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Anti-cancer Treatments

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Learn about the different treatments

Anti-cancer chemotherapies, also known as cytotoxic chemotherapies, are drugs designed to kill cancer cells or prevent their proliferation. They act through various mechanisms of action.

Chemotherapies can also affect healthy cells (blood cells, digestive tract cells, or those responsible for hair, fur, and nails). This is the cause of their side effects:

Weakened immune system – A weakened immune system (low white blood cell count) makes infections more frequent: fever (over 38.3°C / 101°F), chills, cough, or signs of a urinary tract infection…

Anemia – A low red blood cell count can cause fatigue, paleness, shortness of breath, and palpitations.

Digestive issues – Nausea, vomiting, constipation, diarrhea…

Hair loss – Loss of hair and body hair

 

  • They can integrate into DNA by mimicking compounds necessary for its formation, or directly inhibit the production of these essential components (antimetabolites). As a result, the DNA can no longer enable cell reproduction.
  • Others can alter the structure of DNA, also resulting in cell death (topoisomerase inhibitors).
  • Some interfere with DNA replication by forming cross-links that prevent the DNA strands from opening, leading to cell death (alkylating agents).

  • Finally, others inhibit the formation of fibers (called mitotic spindles) that allow the separation of DNA strands during cell division. These agents are known as mitotic spindle poisons. The cell then detects the division anomaly and consequently undergoes self-destruction.

Chemotherapies act on cell division and are particularly effective against rapidly dividing cells, such as cancer cells.

Targeted therapies can focus on specific molecules found either on the surface of cancer cells or inside these cells.

How targeted therapies work

To treat acute leukemias, therapies can target molecules on the surface of cancer cells. Recognizing and targeting these molecules is the role of antibodies.

Some antibodies, called antibody-drug conjugates, act like a Trojan horse: they enter the target cell and release chemotherapy that acts on the DNA of the cancer cell. This is the case with Gemtuzumab Ozogamicin for acute myeloid leukemia (AML) and Inotuzumab Ozogamicin for acute lymphoblastic leukemia (ALL).

Other anti-cancer antibodies, called immunotherapies, help “call in” the immune system cells. This is the case with Rituximab, Daratumumab, and Isatuximab. Some immunotherapies do more than just “raise the alarm”; they create a direct bridge between the cancer cell and immune cells. This is the case with Blinatumomab.

Tyrosine kinase inhibitors act like keys that chemically “lock” certain molecules (tyrosine kinases). Under normal conditions, these tyrosine kinases provide instructions for cell proliferation. When abnormalities occur, they can accelerate cell proliferation and lead to cancer. These “keys” can therefore be used to inhibit them.

Alterations in certain genes can sometimes cause bone marrow cells to transform into cancer cells. Two genes, IDH1 and IDH2, then produce harmful proteins. To prevent this, two drugs called IDH inhibitors have been developed: Ivosidenib and Enasidenib. Thanks to these drugs, leukemic cells can revert to healthy cells.

Proteins called Bcl-2 can make cancer cells “immortal” by blocking the cell death process. Venetoclax is a drug designed to inhibit Bcl-2. It helps restore cell death and triggers the self-destruction of leukemic cancer cells.

GEMTUZUMAB OZOGAMYCINE (MYLOTARG)

Gemtuzumab Ozogamicin (GO) is an antibody linked to chemotherapy. It is a form of targeted chemotherapy. It binds to a protein (CD33) on the surface of blasts in acute myeloid leukemia (AML). When GO is attached to the cell surface, it can enter the leukemic cell. Once inside the cell, the antibody delivers the chemotherapy, which can enter the nucleus and attack the DNA.

The administration (infusion) of GO can cause chills, fever, and, more rarely, respiratory symptoms, low blood pressure, or rapid heartbeat. Additionally, although the protein targeted by GO is mainly present on cancer cells, it is not exclusive to them. GO can therefore also affect “healthy” cells.

This can lead to several side effects:

  • Reduced blood cell counts (white or red blood cells)

  • Reduced platelet counts (requires monitoring)

  • Liver problems (requires liver function tests)

Administered intravenously, as an infusion, in combination with induction chemotherapy consisting of Cytarabine and Daunorubicin. The number of doses can vary from one to three, depending on treatment tolerance. This drug can also be given during a relapse in combination with Cytarabine.

INOTUZUMAB OZOGAMYCINE (BESPONSA)

Inotuzumab Ozogamicin (IO) is an antibody linked to chemotherapy. It is therefore a form of targeted chemotherapy. It binds to a protein (CD22) on the surface of blasts in acute lymphoblastic leukemia (ALL). When IO is attached to the cell surface, it can enter the leukemic cell. Once inside, the antibody delivers the chemotherapy, which can enter the nucleus and attack the DNA.

It is administered intravenously, as an infusion.

This drug is offered during a relapse of B-cell acute lymphoblastic leukemia (B-ALL).

The administration (infusion) of IO can cause chills, fever, respiratory symptoms, low blood pressure, or rapid heartbeat. It can also lower your neutrophil and platelet counts. This treatment may also be toxic to the liver; therefore, your liver function will be closely monitored during your hospitalization.

RITUXIMAB (MABTHERA)

Rituximab is an antibody that targets a protein called CD20. This protein is expressed in some B-cell acute lymphoblastic leukemias (B-ALL). It is an immunotherapy because it partly recruits your healthy immune system to act and destroy leukemic cells.

By binding to a cell that has the CD20 protein, Rituximab triggers three mechanisms to destroy it;

  1. Rituximab sends a death signal to the cell.

  2. Rituximab initiates an immune mechanism called the complement system.

  3. Rituximab enables immune cells to attack the cancer cells.

The administration (infusion) of Rituximab can cause fever, chills, respiratory problems, or low blood pressure. The risk of infections is also monitored, as Rituximab can destroy healthy cells of your immune system. If you have previously had the hepatitis B virus, it may reactivate, and treatment will be offered. Finally, in the long term, you may experience a decrease in white blood cells, which requires ongoing monitoring.

This drug is administered intravenously during the first treatment cycle, called induction, and during the subsequent phases, called consolidation.

BLINATUMOMAB (BLYNCYTO)

Blinatumomab is a drug used in B-cell acute lymphoblastic leukemia (B-ALL).
It is an antibody that can both recognize leukemic cells through the CD19 protein on their surface and attach to the CD3 protein on white blood cells called T lymphocytes.
The antibody creates a bridge between the two cells, allowing the T lymphocytes to destroy the diseased cells.

Due to its mechanism of forcing the immune system to act, Blinatumomab can cause a significant inflammatory reaction. Therefore, the first days of administration are always done in the hospital, with monitoring of your temperature, blood pressure, heart rate, and respiratory parameters.

Possible neurological side effects: memory problems, confusion, speech or writing difficulties, or drowsiness. Very rarely: seizures.
An evaluation of your writing and level of consciousness is performed daily in the hospital and also at home by a nurse.

The drug is used after the induction phase of treatment.
Once in the body, it is rapidly eliminated.
Its administration is therefore special: it is given intravenously every day, continuously, for 28 days via a small pump.

You will come for day hospitalization twice a week to change the treatment bag, and you can continue your activities at home for the rest of the time with the pump worn over the shoulder.

TYROSINE KINASE INHIBITORS

Tyrosine kinases are proteins that enable cell multiplication.
In certain cancers, these proteins are overactive or undergo genetic changes, causing uncontrolled cell proliferation.
Tyrosine kinase inhibitors are targeted drugs that block these proteins. This helps stop the proliferation of cancer cells and can even induce their death.

If a specific genetic abnormality is present, known as the Philadelphia chromosome.

Oral administration of Ponatinib.

Side effects: This drug requires close monitoring of the heart and arteries, as it can cause premature aging of these organs.

If the leukemic cells in your AML have FLT3 gene abnormalities (a gene involved in the proliferation of bone marrow cells), several drugs can be prescribed in combination with chemotherapy.

Oral administration of Midostaurin and Quizartinib.
In case of relapse, Gilteritinib may be offered.

Side effects: These drugs require regular monitoring of your electrocardiogram (twice a week), as they can cause disturbances in the heart’s normal electrical activity. They can also sometimes cause digestive problems.

IVOSIDENIB (TIBSOVO)

Blood cells have a gene called IDH1, which provides the energy needed to nourish the cell. In some leukemias, this gene has abnormalities or mutations.

This mutated version of IDH1 leads to the production of a substance that does not exist in normal cells. This substance prevents blood cells from maturing. The blood cells can no longer differentiate and multiply uncontrollably, leading to acute leukemia.

Ivosidenib blocks the mutated version of IDH1, reducing or eliminating the production of the abnormal substance in the diseased cells, thereby slowing the production or even eliminating the cancerous cells.

Ivosidenib is a well-tolerated drug.
Regular monitoring of your electrocardiogram is performed, as it can sometimes cause changes in the heart’s electrical activity.
Possible side effects include fever, breathing difficulties, and weight gain. These symptoms may be related to the effectiveness of the treatment and should be reported to your hematologist.

Orally, daily and continuously.

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