Transcript Slide 1

Fri 30th Aug 2013
Session 4 / Talk 4
16:30 – 17:00
HEAPHY 1 & 2
PLENARY
Fraser TUMAI
ABSTRACT
The purpose of this presentation is to present the fundamentals or the use of chemical agents
(cytotoxic drugs) in the treatment of cancers and other diseases. This presentation will
briefly focus on the following material.
What is chemotherapy (with a brief history),
The cell cycle,
Anti-cancer medicines and treatments,
Duration and frequency of treatments,
Types of administration methods,
Targeted therapies,
Adverse effects during and after treatment,
Working in combination other treatments,
Technology, education, resources and the internet.
I hope that the material presented will clarify terms and definitions around chemotherapy
and its treatments and an insight of the patient’s journey.
A Blast from the Past.
Chemotherapy 101
Fraser Tumai
Nurse Educator Oncology 2013
Waikato Regional Cancer Centre
Aim of session
THE WAIKATO WAY
HISTORY OF CHEMOTHERAPY
….RADIATION THERAPY
CHEMOTHERAPY
ADMINISTRATION & SAFETY
SIDE EFFECTS
RADIATION / CHEMOTHERAPY
The
Waikato
Way
And this
too…………………………………………
………………..!!!!!!
Good times…..
Whoop whoop….…………
Still smiling………….
2012
2013
Back to Back to ??? Back
Regional Cancer Centre Team Waikato
DHB
Chemotherapy timeline
The discovery of xrays
Wilhem Rontgen a
German physicist
produced and
detected
electromagnetic
radiation in a
wavelength range
today known as Xrays
1895
1901
The beginning of
innovation
Radiation Therapy
Marie Sklodowska
(together with her
husband Pierre
Curie) isolated the
first known
radioactive elements
which she named
Polonium and Radium.
The beginning of
innovation
Chemotherapy
Paul Ehrlich was a
man who developed
drugs to treat
Infectious diseases.
He came up with the
name chemotherapy
and defined it as the
use of chemicals to
treat a disease.
1908
1914-1918
Weapon of Mass
Destruction
The first practical
anticancer drugs were
discovered accidentally.
One such discovery
was an outcome of war,
Stemming from the
finding that sulfur
mustard gas, used as a
toxic vesicant in the
First World War,
caused myelosuppression.
Advent of Modern
day chemotherapy
Louis Goodman and
Alfred Gillmon use
nitrogen mustard to
treat non-Hodgkin’s
Lymphoma.
1942
1962
New Zealand
Institute of Medical
Radiation
Technologists
Encouraging
excellence of
practice,
through sharing and
seeking of
knowledge
in medical imaging
and radiation therapy
Moon landing
Neil Armstrong
and name Edwin
‘Buzz’ Aldrin
lands on the
moon. No
monkeys were
injured during the
filming of the
landing.
1969
1971
Target
Therapies.
Nuclear-free
New Zealand in
the 1980s
1980s
National Cancer Act
Launched the nations war
on cancer in the US of A
(1937 / 1971).
The event to end all
events.
Fraser Tumai was born.
It became a celebrated
event worldwide and the
rest is History.
drugs or other
substances that
block the growth
and spread of
cancer by interfering
with specific
molecules involved
in tumour growth
and progression.
1990s
2000s
Combination
Chemo-radiation first
emerges
Researchers report
successful results of a
new approach for head
and neck cancer
therapy
– so-called
“chemoradiation.”
Futuristic Innovation
Chemical warfare involves using the toxic properties of
chemical substances to kill, injure or incapacitate an
enemy. The United States Military classifies lethal
chemical warfare agents into four categories:
1) “nerve agents which attack the nervous system;
2) blister agents which attack and destroy cell tissue
and cause severe blisters;
3) choking agents which cause inflammation of lung
tissues;
4) blood agents which disrupt blood flow”
The Evolution of Radiation Therapy
1960’s
1970’s
1980’s
The First Clinac
Standard Collimator
The linac reduced
complications
compared to Co60
Cerrobend Blocking
Electron Blocking
Blocks were used to
reduce the dose to
normal tissues
1990’s
Computerized 3D CT
Treatment Planning
Functional
Imaging
Multileaf Collimator
Dynamic MLC
and IMRT
MLC leads to 3D
conformal therapy
which allows the first
dose escalation trials.
2000’s
Computerized IMRT
introduced which
allowed escalation of
dose and reduced
compilations
High resolution IMRT
IMRT Evolution
evolves to smaller
and smaller
subfields and high
resolution IMRT
along with the
introduction of new
imaging
technologies
Test subject: 0031748695
Say
Cheese!!!!
Approaches to Cancer Treatment
Local disease - Surgery and radiation
therapy (targeted therapy)
Systemic disease – Chemo, Hormone
and Immunotherapy
The Big 3
Definition:
CHEMOTHERAPY
The treatment of cancer using specific chemical
agents or drugs that are destructive to malignant
cells and tissues. The term comes from two words
that mean "CHEMICAL" and "TREATMENT."
CYTOTOXIC
Literally translated means ‘TOXIC TO CELLS’.
Modern Era
1940-1950
• Beginnings of the modern era of
chemotherapy traced directly to the
discovery of nitrogen mustard (chemical
warfare agent) as an effective treatment
for cancer.
• Autopsy observations of people exposed to
mustard gas revealed lymphoid and
myeloid suppression
Administration
• Oral
• Intravenous
• Subcutaneous
• Intramuscular
• Topical
• Intraoccular (eyes)
• Intravesical (bladder)
• Intraperitoneal
•
(abdomen)
Intrathecal (space under
the arachnoid membrane of
the brain or spinal cord)
Standard issue PPE
PERSONAL
PROTECTIVE
EQUIPMENT
Minimising the exposure
SIDE EFFECTS OF RADIOTHERAPY /
CHEMOTHERAPY
Nausea and vomiting
I don’t remember having soup for lunch?
Skin changes
Side effects? Nope, no sides effect Doc.
HAIR LOSS - ALOPECIA
Damage to hair follicles can cause
alopecia
Can effect all body hair i.e. eye lashes, eyebrows and
also pubic hair
Hair loss begins 7- 21 days
post chemo –
Wig Referral needs to be
done before this time
Alopecia is nearly
always reversible on
completion of chemotherapy
Chemo-Radiation
History of Cancer Chemotherapy
Combination chemotherapy 1965
• Cancer cells could conceivably mutate to become
resistant to a single agent, but using different
drugs concurrently would make it extremely
difficult for the tumour to develop resistance to
the combination.
• Induced long term remission in children with ALL.
COMBINATION THERAPY
Reduces resistance to drugs
Increased effectiveness
Access to sanctuary sites e.g. lungs, CSF.
Combinations selected to avoid overlapping toxicity
but:
Causes spectrum of adverse effects but minimises
risk of lethal effects.
Feel Good Treatments
THANK YOU
QUESTION
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Challenges……………………….