Cancer Chemotherapy

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

Clinically detectable tumor : 1 × 10 9cell =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 • 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 chlorambucil ; the least toxic alkylating agent cyclophosphamide ; hemorrhagic cystitis , bladder carcinoma ,alopecia ,aspermia , amenorrhea , Ifosfamide ; hemorrhagic cystitis ,alopecia cisplatin ; renal insufficiency ,neuropathy ,ototoxicity , severe nausea and vomiting carboplatin ;

Specific toxicity • Antimetabolites ; cytosar ; cerebellar toxicity ,conjuctivitis 5-FU ; mucositis , diarrhea , capecitabine ( xeloda ) : diarrhea , hand-foot syndrome MTX ; mucositis , impaired renal function , myelosuppression ,

Specific toxicity • Antitumor antibiotics ; bleomycin ; pulmonary fibrosis , anaphylaxis , anthracyclines ; cardiotoxicity , allopecia

Specific toxicity • Mitotic spindle agents ; vincristin , vinblastin ; neuropathy taxane ; hypersensitivity , alopecia , peripheral neuropathy

Specific toxicity • Topoisomerase inhibitors ; etoposide ,irinotecan

Specific toxicity • Tyrosin kinase inhibitors ; gefitinib ( Iressa ) imatinib ( gleevec )

Specific toxicity • Monoclonal antibodies ; relative selectivity for tumor ,cytokine release syndrome ( fevfr , hypotension , bronchospasm ) , Rituximab , Trastuzumab , Alemtuzumab ,Bevacizumab

Growth factors • Erythropoetin • G-csf • Plt growth factor

Cancer Chemotherapy