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. 

Selection of palliative therapy for disease that has become refractory to all curative therapies... 

The most commonly used dose for fludarabine is 20 mg/m2 intravenously daily for 5 consecutive days, whereas chlorambucil can be taken daily as an oral tablet with the dose ranging from 4 to 10 mg/day.21 Fludarabine is associated with more toxicities than chlorambucil, including myelosuppression and prolonged immunosuppression.19 Resulting infectious complications may occur during the periods of prolonged immunosuppression. The ease of administration and limited side effects make chlorambucil a practical option for symptomatic elderly patients who require palliative therapy... 

Hydroxyapatite particles can be used for radiation synovectomy by exploiting the strong binding of rhenium diphosphonate complexes to the surface of hydroxyapatite (vide supra). The same 186Re-HEDP preparations as for bone palliative therapy are used. When injected into joints, these particles (mean diameter 25 pm, maximum diameter 45 pm) remain within the joint to the extent of at least 95% for several days in arthritic rabbits and rats [156], More recently, microspheres have been labeled with 188Re for this purpose [156a,b],... 

If testosterone levels are not suppressed (i.e., greater than 20 ng/dL) after initial LHRH agonist therapy, an antiandrogen or orchiectomy may be indicated. If testosterone levels are suppressed, the disease is considered androgen independent and should be treated with palliative therapy. 

A patient of yours has been receiving 5-fluorouracil as palliative therapy for adenocarcinoma of the pancreas. You suspect that the patient has become resistant to the treatment. You want to understand the most likely cause of the resistance before you select another agent. Which of the following is the most likely cause ... 

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. 

Chlorambucil is used primarily as daily palliative therapy for chronic lymphocytic leukemia, Walden-stroom s macroglobulinemia, myeloma, and other lymphomas. 

Plicamycin (mithramycin, Mithracin) is one of the chro-momycin group of antibiotics produced by Streptomyces tanashiensis. Plicamycin binds to DNA and inhibits transcription. It also inhibits resorption of bone by osteoblasts, thus lowering serum calcium levels. Very little is known about its distribution, metabolism, and excretion. Because of its severe toxicity, plicamycin has limited clinical utility. The major indication for plicamycin therapy is in the treatment of life-threatening hypercalcemia associated with malignancy. Plicamycin also can be used in the palliative therapy of metastatic testicular carcinoma when all other known active drugs have failed. 

Radioactive iodine is indicated in hyperthyroidism due to Graves disease or toxic nodular goitre and also used as palliative therapy after thyroidectomy for papillary carcinoma of thyroid. 

The synthetic adrenergic agonists—phenylephrine, naphazoline, oxymetazoline, and tetrahydrozoline—are available as ocular decongestants (Table 13-2). After topical application to the eye, constriction of conjimcti-val blood vessels occurs at drug concentration levels that generally do not cause pupillary dilation. These agents provide only palliative therapy, because they have no effect on the conjimctival response to antigen. 

In the early stages the management of pterygia usually involves palliative therapy. Patients show significant relief of symptoms with the use of artificial tears and ointments. When these are insufficient, mild steroids, such as... 

Morphological clarification of the findings is necessary if differential diagnosis of a hepatic space-occupying lesion is unclear. Cytological or histological confirmation of tumour malignancy is likewise required prior to palliative therapy, even in patients with no chance of curative treatment. 

Laparoscopy Laparoscopy should be used to confirm the diagnosis morphologically. This technique provides photodocumentary findings and also affords the possibility of targeted thick-needle, fine-needle or forceps biopsy. Tumour biopsy is only deemed necessary prior to palliative therapy. Moreover, explorative laparoscopy offers a much better overview of the whole abdominal area than does explorative laparotomy - and the risk involved is considerably lower. Carrying out laparotomy staging prior to liver transplantation is, in our opinion, also far less efficient and thus not indicated instead, laparoscopy should be the technique of choice, (s. pp 150, 155, 161, 781)... 

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. 

Current drug-based therapies for Parkinson s disease are palliative therapies, i.e. they relieve the symptoms, but do not cure the disease. One of the current and expanding therapies is treatment with dopamine D2/D3 receptor agonists. There are a number of such therapeutics, e.g. bromocriptine, pergolide, apomorphine, ropinirole, and pramipexole. 

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. 

Pentostatin is a purine antimetabolite. It is a potent transition-state inhibitor of the enzyme adenosine deaminase (ADA) that leads to cytotoxicity because of elevated intracellular levels of dATP that can block DNA synthesis through inhibition of ribonucleotide reductase. Pentostatin can also inhibit RNA synthesis as well as cause increased DNA damage. It is indicated in the treatment for both untreated and alpha-interferon-refractory hairy-cell leukemia and as palliative therapy of chronic lymphocytic leukemia, prolympho-cytic leukemia and cutaneous T-cell lymphoma. 

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