By Jacob J. Lokich M.D. (auth.)
Chemotherapy for-cancer is in a kingdom of evolution. simply because a few cancers can now be cured with chemotherapy as a unique modality, this remedy can not be seen as easily a palliative contribution. Chemotherapy has assumed an immense function as an adjuvant to different modalities, together with either surgical procedure and radiation treatment. For a few tumors, the first program of chemotherapy in a mixed modality method of healing treatment has ended in the applying of much less radical surgical procedure whereas reaching significant of fairly infrequent tumors corresponding to therapy premiums. still, with the exception youth tumors, hematologic malignancies, and testicular melanoma, the effec tiveness of chemotherapy in such a lot tumors is significantly restricted. on the mobile point, better figuring out of the categorical mechanism of tumor telephone killing and of the phenomenon of drug resistance are elusive, severe parts within the development of effectiveness in melanoma chemotherapy. Prolonging the publicity time of the tumor phone to medicinal drugs is an idea that used to be addressed within the early levels of the improvement of chemotherapy. How ever, technological barriers inhibited the wider program of chemother apy through infusion until eventually contemporary years. additionally, the ease of intermittent ther apy on an outpatient foundation, with the foremost concept of drug impact in accordance with a dose reaction in addition to the confirmed effectiveness of this time table in a few tumors, has slowed the method of subjecting infusion chemotherapy to the pains of scientific trials.
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Extra resources for Cancer Chemotherapy by Infusion
Venditti's early studies 27 with L1210 leukemia showed that the only active schedule appeared to be small daily treatments (for 9 days). In addition to their other unique properties among the alkylating agents, the nitrosoureas may have increased efficacy when administered by infusion. Further studies are needed, although the instability of these drugs may limit the practical testing of this schedule of administration. Mitomycin-C (MIT) Mitomycin-C was originally thought to be an antibiotic, but it acts as an alkylating agent when its quinone group is reduced.
There are problems with the studies; for example, the concentrations of BLM used for the in vitro studies usually were not clinically achievable. 1 22 The most valuable studies in examining the concentration of bleomycin from a clinical point of view were those by Ludwig et al61 and Matsushima et al. 39 Ludwig et al 61 found that of 25 clinical tumor specimens tested against BLM. only 6 were sensitive to the drug. However, 4 of those 6 were sensitive only at the 2oo-hour exposure. The drug concentration for a I-hour exposure needed to reduce cell growth to 500/0 of control was 900 times higher than the drug concentration for 200 hours needed to reduce cell growth to 50% of control.
Their experiments did not show any advantage to short infusion therapy over frequent divided doses. There have not been any reported in vivo experiments using long-term infusions, similar to those used clinically. 20 5-aza-2'-deoxycytidine 5-aza-2'-deoxycytidine is a derivative of 5-azacytidine, an effective antileukemic agent. 29 There are both in vitr0 30 and in viv0 31 data to support the use of 5-aza-2' -deoxycytidine by continuous infusion, although similar data are not available for 5-azacytidine.