Chemotherapy metastatic

In the veterinary as in the human patient, neoplasms are often metastatic and widely disseminated throughout the body. Surgery and irradiation are limited in use to weU-defined neoplastic areas and, therefore, chemotherapy is becoming more prevalent in the management of the veterinary cancer victim (see Chemotherapeutics, anticancer). Because of the expense and time involved, such management must be restricted to individual animals for which a favorable risk—benefit evaluation can be made and treatment seems appropriate to the practitioner and the owner. In general, treatment must be viewed not as curative, but as palliative. 

Metastatic renal cell carcinoma has a poor prognosis and resists conventional chemotherapy. Immunotherapy with IL-2 and/or IFN-a is currently regarded as the most effective therapy with, however, modest response rates of 15-20%. Similar results are also observed in patients with metastatic melanoma and the response to IFN-a and IL-2 correlates with the occurrence of tumor-infiltrating CD4+ T-lymphocytes identified in aspirates from melanoma metastases. Determination of these cells therefore seems to be a method to predict responders prior to the initiation of cytokine therapy. 

Erlotinib (Tarceva ) competes with ATP in the HER1/EGFR ATP-binding pocket. It is used in the clinic in locally advanced or metastatic non-small cell lung cancer after failure of at least one chemotherapy regime [1, 3, 5]. 

The clinical trial that resulted in FDA approval of bevacizumab (February 2004) was a randomized, double-blind, phase III study in which bevacizumab was administered in combination with bolus-IFL (irinotecan, 5FU, leucovorin) chemotherapy as first-line therapy for previously untreated metastatic colorectal cancer [3]. Median survival was increased from 15.6 months in the bolus-IFL + placebo arm to 20.3 months in the bolus-IFL + bevacizumab arm. 

Determine appropriate indications for endocrine therapy, chemotherapy, and biologic therapy for patients with metastatic breast cancer. 

Evaluate available chemotherapy options for patients with metastatic breast cancer based on pertinent patient and disease-state characteristics. 

The goal of adjuvant chemotherapy is curative, whereas the goal of chemotherapy in the metastatic setting is palliative. 

Approximately 50% to 60% of women who have not received prior chemotherapy for metastatic disease will respond to chemotherapy regimens doxorubicin- and taxane-containing regimens are the most active. 

The taxanes (e.g., paclitaxel and docetaxel) are a newer class of agents that rival the anthracyclines in their activity in metastatic breast cancer, becoming (arguably) the most active class of chemotherapy for this disease. 

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... 

Because most patients are given adjuvant chemotherapy, regimens chosen for first-line use in the metastatic setting often are... 

Understand the role of chemotherapy in the treatment of metastatic prostate cancer. ... 

TABLE 89-7. First-Line Chemotherapy Regimens for Metastatic Hormone-Independent Prostate Cancer... 

Brain metastasis is common in melanoma, and treatment options for brain metastasis include surgery, radiation, and chemotherapy. The choice of therapy depends on the number of metastatic lesions, accessibility of the lesions for surgery, the presence of neurologic symptoms, and the status of extracranial disease. 

Clinical trials combining chemotherapy and immunotherapy are based on the observations of independent clinical activity of each of these treatment modalities in treating metastatic MM. This combination is known as biochemotherapy. Only one phase III clinical trial showed significant improvement in response rate, time to progression, and median survival favoring the biochemotherapy arm versus the combination-chemotherapy arm.59 Currently, the use of biochemotherapy is not justified outside a clinical trial in patients with stage IV MM.53,58,60... 

CA 15-3 serum tumor marker is intended to detect disease recurrence in stage II and stage III breast cancer patients. It has been reported that CA 15-3, together with other suitable markers, is preferred in measuring the effect of applied hormonal therapy or chemotherapy in metastatic disease. Studies have indicated that CA 15-3 assay values are frequently elevated in patients with breast cancer. These... 

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