Cancer Chemotherapy Dr.Azarm
The goal of cancer treatment is eradication of cancer If not possible shifts to palliation,amelioration and preservation of quality of life Dr.Azarm
Surgery Radiotherapy Chemotherapy Biologic therapy Dr.Azarm
Diagnosis Pathology Tumor markers ; germ cell tumors, Dr.Azarm
Staging Clinical Pathologic Dr.Azarm
Surgery Curative Palliative
Radiation Ionization and excitation of atoms and bombs that kills cells Cell killing,nausea, vomiting,fatigue, somnolence Late effect ;fibrosis and gliosis Skin and mucosal reactions are accentuated by other modalities like chemotherapy Acute response, subacute response, late response Definitive, adjuvant, palliative
Chemotherapy
Chemotherapy
Clinically detectable tumor : 1 × 10 9 cell =1 cm Mechanism of drugs : apoptosis, pproliferation control, affect maturation, angiogenesis,
Chemotherapy for what ?? Cure malignancies or improve survival Palliate symptoms Organ preserving
Types of chemotherapy Adjuvant Neoadjuvant Palliative
Type of administration Oral IV Intracavitary
Intravenous Vein selection Irritant : without necrosis,BCNU,cisplatin,dacarbazine, etoposide, vinca alkaloids Vesicant : necrosis, antrscyclines, dactinomycine, nitrogen mustard
Complications of chemotherapy Complications of chemotherapy Myelosuppression Gastrointestinal toxicity : nausea and vomiting, mucositis, diarrhea Abnormal renal function : cisplatin, MTX Hepatotoxicity : vinca alkaloids, antracyclines
Specific toxicity Alkylating agents : carcinogen, busulfan ; irreversible myelosuppression busulfan ; irreversible myelosuppression chlorambucil ; the least toxic alkylating agent chlorambucil ; the least toxic alkylating agent cyclophosphamide ; hemorrhagic cystitis, bladder carcinoma,alopecia,aspermia, amenorrhea, cyclophosphamide ; hemorrhagic cystitis, bladder carcinoma,alopecia,aspermia, amenorrhea, Ifosfamide ; hemorrhagic cystitis,alopecia Ifosfamide ; hemorrhagic cystitis,alopecia cisplatin ; renal insufficiency,neuropathy,ototoxicity, severe nausea and vomiting cisplatin ; renal insufficiency,neuropathy,ototoxicity, severe nausea and vomiting carboplatin ; carboplatin ;
Specific toxicity Antimetabolites ; cytosar ; cerebellar toxicity,conjuctivitis cytosar ; cerebellar toxicity,conjuctivitis 5-FU ; mucositis, diarrhea, 5-FU ; mucositis, diarrhea, capecitabine ( xeloda ) : diarrhea, hand- foot syndrome capecitabine ( xeloda ) : diarrhea, hand- foot syndrome MTX ; mucositis, impaired renal function, myelosuppression, MTX ; mucositis, impaired renal function, myelosuppression,
Specific toxicity Antitumor antibiotics ; bleomycin ; pulmonary fibrosis, anaphylaxis, bleomycin ; pulmonary fibrosis, anaphylaxis, anthracyclines ; cardiotoxicity, allopecia anthracyclines ; cardiotoxicity, allopecia
Specific toxicity Mitotic spindle agents ; vincristin, vinblastin ; neuropathy vincristin, vinblastin ; neuropathy taxane ; hypersensitivity, alopecia, peripheral neuropathy taxane ; hypersensitivity, alopecia, peripheral neuropathy
Specific toxicity Topoisomerase inhibitors ; etoposide,irinotecan etoposide,irinotecan
Specific toxicity Tyrosin kinase inhibitors ; gefitinib ( Iressa ) gefitinib ( Iressa ) imatinib ( gleevec ) imatinib ( gleevec )
Specific toxicity Monoclonal antibodies ; relative selectivity for tumor,cytokine release syndrome ( fevfr, hypotension, bronchospasm ), relative selectivity for tumor,cytokine release syndrome ( fevfr, hypotension, bronchospasm ), Rituximab, Trastuzumab, Alemtuzumab,Bevacizumab Rituximab, Trastuzumab, Alemtuzumab,Bevacizumab
Growth factors Erythropoetin G-csf Plt growth factor