Download Treatment Modalities Pediatric Cancers

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
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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
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Chemotherapy still mainstay of treatment
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Metastatic
Elderly
Adjuvant
Novel therapies hold promise
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Novel combinations
Different settings
Hope for breast, colorectal, pancreatic cancer
- EGFR survival outcomes for patients with locally
advanced or metastatic pancreatic cancer1
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Development of chemoprevention strategies
Kim ES, Astra-Zeneca
Chemotherapy – What’s new
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Combination modality
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Dosing schema
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Agents that are complementary
Inclusion of protective agents
Critical timing of administration
Dose dense
Dose intensification
Dose escalation
Individualized dosing
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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
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Cryosurgery – freezing the cells
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Reconstructive Surgery
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Prostate
Breast
Head and Neck/ dental
Less Invasive/ tissue sparing
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Percutaneous procedures
Stereotactic methods
Use of biomedically engineered devices
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Repiphysis for limb sparing
Reconstruction/prosthetic surgeries
Tissue Sparing
Reconstruction
Limb Sparing
Cryosurgery
Radiation Therapy – What’s New
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More focused
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Prevention of immediate and late SE’s
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Brachytherapy/ implanted
Stereotactic
Radioimmunotherapy – target RT
Protection of RT-sensitive tissues
Protective medications
Normal tissue sparing
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IMRT
Conformal
Radiation Therapy - types
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External
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Total Body Irradiation
Radioimmunotherapy
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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
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Brachytherapy
Implanted
Targeted
Radioisotope Therapy (RIT)
External Beam RT
Mammosite Targeted Implanted RT
IGRT
Biologic/Immunologic therapy
Molecularly targeted therapy
Target Therapy
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Targeting specific antigens (Biologic/Immunotx)
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Targeting mutation-activated kinases (Molecular)
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HER2, CD20, CTLA-4
KIT, PDGF-R, BCR-ABL, EGF-R
Targeting specific pathways
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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
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Conditioning Regimen
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Donor Sources
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Cord Blood
Mismatch family member (Haploidentical transplantation)
Use of specialized machines to decrease side-effects
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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
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Steroids – Dexamethasone, Prednisone
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Estrogen Receptor blockers – Breast cancers
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Tamoxifen (Nolvadex)
Aromatase Inhibitors (Aromasin, Femara, Arimidex)
Anti-androgen drugs - Prostate cancer
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Flutamide (Eulexin; Flutamin)
Bicalutamide (Casodex, Cosudex, Calutide, Kalumid)
Nilutamide (Nilandron; Anandron)
Gene Therapies
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Types
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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
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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
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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
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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
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Management of fever and neutropenia
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Prevention of Infection
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Blood transfusions for anemia, thrombocytopenia,
neutropenia
Monitoring and management of drug toxicity
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Prophylactic use of antibiotics
Blood component therapy
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Use of growth factors – Neupogen, Procrit, Neumega
Proactive use of antibiotic therapy
Patient/family Education
Nutritional support
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Calorie boosters
Other aspect of supportive care
Palliative Care
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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
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group of diverse medical and health care
systems, practices, and products that are
not presently considered to be part of
conventional medicine
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Considered part of supportive care
CAM
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Complementary therapy - used together with
conventional medicine.
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Massage and Hydrotherapy
Music, relaxation, imagery
Vitamins and herbal supplements
Alternative medicine is used in place of
conventional medicine.
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Arbolaryo, hilot
Faith healers
Nursing Requirements
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Thorough knowledge of the treatment modalities
available
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Competency in patient assessments
Competency in drug administration
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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
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It’s all to do with training. You can do a lot
if you are properly trained.
Queen Elizabeth
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Questions??????
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Thank you / Salamat po!!!!!