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Updated: Jun 18 2021


Images induces apoptosis.jpg
  • Introduction
    • Mechanism
      • induces apoptosis
      • may target specific proteins over-expressed in cancer cells
        • e.g. tyrosine kinase inhibitors
          • imatinib (Gleevec) for chronic myelogenous leukemia
          • gefitinib (EGFR inhibitor, Iressa) for lung, breast cancer
          • erlotinib (EGFR inhibitor, Tarceva) for NSCLC and pancreatic cancer
      • eliminates micrometastasis in lungs
      • >98% necrosis with chemotherapy is good prognostic sign
    • Resistance
      • expression of multi-drug resistance (MDR) gene portends very poor prognosis
        • cells can pump chemotherapy out of cell
        • present in 25% of primary lesions and 50% of metastatic lesions
  • Indications
    • Integral component of treatment along with surgical resection in
      • osteosarcoma (intramedullary and periosteal)
      • Ewing's sarcoma/primative neuroectodermal tumor
      • malignant fibrous histiocytoma
      • dedifferentiated chondrosarcoma
      • chemotherapy for soft tissue sarcoma is controversial
  • Administration
    • Preoperative chemotherapy given for 8-12 weeks
    • Maintenance chemotherapy for 6-12 months
  • Specific Agents & Antidotes
    • Doxorubicin (Adriamycin)
      • mechanism
        • doxorubicin is an anthracycline antibiotic commonly used in oncological protocols
        • functions as a cytostatic agent
      • side effects
        • cardiac toxicity
          • leads to congestive heart failure
          • dexrazoxane used to mitigate toxicity
    • Agents and Antidotes
      • mechlorethamine/cisplatin - give sodium thiosulfate
      • doxorubicin/epirubicin - give dexrazoxane
      • vinca alkaloids (vincristine/vinblastine) - give hot compress and hyaluronidase
        • give cold compress for all other vesicants
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