Management of cancer

1. Management of cancer

2. WHAT IS RADICAL THERAPY?
Potentially curative treatment e.g. surgical resection
and/or radical radiotherapy and/or systemic therapy
Aim is to eliminate bulk (macroscopic) disease and
any potential micrometastases and hence intent is to
cure
Must have measurable/evaluable disease to assess
response to therapy
Must balance potential benefits and risks carefully
but accept certain degree of toxicity as price for cure
and organ preservation

3. WHAT IS ADJUVANT THERAPY?
‘Back-up’ therapy after potentially curative treatment
e.g. surgical resection and/or radical radiotherapy
Aim is to eliminate micrometastases and hence
increase probability of cure
Based on probability of relapse of a population of
patients and not the individual
Must balance potential benefits and risks carefully as
some/many receiving therapy are not (as individuals)
truly at risk of disease relapse

4. WHAT IS NEO-ADJUVANT THERAPY?
Primary systemic therapy prior to potentially curative treatment
e.g. surgical resection and/or radical radiotherapy and/or
chemotherapy
Aim is to shrink the tumour bulk and facilitate the local therapy
(radical surgery/radiotherapy)
May also eliminate micrometastases and hence increase
probability of cure
Allows an assessment of the response to chemotherapy as can
assess changes in tumour size/markers etc
May be followed by the same or different chemotherapy regimen
in the adjuvant setting

5. WHAT IS PALLIATIVE THERAPY?
Aim is to stabilise or shrink bulk of metastases with
no potential for cure
Stabilisation as well as shrinkage may be a good
surrogate for symptom control, improved QOL and
longer survival which are the aims of therapy
Must balance potential benefits and risks carefully
including likely survival period, performance status,
co-morbidities, patient wishes etc

6. Surgery from
1600 BC

Radiation cure
in basal cell
skin cancer
1899

Cytotoxic
chemotherapy
experiments
early 1940s
“Magic bullet“ for
cancer treatment
1890s to early
1900s
Monoclonal antibodies
mid-1970s
Imatinib 2001 for
CML and GIST
Sorafenib and Sunitinib
2007 for HCC and
advanced RCC
IFN and high-
dose IL-2 early
1980s
Rituximab
1997
…ERA OF “MOLECULARLY TARGETED THERAPY
PROGRESS IN THE
TREATMENT OF CANCER
Bevacizumab and
Cetuximab 2006 for CRC
Erlotinib 2006 for NSCLC

7. TREATMENT MODALITIES
• Surgery
• Radiotherapy
• Systemic therapies:
- Chemotherapy
- Hormonal therapy
- Immunotherapy
- Biological (targeted) therapies

8. CANCERS REQUIRING CYTOTOXIC
CHEMOTHERAPY
• Breast cancer
• Colorectal cancer
• Cervical cancer
• Leukaemia
• Soft tissue/bone
sarcoma
• Lymphoma
• Ovarian cancer
• Testicular cancer
• Head & neck cancer
• Lung cancer