Palliative Chemotherapy
Jason R. Beckrow, DO
Lighthouse Oncology
Objectives
• Objectives:
– Understand the concept of treat with curative
intent vs. palliative intent.
– Discuss the therapeutic goals of palliative chemo
– Discuss targeted and palliative drug for various
malignancies.
Intentions of Treatment
Palliative
Curative
The Problem:
Conventional Care Model
Fight or Quit
What do we mean by
Palliative Chemotherapy?
GeriPal: A geriatrics and Palliative
Care Blog
• Is there anyone amongst the readership that
can direct me to a list, a compendium of
purely "palliative" chemotherapy regimens?
• You can't find a protocol because there is no
such thing. Chemotherapy produces
symptoms, usually more symptoms than it
relieves….Annonymous
“I Already Do Palliative Care”
anonymous oncologist
Patients Reported Oncology Teams
Often Do Not:
• Consider psychosocial care as a part of
their patients’ cancer care.
• Understand their psychosocial needs,
know about resources, or refer when
needed.
• President’s Cancer Panel 2003, 2004
Community Oncology Offices
Cancer-Free
Survival
Treatment with
Intent to Cure
Managed
Chronic or
Intermittent
Disease
Diagnosis and
Staging
Treatment
Failure
Palliative
Medicine
Death
IOM President’s Cancer Panel, 2003, 2004
Slide Courtesy of Jimmie Holland, MD
Memorial Sloan Kettering Cancer Center
• Where majority
of cancer care
is given today
• Where fewest
psychological
and social
services available
Conventional Care
Anti-disease Therapy
Presentation
Hospice
Care
6m
Death
Bereavement
Care
Model of palliative cancer care.
Ferris F D et al. JCO 2009;27:3052-3058
©2009 by American Society of Clinical Oncology
The Relief of Suffering
Physicians’ failure to
understand the nature of
suffering can result in
medical intervention that
(though technically
adequate) not only fails to
relieve suffering but
becomes a source of
suffering itself.
Eric Cassel, 1982
The Goals of Palliative Chemotherapy
•
•
•
•
•
•
Symptom Relief
Attainment of Life Goals
Portability
Accessibility
Cost efficiency
Your thoughts….
Goals of Palliative Chemotherapy
Early Palliative Care Study Procedures
Palliative Care Guidelines
Illness understanding and education
Inquire about illness and prognostic understanding
Offer clarification regarding treatment goals
Distress Management
Symptom management
Pain
Pulmonary symptoms
Fatigue and sleep disturbance
Mood
Gastrointestinal
Decision-making
Assess mode of decision-making
Assist with treatment decision-making
Coping with life-threatening illness
Patient
Family/family caregivers
www.nationalconsensusproject.org
Prepared and Hopeful
…Principles of Oncology
ECOG Performance Status
Grade
Activity
0
Fully active, no restriction
1
Symptoms, restricted in strenuous activity
2
Ambulatory and capable of all self-care, no work activity. Up
more than 50% of the day
3
Limited self care, confined to bed or chair >50% of the day
4
Completely disabled, unable to care for self, totally confined
to bed or chair.
5
Dead
Oken, MM et al. Am J Clin Oncol
1982
Conditions
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Breast Cancer
Lung Cancer
Prostate Cancer
Multiple Myeloma
Colo-rectal
Lymphoma
•
•
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•
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Brain Mets
Bone Mets
Hypercalcemia
Chord Compression
SVC Syndrome
Hemoptysis
Common Non Cyto-toxic Cancer Meds
• Steroids
• Biphosphanates
Prostate Cancer
• Androgen Deprivation
– LHRH agonists
– Anti androgens
• Taxanes
• Crizotnib
Breast Cancer
• Hormonal Therapy
– Tamoxifen
– Aromatase Inhibitors
• Her-2 Receptivity
– Trastuzamab
– Lapatnib
• Cyto-toxics
– Taxanes
Colon Cancer
• VEGF-Bevacizumab
• EGFR
– Cetuximab
– Pantiumumab
• Cyto-toxics
– 5-FU
– Capecitabin
Non Small Cell Lung Cancer
•
•
•
•
Pemetrexed
Taxanes
Erlotnib
Bevacizumab
Small Cell Lung Cancer
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•
•
Platinum
Etoboside
Topotecan-Salvage
Whole Brain RT
Pancreatic Cancer
• Gemcitabine
• Erlotnib
Multiple Myeloma
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•
•
•
Lenalidomide
Bortezomib
Chlorambucil
Pulse Decadron
Ovarian Cancer
• Platinum
• Taxane
Non Hodgkin Lymphoma
• Rituxamab-CD 20 +
• Cytoxan
Renal Cancer
• Sorafanib
• Sunitnib