Title: CANCER CHEMOTHERAPY (Lecture Outline For Medical Students)
1CANCER CHEMOTHERAPY(Lecture Outline For
Medical Students)
2Cancer 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
3 A Brief Review of Natural History of Cancer
- Normal somatic cell
- mutation
- Malignant change
-
- Cancer cell
Proliferate -
(Mitosis)
4 Cell mitosis
- DNA
- Synthesis Mitosis
- RNA
- S phase M phase
5Cancer cell Number Increasing
- Cancer in situ
- T
- Local tumor mass
- Local infiltration extension
- Locally advanced
- N Lymphatic spread LN
- M Hemangial (Systemic spread)
- Remote metastasis
6Cancer ChemotherapyTNM Staging System
Progression of Cancer
7Cancer, Treatment of Choice
- Localized Cancer Surgery
- Locally Advanced
8Role 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
9In Localized or Regional Cancer
CasesMicro-Metastasis May occur(Sub
Clinical Metastasis)
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12Efficacy of Chemotherapy to Cancers
13Chemotherapy Curable Cancers
- Childhood
- ALL 70
- NHL gt50
- Burkitts Lymphoma gt50
- Wilms Tumor gt50
- Ewings Sarcoma gt50
- Embrynal gt50
- Rhabdomyosarcoma
14Chemo-Resistant (Insensitive) Cancers
- Non-Small Cell Lung Cancer
- G.I. Cancers
- Pancreatic Cancer
- Melanoma
15Mechanism 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
16Difficulties in Cancer Chemotherapy
17(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
18(2) Proliferating Normal Cell Damage
- Myelo Suppression
- Granulocytopenia Infection
- Thrombocytopenia Hemorrhage
- RBC anemia
- Lymphocytopenia Immune Suppression
- Mucous Epith Cells Stomatitis G-I
reactions - Germ Cells Inferlity
- Foetus Teratogenic, Abortion
19- (3) Other Organ Toxicity
- Cardiac, Hepatic, Renal, etc.
- Pulmonary
- (4) Drug Resistance
20Methods of Improvement
- Component Transfusion
- Protected Environment
(life Island, Lamina Air Flow Unit), - Hematopoietic Growth Factore
(G-CSF, GM-CSF, Stem Cell Transplants)
21???????? ? ? ? ? ? ?
- Precaution in Cancer Chemotherapy
22- 1. ?????????
- ?????????? (Multi-Modality treatment)
- 2. ?????????????
- ????? (Curative chemotherapy)
- ?????
- ???? (Palliative chemotherapy)
- ????
- Palliative Care?
23- 3. ????
- Toxicity
- Benefit vs Risk
- Cost
- 4. ??????????
( Standard Protocol) - ?Clinical Study ??
- ????,????????? (Adverse effects)
24Cancer Chemotherapy New Advances
- 1. 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