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PHARM.D 4th year(POST BACCULAUREATE).
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Cancer is a term used for diseases in which
abnormal cells divide without control and are
able to invade other tissues. Cancer cells canspread to other parts of the body through the
blood and lymph systems.
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Cancerous cells develop from healthy cells in a complex
process called transformation.
The first step in the process is initiation :
In which a change cells genetic material
(in the DNA and some times in the chromosome
structure) primes the cell to become cancerous.
o Cancer can occur by carcinogens include(chemicals ,tobacco , viruses , radiation and sunlight) . A genetic
flaw in a cell may make it more susceptible. Even
chronic physical irritations may make a cell more
susceptible to carcinogens.
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The second and final step in the development of
cancer is called promotion.
Unlike carcinogens promoters does not cause cancer
by them selves. But some carcinogens sufficientlypowerful to be able to cause cancer without the need
of promoters.
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1) Leukemia's and lymphomas are cancers of bloodand blood forming tissues.
2) Carcinomas are cancers of epithelial cells which are
the cells cover the surface of body ,hormones andglands.
Eg: skin ,lungs ,stomach, breast, prostate and
thyroid gland cancer.
Typically,carcinomas occur more often in older than
in younger people.
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3
) Sarcomas are cancers of mesodermal cells ,whichare the cells that form muscles and connective
tissue .
Examples of sarcomas are
leiomyosarcoma (cancer of smooth muscle that is
found in the wall of digestive organs) and
osteosarcoma (bone cancer)
4) Central nervous system cancers - cancers thatbegin in the tissues of the brain and spinal cord.
.
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Chemotherapy utilizes chemicals that interferewith the cell division process - damaging
proteins or DNA - so that cancer cells will
commit suicide. These treatments target anyrapidly dividing cells (not necessarily just
cancer cells), but normal cells usually can
recover from any chemical-induced damage
while cancer cells cannot.
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Chemotherapy is generally used to treat cancer that
has spread or metastasized because the medicines
travel throughout the entire body. It is a necessarytreatment for some forms of leukemia and
lymphoma.
Chemotherapy treatment occurs in cycles so the
body has time to heal between doses.
However, there are still common side effects such as
hair loss, nausea, fatigue, and vomiting. Combination
therapies often include multiple types ofchemotherapy or chemotherapy combined with other
treatment options.
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Examples Mechanism of action Side Effects
Alkylating agents
Cyclophosphamide
Chlorambucil
Melphalan
Form chemical bond with
DNA, causing breaks in DNA
and errors in replication ofDNA
Suppress bone marrow
Injure lining of stomach
Cause hair lossMay decrease fertility
Suppress the immune system
May cause leukemia
Antimetabolites
Methotrexate
Cytarabine
6- Mercaptopurine
5-Fluorouracil
Block synthesis of DNASame as for alkylating agents
Do not increase risk of
leukemia
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Examples Mechanism of action Side Effects
Antimitotics
Vincristine
Paclitaxel
Vinorelbine
Docetaxel
Block division of cancer cells
Same as for alkylating agents
Also can cause nerve damage
Do not cause leukemia
Topoisomerase inhibitors
Doxorubicin
Irinotecan
Prevent DNA synthesis and
repair through blockage of
enzymes called
topoisomerases
Same as for alkylating agents
Doxorubicin
can cause heart damage
Platinum derivatives
Cisplatin
Carboplatin
Form bonds with DNA causing
breaks
Same as for alkylating agents
Also can cause nerve and
kidney damage, hearing loss
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Examples Mechanism of action Side Effects
Hormonal therapies
Tamoxifen Blocks estrogen action (in
breast cancer)
Can cause endometrial cancer,
blood clots, hot flashes
Aromatase inhibitors
Bicalutamide
Anastrozole
Exemestane
Letrozole
Blocks androgen action (inprostate cancer)
Block estrogen formation
Can cause erectile dysfunction(impotence) and diarrhea
Can cause bone loss
(osteoporosis) and menopausal
symptoms
Signaling inhibitors
Imatinib
Blocks signal for cell division in
chronic myelocytic leukemia
Can cause abnormal liver
function test results and fluid
retention
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Examples Mechanism of action Side Effects
Gefitinib
Erlotinib
Blocks epidermal growth factor
receptor
Can cause rash, diarrh
Monoclonal antibodies
Rituximab
Trastuzumab
Gemtuzumab
ozogamicin
Induces cell death through
binding to cell surface receptor
on lymphocyte-derived tumors
Blocks growth factor receptor on
breast cancer cells
Contains a specific antibody that
attaches to a receptor found onleukemic cells and then delivers
a toxic dose of its
chemotherapeutic component to
the leukemic cells
Can cause allergic reaction
Can cause heart failure
Contains a specific antibody that
attaches to a receptor found onleukemic cells and then delivers
a toxic dose of its
chemotherapeutic component to
the leukemic cells
Biologic response modifiers
Interferon-alpha Unknown
Can cause fever, chills, bone
marrow suppression, thyroid
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Examples Mechanism of action Side Effects
Differentiating agents
Tretinoin
Arsenic trioxide
Induces differentiation and
death of leukemic cells
Induces differentiation and
death of leukemic cells
Can cause severe difficulty
with breathing (respiratory
distress)
Causes abnormal heart
rhythms and a rash
Agents that block blood
vessel formation
(antiangiogenic agents)
Bevacizumab
Serafinib
Sunitinib
Blocks vascular endothelial
growth factor (VEGF)
BlockVEGF receptor
Can cause high blood
pressure, protein loss in
urine, bleeding, clotting,
intestinal perforation.
Can cause high blood
pressure and protein loss inurine
8/8/2019 Cancer Presentation (Main)
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Most cancers are/become refractory to treatment by a single agent,Most cancers are/become refractory to treatment by a single agent,
combinations of anticancer drugs are often used. The following rules applycombinations of anticancer drugs are often used. The following rules apply
to combining drugs in cancer chemotherapy:to combining drugs in cancer chemotherapy:
1.1. The drugs each must have some activity against the cancer.The drugs each must have some activity against the cancer.
2.2. The drugs should act via different mechanisms.The drugs should act via different mechanisms.
3.3. The drugs should have minimal overlapping toxicity.The drugs should have minimal overlapping toxicity.
4.4. Cellular resistance to each drug should occur by different mechanisms.Cellular resistance to each drug should occur by different mechanisms.
The first drug combination, made famous by Dr. V. DeVita and others atThe first drug combination, made famous by Dr. V. DeVita and others at
NIH, is called MOPP (Mechlorethamine, oncovonin, procarbazine, andNIH, is called MOPP (Mechlorethamine, oncovonin, procarbazine, and
prednisone). MOPP is a curative treatment for Hodgkin's disease and itsprednisone). MOPP is a curative treatment for Hodgkin's disease and its
development was a major step forwarddevelopment was a major step forward
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ABVD: Doxorubicin (adriamycin), bleomycin, vinblastine,
dacarbazine Used for: Hodgkins disease
CHOP: Cyclophosphamide, doxorubicin (hydroxydaunorubicin),vincristine (oncovin), prednisone Used for: Non-Hodgkin'slymphoma
CMF: Cyclophosphamide, methotrexate, fluorouracil Used forBreast carcinoma
IFL: Irinotecan, fluorouracil, leucovorin
Used for: Colorectal carcinoma with or without oxaliplatin
MOPP: Mechlorethamine, vincristine (oncovin), procarbazine,prednisone
Used for: Hodgkins disease
PEB: Cisplatin (platinum), etoposide, bleomycin Used forTesticularcarcinoma
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Carcinoma of lung:
Cisplatin + taxane, or cisplatin + etoposide, or cisplatin +irinotecan
Carcinoma of breast: Hormonal therapy (Tamoxifen or Anastrozole)
FAC: Fluorouracil, doxorubicin (adriamycin),cyclophosphamide
FEC: Fluorouracil, epirubicin, cyclophosphamide
CMF: Cyclophosphamide, methotrexate, fluorouracil
Carcinoma of prostate:
Hormonal therapy:GnRH agonist plus androgenantagonist
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Carcinoma of colon:
IFL: Irinotecan, fluorouracil, leucovorin with orwithout oxaliplatin
In trials: cisplatin, irinotecan, and a taxane
Pedicatric Leukemia
Acute lymphocytic leukemia. Induction:vincristine plusprednisone.
Remission maintenance:mercaptopurine, methotrexate,and cyclophosphamide in various combinations.
Acute myelocytic and myelomonocytic leukemia.Combination chemotherapy: cytarabine and mitoxantroneor daunorubicin or idarubicin
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SHORTTERM
Fever
Nausea
Infusional reactions
Oral complications
Diarrhea
Anemia
Neuropathy
Alopecia
Rash, Extravasation
Emotional
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Long-term :
Cardiac Secondary Malignancies
Fatigue
Neuropathy
Arthropathy
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http://www.cancer.gov/cancertopics/what-is-
cancer
www.medicalnewstoday.com/info/cancer.../w
hatiscancer
www.merckmanualonline.com .
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