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TABLE 30,2 Drugs commonly used as standard treatments for different types of cancer

Cancer type

Drugs of choice

8ladder (urinary) Brain anaplastic astrocytoma glioblastoma Breast

Cervical

Choriocarcinoma Colorectal

Endometrial Ewing's sarcoma«1 Gastric

Head and neck, squamous cell Islet cell (pancreas) Kaposi's sarcoma

Leukaemias Acute lymphocytic leukaemia (ALL)

Acute myelogenous leukaemia (AML)

Chronic lymphocytic leukaemia (CLL) Chronic myelogenous leukaemia (CML) Chronic phase Accelerated Hairy cell leukaemia lung, small cell (oat cell)

Lung (non-small cell)

Lymphomas

Hodgkin's disease

Non-Hodgkin's lymphoma Diffuse large-cell lymphoma Follicular lymphoma Metastatic melanoma Mycosis fungoides

Myeloma

Oesophageal Osteogenic sarcoma» Ovary

Pancreas Prostate

Local: instillation of doxorubicin or 8CG (Bacille Calmetre-Guerin) Systemic: MVAC: methotrexate + vinblastine + doxorubicin + cisplatin

Procarbazine lomuscine + vincristine Carmustine or lomustine

CMF: cyclophosphamide + methotrexate + S-fluorouracil AC: doxorubicin (Adriamycin) ■+■ cyclophosphamide Docetaxel:

Piclitaxcl ± trastuzumab (Herceptin) Tamoxifen

Cisplatin + cyclophosphamide; Bleomycin • ifosfamide * cisplatin

Methotrexate i folinic acid

Dactinomycin

5-fluorouracil ± folinic acid

Irinotecan ± 5-fkiorouracil/folinic acid

Oxaliplatin + 5-fluorouracil ± folinic acid

Doxorubicin + cisplatin + cyclophosphamide

CAV: Cyclophosphamide (or ifosfamide) + doxorubicin (Adriamycin) + vincristine

ECF: epirubicin + cisplatin * S-fluorouracil

Cisplatin + S-fluorouracil: Methotrexate

Streptozotociri + S-fluorouracil

Etoposide or interferon alfa or vinblastine

ABV: doxorubicin (Adriamycin) + bleomycin + vincristine or vinblastine induction! vincristine ' prednisolone + asparaginase ' doxorubicin

CNS prophylaxis: intrathecal methotrexate with cranial irradiation ': systemic high-dose methotrexate with folinic acid rescue ± intrathecal cytarabine I intrathecal hydrocortisone

Maintenance methotrexate + mercaptopunne: bone marrow transplant Induction: cytarabine + either daunorubicin or idarubicin ftostrnduction; high-dose cytarabine : other drugs such as etoposide: bone marrow transplant Chlorambucil I prednisolone: Fludarabine

Hydroxyurea (hydroxycarbamide); imatinib; bone marrow transplant; interferon alfa imatinib; Bone marrow transplant

Pentostatin or cladribine or interferon alfa

CAV: cyclophosphamide + doxorubicin (Adriamycin) + vincristine

EP: etoposide + cisplatin

MVP: mitomycin + vinblastine + cisplatin

Cisplatin + gemcitabine; vinorelbine

MOPP: mustine (chlormethine) + vincristine + procarbazine * prednisolone; ABVD: doxorubicin (Adriamycin) + bleomycin + vinblastine + dacarbazine

CHOP: cyclophosphamide + doxorubicin" + vincristine (Oncovin) + prednisolone

Cyclophosphamide or chlorambucil + prednisolone: Rituximab

Dacarbazine

PUVA (psoralen + ultraviolet A) Mustine (topical);

Interferon alfa; electron beam radiotherapy: methotrexate Melphalan (or cyclophosphamide) + prednisolone;

Vincristine + adriamycin + dexamethasone;high dose melphalan + autograft Cisplatin + S-flirorouracil

Doxorubicin + cisplatin + etoposide + ifosfamide Carboplatin ± paclitaxcl Topotecan; liposomal doxorubicin (caelyx) Gcmcitabinc

Leuprorelin (or goserelin) ' flutamide

TABLE 30.2 (continLfed)

Renal

Sarcomas, adult soft tissue

Testicular

Wilms tumour

Interferon alfa lnier!eukin-2

Doxorubicin + dacarbazine + cyclophosphamide L ifosfamide BEP" bleomycin + etoposide + cisplatin

Dactinomycin + vincristine ± doxorubicin ± cyclophosphamide

Reproduced by courtesy of the Medical L omitted).

- Drugs have major activity only when com The original narne.hydroxydoxyrubicin.gr

atter on Drugs and Therapeutics, New York (abbreviated; numerous alternative regimens bined with surgical resection, radiotherapy or both, ve rise to this acronym.

means of enhancing selectivity. Where it is desired to maximise the effect of methotrexate a potentially fatal dose is given and is followed 24 h later by a dose of tetrahydrofolic (folinic) acid as calcium folinate (Ca Leucovorin), to bypass and terminate its action. This is called folinic acid 'rescue', since if it is not given the patient will die. The therapeutic justification for this manoeuvre is that high concentrations of methotrexate are obtained and that the bone marrow cells recover better than the tumour cells and some degree of useful selectivity is achieved.

Purine antagonists (azathioprine, mercaptopurine, tioguanine) and pyrimidine antagonists (cytarabine, fludarabine, 5-fluorouracil) similarly deprive cells of essential metabolites.

Antimetabolites cause gastrointestinal toxicity including stomatitis and diarrhoea as well as bone marrow depression; renal impairment potentiates the toxicity of methotrexate. Active excretion of methotrexate by the renal tubule is blocked by salicylate, which also displaces it from plasma protein, increasing the risk of toxicity. Hepatic dysfunction potentiates the toxicity of 5-fluorouracil, since it is primarily metabolised by the liver.

5-Fluorouracil has been the mainstay of treatment of gastrointestinal tract tumours for the last 50 years. Combined with cyclophosphamide and methotrexate, the so-called CMF regimen is a gold standard treatment for many women with either early or advanced breast cancer.

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