General principles of cancer treatment

An overview

Lodovico Balducci M.D.

Moffitt Cancer Center

Tampa, FL

USA

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Honoraria da Amgen, J &J, Teva per conferences e consultations

Types of cancer treatment

Local

• Surgery

• Radiation therapy

• Cryotherapy

• Thermoablation

• Radio-frequency ablation

• Infusional therapy

Systemic

• Hormonal therapy

• Cytotoxic Chemotherapy

• Targeted Therapy

• Immune checkpoint

inhibitors

• Vaccines

• Cytokines

Targets of the cancer treatment

• Tumor cell

• Micro-environment ( vessels)

• Immune system

Types of radiation therapy of special

interest to the elderly

• Brachytherapy

• Intensity-modulated Radiation Therapy

• Protons

• Stereotactic Radiosurgery

• Radioisotopes

Applications of cancer treatment

Goals

• Curative

• Palliative

• Life-prolonging

Special definitions

• Adjuvant

• Neoadjuvant

Combinations

Adjuvant treatment: after the basic

treatment

Risk of systemic recurrence at 5 years: 25-30%

Risk of mortality at 5 years: 15-20%

Detection of micrometastases: CTC? Circulating DNA?

Type of adjuvant treatment: Molecular profile

Neoadjuvant treatment: prior to

definitive treatment

Inflammatory breast cancer Borderline pancreatic cancer

Goals of neoadjuvant treatment

• Improve resectability and cure rate

• Organ preservation

Immune check-point inhibitors

Diseases for which Immune checkpoint

inhibitors are indicated

• Melanoma

• Lung cancer

• Urothelial cancer

• Renal cell carcinoma

• Hodgkin’s disease

Local management of metastases

• Palliative: RT for bone pain; intestinal bypass

for intestinal obstruction from peritoneal

carcinomatosis

• Curative: single metastases to the liver or the

lung

• Life-prolonging: radio or chemo embolization

for liver metastases

Oligometastatic disease

Questions:

• Management of primary tumor

• Local management of metastases

Table 1 Studies defining oligometastatic prostate cancer

Tosoian, J. J. et al. (2016) Oligometastatic prostate cancer: definitions, clinical outcomes, and treatment considerations

Nat. Rev. Urol. doi:10.1038/nrurol.2016.175

Finally, don’t forget

• Life is a sexually-transmitted

terminal disease.

M.Cleese