Chemotherapy

KSM ILMU PENYAKIT DALAM

SUB BAGIAN HEMATOLOGI ONKOLOGI MEDIK
RUMAH SAKIT IMMANUEL / FK-UKM
BANDUNG 2014
 Chemotherapy
Ideal anticancer drug should be able to kill tumor
cell and be harmless for any normal cell
Only the rate of cell division makes tumor cell more
prone to poisonous effect of chemotherapy.
Clinical obstacles :
Normal cells with fast pace of divisions are also
very susceptible to chemotherapy side effects.
after rounds of chemotherapy and successful
shrinkage of tumor and/or remission tumor cells
become resistant to treatment side effects
prevail over benefits clinician has to stop
treatment and tumor start to grow again
second-line or salvage regimen
 Chemotherapy toxicity
Acute toxicity
Myelosuppression
Nausea, vomiting and other G.I effects
Mucous membrane ulceration
Alopecia

Late toxicity
Cardiac
Pulmonary
Nephrotoxicity
Neurotoxicity
Hematologic and immunologic impairement
Hepatotoxicity
Premature menopause, endocrine problems
infertility
 Selective toxicities
Drugs Toxicity
Anthracyclines Cardiomyopathy
Asparaginases Anaphylaxis, pancreatitis
Cisplatin Renal toxicity and neurotoxicity
Cyclophosphamide Hemorrhagic cystitis
Mitomycin Endothelial cell injuries
Monoclonal Antibodies Hypersensitivity reactions
Paclitaxel Neurotoxicity, acute hypersensitive
reactions
VEGF inhibitors Gastrointestinal perforation, impaired
wound healing
Vinca alkaloids neurotoxicity
 Setting of use chemotherapy
As a single modality
radical / definitive
palliative

In combined (multimodality) therapy

before local treatment (induction, neoadjuvant)
during local treatment (concomitant)
alternating with local treatment
after local treatment (adjuvant)
 Chemotherapy preparation
Begin the process of physiologic preparation. This will include
hydration. Obtain baseline vital signs, and performance
status.
Review the diagnosis and staging
Review the individual treatment plan for any required
pretreatment laboratory test, imaging studies or specialized
organ evaluations.
Check the general treatment plan for any amendments and
updates that may alter therapy
Always tahe an account to co-morbidities
Follow institutional policies for verifying chemotherapy orders
Clarify any discrepancies.
 Why in courses?
Use pulsed intermittent therapy to allow normal cells
to recover
Normal (bone marrow cells) cells recover quicker
from chemotherapy then cancer cells
Normal tissues are invevitably damaged by
chemotherapy-bone marrow & epithelial lining cells
usually recover within 2-3 weeks.
On this basis, most chemotheraphy given at 2-3
weekly intervals.
 Classification of Chemotherapeutic Agents
Alkylating Anti Mitotic Antibiotics Others
agents metabolites inhibitors

Busulfan Cytosine Etoposide Bleomycin I-sparaginase

Carmustine Arabinoside Teniposide Dactinomycin Hydroxyurea
Chlorambucil Floxuridine Vinblastine Daunorubicin Procarbazine
Cisplatin Fluorouracil Vincristine Doxorubicin
Cyclophos Mercaptopurine Vinorelbine Mitomycin-c
Phamide Methotrexate Taxoids Mitoxantrone
Ifosfamide Gemzhr Eribulin
melphalan
 Combination chemotherapy
Rationale for combination chemotherapy is to :
Known to be effective as single agents
Overcome drugs resistance to individual agents
Additive or synergistic mechanisms of action
Non-overlapping/different toxicity profiles
Improved remission rates and duration compared with
single agent therapy
No clinically important drug interactions between the
agents.
 Routes of administration
Oral
Intravenous
Intramuscular
Intrathecal
Intraperitoneal
Intrapleural
Intrapericardial
Intraarterial : TACE
Isolated organ perfusion : portal vein, limb
Understanding the biology of malignant
disease is the key to effective therapeutic
management
Thank You