Oncology
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss in Understanding Medical Terms, 2020
Lung cancers are classed as small cell carcinoma (SCLC) or the non-small cell carcinomas (NSCLC), which include squamous cell (epidermoid) carcinoma, adenocarcinoma, and large cell carcinoma. Staging by TNM is designated after use of chest X-ray. fiberoptic bronchoscopy, computed tomography, and routine laboratory tests to identify any metastases. In early stages of NSCLC, surgery is the treatment of choice. Radiation is used as an adjunct and for nonsurgical candidates. Combination chemotherapy regimens are also being used increasingly for NSCLC and as the standard treatment for both limited and extensive SCLC.
Mechanisms of Resistance to Antineoplastic Drugs
Robert I. Glazer in Developments in Cancer Chemotherapy, 2019
Chemotherapy with cytotoxic drugs remains the most effective method of treatment for a wide variety of disseminated cancers. Particular success has been achieved through the use of combination chemotherapy regimens in the treatment of Hodgkin’s disease, acute lymphocytic leukemia, diffuse lymphoma, and testicular cancer.1 In these diseases, chemotherapy regimens frequently produce complete clinical remissions. Combination chemotherapy regimens are also beneficial in patients with many other cancers, including ovarian cancer, breast cancer, and small-cell lung cancer. Although response rates to initial therapy are quite high in these diseases, many patients will eventually relapse. Whereas salvage chemotherapy may be successful in some of these patients, tumors in most patients who relapse are quite refractory to antineoplastic agents. A particularly vexing aspect of this phenomenon is that tumor cells in the setting of relapse are often cross-resistant to agents to which they have never been exposed.
Lymphocyte and plasma cell malignancies
Gabriel Virella in Medical Immunology, 2019
The treatment of ALL has significantly changed over the past 20 years. In general, children, adolescents, and young adults (<40 years old) with ALL can be treated, and in many instances cured, with just chemotherapy. Chemotherapy regimens for ALL are complex and have several “phases” of treatment expanding several months. Adults >40 years old are treated with induction chemotherapy followed by an allogeneic stem cell transplant for those patients who are eligible. This combination of chemotherapy and transplant is the only known curative treatment for ALL in adults. The treatment of relapsed/refractory ALL in children and adults has seen the most dramatic advances with the development of immune therapies targeting CD19, a molecule expressed by the majority of ALL cells. The two main immunotherapies used for the treatment of ALL are chimeric antigen receptor T cells (CAR T cells) and blinatumomab, a bispecific T-cell engager (BiTe). (See Chapter 26 for more information regarding these therapies.)
Pharmacovigilance of anti-cancer medicines: opportunities and challenges
Published in Expert Opinion on Drug Safety, 2020
Diana Crestan, Marta Paulina Trojniak, Sara Francescon, Giulia Fornasier, Paolo Baldo
Chemotherapy regimens often involve several different classes of drugs. Cancer patients, in addition to their cancer therapy, also often receive palliative and analgesic therapies, antiemetics, and complementary and alternative medicines to help manage ADRs. The assumption of complex combinations of medicines, involving multiple drugs, is called ‘polypharmacy’ [37]. Polypharmacy increase the risk of interactions among drugs or between drugs and other products, including natural ones. A recent retrospective observational study [38] found that one in four patients treated with parenteral antineoplastic drugs had at least one clinically relevant, potential drug-drug interaction; often the drug combinations were already known to be contraindicated. Furthermore, patients often consider natural products and food supplements (CAM – complementary and alternative products) as completely safe, without understanding that those molecules can interact with chemotherapy, increasing the risks originating from polypharmacy [39].
Outcomes of pediatric retinoblastoma treated with ICEV regimen: A single-center study
Published in Pediatric Hematology and Oncology, 2019
Jassada Buaboonnam, Nattee Narkbunnam, Nassawee Vathana, Chayamon Takpradit, Kamon Phuakpet, Bunchoo Pongtanakul, Sasima Tongsai, La-Ongsri Atchaneeyasakul, Kleebsabai Sanpakit
In these four groups, local treatment, including laser photocoagulation, cryotherapy, and/or thermotherapy, was commenced concurrently with chemotherapy. Chemotherapy regimen varied according to the stage of disease. Those with non-advanced-stage (groups B and C) were treated with combination carboplatin, etoposide, and vincristine (CEV), based on a previously reported schedule and dosage [9], while those with advanced-stage disease (groups D and E) were treated with combination of ifosfamide, carboplatin, etoposide, and vincristine (ICEV). The treatment protocol was as follows: ifosfamide 1800 mg/m2 intravenous drip in 30 min on Days 1 to 3; MESNA 600 mg/m2 intravenous drip in 30 min at Hours 0, 3, and 6 of ifosfamide on Days 1 to 3; carboplatin 560 mg/m2 intravenous drip in 15 min on Day 1; etoposide 150 mg/m2 intravenous drip in 60 min on Days 1 to 3; and vincristine 1.5 mg/m2 intravenous push on Day 1. The evaluation of response was performed every 4 weeks using ophthalmologic examination under anesthesia and compared with previous result.
Tumor mutational burden is not predictive of cytotoxic chemotherapy response
Published in OncoImmunology, 2020
Mina Nikanjam, Paul Riviere, Aaron Goodman, Donald A. Barkauskas, Garrett Frampton, Razelle Kurzrock
Cytotoxic chemotherapy has been the mainstay of treatment for metastatic solid tumors. Chemotherapy regimens have traditionally been selected based on tumor type. Protein markers have been explored as predictive biomarkers for response to chemotherapy ,10 however these markers may not be predictive for all tumor types .11 There is evidence that somatic mutations in genes such as ATM and BRCA can predict responsiveness to platinum chemotherapy .12 Additional biomarkers predictive of response to cytotoxic chemotherapy would be of benefit for a personalized approach to cancer treatment. The relationship between TMB and chemotherapy response is unknown. Many cytotoxic therapies affect DNA replication, and specific mutations affecting DNA repair pathways have been associated with chemotherapy responsiveness .12 However, mutations can also occur in sites that are not relevant to chemotherapy response. Thus, a high TMB could theoretically make a tumor more sensitive to DNA-damaging chemotherapy; furthermore, high TMB might decrease tumor cell viability in a manner analogous to aneuploidic tumor suppression, making it vulnerable to cytotoxics .13,14 Alternatively, a high TMB might be associated with the presence of resistance mutations and, hence, attenuate chemotherapy sensitivity.
Related Knowledge Centers
- Adverse Effect
- Cytostasis
- Cytotoxicity
- Chemotherapy
- Regimen
- Oncology
- History of Cancer Chemotherapy
- Mopp
- Lymphoma
- Maintenance Therapy