CHAPTER 081 PRINCIPLES OF CANCER TREATMENT PART 10

Chapter 081. Principles of Cancer Treatment (Part 10) Integration of cell death responses. Cell death through an apoptotic mechanism requires active participation of the cell. In response to interruption of growth factor (GF) or propagation of certain cytokine death signals (e.g., tum[r]

Chapter 081. Principles of Cancer Treatment (Part 19) Solid Tumors Small-molecule epidermal growth factor (EGF) antagonists act at the ATP binding site of the EGF receptor tyrosine kinase. In early clinical trials, gefitinib showed evidence of responses in a small fraction of patients with n[r]

Chapter 081. Principles of Cancer Treatment (Part 20) Transfusion of granulocytes has no role in the management of febrile neutropenia, owing to their exceedingly short half-life, mechanical fragility, and clinical syndromes of pulmonary compromise with leukostasis after their use. Instead,[r]

Chapter 081. Principles of Cancer Treatment (Part 18) Site of action of targeted agents. Signals proceeding from growth factor–related receptor tyrosine kinases (RTKs) such as EGF-R, erbB2, or c-kit can be interrupted by lapatinib, erlotinib, gefitinib, and imatinib, acting at the ATP bindin[r]

Chapter 081. Principles of Cancer Treatment (Part 17) Prostate cancer is classically treated by androgen deprivation. Diethylstilbestrol (DES) acting as an estrogen at the level of the hypothalamus to downregulate hypothalamic luteinizing hormone (LH) production results in decreased elaborat[r]

Chapter 081. Principles of Cancer Treatment (Part 16) The taxanes include paclitaxel and docetaxel. These agents differ from the vinca alkaloids in that the taxanes stabilize microtubules against depolymerization. The "stabilized" microtubules function abnormally and are not able to undergo[r]

Chapter 081. Principles of Cancer Treatment (Part 15) Pemetrexed is a novel folate-directed antimetabolite. It is "multitargeted" in that it inhibits the activity of several enzymes, including thymidylate synthetase, dihydrofolate reductase, and glycinamide ribonucleotide formyltransferase,[r]

Chapter 081. Principles of Cancer Treatment (Part 21) Primary prophylaxis (i.e., shortly after completing chemotherapy to reduce the nadir) of G-CSF to patients receiving cytotoxic regimens is associated with a 20% incidence of febrile neutropenia. "Dose-dense" regimens, where cycling of che[r]

Chapter 081. Principles of Cancer Treatment (Part 14) Mitomycin C undergoes reduction of its quinone function to generate a bifunctional DNA alkylating agent. It is a broadly active antineoplastic agent with a number of unpredictable toxicities, including delayed bronchospasm 12–14 h after d[r]

Chapter 081. Principles of Cancer Treatment (Part 13) Cisplatin was discovered fortuitously by observing that bacteria present in electrolysis solutions could not divide. Only the cis diamine configuration is active as an antitumor agent. It is hypothesized that in the intracellular environm[r]

Chapter 081. Principles of Cancer Treatment (Part 12) Direct DNA-Interactive Agents DNA replication occurs during the synthesis or S-phase of the cell cycle, with chromosome segregation of the replicated DNA occurring in the M, or mitosis, phase. The G1 and G2 "gap phases" precede S and M, r[r]

Chapter 081. Principles of Cancer Treatment (Part 11) Table 81-2 Commonly Used Cancer Chemotherapy Agents Drug Examples of Usual Doses Toxicity Interactions, Issues Direct DNA-Interacting Agents Alkylators Cyclophospha 400–2000 mg/m2 Marrow (relative Liver metabolism required mide IV 100 mg[r]

Chapter 081. Principles of Cancer Treatment (Part 9) Following demonstration of activity in animal models, conventional chemotherapeutic agents are further evaluated to define an optimal schedule of administration and arrive at a drug formulation designed for a given route and schedule. Safe[r]

Chapter 081. Principles of Cancer Treatment (Part 8) Principles of Chemotherapy Medical oncology is the subspecialty of internal medicine that cares for and designs treatment approaches to patients with cancer, in conjunction with surgical and radiation oncologists. The core skills of the me[r]

Chapter 081. Principles of Cancer Treatment (Part 7) Karnofsky was among the first to champion the evaluation of a chemotherapeutic agent's benefit by carefully quantitating its effect on tumor size and using these measurements to objectively decide the basis for further treatment of a parti[r]

Chapter 081. Principles of Cancer Treatment (Part 6) Application to Patients Teletherapy Radiation therapy can be used alone or together with chemotherapy to produce cure of localized tumors and control of the primary site of disease in tumors that have disseminated. Therapy is planned based[r]

Chapter 081. Principles of Cancer Treatment (Part 5) Although radiation can interfere with many cellular processes, many experts feel that a cell must undergo a double-strand DNA break from radiation in order to be killed. The factors that influence tumor cell killing include the D0 of the t[r]

Chapter 081. Principles of Cancer Treatment (Part 4) Palliation Surgery is employed in a number of ways for supportive care: insertion of central venous catheters, control of pleural and pericardial effusions and ascites, caval interruption for recurrent pulmonary emboli, stabilization of ca[r]

Chapter 081. Principles of Cancer Treatment (Part 3) Staging As noted in Chap. 77, an important component of patient management is defining the extent of disease. Radiographic and other imaging tests can be helpful in defining the clinical stage; however, pathologic staging requires defining[r]

Chapter 081. Principles of Cancer Treatment (Part 2) Figure 81-1 Gompertzian tumor growth. The growth fraction of a tumor declines exponentially over time (top). The growth rate of a tumor peaks before it is clinically detectable (middle). Tumor size increases slowly, goes through an expone[r]