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High-dose chemotherapy (HDC) is a regimen of chemotherapy medicines given at larger dosages. This therapeutic strategy is used to treat some cancers, especially those that are aggressive or have a high chance of coming back. With increased doses of chemotherapy chemicals administered to the body, HDC seeks to optimize the death of cancer cells.
It was promoted as a treatment for advanced breast cancer starting in the 1980s. [3] The treatment of high-dose chemotherapy with autologous bone marrow transplant had serious, lasting, and sometimes deadly side effects for the patient, including cardiac toxicity, sepsis, pulmonary failure, and nephrotoxicity, among others.
Cancer cells can also cause defects in the cellular pathways of apoptosis (programmed cell death). As most chemotherapy drugs kill cancer cells in this manner, defective apoptosis allows survival of these cells, making them resistant. Many chemotherapy drugs also cause DNA damage, which can be repaired by enzymes in the cell that carry out DNA ...
[12] [25] As with all chemotherapy, adverse effects are common, and many side effects have been documented. [17] [19] Because docetaxel is a cell-cycle-specific agent, it is cytotoxic to all dividing cells in the body. [26] This includes tumour cells as well as hair follicles, bone marrow and other germ cells.
Patients receiving these agents experienced severe side-effects that limited the doses which could be administered, and hence limited the beneficial effects. Clinical investigators realized that the ability to manage these toxicities was crucial to the success of cancer chemotherapy. Several examples are noteworthy.
Palliative chemotherapy is used to control (but not cure) the cancer in settings in which the cancer has spread beyond the breast and localized lymph nodes. See metastatic breast cancer. Combined therapies These combine, for example, non-drug treatments with localized chemotherapy to limit toxicity and achieve better results. [3]
Bone marrow suppression is a serious side effect of chemotherapy and certain drugs affecting the immune system such as azathioprine. [2] The risk is especially high in cytotoxic chemotherapy for leukemia. In the case of non-small-cell lung cancer, myelosuppression predisposition was shown to be modulated by enhancer mutations. [3]
The majority of drugs used in cancer chemotherapy are cytostatic, many via cytotoxicity. A fundamental philosophy of medical oncology , including combination chemotherapy, is that different drugs work through different mechanisms, and that the results of using multiple drugs will be synergistic to some extent.