Cancer therapy principles 대장경 정리

1. Radiation recall 일으키는 약제: 5-fluorouracil, actinomycin-D, doxorubicin

2. Chemotherapy로 완치가능한 암(9개)

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 chemotherapy가 효과적인 암(5개)

breast cancer, colorectal cancer(stage III), osteogeni sarcoma, ovarian cancer(stage

III), testicular cancer

* 15판에는 soft tissue sarcoma가 추가되고 testicular ca, ovarian cancer가 빠짐

4. combined chemotherapy원칙

i) 각 약제는 특정종양에 대하여 independent activity를 가져야 한다.

ii) 각 약제는 다른 action mechanism을 가져야 한다.

iii) 각 약제간에 cross resistance가 없어야 한다.

iv) 각 약제는 서로 다른 dose-limiting toxicity를 가져야 한다.

5. cell cycle specific agent

antimetabolites : S phase-specific

plant alkaloid : M phase-specific

* anthracycline(doxorubicin등) 해리슨에는 phase non-specific, cecil에는 cycle-specific

6. 5-FU : continuous infusion -> GI toxicity

bolus IV -> BM suppression

5-FU + leucovorin => synergistic effect

7. methotrexate는 renal excretion되므로 고용량을 쓰면 acute renal injury를 입힌다.

이를 예방하기 위해 고용량의 methotrexate를 쓸때는 vigorous hydration & urine

alkalinization이 필요하다.

8. Paclitaxel(Taxol) - breast, ovary, lung cancer에 효과가 입증

기전: microtubule stabilization

부작용: 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

대투(DAE-II)니까!!

11. 신기능저하시 감량이 필요한 항암제: cisplan, methotrexate, etoposide, hydroxyurea,

bleomycin

Bilirubin>3이상시 감량하는 항암제: doxorubicin

12. intrathecal chemotherapy: MTX, cytarabine, thio-TEPA, steroid

13. delayed myelosuppression(4-6주)

mitomycin-C, nitrogen mustard(BCNU, CCNU), nitrosourea

procarbazine, dacarbazine추가

14. bleomycin에 의한 pulmonary fibrosis risk factor

45세 이상, 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

cyclophosphamide와 동시사용

underlying heart disease

>70세

hypertension

17. SIADH 유발 항암제

cyclophosphamide, vincristine

18. extravasation시 tissue necrosis를 일으키는 항암제

"비단(VDAN) mitomycin만 vesicant를 일으키는 것은 아니다"

V - vinca alkaloid

D - daunorubicin, idarubicin

A - adriamycin

N - nitrogen mustard

19. MDR family(PDA)

anthracycline, plant alkaloid, dactinomycin

20. 약제내성 극복하기 위해 사용가능한 약제: verapamil, quinidine, cyclosporine

21. Interferon-α가 효과적인 암(9개)

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. cancer환자 사망원인

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