PRINCIPLES OF CANCER CHEMOTHERAPY
Tumor cells must be susceptible to the selected drug.
Not all tumors are responsive to single agent.
Anti-tumor effects can be increased by giving
combination of anticancer drugs with different
mechanism of action.
Combined therapy is used to decrease toxicity.
Method of drug administration should not have
intolerable local or systemic toxicity that would
prevent completion of adequate course of the
Drug must come in contact with tumor cells specially
during critical periods of cell’s metabolic cycle.
Cancer chemotherapy is more effective when tumor
mass is small than when tumor burden is high.
Ultimate goal of therapy is to destroy all cancer cells,
since survival of few or even single malignant cell
may lead to tumor re-growth.
EFFECT OF ANTICANCER DRUGS
CELL LIFE CYCLE
Gap 0: Resting phase; cell not dividing
Gap 1 (G1): RNA and enzyme synthesis
2 hours to Several Days
Synthesis (S): DNA is produced
8 to 30 hours
Gap 2 (G2): RNA and mitotic protein production
lasts a few hours only
Mitosis (M): Cell division occurs
30 to 90 minutes; cell very vulnerable at mitosis.
Classification according to structure
ACCORDING TO MECHANISM OF ACTION
Drugs affecting biosynthesis of nucleic acid
Drugs destroying DNA structure and function
Drugs interfering with transcription and blocking
Drugs affecting protein synthesis
PROBLEMS WITH CHEMOTHERAPEUTIC DRUGS
Mechanisms of resistance:
Expulsion of the anticancer drugs.
Destruction of anticancer drugs.
Lack of the access of drug to cancer cells.
Anticancer agents have narrow therapeutic index.
They produce damage to normal cells.
Severe vomiting, stomatitis, and alopecia occur with
all anticancer drugs, myelosuppression is common to
many anticancer drugs.
TREATMENT INDUCED TUMORS:
Since most anticancer drugs are mutagenic, therefore
tumors may arise after chemotherapy.
This problem is particularly common with alkylating
CLASSIFICATION OF ANTICANCER DRUGS
2. ALKYLATING AGENTS:
SEMUSTINE (METHYL CCNU).
4. MITOTIC SPINDLE POISONS (PLANT
WHAT IS LEUKEMIA?
Cancer of the white blood cells
Acute or Chronic
Affects ability to produce normal blood cells
Bone marrow makes abnormally large number of
immature white blood cells called blasts.
Acute Lymphocytic Leukemia (ALL)
Acute Mylogenous Leukemia (AML)
Chronic Lymphocytic Leukemia (CLL)
Chronic Mylogenous Leukemia (CML)
TREATMENT FOR ACUTE LEUKEMIA
Chemotherapy is the use of drugs to fight cancer. It
is the usual treatment for acute leukemia. For most
people, that means receiving drugs in stages:
The goal of induction is to kill leukemia cells in the
blood and bone marrow to induce remission. During
remission, there are no signs or symptoms of
The goal of consolidation is to kill any leukemia cells
that may be present even though they don't show up
in tests. If these cells regrow, they could cause a
The goal of maintenance also is to prevent any
remaining leukemia cells from growing. This may be
done using lower doses of chemotherapy than those
used during induction or consolidation. This is only
used in people with ALL and a few rare forms of AML.
Chemotherapy is the most effective method of
leukemia cancer treatment. Various anticancer drugs
are used, usually in combination.
In general, treatment for AML uses higher doses of
chemotherapy over a shorter period of time.
Treatment for ALL involves lower doses of
chemotherapy over a longer period of time.
Some types of acute leukemia spread to the brain and
Regular chemotherapy cannot reach those areas,
because your body puts up a special barrier to protect
them. A different way of giving chemotherapy, called
To bring about bone marrow remission.
For adults, standard induction plans include:
Other drug plans may include:
L-asparaginase or cyclophosphamide.
For children with low-risk ALL, standard therapy
usually consists of three drugs.
(prednisone, L-asparaginase, and vincristine) for
the first month of treatment.
CONSOLIDATION THERAPY OR
To eliminate any remaining leukemia cells. There are
many different approaches to consolidation, but it is
typically a high-dose, multi-drug treatment that is
undertaken for a few months.
Patients with low- to average-risk ALL receive therapy
with antimetabolite drugs such as methotrexate and
High-risk patients receive higher drug doses of these
drugs, plus additional drugs.
With chemotherapeutic drugs to prevent disease
recurrence once remission has been achieved.
Maintenance therapy usually involves lower drug
doses, and may continue for up to three years.
Treatment focuses on controlling the disease and its
symptoms rather than on an outright cure.
CLL is treated by chemotherapy, radiation therapy,
biological therapy, or bone marrow transplantation.
Symptoms are sometimes treated surgically
(splenectomy removal of enlarged spleen) or by
An initial treatment regimen that contains:
(FCR) has demonstrated higher overall response
rates and complete response rates.
Leukemia is rarely associated with pregnancy,
affecting only about 1 in 10,000 pregnant women.
Treatment for chronic lymphocytic leukemias can
often be postponed until after the end of the
If treatment is necessary, then giving chemotherapy
during the second or third trimesters is less likely to
result in pregnancy loss or birth defects than
treatment during the first trimester
SIDE EFFECTS FROM CHEMOTHERAPY
Chemotherapy symptoms vary with the drugs being
used and among individuals; however, the following
are some common side effects:
Nausea / vomiting, Hair loss, Fatigue
Increased risk of infection, Fever
Easy bruising / bleeding, Tingling in the fingers and
Ringing in the ears / difficulty hearing
Menopausal symptoms such as hot flashes or vaginal
(Rare) damage to the reproductive organs and/or