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Treatment Modalities Ayda G. Nambayan, RN, DSN International Outreach Program St. Jude Children’s Research Hospital Memphis, TN Traditional Cancer Therapies Novel Cancer Therapy Evolves Surgery -- less invasive Radiation – more focused and intense Chemotherapy – still the mainstay Hormone therapy – as adjuvant/maintenance Bone marrow/stem cell transplantation Biologic/Immunologic therapy - promising Molecularly targeted therapy Gene therapy – experimental stage Supportive Therapy Complementary and Alternative Therapies Chemotherapy Science is Rapidly Unfolding Chemotherapy still mainstay of treatment Metastatic Elderly Adjuvant Novel therapies hold promise Novel combinations Different settings Hope for breast, colorectal, pancreatic cancer - EGFR survival outcomes for patients with locally advanced or metastatic pancreatic cancer1 Development of chemoprevention strategies Kim ES, Astra-Zeneca Chemotherapy – What’s new Combination modality Dosing schema Agents that are complementary Inclusion of protective agents Critical timing of administration Dose dense Dose intensification Dose escalation Individualized dosing Drug pharmacokinetics Pharmacogenomics Surgical Management Wide resection – pelvic exenteration Tissue Sparing – lumpectomy Stereotactic Laser Surgery – brain tumors Debulking - lymphomas Reconstructive – breast reconstruction Palliative – ostomies Supportive Measures – VAD insertions, PEG tube Surgery – What’s New Cryosurgery – freezing the cells Reconstructive Surgery Prostate Breast Head and Neck/ dental Less Invasive/ tissue sparing Percutaneous procedures Stereotactic methods Use of biomedically engineered devices Repiphysis for limb sparing Reconstruction/prosthetic surgeries Tissue Sparing Reconstruction Limb Sparing Cryosurgery Radiation Therapy – What’s New More focused Prevention of immediate and late SE’s Brachytherapy/ implanted Stereotactic Radioimmunotherapy – target RT Protection of RT-sensitive tissues Protective medications Normal tissue sparing IMRT Conformal Radiation Therapy - types External Total Body Irradiation Radioimmunotherapy Conformal RT Intensity Modulated RT Image Guided RT Stereotactic RT Palliative Zevalin (Ibritumomab tiuxetan; anti-CD20 + Yttrium-90) Bexxar (Tositumomab Iodine-131; anti-CD20 + Iodine 131) Internal Brachytherapy Implanted Targeted Radioisotope Therapy (RIT) External Beam RT Mammosite Targeted Implanted RT IGRT Biologic/Immunologic therapy Molecularly targeted therapy Target Therapy Targeting specific antigens (Biologic/Immunotx) Targeting mutation-activated kinases (Molecular) HER2, CD20, CTLA-4 KIT, PDGF-R, BCR-ABL, EGF-R Targeting specific pathways Angiogenesis inhibition via VEGF-receptors CpG immunosyimulation through TLR-9 Small Molecules TKI – small molecules Molecular - mTOR Transplantation – BMT, SCT ALLOGENEIC PATIENT Store and Freeze Sibling/Relative Marrow Harvest Unrelated Marrow Harvest at another location AUTOLOGOUS Pre BMT Conditioning Thaw and Infuse Bone Marrow/Stem Cell Transplantation Conditioning Regimen Donor Sources Cord Blood Mismatch family member (Haploidentical transplantation) Use of specialized machines to decrease side-effects Less toxicity Clinimac separator machine Newer drugs to combat GvHD CliniMACS Selection System CliniMACS cells plus magnetic microbeads with anti-CD133 magnet magnet CD133+ cells (graft) Waste Integumentary GvHD Hormonal Therapies Steroids – Dexamethasone, Prednisone Estrogen Receptor blockers – Breast cancers Tamoxifen (Nolvadex) Aromatase Inhibitors (Aromasin, Femara, Arimidex) Anti-androgen drugs - Prostate cancer Flutamide (Eulexin; Flutamin) Bicalutamide (Casodex, Cosudex, Calutide, Kalumid) Nilutamide (Nilandron; Anandron) Gene Therapies Types Replacement - healthy variant of an otherwise mutated gene is re-introduced into the cell, thereby repairing the function of the mutated gene and reverting the phenotype Suicide - the delivery of a cytotoxic gene into the cancer cells, which upon activation, results in the production of a toxic component causing cell death Suicide Gene Therapy Supportive Therapies Important dimension of cancer therapy Treatment modalities prevents, alleviate disease and treatment – related effects Proven to an effective ally in decreasing morbidity and mortality from cancer therapies Improves patient’s quality of life Goal Prevent or treat as early as possible the symptoms of the disease, side effects caused by treatment of the disease, Manage psychological, social, and spiritual problems related to the disease or its treatment. Improve patient’s quality of life Types of Supportive Therapies Management of fever and neutropenia Prevention of Infection Blood transfusions for anemia, thrombocytopenia, neutropenia Monitoring and management of drug toxicity Prophylactic use of antibiotics Blood component therapy Use of growth factors – Neupogen, Procrit, Neumega Proactive use of antibiotic therapy Patient/family Education Nutritional support Calorie boosters Other aspect of supportive care Palliative Care Care given to improve the quality of life of patients who have a serious or lifethreatening disease. Aggressive EOL symptom management Complementary and Alternative Therapy group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine Considered part of supportive care CAM Complementary therapy - used together with conventional medicine. Massage and Hydrotherapy Music, relaxation, imagery Vitamins and herbal supplements Alternative medicine is used in place of conventional medicine. Arbolaryo, hilot Faith healers Nursing Requirements Thorough knowledge of the treatment modalities available Competency in patient assessments Competency in drug administration Actions Side-effects and its management Venous access skills Ability to observe and recognize adverse reactions and complications of therapy Competency in patient and family education It’s all to do with training. You can do a lot if you are properly trained. Queen Elizabeth Questions?????? Thank you / Salamat po!!!!!