Disease-Modifying Therapies Flashcards
Aims of DMT
Aim may be curative in certain contexts:
Aim may also be palliative
- Improve or stabilize quality of life
- Prolong survival
Advanced Cancers that be cured with chemo alone
- Acute lymphoblastic leukemia (in Children - chemo)
- Acute myeloid leukemia (chemo)
- Choriocarcinoma (chemo)
- High grade Non-hodgkin’s lymphoma (chemo)
- Hodgkin’s lymphoma (chemo)
Advanced Cancers that may be cured with chemorads
- Anal cancer
- Cervical cancer
- Head and neck cancer
- Lymphoma
- NSCLC
- SCLC
Surgery in advanced cancer
- May be used to achieve cure or better disease control
Palliative setting:
- Metastatic renal cell ca, nephrectomy may result in regression of lung mets and improves overall survival. Primary tumour may secrete angiogenic factors
- Breast Ca and Colorectal CA, removal of primary may result in better OS
- Lung mets, metastectomy may be considered if primary is controlled and there are no other extra-thoracic lesions with the exception of resectable hepatic lesions
- Liver mets in colorectal CA
- Solitary brain met with whole brain rads in patients with good PS (improved function and OS)
- Metastectomy of adrenal mets or bone may improve comfort (but not survival)
Radiotherapy: Cancers where there is an impact on disease outcome and overall survival
Small cell lung cancer, extensive stage
- Combination with chemo improves local control and survival
- Prophylactic whole brain rads leads to significant reduction in symptomatic brain mets and OS
Solitary brain mets
- Combo of surgery and whole brain rads improves tumour control of original metastatic site and in the brain overall compared to resection alone
Recurrent Head and neck cancer
- Re-irradiation of head and heck region with or without chemo can induce long term disease control
Metastatic thyroid cancer
- Radioactive iodine may control metastatic disease
Carcinoid tumours
Castration resistant prostate cancer
Treatment of advanced breast cancer: Hormonal Tx
-70% of breast cancers are ER or PR positive
Aromatase inhibitors (for ER+) or Estrogen blockers
- Improve disease-free progression and OS
- Postmenopausal - AIs (letrozole, anastrozole, exemestane), which blocks peripheral estrogen production
- Pre-menopausal - Tamoxifen and ovarian suppression
Treatment of advanced Endometrial cancer: Hormonal Tx
- Progesterone or tamoxifen may be helpful
Treatment of advanced Prostate cancer: Hormonal Tx
Androgen deprivation therapy
- Orchiectomy
- LHRH agonists or antagonists
- Reduces disease progression, but does not induce a clear survival benefit and may have unpleasant side effects (osteoporosis, sexual dysfunction, hot flashes, metabolic syndrome, CV morbidity)
- Hormonal tx remains effective in patients who are castration resistant with a survival benefit with abiraterone
Treatment of advanced thyroid cancer
- L-thyroxine at doses to suppress TSH
- Dose according to risk of disease, given significant side effects
Treatment of neuroendocrine tumours
- Somatostatin analogues (octreotide or lanreotide) to improve symptoms and progression free survival
Cytotoxic agents
‘Conventional’ chemotherapy to interfere with cell cycle processes
- Therapeutic index between activity and toxicity is very narrow
- In the curative setting, most often combined with surgery or rads
- Can be curative alone for cancers (testicular, germ cell tumours, lymphoma, some heme malignancies)
In advanced disease, use for disease control to improve QOL and extend survival
Targeted agents
Monoclonal antibodies against the EGFR receptor
- Cetuximab, panitumumab
Tyrosine kinase inhibitors (gefitinib, erlotinib, afatinib)
- TKs are part of intracellular signal transduction pathway
Monoclonal antibodies against HER-2 receptor
- Trastuzumab, Pertuzumab
- Oncogene in the epidermal growth factor receptor family
VEGF and VEGF receptor
- Bevacizumab, sorafinib, sutinib
