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Advances in Cancer Chemotherapy: Mechanisms, Efficacy, and New Developments

Explore the role, mechanisms, difficulties, and advancements in cancer chemotherapy, covering TNM staging, treatment options, efficacy rates, resistance, and precautions to consider. Delve into the latest therapies, from stem cell transplants to novel drugs targeting specific pathways.

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Advances in Cancer Chemotherapy: Mechanisms, Efficacy, and New Developments

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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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