1. Cancer Chemotherapy Dr.Azarm

2.  The goal of cancer treatment is eradication of cancer  If not possible shifts to palliation,amelioration and preservation of quality of life Dr.Azarm

3.  Surgery  Radiotherapy  Chemotherapy  Biologic therapy Dr.Azarm

4. Diagnosis  Pathology  Tumor markers ; germ cell tumors, Dr.Azarm

5. Staging  Clinical  Pathologic Dr.Azarm

6. Surgery  Curative  Palliative

7. Radiation  Ionization and excitation of atoms and bombs that kills cells  Cell killing,nausea, vomiting,fatigue, somnolence  Late effect ;fibrosis and gliosis  Skin and mucosal reactions are accentuated by other modalities like chemotherapy  Acute response, subacute response, late response  Definitive, adjuvant, palliative

8. Chemotherapy

9. Chemotherapy

10.  Clinically detectable tumor : 1 × 10 9 cell =1 cm  Mechanism of drugs : apoptosis, pproliferation control, affect maturation, angiogenesis,

11. Chemotherapy for what ??  Cure malignancies or improve survival  Palliate symptoms  Organ preserving

12. Types of chemotherapy  Adjuvant  Neoadjuvant  Palliative

13. Type of administration  Oral  IV  Intracavitary

14. Intravenous  Vein selection  Irritant : without necrosis,BCNU,cisplatin,dacarbazine, etoposide, vinca alkaloids  Vesicant : necrosis, antrscyclines, dactinomycine, nitrogen mustard

15. Complications of chemotherapy Complications of chemotherapy  Myelosuppression  Gastrointestinal toxicity : nausea and vomiting, mucositis, diarrhea  Abnormal renal function : cisplatin, MTX  Hepatotoxicity : vinca alkaloids, antracyclines

16. Specific toxicity  Alkylating agents : carcinogen, busulfan ; irreversible myelosuppression busulfan ; irreversible myelosuppression chlorambucil ; the least toxic alkylating agent chlorambucil ; the least toxic alkylating agent cyclophosphamide ; hemorrhagic cystitis, bladder carcinoma,alopecia,aspermia, amenorrhea, cyclophosphamide ; hemorrhagic cystitis, bladder carcinoma,alopecia,aspermia, amenorrhea, Ifosfamide ; hemorrhagic cystitis,alopecia Ifosfamide ; hemorrhagic cystitis,alopecia cisplatin ; renal insufficiency,neuropathy,ototoxicity, severe nausea and vomiting cisplatin ; renal insufficiency,neuropathy,ototoxicity, severe nausea and vomiting carboplatin ; carboplatin ;

17. Specific toxicity  Antimetabolites ; cytosar ; cerebellar toxicity,conjuctivitis cytosar ; cerebellar toxicity,conjuctivitis 5-FU ; mucositis, diarrhea, 5-FU ; mucositis, diarrhea, capecitabine ( xeloda ) : diarrhea, hand- foot syndrome capecitabine ( xeloda ) : diarrhea, hand- foot syndrome MTX ; mucositis, impaired renal function, myelosuppression, MTX ; mucositis, impaired renal function, myelosuppression,

18. Specific toxicity  Antitumor antibiotics ; bleomycin ; pulmonary fibrosis, anaphylaxis, bleomycin ; pulmonary fibrosis, anaphylaxis, anthracyclines ; cardiotoxicity, allopecia anthracyclines ; cardiotoxicity, allopecia

19. Specific toxicity  Mitotic spindle agents ; vincristin, vinblastin ; neuropathy vincristin, vinblastin ; neuropathy taxane ; hypersensitivity, alopecia, peripheral neuropathy taxane ; hypersensitivity, alopecia, peripheral neuropathy

20. Specific toxicity  Topoisomerase inhibitors ; etoposide,irinotecan etoposide,irinotecan

21. Specific toxicity  Tyrosin kinase inhibitors ; gefitinib ( Iressa ) gefitinib ( Iressa ) imatinib ( gleevec ) imatinib ( gleevec )

22. Specific toxicity  Monoclonal antibodies ; relative selectivity for tumor,cytokine release syndrome ( fevfr, hypotension, bronchospasm ), relative selectivity for tumor,cytokine release syndrome ( fevfr, hypotension, bronchospasm ), Rituximab, Trastuzumab, Alemtuzumab,Bevacizumab Rituximab, Trastuzumab, Alemtuzumab,Bevacizumab

23. Growth factors  Erythropoetin  G-csf  Plt growth factor