HEAPHY 1 & 2

PLENARY

Fraser TUMAI

Fri 30th Aug 2013

Session 4 / Talk 4

16:30 – 17:00

ABSTRACTThe purpose of this presentation is to present the fundamentals or the use of chemical agents (cytotoxic drugs) in the treatment of cancers and other diseases. This presentation will briefly focus on the following material.What is chemotherapy (with a brief history), The cell cycle, Anti-cancer medicines and treatments, Duration and frequency of treatments, Types of administration methods,Targeted therapies, Adverse effects during and after treatment,Working in combination other treatments,Technology, education, resources and the internet.I hope that the material presented will clarify terms and definitions around chemotherapy and its treatments and an insight of the patient’s journey.

A Blast from the Past. Chemotherapy 101

Fraser Tumai

Nurse Educator Oncology 2013

Waikato Regional Cancer Centre

Aim of session

THE WAIKATO WAYHISTORY OF CHEMOTHERAPY ….RADIATION THERAPYCHEMOTHERAPYADMINISTRATION & SAFETYSIDE EFFECTSRADIATION / CHEMOTHERAPY

The Waikato Way

And this too…………………………………………………………..!!!!!!

Good times…..

Whoop whoop….…………

Still smiling………….

2012

2013

Back to Back to ??? Back

Regional Cancer Centre Team Waikato DHB

1895 1901 1908 1914-1918 1969 1971

Weapon of MassDestructionThe first practical anticancer drugs werediscovered accidentally.One such discovery was an outcome of war,Stemming from the finding that sulfur mustard gas, used as atoxic vesicant in the First World War, caused myelosuppression.

The discovery of x-rays Wilhem Rontgen a German physicist produced and detected electromagnetic radiation in a wavelength range today known as X-rays

The beginning of innovation ChemotherapyPaul Ehrlich was a man who developed drugs to treat Infectious diseases.He came up with the name chemotherapy and defined it as the use of chemicals to treat a disease.

The beginning of innovation Radiation TherapyMarie Sklodowska (together with her husband Pierre Curie) isolated thefirst known radioactive elements which she named Polonium and Radium.

Advent of Modernday chemotherapyLouis Goodman andAlfred Gillmon usenitrogen mustard to treat non-Hodgkin’sLymphoma.

Moon landing Neil Armstrong and name Edwin‘Buzz’ Aldrin lands on the moon. No monkeys were injured during thefilming of the landing.

Chemotherapy timeline

1990s

Nuclear-free New Zealand in the 1980s

New Zealand Institute of Medical Radiation TechnologistsEncouraging excellence of practice, through sharing and seeking of knowledge in medical imaging and radiation therapy

The event to end all events. Fraser Tumai was born. It became a celebrated event worldwide and therest is History.

2000s

Target Therapies.drugs or other substances that block the growth and spread of cancer by interferingwith specific molecules involved in tumour growth and progression.

National Cancer ActLaunched the nations war on cancer in the US of A(1937 / 1971).

1980s19621942

Combination Chemo-radiation first emerges Researchers report successful results of a new approach for headand neck cancer therapy– so-called “chemoradiation.”

Futuristic Innovation

Chemical warfare involves using the toxic properties of chemical substances to kill, injure or incapacitate an

enemy. The United States Military classifies lethal chemical warfare agents into four categories:

1)    “nerve agents which attack the nervous system;2)    blister agents which attack and destroy cell tissue and cause severe blisters; 3)    choking agents which cause inflammation of lung tissues;4)    blood agents which disrupt blood flow”

The Evolution of Radiation The Evolution of Radiation TherapyTherapy

High resolution IMRTMultileaf Collimator

Dynamic MLCand IMRT

1960’s1960’s 1970’s1970’s 1980’s1980’s 1990’s1990’s2000’s2000’s

Cerrobend BlockingElectron Blocking

Blocks were used to Blocks were used to reduce the dose to reduce the dose to normal tissuesnormal tissues

MLC leads to 3D MLC leads to 3D conformal therapy conformal therapy which allows the first which allows the first dose escalation trials.dose escalation trials.

Computerized IMRT Computerized IMRT introduced which introduced which allowed escalation of allowed escalation of dose and reduced dose and reduced compilationscompilations

Functional Functional ImagingImaging

IMRT Evolution IMRT Evolution evolves to smaller evolves to smaller and smaller and smaller subfields and high subfields and high resolution IMRT resolution IMRT along with the along with the introduction of new introduction of new imaging imaging technologiestechnologies

The First ClinacComputerized 3D CT Treatment Planning

Standard Collimator

The linac reduced The linac reduced complications complications compared to Co60compared to Co60

Test subject: 0031748695

Say Cheese!!!!

Approaches to Cancer Treatment

Local disease - Surgery and radiation

therapy (targeted therapy)

Systemic disease – Chemo, Hormone

and Immunotherapy

The Big 3

Definition:CHEMOTHERAPYThe treatment of cancer using specific chemical agents or drugs that are destructive to malignant cells and tissues. The term comes from two words that mean "CHEMICAL" and "TREATMENT."

CYTOTOXICLiterally translated means ‘TOXIC TO CELLS’.

Modern Era

1940-1950

• Beginnings of the modern era of chemotherapy traced directly to the discovery of nitrogen mustard (chemical warfare agent) as an effective treatment for cancer.

• Autopsy observations of people exposed to mustard gas revealed lymphoid and myeloid suppression

Administration• Oral• Intravenous• Subcutaneous• Intramuscular• Topical• Intraoccular

(eyes)• Intravesical

(bladder)• Intraperitoneal

(abdomen)• Intrathecal (space

under the arachnoid membrane of the brain or spinal cord)

Standard issue PPE

PERSONAL PROTECTIVE EQUIPMENT

Minimising the exposure

SIDE EFFECTS OF RADIOTHERAPY / CHEMOTHERAPY

I don’t remember having soup for lunch?

Nausea and vomiting

Side effects? Nope, no sides effect Doc.

Skin changes

HAIR LOSS - ALOPECIA

Damage to hair follicles can cause alopecia

Can effect all body hair i.e. eye lashes, eyebrows and also pubic hair

Hair loss begins 7- 21 days post chemo –

Wig Referral needs to be done before this time

Alopecia is nearly always reversible on

completion of chemotherapy

Chemo-Radiation

History of Cancer Chemotherapy

Combination chemotherapy 1965

• Cancer cells could conceivably mutate to become resistant to a single agent, but using different drugs concurrently would make it extremely difficult for the tumour to develop resistance to the combination.

• Induced long term remission in children with ALL.

COMBINATION THERAPY

Reduces resistance to drugs

Increased effectiveness

Access to sanctuary sites e.g. lungs, CSF.

Combinations selected to avoid overlapping toxicity

but:

Causes spectrum of adverse effects but minimises

risk of lethal effects.

Feel Good Treatments

THANK YOU

QUESTION

Challenges……………………….

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