Indications of Chemotherapy

Late-stage cancer treatment Palliative or symptomatic treatment in cancer patients Treatment for cancer before and after surgery or radiation therapy Treatment for Lupus and Rheumatoid Arthritis

Classifications of Chemotherapeutic Agents

Alkylating Agents Examples: busulfan( Busufex,Myleran), carboplatin (Paraplatin), Chlorambucil (Leukeran), cisplatin (Platinol-AQ), cyclophosmide (Cytoxan), dacarbazine (DTIC-Dome), hexamethylene amine or altretamine (Hexalen), ifosfamide (Ifex), melphalan (Alkeran), oxaliplatin (Eloxatine), thiotepa (Thioplex) Mechanism of Action Alter DNA structure by misreading DNA code, initiating breaks in the DNA molecule, cross-linking DNA strands Cell cycle nonspecific Common Side effects Bone marrow suppression, nausea, vomiting, cystitis (cyclophosphamide. Ifosfamide), stomatitis, alopecia, gonadal suppression, renal toxicity (cisplatin)

Nitrosoureas Examples: Carmustine , lomustine or CCNU (CeeNU), semustine (Methyl CCNU [MeCCNU]), streptozocin (Zanosar) Mechanism of Action Similar to alkylating agents; cross the blood-brain barrier

Cell cycle- nonspecific Common Side Effects Delayed and cumulative myelosuppression,mespecially thrombocytopenia,nausea, vomiting Topoisomerase I Inhiitors Examples: Irinotecan (Camptosar) Topotecan (Hycamtin)

Mechanism of Action Induce breaks in the DNA strand by binding to enzyme topoisomerase I, preventing cells from dividing Cell cycle- specific (S phase) Common Side Effects Bone marrow suppression, diarrhea, nausea, vomiting, hepatotoxicity

Antimetabolites 5- Azacytadine, capecitabine (Xeloda), cytarabine (Depocyt, Tarabine) edatrexate fludarabine (Fludara), 5-fluorouracil (5-FU), gemcitabine (Gemzar), hydroxyurea (Droxia, Hydrea), cladribine (Leustatin), 6-mecraptopurine (Purinethol), methotrexate (Trexall, Rheumatrex), pentostatin (Nipent), 6-thioguanine (Tabloid) Mechanism of Action Interferes with the biosynthesis of metabolites or nucleic acids necessary for RNA and DNA synthesis Cell cycle- specific (S phase) Common Side Effects Nausea, vomiting, diarrhea, bone marrow suppression, proctitis, stomatitis, renal toxicity (methotrexate), hepatotoxicity Antitumor Antibiotics Examples: Bleomycin (BLM, Blenoxane), dactinomycin (Cosmegen), daunorubicin (DaunoXome), doxorubicin (Adriamycin), idarubicin (Idamycin), mitomycin (Mutamycin), mitoxantrone (Novantrone), plicamycin (Mithracin) Mechanism of Action Interfere with DNA synthesis by binding DNA; prevent RNA synthesis

Cell cycle- nonspecific Common Side Effects Bone marrow suppression,nausea, vomiting, alopecia, anorexia, cardiac toxicity (daunorubicin, doxorubixin)

Mitotic Spindle Poisons Plant Alkaloids Examples: Etoposide (Toposar), teniposide (Vumon), vinblastin (Velban), vincristine (VCR [Oncovin]), vindesine (Eldisine), vinorelbine (Navelbine) Mechanism of Action Arrest metaphase by inhibiting mitotic tubular formation (spindle); inhibit DNA and protein synthesis Cell cycle- specific (M phase) Common Side Effects Bone marrow suppression (mild with VCR), neuropathies (VCR), stomatitis

Taxanes Examples: Paclitaxel (Taxol), docetaxel (Taxotere)

Mechanism of Action Arrest metaphase by inhibiting tublin depolymerization

Cell cycle-specific (M phase) Common Side Effects Bradtcardia, hypersensitivity reactions, bone marrow suppression, alopecia, neuropathies

Hormonal Agents Androgens and antiandrogens, estrogens and antiestrogens, progestins and antiprogestins, aromatase inhibitiors, luteinizing hormone-realeasing hormone analogues, steroids

Mechanism of Action Bind to hormone receptor sites that alter cellular growth; receptor sites (antiestrogens); Inhibits RNA synthesis; suppress aromatase of P450 system, which decreases level Cell cycle- nonspecific Common Side Effects Hypercalemia, jaundice, increased appetite, masculinization, feminization, sodium and fluid retention, nausea, vomiting, hot flashes, vaginal estrogen dryness Miscellaneous Asparaginase (Elspar), procarbazine (Matulane)

Mechanism of Action Uknown or too complex to categorize

Cell cycle Varies Common Side Effects Anorexia, nausea, vomiting, bone marrow suppression, hepatotoxicity, anaphylaxis, hypotension, alter glucose metabolism