Cancer palliative therapy

Chemotherapy may be given to cure cancers that are curable, or it may be given to help control the symptoms of an incurable cancer, which is referred to as palliative therapy. 

The major indications for melphalan are in the palliative therapy of multiple myeloma and cancers of the breast or ovary. Because it does not produce alopecia, melphalan is occasionally substituted for cyclophosphamide in the CMF regimen for breast cancer. 

Systemic chemotherapy is usually not indicated in non-colorectal liver metastases due to lack of response. The systemic administration of cytostatics (also in combination) possesses the status of palliative therapy. However, in metastatic neuroendocrine tumours, a combination of octreotide -i- IFN had a positive effect on the survival time. Systemic chemotherapy produced remission rates of up to 60%. (320) In metastatic breast cancer, systemic chemotherapy is indicated, usually in combination with hormonal and immune therapy. (316, 342) In metastatic gastric carcinoma, palliative chemotherapy can achieve a remission rate of up to 40%, with a slight extension of survival time. 

Although advanced age is not an absolute contraindication for relatively aggressive therapies, a consideration of the age of the patient, concomitant disease states, lifestyle factors, and the patient s preferences are incorporated into the treatment planning process. Special or emergent conditions, such as bowel perforation, spinal cord compression, and severe pain, anemia, or other symptomatic problems, need to be addressed acutely, after which time a more long-term disease-specific plan can be developed. The treatment approaches for colorectal cancer reflect two primary treatment goals curative therapy for localized disease, and palliative therapy for metastatic cancer. 

Moderate to severe vasomotor mptoms associated with menopause, atrophic vaginitis, female hypogonadism, female castration, primary ovarian failure, palliative therapy for breast and prostate cancer, treatment of abnormal uterine bleeding due to hormone imbalance Moderate to severe vasomotor symptoms associated with menopause, atrophic vaginitis, female hypogonadism, female castration, primary ovarian failure Same as conjugated estrogens... 

Testosterone propionate IM. Short acting. Useful for palliative treatment of breast cancer because therapy can be discontinued rapidly if hypercalcemia develops. 

Hepatocellular carcinoma (HCC) represents one of the most common types of cancer, with more than 1 million new cases worldwide and a dramatic increase in the western world. In most cases, HCC is detected at an advanced stage and frequently liver cirrhosis as an underlying disease is present. Therefore, therapeutic options are limited. Beside resection, liver transplantation is regarded the only curative therapy [4]. However, only 10%-15% of patients are candidates for curative surgery - especially due to the shortage of liver donors. There are no effective systemic treatments [4] to date for these patients and transarterial chemoembolization or RE are therefore the only palliative therapies. 

Hormonal drags do not cure cancer, although they do exhibit pronounced palliative action, with the exception of the cytotoxic action of glucocorticoids on lymphoid cells. In particular, this concerns predinsone, which is used to treat lymphomas and certain leukemias in combination therapy. 

A phase I study of Xeloda in combination with XRT in rectal cancer is in the adjuvant, neoadjuvant, and palliative settings (71-73). The DLT of the combination is hand-foot syndrome and mild to moderate leukopenia, diarrhea, and local skin reaction (71-73). The recommended dose for phase 2 studies is Xeloda 825 mg/m2 twice daily without interruption in combination with standard dose of radiation. Promising activity has been demonstrated in neoadjuvant therapy with six objective responses in seven evaluable patients including one pathological confirmed CR. 

Buserelin (Suprefact) and leuprolide (Lupron) are peptide analogues of the hypothalamic hormone LH-RH (luteinizing hormone-releasing hormone). Chronic exposure of the pituitary to these agents abolishes gonadotropin release and results in markedly decreased estrogen and testosterone production by the gonads. Their major clinical use is in the palliative hormonal therapy of cancer of the prostate. 

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