Chemotherapy Review | Chemotherapy | Cancer

Chemotherapy Review

S phase Methotrexate Cytarabine Gemcitabine 6-mercaptopurine Hydroxyurea

Cell cycle specific drugs M phase G2 phase Vinca alkaoids Epipodophylotoxins Taxanes Bleomycin

Cell cycle non specific drugs Alkylating agents Anthracyclines Platinum compounds

Common drug combination regimens
Regimen BEP PVB MOPP ABVD R-CHOP Drugs Bleomycin, etoposide, platinum (cisplatin) Platinum(cisplatin), vinblastine, bleomycin Mechlorethamine, oncovin(vincristine), procarbazine, prednisone Adriamycin(doxorubicin), bleomycin, vinblastine, dacarbazine Rituximab, Cyclophosphamide, hydroxydaunorubicin, oncovin, prednisone Mtx, vinblastine,adriamycin, cisplatin 5-FU, oxaplatin, leucovorin Vincristine, adriamycin, dexamethasone Cyclophosphamide, adriamycin, 5-FU Cyclophosphamide, Mtx, 5-FU Indication Testicular cancer

Hodgkins lymphoma

M-VAC FOLFOX VAD CAF CMF

Ca Bladder Colon cancer Multiple myeloma Ca breast

acrolein Prevn. lomustine Streptozocin Thiotepa Pulmonary fibrosis (busulfan lung) Renal failure Another most common used agents for brain tumors is temozolomide .MESNA Melphalan Chlorambucil Busulfan Nitrosureas: Carmustine .Hodgkin’s disease CHOP-Non hodgkins lymphoma Autoimmune diseases: lupus nephritis Multiple myeloma CLL CML Brain tumors (Glioblastoma multiforme) Insulinoma Pancreatic beta cell carcinoma Ca bladder Myelosuppression Hemorrhagic cystitis Cause. smustine.Alkylating agents Uses Specific toxicity Mechanism: Alkylation of N7 guanine residues in DNA Mechlorethamine Cyclophosphamide MOPP.

superficial basal cell carcinoma(topical) AML Non hodgkins lymphoma Purine analogues ALL AML Myelosuppression Specific toxicity Mucositis Crystalluria Myelosuppression Leucovorin – to rescue normal cells Methotrexate Inhibits DHFR.Antimetabolites Uses Folate antagonist Cancers • ALL • Choriocarcinoma • Burkits lymphoma • Non hodgkins lymphoma As immunosuppressants • Psoriasis • Rheumatoid arthritis • Transplantation • Crohns disease Therapeutic abortion Pyrimidine antagonists 5 FUinhibit thymydidylate synthetase Cytarabine (Sphase specific) Inhibit NA polymerase 6-MP Converted by HGPRT to active metabolite – inhibits nucleotide metabolism – base mispairing Gemcitabine Colon cancer-FOLFOX(i.-indirect inhibition of DNA synthesis Pancreatic cancer Non small cell lung cancer .v) Premalignant keratoses.

hodgkins DNA fragmentation Chromosomal aberrations PVB.testicular microtubule cancer assembly MOPP.hodgkins Inhibit CAF.Ca breast topoisomerase II M-VAC Ca bladder Generation of O2 VAD.Natural products Mechanism Use Vinca alkaloids Disrupt PVB.multiple radicals myeloma R-CHOP.non Hodgkins Acute leukemia Non small cell lung cancer Taxanes Stabilizes Ovarian cancer microtubules to Kaposi’s sarcoma disassembly Prostate cancer Epipodophylotoxins Inhibit BEP .testicular cancer Toxicity Myelosuppression Peripheral neuropathy Vinblastine Vincristine (oncovin) Vinorelbine Paclitaxel Docetaxel Etiposide Teniposide Topotecan Irinotecan Doxorubicin (adriamycin) Peripheral neuropathy Hypersensitivity Diarrhea Cardiomyopathy PrevnDexrazoxane Daunorubicin Bleomycin Pulmonary fibrosis Cutaneous toxicity .hodgkins CHOP.testicular topoisomerase IIcancer double stranded DNA breaks Camptothecins Inhibit Ovarian cancer topoisomerase I Colorectal cancer Antibiotics DNA intercalation ABVD.

CHOP.lymphomas Endometrial carcinoma Androgen dependent prostate carcinoma Estrogen Receptor +ve Breast carcinoma Carcinoma prostate Estrogen Receptor +ve Breast carcinoma . goserelin Aromatase inhibitoraminoglutethimide anastrozole.Tamoxifen Gonadotrophin releasing hormones – leuprolide. exemestane Use Hairy cell leukemia CML Kaposis sarcoma Metastatic kidney cancer Brain tumor Kaposis sarcoma Multiple myeloma CML Non-small cell lung cancer Non hodgkins lymphoma ITP HER-2 +ve metastatic breast cancer EGFR expressing metastatic colon cancer metastatic colorectal cancer Use Acute leukemia MOPP.Tyrosine kinase Inhibitor of bcr-abl oncoprotein Geftinib .diethylstilbestrol Antiestrogen . erlotinib Tyrosine kinase Inhibitor of Epidermal growth factor receptor(EGFR) Rituximab Binds to CD20 antigen on b cells Trastuzumab HER-2 Cetuximab EGFR Bevacizumab Vascular endothelial growth factor(VEGF) Hormonal agent Prednisone Progestin.Biological agent Alpha interferon Interleukin-2 Thalidomide TNF modifier Imatinib .megestrol Estrogens.

Adjunct agents used in cancer chemotherapy – used mainly to treat complications of cancer chemotherapeutic agents Adjunct Agent Leucovorin or citrovorum factor Formyltetrahydrofolic acid MESNA Mercaptoethane sulfonate Dexrazoxane Free radical scavenger Filgrastim and pegfilgastim granulocyte colony stimulating factor(G-CSF) Sargromastim Granulocyte/macrophage colony stimulating factor(GM-CSF) Epoetin alpha (analog of erythropoietin) Oprelvekin Interleukin -11 Amifostine Used for Cytoprotection Zeldronic acid Bisphosphonate – inhibits osteoclastic bone resorption – induces osteoclast apoptosis Use Rescue from methotrexate toxicity Prevents hemorrhagic cystis caused by cyclophosphamide Prevents cardiotoxicity with doxorubicin Chemotherapy induced leucopenia Chemotherapy induced leucopenia Patients undergoing Autologous stem cell transplantation and high dose chemotherapy Anemia caused by chemotherapy or renal failure Chemotherapy induced thrombocytopenia Ovarian and non small cell lung cancer.reduces nehrotoxicity Irradiation of head and neck regionsprevents mucositis Bone metastasis from multiple myeloma .

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