common clinical application of chemo ppt.pptx

education

1. HCMO 3224: PEDIATRIC & GERIATRIC ONCOLOGY DEPARTMENT: HEALTH SCIENCES PROGRAMME: MSC IN CLINICAL MEDICINE ONCOLOGY KIRINYAGA UNIVERSITY ABBY MUSA

2. CLINICAL APPLICATION OF CHEMOTHERAPY Chemotherapy plays a central role in treating childhood cancers, either as a curative, palliative, or adjuvant therapy. Unlike adult cancers, which are often associated with environmental or lifestyle factors, pediatric cancers are usually linked to genetic mutations and developmental abnormalities. Primary Treatment of Pediatric Cancers Pediatric cancers are more responsive to chemotherapy compared to adult cancers due to their rapid growth and high mitotic rate. Leukemias (Acute Lymphoblastic Leukemia [ALL], Acute Myeloid Leukemia [AML]) Standard regimens: Vincristine, Doxorubicin, Methotrexate, Cytarabine, Mercaptopurine. ALL is highly responsive to chemotherapy, with survival rates exceeding 90% in many cases.

3. Lymphomas (Hodgkin’s and Non-Hodgkin’s Lymphoma) CHOP regimen (Cyclophosphamide, Doxorubicin, Vincristine, Prednisone) for Non-Hodgkin’s Lymphoma. ABVD regimen (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) for Hodgkin’s Lymphoma. Brain Tumors (Medulloblastoma, Ependymoma, Gliomas) Chemotherapy is often used after surgery due to the blood-brain barrier limiting drug penetration. Drugs: Cisplatin, Vincristine, Lomustine , Temozolomide. Neuroblastoma Common regimen: Cyclophosphamide, Vincristine, Doxorubicin, Cisplatin. High-risk cases require high-dose chemotherapy followed by stem cell transplant.

4. Wilms Tumor (Nephroblastoma) Vincristine, Doxorubicin, Actinomycin-D. Retinoblastoma Chemotherapy is used for bilateral disease or as neoadjuvant therapy before laser therapy or surgery. Drugs: Carboplatin, Etoposide, Vincristine. Osteosarcoma & Ewing Sarcoma High-dose Methotrexate, Doxorubicin, Cisplatin for Osteosarcoma. Vincristine, Dactinomycin, Ifosfamide , Etoposide for Ewing Sarcoma.

5. 2. Chemotherapy in Different Clinical Settings Curative Chemotherapy Used as the main treatment in blood cancers like ALL and AML, achieving high cure rates. b. Adjuvant Chemotherapy (Post-Surgery or Radiation) Used after tumor resection to eliminate residual cancer cells and prevent recurrence. c. Neoadjuvant Chemotherapy (Pre-Surgery) Administered to shrink tumors before surgery, making resection easier and preserving organs (e.g., Wilms tumor, osteosarcoma). d. Palliative Chemotherapy Used in metastatic or relapsed cases to prolong survival and reduce symptoms. e. High-Dose Chemotherapy with Stem Cell Transplantation Used for high-risk neuroblastoma, lymphoma, and leukemia to replace bone marrow after intensive chemotherapy.

6. 3. Drug Selection and Dosing in Pediatric Patients Pediatric chemotherapy dosing is based on body surface area (BSA) or weight (mg/kg), ensuring appropriate drug exposure while minimizing toxicity. Modified drug schedules to reduce toxicity in growing children. Pharmacogenomics testing (e.g., TPMT gene for Mercaptopurine metabolism) to prevent severe toxicity. Supportive care (antiemetics, granulocyte colony-stimulating factors, and hydration) is essential to manage side effects.

7. 4. Challenges and Considerations in Pediatric Chemotherapy Toxicity and Side Effects Children have developing organs, making them more susceptible to chemotherapy-related toxicities, including: Hematologic toxicity (myelosuppression, anemia, neutropenia). Neurotoxicity (Vincristine-induced neuropathy). Cardiotoxicity (Doxorubicin-related heart damage, requiring echocardiography monitoring). Nephrotoxicity (Cisplatin-induced kidney damage, requiring hydration protocols). Growth and Developmental Delays due to prolonged chemotherapy exposure.

8. b. Long-Term Effects (Late Effects of Chemotherapy) Infertility (due to alkylating agents like Cyclophosphamide). Secondary cancers (e.g., therapy-related leukemias). Neurocognitive impairment (especially after brain tumor treatment). Endocrine dysfunction (hypothyroidism, growth hormone deficiency). c. Drug Resistance and Relapse Some pediatric tumors develop resistance, requiring combination regimens or targeted therapies. Relapsed leukemia may need novel agents like Blinatumomab ( BiTE therapy) or CAR-T cell therapy.

9. 5. Advances in Pediatric Chemotherapy Targeted Therapy (e.g., Imatinib for Philadelphia chromosome-positive ALL). Immunotherapy (e.g., CAR-T cell therapy for relapsed B-cell ALL). Gene Therapy for inherited cancer syndromes (e.g., Li-Fraumeni syndrome). Less toxic chemotherapy agents to improve quality of life .