Cancer chemotherapy case studies

Case study level Ma - Management of testicular cancer 178 Case study level Mb - Oral chemotherapy 181... 

Data regarding the toxic effects of hydrazines in humans are limited to a few case studies of accidental exposure and chemotherapy trials in cancer patients. Studies consistently indicate that the central nervous system is the primary target for hydrazine and 1,1 -dimethylhydrazine following inhalation, oral, and dermal exposures. In some cases, neurological effects were delayed, but most effects were observed either during exposure or soon after. Quantitative data on human exposures are available only for oral exposures of intermediate durations. 

The antiemetic effect of nabilone in the clinic is well established in numerous studies. In an early study with 113 patients undergoing cancer chemotherapy with a wide variety of anticancer drugs, 80% experienced full or partial improvement of nausea and emesis while only 36% responded to prochlorperazine treatment. Drowsiness and dizziness were reported in many cases. Euphoria (16%), dry mouth and blurred vision (4.5 %), orthostatic hypotension (1 %) and visual hallucinations (1 %) were the more serious side-effects [ 167]. This general picture has been repeated over and over again. 

Skin DOX chemotherapy has been associated with the development of subacute cutaneous lupus erythematosus (SCLE). This has been observed with the combination of cyclophosphamide and DOX. In a case study SCLE was observed in a patient with metastatic breast cancer treated with DOX alone After her second cycle of chemotherapy a pruritic facial rash developed and subsequently worsened with two further cycles of DOX. Treatment was initiated and DOX chemotherapy was discontinued and the SCLE resolved after 5 weeks. 

Cytotoxic chemotherapy is eventually required in most patients with metastatic breast cancer. Patients with hormone-receptor-negative tumors require chemotherapy as initial therapy of symptomatic metastases. Patients who respond initially to hormonal manipulations eventually cease to respond and go on to require chemotherapy. The median duration of response is 5 to 12 months, but some patients will have an excellent response to an initial course of chemotherapy and may live 5 to 10 years or longer without evidence of disease. In general, median survival of patients after treatment with commonly used drug combinations for metastatic breast cancer is 14 to 33 months. The median time to response has ranged from 2 to 3 months in most studies, but this period depends in large part on the site of measurable disease. The median time to appearance of response is between 3 and 6 weeks in patients whose disease is primarily in the skin and lymph nodes, 6 to 9 weeks in patients with metastatic lung involvement, 15 weeks in patients with hepatic involvement, and nearly 18 weeks in patients with bone involvement. Thus it is often the case that an immediate response to therapy is not... 

Peripheral neuropathy (degeneration of peripheral sensory and/or motor neurons) represents another target for neurotrophic intervention. It often occurs as a complication of diabetes or in cancer patients receiving chemotherapy. In severe cases, amputation of limbs affected by neuronal loss is warranted. Pre-clinical studies have clearly shown that sensory and sympathetic neurons depleted in peripheral neuropathy respond to NGF. Indeed, NGF, along with IGF-1, can prevent the occurrence of drug-induced peripheral neuropathy in animals. Human clinical trials continue. 

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