Cancer therapy principles ´ëÀå°æ Á¤¸®
1. Radiation recall ÀÏÀ¸Å°´Â ¾àÁ¦: 5-fluorouracil, actinomycin-D, doxorubicin
2. Chemotherapy·Î ¿ÏÄ¡°¡´ÉÇÑ ¾Ï(9°³)
AML, ALL, Hodgkin's disease, NHL(Burkitt's lymphoma, DLCL, follicular mixed
lymphoma), gestational trophoblastic carcinoma, Ewing's sarcoma, testicular cancer,
Rhabdomyosarcoma, Wilms' tumor
3. Adjuvant chemotherapy°¡ È¿°úÀûÀÎ ¾Ï(5°³)
breast cancer, colorectal cancer(stage III), osteogeni sarcoma, ovarian cancer(stage
III), testicular cancer
* 15ÆÇ¿¡´Â soft tissue sarcoma°¡ Ãß°¡µÇ°í testicular ca, ovarian cancer°¡ ºüÁü
4. combined chemotherapy¿øÄ¢
i) °¢ ¾àÁ¦´Â ƯÁ¤Á¾¾ç¿¡ ´ëÇÏ¿© independent activity¸¦ °¡Á®¾ß ÇÑ´Ù.
ii) °¢ ¾àÁ¦´Â ´Ù¸¥ action mechanismÀ» °¡Á®¾ß ÇÑ´Ù.
iii) °¢ ¾àÁ¦°£¿¡ cross resistance°¡ ¾ø¾î¾ß ÇÑ´Ù.
iv) °¢ ¾àÁ¦´Â ¼·Î ´Ù¸¥ dose-limiting toxicity¸¦ °¡Á®¾ß ÇÑ´Ù.
5. cell cycle specific agent
antimetabolites : S phase-specific
plant alkaloid : M phase-specific
* anthracycline(doxorubicinµî) ÇØ¸®½¼¿¡´Â phase non-specific, cecil¿¡´Â cycle-specific
6. 5-FU : continuous infusion -> GI toxicity
bolus IV -> BM suppression
5-FU + leucovorin => synergistic effect
7. methotrexate´Â renal excretionµÇ¹Ç·Î °í¿ë·®À» ¾²¸é acute renal injury¸¦ ÀÔÈù´Ù.
À̸¦ ¿¹¹æÇϱâ À§ÇØ °í¿ë·®ÀÇ methotrexate¸¦ ¾µ¶§´Â vigorous hydration & urine
alkalinizationÀÌ ÇÊ¿äÇÏ´Ù.
8. Paclitaxel(Taxol) - breast, ovary, lung cancer¿¡ È¿°ú°¡ ÀÔÁõ
±âÀü: microtubule stabilization
ºÎÀÛ¿ë: hypersensitivity reaction
9. vinca alkaloid: microtubule assembly inhibition
taxanes: microtuble stabilization/microtubule disassembly inhibition
cf. topotecan: topoisomerase I inhibitor
10. topoisomerase I inhibitor: topotecan, irrinotecan, 9-aminocampthecin
topoisomerase II inhibitor: epipodophylotoxin(etoposide, teniposide)
anthracyclines(adriamycin, daunorubicin, idarubicin, epirubicin)
mitoxantrone, dactinomycin
´ëÅõ(DAE-II)´Ï±î!!
11. ½Å±â´ÉÀúÇϽà °¨·®ÀÌ ÇÊ¿äÇÑ Ç×¾ÏÁ¦: cisplan, methotrexate, etoposide, hydroxyurea,
bleomycin
Bilirubin>3ÀÌ»ó½Ã °¨·®ÇÏ´Â Ç×¾ÏÁ¦: doxorubicin
12. intrathecal chemotherapy: MTX, cytarabine, thio-TEPA, steroid
13. delayed myelosuppression(4-6ÁÖ)
mitomycin-C, nitrogen mustard(BCNU, CCNU), nitrosourea
procarbazine, dacarbazineÃß°¡
14. bleomycin¿¡ ÀÇÇÑ pulmonary fibrosis risk factor
45¼¼ ÀÌ»ó, total cumulative dose >200 U/m2, prior chest irradiation
underlying pulmonary disease
15. hypersensitivity reaction
: taxane(paclitaxel, docetaxel), L-asparaginase, bleomycin
procarbazine, teniposide
16. Adriamycin-induced cardiomyopathy risk factor
previous chest radiotherapy
cyclophosphamide¿Í µ¿½Ã»ç¿ë
underlying heart disease
>70¼¼
hypertension
17. SIADH À¯¹ß Ç×¾ÏÁ¦
cyclophosphamide, vincristine
18. extravasation½Ã tissue necrosis¸¦ ÀÏÀ¸Å°´Â Ç×¾ÏÁ¦
"ºñ´Ü(VDAN) mitomycin¸¸ vesicant¸¦ ÀÏÀ¸Å°´Â °ÍÀº ¾Æ´Ï´Ù"
V - vinca alkaloid
D - daunorubicin, idarubicin
A - adriamycin
N - nitrogen mustard
19. MDR family(PDA)
anthracycline, plant alkaloid, dactinomycin
20. ¾àÁ¦³»¼º ±Øº¹Çϱâ À§ÇØ »ç¿ë°¡´ÉÇÑ ¾àÁ¦: verapamil, quinidine, cyclosporine
21. Interferon-¥á°¡ È¿°úÀûÀÎ ¾Ï(9°³)
CML, hairly cell leukemia, Kaposi's sarcoma
melanoma, renal cell ca, low grade NHL
multiple myeloma, mycosis fungoides, carcinoid tumor
22. IL-2 & LAK therapy
renal cell ca, melanoma, lymphoma
23. cancerȯÀÚ »ç¸Á¿øÀÎ
infection > respiratory failure > hepatic failure > renal failure
24. Hormonal therapy
estrogen -> breast, prostate
antiestrogen(tamoxifen) -> breast
aromatase inhibitor(aminoglutethimide) -> prostate, breast
progestins(megesterol, hydroxyprogesterone) -> breast, endometrial, renal
androgen(Flutamide=Eulexin) -> prostate
GnRH agonist(leuprolide, Goserelin=Zoladex) -> prostate