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