1. CANCER CHEMOTHERAPY (Lecture Outline For Medical Students)
管 忠 震

2. 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

3. A Brief Review of Natural History of Cancer
Normal somatic cell
mutation
Malignant change
Cancer cell Proliferate
(Mitosis)

4. Cell mitosis:
DNA
Synthesis Mitosis
RNA
S phase M phase

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

6. Cancer Chemotherapy TNM Staging System Progression of Cancer

7. Cancer, Treatment of Choice
Localized Cancer: Surgery
Locally Advanced:

8. 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

9. In Localized or Regional Cancer Cases Micro-Metastasis May occur (Sub Clinical Metastasis)

12. Efficacy of Chemotherapy to Cancers

13. Chemotherapy Curable Cancers
Childhood:
ALL %
NHL >50%
Burkitt’s Lymphoma >50%
Wilm’s Tumor >50%
Ewing’s Sarcoma >50%
Embrynal >50%
Rhabdomyosarcoma

14. Chemo-Resistant (Insensitive) Cancers
Non-Small Cell Lung Cancer
G.I. Cancers
Pancreatic Cancer
Melanoma

15. 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

16. Difficulties in Cancer Chemotherapy

17. (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

18. (2) Proliferating Normal Cell: Damage
Myelo Suppression:
Granulocytopenia Infection
Thrombocytopenia Hemorrhage
RBC anemia
Lymphocytopenia Immune Suppression
Mucous Epith Cells Stomatitis G-I reactions
Germ Cells Inferlity
Foetus Teratogenic, Abortion

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

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

21. Precaution in Cancer Chemotherapy
肿瘤化学治疗中 值 得 注 意 的 事 项
Precaution in Cancer Chemotherapy

22. 有机结合各种治疗手段 (Multi-Modality treatment) 2. 每一患者均有具体的治疗目标:
1. 全面评估患者的病情
有机结合各种治疗手段 (Multi-Modality treatment)
2. 每一患者均有具体的治疗目标:
根治性化疗 (Curative chemotherapy)
姑息性化疗:
延长寿命 (Palliative chemotherapy)
缓解症状
Palliative Care?

23. 4. 尽量使用标准治疗方案: ( Standard Protocol)
3. 权衡利弊
Toxicity
Benefit vs Risk
Cost
4. 尽量使用标准治疗方案: ( Standard Protocol)
经Clinical Study 证实
密切观察,防止及处理不良反应 (Adverse effects)

24. 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