vlnca

alkalolds

ŴvlncrlsLlne
ŴvlnblasLlne
Ŵvenrelblne
work ln M phase by lnhlblLlng
Lubulln polymerlzaLlon
resulLlng ln mlLoLlc arresL

ŴALL from Madagascar perlwlnkle
planLŦ
ŴmeLabollzed by hepaLlc C?Þ
enzymes and excreLed fecallyŦ
Ŵ vlncrlsLlne and vlnblasLlne Ŷ lv
Ŵ venerelblne ls made synLheLlcally
from vlnblasLlne
Ŵ vlncrlsLlneŴ
chlldhood Lumorsţ
ALLţ PLţ nPL
Ŵ vlnblasLlneŴbreasLţ
PLţ nPLţ germ cell
Ŵ venerelblneŴ non
small cell lungţ breasLţ
ovaryţ prosLaLe
Ŵ vlncrlsLlneŴneuroLox (fooL drop)ţ alopeclaţ
myleosuppresslonţ hyponatrem|a (SIADn)
Ŵ vlnblasLlneŴbone marrow suppresslonţ Cl
LoxlclLyţ alopeclaţ bllsLer formaLlon and necrosls
where lL has leaked from velnsŦ
Ŵ venerelblneŴ 8M suppresslonţ Cl LoxlclLyţ llver
fnx abnmlţ alopecla

1axanes

ŴpacllLaxel
ŴdoceLaxel
Ŵlxabeplllone
8lnd Lo Lubulln Lo enhance
lLs polymerlzaLlonţ whlch
locks lL ln placeŦ Cell dlesŦ

lxabepllloneŴblnds and
sLablllzes mlcroLubules
Ŵuerlved from paclflc or Luropean
yew Lrees
ŴClven lvŦ PepaLlc C?Þ2C8 and
3A4/3Ŧ 8lllary excreLlonŦ
Ŵ |xabep|||oneŴ reLalns acLlvlLy
agalnsL Lumors LhaL over express pŴ
glycoproLelnŦ made from
sporanglum cellulosum a soll
dwelllng gram Ŷ bacLerla
ŴpacllLaxel ŴÞuL
ln sLenLs! and
doceLaxel Ŵsolld
Lumors

ŴpacllLaxelŴLoxlclLy ls from Lhe so|vent castor o|| |t |s
d|sso|ved |nŦ Þroduces hypersenslLlvlLy ln 3Ʒ of pLs so
preLreaL ppl wlLh hlsLamlnes ecLŦ new formula wlLh
albumln and no casLor oll ls ouL buL very expenslveŦ
Ŵ doceLaxelŴalopeclaţ myelosupresslonţ neuroLoxţ fluld
reLenLlon
Ŵ lxabepllloneŴsame as above

LplpodophylloLoxln

ŴeLoposlde

ŴlnhlblL top|o|somerase II Ŵfrom mayapple rooL
Ŵlv or oral (30Ʒ)
ŴhepaLlc C?Þ3A4 and
excreLed renally
ŴPL and nPL
ŴablaLlve Lx pre
8M1
Ŵmyeosupresslonţ aplopeclaţ hypoLenslonţ n/v/dţ
apLhpous ulcersŦ

CampLoLheclns

ŴLopoLecan
ŴlrlnoLecan



lorm a cleavable complex
wlLh unA and
Lopolsomerase lţ whlch
cuLs a relegaLes ssunA
Ŵchlnese happy Lree/of llfe
ŴLopoLecanŴorally or lvŦ hepaLlc renal
excreLlon
ŴlrlnoLecanŴlv prodrugŦ CeneLlc maLLer! 28
varlanLŴgllberL's syndrome produce less
enz and are aL hlgher rlsk for adverse
effecLsŦ blle and feces ellmlnaLlon
ŴLopoLecanŴ
ovary cervlcal
small cell lung
ŴlrlnoLecanŴ
co|orecta|

ŴLopoLecanŴ8M suppresslon and dlarrhea
ŴlrlnoLecanŴmyelosupresslon and llfe LhreaLenlng
d|arrhea!!! aLroplne and flulds wlLhln 24 hours of
glvlng drugŦ CLher laLer dlarrhea ls worse and
doesn'L respond Lo LxŦ





3 famllles of anLlLumor anLlbloLlcsť anLhracycllnesţ mlLomycln Cţ bleomycln all come from sollŴdwelllng sLrepLomyces
AnLhracycllnes

Ŵdoxorublcln
ŴdaunorublclnŴnoL
good for sollds
Ŵldarublcln
Ŵeplrublcln
4 MCA
ŴlnhlblL topo|s|omerase II
Ŵ|nterca|at|on Lo unA
Ŵsemlqulnone and oxygen free
rad|ca|sŴcard|otox|c mechan|sm
ŴalLer membrane fluldlLy and lon
LransporL
Ŵlv llver
meLabollsm
Ŵ30Ʒ bllllary
excreLlon
Ŵ doxorublclnŴloLs
used ln combo
usually
ŴldarublclnŴAML
ŴeplrublclnŴsLage ll
breasL

ŴNeutropen|aţ LhrombocyLopenlaţ mucos|t|s
ŴwlLh radlaLlon can have eryLhema and desquamlnaLlon
of Lhe sklnŦ Much card|otox|c|ty (llmlL dose and glve
w/dexrazoxane Lo llmlL free rads)
mlLoxanLroneŴ noL chemlcally an anLhracycllneţ buL has 3 of 4 mechanlsmsŦ no free radlcal acLlvlLyţ buL ls sLlll cardloLoxlcŦ 8LuL dlscoloraLlon of flnger nalls and
sclera flrsL few days afLer admlnŦ
MlnLomycln c Þrodrug undergoes reducLlon Lo
generaLe an alkylaLlng agenL LhaL cross
llnks unA
Ŵ can be glven
lnLraveslcally for
bladder
Ŵlv
Ŵhypoxlc solld
Lumorsţ bladderţ
breasL
Ŵanal CA wlLh 3lu
Ŵmyelosupresslonţ mucoslLlsţ asLhenlaţ anorexlaţ PuSţ
lnLersLlLlal pneumonlLlsŦ

8leomycln G2 phase acLlve pepLlde LhaL has unA
blndlng reglon and lron blndlng reglonŦ
unA parL causes s|ng|e and doub|e
stranded breaksŦ 1hen kCS cause more
damageŦ
ŴexcreLed renally
Ŵglven lv SC or lM

Ŵlymphomasţ germ
cell Lumorsţ cervlcalţ
squamous cell
Ŵ||tt|e 8M tox|c|ty
Ŵpneumon|t|sŴcough dyspnea and |nf||trates decades
afLer LxŦ
Ŵskln LoxlclLyţ mucoslLlsţ alopecla

1yroslne klnase lnhlblLors

ŴlmaLlnlbŴbcrŴabl
ŴdasaLlnlb SCr cklL ÞuClŴb
ŴnlloLlnlbŴ bcrŴabl ÞuCl8 beLa

lnhlblLor Lyroslne
klnases
ŴlmaLlnlbŴorally hepaLlc
meLab C?Þ3A4 (grape
frulL sL [ohn's warL)Ŧ
LllmlnaLed fecally or
blllaryŦ
Ŵ lmaLlnlbŴCML
Ŵ dasaLlnlbŴCML or ALL
reslsLanL Lo lmaLlnlb
Ŵ nlloLlnlbŴ 20Ŵ30xs
greaLer afflnlLy for
CML reslsLanL Lo
lmaLlnlb
ŴlmaLlnlbŴedemaţ dlarrheaţ myalglasţ Pl
Ŵ nlloLlnlb 8LACk 8Ck warn|ng about nI

vegfrŴ hyperLenslonţ bleedlngţ and faLlgue



Lpldermal growLh facLor
recepLor LCl8

ŴgeflLlnlb
ŴerloLlnlb
lnhlblLs LCl8 Ŵ orally hepaLlc meLab
C?Þ3A4 (grape frulL sL
[ohn's warL)Ŧ LllmlnaLed
fecally or blllaryŦ
ŴgeflLlnlb and erloLlnlb
lor non small cell lung
CA usually Lhe non
smoker varleLy
ularrheaţ acneŴllke rashţ anorexlaţ faLlgueţ and
rarely lnLersLlLlal lung dx

vascular endoLhellal growLh
facLor recepLor vLCl8

ŴsorafenlbŴ82ţ 83ţ ÞuCl beLaţ
raf klnase
ŴsunlLnlb Ŷ81ţ 82ţ 83ţ cŴklLţ
ÞuCl alpha and beLa
lnhlblLs vLCl8Ŵ whlch
normally sLlmulaLes
blood flow and growLh
of Lumors
Ŵ orally hepaLlc meLab
C?Þ3A4 (grape frulL sL
[ohn's warL)Ŧ LllmlnaLed
fecally or blllaryŦ
ŴSorafenlbŴrena| CA
hepaLocellular
Ŵ sunlLnlbŴrenal and Cl
Ŵhypertens|on (marker of response to tumors
good s|gn)ţ bleedlngţ faLlgue
ŴSorafenlbŴskln rash and hand ln fooL sx ln 1/3Ŵ
1/2 of paLlenLs
Ŵ sunlLnlbŴ hearL fallure

AnLlbodles LargeLlng LCl8

ŴceLuxlmab
ŴpanlLumumab
ŴLrasLuzumab
A8 dlrecLed agalnsL
LCl8
Ŵlv Ŵ ceLuxlmab and
panlLumumab
meLasLaLlc colon besL
lf W1 for kŴras
Ŵ LrasLuzumabŴ
PL82/neu breasL

Ŵ ceLuxlmabŴacne llke rashţ hypersenslLlvlLy rxnţ
hypomagnesemlaţ faLlgueţ lnLersLlLlal lung
dlsease
Ŵ panlLumumabŴ less hypersenslLlvlLy same
everyLhlng elseŦ
Ŵ1rasLuzumabŴPearL fallure and
cardlomyopaLhy 3Ŵ7Ʒ of Llme

AnLlbodles LargeLlng vLCl8

Ŵbevaclzumab
ŴranlblzumabŴlAu approved for
ophLhalmlc ls a lab fragmenL of
bevaclzumab
ŴLargeLs vLClŴA Ŵvery very
expenslve
Ŵnon small cell lung
Ŵcolon
Ŵrenal cell
ŴmeLasLaLlc breasL
Ŵg||ob|astoma
Ŵmacu|ar degenerat|on and
d|abet|c ret|nopathy off |abe|
ŴP1nţ delayed wound heallngţ lncreased rlsk of
bleedlngţ proLelnurlaţ lnLesLlnal perforaLlon a
hlgh rlsk Cv evenLs

AnLlbodles wlLh
oLher LargeLs

ŴrlLuxlmabŴCu20
ŴofaLamumab
ŴalemLuzumab
Ŵ8lLuxlmabŴpromoLes ellm of
Cu20+ cells from bodyŦ
ŴofaLamumabŴ also anLl Cu20
Ŵ alemLuzumabŴCu32 lymphocyLes
maLure noL sLem cellsŴ
complemenL medlaLed lysls
lv Ŵ rlLuxlmabŴgreaL for CLLţ nPL b
cell problems
Ŵ ofaLamumabŴCLL very expenslve
Ŵ alemLuzumabŴ8 cell lymphocyLlc
leukemla
Ŵ rlLuxlmabŴhypersenţ Lumor lysls syndromeţ
reacLlvaLlon of vlral lnfecLlons hep 8ţCţL
Ŵ alemLuzumabŴhypersensţ lmmunodeflclencyŴ
lnfecLlonsţ reacLlvaLlon of de novo auLolmmune
dlseases

LŴasparaglnase Ŵonly leukemlc cells lack
asparaglnes synLheLaseŦ glvlng
drug denles CA cells Lhls essenLlal
AA and Lhey dleŦ
lvţ lM sub C ŴALL |n k|ds ÞancreaLlLlsţ hypersenslLlvlLy rxnţ bleedlng anf
cloLLlngţ neuroLoxlclLy

8eLlnolc acld
derlvaLlves

ŴLreLlnoln (allŴLrans
reLlnolc acld )
luses gene for reLlnolc acld 8A8
alpha Lo Lhe ÞML gene maklng
Lhem unable Lo prollferaLeŦ
Ŵ cysLlc acneţ AÞL 13ť17
LranslocaLlon
ŴvlLamln a LoxlclLyŴPA fever xerodermaţ slcca
syndrome
ŴreLlnolc acld slndromeŴfever leukocyLoslsţ
elevaLed serum Llglycerlde and colesLerolţ
dlarreaţ abd palnţ CnS LoxlclLy

Arsenlc Lrloxlde
As2o3
ŴpaLlenL wlLh L(13ť17)
Ŵdegrades Lhe chlmerlc ÞML/8A8
alpha proLeln and lnduces
apopLosls
lv admln ŴAÞL LhaL dldn'L respond Lo above ŴLkC changesţ arrhyLhmlasţ faLlgue and
syndrome LhaL lncludes SC8ţ rashţ fluld
reLenLlon and welghL galnŦ



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