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CANCER CHEMOTHERAPY (Lecture Outline For Medical Students)

CANCER CHEMOTHERAPY (Lecture Outline For Medical Students). 管 忠 震. 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

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CANCER CHEMOTHERAPY (Lecture Outline For Medical Students)

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  1. CANCER CHEMOTHERAPY(Lecture Outline For Medical Students) 管 忠 震

  2. 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

  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

  5. 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

  6. Cancer ChemotherapyTNM Staging System Progression of Cancer

  7. Localized Cancer: Surgery Locally Advanced: Cancer, Treatment of Choice

  8. 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

  9. In Localized or Regional Cancer CasesMicro-Metastasis May occur(Sub Clinical Metastasis)

  10. Efficacy of Chemotherapy to Cancers

  11. Chemotherapy Curable Cancers • Childhood: • ALL 70% • NHL >50% • Burkitt’s Lymphoma >50% • Wilm’s Tumor >50% • Ewing’s Sarcoma >50% • Embrynal >50% • Rhabdomyosarcoma

  12. Chemo-Resistant (Insensitive) Cancers Non-Small Cell Lung Cancer G.I. Cancers Pancreatic Cancer Melanoma

  13. 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

  14. Difficulties in Cancer Chemotherapy

  15. (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

  16. (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

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

  18. Methods of Improvement: • Component Transfusion • Protected Environment (life Island, Lamina Air Flow Unit), • Hematopoietic Growth Factore (G-CSF, GM-CSF, Stem Cell Transplants)

  19. 肿瘤化学治疗中值 得 注 意 的 事 项 Precaution in Cancer Chemotherapy

  20. 1. 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?

  21. 3. 权衡利弊 • Toxicity • Benefit vs Risk • Cost • 4. 尽量使用标准治疗方案: ( Standard Protocol) • 经Clinical Study 证实 • 密切观察,防止及处理不良反应(Adverse effects)

  22. 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

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