what's new in cancer treatment; chemotherapy vs. targeted therapy
Post on 20-Dec-2014
4.383 Views
Preview:
DESCRIPTION
TRANSCRIPT
Chemotherapyvs.
Targeted Therapy
James J Lechner, MD
Medical DirectorProvidence Regional Cancer System
The Role of Systemic Therapy
• Treatment of the whole body• Intent?
– Induction therapy– Adjuvant therapy– Palliative
Chemotherapy vs Targeted Therapy
• Chemotherapy:– Drugs that effect cells that are doubling– Not very specific– Mostly intravenous, some oral agents– Cytotoxic
• Targeted therapy:– Drugs that inhibit a more specific target in cells– Many are oral agents– Mixture of cytostatic and cytotoxic
Sidney Farber (1903–1973)
The Normal Cell Cycle
Classes of Chemotherapy Drugs
• Alkylating agents• Antimetabolites• Anthracyclines• Anti-tumor antibiotics• Plant alkaloids
– Topoisomerase inhibitors– Vinca alkaloids– Taxanes
Class Example Method of Action Cycle Specfic
Alkylating agents Cytoxan Effects DNA chemically All
Antimetabolites 5-FUGemzar
Substitutes for normal cell building blocks
S
Anthracyclines Adriamycin DNA damage or inhibit topoisomerase
All
Anti-tumor Antibiotics
Bleomycin DNA damage All
Topoisomerase Inhibitors
Irinotecan Complex DNA and topoisomerase together
SG-2
Vinca Alkaloids Vincristine Binds to tubulin, interferes with mitosis
M
Taxanes TaxolTaxotere
Prevents microtubules from disassociating
M
Targeted Therapy
Attempts to take advantage of a genetic change in the malignant cells
The Origins of CML
Gleevec
BRAF Mutation in Melanoma
EML4-ALK Mutation in Lung Cancer
• Present in 3-5% of non-small cell lung cancer, usually adenocarcinoma
• Mutation leads to formation of a fusion gene that codes for an abnormal tyrosine kinase receptor
Response to crizotinib in patients with EML-ALK NSCLCA
Drugs in the Pipeline for ALK
Her-2/neu
• About 25% of breast cancer cases are associated with a amplification of the genes coding for a cell surface receptor called Her-2/neu
• These cells may a 1000 fold increase in the number of these receptors over normal breast cells
• Associated with rapid growth
Herceptin
There Are Multiple Agents Already Available
Non-Hodgkin Lymphoma
Old News Targeted Therapy
(But crucial in breast cancer)
Normal Estrogen Effects in Breast Cells
Anti-estrogen Therapy in Breast Cancer
Antibody-Drug Conjugates
A New Agent in Hodgkin's Disease
Stimulating an Immune Response
New Agent in Melanoma Therapy
Pushing Immune Cells to Recognize Cancer Cells
Provenge in Prostate Cancer
Recommended Reading
Thank You
top related