nullCANCER CHEMOTHERAPY
(Lecture Outline For Medical Students)
CANCER CHEMOTHERAPY
(Lecture Outline For Medical Students)
管 忠 震医学全在线 www.med126.com Cancer ChemotherapyCancer 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 A Brief Review of Natural History of Cancer A Brief Review of Natural History of CancerNormal somatic cell
mutation
Malignant change
Cancer cell Proliferate
(Mitosis) Cell mitosis: Cell mitosis: DNA
Synthesis Mitosis
RNA
S phase M phaseCancer cell: Number IncreasingCancer cell: Number Increasing Cancer in situ
T
Local tumor mass
Local infiltration & extension
Locally advanced
N Lymphatic spread: LN
M Hemangial (Systemic spread):
Remote metastasisCancer Chemotherapy
TNM Staging System Progression of CancerCancer Chemotherapy
TNM Staging System Progression of CancerCancer, Treatment of ChoiceCancer, Treatment of ChoiceLocalized Cancer: Surgery
Locally Advanced:
Role of Chemotherapy in Cancer TreatmentRole 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
In Localized or Regional Cancer Cases
Micro-Metastasis May occur
(Sub Clinical Metastasis)
In Localized or Regional Cancer Cases
Micro-Metastasis May occur
(Sub Clinical Metastasis)
nullnullEfficacy of Chemotherapy to CancersEfficacy of Chemotherapy to CancersChemotherapy Curable CancersChemotherapy Curable CancersChildhood:
ALL 70%
NHL >50%
Burkitt’s Lymphoma >50%
Wilm’s Tumor >50%
Ewing’s Sarcoma >50%
Embrynal >50%
RhabdomyosarcomaChemo-Resistant (Insensitive) CancersChemo-Resistant (Insensitive) CancersNon-Small Cell Lung Cancer
G.I. Cancers
Pancreatic Cancer
MelanomaMechanism of Cancer Chemotherapy(Cytostatic Drugs)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
Difficulties in Cancer ChemotherapyDifficulties in Cancer Chemotherapy(1) Non-dividing Cancer Cells (Go cells)(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
(2) Proliferating Normal Cell: Damage(2) Proliferating Normal Cell: DamageMyelo Suppression:
Granulocytopenia Infection
Thrombocytopenia Hemorrhage
RBC anemia
Lymphocytopenia Immune Suppression
Mucous Epith Cells Stomatitis G-I reactions
Germ Cells Inferlity
Foetus Teratogenic, Abortionnull(3) Other Organ Toxicity
Cardiac, Hepatic, Renal, etc.
Pulmonary
(4) Drug ResistanceMethods of Improvement:Methods of Improvement:Component Transfusion
Protected Environment (life Island, Lamina Air Flow Unit),
Hematopoietic Growth Factore (G-CSF, GM-CSF, Stem Cell Transplants)肿瘤化学治疗中
值 得 注 意 的 事 项肿瘤化学治疗中
值 得 注 意 的 事 项Precaution in Cancer Chemotherapynull1. 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?null3. 权衡利弊
Toxicity
Benefit vs Risk
Cost
4. 尽量使用标准治疗
: ( Standard Protocol)
经Clinical Study 证实
密切观察,防止及处理不良反应 (Adverse effects)Cancer Chemotherapy: New AdvancesCancer Chemotherapy: New Advances1. 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