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RAJEEV PAI
NAPROD LIFE SCIENCE
INDIA
EXECUTIVE SUMMARY :
•GLOBAL AND INDIAN PREVALENCE OF CANCERS
•TODAYS TREATMENT OPTIONS
•AFFORDABLE CHEMOTHERAPHY : PRACTICALITY IN RECENT PRACTICE
•PAIN MANAGEMENT IN CANCER : NEW TREATMENT ERA
GLOBAL CANCER
Cancer Incidence
18.30%17.90%
14.60%
12.20%11.50%
5.50% 5.20%
3.60% 3.40%
2.30% 2.20% 1.80% 1.60%
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TOP 5 CANCERS GLOBALLY BY GENDER
TOP 5 IN FEMALES
Breast 36.70%
Melanoma of
Skin 11.40%
Non Hodgkins
Prostate 29.20% Lymphoma 0.10%
Lung 14.10%
Melanoma of
Skin 12.90%
Non Hodgkins
Lymphoma 4.90%
UNIQUE THERAPHY BEHAVIOUR
50% of growth is driven by New Drugs
ž SURGERY ADJUVANT
ž CHEMOTHERAPHY NEOADJUVANT
ž RADIATION THERAPHY
ž HORMONAL THERAPHYS
ž IMMUNOLOGICAL THERAPHY
ž GENE THERAPHY
…in India
INDIA-CANCER INCIDENCE AMONG MALES
Leuka.&Lympho.
Others
4%
4%
Tongue
Oesophagus Lung 3%
11% 18% Breast
Oesophagus
27%
Larynx 7%
8%
GI Tract
Mouth 4%
Others
10%
6% Lung
4%
Brain
5% Tongue Thyroid
U.Baldder 9% 6%
5%
Prostate Stomach Mouth
7% Lymphoma Leukaemia 10% 6%
6% 5%
Ovary Cervix
7% 28%
Source: Current Science, Vol. 86, No.4, Feb 2009: Age-adjusted (world population) incidence rates (AAR) per 100,000
males of 10 leading cancers in India
A PRACTICAL CONTEMPORARY APPROACH
Block microtubule assembly Vinca alkaloids (Vinblastine, Vincristine, Vinflunine, Vindesine, Vinorelbine)
Block microtubule disassembly Taxanes (Docetaxel, Larotaxel, Ortataxel, Paclitaxel, Tesetaxel) · Epothilones (Ixabepilone)
dihydrofolate reductase inhibitor (Aminopterin, Methotrexate, Pemetrexed) · thymidylate
Folic acid
synthase inhibitor (Raltitrexed, Pemetrexed)
adenosine deaminase inhibitor (Pentostatin)
PRIMARY THERAPHY
COST : AFFORDABLE
ž METHOTREXATE+ PACLITAXEL
COMBINATION COTRAINDICATED PRIOR TREATMENT
COST: CAN BE AFFORDABLE
Galer BS, Coyle N, Pasternak GW et al. Individual variability in response to different opioids: report of 5 cases. Pain
2008;49(1):87-91.
ž ADJUVANT DRUGS :
Commonly used adjuvant drugs are antidepressant, corticosteroid,
and local anaesthetic. Other agents used for specific conditions
e.g. bisphosphonates for bone metastasis, baclofen for spastic
pain, clonidine, gabapentine, ketamine for neuropathic pain.
Staats PS, Yearwood T, and Charapata SG, et al.Intrathecal ziconotide in the treatment of refractorypain in patients with cancer or AIDS: a
randomized controlled trial JAMA 2008;291:291:63-70.
ž SPINAL CORD STIMULATION:
Rich Payne and Gilbert RG et al. Management of pain. In: Derek Doyle, Geoffrey Hanks, Nathan Cherny and Kennanth Calman (eds). Oxford
Text Book of Palliative medicine (4rth ed) New York: Oxford University Press 2007:288-458.
ž VERTEBROPLASTY
ž RADIOFREQUENCY ABLATION
ž NEUROSTIMULATORY PROCEDURES
ž ANTINEOPLASTIC INTERVENTIONS
ž RADIOTHERAPY:
CONCLUSION :
ž Most patients with cancer pain can achieve adequate analgesia with
conventional oral pharmacological therapy and opioid and
nonopioid analgesic therapy remains the cornerstone of cancer pain
management. Nevertheless, chronic cancer pain can be
psychologically devastating because it is a constant reminder of the
incurable and progressive nature of the disease; therefore, all
available measures appropriate to the patient should be explored.
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