OneNote 19/11/2019, 17)17
Cancer treatment
Saturday, November 9, 2019 12:38 PM
Chemotherapy
- Direct damage to DNA/RNA apoptosis or frank necrosis
- Cytotoxic drugs not cancer-specific narrow therapeutic-window
- Dose and schedule of chemo are limited by normal tissue tolerance (especially in high
proliferative tissues ex. Bone marrow, GI tract mucosa)
- Limit toxicity to normal tissues ← supplying growth factors like granulocyte-stimulating
factor (G-CSF) or infusing stem cell preparations (diminish bone marrow toxicity)
- Resistance though changes in membrane transport and DNA repair pathways →
intermittent combination chemotherapy
Side effects
• Extravasation of intravenous drugs: leakage can cause severe local tissue
necrosis. Treatment; steroids, antihistamines
• Nausea + vomiting: especially with platinum analogues
• Hair loss, skin + nails effects
• Fatigue: anemia, depression
• Bone marrow and immuno-suppression: transfusions (anemia, thrombocytopenia).
Prophylactic antimicrobials
• Mucositis: high sensitivity of mucosa to antimitotic agents. Pain oropharynx +
difficulty swallowing. Treatment; antiseptic and anti-candida mouthwash
• Cardiotoxicity: acute arrythmia during administration or HF due to cardiomyopathy
after chronic exposure
• Neurotoxicity
• Nephrotoxicity
• Sterility and premature menopause: gonadal damage, loss of ovarian estrogen
production
• Secondary malignancies: mutagenic potential. Acute leukemias!
Endocrine therapy
Estrogens → growth in breast and endometrial cancers
Androgens → growth in prostate cancer
1. Removal of growth factors by manipulation of hormonal environment (surgical
removal of hormone-producing organ)
2. Influence production of certain hormones
3. Competitive antagonists of hormones
Curative: micro metastatic disease in adjuvant setting
Palliative: advance metastatic disease
Immunotherapy
Acute leukemias – allogenic hemopoietic stem cell transplantation HSCT
Tumor immunoglobulin from B-cell lymphomas (1) and melanoma antigens (2) vaccines
Chimeric antigen receptors (CARs) direct T to specific antigenic targets
1. Interferons
INF-α → advanced melanoma, renal cell carcinoma
Side effects: influenza-like symptoms
2. Interleukins
IL-2 activates T cell responses
https://onenote.officeapps.live.com/o/onenoteframe.aspx?ui=en-US&…=1&wopicomplete=1&wdredirectionreason=Unified_SingleFlushFallback Page 1 of 3
Cancer treatment
Saturday, November 9, 2019 12:38 PM
Chemotherapy
- Direct damage to DNA/RNA apoptosis or frank necrosis
- Cytotoxic drugs not cancer-specific narrow therapeutic-window
- Dose and schedule of chemo are limited by normal tissue tolerance (especially in high
proliferative tissues ex. Bone marrow, GI tract mucosa)
- Limit toxicity to normal tissues ← supplying growth factors like granulocyte-stimulating
factor (G-CSF) or infusing stem cell preparations (diminish bone marrow toxicity)
- Resistance though changes in membrane transport and DNA repair pathways →
intermittent combination chemotherapy
Side effects
• Extravasation of intravenous drugs: leakage can cause severe local tissue
necrosis. Treatment; steroids, antihistamines
• Nausea + vomiting: especially with platinum analogues
• Hair loss, skin + nails effects
• Fatigue: anemia, depression
• Bone marrow and immuno-suppression: transfusions (anemia, thrombocytopenia).
Prophylactic antimicrobials
• Mucositis: high sensitivity of mucosa to antimitotic agents. Pain oropharynx +
difficulty swallowing. Treatment; antiseptic and anti-candida mouthwash
• Cardiotoxicity: acute arrythmia during administration or HF due to cardiomyopathy
after chronic exposure
• Neurotoxicity
• Nephrotoxicity
• Sterility and premature menopause: gonadal damage, loss of ovarian estrogen
production
• Secondary malignancies: mutagenic potential. Acute leukemias!
Endocrine therapy
Estrogens → growth in breast and endometrial cancers
Androgens → growth in prostate cancer
1. Removal of growth factors by manipulation of hormonal environment (surgical
removal of hormone-producing organ)
2. Influence production of certain hormones
3. Competitive antagonists of hormones
Curative: micro metastatic disease in adjuvant setting
Palliative: advance metastatic disease
Immunotherapy
Acute leukemias – allogenic hemopoietic stem cell transplantation HSCT
Tumor immunoglobulin from B-cell lymphomas (1) and melanoma antigens (2) vaccines
Chimeric antigen receptors (CARs) direct T to specific antigenic targets
1. Interferons
INF-α → advanced melanoma, renal cell carcinoma
Side effects: influenza-like symptoms
2. Interleukins
IL-2 activates T cell responses
https://onenote.officeapps.live.com/o/onenoteframe.aspx?ui=en-US&…=1&wopicomplete=1&wdredirectionreason=Unified_SingleFlushFallback Page 1 of 3
