ANTINEOPLASTIC

DRUGS / ANTI-CANCER
Group 2 Presentation
BSN 2 J
General and Specific Objectives
AFTER 1 HOUR AND 30 MINUTES OF VARIED – LECTURE DISCUSSION THE BSN 2 STUDENTS
WILL BE ABLE TO ENHANCE POSITIVE ATTITUDE, ACQUIRED BASIC KNOWLEDGE AND SKILLS
IN THE CONCEPT OF THE USE OF ANTINEOPLASTIC / ANTICANCER DRUGS.
THE STUDENTS WILL BE ABLE TO:

1. Define chemotherapy as an anticancer drug.

2. Differentiate between cell cycle-specific and cell cycle-nonspecific anticancer drugs.
3. Compare the uses and considerations for alkylating compounds, antimetabolites,
antitumor antibiotics, hormones, and biotherapy agents
4. Prioritize appropriate nursing interventions to use while patients receive anticancer
drugs.
5. Develop a focused teaching plan on the uses and side effects of anticancer drugs.
 Cancer
● A group of diseases in which
abnormal cells grow out of
control and can spread to
other areas of the body.
● Not just a single disease. It is
a group of more than 200
different diseases.
● May spread to other parts of
the body.
Brief Introduction and History of Cancer
● Medical term for Tumor or Cancer is Neoplasm - autonomous growth
● Neoplasm means New Growth
● Process of cell proliferation is called Neoplasia
● Oncology - Branch of medicine which deals with the study of
neoplasm and its development, diagnosis, and treatment
● The term cancer was translated from a Latin word carcino i.e. Crab by
Celsus.
● Galen used 'oncos' to describe all tumours, the root of the modern
word 'oncology’
● Hippocrates coined the greek word Karkinos i.e. (crab/crayfish) for
malignant breast cancer
 Classification of Tumors
● Malignant Tumors - spreads from the original site
and cause secondary tumours.
● Non Malignant Tumors or Benign Tumor - does not
metastasize; not usually a threat; confined to one area
○ Papilloma - projecting mass on the skin
○ Adenoma - In and around the glands
○ Lipoma - In fatty tissues
○ Osteoma - Originates in the bones
○ Myoma - In muscle tissue
○ Angioma- composed of small blood or lymph vessels
○ Nevus- small skin tumor of one variety of tissues
Broad Classification of Cancers
● Carcinomas - cancers that cover the internal and external
parts of the body such as lung, breast, and colon cancer.
● Sarcomas - cancers that are located in bone, cartilage, fat,
connective tissue, muscle, and other supportive tissues.
● Lymphomas - cancers that begin in the lymph nodes and
immune system tissues.
● Leukemias - cancers that begin in the bone marrow and
often accumulate in the bloodstream.
● Adenomas - cancers that arise in the thyroid, the pituitary
gland, the adrenal gland, and other glandular tissues.
Influences on Cancer Development

Environmental Infective
● Tobacco
● Herpes Simplex 2 Virus Genital Herpes
● Asbestos
● Hepatitis B and C Viruses
● Benzene
● Epstein-Barr Virus
● Formaldehyde
● Human Papillomavirus (HPV)
● Arsenic
● Human Immunodeficiency Virus (HIV)
● Ionizing Radiation
● Human T-Cell Lymphotropic Virus
● Ultraviolet Rays
● Helicobacter pylori
● Aflatoxin
Influences on Cancer Development
Dietary
● Animal Fat
● Heterocyclic Amines
● Alcohol Inflammatory
Inflammation is a normal
physiologic process to heal injured
tissues. Continued inflammation
Genetic
can lead to DNA damage and can
● Deletion
result in cancer.
● Translocation
● Duplication
● Inversion
● Insertion of genetic material
CANCER
CHEMOTHERAPY

● Adjuvant Therapy
● Neoadjuvant Chemotherapy
● Palliative Chemotherapy
● Combination Chemotherapy
The Cell Cycle
A series of events that
occur in a cell's life,
leading to its division into
two daughter cells.
 Cell Cycle-Specific Agents
&
Cell Cycle-NonSpecific Agents
 Cell Cycle-
Specific Agents
Substances or drugs that act on the
cell during a particular phase of
the cell cycle
● Antimetabolites
● Plant Alkaloids
Cell Cycle-
NonSpecific Agents
Substances or drugs that act on
cells during any phase of the cycle
● Alkylating Agents
● Antitumor Antibiotics
● Hormones
Antimetabolites

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 Antimetabolites
➢S phase-specific drugs that are structural analogues of essential metabolites and that interfere
with DNA synthesis.

Classification: Pharmacokinetics:
A)Folic Acid Antagonists ● Administered orally or intravenously
○ Common Medication: Methotrexate ● Metabolism occur in the liver
B)Purine Analogues ● Elimination usually involves renal excretion
○ Common Medication:
Mercaptopurine (6-MP) & Thioguanine
(6-TG)
C)Pyrimidine Analogues Over-All Indications:
○ Common Medication: 5-Fluorouracil ● Hematologic malignancies (e.g., leukemia,
(5-FU), 5-Floxuridine (5-FDU), & lymphoma, myelodysplastic syndrome)
Cytarabine ● Solid tumors (e.g., breast cancer, head and
neck cancer, osteosarcoma)
 Antimetabolites

Mechanism
Mechanismof
ofAction:
Action: Common Adverse Effects:
Mimicking
Mimicking folic
folicacid
acidor
ornucleobases
nucleobasesor orinhibit
inhibit All Antimetabolites cause Bone
enzymes disrupt DNA synthesis pathway
enzymes → disrupt DNA synthesis pathway→
→ →Stop
Stop Marrow Suppression → which leads
DNA
DNA replication and cell proliferation come to ahalt
replication and cell proliferation come to a halt to leukopenia, thrombocytopenia,
→ cancer cell death
→ cancer cell death and anemia
● GI Toxicity (Anorexia, Nausea,
Vomiting, Diarrhea)
Over-all Contraindications: ● Pulmonary Toxicity (Pulmonary
● Pregnancy Fibrosis, Pneumonitis)
● Breastfeeding ● Dermatological Toxicity
● Liver and renal disease (Rashes, Skin Ulcerations)
● Severe infection ● Neurotoxicity
● Myelosuppression ● Hepatotoxicity
● Clients taking gout medications (allopurinol
/ febuxostat) → increased risk of toxicity
A) Folic Acid Antagonists
● Methotrexate

Indications:
ROUTE/S OF ADMINISTRATION: ● Choriocarcinoma
● PO (Orally) ● Acute Lymphocytic Leukemia
● SubQ (Subcutaneous) ● Meningeal Metastases
● IM (Intramuscular injection)
● IV (Intravenous)
● Intrathecal

Adverse Effects:
● Severe Leukopenia
● Thrombocytopenia
B) Purine Analogues
● 6-Mercaptopurine (6-MP) & 6-Thioguanine (6-TG)

Indications:
● Acute Lymphocytic Leukemia
● Acute Nonlymphocytic leukemia

Adverse Effects:
● Mouth sores
C) Pyrimidine Analogues
● 5-Fluorouracil (5-FU), 5-Floxuridine (5-FDU) and Cytarabine

Adverse Effects:
Indications:
● Oral and Gastrointestinal Ulceration
● Solid tumors
● Mild diarrhea
○ Breast cancer
● Tiredness
○ Colorectal cancer
● Redness on injection site.
○ Gastric tumor
● Squamous cell tumors of the head and neck
● Liver metastases of gastrointestinal
Ulceration.
● Liver metastases of gastrointestinal
malignancy
● Acute Nonlymphocytic Leukemia
Plant Alkaloids

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 Plant Alkaloids
➢Derived from plants. Blocks cell division
Classification:
during the M phase of the cell cycle
● Antimicrobials or Taxanes
➢Low toxicity
○ Common Medications - Yew Tree
➢Cell culture techniques are involved to
Docetaxel & Paclitaxel
produce new botanical therapeutic agents to
● Epipodophyllotoxins
treat neoplasms
○ Common Medications - Apple Tree
Etoposide & Teniposide
● Camptothecin Analogues
○ Common Medications: Camptotheca Mechanisms of Action:
acuminata
Irinotecan & Topotecan ● Interfere with microtubule function
● Retinoids
○ Common Medication: Bexarotene
● Vinca Alkaloids
○ Common Medications:
Vinblastine, Vincristine & Periwinkle
Plant
Vinorelbine
A) Anti Microtubules or Taxanes
Common Medications: Paclitaxel & Docetaxel

Indications:
● Ovarian cancer Mechanism of Action:
● Disrupt cell division by stabilizing
● Lung carcinoma
● Gastric & Cervical cancers microtubules, preventing their
● Prostate & colon cancer disassembly. This leads to cell cycle
arrest and inhibits cancer cell
growth.
Adverse Effects:
● Gastrointestinal Disturbances
● Hepatotoxicity
● Liver and Kidney Toxicity Pharmacokinetics:
● Hypersensitivity reactions ● IV Administered
● -Steven-Johnson syndrome ● Metabolize in liver
● -Toxic epidermal necrolysis ● Excreted in bile
● -Anaphylaxis
● Bone marrow suppression
B) Epipodophyllotoxins
Common Medications: Etoposide & Teniposide

Indications:
Mechanism of Action: ● Lymphosarcoma
Inhibits topoisomerase II an enzyme ● Hodgkin’s disease
involved in DNA replication and ● Lymphatic leukemia
repair. ● Cancer of breast, testes, & kidney

Pharmacokinetics: Adverse Effects:

● IV Administered ● Bone Marrow Suppression
● Metabolize in liver ● Gastrointestinal upset
● Excreted in urine ● Mucositis
● Hepatotoxicity
C) Camptothecin
Common Medications: Irinotecan & Topotecan
Mechanism of Action:
Inhibits topoisomerase I, another
enzyme involved in DNA processes.
Pharmacokinetics:
● IV Administered
● Metabolize in liver
● Excreted in bile
Indications:
● Ovarian cancers
● Colorectal cancer
● Cancer of neck & head
● Liver cancer
Adverse Effects:
● Neutropenic Fever
● Alopecia (Hair Loss)
● Hepatotoxicity
● Fatigue
● Mucositis
D) Retinoids
● Bexarotene

Indications:
Mechanism of Action: ● Acne vulgaris
Derivatives of vitamin A that ● Psoriasis
regulate cell growth and ● Keratinization disorder
differentiation through nuclear ● Wrinkles and photoaging
receptors.

Adverse Effects:
● Visual Disturbance
CONTRAINDICATIONS
CONTRAINDICATIONS ● Lipid Abnormalities
●● Pregnancy
Pregnancy ● Pancreatitis
●● Breastfeeding
Breastfeeding
●● Infants ● Hepatotoxicity
Infants
●● Bone
Bonemarrow
marrowsuppression
suppression
●● Leukopenia
Leukopenia
E) Vinca Alkaloids
Common Medications: Vinblastine, Vincristine & Vinorelbine
Mechanism of Action:
Inhibit microtubule dynamics during
cell division,.
Pharmacokinetics:
● IV Administered
● Metabolize in liver
● Excreted in bile
Indications:
● Acute leukemia
● Breast cancer
● Neuroblastoma
● Kaposi’s Sarcoma
Adverse Effects:
● Bone Marrow Suppression
● Gastrointestinal upset
● Constipation
● Neurotoxicity(Headaches and
Seizure)
ALKYLATING AGENTS
COMMONLY USED
ALKYLATING AGENTS:
NITROGEN MUSTARD GAS DERIVATIVES

● Bendamustine (TREANDA)
● Chlorambucil (LEUKERAN)
● Cyclophosphamide (CYTOXAN)
● Estramustine (ESTRACYT)
● Melphalan (ALKERAN)
● Ifosfamide (IFEX)
● Mechlorethamine Hydrochloride (MUSTARGEN)
-
ALKYLATING AGENTS
MECHANISM OF ACTION:
DNA damage in all phases of cell- Overall Contraindications:
cycle → cancer cell death. DNA cross- ● Pregnancy
linking → inhibition of essential cell ● Breastfeeding
processes ● Liver disease
● Renal disease

Overall Route of Administration:

● IV or PO
Adverse Effects:
● Nausea
● Vomiting
NURSING INTERVENTIONS:
● Fever
● Assessment and Monitoring
● Bone Marrow Suppression
● Prevention and Management of
Side Effects
● Patient Education
Antitumor Antibiotic
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ANTITUMOR ANTIBIOTICS
Anthracyclines Antitumor Antibiotics
● Doxorubicin ● Bleomycin
● Daunorubicin
● Idarubicin
● Epirubicin
● Mitoxantrone
 INDICATIONS:
ANTITUMOR ANTIBIOTICS ●

●
Leukemia
Lymphoma
● soft tissue sarcoma
● osteosarcoma
Solid tumors:
● breast
DRUG NAME: ● bladder
● ovarian
● Doxorubicin (Adriamycin), ● lung cancers
● Daunorubicin (Cerubidine)
● Idarubicin (Idamycin),
● Epirubicin (Ellence),
ROUTE(S) of ADMINISTRATION: IV (primarily)
● Mitoxantrone ( Novantrone)
Common Adverse effects
MECHANISM of ACTION: · Cardiotoxicity
a. Intercalate DNA strands · Bone marrow suppression
b. Activate Topoisomerase 2 · GI toxicity: nausea, vomiting, diarrhea,
stomatitis
c. Production of free radicals
· Alopecia
· Vesication
ANTITUMOR ANTIBIOTICS

COMMON CONTRAINDICATIONS & CAUTIONS:

● Pregnancy
● Lactation
● Severe cardiac disease
● Use with caution in hepatic and renal impairment
● Recent myocardial infarction
● Myocardial insufficiency
● Arrhythmias
● Myelosuppression
ANTITUMOR ANTIBIOTICS
DRUG NAME:
· Bleomycin (Blenoxane)
MECHANISM of ACTION:
Produce free radicals
Interference with the DNA/RNA synthesis
in cells that are rapidly dividing.
INDICATIONS: Leukemia, Hodgkin
Lymphoma, soft tissue sarcoma,
ROUTE(S) of ADMINISTRATION: IV
(primarily)
ADVERSE EFFECTS:
· Pulmonary Toxicity
· Hypersensitivity Reaction ( Fever, Chills,
Anaphylaxis
· Bone marrow suppression
· GI toxicity: nausea, vomiting, diarrhea, a
· Alopecia
· Vesication
ANTITUMOR ANTIBIOTICS

CONTRAINDICATIONS & CAUTIONS

of BLEOMYCIN:
· Pregnancy
· Lactation
· Severe cardiac disease
· Use with caution in hepatic and
renal impairment
Nitrosoureas
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Nitrosoureas
Nitrosoureas:
a. Alkylating agents that are stronger and
have a greater ability to attack cells in the
resting phase of cell growth.
b. These drugs can cross the blood-brain
barrier.
Common Drugs:
Carmustine
Lomustine
-

Nitrosoureas
Mechanism of Action:
● Alkylation of DNA strands, which Contraindications:
results in DNA damage and cellular ● Hypersensitivity
death. ● Thrombocytopenia
● Pregnancy and Breastfeeding

Indications:
Adverse Effects:
● Brain Cancer Tumor ● Myelosuppression
● Hodgkin Lymphoma ● N\V
● Impotence
Route of Administration: ● Pulmonary Toxicity
● Carmustine - IV and Vapor ● Infertility
Implementation
● Lomustine- PO
ALKYL SULFONATES

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-

BUSULFAN (MYLERAN)
Mechanism of Action:
● Damaging the DNA within cells,
by forming cross-links between
DNA strands.
Contraindications:
● Hypersensitivity
● Thrombocytopenia
● Pregnancy and Breastfeeding

Indications:
Adverse Effects:
● Myelocytic leukemia.
● Intestinal mucosal damage
● Alopecia
● Pancytopenia
Route of Administration: ● Anemia
● IV ● Amenorrhea
ALKYLATING-LIKE AGENTS

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ALKYLATING-LIKE AGENTS:

● Altretamine (HEXALEN)
● Carboplatin (PARAPLATIN)
● Cisplatin (PLATINOL)
● Dacarbazine (DTIC)
● Oxaliplatin (ELOXATIN)
-
ALKYLATING- LIKE AGENTS
MECHANISM OF ACTION:
DNA damage in all phases of cell-cycle → Overall Contraindications:
cancer cell death. DNA cross-linking ● Pregnancy
● Breastfeeding
● Liver disease
● Renal disease
Overall Route of Administration:
● IV or PO

Adverse Effects:
● Nausea
NURSING INTERVENTIONS:
● Vomiting
● Assessment and Monitoring
● Fever
● Prevention and Management of
● Bone Marrow Suppression
Side Effects
● Patient Education
Hormonal Agents
hormone therapy or hormonal therapy

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 Hormonal Agents
➢ Hormones are body-made substances that regulate
various cell functions.
➢ Some cancers use hormones to grow or develop.
They are hormone-sensitive or hormone-dependent
➢ A systemic treatment because the hormones
targeted circulate in the body.
➢ It does not work for all cancers, but it is used as
palliative treatment for brain and renal cancers.
Hormonal Agents
General Hormone Sensitive
Mechanism of Action Cancers
● STOPS the body from producing ● Breast Cancer
the hormone
● Prostate Cancer
● BLOCKS the hormone from
● Ovarian Cancer
attaching to cancer cells
● Womb Cancer (also called
● ALTERS the hormone so it doesn't
Uterine or Endometrial Cancer)
work like it should
Classification of Hormonal Agents

● Corticosteroids
● Sex Hormones
● Antiandrogens
● Selective Estrogen Receptor
Modulators (SERMs)
● Luteinizing Hormone-Releasing
Hormone Agonists, also known as
Gonadotropin-Releasing Hormone
Analogues or Agonists
● Aromatase Inhibitors
Common Adverse Effects Gastrointestinal
● Weight gain Side Effects
● Myalgia ● Anorexia
● Arthralgia ● Nausea
● Fractures due to decreased bone ● Vomiting
mineral density
● Diarrhea
● Decreased libido
● Gynecomastia
● Hot flashes
● Vaginal discharge, dryness, or
irritation. Overall Contraindications
● Pregnancy and Breastfeeding
● Hepatic or Renal Disease
1. Corticosteroids
Mechanism of Action:
● Suppresses the inflammatory process
● Natural hormones and hormone like associated with tumor growth
drugs used to treat many cancer and
noncancerous illnesses

● Divided into 2 types: Pharmacokinetics:

○ Glucocorticoids ● Metabolized in the liver
○ Mineralocorticoids ● Excreted in the urine

Indications: Adverse Effects:

● Leukemias ● Delirium
● Multiple Myeloma ● Elevated Serum Glucose
● IBD ● Insomnia
● Transplant Rejections ● Irritability and other psychological
problems
1. Corticosteroids
Common Medications:
● Dexamethasone
● Hydrocortisone
● Methylprednisolone
● Prednisone
- Most commonly prescribed steroid; older adults who
are at a high risk for delirium are recommended to
avoid this drug
2. Sex Hormone Common Medications:
● Conjugated Estrogens
● Hydroxyprogesterone
○ Route of Administration: IM & SubQ
Mechanism of Action: ○ Indication: Advanced Uterine
● Suppress production of sex hormone; Adenocarcinoma
delays growth of tumors ● Medroxyprogesterone
● Megestrol
○ Route of Administration: PO
○ Indication: Endometrial Cancer, Breast
Adverse Effects: Cancer
● Fluid Retention
● Thrombosis
● Menstrual Irregularities Pharmacokinetics:
● Osteoporosis ● Metabolized in the liver
● Excreted through the Biliary System
● Eliminated by the kidneys
3. Antiandrogens

Mechanism of Action: Common Medications:

● Block Androgen Receptors on cancer ● Flutamide
cells; stops growth of androgen- ● Apalutamide
dependent tumors ● Bicalutamide

Route of Administration: Indication:

● PO ● Prostate Cancer
4. Selective Estrogen Receptor
Modulators (SERMs)
➢ Has estrogenic agonist and antagonist effects
towards different parts of the body
Common Medications:
● Tamoxifen
● Raloxifene
Mechanism of Action:
● Block estrogen receptors on cancer
cells

Route of Administration:
● PO
Indications:
● Osteoporosis
● Breast Cancer
5. Luteinizing Hormone-Releasing
Hormone Agonists
Mechanism of Action:
● Blocks secretion of sex hormones;
stops the growth of sex hormone-
dependent tumors
Common Medications:
● Leuprolide
○ Route of Administration: SubQ and IM
● Goserelin
○ Route of Administration: SubQ only
6. Aromatase Inhibitors

Mechanism of Action: Common Medications:

● Reduces estrogen production ● Anastrozole
● Letrozole
● Exemestane

Route of Administration:
● PO
● Primarily for Post-Menopausal
Women with Breast Cancer
 Liposomal
Chemotherapy
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Liposomal Chemotherapy

➢ A more recent change in chemotherapy delivery involves

using anticancer drugs packaged inside synthetic fat
globules called liposomes.

➢ The fatty coating helps the chemotherapy drug remain in

the system longer and increases the duration of
therapeutic effects; it also decreases side effects such as
hair loss, nausea, and cardiotoxicity.
 Examples of Liposomal Chemotherapy

Liposomal Daunorubicin Vincristine Cytarabine

Doxorubicin
1. Liposomal doxorubicin
Indications Contraindications
● ovarian cancer ➢ Hypersensitivity reactions to
● AIDS-associated Kaposi's doxorubicin hydrochloride or the
Sarcoma components of doxorubicin
● multiple myeloma. hydrochloride liposome injection.
Actions
➢ Ability to bind DNA and inhibit
nucleic acid synthesis. Adverse effects
➢ Asthenia, fatigue, fever, anorexia,
Pharmacokinetics nausea, vomiting, stomatitis,
➢ IV diarrhea, constipation, hand-foot
➢ Metabolized in liver and spleen. syndrome, rash, neutropenia,
➢ Excreted in urine. thrombocytopenia, and anemia.
2. Daunorubicin
Indications Contraindications
➢ Acute lymphoblastic leukemia ➢ Hypersensitivity
➢ Acute non-lymphocytic leukemia ➢ Chickenpox or herpes
Actions zoster
➢ Damages DNA by intercalation
between base pairs resulting in ➢ Heart disease.
the uncoiling of the helix, Adverse effects
ultimately inhibiting DNA synthesis
➢ Myelosuppression,
Venus
and DNA-dependent RNA
synthesis. cardiotoxicity,
Pharmacokinetics reversible alopecia,
➢ Absorbed via IV rash, contact
infusion. dermatitis, urticaria,
➢ Metabolize in liver. nausea and vomiting,
diarrhea and
3. Vincristine
Indications Contraindications
➢ Leukemia
➢ Hypersensitivity
➢ Hodgkin's disease ➢ Charcot-Marie-Tooth syndrome
➢ Non-Hodgkin's lymphoma (demyelinating form)
➢ Rhabdomyosarcoma ➢ Intrathecal (IT) administration.
➢ Neuroblastoma
➢ Wilms' tumor
Actions
➢ Inhibition of intracellular microtubule Adverse effects
formation. Vincristine shows its action ➢ Loss of sleep, tendon reflexes,
by binding to tubulin to prevent it from severe peripheral neuropathy,
polymerizing into microtubules. sometimes in severe cases loss of
motor function, foot drop, ataxia,
Pharmacokinetics bone marrow suppression (it is less
➢ Absorbed via IV infusion only. common than vinblastine), urinary
➢ Metabolized by the liver. disturbances, and alopecia.
➢ Eliminated in the feces and urine.
4. Cytarabine
Indications Contraindications
➢ Acute non-lymphocytic leukemia
➢ Patients who have had a
➢ Acute lymphocytic leukemia
hypersensitivity reaction to it or
➢ Blast phase of chronic myelocytic
any of the fundamental
leukemia. ingredients used in the
preparation of the drug.
Actions
➢ Metabolite cytarabine-5'-triphosphate
inhibits DNA polymerase during the S Adverse effects
phase. ➢ Anorexia, nausea, vomiting,
diarrhea, oral/anal inflammation,
Pharmacokinetics thrombophlebitis, bleeding,
➢ Absorbed through rapid IV, infusion myelosuppression, rash, fever,
over 1-3 hr. and hepatic dysfunction.
➢ Metabolize in the liver (major), and
kidneys (minor)
➢ Excreted in urine.
 Combination
Chemotherapy

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Combination Chemotherapy
➢ To reduce cancer cells or shrink a tumour and prevent cancer
from spreading to other parts of the body.

➢ It involves the use of two or more anticancer medications,

using more than one medication decreases the likelihood
that cancerous cells will develop resistance to a particular
drug.

➢ combination chemotherapy may include:

○ Alkylating agents.
○ Antimetabolites.
○ Antitumor antibiotics.
○ Hormonal Agents
○ Plant alkaloids.
Combination Chemotherapy
Contraindications and Cautions:
Side Effects of Combination
● Certain Antibiotics,antihistamines,Potent
Chemotherapy
narcotic methadone
● diarrhea ● Severe infections
● dizziness ● Pregnancy and Lactation
● Individual with pre-existing organ
● fatigue
dysfunction, such as severe liver or kidney
● hair loss
impairment, may limit the body's ability to
● infections
process and eliminate chemotherapy drugs,
● lack of appetite making it unsafe for certain individuals.
● Mouth sores
● nausea and vomiting
● numbness or tingling
Selected Combination of Anticancer
Drugs
● Each individual drug used in combination
chemotherapy should have a proven
tumoricidal activity. A different
mechanism of action and different
Miscellaneous
Chemotherapy
Agents
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Drug Name:
● Asparaginase (Elspar)
● Pegaspargase (Oncaspar)
Mechanism of Action:
● Deplete circulating asparagine levels
→ cancer cells cannot synthesise
their own asparagine → impaired
protein synthesis, apoptosis
Indications:
● Acute lymphoblastic leukaemia
Route(s) of Administration: IM
Side Effects GI Toxicity:
● Nausea, vomiting, diarrhea
● Hypersensitivity reactions
● Asparaginase: pancreatitis, fever,
hepatotoxicity, hyperglycemia
Contraindications & Cautions:
● Pregnancy and breastfeeding,
● History of pancreatitis, thrombosis
or hemorrhagic events with
previous asparaginase treatment
 Indications:
Drug Name:
● Chronic myeloid leukemia; head
● Hydroxyurea (Droxia, Hydrea, and neck cancer
Siklos) Route(s) of Administration: PO

Side Effects GI Toxicity:

● Risk of secondary malignancy (boxed warning)
● Bone marrow suppression Dermatological
reactions (rash, eczema, pruritus, alopecia)
● GI toxicity: nausea, vomiting, diarrhea Fever
Mechanism of Action: Headache Stomatitis
● Inhibits enzymes involved in DNA
synthesis → stops cancer cell division
Contraindications & Cautions:
● Pregnancy and breastfeeding
● Elderly population
● Renal disease
● Radiation therapy in the past HIV
medications
Thank
You!
Research resources

● Combination Cancer Therapy By Robert Peter Gale ,

MD, PhD, DSC(hc), Imperial College London.
● Other antineoplastics: Nursing pharmacology →
https://www.osmosis.org/learn/Other_antineoplastic
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