Professional Documents
Culture Documents
Cancer Drug
Cancer Drug
Cancer Drug
Fundamental principles
• Primary of patient welfare
• Patient autonomy
• Social justice
Patient safety
• * medical errors and iatrogenic complication
Systemic anti-cancer treatment
• Cell cycle nonspecific agents
◦ Alkylating agent
‣ Cyclophosphamide
• DNA damage -> cell death
• Cause cross linkage
• S/E : neurptoxicity
◦ Platinol
‣ Cisplatin
• Act like DNA alkylating agents
• More potent
• Used for solid tumor
• S/E : GI disturbance,neuro and nephro toxicity
◦ Anthracyclines
‣ Doxorubicin
• Oxidised Fe+ -> free radical
• S/E : cardiotoxicity
◦ Topoisomerase II inhibitor and Topoisomerase I inhibitor
‣ Etoposide
‣ Topotecan
‣ Like anthracycline but not produce cardiotoxicity effect
• Cell cycle specific agents
◦ Antimetabolite ( S phase)
‣ MTX (folic)
• Purine analog
• S/E : mucositis ,contraindication in pregnancy
‣ 5-FU
• Pyrimidine analog
• Used with leucovorin
• S/E: BM suppression
‣ 6-MP
• Purine analog
◦ Antitumor antibiotic ( G2-M phases)
‣ Bleomycin
• S/E : pulmonary fibrosis
◦ Taxanes
‣ Paclitaxel
◦ Vinca alkaloid ( Mphase)
‣ Vinblastine
‣ Vincristine
• Inhibit beta tubular to form mitotic spindle
• EGFR : cetuximab
• HER2 : Transtuzumab
• VEGF : Bevacizumab
• CD20 : rituximab
• CD52 : Alemtuzumab ( all lymphocyte)
Analgesic ladder
• 1
◦ Aspirin
◦ Paracetamol
◦ NSAID
• 2
◦ Codeine
◦ Tramadol
• 3
◦ Morphine
◦ Oxycodone
◦ Fentanyl
Pain
• Neuropathic pain
◦ Antidepressant
◦ Anticonvulsant
• Bone pain
◦ bisphosphanate
◦ Steroids
• Adenocarcinoma : peripheral
• Airway in the center : squamous and small cell
• Lung : plastin
• Breast : doxorubicin
• Triple negative : BRCA
• Antimetabolite : not alopecia ]
Breast cancer
• Tamoxifen ( anti - estrogen) : lymph node - , estrogen receptor + , pre-post menopasusal
• Aromatase inhibitor : lymph node + ,estrogen + ,postmenopasusal
◦ Chemotherapy