This document provides an overview of basic principles of chemotherapy. It discusses chemotherapy for leukemias/lymphomas which involves several phases including remission induction, consolidation, and maintenance. For solid tumors, it describes adjuvant, neoadjuvant, and palliative chemotherapy. Dosing is based on body weight, surface area, or area under the curve. Combination therapy is commonly used to increase efficacy. Chemotherapy agents are administered via several routes including intravenous, oral, and intra-arterial routes. Response to chemotherapy is assessed using categories like complete response, partial response, stable disease, and progressive disease. Factors like tumor heterogeneity, drug resistance, dose intensity, and patient health can impact response to chemotherapy.

1. Basic
principles of
Chemotherapy
Dr. V. S.Swathi
Assistant Professor

3. For Leukaemia and Lymphomas
• Several phases of chemotherapy is required
• Cure can be achieved with aggressive therapy for a prolonged time
Remission induction
• This is given for killing maximum number of cancer cells
Consolidation/ Intensification/ Post remission
• This is given to eradicate any clinically undetectable disease and lower the tumor
cell burden below 103 at which host immune system can keep cancer cells in
control
Maintainenance
• This is given for maintaining or prolonging the remission

4. For Solids tumors
Adjuvant therapy
• It is given after more definitive therapy like surgery for eliminating remaining
disease or undiagnosable micro metastasis
Neoadjuvant chemotherapy
• It is given before definitive therapy to decrease the tumor burden ( Surgery/
Radiation)
Palliative therapy
• It is given when complete eradication of tumor is not possible or patient refused
aggressive therapy.
• It is given to decrease tumor size, to control tumor cell growth and to reduce
symptoms
Salvage therapy
• It is given for getting remission in case of other therapies are failed

5. Dosing of chemotherapy agents
Dose of chemotherapy drugs is adjusted based on:
• Body weight- Used in case of patient body weight is 10-11kg
• Body surface area- It is widely used
• Area under the curve plot
Dose of chemotherapy agents is adjusted in case of renal and hepatic impairment
patients

6. Combination therapy
• It is given generally to get maximum efficacy
Main reasons for combination therapy:
• Overcoming/ preventing resistance
• To kill resting and dividing cells
• To increase effect
• To rescue normal cells
• Chemotherapy regimens are given at short course in cyclic manner

7. Acronyms are used to designate
chemotherapy agents

8. Route of administration
Chemotherapy agents are given in the following routes
• Intravenous route
• Oral
• Subcutaneous
• Intrathecal
• Intra arterial
• Intra peritoneal
• Intra vesicle
• Continuous IV Infusion
• Hepatic artery infusion
• Mostly IV route is used
• Products like liposomal/ pegylated agents are used to decrease toxicities

9. Response to chemotherapy
Complete response(CR)
• Here all clinical, gross and microscopical changes are disappeared
Partial response(PR)
• Here tumor size reduces to half, and lasts for reasonable period
Response rate (RR)
• It is combination of complete and partial response
RR=CR+PR
Stable Disease (SD)
• It indicates tumor neither grows or nor shrinks significantly (Less than 25% change)
Progressive Disease (PD)
• It indicates no response or increase in tumor size or appearance of new lesions
(More than 25% change)

10. Factors affecting response to
chemotherapy
• Tumor cell heterogenecity- Requires aggressive therapy
• Drug resistance- Tumor size is directly proportional to resistance
• Drug intensity- in case of complications dose intensity should be decreased
• Dose density- In case of getting more effect dose density is decreased
Patient specific factors include:
– Poor functional status
– Impaired organ function
– Co morbid conditions