Lymphomas squamous cell, treatment

Cancer treatment is a multimodality treatment, i.e., surgery is combined with radiotherapy and antineoplastic chemotherapy. The latter treatment mode is used mainly for cancers which have disseminated. Different forms of cancer differ in their sensitivity to chemotherapy with antineoplastic agents. The most responsive include lymphomas, leukemias, choriocarcinoma and testicular carcinoma, while solid tumors such as colorectal, pancreatic and squamous cell bronchial carcinomas generally show a poor response. The clinical use of antineoplastic agents is characterized by the following principles. 

Bonner, J.A. et al., Cetuximab prolongs survival in patients with locoregionally advanced squamous cell carcinoma of head and neck a phase III study of high dose radiation therapy with or without cetuximab, Proc. Am. Soc. Clin. Oncol., 22, 489S, Abstr. 5507, 2004. McLaughlin, R et al., Rituximab chimeric anti-CD20 monoclonal antibody therapy for relapsed indolent lymphoma half of patients respond to a four-dose treatment program, /. Clin. Oncol., 16, 2825-2833, 1998. 

Bleomycin, in combination with cisplatin or etopo-side, is important as part of the potentially curative combination chemotherapy of advanced testicular carcinomas. Bleomycin is used in some standard regimens for the treatment of Hodgkin s and non-Hodgkin s lymphomas, and it is useful against squamous cell carcinomas of the head and neck, cervix, and skin. 

Bleomycin (Blenoxane) causes chain scission and fragmentation of DNA. With the exception of the skin and lungs, most tissues can enzymatically inactivate bleomycin. Bleomycin is used in the management of squamous cell carcinoma of the head, neck, and esophagus in combination with other drugs in patients with testicular carcinoma, and in the treatment of Hodgkin s disease and other lymphomas. Bleomycin causes stomatitis, ulceration, hyperpigmentation, erythema, and pulmonary fibrosis. 

Systemic vinblastine (velban, others) is approved for use in Kaposi s sarcoma and advanced cutaneous T-cell lymphoma. Intralesional vinblastine also is used to treat Kaposi s sarcoma. Intrale-sional bleomycin (blenoxane, others) is used for recalcitrant warts and has cytotoxic and proin-flammatory effects. Intralesional injection of bleomycin into the digits has been associated with a vasospastic response that mimics Raynaud s phenomenon, local skin necrosis, and flagellate hyperpigmentation. Intralesional bleomycin has been used for palliative treatment of squamous cell carcinoma. Systemic bleomycin has been used for Kaposi s sarcoma (see Chapter 51 for a more complete discussion of these agents). Liposomal anthracyclines [specifically doxorubicin (doxil, CAELYX)] may provide first-line monotherapy for advanced Kaposi s sarcoma. 

Bleomycins glycopeptide antibiotics produced by Streptomyces verticillus and used widely for treatment of squamous cell carcinomas, lymphomas and testicular cancer. About 200 different B. are known, differing mostly in the nature of the C-terminal substituent, which can be varied by adding difierent amines to the bacterial culture medium. The clinically used preparation is a mixture of 11 B., known by the trade name Blenoxane the chief constituents are B.A2 (60-70%) and B.B (20-25%) (Fig.). 

Bleomycins are a family of structurally related compounds produced by Streptomyces verticillus (Umezawa et al. 1966). They act through a peculiar mechanism, causing nicks in DNA strands by a complex reaction involving oxygen and metals. A mixture of bleomycins A2 and B2 was introduced in clinics in 1966 for the treatment of squamous cell carcinomas and malignant lymphomas and is still used, mainly in combinations. 

---