Key Topics

• • Introduction
• • Chemotherapy
• • Hormone therapy
• • Biological therapy
• • Transplants
• • Bisphosphonates
• • Other treatments

Learning Objectives

• • To be familiar with the various therapeutic agents used in the management of cancer
• • To be aware of the various oral adverse effects related to anti neoplastic treatments
• • To understand the role of the dentist during cancer treatment

Introduction

A neoplasm is a new and abnormal growth of cells. A malignant neoplasm, more commonly known as cancer, has the potential to invade and spread throughout the body.

Management of cancer has traditionally focused on a trio of potential treatments including chemotherapy, surgery and radiotherapy; however, the area of antineoplastic therapeutics is rapidly progressing. Advanced new treatments are being developed to direct treatments in a more defined way. These include hormone therapies, biological therapies and bisphosphonates.

The number of patients surviving and living with cancer is increasing and many of these patients will be under the care of the oncology team and may be prescribed long-term antineoplastic therapies. The traditional intravenous inpatient ‘chemotherapy’ is still an important part of cancer management. However, a number of new medications for cancer now allow patients to self-administer treatments at home. These patients may not think of their medications as ‘chemotherapy’ especially those patients on oral tablet treatment, however it is essential that dentists are fully aware of all the drugs the patient may be taking due to the potential impact on oral health and interactions with dental prescribing.

This chapter will give a brief overview of the currently known therapeutics available for cancer (Table 22.1).

Chemotherapy (cytotoxic therapeutics)

Chemotherapy literally translated means treatment with drugs, but in cancer, chemotherapy describes the use of cytotoxic treatments. There are over 100 different cytotoxic drugs available for cancer treatment. Patients can be treated with both individual and combination regimes.

There are a number of generic side effects that are commonly associated with cytotoxic drugs. These are listed in Table 22.2.

These side effects, in turn, may be managed by a range of specific agents, for example, folinic acid is used to counter the effects of methotrexate which is a folic acid antagonist (see Table 22.3).

Cytotoxic therapeutics can be divided into the drug types shown in Table 22.4.

Alkylating drugs

These are the most commonly used cytotoxic drugs. They work by causing damage to the DNA within the cell which stops the cell from replicating. The main action is on rapidly proliferating cells leading to a depletion of B and T cell lymphocytes and suppression of both cell-mediated immunity and antibody production.

The main problems encountered with prolonged use of this group of drugs are teratogenicity and an increase in the incidence of acute non-lymphoblastic leukaemia (especially when treatment is combined with radiotherapy). The more common alkylating drugs are shown in Table 22.5. Cisplatin, an alkylating-like drug, is particularly used in testicular and ovarian cancers.