Cancer chemotherapy

on 29.8.08 with 0 comments

Chemotherapy can potentially cure…

  • acute leukemias (particularly in children—90+%; 50-60% in adults)

  • lymphomas

  • small cell carcinoma of the lung, which behaves like a lymphoma

  • testicular cancer, even with significant metastases (e.g. to the brain)

  • childhood solid tumors

    • osteosarcoma

    • neuroblastoma

    • Ewing’s sarcoma

  • these are the fast-growing tumors

Adjuvant chemotherapy (i.e., chemo after surgery) can prevent relapses in…

  • breast cancer, in > ½ of people

  • colorectal cancer

  • lung cancer—adjuvant chemo helping lung cancer relapse is relatively new information (2 years)

  • maybe prostate and bladder cancer

Neo-adjuvant chemo-radiotherapy can downstage to allow resection of locally advanced tumors

  • first, chemotherapy sensitizes the tumor to radiotherapy and then radiotherapy works locally to shrink the tumor

  • breast cancer

  • lung cancer (“Pancoast tumor”)

  • rectal cancer

  • esophageal cancer

  • head & neck cancer

  • bladder cancer

Palliative chemotherapy for metastatic solid tumors

  • most of the metastatic solid tumors (with the exception of those mentioned earlier) have growth so large that they are usually not curable

  • these include metastatic lung, breast, colorectal, prostate ca

  • goals

    • prolong life (breast cancer metastasis—pt might live for a decade) or delay symptoms

    • palliate existing symptoms and improve quality of life

      • reduce pain, obstruction

      • reduce B-symptoms, i.e. consequences of cytokine release from tumors

        • fevers

        • night sweats

        • weight loss

    • minimize side effects (do no harm)

Chemotherapy for non-malignant diseases

  • immunosuppression post organ transplant

  • rheumatologic disease: rheumatoid arthritis, systemic lupus erythematosus (methotrexate)

  • multiple sclerosis

  • psoriasis (methotrexate)

  • autoimmune hemolysis and idiopathic thrombocytopenic purpura (Rituximab)

  • sickle cell anemia

Problems with chemotherapy

  • low therapeutic indices

  • limited activity in non-cycling cells; limited effect on cancer stem cells

  • rapid emergence of resistant clones

  • there is no single unique cancer phenotype, except in chronic myelogenous leukemia (BCR-ABL)

  • targeted therapy typically has low response rates unless used in combination

Category: Pharmacology Notes



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