CANCER CHEMOTHERAPY (Lecture Outline For Medical Students)

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CANCER CHEMOTHERAPY(Lecture Outline For
Medical Students)

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Cancer 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

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A Brief Review of Natural History of Cancer

• Normal somatic cell
• mutation
• Malignant change
• Cancer cell
  Proliferate
• 
  (Mitosis)

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Cell mitosis

• DNA
• Synthesis Mitosis
• RNA
• S phase M phase

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Cancer 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

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Cancer ChemotherapyTNM Staging System
Progression of Cancer
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Cancer, Treatment of Choice

• Localized Cancer Surgery
• Locally Advanced

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Role 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

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In Localized or Regional Cancer
CasesMicro-Metastasis May occur(Sub
Clinical Metastasis)
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Efficacy of Chemotherapy to Cancers
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Chemotherapy Curable Cancers

• Childhood
• ALL 70
• NHL gt50
• Burkitts Lymphoma gt50
• Wilms Tumor gt50
• Ewings Sarcoma gt50
• Embrynal gt50
• Rhabdomyosarcoma

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Chemo-Resistant (Insensitive) Cancers

• Non-Small Cell Lung Cancer
• G.I. Cancers
• Pancreatic Cancer
• Melanoma

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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

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Difficulties in Cancer Chemotherapy
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(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

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(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

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• (3) Other Organ Toxicity
• Cardiac, Hepatic, Renal, etc.
• Pulmonary
• (4) Drug Resistance

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Methods of Improvement

• Component Transfusion
• Protected Enviroment
  (life Island, Lamina Air Flow Unit),
• Hematopoietic Growth Factore
  (G-CSF, GM-CSF, Stem Cell Transplants)

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• Precaution in Cancer Chemotherapy

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• 1. ?????????
• ?????????? (Multi-Modality treatment)
• 2. ?????????????
• ????? (Curative chemotherapy)
• ?????
• ???? (Palliative chemotherapy)
• ????
• Palliative Care?

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• 3. ????
• Toxicity
• Benefit vs Risk
• Cost
• 4. ??????????
  ( Standard Protocol)
• ?Clinical Study ??
• ????,????????? (Adverse effects)

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Cancer 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