Academic journal article TriQuarterly

Lecture to Second-Year Medical Students

Academic journal article TriQuarterly

Lecture to Second-Year Medical Students

Article excerpt

This morning I'd like to concentrate on the case of a 28-

year-old man with non-Hodgkin's lymphoma treated with the COMLA

regimen, an acronym

for the 5 drugs given intravenously, simultaneously

with radiation. Cytoxan cleaves the DNA similarly to high-intensity radiation.

In fact, the dosage 50 miles from Chernobyl produced a fraction of the cell kill

he received in 10 seconds. It produces nausea in 1 hour, diarrhea

in 1 day, leukopenia and anemia in 1 week, and hair loss in 1 month. Of course

the goal is to kill the vagrant cancer cells with errant

DNA. If we calculate the ratio of cells killed (normal versus cancer), we know

the odds of response for each level of toxicity. Once

we establish his specific tolerance it's possible to balance

competing factors. Then we determine the interim

blood counts, and retreat as soon as recovery is almost complete.

Oncovin causes neurological toxicity with high specificity

for the hands and feet. …

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