chemotherapy, immunotherapy and targeted therapy - Regional chemo administration o Involves delivery of drug directly to the tumor site o Advantage: higher concentrations of drug can be delivered to the tumor with reduced systemic toxicity o Intraarterial chemo: delivers drugs to the tumor via the arteries supplying tumor One method involves surgical placement of a catheter that is subsequently connected to an external infusion pump o Intraperitoneal chemo: Delivery of chemotherapy to the peritoneal cavity for treatment of peritoneal metastases from primary colorectal and ovarian cancers Infused into peritoneum in 1-2 L of fluid and allowed to dwell in peritoneum for 1-4 hours After dwell time, fluid is drained from peritoneum
o Intrathecal or Intraventricular chemo: cancers that metastasize to CNS are difficult to treat because blood brain barrier prevents distribution of chemotherapy to this area Involves lumbar puncture and injection of chemo into subarachnoid space To reduce need for repeated lumbar punctures, patients may have an Ommaya reservoir inserted = dome-shaped disk with an extension catheter that is surgically implanted through cranium into lateral ventricle o Intravesical Bladder chemo: instillation of chemo into bladder via urinary catheter and retained for 1-3 hours - Effects of chemo on normal tissues: o Can’t selectively distinguish between normal cells and cancer cells o Chemo-induced side effects are the result of the destruction of normal cells, especially those that are rapidly proliferating such as those in bone marrow, lining of GI system and integumentary system (skin, hair and nails) o Acute toxicity: occurs during and immediately after drug administration Includes anaphylactic and hypersensitivity reactions, extravasation or a flare reaction, anticipatory n/v, cardiac dysrhythmias o Delayed effects: numerous; include delayed n/v, mucositis, alopecia, skin rashes, bone marrow suppression, altered bowel function (diarrhea or constipation) and variety of cumulative neurotoxicities o Chronic toxicities: damage to organs such as heart, liver, kidneys and lungs Can be either long term effects that develop during or immediately after treatment and persist or late effects that are absent during treatment and manifest later - Treatment plan: o Common modality is combining agents in multidrug regimens Targets more than one signaling pathway and has proven to be more effective in managing most cancers Patient can experience increase in toxicities o Chemo is most effective when the tumor burden is low, therapy is not interrupted and the patient receives intended dose o Dose of each drug is based on patient’s body weight and height using the BSA calculation o Mutations of cancer cells within the tumor can result in cells that are resistant to chemo Multiple drugs that work at different places in the cell cycle can more effectively kill cancer cells Radiation Therapy - Radiation:
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- Fall '19