Hypoxic Cell Sensitizers and H&N Radiotherapy http://isocentre.wikidot.com/forum/t-263546/hypoxic-cell-sensitizers-and-h-n-radiotherapy Posts in the discussion thread "Hypoxic Cell Sensitizers and H&N Radiotherapy" Fri, 15 May 2026 17:04:33 +0000 http://isocentre.wikidot.com/forum/t-263546#post-868355 Re: Hypoxic Cell Sensitizers and H&N Radiotherapy http://isocentre.wikidot.com/forum/t-263546/hypoxic-cell-sensitizers-and-h-n-radiotherapy#post-868355 Thu, 09 Sep 2010 03:41:07 +0000 radtuxabhishek 495857 I had been thinking about following points of discussion:

1) Altered Fractionation is not feasible in India for one major reason- logistics. Although, I'd love to dedicate a single machine solely for this purpose.

2) There is a compelling rationale for combining bioreductive drugs with Radiation most suitably Tirapazamine which undergoes activation under hypoxic conditions and whereby it is lethal at the same time. Unfortunately, the recently concluded Phase III trial with the same drug and XRT in head and neck failed to show any conclusive benefit. (http://www.ncbi.nlm.nih.gov/pubmed/20479425). I don't have access to full length article in JCO so would not be able to comment on it's merits or demerits.

3) Is there ANY case for combining the two drugs- Nimorazole and Tirapazamine since both of them have DIFFERENT mechanisms of action? I am not aware of any such thought process though.

4) Since hypoxia is a known marker for aggressiveness of tumor including it's metastatic potential, should the future trials incorporate "metastasis free survival" as one of the end points (although I am not sure how would it really impact another metric of "overall survival").

5) Chemoradiation is a fancy concept, in my opinion, but unfortunately, as mentioned above, it is the "standard" that needs to be addressed before it can be claimed that Nimo/Tira combination or alone with altered fractionation is definitely superior in terms of improving survival.

@ Santam Sir. I have been experimenting with my new toy having Android. It's awesome concept; brilliant execution. That has been keeping me away from here :-( but not for long!

]]> http://isocentre.wikidot.com/forum/t-263546#post-867768 Re: Hypoxic Cell Sensitizers and H&N Radiotherapy http://isocentre.wikidot.com/forum/t-263546/hypoxic-cell-sensitizers-and-h-n-radiotherapy#post-867768 Wed, 08 Sep 2010 14:40:37 +0000 Santam Chakraborty 416676 I think the rationale is to build up on the results of the Acc RT trial by IAEA.. In resource poor setting concurrent chemoradiation is not as straightforward. I believe they will build up to a concurrent CRT vs Nim + RT trial if Nim proves superior in these settings later on

]]> http://isocentre.wikidot.com/forum/t-263546#post-867643 Re: Hypoxic Cell Sensitizers and H&N Radiotherapy http://isocentre.wikidot.com/forum/t-263546/hypoxic-cell-sensitizers-and-h-n-radiotherapy#post-867643 Wed, 08 Sep 2010 10:59:03 +0000 Rohit Malde 418807 Its a surprising randomisation between Acc RT ( 6 d/ week) Vs Nimorazole + RT

In this modern era, not having a concomitant ChemoRT arm with Platinum would just not be acceptable in the international community.

Surpisingly IAEA are proposing this trial as a resource sparing strategy while maximising the theraupeutic efficacy.

]]> http://isocentre.wikidot.com/forum/t-263546#post-867206 Re: Hypoxic Cell Sensitizers and H&N Radiotherapy http://isocentre.wikidot.com/forum/t-263546/hypoxic-cell-sensitizers-and-h-n-radiotherapy#post-867206 Wed, 08 Sep 2010 02:36:22 +0000 Santam Chakraborty 416676 Hi Abhishek,
Jens and IAEA are going to plan a multicentre international trial using Nimorazole. I know as PGI is in the list of the institutions. The drug is being licensed for use in India. I am sure you will see it here within a couple of years
Santam

]]> http://isocentre.wikidot.com/forum/t-263546#post-866701 Re: Hypoxic Cell Sensitizers and H&N Radiotherapy http://isocentre.wikidot.com/forum/t-263546/hypoxic-cell-sensitizers-and-h-n-radiotherapy#post-866701 Tue, 07 Sep 2010 16:56:43 +0000 Rohit Malde 418807 Jens overgaard had gifted TMH with Nimorazole in early 1990s for use in H & N cancers.
Unfortuately, Nimoroazle is an orphan drug and no major pharmaceutical company has bought this drug / manufacturing unit in Denmark.

The small manufacturing unit has not really looked at the international market, and there are problems with customs getting this drug across the world, from a legal pin of view… which no oncologist/hospital is prepared to go through.

Time and again, various review articles have blamed the oncology community for not exploring this wonderful therapeutic potential, such that interest in Nimorazole is nearly lost as we look forward to newer drugs.

There is a myth , if that if there is a cheap drug … the results will also be cheap
If the drug is really expensive, it must be good and effective
Thats how pharmaceutical industry works via marketing and experts talk about newer and expensive drug all the time.
All in the name of research.

]]> http://isocentre.wikidot.com/forum/t-263546#post-866510 Hypoxic Cell Sensitizers and H&N Radiotherapy http://isocentre.wikidot.com/forum/t-263546/hypoxic-cell-sensitizers-and-h-n-radiotherapy#post-866510 Tue, 07 Sep 2010 12:33:17 +0000 radtuxabhishek 495857 For all the benefits of using hypoxic cell sensitizers, I do fail to understand why it is not being followed except in Denmark! Theoretically it is sound, technically feasible and we have a strong evidence in form a Phase III trial (DAHANCA 6& 7).

Seminars in Radiation Oncology has a lovely issue on Hypoxia (http://www.semradonc.com/issues/contents?issue_key=S1053-4296(00)X0016-1).

What is the opinion of the house- for or against?

Has anyone practised it? Where have you sourced Nimorazole (or any other drug) from?

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