Systemic anti-cancer therapy (SACT) 

 

Cytotoxic chemotherapy

 

• They work by interfering with the processes involved in cell division. 
• Side effects of treatment are largely a result of their antiproliferative actions in normal tissues such as the bone marrow, skin and gut; other organs, such as the heart, kidney and peripheral nervous system, may also be affected.
• The dosing schedule is determined by the choice of treatments and recovery of normal tissues, usually the bone marrow. 
• Adverse effects:

1. Nausea and vomiting: combination of dexamethasone & ondansetron
2. Myelosuppression: The risk of neutropenia can be reduced with the use of specific growth factors (G–CSF) 

 

Hormone therapy

 

• Hormones are important cell-signaling molecules and, in some cancers, may be key drivers of tumor growth.  
• Example:

1. ER-positive breast cancer: 

• adjuvant hormone therapy 

1. Prostate cancer: hormonal therapy 

• luteinising hormone releasing hormone (LHRH) analogue: goserelin 
• anti-androgen: bicalutamide

 

Targeted therapies

 

• They target specific genes & proteins that are involved in the growth and survival of cancer cells.
• Two groups: 

1. monoclonal antibodies (-mab): target molecules are overexpressed on the outside of the cancer cell.
2. small molecule inhibitors (-ib): they target processes within the cell, such as the cytoplasmic tyrosine kinase, and are designed to be small enough to enter the cell. 

• Example: 

1. Epidermal growth factor receptor (EGFR) inhibitor: 

• for lung adenocarcinomas (EGO): erlotinib, gefitinib or osimertinib. 

1. HER2 (member of the  EGFR family): 

• found in breast, gastric, pancreatic, lung cancer; poor prognosis factor
• trastuzumab, pertuzumab. 

1. Vascular endothelial growth factor receptor (VEGFR) inhibitors: 

• for renal cell carcinoma:  sunitinib, pazopanib and cabozantinib 
• hepatocellular carcinoma: sunitinib 
• thyroid cancer: 

1. VEGF-A antibody for ovarian, colorectal and breast: 

• Bevacizumab

• Colorectal cancer: 

• cetuximab, panitumumab

 

Immunotherapy

 

• anti-cancer therapies that work by harnessing the immune system to attack cancer cells. 
• Example:

1. Cytokines therapy  (interferon alpha and interleukin-2): 

• melanoma, RCC

1. Immune checkpoint inhibitor: 

• melanoma, RCC, lung, bladder, head and neck etc. 
• Nivolumab, pembrolizumab

1. Cellular immunotherapy: (modified cell therapy)

• hematological malignancies. 
• TIL therapy, TCR therapy, CART therapy  

• Cancer treatment vaccines 

SAQ. Role of immunotherapy in oncology. How will you assess and manage Immune Related Adverse Effects (IRAE)

 

Immune-related adverse events 

 

• Side-effects of checkpoint inhibitor immunotherapy agents occur when the immune system is stimulated to attack healthy cells and tissues in the body. 
• These immune-related adverse events (IRAEs) are increasingly being recognized as oncological emergencies. 

 

Clinical features: 

• Almost any body system may be affected,

• colon, endocrine organs (thyroid, adrenal and pituitary glands) , lungs, liver, skin, nervous system

 

Investigatigation:

• multidisciplinary approach including oncologists and relevant system specialists. 
• Specialist investigations may be required depending on the body system affected. 

 

Treatment:

• Dampening the immune response: high-dose steroids. 
• Additional immunosuppressive therapies
• In case of endocrine organ inflammation: replacement of deficient hormones
• Checkpoint inhibitor immunotherapy treatment: permanently discontinued. 
• In other cases, and in patients with endocrine IRAEs who commence replacement hormone therapy, it may be possible to reintroduce checkpoint inhibitor immunotherapy treatment. 

 

SAQ. A 60 year old female patient with stage 3 adenocarcinoma of lung presented with fatigue and constipation. She is taking durvalumab for his cancer. On examination pulse: 48 beats/min, BP: 130/100 mmHg. On investigation S.TSH 13 mIU/l, FT4 normal.

 

1. Write down the complete diagnosis. 

• Stage 3 adenocarcinoma of lung with durvalumab induced immune related adverse events causing hypothyroidism.

 

1. Name 5 other organs that may be affected in this case.

1. Lung, Liver, Skin
2. Nervous system
3. Endocrine organs( adrenal, thyroid, pituitary)

 

1. Enumerate 3 management options

• Multidisciplinary approach 
• High dose steroids
• Additional immunosuppressants 
• Replacement of thyroid hormone
• Discontinuation of immunotherapy ( checkpoint inhibitor)

 

SAQ. Mention the role of molecular targeted therapies in the management of cancer patients with their examples.

Ans to the Q.N- 2(C)

 

Moleculare the moleculare different in di targeted therapy patients with taregeted therapy can cere. is the new ho Now a day widely use cancarco 10

 

Target of the Specific therapy: Treatment molecules Spread of cancere involved Cells. in is targeled growth the

 

Types of targeted therapy:

 

Monoclonal anlibodies.

 

II Small molecules inhibitores.

 

Some con cere common targeted therrapy used in patients:

Biraast receptore Cancerc: Those who have Trastuzumab. positive HER 2

 

0 Chronic myeloid leukaemia Philadelphia kinase chromosome. inhibitores Those positive who Tyrosine Imatinib. arce

 

D Renal cell carcinoma

 

TKI Sunitinib s Pazopanib

 

• MTOR Temsircolimus severcolimus.

 

Lymphoma : Anti-CD20 monoclonal antibody Rituximab

 

• Anti-CD 30 Breentuximab (fore Hodgkin’s disense)

 

Lung Cancerc

 

Tk1

 

Erlotinib

 

• Monoclonal antibody to EGFR

 

Bevacizumab.

 

Myeloma : Anti- 27 (Refractory cases) CD 38 monoclonal antibody eg Dara tumumab.

26

• They target specific genes & proteins that are involved in the growth and survival of cancer cells.
• Two groups: 

1. monoclonal antibodies (-mab): target molecules are overexpressed on the outside of the cancer cell.
2. small molecule inhibitors (-ib): they target processes within the cell, such as the cytoplasmic tyrosine kinase, and are designed to be small enough to enter the cell. 

• Example: 

1. Epidermal growth factor receptor (EGFR) inhibitor: 

• for lung adenocarcinomas (EGO): erlotinib, gefitinib or osimertinib. 

1. HER2 (member of the  EGFR family): 

• found in breast, gastric, pancreatic, lung cancer; poor prognosis factor
• trastuzumab, pertuzumab. 

1. Vascular endothelial growth factor receptor (VEGFR) inhibitors: 

• for renal cell carcinoma:  sunitinib, pazopanib and cabozantinib 
• hepatocellular carcinoma: sunitinib 
• thyroid cancer: 

1. VEGF-A antibody for ovarian, colorectal and breast: 

• Bevacizumab

• Colorectal cancer: 

• cetuximab, panitumumab