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Tumor Chemotherapy Sun Yet-san University Cancer Center Rui-Hua Xu, Zhi-Ming Li E-mail: xurh@mail.sysu.edu.cn [email_address] Tel:  8734 3356
[object Object],[object Object],[object Object],[object Object],Survey
Definition ,[object Object],[object Object],[object Object],[object Object]
Basic theories of chemotherapy ,[object Object],[object Object],[object Object],[object Object],[object Object]
Development of Chemo-drugs Nitrogen Mustard for lymphoma 40s 50s MTX for   hematological malignancies   & children’s ALL 70s DDP 、 ADM—palliative chemotherapy transition to  curative chemotherapy, medical oncology established 80s Adjuvant/Neo-adjuvant chemotherapy 90s 21 st   Biological Response Modifier   , supportive care , High dose chemotherapy + HSCT Molecular target drug
Milestones of anticancer therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Achievements of chemotherapy ,[object Object],[object Object],[object Object],[object Object],[object Object],Comparison of children’s ALL Hodgkin’ Lymphoma Testicular tumor 100 80 60 40 20 0 0  6  12  18 CT BSC Chemotherapy of Advanced NSCLC  Progress of mCRC  BSC  1980s 5-FU/LV  1990s 5-FU/LV Civ  1990s 5-FU/LV/Irino  2000 5-FU/LV/Oxal   2000 FOLFOX/ FOLFIRI FUFOX  200 1 FOLFOX/IRI+Target Therapy  2004 Adjuvant chemotherapy of breast cancer Adjuvant chemotherapy of NSCLC MOSAIC trial for CRC Adjuvant chemotherapy of  colorectal cancer
Basic theories of chemotherapy ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
[object Object],[object Object]
  Cell cycle kinetics ,[object Object],[object Object],[object Object],[object Object],Cells without proliferation ability G0 ( resting phase ) Death Cells in proliferation cycle Refers to a process from the former ending of mitosis to the next ending. Regulated by cyclins ( CKDs 、 CDKIs ) G1 M G2 S
Tumor biology   — growth kinetics   ,[object Object],cells without  proliferation capacity G0 ( quiescent cell ) √ Growth fraction ( GF ) :   The percentage of  the cells in  active proliferation phase in total cells. Growth part
Tumor biology   — growth kinetics   ,[object Object],[object Object],[object Object]
Tumor biology     -  growth kinetics   ,[object Object],[object Object],Normal cell Dividing Malignant transformation 2 cancer cells Doubling 4 cells Doubling 8 cells Doubling 16 cells 1 million cells (20 doublings) undetectable 1 billion cells (30 doublings) lump appears 1 trillion cells (40 doublings – 2 lb/1kg) 41 – 43 doublings — Death
时间 指数生长 癌瘤 正常 细胞产生 = 细胞丢失 稳定态 Gompertzian  生长   对数细胞数 时间 指数生长 癌瘤 正常 细胞产生 = 细胞丢失 稳定态 Gompertzian  生长   对数细胞数 时间 指数生长 癌瘤 正常 细胞产生 = 细胞丢失 稳定态 Gompertzian  生长   对数细胞数 Time Exponential Growth  tumor normal cell produce=cell loss Stable state Gompertzian growth  cell produce > cell loss l Log of Cells
Tumor biology—loss of tumor cells ,[object Object],[object Object],[object Object]
[object Object],[object Object]
Tumor biology     Total  kill ,[object Object],[object Object],[object Object],10 12 10 6 10 12 10 11 10 10 10 9 10 8 10 7 10 6 Anticancer drug’s killing kinetics The number of  tumor cells in vivo 10 12 ( 1kg) 10 9 ( 1g) 10 6 ( 1mg) 10 3 ( 1ug) 1 Clinical detection Clinical cure Host immune clearance Induce Consolidation Maintenance Cure Tumor reaction to anticancer drugs
Complexity of tumor’s drug resistance ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Tumor drug resistance
Tumor multiple drug resistance (MDR) ,[object Object],[object Object],[object Object]
Mechanism of MDR ,[object Object],ATP P-glycoprotein 170   ATP Drug Drug Cell membrane
NEJM 2003 348:538-549 Target enzyme and  efficacy of anticancer drug
Clin Cancer Res 4139 2006;12(14) July 15, 2006
Basis theories of chemotherapy ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
Drug ,[object Object],[object Object],[object Object],[object Object]
Cell cycle non-specific agents 100  S  细 胞 存 活  R  率 %  剂量  S: Slow growth (normal cell)   R: Rapid growth (tumor cell)
Cell cycle specific agents 100  S  细 胞 存 活  R 率 %  剂量  S: Slow growth (normal cell)   R: Rapid growth (tumor cell)
The connection of anticancer drug’s effect and cell cycle ,[object Object],[object Object],S (2-6h) G 2 (2-32h) M (0.5-2h) Alkylating agent G 1 (2-  h) G 0 Vinblastine Anti-mitosis drugs Taxoids
Classification of anticancer drugs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Alkylating agent ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Alkylating agent ,[object Object],[object Object],[object Object],[object Object],DNA double strands inhibit DNA replication C+ C+
Alkylating agent  Cyclophosphamide ,[object Object],4-OH CTX aldophosphamide   phospho ramide mustard   4-keto cyclophosphamide Carboxyl phosphamide Acrolein   Hepatic Cytochrome   P 450 activated Cell toxicity Toxicity inactivate Acetaldehyde   dehydrogenase
Platinum drugs Pt(II) NH 3 NH 3 Pt(II) NH 3 NH 3 + 2H 2 O Cisplatin Reactive complex + 2Cl - Pt G G Cl Cl H 2 O + H 2 O + DNA Strand
Platinum drugs ,[object Object],[object Object],[object Object],[object Object],[object Object]
Anti-metabolite   anticancer drugs ,[object Object],[object Object],[object Object],[object Object],[object Object]
Anti-metabolite   anticancer drugs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Anti-metabolite   anticancer drugs Dihydrofolate Reductase   METHOTREXATE   (MTX) FH 2 FH 4 Uracil   + N 5-10  methylene FH 4 deoxynucleotide ( dUMP ) 5- fluorouracil   (5-FU) Purine Nucleotide thymidine   deoxynucleotide   (dTMP) Thymidylate Synthase   (TS) fluorouracil deoxynucleotide   ( F dUMP ) DNA DNApolymerase  Cytarabine  (Arac) Gemcitabine   6MP 、 6TG
Antibiotic anticancer drugs Double strand dissociation Interfere DNA transcription  and mRNA  synthesis Anthracycline  antibotics   insert to the base pair near the DNA double strand
Antibiotic anticancer drugs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Antibiotic anticancer drugs ,[object Object],[object Object]
Tubulin inhibitor ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Tubulin inhibitor Interfere tubulin polymerization   :   colchicine   Vinblastine block tubulin depolymerization   :   Taxoids tubulin tubule 20nm  
Anti-mitosis anticancer drugs ,[object Object],[object Object],[object Object],Taxoids Promote tubulin polymerization Prevent tubulin depolymerization Vinblastine inhibit spindle fibers’ formation Prometaphase of mitosis
Topoisomerase inhibitors ,[object Object],[object Object],[object Object],[object Object],[object Object]
Topoisomerase inhibitors ,[object Object],[object Object],[object Object],[object Object]
Topoisomerase   ,[object Object],DNA DNA replication DNA rotating  along its axis interfere DNA replication Double-strand torsion increased
Topoisomerase Attached double-stranded DNA , cut through the DNA  strand transiently , the torsion disappeared , then catch the rotated DNA again , re-adhesion the DNA strand
Topoisomerase  I  inhibitors Topoisomerase  I  inhibitors combined with TOPO I-DNA  complex
Topoisomerase  I  inhibitors combination of replication fork &  Breaking of DNA single strand  Interruption of the cell cycle Cell death
Mechanism of anticancer drugs
Molecular target drugs ,[object Object],[object Object],[object Object]
Common target drugs Name Trade name Main targets Structure Indication Imatinib Gleeve Bcr/Abl, c-kit, PDEFR Small Molecule  Compounds   CML  GIST Retuximab MabThera  CD-20( B limphocyte) Chimeric Antibody   NHL Transtuzumab Herceptin HER2/neu Human antibody Breast cancer Gefitinib Iressa EGFR-TK Small Molecule  Compounds NSCLC Cetuximab Erbitux EGFR Chimeric Antibody Colorectal, head & neck Erlotinib Tarceva EGFR-TK Small Molecule  Compounds 非小细胞肺癌 NSCLC Bevacizumab Avastin VEGF Human antibody Colorectal Ca
Gefitinib erlotinib Anti-EGFR 2: Herceptin Anti-EGFR 1: Cetuximub
Basis theories of chemotherapy ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
Adverse effect of anticancer drugs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Adverse effect of anticancer drugs ,[object Object],[object Object]
Basis theories of chemotherapy ,[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical application of chemotherapy goals of chemotherapy ,[object Object],[object Object],[object Object],[object Object],[object Object],√ √ √ √ √
Clinical application—curative chemotherapy ,[object Object],[object Object]
Clinical application—curative chemotherapy ,[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical application—adjuvant chemotherapy ,[object Object],[object Object],[object Object],[object Object]
Clinical application—neo-adjuvant chemotherapy ,[object Object],[object Object],[object Object],[object Object]
Clinical application—palliative chemotherapy ,[object Object],[object Object],[object Object]
Balance of c hemotherapy efficacy and toxicity  Efficacy Safety Strategy for the reasonable application  of chemotherapy
Patient’s survival time and quality of life after treatment
Clinical application---- investigative chemotherapy ,[object Object],[object Object],[object Object]
Clinical application of chemotherapy —the principle of Rational Drug Use ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],√
Research for enhancing the effect of systemic chemotherapy  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PROGRESS IN MEDICAL ONCOLOGY 1975 -> 2000 -> 2025 MOLECULAR MEDICINE EVIDENCE-BASED MEDICINE SMALL, PILOT TRIALS P R O G R E S S 1975 1980 2000
Conclusions ,[object Object],[object Object],[object Object],[object Object],[object Object]
Thank you!

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9 Tumor+Chemotherapy English +Version Imp

  • 1. Tumor Chemotherapy Sun Yet-san University Cancer Center Rui-Hua Xu, Zhi-Ming Li E-mail: xurh@mail.sysu.edu.cn [email_address] Tel: 8734 3356
  • 2.
  • 3.
  • 4.
  • 5. Development of Chemo-drugs Nitrogen Mustard for lymphoma 40s 50s MTX for hematological malignancies & children’s ALL 70s DDP 、 ADM—palliative chemotherapy transition to curative chemotherapy, medical oncology established 80s Adjuvant/Neo-adjuvant chemotherapy 90s 21 st Biological Response Modifier , supportive care , High dose chemotherapy + HSCT Molecular target drug
  • 6.
  • 7.
  • 8.
  • 9.
  • 10.
  • 11.
  • 12.
  • 13.
  • 14.
  • 15. 时间 指数生长 癌瘤 正常 细胞产生 = 细胞丢失 稳定态 Gompertzian 生长 对数细胞数 时间 指数生长 癌瘤 正常 细胞产生 = 细胞丢失 稳定态 Gompertzian 生长 对数细胞数 时间 指数生长 癌瘤 正常 细胞产生 = 细胞丢失 稳定态 Gompertzian 生长 对数细胞数 Time Exponential Growth tumor normal cell produce=cell loss Stable state Gompertzian growth cell produce > cell loss l Log of Cells
  • 16.
  • 17.
  • 18.
  • 19.
  • 20.
  • 21.
  • 22. NEJM 2003 348:538-549 Target enzyme and efficacy of anticancer drug
  • 23. Clin Cancer Res 4139 2006;12(14) July 15, 2006
  • 24.
  • 25.
  • 26.
  • 27. Cell cycle non-specific agents 100 S 细 胞 存 活 R 率 % 剂量 S: Slow growth (normal cell) R: Rapid growth (tumor cell)
  • 28. Cell cycle specific agents 100 S 细 胞 存 活 R 率 % 剂量 S: Slow growth (normal cell) R: Rapid growth (tumor cell)
  • 29.
  • 30.
  • 31.
  • 32.
  • 33.
  • 34. Platinum drugs Pt(II) NH 3 NH 3 Pt(II) NH 3 NH 3 + 2H 2 O Cisplatin Reactive complex + 2Cl - Pt G G Cl Cl H 2 O + H 2 O + DNA Strand
  • 35.
  • 36.
  • 37.
  • 38. Anti-metabolite anticancer drugs Dihydrofolate Reductase METHOTREXATE (MTX) FH 2 FH 4 Uracil + N 5-10 methylene FH 4 deoxynucleotide ( dUMP ) 5- fluorouracil (5-FU) Purine Nucleotide thymidine deoxynucleotide (dTMP) Thymidylate Synthase (TS) fluorouracil deoxynucleotide ( F dUMP ) DNA DNApolymerase Cytarabine (Arac) Gemcitabine 6MP 、 6TG
  • 39. Antibiotic anticancer drugs Double strand dissociation Interfere DNA transcription and mRNA synthesis Anthracycline antibotics insert to the base pair near the DNA double strand
  • 40.
  • 41.
  • 42.
  • 43. Tubulin inhibitor Interfere tubulin polymerization : colchicine Vinblastine block tubulin depolymerization : Taxoids tubulin tubule 20nm  
  • 44.
  • 45.
  • 46.
  • 47.
  • 48. Topoisomerase Attached double-stranded DNA , cut through the DNA strand transiently , the torsion disappeared , then catch the rotated DNA again , re-adhesion the DNA strand
  • 49. Topoisomerase I inhibitors Topoisomerase I inhibitors combined with TOPO I-DNA complex
  • 50. Topoisomerase I inhibitors combination of replication fork & Breaking of DNA single strand Interruption of the cell cycle Cell death
  • 52.
  • 53. Common target drugs Name Trade name Main targets Structure Indication Imatinib Gleeve Bcr/Abl, c-kit, PDEFR Small Molecule Compounds CML GIST Retuximab MabThera CD-20( B limphocyte) Chimeric Antibody NHL Transtuzumab Herceptin HER2/neu Human antibody Breast cancer Gefitinib Iressa EGFR-TK Small Molecule Compounds NSCLC Cetuximab Erbitux EGFR Chimeric Antibody Colorectal, head & neck Erlotinib Tarceva EGFR-TK Small Molecule Compounds 非小细胞肺癌 NSCLC Bevacizumab Avastin VEGF Human antibody Colorectal Ca
  • 54. Gefitinib erlotinib Anti-EGFR 2: Herceptin Anti-EGFR 1: Cetuximub
  • 55.
  • 56.
  • 57.
  • 58.
  • 59.
  • 60.
  • 61.
  • 62.
  • 63.
  • 64.
  • 65.
  • 66. Balance of c hemotherapy efficacy and toxicity Efficacy Safety Strategy for the reasonable application of chemotherapy
  • 67. Patient’s survival time and quality of life after treatment
  • 68.
  • 69.
  • 70.
  • 71. PROGRESS IN MEDICAL ONCOLOGY 1975 -> 2000 -> 2025 MOLECULAR MEDICINE EVIDENCE-BASED MEDICINE SMALL, PILOT TRIALS P R O G R E S S 1975 1980 2000
  • 72.

Notes de l'éditeur

  1. electrophiles
  2. 2 2 Simplified diagram of the EGFR pathway consisting of the EGFR signal transduction cascade, and cellular effects of stimulation through the EGFR. 5 The ligand binding site serves as the receptor for ligands such as EGF and TGF-  Upon ligand binding, subsequent receptor signaling, including autophosphorylation of the receptor and phosphorylation of target proteins, occurs downstream in the signal transduction cascade. 2 • EGFR is expressed in a significant percentage of human tumors. Expression has been correlated with poor prognosis, decreased survival, and/or increased metastases. 2 • EGFR plays a critical role in cellular growth, repair, and survival and has been demonstrated to function as a key pathway for the regulation of growth in many tumor types. 2 • Current therapies have significant therapeutic and safety limitations in the management of solid tumors. The use of EGFR targeted therapy is a potentially important addition to standard anticancer therapy. 2 • It has been postulated that EGFR inhibitors may synergize with radiation and certain chemotherapeutic agents, possibly through apoptotic, antiangiogenic, and/or cell cycle effects. 2