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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