general principles of cancer treatmentgeneral principles of cancer treatment an overview lodovico...

General principles of cancer treatment

An overview

Lodovico Balducci M.D.

Moffitt Cancer Center

Tampa, FL

USA

Disclosure

Use this space to declare your Conflicts of Interests and insert this slide at the

beginning of your presentation.

Please note that this is a mandatory requirement by the CME authorities.

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