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    Cancer Chemotherapy

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    Noor Khaiat
    This document provides an overview of cancer chemotherapy. It discusses the role of chemotherapy in cancer treatment, including as an adjuvant or neo-adjuvant therapy. It reviews the mechanisms of chemotherapy drugs and difficulties including toxicity to normal cells and drug resistance. The document also discusses improvements in chemotherapy through supportive care, new drugs that target specific pathways, and emerging therapies like monoclonal antibodies and gene therapy.

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    Cancer Chemotherapy

    Uploaded by

    Noor Khaiat
    142 views24 pages
    This document provides an overview of cancer chemotherapy. It discusses the role of chemotherapy in cancer treatment, including as an adjuvant or neo-adjuvant therapy. It reviews the mechanisms of chemotherapy drugs and difficulties including toxicity to normal cells and drug resistance. The document also discusses improvements in chemotherapy through supportive care, new drugs that target specific pathways, and emerging therapies like monoclonal antibodies and gene therapy.

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    informATION AND TOPICS ON CANCER CHEMOTHERAPY

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    cancer chemotherapy

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    This document provides an overview of cancer chemotherapy. It discusses the role of chemotherapy in cancer treatment, including as an adjuvant or neo-adjuvant therapy. It reviews the mechanisms of chemotherapy drugs and difficulties including toxicity to normal cells and drug resistance. The document also discusses improvements in chemotherapy through supportive care, new drugs that target specific pathways, and emerging therapies like monoclonal antibodies and gene therapy.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    142 views24 pages

    Cancer Chemotherapy

    Uploaded by

    Noor Khaiat
    This document provides an overview of cancer chemotherapy. It discusses the role of chemotherapy in cancer treatment, including as an adjuvant or neo-adjuvant therapy. It reviews the mechanisms of chemotherapy drugs and difficulties including toxicity to normal cells and drug resistance. The document also discusses improvements in chemotherapy through supportive care, new drugs that target specific pathways, and emerging therapies like monoclonal antibodies and gene therapy.

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    CANCER CHEMOTHERAPY

    (Lecture Outline For Medical Students)

    Cancer Chemotherapy
    (1) The role of chemotherapy in cancer treatment (2) Current status of cancer chemotherapy: How effective it is? (3) Mechanism of cancer chemotherapy: a brief review (4) Difficulties in cancer chemotherapy: How to overcome? (5) New developments

    A Brief Review of Natural History of Cancer


    Normal somatic cell mutation Malignant change Cancer cell

    Proliferate (Mitosis)

    Doubling

    Cell mitosis:
    DNA

    Synthesis RNA S phase

    Mitosis M phase

    Cancer cell: Number Increasing


    T N M Cancer in situ Local tumor mass Local infiltration & extension Locally advanced Lymphatic spread: LN Hemangial (Systemic spread): Remote metastasis

    Cancer Chemotherapy
    TNM Staging System
    T1 N0M0 T2 T3 N0M0 T4 TxN1M0 N2 N3 TxNxM1

    Progression of Cancer
    Early, localized

    Localized Cancer

    Infiltration & Local extension

    Locallly advanced

    Regional LN involvement Remote or Systemic metastasis

    Reginal Metastatic

    Cancer, Treatment of Choice


    Localized Cancer: Surgery Locally Advanced:
    If Surgery not possible, Radio therapy Chemotherapy Radio + Chemo (Radio-sensitizer) Chemo Radio Radio, Chemo Surgery (Neo. Adjuvant Chemotherapy) If Surgery possible, Post-operative Radio or Chemo (Adjuvant Chemotherapy) Reginal: Radiotherapy Chemo (Adjuvant) En-bloc Surgery, if possible therapy Metastatic Cancer: Chemotherapy (Palliative or Curative)

    Role of Chemotherapy in Cancer Treatment


    (1) Metastatic Cancer: Palliative or Curative Chemotherapy (2) Adjuvant Chemotherapy: to erradicate or control micro-metastasis (3) Neo-adjuvant Chemotherapy (Induction Chemotherapy) to make Surgery of RT possible
    to alleviate surgical damage to eradicate micro-metastasis

    (4) Hematological Malignancies: Primary Treatment

    In Localized or Regional Cancer Cases Micro-Metastasis May occur

    (Sub Clinical Metastasis)

    e.g.
    (1) Stage II Breast Cancer Breast Cancer with (+) Axillary L.N. (N1 or N2) Mo, Surgery Possible Actually, Micro Metastasis present LN<4, 50%(Micro-Met+) LN>4, 80%(Micro-Met+) Recurrence following Surgery Adjuvant Chemotherapy necessary

    (2) Osteogenic Sarcoma of Lower ectremities Chest X-ray(-) Amputation, 80% Recurrence Rate Reason: Micro Metastasis present Treatment: Surery + Intensive Adjuvant Chemotherapy

    Efficacy of Chemotherapy to Cancers

    Chemotherapy Curable Cancers


    Childhood: ALL NHL

    Adult: 70% Chorio-Carcinoma 90% >50% Testis Cancer >75% Burkitts Lymphoma >50% Hodgkins Disease 70% Wilms Tumor >50% Aggressive NHL >50% Ewings Sarcoma >50% AML 25%-50% Embrynal >50% Ovarians Cancer 10%-20% Rhabdomyosarcoma

    Chemo-Resistant (Insensitive) Cancers


    Non-Small Cell Lung Cancer G.I. Cancers Pancreatic Cancer Melanoma

    Mechanism of Cancer Chemotherapy(Cytostatic Drugs)


    Anti-proliferation
    (1) Blockage DNA Synthesis
    Blockage purined pyramidine synthesis Inhibit DNA polymerase

    (2) Direct Damage to DNA


    Breakage of DNA chain Cross-linkage, inhibit depolarization

    (3) Inhibit Transduction (DNA RNA) (4) Spindle toxin Mitosis damage (5) Inhibit topoisomerase

    Difficulties in Cancer Chemotherapy

    (1) Non-dividing Cancer Cells (Go cells)


    Growth Fraction (GF) and sensitivty Insensitive Cancers:
    Non-small Cell Lung Cancer G-I Cancers Liver Cancer, etc

    Go Cells in Sensitive Cancer: Recurrence

    (2) Proliferating Normal Cell: Damage


    Myelo Suppression:
    Granulocytopenia Thrombocytopenia RBC anemia Lymphocytopenia Infection Hemorrhage
    Immune Suppression

    Mucous Epith Cells Stomatitis G-I reactions Germ Cells Inferlity Foetus Teratogenic, Abortion

    (3) Other Organ Toxicity Cardiac, Hepatic, Renal, etc. Pulmonary (4) Drug Resistance

    Methods of Improvement:
    Component Transfusion Protected Environment (life Island, Lamina Air Flow Unit), Hematopoietic Growth Factore (G-CSF, GM-CSF, Stem Cell Transplants)


    Precaution in Cancer Chemotherapy

    1. (Multi-Modality treatment) 2. : (Curative chemotherapy) :


    (Palliative chemotherapy)

    Palliative Care?

    3.
    Benefit vs Toxicity Risk Cost

    4. : ( Standard Protocol)
    Clinical Study

    , (Adverse effects)

    Cancer Chemotherapy: New Advances


    1. Hi Dose CT/Stem Cell Transplantation 2. New Anticancer Drugs
    Taxanes: TAXOL, TAXOTERE Topoisomerase I Inhibitor: CPT-10, CPT-11, TOPOTECAN Gemcitabine Oxaliplatin, Lobaplatin

    New Theraputic Targets


    e.g. Anti-angioclonal(Angiostatin, Endostatin) Monoclonal Antibody: Herceptin For Breast Cancer (Her 2 neu over expression) Gene therapy

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