type of tumor
stage & rate of growth
age & medical condition
economic factors
Therapeutic Modalities
Surgery
Radiation Therapy
Chemotherapy
Endocrine
Biological
Experimental
Chemotherapy
Includes administration of cytotoxic
drugs, hormonal & endocrine Tx
Origins in 1940s -- Goodman & Gilman
used nitrogen mustards for lymphoma
Today, >50 cytotoxic agents; >15
hormonal agents in use
Not usually used for localized cancers
Chemotherapy
Mainly used for disseminated cancers systemic at
time of diagnosis:
Cancers with metastatic spread
==> intent to prolong life, palliate symptoms
hematological malignancies
==>cure or prolong life
Cancers with suspected micrometastatic spread (
adjuvant therapy)
Tumor cell sanctuaries -- CNS & testes a
limitation
Chemotherapy
Adjuvant therapy:
debulking prior to surgery
augment effects of RT (either additive,
or as radiosensitizers)
May be used in cancer prevention
trials on estrogen receptor antagonists
for women at high risk of breast cancer
Can be administered regionally
Chemotherapy
Localized Administration
Limb: Melanoma -- isolated limb perfusion
Abdomen: Ovarian Ca -- intraperitoneal Tx
CNS: Meningeal disease -- intrathecal/ iventric.
Skin Lesions: Squamous, basal cell Ca -- topical
Liver: Hepatoma, mets -- hepatic artery infusion
Pleura: Pleural effusions -- pleural instillation
Bladder: Superficial bladder Ca -- intravesical
Cure Possible
Choriocarcinoma Embryonal
Neuroblastoma rhabdomyosarcoma
Acute leukemias Intermediate- grade
Testicular cancer lymphomas
Hodgkins disease Lymphoblastic
Wilms tumor lymphoma
Ewings sarcoma Small Burkitts lymphoma
cell lung ca.
Adjuvant Cures
Possible
Breast cancer
Colorectal cancer
Osteogenic sarcoma
Soft tissue sarcoma
Head & neck cancer
Not yet Curable
Bladder cancer Gastric cancer
Breast cancer Glioblastoma
Cervical/ endometrial multiforme
cancers Soft tissue sarcoma
Prostate cancer Colorectal cancer
Multiple myeloma Chronic leukemia
Low- grade lymphomas Head & neck ca.
Poor Response
Osteogenic sarcoma
Pancreatic cancer
Renal cell carcinoma
Thyroid cancer
Non- small cell lung cancer
Melanoma
Prinsip kemoterapi kanker
Kanker hanya terdeteksi bila jumlah sel
109,yang dapat dibasmi 99.9%, sisa 106.
Sebaiknya sel tumor kurang dari 10 5
Ada hubungan dosis respon positip, dosis
tinggi => efek tinggi => sampingan tinggi
Pemakaian intermiten, efektif tanpa
mengganggu sel normal
Prinsip kemoterapi kanker
Kemoterapi tertuju pada sel kanker
Pemakaian dini:
jumlah sel masih sedikit
sel resisten belum banyak
obat mudah mencapai semua sel kanker
keadaan umum pasien masih baik
Prinsip kemoterapi kanker
Sifat pertumbuhan sel ganas mula-mula
lambat, lalu eksponensial, kemudian
melambat kembali
Efektifitas selektif terhadap sel histologik
tertentu
Prinsip kemoterapi kanker
Terapi kombinasi:
mekanisme kerja beda
efek toksik beda
diberikan pada masa siklus yang tepat.