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Principles of cancer chemotherapy Treatment of cancer with an antineoplastic drugs or a combination of drugs into a standardised regimen (1) Impair mitosis(cell division): cytotoxic event or apoptosis (2) Sites of action: DNA/metabolically active tissues 2 .

G1 phase: synthesis of cellular components of DNA synthesis (growth phase) S phase: replication of DNA/duplication of chromosomes G2 phase: synthesis of enzymes/proteins (prepared for mitosis) M phase: mitosis(cell division) 3 .

(3) Affects the proliferating normal & abnormal cells 4 .

effective in killing fast dividing cancer cells (3) Palliative chemotherapy .Types of chemotherapy (1) Combined modality chemotherapy .reduces the reactivation of cancer cells .prolongs life 5 .reduces the chances of resistance of a particular drug (2) Adjuvant therapy .reduces tumor load .combination of drugs & cancer treatments .

Chemotherapeutic drugs Affect cell division or DNA synthesis 6 .

Antimetabolites: 6-mercaptopurine MOA (1) Inhibition of purine synthesis (2) Produces non functional RNA/DNA 7 .

Alkylating agents: Mechlorathamine MOA Alkylation Cross linkage b/t guanine in DNA strands DNA strands breakage 8 .

Microtubules inhibitors Vinca alkaloid Blocks mitosis in M phase Binds to tubulin Taxanes Binds to tubulin Increases polymerisation Stabilises the polymers Interferes the formation of microtubules Dysfunction spindle Metaphase arrest Interphase arrest 9 .

Topoisomerase inhibitors Epipodophyllotoxins Blocks topoisomerase II Camptothecin S phase Inhibits topoisomerase I Prevent religation of DNA breaks Cleavage of enzyme-DNA complex Irreversible DNA double strands break 10 .

: Rituximab.g. Transtuzumab 11 .Alternative chemotherapeutic agents Interferon • suppress cell proliferation • activates macrophage • activates lymphocyte Monoclonal antibodies • reduces cancer cells proliferation • E.

g.: breast cancer(inhibits action of HER2) (3) Bone marrow transplantation (4) Gene therapy • DNA is used to replace altered genes: viral methods or non viral methods (5) Immunotherapy • Works out with body immune system 12 .Adjuvant therapy (1) Radiation therapy • Uses X rays • Reduces the recurrence of cancer cells (2) Targeted therapy • Prevents abnormalities present in the cancer cells • Targets specific proteins synthesis • E.

Treatment regimens Single drug therapy .Combinations of several types of drugs with different mode of actions/side effects • more effective than single drug treatment • Advantages: (i) provide maximal cell killing (ii) effective against vast tumor population (iii) delay drug resistance 13 .Treatment by a single type of drug Multiple drugs therapy .

Adverse effects of cytotoxic drugs (1)Immunosuppression (2) Alopecia (3) Nausea/vomiting (4) Tetratogenicity (5)erythema/xerostomia(rare) (6)hyperuricemia 14 .

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