pharmacokinetic effects of Ondansetron, Morphine IV, and Dexamethasone applied to Nigel

CASE STUDY 4
will be affected, thereby leading to their ineffective. Hepatic dysfunction will affect the
pharmacokinetic results of chemotherapy drugs by decreasing drug metabolism activity.
The impairment of drug metabolism will then lead to an increase in the degree of histological
evidence of cancer. The cytochrome P-450 level is reduced, and specific qualitative changes of
the chemotherapy drug metabolism pattern may occur. For example, the pharmacokinetics of
Docetaxel was altered in patients who had liver dysfunction. It depends on the enzyme affected,
for instance, the impairment of docetaxel metabolism may be as a result of either breakdown of
the drug in unexpected low concentration of the metabolites or elevated levels of the parent drug.
As a result, Nigel will experience an increase in chemotherapy drug toxicity or a decrease in the
efficacy of these chemotherapy drugs. The liver dysfunction affects the efficiency and
effectiveness of chemotherapy drugs in that it increases the plasma concentration as a result of
reduced rate of drug metabolism (Marzuka et al., 2015).
Besides, the clearance values of chemotherapy drugs significantly decrease, and their
half-life values increase. According to the study, the clearance of Docetaxel was reduced to 50 %
in patients who had hepatic impairment. Besides, there was a corresponding increase in half-life,
which indicates that hepatic impairment has minimized the rate of drug metabolism. The
assessment of chemotherapy drugs pharmacokinetics in patients with secondary liver cancer,
which leads to liver dysfunction like Nigel is critical to avoid toxicity (Dezube et al., 2010).

CASE STUDY 5
Question Three
The chemotherapy medications provided in the case that is cisplatin and docetaxel can
effectively cure Nigel’s lung cancer. Chemotherapy involves drugs that are toxic to tumor cells,
and they are usually administered through a catheter placed in a large vein or by direct injection
into a vein. Nigel has a primary stage non-small lung cancer, which is widespread throughout his
lungs, thus the need for chemotherapy medications. Surgery may be futile for Nigel as tumor
cells have spread to various parts of his body. Thus chemotherapy or radiation therapy alone or
combined can help in curing of Nigel’s conditions (Florea and Büsselberg, 2011).
The chemotherapy drugs that Nigel has been prescribed can be effective to treat his lung by
killing rapidly diving cells. The cancer cells divide more frequently than most cells in the body,
but they are susceptible when one is under chemotherapy medications. Different chemotherapy
drugs work effectively at various stages of cell division; thus, the reason for why it is essential
for one to be given two or more combination of chemotherapy drugs like in the case of Nigel.
Nigel has been prescribed two chemotherapy medications, which include Docetaxel and
Cisplatin. The combination of these chemotherapy drugs is important for Nigel’s lung cancer
treatment as both will kill as many cancer cells as possible (DiPiro et al., 2015).
Also, morphine is effective in the treatment of lung cancer as it can relieve pain that is making
Nigel feel uncomfortable. Ondansetron is also effective to prevent nausea and vomiting, which is
linked to the use of Cisplatin chemotherapy drug.

CASE STUDY 6
Question Four
Cisplatin is a well-known alkylating agent that is known for its chemotherapeutic action. It is
used to treat various human cancers, including lung cancer as in the case of Nigel, among other
types of cancer. It is effective in sarcomas, carcinomas, lymphomas, and germ cell tumors. Its
mode of action in treating cancer is that it can interfere with the DNA repair process by cross-
linking with the purine bases of DNA (Dasari and Tchounwou, 2014). This results in damage of
DNA, which subsequently leads to apoptosis in tumor cells. This mechanism is believed to
function in three different ways. One of the cases is that it attaches the alkyl unit to bases of the
DNA leading to fragmentation of DNA by its repair enzymes. The fragmentation of DNA by
repair enzymes is as a result of DNA enzyme’s attempts to replace the alkylated bases thereby
leading to the prevention of DNA synthesis and RNA transcription processes from taking place
in the affected DNA. The other case is through the DNA damage through the formation of cross-
links, which bonds between atoms of the DNA are thereby preventing the separation of DNA
synthesis or RNA transcription. The third case of the mechanism is the induction of miss pairing
of the nucleotides, thereby resulting in mutations (Caley and Jones, 2012).
Docetaxel, on the other hand, is a well-known anti-mitotic chemotherapy drug which is
used to cure non-small cell lung cancer like as in the case of Nagel among other types of cancer.
Its mechanism of action is understood to interfere with the normal function of microtubule
growth. Docetaxel arrests the functions of microtubules by having the opposite effect of
depolymerization (Galluzzi et al., 2012). It hyper- stabilizes the structure of microtubules,
thereby damaging cancer’s cell’s capability to utilize its cytoskeleton in versatile manner. In
particular, it ties to the beta subgroups of tubulin. Since tubulin is the structure square of
microtubules, the authoritative of docetaxel bolts together these structure squares to result in

CASE STUDY 7
docetaxel/microtubule complex that comes up short on the capacity to dissemble. This result in
adverse effects of lung cancer cell since the microtubule’s dynamic instability have been
shortened and lengthened. Further research has also indicated that docetaxel kills cancer cells by
inducing the programmed cell death, also known as apoptosis in tumor cells. The apoptosis of
cancer cells is as results of binding of stopping protein known as Bcl-2 to cancer cells, thus
arresting its function (Hanigan et al., 2011).
On the other hand, Nivolumab drugs mechanism of action relies on immunotherapy.
Immunotherapy drugs are the medicine that cures cancer by stimulating the patient's immune
system to perceive and decimate tumor cells effectively (Dasari and Tchounwou, 2014).
Nivolumab is another chemotherapy that can be utilized in hospital setting to treat non-small cell
lung cancer that Nigel is suffering from. The nivolumab can heal cancerous cells as it can keep
the immune system from attacking its normal cells. It makes the use of checkpoints which
involve molecules in the immune cells that can be turned on and off on immune response. The
idea behind this action is that sometimes, the tumor cells make use of these checkpoints to avoid
being attacked by the immune system. Nivolumab blocks the immune checkpoint, which in this
case is PD-1. The strategy behind the nivolumab mechanism is linked to the reduction of the
inhibitory signaling, which restores the natural tumor-specific T-cell immune response of the
patient (Brahmer et al., 2015).

CASE STUDY 8
Question Five
Nausea and vomiting may come suddenly or happen at random after cisplatin, nivolumab,
and docetaxel medication, even though such medications are not administered orally. Besides, it
has been reported by various studies that nausea and vomiting are common adverse effects of
chemotherapy drugs. Feeling of nausea and vomiting as a result of chemotherapy drugs
mentioned above can either be acute, delayed, or anticipatory. In this case, acute means it can
come within the first one day, whereas delayed vomiting occurs after one day and anticipatory in
that it can happen as a result of learned response or as a result of the stimulation from these
chemotherapy medications. In many cases, nausea and vomiting occur after the initial exposure
of these chemotherapy medications and before subsequent treatment (Brown et al., 2011).
The mechanism behind nausea and vomiting after chemotherapy medication is well
described from various research studies. It is understood that there is a specific region in the
brain that regulates vomiting, also referred to as the vomiting center. Nausea and vomiting
occurs when the vomiting center receives a signal from the brain, and the gastrointestinal tract,
which detects the movement. Chemotherapy drugs such as nivolumab, docetaxel, and cisplatin
stimulates the release of hormones such as serotonin (5-HT) and other hormornes in the
gastrointestinal tract (Algarra et al., 2017). It is these series of signals from these chemicals
hormones that stimulates the vomiting center in the brain to effectuate nausea and vomiting thus
adverse reaction.
The common factors that increase the risk of occurrence of nausea and vomiting include
dietary changes, gender, age, alcohol, and drug use. To prevent nausea and vomiting after
chemotherapy medication, the physician can administer antiemetic medications, which blocks

CASE STUDY 9
serotonin receptor. The medication stops the signal thus resulting into emesis. Some examples
approved antiemetic drugs that can be used together with the mentioned chemotherapy drugs
include Granisetron, Dolasetron, and Ondansetron (Wiffen, Wee and Moore, 2016).
Question Six
Nigel’s is in the primary stage 4 of non-small cell lung cancer. Considering the cancer cells
has spread throughout his lungs means that he is having pain, which makes him feel discomfort.
This pain has to be managed, thus the reason for administration of Morphine IV, which is known
for its strong pain relieve (Afsharimani, Cabot and Parat, 2011). Besides its use, it has its side
effects that can cause harm to Nigel.
One main adverse reaction that may occur as a result of Nigel’s morphine administration is
drug interactions that may lead to depressants effects of morphine. Morphine iv is known to be
antagonized by acidifying agents and potentiated by alkalizing agents. In this scenario, morphine
can interact with other medications that Nigel is using, such as cisplatin, docetaxel,
dexamethasone, and ondansetron leading negative impacts. For instance, morphine is understood
to interact with alkalizing agents like docetaxel leading to depressants effects. This adverse effect
can be avoided by taking the prescribed drugs at a different time with Morphine (Ali et al.,
2011). Taking morphine at different time with other chemotherapy drugs ensures there are no
adverse drug interactions.

CASE STUDY 10
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CASE STUDY 11
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CASE STUDY 12
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