CLINICAL PHARMACOLOGY 2003 (PART 31)

Neoplastic diseaseIn most cases, the cause of cancer is multifactorial. About 75% of cancers are due to environmental factors, some of which are within the control of the individual, e.g. tobacco smoking, exposure to sunlight. Growing understanding of cancer genetics and inherited disease suggests that fewer than 10% of cancers are familial.The different systemic modalities used to treat cancer patients are discussed. Immunosuppressive drugs are described here as they share many characteristics with cytotoxics. ...
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CLINICAL PHARMACOLOGY 2003 (PART 31) 30 Neoplastic disease and immunosuppression SYNOPSIS Neoplastic disease Neoplastic disease In most cases, the cause of cancer is multifactorial. About 75% of cancers are due to environmental factors, some of which are Cancer treatments and within the control of the individual, e.g. outcomes tobacco smoking, exposure to sunlight. Growing understanding of cancer genetics and Cancers share some common characteristics: inherited disease suggests that fewer than 10% Growth that is not subject to normal restrictions of cancers are familial.The different systemic for that tissue and fails to respond to apoptotic modalities used to treat cancer patients are signals (see later) or in which a high proportion discussed. Immunosuppressive drugs are of cells are dividing, i.e. there is a high growth described here as they share many fraction characteristics with cytotoxics. Local invasiveness Cancer treatments and outcomes Tendency to spread to other parts of the body Rationale for cytotoxic chemotherapy1 (metastasise) Classes of cytotoxic chemotherapy drugs Less differentiated cell morphology Chemotherapy in clinical practice Tendency to retain some characteristics of the Endocrine therapy tissue of origin. Immunotherapy and biological therapies Cancer treatment employs six established princi- Emerging anticancer treatments pal modalities: Immunosuppression and immunosuppressive drugs 1. surgery 2. radiotherapy 3. chemotherapy 4. endocrine therapy1 Although not in strict accord with the definition of Chapter 5. immunotherapy11, the word chemotherapy is in general use in this 6. biological therapy.connection and it would be pedantic to avoid it. It arosebecause some malignant cells can be cultured and the disease Details of the exploitation of all of these tech-transmitted by inoculation, as with bacteria. The more niques, whether alone, sequentially or concurrentlyprecise term cytotoxic chemotherapy is adopted here. is beyond the scope of a book on clinical phar- 603 30 N E O P L A S T I C D I S E A S E AND I M M U N O SU P PRESSI O Nmacology. This account will essentially be confined primary surgery. This strategy has improved over-to the use of drugs (see Table 30.1). It is important all survival for patients with, for example, breasthowever, to understand the context in which systemic and colorectal cancer.therapy is offered to patients. Most treatments currently available are associ- ated with unwanted effects of varying degrees of severity. The risk of causing harm must be weighedSYSTEMIC CANCER CHEMOTHERAPY against the potential to do good in each individualCancers originating from different organs of the case. Chemotherapy depends on developing drugsbody differ in their behaviour and in their response that kill malignant cells or modify their growth andto treatments. Primary surgery and/or radio- leave those of the host unharmed or, and moretherapy to a localised cancer offer the best chance of usually, harmed but capable of recovery. Whencure for patients. Drug treatments in the past were there is realistic expe ...