What are the classes of chemotherapy drugs?
Alkylating Agents
Antimetabolites
Mitotic inhibitors
Anthracyclines
Topoisomerase inhibitors
Miscellaneous
Alkylating Agents:
- MOA
- class SE
- what are the the sub-classes
MOA: directly damage DNA to keep cell from reproducing, works in ALL phases of cell cycle.
SE: nausea, vomiting, myelosuppression, alopecia
*Leukemia in rare cases.
Sub-classes:
- nitrogen mustards
- platinum analogs
- tiazenes
- misc.
Alkylating Agents- Nitrogen Mustards:
- drugs
- SE
Drug: cyclophosphamide (Cytoxan)
SE:
- hemorrhagic cystitis:
- -sheds large segments of bladder mucosa leading to prolonged hematuria. Potentially leading to urinary obstruction (Clots)
Alkylating Agents-Platinum analogues
- drugs
- SE
- what can be given prophylactically to prevent SE?
Drugs: cisplatin (platinol)
SE:
-neurotoxicity: peripheral neuropathy, ototoxicity that can lead to deafness
-nephrotoxicity; pt must be vigorously hydrated prior during and after admin of drug
Amifostine is given IV to protect against SE from cisplatin.
Antimetabolites
- MOA
- SE
- what are the sub-classes?
MOA: Interfere with DNA and RNA growth, damage cells during the S phase when cells chromosomes are being copied.
SE:
- myelosuppression
- n/v
- mucositis
- dermatologic (rash, injection site rxn, dermatitis, pruritis)
Sub-classes:
- foalte antagonists (methotrexate)
- purine analogs (Mercaptopurine)
- Pyrimidine analogs (Fluorouracil, gemcitabine)
Antimetabolite-Folate Antagonists
- drugs
- SE
- what can be given prophylactically to prevent SE?
Drug: methotrexate (MTX; Trexall)
SE:
- myelosuppression
- mucositis
- decreased renal clearance
Leucovorin is given to reverse toxic effects of MTX otherwise the pt may die.
Mitotic Inhibitors:
- MOA
- subclasses
- SE
MOA: work by altering DNA inside CA cells to keep them from growing and mulitplying, work by stopping mitosis in the M phase BUT CAN DAMAGE CELLS in ALL phases of cell cycle
Sub-classes:
- vinca alkaloids
- taxanes
- epothilone
- anthracyclines
SE:
-myelosuppression, anaphylactic rxn, peripheral neuropathy*
Mitotic Inhibitors-Taxanes
-drugs
Drug: Paclitaxel (Taxol)
Mitotic Inhibitors-Vinca Alkaloids:
- drugs
- SE
Drug: Vincristine (Oncovin)
SE:
- neuropathy: paresthesias in fingers and toes
- constipation
Mitotic Inhibitor-Anthracyclines:
- drugs
- SE
- what baseline tests need to be done before starting this medication?
Drugs:
- daunorubicin (Cerubidine)
- doxorubicin (adriamycin)
SE:
- Cardiotoxicity leading to systolic CHF (MC associated with adriamycin)
- *may be irreversible
Baseline tests: MUGA scan to calculate Ejection fraction, must be greater than 50% for this medication.
Topoisomerase Inhibitors:
- MOA
- subclasses of drugs
- SE
MOA: inhibit topoisomerases in S phase. (inhibit replication)
Drug subclass:
- Topoisomerase 1 inhibitors (Topotecan)
- Topoisomerase 2 inhibitors: (etoposide)
SE:
-myelosuppression, alopecia, GI toxicity
Miscellaneous Drugs:
-drug names?
Drugs:
- actinomycin-D
- bleomycin
SE of Bleomycin?
- edema of the interphalangeal joints and hardening of the skin on the palms and soles of the feet.
- pulmonary fibrosis
- hypotensive rxn
Targeted Therapies:
- MOA
- Drug name
Differentiating agents:
- MOA
- drugs
Hormone Therapy:
- MOA
- drugs
MOA: attack cancer cells more specifically than traditional chemotherapy drugs.
Drug: Imatinib (Gleevec)
Differentiating agents:
- MOA: act on cancer cells to make them into mature normal cells.
- drugs: Retinoids (Tretinoin)
Hormone therapy:
-MOA: work by making the cancer cells unable to use the hormone they need to grow or by preventing the body from making the hormone.
these drugs are used to slow the growth of breast, prostate, and endometrial CA which normally grow in response to natural sex hormones in the body
Drugs:
- anti-estrogens: Tamoxifen
- Aromatase inhibitors: anastrozole
- Progestins (Megace)
- Estrogens
- Anti-androgens: Bicalutamide
- Gonadotropin-releasing hormone: Leuprolide (Lupron)
Immunotherapy:
- what are the two types of immunotherapy?
- drugs
Types:
-active immunotherapy: stimulate bodys own immune system to fight dz
-passive immunotherapies: do not rely on body to attack dz, abys created outsidde the body and given to fight CA.
Drugs:
-Rituximab (Rituxan) (Active immunotherapies)
Define:
- adjuvant
- neoadjuvant
- induction
- maintenance
Adjuvant: set course given to pts with no evidence of dz after surgery or radiation
neoadjuvant: aims at eradicating micrometastatic dz or reduce inoperable dz
Induction: combination chemotherapy given in high dose to cause a remission
Maintenance: aka consolidation, long term, low dose regimen given in remission (maintains remission by inhibiting growth of remaining CA cells)
Radiation Therapy
- what is this?
- determination of dose?
What: use of high energy radiation from x-rays, gamma rays, neutrons, protons, to kill cancer cells and shrink tumors. Production of free hydrogen ions and hydroxyl radicals
Dose:
-tumors have individual radiobiologic characteristics
Toxicity of Radiation:
- Toxicity of skin
- Toxicity of Brain
- Toxicity of Head/Neck
- Toxicity of Breast
- Toxicity of Lung
SE: Skin: -erythemia -dry desquamation -moist desquamation -hyperpigmentation (early) -hypopigmentation, telangiectasias, fibrosis (late)
Brain:
- acute: fatigue, hair loss
- late: cognitive dysfunction, edema, necrosis
Head Neck:
- acute: odynophagia, dehydration, wt loss, taste dysfunction, pain, xerostomia
- late: permanent xerostomia, soft tissue fibrosis, dysphagia, pharyngeal stricture
Breast: Acute: -erythema* -dry/moist desquamation -pain -fatigue Late: -fibrosis -hyperpigmentation -cosmetic fx -rib fx -pna
Lung: -esophagitis -cough -skin rxn -fatigue Late: -pneumonitis -pulm fibrosis -esophageal stricture
Radiation Toxicity:
- Toxicity Esophageal
- Toxicity of Abd, Stomach, pancreas, hepatobiliary
- Toxicity of Pelvis
- Toxicity Anal
- Toxicity GYN
Esophageal: -esophagitis -skin tanning -fatigue -wt loss -diarrhea -n/v LATE: -esophageal stricture & stenosis -perforation -pneumonitis
Abd: -dyspepsia -anorexia -nauseea -fatigue LATE: -bowel obstruction -worsening of T2DM -Liver/kidney probs
Pelvis: -diarrhea, rectal irritation, urinary sx, fatigue LATE: -persistent urinary sx -bowel changes -ED
ANal: -skin rxn -leukopenia -thrombocytopenia -proctisis -diarrhea, cystisis LATE: -chronic diarrhea, rectal urgency, sterility, impotence, vaginal dryness/fibrosis
GYN:
- cysitis, proctitis, fistula
- vaginal ulceration, vaginal stenosis
- skin rxn
