Modalities of Cancer Treatment PDF

Modalities of Cancer Treatment AAAT, RPh, PharmD, CIP  Introduction Treatment of cancer varies depending on the type of cancer and how advanced the cancer is. Some people with cancer will have only one treatment. But most people have a combination of treatments, such as: Surg...

Modalities of Cancer Treatment AAAT, RPh, PharmD, CIP  Introduction Treatment of cancer varies depending on the type of cancer and how advanced the cancer is. Some people with cancer will have only one treatment. But most people have a combination of treatments, such as: Surgery with Chemotherapy Chemotherapy alone Radiation therapy  Introduction Earlier diagnosis might lead to increased cure rates. Surgery remains the treatment of choice for most solid tumors diagnosed in the early stages. Early micrometastasis is a characteristic feature of these neoplasms, indicating that a systemic approach with chemotherapy is required.  A.CHEMOTHERAPY B.HORMONE THERAPY C.SURGERY Modalities of D.RADIATION THERAPY E.TARGETED THERAPY Cancer F.IMMUNOTHERAPY Treatment G.STEMCELL TRANSPLANT H.BIOMARKER TESTING I.HYPERTHERMIA J. PHOTODYNAMICTHERAPY  Chemotherapy may be given in many ways: Oral route - e.g. Capecitabine Intravenous - e.g Docetaxel Chemotherapy Subcutaneous - e.g Methotrexate Intrathecal - e.g Methotrexate and Chemotherapy works by stopping or slowing the growth of cancer Cytarabine cells, which grow and divide Intraperitoneal - e.g Mitomycin C, quickly. Cisplatin Intra-arterial - e.g Melphalan, Topotecan and Carboplatin Topical - e.g Fluorouracil (Efudix)  Hormone therapy can also be used with other cancer treatments. Neoadjuvant therapy - can shrink Hormone Therapy tumors prior to surgery or radiation This treatment slows or stops the Adjuvant therapy - Lower the risk growth of breast and prostate cancers that use of remission. hormones to grow. Hormone therapy Can also destroy cancer cells that is also called hormonal therapy, have returned or spread to other hormone treatment, or endocrine parts of the body. therapy.  Examples of Hormone therapy: 1. Anastrozole - Aromatase inhibitors block this conversion, leading to Hormone Therapy less estrogen in the body Used in the treatment of This treatment slows or stops the Breast cancer growth of breast and prostate cancers that use 2. Bicalutamide - Anti-androgen hormones to grow. Hormone therapy which blocks the effects of is also called hormonal therapy, testosterone. hormone treatment, or endocrine Used in the treatment of therapy. Prostate Cancer  Remove the entire tumor Surgery removes cancer that is contained in one area Debulk a tumor Surgery Debulking is used when removing an entire tumor that might damage an Used to treat cancer wherein organ or the body. Removing part of a surgical procedure is down by tumor can help other treatments work removing the cancerous tumor in the body. better Ease cancer symptoms Surgery is used to remove tumors that are causing pain or pressure.  Examples of Surgery performed to treat cancer: 1. Cryosurgery- type of treatment in which Surgery extreme cold produced by liquid nitrogen or argon gas is used to destroy Used to treat cancer wherein abnormal tissue. surgical procedure is down by Used to treat early-stage skin cancer, removing the cancerous tumor in retinoblastoma, and precancerous the body. growths on the skin and cervix. 2. Mastectomy - surgical removal of one or both breasts, partially or completely Treatment of breast cancer  Two types External Beam Internal Beam Kills cancer cells or slows their growth Radiation Therapy by damaging their DNA. Cancer cells whose DNA is damaged Type of cancer treatment that uses beyond repair stop dividing or die. high doses of radiation to kill Radiation therapy does not kill cancer cancer cells and shrink tumors cells right away. It takes days or weeks of treatment before DNA is damaged enough for cancer cells to be eliminated.  Radiation Therapy External radiation vs. Internal Radiation  How does Targeted Therapy work? Helps the immune system to destroy cancer cells. Stop cancer cells from growing by Targeted Therapy interrupting signals that cause them to grow and divide without order. Type of cancer treatment that Stop signals that help form blood targets the changes in cancer vessels. cells that help them grow, Deliver cell-killing substances to cancer divide, and spread. cells. Type of precision cancer Cause cancer cell death. treatment Starve cancer of hormones it needs to grow.  Examples of Targeted Therapy: Monoclonal Antibodies These engineered molecules are designed to attach to specific targets Targeted Therapy found on cancer cells. e.g. Rituximab for Chronic Lymphocytic Leukemia (CLL) Apoptosis inducers Apoptosis inducers are used to allow apoptosis, helping to prevent recurrence and metastasis. e.g. Cisplatin - induces DNA damage.  Examples of Targeted Therapy: Hormone Therapy Target specific hormones, such as estrogen, to decrease the amount of Targeted Therapy that hormone in the body, slow the production of the hormones or block them entirely from feeding cancer cells. e.g. Tamoxifen (SERM) - used in the treatment of Breast Cancer.  Types of Immunotherapy include the ffg: Immunotherapy Immune checkpoint inhibitors T-cell transfer therapy Type of cancer treatment that Monoclonal antibodies helps the immune system fight Treatment vaccines cancer. Immune system modulators Tasdf Type of biological therapy Biological therapy is a type of treatment that uses substances made from living organisms to treat cancer. Stem Cell Transplant Procedures that restore stem Tasdf cells that grow into blood cells in people who have had theirs destroyed by high doses of chemotherapy or radiation therapy  Used to detect and identify a given type Biomarker Testing of cancer in an individual. These markers are expected to have high specificity and sensitivity. Biomarker testing is a way to e.g. The presence ofTasdf Bence–Jones look for genes, proteins, and protein in urine remains one of the other substances (called biomarkers or tumor markers) strongest diagnostic indicators of that can provide information multiple myeloma. about cancer.  Different types of techniques may be used to create heat for hyperthermia treatment. These techniques include: Hyperthermia Probes that make energy from microwaves Radio waves (also called radiofrequency) Type of treatment in which lasers Tasdf body tissue is heated to as high Ultrasound as 113 °F to help damage and kill cancer cells with little or no Heating fluids such as blood or harm to normal tissue. chemotherapy drugs and putting them into the body (called perfusion) Placing the entire body in a heated chamber or hot water bath or wrapping with heated blankets Hyperthermia Type of treatment in which Tasdf body tissue is heated to as high as 113 °F to help damage and kill cancer cells with little or no harm to normal tissue. Hyperthermia Type of treatment in which Tasdf body tissue is heated to as high as 113 °F to help damage and kill cancer cells with little or no harm to normal tissue. Principles of Cancer Chemotherapy  As a group, the anticancer drugs are more toxic than any other pharmaceutical agents. Ideal Chemotherapeutic Agent: Chemotherapy a. Selectively Toxic - toxic to the diseased cells than to the healthy cells. b. Relatively soluble in bodily fluids - Easily The ultimate goal in cancer transported to the site of action chemotherapy is to use advances c. Maintain standard toxicity and not be made in cell biology to develop drugs more or less potentTasdf by interactions (food, that selectively target specific drugs, and disease) cancer cells. d. No Allergic Reaction e. Sufficient stable to maintain a constant therapeutic concentration. f. Must not generate or lead to resistance to its effect g. Must have a long Shelf life h. Must be affordable  There is no existing chemotherapeutic agent that possesses ALL of the said attributes. Most Anticancer drug act by inhibiting cell Chemotherapy proliferation. - this is achieved by damaging DNA or preventing DNA repair. Four Ways Anticancer drugs inhibits proliferation: The ultimate goal in cancer a. Cross linking DNA - prevents DNA strand chemotherapy is to use advances separation in cell biology to develop drugs b. Linking Alykl groupsTasdf to DNA Bases - which that selectively target specific inhibits DNA repair. cancer cells. c. Mimics DNA Bases - results in incorporation of drug into DNA or RNA d. Intercalating between base pairs of DNA - which damage the DNA.  1. Adjuvant Chemotherapy Chemotherapy is given to destroy left- over(microscopic)cells that may be present Chemotherapy after the known tumor is removed by surgery. Adjuvant chemotherapy is given to prevent a Terms possible cancer reoccurrence. 2. Neoadjuvant Chemotherapy Chemotherapy given prior to the surgical procedure. Tasdf Neoadjuvant chemotherapy maybe given to attempt to shrink the cancer so that the surgical procedure may not need to be as extensive. 3. Induction Chemotherapy Given to induce a remission. Thistermiscommonly used in the treatment of acute leukemias  4. Consolidation Chemotherapy Chemotherapy given once a remission is achieved. The goal of this therapy is to sustain a remission Chemotherapy This term is commonly used in the treatment of Terms acute leukemias. 5. First Line Chemotherapy Chemotherapy that has, through research studies and clinical trials, Tasdf been determined to have the best probability of treating a given cancer. Also called Standard therapy. 6. Second Line Chemotherapy Chemotherapy that is given if a disease has not responded or reoccurred after first line chemotherapy Also called Salvage Therapy.  7. Palliative Chemotherapy Chemotherapy This Chemotherapy is given specifically to Terms address symptom management without expecting to significantly reduce the cancer. Tasdf  Indicated in 75% of tumors (25% surgery & radiation) Examples of responsive tumors (cure) Role of Leukemia, Lymphoma, Choriocarcinoma, Chemotherapy Ewing’s Sarcoma, Burkitt’s Lymphoma, and Testicular Carcinoma Examples of intermediate response: Bladder, head and neck, SCLC, sex-related Tasdf cancers (breast, ovary, endometrium, prostate) Osteogenic sarcoma  Clinical detectable tumor: 1 cm Total Tumor Burden 20 cm (lethal tumors) (Size) The larger the tumor, the harder it is to kill Tasdf More difficult for drugs to penetrate Many cells not proliferating Increased incidence of metastasis  Chemotherapeutic Agents Alkylating Agents Antimetabolites Mitotic Inhibitors Topoisomerase Inhibitor Miscellaneous  Alkylating Agents Contains reactive groups Effective against: (usually Alkyl) that attach to Hematologic Malignancies Leukemia DNA or RNA, leading to Lymphoma interruption in synthesis of Multiple Myeloma DNA and RNA proteins. Solid Tumors Breast Ovarian Lung Uterus Bladder  Types of Alkylating Agents Nitrogen Mustards- The most frequently used alkylating agents. Five are commonly used in cancer therapy today: Mechlorethamine Cyclophosphamide - Not a reactive compound, but undergoes activation in the body Ifosfamide - Structural isomer of cyclophosphamide that is used particularly in the treatment of testicular tumors and sarcomas Melphalan - used in the treatment of multiple myeloma, ovarian cancer, and breast cancer Chlorambucil - used in chronic lymphocytic leukemia, Ovarian carcinoma, and Lymphoma  Types of Alkylating Agents Aziridines and Epoxides - Closely related to the nitrogen mustards Thiotepa - carcinomas of the ovary and breast and for the intrathecal therapy of meningeal carcinomatosis Mitomycin C - breast cancer and cancers of the gastrointestinal tract Diaziquone (AZQ) - lipophilic to readily cross the blood-brain barrier for the treatment of CNS tumors.  Antimetabolites Antimetabolites are structural analogues of naturally occurring molecules required for DNA and RNA synthesis. When substituted for the natural body substances, they disrupt DNA and RNA Synthesis. Drugs that are chemically similar to naturally occurring metabolites, but differ enough to interfere with normal metabolic pathways  Examples of Antimetabolites Pyrimidine analog Fluorouracil - used to treat basal cell carcinomas, and as an injection in palliative cancer treatment. Nucleoside metabolic inhibitor Gemcitabine - used as adjunct therapy in the treatment of certain types of ovarian cancer, non-small cell lung carcinoma, metastatic breast cancer, and as a single agent for pancreatic cancer. Capecitabine (oral) - different gastrointestinal, including pancreatic cancer, and breast cancer. Pyrimidine nucleoside analogue Cytarabine - acute non-lymphocytic leukemia, lymphocytic leukemia, and the blast phase of chronic myelocytic leukemia  Mitotic Inhibitors A.k.a Antimicrotubule Agents - inhibit cell mitosis by interfering with microtubule formation or function. Examples: Paclitaxel Docetaxel Vinblastine Vincristine  Topoisomerase Inhibitors Topoisomerase Inhibitors (I and II) cause DNA strand breaks by disrupting the function of topoisomerase enzymes, which are responsible for regulating the 3-D structure of DNA. Examples: Topoisomerase I Irinotecan Topotecan Topoisomerase II Anthracyclines Daunorubicin Doxorubicin Epirubicin Idarubicin Chemotherapeutic Agents Cell cycle specific Agents Cell cycle specific Agents Cell cycle specific Agents