LO 9: Principles of Cancer Chemotherapy

Chemotherapy Role In Tumor Therapy

Since the 1970s:

cancer chemotherapy; palliative therapy curative 10 types of cancer can be cured

Most cancer patients long survival can be extended (mammary cancer, prostate, neuroblastoma, head, neck, etc.)

Classification of Antitumor Drugs And Mechanism Works

According to the origin of medicine, chemical structure, and its mechanism of action, divided into 7 categories: 1. Alkilator 2. Antimetabolite 3. Class of antibiotics 4. Protein inhibitor of microtubule 5. Topoisomerase inhibitors 6. Classes of hormones 7. Class of molecular targets

1. Alkilator
Has an active group alkilator form covalent bonds Cytotoxic effects of substance alkilator: 1. The establishment radical crosslinking with N7 or N3 adenine guanine bases of DNA molecules 2. Crosslinking with DNA and protein molecules structures damaged and dead cells Example: nitrogen mustard (HN2), nitrosourea, cisplatin (PDD) etc

2. Antimetabolite
harass nucleic acid metabolism affects DNA synthesis, RNA, and protein macromolecules L-asparaginase enzyme hydrolyzing asparagine aspartic acid and ammonia tumor cells inhibited protein synthesis Example: methotrexate (MTX), merkaplopurin (6MP), tioguanin (6TG) etc.

3. Class of antibiotics

Infiltrate into the base pairs in the DNA double chain close second separation of DNA chains / harass transcription of DNA / mRNA production Example: adriamycin (ADR), bleomycin, mitomycin (MMC) etc. Bleomycin single chain DNA fragmentation Mitomycin (MMC) form crosslinks with DNA

4. Protein inhibitor of microtubule

Microtubule protein binds to tumor cell nuclei inhibit microtubule polymerization synthesis and mitosis stopped at metaphase Example: vinblastine, vincristine, vindesin, navelbin etc.

5. Topoisomerase Inhibitors
Inhibiting the enzyme topoisomerase inhibit engagement back after each separate double chain (DNA replication) double chain cut Example: etoposide, teniposid etc.

6. Classes of hormones
Receptor blockers (antiestrogen and antiandrogen) binds competitively in tumor cells Example: tamoxifen, toremifen etc.

7. Class of molecular targets

Drugs have been developed which are mapped into a key molecular targets that arise within the process and development of cancer Has a specific effect Gleevec, mabtera, transtuzumab etc.

Clinical use of chemotherapy

1. Specify the therapeutic objective 2. Rational use of medicines 3. Strengthen supportive therapy, active prevention and chemotherapy complications 4. Overcome drug resistance

1. Specify the therapeutic objective

a. b. c. d. e. Curative chemotherapy Adjuvant chemotherapy Neoadjuvant chemotherapy Palliative chemotherapy Chemotherapy investigative

2. Rational use of medicines

Specific antimetabolite drugs (5-FU) iv reduce longterm toxicity; allowing the use of large doses increased effectiveness Used small doses of etoposide po for small cell cancer and advanced stage lymphoma in elderly frail stature Intracavital drugs (DDP etc.) high dose, simultaneously given iv sodium thiosulfate (detoxification) etc.

3. Strengthen supportive therapy, active prevention and chemotherapy complications

Increasing the dose increase effectiveness increase toxic effects An Environmental hygiene, oral hygiene, good foster care reduce the incidence of complications Substances 5HT3 receptor blockers prevent and treat nausea, vomiting

4. Overcome drug resistance

At best, alternately using two sets of the same chemotherapy regimen effective in turn, no crossresistance