Radioimmunotherapy for the Treatment of Term Paper

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This has been the traditionally used mode of treatment for non-Hodgkin's Lymphomas, but the fact remains that there have not been many clinical trials conducted that would reveal the benefits of CHOP in comparison to various other chemotherapy options for the treatment of CLL, which is a very slowly growing form of cancer and is therefore conversely very difficult to treat and cure because of the fact that all the traditional methods of treatment, whether chemotherapy or radiation, are meant to quickly and rapidly destroy the fast growing cancerous cells. (Cancer Treatment and Prevention)

Curing a patient with the CLL or SLL forms of cancer is considered to be highly unusual, but it is true that these patients will b able to lead productive lives even after 6 to 10 years after the cancer have been diagnosed for them. A patient when he is making the choice of treatment for his type of cancer will generally be for the purpose of improving his symptoms through the localized control of the cancerous cells, or to live longer, or to greatly increase his chances of being cured of this dreaded disease. This would mean that the patient must be able to achieve a fine balance between the potential benefits of receiving the proposed treatment and the potential risks that he would be faced with in his particular choice of the cancer treatment.

As far as CHOP is concerned, a study that was conducted by the French Cooperative Group compared CHOP and Fludara®, and the treatment of CAP, which is that of a combination of Cyclophosphamide, Doxorubicin, and prednisone. It was discovered that for those patients who were treated with CHOP, the chances of clinical remission rates based on molecular analysis were about 30%, and the average time taken for the progression of cancer under CHOP was about 29.5 months, and the symptoms of hair loss and vomiting were higher in CHOP and CAP than in the other forms of treatment. (Cancer Treatment and Prevention)

CHOP is said to have a per-life time limit of only about six to eight treatment cycles and no more, and using this form of treatment is not as guarantee that the transformation to 'diffuse lymphoma' will not occur. It is also said that CHOP and Rituxan - CHOP + R when used together in the treatment for cancer will be able to transform the lethargic as well as the aggressive lymphomas that show CD20. There are a few strategies that would increase the efficacy of the CHOP treatment in cancer patients. These are: the time between treatment cycles may well be decreased so that the patient would be able to receive more number of treatments for his cancer. For example, when a patient undergoes chemotherapy, his white blood cell count will drop significantly. (CHOP - complementary considerations)

When this happens, the patients will not be able to avail of any treatment, and the next round will have to wait until the patient's white blood count is restored to a more normal level, and it is during this time of low blood count that the patient is very prone to infections, and the long delays between one treatment and the next would mean that the malignant cells that were meant to be destroyed by the treatment would make a recovery and come back in full swing. Therefore, it is advocated that the white blood counts of these patients be raised to better levels so that the treatment cycles are not unnecessarily delayed and postponed. CHOP treatment does precisely this, especially in elderly patients. At present, various studies are also being conducted as to whether it is possible to reduce the toxic nature of CHOP to a more bearable level, either by using alternatives or by some other methods. (CHOP - complementary considerations)

Basically, CHOP consists of a combination of the following drugs: Cyclophosphamide, Adriamycin, Vincristine, and Prednisolone, and three of the drugs are administered intravenously, that is, through a vein into the bloodstream, and one drug is given orally, and the patient will be asked to visit the hospital or other place of treatment for a period of three weeks, every week, and up to a maximum of four visits. The known side effects of the treatment are nausea and vomiting, a sore mouth as well as mouth ulcers, bone marrow suppression that in other words means that the process of the manufacture of blood cells within the body will be interrupted, and sometimes, a high fever accompanied by shivering and chills will also be seen. Some other side effects are hair loss, a tingling feeling in the fingers and the toes of the patient, fatigue and extreme tiredness, and sometimes, extravasations, wherein the drug that is being administered intravenously will somehow get displaced and enter the surrounding tissues.

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This is a very painful condition, but can be easily rectified. (CHOP Patient Information Sheet)

What is radioimmunotherapy? Radiotherapy is a therapy in which cytotoxic radionuclides are linked or combined with antibodies so that it would be possible to deliver toxins as necessary to the tumor targets, directly. This type of therapy with targeted radiation rather than with antibody-targeted toxins is definitely better because of the fact that in this method, it would be possible that the adjacent tumor cells, which do not have the appropriate antigenic determinants, would be destroyed by the so-called 'radiation cross-fire'. Radioimmunotherapy is sometimes also referred to as 'targeted radiotherapy'. (Radioimmunotherapy?)

The two different radioimmunotheraphy treatments that are popularly used today for the treatment of non-Hodgkin's lymphoma are those of Zevalin and Bexxar. Let us analyze the facts about Zevalin first. What in fact is Zevalin, and how does it work, what is the process involved in treating a patient with Zevalin, and what is the dosage, how is it administered, and what are the various radiation and safety issues involved in the treatment using Zevalin? Zevalin® or Ibritumomab tiuxetan was in fact the very first radioimmunotheraphy treatment that was approved by the Food and Drug Administration of the United States of America, for the treatment of non-Hodgkin's lymphoma. The types of lymphomas that it has been approved for are as follows: relapsed or refractory low-grade or follicular, or the transformed B-cell non-Hodgkin's lymphoma, and for those patients with follicular non-Hodgkin's lymphoma who are no longer able to respond favorably to the treatment of the drug Rituxan, which is a monoclonal antibody therapy. (Facts on Zevalin: Lymphoma Research Foundation)

The efficacy and the popularity of the treatment of non-Hodgkin's lymphoma with Zevalin lie in the fact that it is very different from the conventional methods of chemotherapy and the external beam radiation therapy. Zevalin also combines cell targeting and cell killing in one package, and this is achieved through a combination of a monoclonal antibody that targets a cell, and a radioactive particle or in other words, a 'radioisotope', called 'yttrium-90' that kills a cell. When Zevalin is used, the treatment for the patient would only last for about a week, and the patient can be an outpatient. This treatment is generally tolerated well by the patient, and the usual side effects that are caused by other traditional treatment, like that of hair loss and nausea and vomiting will not be present. The only side effect that is evident is the loss of blood cell counts in the patient, and in most cases, even this is temporary.

A monoclonal antibody is nothing but an antibody, or in other words a vital component of the human body's immune system that is generally able to recognize and fight against the foreign invaders and germs causing infections and diseases, and these are bacteria and different types of viruses. A monoclonal antibody has the innate capacity to be able to recognize certain specific targets, in other words, antigens that will inevitably be present in particular types of cancerous cells. Among the first few monoclonal antibodies that received the stamp of approval from the FDA was the drug Rituxan. What is especially important about a monoclonal antibody of this type is the fact that this is perhaps the best way in which to specifically target and aim at certain specific types of cancer cells and that too with a very low effect or impact on the other normal cells within the body. (Facts on Zevalin: Lymphoma Research Foundation)

The therapy can be administered to the patient intravenously, when the patient is an outpatient, and this is how it works. When it enters the patient's bloodstream, the antibody is capable of finding its specified target and then attaching itself to that particular cell that has the specific target antigen, and this starts the body's own immunity system on a path of alertness and discovery, due to which the cancer cells that are within the body are targeted and destroyed. Though it is a natural result of the therapy that the specific target antigen will also inevitably affect some normal cells,….....

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