肿瘤化疗,中山大学.ppt

《肿瘤化疗,中山大学.ppt》由会员分享，可在线阅读，更多相关《肿瘤化疗,中山大学.ppt（24页珍藏版）》请在淘文阁 - 分享文档赚钱的网站上搜索。

1、CANCER CHEMOTHERAPY(Lecture Outline For Medical Students)管管 忠忠 震震Cancer Chemotherapy(1)The role of chemotherapy in cancer treatment(2)Current status of cancer chemotherapy:How effective it is?(3)Mechanism of cancer chemotherapy:a brief review(4)Difficulties in cancer chemotherapy:How to overcome?(5)

2、New developments A Brief Review of Natural History of CancerNormal somatic cellmutation Malignant change Cancer cell Proliferate (Mitosis)Cell mitosis:DNA Synthesis Mitosis RNA S phase M phaseCancer cell:Number Increasing Cancer in situT Local tumor mass Local infiltration&extension Locally advanced

3、N Lymphatic spread:LNM Hemangial(Systemic spread):Remote metastasisCancer ChemotherapyTNM Staging System Progression of CancerCancer,Treatment of ChoiceLocalized Cancer:SurgeryLocally Advanced:Role of Chemotherapy in Cancer Treatment(1)Metastatic Cancer:Palliative or Curative Chemotherapy(2)Adjuvant

4、 Chemotherapy:to erradicate or control micro-metastasis(3)Neo-adjuvant Chemotherapy (Induction Chemotherapy)to make Surgery of RT possible to alleviate surgical damage to eradicate micro-metastasis(4)Hematological Malignancies:Primary TreatmentIn Localized or Regional Cancer CasesMicro-Metastasis Ma

5、y occur(Sub Clinical Metastasis)Efficacy of Chemotherapy to CancersChemotherapy Curable CancersChildhood:ALL 70%NHL 50%Burkitts Lymphoma 50%Wilms Tumor 50%Ewings Sarcoma 50%Embrynal 50%RhabdomyosarcomaChemo-Resistant(Insensitive)CancersNon-Small Cell Lung CancerG.I.CancersPancreatic CancerMelanomaMe

6、chanism of Cancer Chemotherapy(Cytostatic Drugs)Anti-proliferation(1)Blockage DNA Synthesis Blockage purined pyramidine synthesisInhibit DNA polymerase(2)Direct Damage to DNABreakage of DNA chainCross-linkage,inhibit depolarization(3)Inhibit Transduction(DNA RNA)(4)Spindle toxin Mitosis damage(5)Inh

7、ibit topoisomeraseDifficulties in Cancer Chemotherapy(1)Non-dividing Cancer Cells (Go cells)Growth Fraction(GF)and sensitivtyInsensitive Cancers:Non-small Cell Lung CancerG-I CancersLiver Cancer,etcGo Cells in Sensitive Cancer:Recurrence(2)Proliferating Normal Cell:DamageMyelo Suppression:Granulocyt

8、openia InfectionThrombocytopenia HemorrhageRBC anemiaLymphocytopenia Immune SuppressionMucous Epith Cells Stomatitis G-I reactionsGerm Cells InferlityFoetus Teratogenic,Abortion(3)Other Organ Toxicity Cardiac,Hepatic,Renal,etc.Pulmonary(4)Drug ResistanceMethods of Improvement:Component TransfusionPr

9、otected Environment (life Island,Lamina Air Flow Unit),Hematopoietic Growth Factore (G-CSF,GM-CSF,Stem Cell Transplants)肿瘤化学治疗中肿瘤化学治疗中值值 得得 注注 意意 的的 事事 项项Precaution in Cancer Chemotherapy1.全面评估患者的病情全面评估患者的病情有机结合各种治疗手段 (Multi-Modality treatment)2.每一患者均有具体的治疗目标每一患者均有具体的治疗目标:根治性化疗 (Curative chemotherap

10、y)姑息性化疗:延长寿命 (Palliative chemotherapy)缓解症状Palliative Care?3.权衡利弊权衡利弊 ToxicityBenefit vs Risk Cost4.尽量使用标准治疗方案尽量使用标准治疗方案:(Standard Protocol)经经Clinical Study 证实证实密切观察密切观察,防止及处理不良反应防止及处理不良反应 (Adverse effects)Cancer Chemotherapy:New Advances1.Hi Dose CT/Stem Cell Transplantation2.New Anticancer DrugsTaxanes:TAXOL,TAXOTERETopoisomerase I Inhibitor:CPT-10,CPT-11,TOPOTECANGemcitabineOxaliplatin,LobaplatinNew Theraputic Targetse.g.Anti-angioclonal(Angiostatin,Endostatin)Monoclonal Antibody:Herceptin For Breast Cancer (Her 2 neu over expression)Gene therapy