제 7장. 비뇨기계 항암제 사용법 - 편집 역사

Sjlee: /* Castration resistant prostate cancer */

2019-05-23T03:09:29Z

Castration resistant prostate cancer

Sjlee: /* Androgen deprivation therapy */

2019-05-23T03:06:48Z

Androgen deprivation therapy

Sjlee: /* Advanced Bladder Cancer (upper tract urothelial cancer도 같다.) */

2019-05-23T03:05:57Z

Advanced Bladder Cancer (upper tract urothelial cancer도 같다.)

Sjlee: /* 각론 */

2019-05-23T03:02:29Z

각론

차이 보기

Sjlee: /* Leucogen (GM-CSF) 투여 */

2019-05-23T02:44:12Z

Leucogen (GM-CSF) 투여

Sjlee: /* IV 투여 및 Nutrition */

2019-05-23T02:43:20Z

IV 투여 및 Nutrition

Sjlee: /* IV 투여 및 Nutrition */

2019-05-23T02:43:10Z

IV 투여 및 Nutrition

Sjlee: /* Nausea & Vomiting control */

2019-05-23T02:42:53Z

Nausea & Vomiting control

Sjlee: /* Nausea & Vomiting control */

2019-05-23T02:42:37Z

Nausea & Vomiting control

Sjlee: /* Nausea & Vomiting control */

2019-05-23T02:42:12Z

Nausea & Vomiting control

@@ 563번째 줄: / 563번째 줄: @@
 ) CRPC without Symptom or minimal Symptom
+:(1) Observation
-(1) Observation
+:(2) 2nd hormonal Tx
+:- Ketoconazole: 200mg tid+prednisolone 5mg bid
-(2) 2nd hormonal Tx
+::그외 Alternative antiandrogen, High dose antiandrogen, Estrogen, Glucocorticoid 등이 있음.
 ) CRPC with Symptom
+:(1) Docetaxel+prednisolone
-(1) Docetaxel+prednisolone
+::Docetaxel 75mg/m2+P/S 200ml IV for 1hr Day1+PRD 5mg bid po q 3wks
+::RR: 70% (PR: 38%, CR: 32%), median survival: 12.7 mo response rate of reduction in PSA 45%
-Docetaxel 75mg/m2+P/S 200ml IV for 1hr Day1+PRD
+::- Ref) NEJM 2004;351:1502-1512
 <nowiki>**</nowiki> Docetaxel 투여시 전처치 및 주의사항
+:- Prevention of hypersensitive reaction
 ) dexamethasone 20mg iv before 30min of chemotherapy(Day1)
 ) dexamethasone (8mg orally twice daily, Day 2-3)
+:steroid 전처치: hypersensitivity 감소, fluid retention 감소, asthenia 감소
 ) pheniramine 1x iv
@@ 601번째 줄: / 587번째 줄: @@
 ) 20% dose reduction:
+:prolonged grade 4 neutropenia (>7days)
-prolonged grade 4 neutropenia (>7days)
+:grade 4 thrombocytopenia
+:grade ≥2 liver toxicity
-grade 4 thrombocytopenia
+:grade ≥3 diarrhea
+:grade ≥3 cutaneous toxicity
 ) Discontinue
+:grade > 2 renal toxicity: Clcr < 60ml/min
-grade > 2 renal toxicity: Clcr < 60ml/min
+:grade 3 liver toxicity
+:grade ≥ 3 neuropathy
-grade 3 liver toxicity
+:grade 4 cutaneous toxicity
+:grade 3 anaphylactoid reaction
 <nowiki>*</nowiki> Docetaxel chemoTx 예시 (OPD)
-. Prehydration P/S 500cc (300cc/hr)
+:1. Prehydration P/S 500cc (300cc/hr)
+:2. dexamethasone 10mg iv
-. dexamethasone 10mg iv
+:3. metoclopramide 10mg iv
+:4. chemo
-. metoclopramide 10mg iv
+::Docetaxel 75mg/m2+P/S 200cc (200cc/hr)
+:5. posthydration P/S 500cc (300cc/hr)
-. chemo
+:6. med) solondo (prednisolone) 5mg bid for 21days PRN med
+:(2) Mitoxantrone+prednisolone (이 regimen은 pain palliation이 목적임.)
-Docetaxel 75mg/m2+P/S 200cc (200cc/hr)
+::Mitoxantrone (Mitron) 12mg/m2+P/S 100ml IV Day1+PRD 5mg BID for 21days
+::Ref> JCO 1996;14:1756
 <nowiki>**</nowiki> 새로운 약제들
 ) Abiraterone acetate, androgen synthesis inhibitor (CYP 17 inhibitor)- CRPC, docetaxel 사용 전, 혹은 후 Abiraterone acetate 1,000mg once a day+prednisolone 5mg bid
+:OS: 14.8 month PFS: 5.6 month
-OS: 14.8 month PFS: 5.6 month
+:Ref> NEJM 2011;364:1995, 2013;368;138
 ) Enzalutamide (MDV 3,100), New androgen receptor inhibitors - CRPC, docetaxel fail 후에 Enzalutamide 160mg once a day
+:OS: 18.4 month
-OS: 18.4 month
+:Ref> NEJM 2012;367:1187
 ) Cabazitaxel- CRPC, docetaxel fail 후
-Cabazitaxel 25mg/m2 iv over 1hr every 3weeks+prednisolone 5mg bid
+:Cabazitaxel 25mg/m2 iv over 1hr every 3weeks+prednisolone 5mg bid
+:OS: 15.1 month, PFS: 2.8 month
-OS: 15.1 month, PFS: 2.8 month
+:Ref> Lancet 2010;376:1147
 <nowiki>**</nowiki> Spinal cord compression
+:Dexamethsone 10mg loading after 4mg q 6hr+RT
 ==Germ Cell Tumor==

@@ 530번째 줄: / 530번째 줄: @@
 ) Bilateral orchiectomy
-<nowiki>:</nowiki> Within 24hours of surgical castration, testosterone levels are reduced by more than 90%
+:<nowiki>:</nowiki> Within 24hours of surgical castration, testosterone levels are reduced by more than 90%
 ) Inhibition of LHRH
-(1) LHRH agonist
+:(1) LHRH agonist
+:synthetic analogs of native LHRH
-synthetic analogs of native LHRH
+:initial exposure to agonists of LHRH results in a flare of LH testosterone levels
+:<nowiki>:</nowiki> known as the ‘testosterone surge’ or ‘flare up’ phenomenon (begins within 2-3days of the first injection and lasts through approximately the first week of therapy)
-initial exposure to agonists of LHRH results in a flare of LH testosterone levels
+:<nowiki>:</nowiki> result in a severe, life-threatening exacerbation of symptoms
+:→ co-administration of an antiandrogen (for only 21-28 days)
-<nowiki>:</nowiki> known as the ‘testosterone surge’ or ‘flare up’ phenomenon (begins within 2-3days of the first injection and lasts through approximately the first week of therapy)
+:Goserelin acetate (Zoladex): 3.6mg sc monthly
+:Leuprorelin acetate (Leuplin): 3.75mg sc monthly
-<nowiki>:</nowiki> result in a severe, life-threatening exacerbation of symptoms
+:Leuprolide acetate: 7.5mg sc monthly
 ) Antiandrogens
+:Compete with testosterone and DHT for binding sites on their receptors in the prostate cell nucleus: promoting apoptosis and inhibiting prostate cancer growth
-Compete with testosterone and DHT for binding sites on their receptors in the prostate cell nucleus: promoting apoptosis and inhibiting prostate cancer growth
+:- Steroidal antiandrogens
+:<nowiki>:</nowiki> Cyproterone Acetate, Megesterol acetate, medroxyprogesterone acetate
-- Steroidal antiandrogens
+:- Non-steroidal or pure antiandrogen
+:<nowiki>:</nowiki> Flutamide (250mg tid), bicalutamide (50mg po daily), nilutamide (150mg daily)
 ) Antiandrogen withdrawal phenomenon
-정의: experience a decline in PSA level, objective
+:정의: experience a decline in PSA level, objective
+:responses with the withdrawal of the antiandrogen from the combination with LHRH agonist
-responses with the withdrawal of the antiandrogen from the combination with LHRH agonist
+:- Declines in PSA level are seen
+:→ within 4weeks with flutamide withdrawal
-- Declines in PSA level are seen
+:→ within 6weeks with bicalutamide, nilutamide withdrawal
+:- Declines in PSA level of more than 50% (15-30%), and median duration of 3.5-5months
 ===Castration resistant prostate cancer===

@@ 488번째 줄: / 488번째 줄: @@
 :(2) 환자가 75세 이상이거나 PS score 1 이상시 GC 모두 80%로 시작하는 것이 좋음 (Cisplatin은 GFR 계산하여야함) → 그 후 위에서 언급한 문제가 발생하였다면 70%로 감량하여 사용
 :(3) 용량을 감량하였음에도 불구하고 toxicity를 보인다면 8일째를 10일째로 옮기고 15일째를 17일째로 옮긴다 (그러나 28일 주기는 맞춰야 한다.).
-:JCO 2000;17:3068-3077
+:JCO 2000;17:3068-3077 * Gemcitabine+Cisplatin chemoTx 예시
 :D1
 :1. Check V/S 8hr
@@ 531번째 줄: / 530번째 줄: @@
 ) Bilateral orchiectomy
-: Within 24hours of surgical castration, testosterone levels are reduced by more than 90%
+<nowiki>:</nowiki> Within 24hours of surgical castration, testosterone levels are reduced by more than 90%
 ) Inhibition of LHRH
@@ 541번째 줄: / 540번째 줄: @@
 initial exposure to agonists of LHRH results in a flare of LH testosterone levels
-: known as the ‘testosterone surge’ or ‘flare up’ phenomenon (begins within 2-3days of the first injection and lasts through approximately the first week of therapy)
+<nowiki>:</nowiki> known as the ‘testosterone surge’ or ‘flare up’ phenomenon (begins within 2-3days of the first injection and lasts through approximately the first week of therapy)
-: result in a severe, life-threatening exacerbation of symptoms
+<nowiki>:</nowiki> result in a severe, life-threatening exacerbation of symptoms
 → co-administration of an antiandrogen (for only 21-28 days)
@@ 559번째 줄: / 558번째 줄: @@
 - Steroidal antiandrogens
-: Cyproterone Acetate, Megesterol acetate, medroxyprogesterone acetate
+<nowiki>:</nowiki> Cyproterone Acetate, Megesterol acetate, medroxyprogesterone acetate
 - Non-steroidal or pure antiandrogen
-: Flutamide (250mg tid), bicalutamide (50mg po daily), nilutamide (150mg daily)
+<nowiki>:</nowiki> Flutamide (250mg tid), bicalutamide (50mg po daily), nilutamide (150mg daily)
 ) Antiandrogen withdrawal phenomenon
@@ 603번째 줄: / 602번째 줄: @@
 - Ref) NEJM 2004;351:1502-1512
-** Docetaxel 투여시 전처치 및 주의사항
+<nowiki>**</nowiki> Docetaxel 투여시 전처치 및 주의사항
 - Prevention of hypersensitive reaction
@@ 643번째 줄: / 642번째 줄: @@
 grade 3 anaphylactoid reaction
-* Docetaxel chemoTx 예시 (OPD)
+<nowiki>*</nowiki> Docetaxel chemoTx 예시 (OPD)
 . Prehydration P/S 500cc (300cc/hr)
@@ 665번째 줄: / 664번째 줄: @@
 Ref> JCO 1996;14:1756
-** 새로운 약제들
+<nowiki>**</nowiki> 새로운 약제들
 ) Abiraterone acetate, androgen synthesis inhibitor (CYP 17 inhibitor)- CRPC, docetaxel 사용 전, 혹은 후 Abiraterone acetate 1,000mg once a day+prednisolone 5mg bid
@@ 687번째 줄: / 686번째 줄: @@
 Ref> Lancet 2010;376:1147
-** Spinal cord compression
+<nowiki>**</nowiki> Spinal cord compression
 Dexamethsone 10mg loading after 4mg q 6hr+RT
 ==Germ Cell Tumor==
+<nowiki>**</nowiki> 분류
 Nonseminomatous GCT:

@@ 395번째 줄: / 395번째 줄: @@
 == Leucogen (GM-CSF) 투여 ==
-. Indication: granulocytopenia (<1,000)
+'''1. Indication: granulocytopenia (<1,000)'''
-. Use: a. Leucogen (GM-CSF)-400ug/sc 는 호중구수가 1,000개 이하일 때 보험이 인정되며 모두 10회까지 인정하게 된다.
+'''2. Use: a. Leucogen (GM-CSF)-400ug/sc 는 호중구수가 1,000개 이하일 때 보험이 인정되며''' 모두 10회까지 인정하게 된다.
-.side effect: 발열, 오한, 두통 등이 발생할 수 있으므로 투여 30분에서 1시간전에서 AAP 2T
+'''3. side effect: 발열, 오한, 두통 등이 발생할 수 있으므로 투여 30분에서 1시간전에서 AAP 2T'''
 <nowiki>#</nowiki> OD PO를 처방하기도 한다.
-.투여 후 Daily CBC check
+'''4. 투여 후 Daily CBC check'''
-.부작용이 심하여 계속 투여하기가 어려운 경우는 Gracin (G-CSF)로 change함.
+'''5.부작용이 심하여 계속 투여하기가 어려운 경우는 Gracin (G-CSF)로 change함.'''
-*. leucogen은 solid cancer에만 보험 인정되며, Gracin은 hematologic malignancy에만 보험 인정된다.
+<nowiki>*</nowiki>. leucogen은 solid cancer에만 보험 인정되며, Gracin은 hematologic malignancy에만 보험 인정된다.
 == 반응 평가 및 F/U 시의 검사 ==

@@ 311번째 줄: / 311번째 줄: @@
 :- bolus투여의 경우: 어떤 약제이든 최소 3분이상, 5ml/min (60gtt)이하의 속도로 투여해야 한다.
-:cf) continous infusion: 정확한 시간을 지키기 위해서는 infusion pump를 사용할 것, 특히 24시간 continuous infusion시에는 총 투여기간이 늘어 지지 않도록 매일
+:cf) continous infusion: 정확한 시간을 지키기 위해서는 infusion pump를 사용할 것, 특히 24시간 continuous infusion시에는 총 투여기간이 늘어 지지 않도록 매일 같은 시간에 교체하도록 할 것.
 ) Nutrition에 대한 처치

@@ 310번째 줄: / 310번째 줄: @@
 ) IV 투여 속도의 조절
-- bolus투여의 경우: 어떤 약제이든 최소 3분이상, 5ml/min (60gtt)이하의 속도로 투여해야 한다.
+:- bolus투여의 경우: 어떤 약제이든 최소 3분이상, 5ml/min (60gtt)이하의 속도로 투여해야 한다.
+:cf) continous infusion: 정확한 시간을 지키기 위해서는 infusion pump를 사용할 것, 특히 24시간 continuous infusion시에는 총 투여기간이 늘어 지지 않도록 매일
 같은 시간에 교체하도록 할 것.
@@ 327번째 줄: / 326번째 줄: @@
 ::짝수날 IVH3 1,000ml+Intralipose 500ml+newcare 2can
 ::홀수날 IVH3 1,000ml+20%DW 1,000ml+newcare 2can
 ::(cf. IVH3에는 cafsol 포함되어 있음.)
 === 비뇨기계 암 항암제의 독성 ===

@@ 292번째 줄: / 292번째 줄: @@
 |Dexa 10mg IV/p.o
 |}
-(2) Moderate emetogenetics (30-90%) (e.g Prostate cancer 시 Mitoxantrone+PD chemo)
+:(2) Moderate emetogenetics (30-90%) (e.g Prostate cancer 시 Mitoxantrone+PD chemo)
 {| class="wikitable"
 !Day1

@@ 264번째 줄: / 264번째 줄: @@
 ::Metochlopramide
-② Delayed
+:② Delayed
-::- chemoTx 24-72시간 이후
+:- chemoTx 24-72시간 이후
-::Emend (aprepitant)
+:Emend (aprepitant)
 ) Antiemetics order내기

@@ 247번째 줄: / 247번째 줄: @@
 antibodies, bleomycin, and vinblastine
-:1) Anticipatory emesis
+) Anticipatory emesis
-::① chemotherapy 24시간 전에 발생: psychologic mechanism 관여
+:① chemotherapy 24시간 전에 발생: psychologic mechanism 관여
-::② 치료: Lorazepam 0.5-1.5mg 2-3일전부터 투여
+:② 치료: Lorazepam 0.5-1.5mg 2-3일전부터 투여
-:2) 발생 시간에 따른 분류
+) 발생 시간에 따른 분류
-::① acute chemotherapy induced emesis
+:① acute chemotherapy induced emesis
-::- chemoTx 1-2hr후에 발생
+:- chemoTx 1-2hr후에 발생
-::- 5HT3 antagonist:
+:- 5HT3 antagonist:
-:::Kytril (Granisetron): 3mg IV or 2mg PO, Zofran
+::Kytril (Granisetron): 3mg IV or 2mg PO, Zofran
-:::(Ondansetron): 8mg IV or 16mg PO,
+::(Ondansetron): 8mg IV or 16mg PO,
-:::Anzemet (Dolesetron): 100mg IV or PO, Navoban
+::Anzemet (Dolesetron): 100mg IV or PO, Navoban
-:::(Tropisetron): 5mg IV & 5days PO
+::(Tropisetron): 5mg IV & 5days PO
-:::Aloxi (Palonosetron): 0.25mg IV 1회
+::Aloxi (Palonosetron): 0.25mg IV 1회
-:::Dexamethasone 20mg IV
+::Dexamethasone 20mg IV
-:::Metochlopramide
+::Metochlopramide
-:"② Delayed
+② Delayed
-:::- chemoTx 24-72시간 이후
+::- chemoTx 24-72시간 이후
-:::Emend (aprepitant)
+::Emend (aprepitant)
 ) Antiemetics order내기