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Treatment Modalities

Treatment Modalities. Ayda G. Nambayan, RN, DSN International Outreach Program St. Jude Children’s Research Hospital Memphis, TN. Traditional Cancer Therapies. Novel Cancer Therapy Evolves. Surgery -- less invasive Radiation – more focused and intense Chemotherapy – still the mainstay

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Treatment Modalities

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  1. Treatment Modalities Ayda G. Nambayan, RN, DSN International Outreach Program St. Jude Children’s Research Hospital Memphis, TN

  2. Traditional Cancer Therapies

  3. Novel Cancer Therapy Evolves • Surgery -- less invasive • Radiation – more focused and intense • Chemotherapy – still the mainstay • Hormone therapy – as adjuvant/maintenance • Bone marrow/stem cell transplantation - • Biologic/Immunologic therapy - promising • Molecularly targeted therapy • Gene therapy – experimental stage • Supportive Therapy • Complementary and Alternative Therapies

  4. Chemotherapy Science is Rapidly Unfolding • Chemotherapy still mainstay of treatment • Metastatic • Elderly • Adjuvant • Novel therapies hold promise • Novel combinations • Different settings • Hope for breast, colorectal, pancreatic cancer - EGFR survival outcomes for patients with locally advanced or metastatic pancreatic cancer1 • Development of chemoprevention strategies Kim ES, Astra-Zeneca

  5. Chemotherapy – What’s new • Combination modality • Agents that are complementary • Inclusion of protective agents • Critical timing of administration • Dosing schema • Dose dense • Dose intensification • Dose escalation • Individualized dosing • Drug pharmacokinetics • Pharmacogenomics

  6. Surgery – What’s New • Cryosurgery – freezing the cells • Prostate • Reconstructive Surgery • Breast • Head and Neck/ dental • Less Invasive/ tissue sparing • Percutaneous procedures • Stereotactic methods • Use of biomedically engineered devices • Repiphysis for limb sparing • Reconstruction/prosthetic surgeries

  7. Limb Sparing Tissue Sparing Reconstruction Cryosurgery

  8. Radiation Therapy – What’s New • More focused • Brachytherapy/ implanted • Stereotactic • Radioimmunotherapy – target RT • Prevention of immediate and late SE’s • Protection of RT-sensitive tissues • Protective medications • Normal tissue sparing • IMRT • Conformal

  9. Radiation Therapy - types • External • Conformal RT • Intensity Modulated RT • Image Guided RT • Stereotactic RT • Palliative • Total Body Irradiation • Radioimmunotherapy • Zevalin (Ibritumomab tiuxetan; anti-CD20 + Yttrium-90) • Bexxar (Tositumomab Iodine-131; anti-CD20 + Iodine 131) • Internal • Brachytherapy • Implanted • Targeted • Radioisotope Therapy (RIT)

  10. External Beam RT Mammosite Targeted Implanted RT IGRT

  11. Biologic/Immunologic therapy Molecularly targeted therapy

  12. Target Therapy • Targeting specific antigens (Biologic/Immunotx) • HER2, CD20, CTLA-4 • Targeting mutation-activated kinases (Molecular) • KIT, PDGF-R, BCR-ABL, EGF-R • Targeting specific pathways • Angiogenesis inhibition via VEGF-receptors • CpG immunosyimulation through TLR-9

  13. Small Molecules

  14. TKI – small molecules

  15. Molecular - mTOR

  16. Transplantation – BMT, SCT Unrelated

  17. Bone Marrow/Stem Cell Transplantation • Conditioning Regimen • Less toxicity • Donor Sources • Cord Blood • Mismatch family member (Haploidentical transplantation) • Use of specialized machines to decrease side-effects • Clinimac separator machine • Newer drugs to combat GvHD

  18. CliniMACS Selection System

  19. CliniMACS cells plus magneticmicrobeads with anti-CD133 magnet magnet CD133+ cells (graft) Waste

  20. Integumentary GvHD

  21. Hormonal Therapies • Steroids – Dexamethasone, Prednisone • Estrogen Receptor blockers – Breast cancers • Tamoxifen (Nolvadex) • Aromatase Inhibitors (Aromasin, Femara, Arimidex) • Anti-androgen drugs - Prostate cancer • Flutamide (Eulexin; Flutamin) • Bicalutamide (Casodex, Cosudex, Calutide, Kalumid) • Nilutamide (Nilandron; Anandron)

  22. Gene Therapies • Types • Replacement - healthy variant of an otherwise mutated gene is re-introduced into the cell, thereby repairing the function of the mutated gene and reverting the phenotype • Suicide - the delivery of a cytotoxic gene into the cancer cells, which upon activation, results in the production of a toxic component causing cell death

  23. Suicide Gene Therapy

  24. Supportive Therapies • Important dimension of cancer therapy • Treatment modalities prevents, alleviate disease and treatment – related effects • Proven to an effective ally in decreasing morbidity and mortality from cancer therapies • Improves patient’s quality of life

  25. Goal • Prevent or treat as early as possible the symptoms of the disease, side effects caused by treatment of the disease, • Manage psychological, social, and spiritual problems related to the disease or its treatment. • Improve patient’s quality of life

  26. Types of Supportive Therapies • Management of fever and neutropenia • Use of growth factors – Neupogen, Procrit, Neumega • Proactive use of antibiotic therapy • Prevention of Infection • Prophylactic use of antibiotics • Blood component therapy • Blood transfusions for anemia, thrombocytopenia, neutropenia • Monitoring and management of drug toxicity • Patient/family Education • Nutritional support • Calorie boosters

  27. Other aspect of supportive carePalliative Care • Care given to improve the quality of life of patients who have a serious or life-threatening disease. • Aggressive EOL symptom management

  28. Complementary and Alternative Therapy • group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine • Considered part of supportive care

  29. CAM • Complementarytherapy - used together with conventional medicine. • Massage and Hydrotherapy • Music, relaxation, imagery • Vitamins and herbal supplements • Alternative medicine is used in place of conventional medicine. • Arbolaryo, hilot • Faith healers

  30. Nursing Requirements • Thorough knowledge of the treatment modalities available • Actions • Side-effects and its management • Competency in patient assessments • Competency in drug administration • Venous access skills • Ability to observe and recognize adverse reactions and complications of therapy • Competency in patient and family education

  31. It’s all to do with training. You can do a lot if you are properly trained. Queen Elizabeth

  32. Questions??????

  33. Thank you / Salamat po!!!!!

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