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Chemotherapy – Options

Induction

Adjuvant

Neoadjuvant

Palliation

Induction chemotherapy

   Primary treatment of cancer (before surgery)

   No alternative treatment exists (leukaemia)

Adjuvant chemotherapy

  Use of systemic treatment after local therapy (minimal tumor bulk)

  Use based on risk of recurrence (presence of microscopic disease)

  Use based on response of similar tumors at advanced stage

Primary chemotherapy

  Neoadjuvant

  Used in tumors where alternative treatment is available but is less acceptable

  Allows organ preservation (osteogenic sarcoma/breast cancer)

  Can assess efficacy of treatment

End points in evaluating response

Partial response (PR)

Complete response (CR)

Relapse free survival (RFS)

Freedom from progression (FFP)

Combination chemotherapy – Rationale for use

Single drugs at tolerable doses unable to cure cancer

Allows maximum cell kill with tolerable host toxicity

Allows range of drug interaction with tumor cells with different genetic abnormalities

May prevent or slow development of drug resistance

Only drugs known to be effective as single agents used

Drugs causing CR preferred

Select drugs whose toxicities do not overlap

Optimize dose and schedules

Keep interval dosing consistent

Shortest possible time for sensitive tissue recovery

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