Chemotherapy in surgery: systemic cancer treatment

Chemotherapy goal is to inhibit cell proliferation and tumor multiplication as well as avoiding invasion and metastasis

1. Chemotherapy in surgery FATIMATUZZAHRA HASHIM FAUZY DEPARTMENT OF SURGERY HOSPITAL SERI MANJUNG

2. Neoplasm

3. CANCER TREATMENT MODALITIES

4. CHEMOTHERAPY Goal : to inhibit cell proliferation and tumor multiplication  avoiding invasion and metastasis Paul Ehrlich

5. mechANISMS

6. Cancer chemotherapy

7. Primary chemotherapy

8. Neoadjuvant Chemotherapy use of chemotherapy in patients who present with localized cancer for which alternative local therapies, such as surgery, exist but which have been shown to be less than completely effective

9. Adjuvant chemotherapy an adjuvant to local treatment modalities such as surgery. administered after surgery has been performed, Goal: to reduce the incidence of both local and systemic recurrence and to improve the overall survival of patients. effective in prolonging both disease-free survival and overall survival in patients with breast cancer, colon cancer, gastric cancer, NSCLC, Wilms’ tumor , anaplastic astrocytoma, and osteogenic sarcoma.

10. Anti-cancer drugs

11. Multitargeted/combination theraphy More superior to single-agent therapy in most cancer treatments. Combination chemotherapy agents with different MOA and nonoverlapping toxicities  decrease resistance and toxicities. Delivered cyclically Prevent development of resistant clones by promoting cytotoxicity in resting and dividing cells.

12. Side effects management Premedications : Docetaxel –T. Dexa 8mg BD (D0,D1,D2) Paclitaxel- IV Dexa 16mg OD, antihistamin FOLFIRI (Irinotecan)- SC Atropine Kytril , Dexamethasone, PPIs Post chemo Medications: T. Metochlorpramide 10mg TDS x3/7 T. Dexamethasone 4mg BD x3/7 T. Pantoprazole 40mg OD

13. Administration of chemotherapy

14. routes

15. Dose (BSA) : [height (cm) x weight (kg)] 3600

16. Pre-procedural steps Explain the procedure to the patient and take consent. Educate the patient regarding adverse effect of chemotherapy and the strategies to manage these effects. Instruct the patient to report any side effect of chemotherapy Check: any supportive care medications including premedications antiemetics, hydration, growth factor Review patients medication history including over the counter medications for possible interactions. Current laboratory values (complete blood count, differential platelets, liver function test and creatinine). Drugs may be withheld in severe neutropenia, thrombocytopenia or impaired liver or kidney function.

17. Intra-procedural steps

18. chemoport

19. https://youtu.be/ExTv35OUDIg?si=To6MGSyEvaAqqmy8

20. If doubt exist about vein patency and safety of chemotherapy administration:

21. During drug administration- Use a disposable, absorbent, plastic- backed pad under the work area Put on protective gown, gloves and eyewear. Monitor the patient particularly during the first 15 minutes for signs of hypersensitivity or anaphylaxis Monitoring the IV site throughout the infusion

22. Management of extravasation If an extravasation is suspected, stop the transfusion of the chemotherapy. Disconnect IV tubing and attempt to aspirate all residual chemotherapy in the IV catheter using a syringe to prevent further infusion of chemotherapeutic agent. Apply warm or cold packs to area for 15 to 20 minutes 4 times a day for 24 hours. Cold packs for injection Dactinomycin, Idarubicin, Daunorubicin, Mechlorethamine, Doxorubicin, Mitomycin, Epirubicin, Streptozotocin. Warm packs for injection Vincristine, Vinorelbine, Vinblastine

23. If an antidote is available, administer as prescribed. Gently clean the area around the extravasation with an alcohol pad. Inject the antidote subcutaneously in a circular pattern around the site of extravasation using a 25-gauge needle. 1-5 injections will be needed, depending on the volume of extravasation. Change the needle with each new injection. Elevate affected limb if applicable for 48 hours. Reapply warm or cold compress as indicated, depending on the chemotherapeutic agent that has been extravasated

24. references https://www.tandfonline.com/doi/epdf/10.1080/02841860151116204?needAccess=true https://d1wqtxts1xzle7.cloudfront.net/61769274/_Bertram_G._Katzung__Basic___Clinical_Pharmacology20200113-107621-ynrw1o-libre.pdf?1578937350=&response-content-disposition=inline%3B+filename%3DBasic_and_Clinical_Pharmacology_Fourteen.pdf&Expires=1708435368&Signature=GSkRW4u79ypz0t7hwpv-0R9zb9ZOI4q4AQTaHw~oRhBRMC3IPNPNJ-m6N0dFC~VlHoeeSE1gJFM1~81MYvPy-k5owXc05zMS~zVcDH6M0voqIlqT6Qwxj9HsO0YZwaffY6tL4Q4FlSTW-36qi2FASIxXMw1Wt7lM-QEoSzgA~OxPCJLRpZNqqKJEPiPtCm8YIKzxEfxQqhV-V8V9C7woiHPnJ3MNsj56Ewg7U0MiZ8YE0Sg2BqpfAJOSh-ea-V5bGCKfs1tpVpe3ZrRzdokd89HbQWfo~g9YXsWr6Rn2hqUupZGq~a24N~kw8DfmL7wwpqYnj0zhy0HnbDE5tb5rbg__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA#page=962

25. https://www.ncbi.nlm.nih.gov/books/NBK545232/#:~:text=Folinic%20acid%20is%20a%20medication,the%20chemotherapy%20class%20of%20medications . https://www.tandfonline.com/doi/pdf/10.3109/00016925109176996 https://academic.oup.com/oncolo/article/15/S5/8/6398939 https://www.ncbi.nlm.nih.gov/books/NBK564367/

26. Provoking internal and external apoptosis pathways through increasing Fas ligand ( FasL ) expression and consequently cytochrome C release

27. Inducing cell cycle arrest through activation of p53 gene following DNA damage and inhibition of kinases