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3. Hormonal therapies
- Tumor response
Gradation of toxicity:
V. death
Response:- induce cancer cell death
Dosage factors:-
Dose escalation
Reducing interval between treatment cycles
Sequential scheduling of either single agents or of
combination regimens
Cancer Chemotherapy
After completion of mitosis, the resulting daughter
cells have two options:
(1) they can either enter G1 & repeat the cycle or
(2) they can go into G0 and not participate in the
cell cycle.
Growth fraction - at any particular time some cells
are going through the cell cycle whereas other cells
are resting.
The ratio of proliferating cells to cells in G0, is
called the growth fraction.
A tissue with a large percentage of proliferating
cells & few cells in G0 has a high growth fraction.
Conversely, a tissue composed of mostly of cells
in G0 has a low growth fraction.
Cell Cycle Specific (CCS) & Cell Cycle Non-
Specific Agents (CCNS)
Log kill hypothesis
According to the log-kill hypothesis,
chemotherapeutic agents kill a constant fraction
of cells (first order kinetics), rather than a
specific number of cells, after each dose
1. Solid cancer tumors - generally have a low
growth fraction thus respond poorly to
chemotherapy & in most cases need to be
removed by surgery
2. Disseminated cancers- generally have a high
growth fraction & generally respond well to
chemotherapy
Log kill
LOG kill hypothesis
The example shows the
effects of tumor burden,
scheduling, initiation/duration
of treatment on patient
survival.
The tumor burden in an
untreated patient would
progress along the path
described by the RED LINE
The tumor is detected (using
conventional techniques)
when the tumor burden
reaches 109 cells
The patient is symptomatic
at 1010-1011 cells
Dies at 1012 cells.
Primary induction:- chemotherapy Primary treatment
advanced cancer no alternative treatment
Curable : Hodgkin's, NHL, AML, Germ cell , choinoca.
Child :- ALL, B inkitts, Wilma's, embryonal shabdo
myosarcoma.
New adjustment : localized cancer for which
alternative local exist less effective.
- Avil, Bladder, Breast, esoyhagin, laring. NSCLS,
Osteogeric sancoma.
Adjustment: - adjunct to local modalities
eg :. Hormonal agents for g breast