Dr. Adil Hassan
Consultant Medical Oncologist,
MBBS, MD (Internal Med),
DM (Medical Oncology),
DrNB (Medical Oncology),
MRCP UK-SCE (Oncology),
Certified by ESMO

Chemotherapy

Chemotherapy is a type of cancer treatment that uses drugs to kill cancer cells or stop them from growing. The drugs can work by interfering with the cancer cells' ability to divide and grow.

There are several ways chemotherapy can be administered:

• Intravenous (IV): Directly into a vein.
• Oral: In the form of pills or capsules.

Palliative Therapy in Advanced Tumours

Palliative therapy, also known as palliative care, focuses on improving the quality of life for patients with serious illnesses, rather than trying to cure the illness. It aims to alleviate symptoms, pain, and stress related to the illness, and to support the emotional, social, and spiritual needs of both the patient and their family.

Key aspects of palliative therapy include:

• Symptom Management
• Emotional and Psychological Support
• Communication and Decision-Making
• Coordination of Care
• Support for Families

Targeted Therapy

Targeted therapy is a type of cancer treatment that specifically targets the molecular and genetic changes associated with cancer cells, rather than affecting all rapidly dividing cells like traditional chemotherapy. This approach aims to disrupt cancer cell growth and survival more precisely, potentially leading to fewer side effects and greater effectiveness.

Monoclonal Antibodies: These are lab-made molecules that can specifically bind to cancer cell antigens (proteins on the surface of the cells). For example, trastuzumab (Herceptin) targets HER2-positive breast cancer cells.

Small Molecule Inhibitors: These drugs are typically taken orally and work inside cells to block the activity of specific proteins that promote cancer growth. Examples include imatinib (Gleevec) for chronic myeloid leukemia and gefitinib (Iressa) for non-small cell lung cancer.

Immunotherapy

Immunotherapy is a type of cancer treatment that leverages the body's own immune system to fight cancer. Unlike traditional treatments like chemotherapy and radiation, which target cancer cells directly, immunotherapy aims to enhance or restore the immune system's natural ability to recognize and destroy cancer cells.

Here are the main type of immunotherapy

Checkpoint Inhibitors

Checkpoint inhibitors are drugs that block checkpoint proteins from binding with their partner proteins. This prevents the "off" signal from being sent, allowing the T cells to kill cancer cells. Common checkpoints targeted include:

• PD-1/PD-L1 Inhibitors: Drugs like pembrolizumab (Keytruda) and nivolumab (Opdivo) block the PD-1 or PD-L1 protein, which tumors often use to evade immune detection.
• CTLA-4 Inhibitors: Drugs like ipilimumab (Yervoy) target CTLA-4, a protein that inhibits T cell activation.

Hormonal Therapy

Breast cancer can be hormone receptor-positive, meaning that the cancer cells grow in response to hormones such as estrogen and/or progesterone. Hormonal therapies target these hormone pathways to slow or stop the growth of the cancer.

Estrogen Receptor-Positive Breast Cancer

• Selective Estrogen Receptor Modulators (SERMs): These drugs block estrogen from binding to estrogen receptors on cancer cells. They are often used in premenopausal women.
• Aromatase Inhibitors: These drugs lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen. They are used primarily in postmenopausal women.
• Estrogen Receptor Downregulators (ERDs): These drugs block and degrade estrogen receptors.

Hormonal Therapy for Prostate Cancer

Prostate cancer often depends on androgens, such as testosterone, to grow. Hormonal therapy for prostate cancer aims to lower these hormone levels or block their effects.

Androgen Deprivation Therapy (ADT)

• Luteinizing Hormone-Releasing Hormone (LHRH) Agonists Leuprolide (Lupron), Goserelin (Zoladex), and Triptorelin
• LHRH Antagonists Degarelix (Firmagon)
• Anti-Androgens: These drugs block the action of testosterone at the receptor level. Bicalutamide (Casodex), Enzalutamide (Xtandi), and Apalutamide (Erleada)
• Androgen Synthesis Inhibitors Abiraterone (Zytiga)