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In this webinar:
The basics of advanced prostate cancer, what it means to have non-metastatic castration resistant prostate cancer, the new treatment options now available for this disease space, and the prognosis for patients in this state of disease.
Presented by Dr. Robert Hamilton, urologic oncologist at Princess Margaret Cancer Centre and Associate Professor in the Department of Surgery (Urology) at the University of Toronto, this webinar will provide an overview of this subset of prostate cancer.
Dr. Hamilton’s clinical and research interests are in prostate cancer and testicular cancer. Dr. Hamilton trained at the University of Toronto and has completed a Masters of Public Health at The University of North Carolina at Chapel Hill, and a research fellowship at Duke University. He has also completed a fellowship at Memorial Sloan-Kettering Cancer Centre.
View the video:
https://youtu.be/wE3EVJm5Oo4
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Gastrointestinal stromal tumor, also called GIST is the most common mesenchymal tumor of GI tract. Over the years, the management of these tumors have evolved. This ppt shows the importance of mutation testing, wild type GIST, Newer drugs like avapritinib and ripretinib etc. Along with that it also shows Indian perspective and need of dedicated GIST clinics in India
Geoffrey Oxnard, MD, discusses the latest research in targeted therapies and molecular testing to treat lung cancer.
This presentation was originally given as part of "Living with Lung Cancer: A Forum for Patients and Caregivers" on Nov. 14, 2015 at Dana-Farber Cancer Institute in Boston, Mass.
Don’t miss our upcoming webinars: Subscribe today!
In this webinar:
The basics of advanced prostate cancer, what it means to have non-metastatic castration resistant prostate cancer, the new treatment options now available for this disease space, and the prognosis for patients in this state of disease.
Presented by Dr. Robert Hamilton, urologic oncologist at Princess Margaret Cancer Centre and Associate Professor in the Department of Surgery (Urology) at the University of Toronto, this webinar will provide an overview of this subset of prostate cancer.
Dr. Hamilton’s clinical and research interests are in prostate cancer and testicular cancer. Dr. Hamilton trained at the University of Toronto and has completed a Masters of Public Health at The University of North Carolina at Chapel Hill, and a research fellowship at Duke University. He has also completed a fellowship at Memorial Sloan-Kettering Cancer Centre.
View the video:
https://youtu.be/wE3EVJm5Oo4
To learn more about CCSN, visit us at survivornet.ca
Follow CCSN on social media:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Instagram: https://www.instagram.com/survivornet_ca/
Pinterest - https://www.pinterest.com/survivornetwork
Gastrointestinal stromal tumor, also called GIST is the most common mesenchymal tumor of GI tract. Over the years, the management of these tumors have evolved. This ppt shows the importance of mutation testing, wild type GIST, Newer drugs like avapritinib and ripretinib etc. Along with that it also shows Indian perspective and need of dedicated GIST clinics in India
Geoffrey Oxnard, MD, discusses the latest research in targeted therapies and molecular testing to treat lung cancer.
This presentation was originally given as part of "Living with Lung Cancer: A Forum for Patients and Caregivers" on Nov. 14, 2015 at Dana-Farber Cancer Institute in Boston, Mass.
This presentation is intended for all urology and oncology physicians and staff. Learn more about the utilization of Enzalutamide in metastatic prostate cancer and the prostate cancer patient journey with a specialty pharmacy.
• Enzalutamide outcomes prior to chemotherapy
• Adverse events associated with Enzalutamide
• Utilization of a specialty pharmacy
More information is available to you for urology medications, treatment options and referral forms here: http://www.avella.com/specialties/urology
The emerging field of oncogeriatrics, or geriatric oncology, deals with management of cancer in older people. This presentation introduces the area and reviews the evidence base. It also explains how cancer presents and behaves differently in older people.
Carcinoma rectum the complete aproach to how to investigate and treat a case ...nikhilameerchetty
this is a complete guide to the understanding of the anatomy clinical features and the latest investigation to the most modern methods of treating the case of carcinoma rectum , all the latest journal published and the ongoing trials hav been searched and incorporated
this slide contain information about antibody mediated anti-cancer therapy like antibody drug conjugates (ADC), Bispecific monoclonal antibody, Immuno-checkpoint therapy, biomarkers, mechanism of action of all 3 therapies, approved drugs of each category
Chemotherapy is an aggressive form of chemical drug therapy meant to destroy rapidly growing cells in the body.It is usually used to treat cancer, as cancer cells grow and divide faster than other cells.
This presentation is intended for all urology and oncology physicians and staff. Learn more about the utilization of Enzalutamide in metastatic prostate cancer and the prostate cancer patient journey with a specialty pharmacy.
• Enzalutamide outcomes prior to chemotherapy
• Adverse events associated with Enzalutamide
• Utilization of a specialty pharmacy
More information is available to you for urology medications, treatment options and referral forms here: http://www.avella.com/specialties/urology
The emerging field of oncogeriatrics, or geriatric oncology, deals with management of cancer in older people. This presentation introduces the area and reviews the evidence base. It also explains how cancer presents and behaves differently in older people.
Carcinoma rectum the complete aproach to how to investigate and treat a case ...nikhilameerchetty
this is a complete guide to the understanding of the anatomy clinical features and the latest investigation to the most modern methods of treating the case of carcinoma rectum , all the latest journal published and the ongoing trials hav been searched and incorporated
this slide contain information about antibody mediated anti-cancer therapy like antibody drug conjugates (ADC), Bispecific monoclonal antibody, Immuno-checkpoint therapy, biomarkers, mechanism of action of all 3 therapies, approved drugs of each category
Chemotherapy is an aggressive form of chemical drug therapy meant to destroy rapidly growing cells in the body.It is usually used to treat cancer, as cancer cells grow and divide faster than other cells.
This presentation comprises of various chemotherapeutic agents used in ENT malignancies and other conditions. Its classifies the agents and briefly discusses the dosage and their common side effects.
Chemotherapy drugs are managed by the trained healthcare professional with many standard precautions. Most of the cancer patients must gone through the chemotherapy treatment
Cancer chemotherapy- General IntroductionpptxAbarna Ravi
General introduction..References from pharmacology text books
1. KD TRIPATHY-ESSENTIALS OF MEDICAL PHARMACOLOGY
2.LIPPINCOTT'S ILLUSTRATED REVIEWS -PHARMACOLOGY
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
1. Nancy T. Sklarin, MD, MS
Director of Chemotherapy Practice MSKCC
The following material is intended for MSKCC internal medicine house staff teaching purposes only.
The slides were updated for the LibGuide in 2013-2014.
2. Develop a framework for understanding
antineoplastic chemo and biotherapeutic agents
Review basic chemotherapy principles
Discuss some common chemotherapeutic agents
and side effects
4. Surgery
• Localized disease
Often the most effective and definitive curative therapy
Local control of mass even in setting of metastases
• Metastatic disease
Curative in rare cases – solitary liver metastasis in colon cancer
Relief of compression - solitary brain, spinal cord
Bowel obstruction
Radiation
• Cure or control of localized disease
• Prophylaxis of sites at high risk for metastasis
• Palliation for relief of
pain, spinal cord compression, brain metastases, organ obstruction, bleeding mass
Mechanical
• Stents to bypass obstructions
• Radiofrequency ablation of isolated lung metastases
• Embolization of bleeding tumor or liver metastasis
5. Cure
• As an adjunct to surgery
• As an adjunct to radiation
• Curative single modality therapy
Prevention
• Hormonal therapy as chemoprophylaxis for breast cancer
• Imatinib in CML
Improved survival in metastatic disease
Palliation of symptoms
6. Adjuvant Therapy
• Treatment given after the primary treatment to lower the risk of
recurrence caused by micrometastatic or residual disease;
• Usually with curative intent
Neoadjuvant therapy
• Treatment to shrink tumor before main treatment; usually surgery
• Goals:
Improve operability
Preserve anatomic structure: larynx, anal sphincter, breast
Assess responsiveness of tumor to chemotherapy
Salvage therapy
• Treatment given after the cancer has not responded to other
treatments.
• May be for curative intent
7. Palliative therapy
• Treatment not curative, but given to relieve symptoms and reduce
suffering caused by the disease
Dose-dense or Accelerated therapy
• Chemotherapy given more frequently or at higher dose to attempt to
kill tumor cells early in the regrowth phase
• Requires colony stimulating factor support
High-dose therapy
Regimen given at doses so high that counts would not recover on
their own
Requires stem cell support
8. Therapeutic Index
• Ratio of the doses that cause therapeutic effect versus toxicity
Dose Limiting Toxicity (DLT)
• A dose that yields greater than acceptable toxicity
Maximal Tolerated Dose (MTD)
• Dose just lower than DLT; usually the dose suitable for phase II trials
NCI Common Toxicity Criteria
• Standard toxicity definitions used to communicate level of toxicity
9. Phase I
• First time using the drug in humans
• Evaluate safety, toxicities and establish safe dose of the agent
Phase II
• Is the drug effective
• Establish further dosing and safety data
Phase III
• Confirm effectiveness
• Monitor side effects
• Compare to established agents
10. Narrow therapeutic-safety index
• Small Δ dose Large Δ toxicity
Potentially lethal toxicities
• Marrow, pulmonary, hepatic
Wide range of dosing for some drugs
• Appropriate methotrexate dose can be 12mg or 12,000 mg
• More difficult to judge if orders are correct
Complex regimens
• Multidrug, multiday
Many research protocols
• Unfamiliar drugs and schedules
11. Cancer cells lose regulatory mechanisms for differentiation, growth
arrest, and self-renewal capacity that allows for loss of tissue
architecture and homeostasis.
12. Growth fraction:
Percentage of cells that are growing starts at
100% and declines exponentially over time
with increasing tumor burden
Growth rate:
Slowly progresses to an exponential phase,
and slows again as the size of the tumor
outstrips it blood supply
Treatment Challenge:
Treatment results in an increase in the
growth fraction and growth rate
Chemotherapy is given in cycles:
To allow recovery from toxicity and address
regrowth of cancer cells
14. Non-Cell cycle-specific agents
• Kill both resting and replicating cells
• Induce apoptosis through DNA damage
• Interrupt transcription, translation, and protein synthesis
necessary for cellular replication and function
• eg: Alkylating agents, Antitumor antibiotics
Cell cycle-specific agents
• Block specific parts of the cycle as cells divide
• S phase - Antimetabolites
• S and G2 phase - Topoisomerase Inhibitors
• G2 and M phase - Mitotic Spindle Inhibitors
17. Structural analogues of cellular substrates
• Incorporated into DNA & RNA causing transcription to
halt purine or pyrimidine synthesis
• Inhibit enzymes in DNA replication & repair
Toxicities
• Myelosuppression
• Stomatitis
• Diarrhea
18. Methotrexate
• Competitively inhibits DHFR & inhibits conversion
of FH2 FH4 necessary for reduced folates.
• Leukemia, lymphoma, breast cancer, head & neck
cancers, gestational trophoblastic disease,
rheumatologic diseases
• Intrathecal route or high-dose IV can penetrate
CNS
• Toxicities:
Related to length of exposure
Don’t give w/ascites of effusion because accumulates in 3rd
space & released over time
Myelosuppression, hepatoxicity, nephrotoxicity,
hypersensitivity pneumonitis
19. • Leucovorin starts 24 hours after moderate-high doses
methotrexate to “rescue” normal cells
• High-dose:
Metabolized to insoluble form at physiologic pH
Must alkalinize blood & urine to eliminate the drug for mod-high dose
Monitor urine pH, output, creatinine, methotrexate levels daily
Clearly sign out need to follow up urinalyses to covering night staff
Service attending to be notified about decrease in urine pH or oliguria
20. Pemetrexed
• Mesothelioma
• Myelosuppression, mucositis, rash
• Must give folic acid & B12
Pralatrexate
• Peripheral T-cell lymphoma
• Mucositis, ↓ plts, nausea, fatigue
• Must give folic acid & B12
21. 6 Mercaptopurine
• ALL, AML
• If give with allopurinol, must decrease mercaptopurine by 75%
• Myelosuppression, mucositis, jaundice
Nelarabine
• T-ALL, T-lymphoblastic lymphoma
• Neurotoxic, N/V, myelosuppression, cough
6 Thioguanine
• AML, CML, ALL
• myelosuppression
25. Cytosine arabinoside (ara-C)
• AML, lymphomas, MDS, ALL
• Myelosuppression, cerebellar, mucositis, hepatic, conjunctiviti
s in hi-dose (Rx w steroid drops)
• Can be given intrathecally
5-azacytidine
• MDS
• Myelosuppression, nausea
Decitabine
• MDS
• Edema, neuro, myelosuppression, hyperglycemia, nausea, con
stipation
26. Alkyl groups covalently bind to DNA
strands
• Leads to cross-linking of DNA strands, abnormal base
pairing, and breaks in the DNA
• Inhibits transcription causing cell-cycle arrest and apoptosis
• No discrimination between resting or dividing cells
Toxicities
• Myelosuppression
• Alopecia
• Mucositis
• Pulmonary toxicity
• Infertility
• Immunosuppression
• Mutagenic
34. Intercalate into DNA directly
• Disrupt transcription & replication
• Generate free radicals damage DNA
• Topoisomerase II inhibitors
Toxicities
• Nausea/vomiting
• Myelosuppression
• Cardiotoxicity
• Biliary excretion
• Anthracyclines are vesicants
35. Life-time cumulative dose dependent
• Varies by drug
Get echocardiogram or MUGA prior to therapy
Heart failure may be seen decades afterwards
Dexrazoxane used as cardioprotective agent
38. Mechanism
• Topoisomerase I: creates single strand breaks in DNA
• Topoisomerase II: creates double strand breaks in DNA
• Interferes with DNA’s capacity to unwind and allow for
normal replication or transcription
Toxicities
• Myelosuppression
• Mucositis
• Secretory diarrhea
Rx w/anticholinergics
39. Irinotecan
• Colorectal, lung, breast
Topotecan
• Ovarian, small cell lung
• Flu-like
Topoisomerase II
Etoposide
• Lung, germ cell, Kaposi’s, AML, lymphoma
• Liver metabolism, renal excretion
• hypoT is given fast
Antibiotics
Topoisomerase I
50. TARGET DRUG (generic) DRUG (brand) DISEASE
Histone deacetylase vorinostat Zolinza® CTCL
romidepsin Istodax® CTCL
Retinoid X receptors bexarotene Targretin® CTCL
tretinoin Vesanoid® APL
Modify proteins regulating gene expression
Induce apoptosis
TARGET DRUG (generic) DRUG (brand) DISEASE
Proteasome bortezomib Velcade® Multiple myeloma
Block angiogenesis
TARGET DRUG (generic) DRUG (brand) DISEASE
VEGF bevacizumab Avastin® GYN, Glioblastoma
PDGFR, VEGFR sorafenib Nexavar® Renal
sunitinib Sutent® Renal, GIST
pazopanib Votrient® Renal, Sarcoma
51. TARGET DRUG (generic) DRUG (brand) DISEASE
CTLA-4 ipilimumab Yervoy® Melanoma
CD20 rituximab Rituxan® Lymphoma
ofatumumab Arzerra® CLL
CD52 alemtuzumab Campath® CLL
MoAbs that help immune system kill cells
MoAbs that deliver toxic molecules
TARGET DRUG (generic) DRUG (brand) DISEASE
CD20 ibritumomab tiuxetan Zevalin® Lymphoma
tositumomab Bexxar® Lymphoma
CD30 brentuximab Adcetris® ALCL, HD
denileukin diftitox Ontak® CTCL
MoAb that stops cells destruction
TARGET DRUG (generic) DRUG (brand) DISEASE
C5 eculizumab Soliris® PNH
52. Reduce dose
Improve elimination of metabolites
• Hydration / diuresis
Alter schedule of therapy
• Frequent low dose
• Increasing length of time between cycles
Limit extent of delivery
• Perfuse tumor locally (hepatic pump)
Minimize effect of drug on other tissue
• Leucovorin rescue with MTX
Improve recovery from toxicities
• G-CSF (Neupogen, Neulasta)
53. Tumor heterogeneity
Efflux pumps
Increased rate of DNA repair
Changes in the drug sensitivity
of a target enzyme
Decreased activation of pro-drugs (precursors)
Inactivation of anticancer drugs by enzymes
54. Drugs
• Vesicants - anthracyclines, vinca alkaloids
• Irritants - taxanes
Signs/Symptoms
• Pain, Redness, Swelling
• Decreased range of motion
• Change in sensation
• Change in skin temperature
Management
• Stop infusion
• Elevate the extremity
• Contact attending physician for plan of care and to obtain antidote orders
• Apply cold or warm compresses per MSKCC guidelines
• Consider topical or systemic antibiotics as needed
• Consider plastic surgery consult
56. Goal
• Target cells not equally sensitive to a single drug
• Avoid selection of resistant cell lines
Choosing drugs for regimen
• Each with activity against this cancer type
• Have different mechanisms of action
• Non-cross-resistance
• Non-overlapping toxicities