Oncology Drugs
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| Ifosfamide | Akylating agent-Form covalent bond w/ cancer DNA, which prevents unwinding and replication of DNA. Cell cycle non-specific | CNS toxicites caused by chloroacetaldehyde metabolite-D/C therapy | sarcomas, lymphoma, testicular, bladder, head and neck, cervical and lung cancers | Myelosuppresion(DLT), N/V, alopecia, Amenorrhea, infertility, Hemorrhagic cystist(must use MESNA), nephrotoxicity, cardiotoxicity, CNS toxicites
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| oxaliplatin | Akylating agent-Form covalent bond w/ cancer DNA, which prevents unwinding and replication of DNA. Cell cycle non-specific | warn them about chest numbness | colorectal and esophageal cancers | mild myelosuppression, N/V, diarrhea, neuropathy(DLT)(can't feel breathing and intolerant to cold), nephrotoxicity uncommon
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| Cisplatin | Akylating agent-Form covalent bond w/ cancer DNA, which prevents unwinding and replication of DNA. Cell cycle non-specific | have to give plenty of fluids + mannitol and antiemetics | lung, ovarian, testis, bladder, head and neck, lymphomas, and esophageal cancers | mild myelosuppresion, severe N/V, nephrotoxicity(DLT), severe decrease in Mg and K, Neuropathy, ototoxicity
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| Carboplatin | Akylating agent-Form covalent bond w/ cancer DNA, which prevents unwinding and replication of DNA. Cell cycle non-specific | use calvert equation to dose=AUC x (GFR + 25) | lung, ovarian, testes, bladder, breat, endometrial, relapse leukemias, and head and neck cancers. | more myelosuppresion(DLT) (thrombocytopenia), less nephrotoxicity, neuropathy, ototoxicity, and N/V
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| Methotrexate | Antifolate Antimetabolite agent-inhibit dihydrofolate reductaseactive in S phase | hydration w/ urinary alkalinization, antiemeticsLeucovorin is a rescue when a high dose is given. | leukemia, lymphoma, osteosarcoma, breast, head and neck and bladder cancers | myelosuppresion, mucositis, N/V/D, hepatotoxicity, nephrotoxicity
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| Pemetrexed | Antifolate Antimetabolite agents-inhibits dihydrofolate reductase and thymidylate synthase | must be given w/ folic acid and Vit. B12 to reduce myelosuppression | mesothelioma, non-small cell lung, colorectal, breast, pancreatic, and bladder cancers | myelosuppression(DLT), N/V, mucositis, skin rash
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| 5-Fluorouracil | 5-Fluoropyrimidine Antimetabolite agent-incorporated into DNA as a false base pair. Inhibits TS which results in thymidylate deficiency. Prevents DNA repair and synthesis | Continous-D/mucositis, Hand/Foot, Vasospastic anginabolus-BM suppresion, metallic tasteleucovorin enhances the drug. | breast, colorectal, gastric, pancreatic, ovarain, head and neck and basal cell skin(topical) | N/V, excessive lacrimation, somnolence, photosensitiviy, dry skin
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| Capecitabine | 5-Fluoropyrimidine Antimetabolite agent-incorporated into DNA as a false base pair. Inhibits TS which results in thymidylate deficiency. Prevents DNA repair and synthesis | oral prodrug of 5-FU, 3 step enzymatic process that occurs only in tumorblack box: with warfarin | colorectal and metastic breast cancer | N/V, mucositis, Diarrhea, HAND AND FOOT SYNDROME
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| cytarabine | Cytidine Antimetabolite agent-ARa-C is triphosphorylated to ara-CTp which is incorporated into the DNA and halts strand elongation/repair | high-dose: Cerebellar toxicity(ataxia, nystagmus, slurred speech, tremor)5 days after tx and chemical conjunctivitishand and foot rare | acute & chronic leukemia, NHL, leptomeningeal carcinomatosis | depends on dose and schedule: myelosuppression, N/V, Diarrhea, Mucositis, hepatic dysfunction
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| Gemcitabine | Cytidine Antimetabolite agent-ARa-C is triphosphorylated to ara-CTp which is incorporated into the DNA and halts strand elongation/repair | soft tissue sarcomas, pancreatic, lung, breast, ovarian, and bladder cancers | myelosuppression(DLT), flu-like, asthenia, increased transaminases
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| vincristine | vinca alkaloids-bind to tubulin, which inhibits polymerization,which is needed to form mitotic spindle. M phase specific | dose empirically capped at 2mg due to neurotoxicity Vesicant | leukemia, lymphoma, Wilm's tumor, neuroblastoma, brain, sarcoma | neuropathy(DLT), constipation, SIADH, mucositis, decreased myelosuppression
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| vinblastine | vinca alkaloids-bind to tubulin, which inhibits polymerizationwhich is needed to form mitotic spindle,. M phase specific | causes more myelosuppression than neuropathyvesciant | testicular cancer, lymphoma, kaposi's sarcoma, neuroblastoma | myelosuppression(DLT), neuropathy, constipation, SIADH, mucositis
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| Vinorelbine | vinca alkaloids-bind to tubulin, which inhibits polymerization, which is needed to form mitotic spindle. M phase specific | Vesicant | NSCLC, breast | More myelosuppresion than Vinblastine(DLT), neuropathy, SIADH, mucositis
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| Doxorubicin | Anthracycline agent-Topoisomerase II inhibitor, DNA intercalation, inhibits DNA dependent Rna polymerase, free radical generation | extravasation(vesicant) | breast, lung, gastric, bladder, thyroid, and ovarain cancers, leukemia, lymphoma, multiple myeloma, neuroblastoma, and soft tissue sarcoma | myelosuppression(DLT),N/V, mucositis & diarrhea, alopecia, hyperpigmentation of nails, rare skin rash, urticaria, cardiotoxicity, red/orange urine
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| Daunorubicin | Anthracycline agent-Topoisomerase II inhibitor, DNA intercalation, inhibits DNA dependent Rna polymerase, free radical generation | drug is a red/orange colorvesicant | acute myeloid leukemia, acute lymphoid leukemia | myelosuppression(DLT),N/V, mucositis & diarrhea, alopecia, hyperpigmentation of nails, rare skin rash, urticaria, cardiotoxicity, red/orange urine
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| idarubicin | Anthracycline agent-Topoisomerase II inhibitor, DNA intercalation, inhibits DNA dependent Rna polymerase, free radical generation | drug is a red/orange colorvesciant | acute myeloid leukemia | myelosuppression(DLT),N/V, mucositis & diarrhea, alopecia, hyperpigmentation of nails, rare skin rash, urticaria, cardiotoxicity, red/orange urine
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| liposomal doxorubicin | Anthracycline agent-Topoisomerase II inhibitor, DNA intercalation, inhibits DNA dependent Rna polymerase, free radical generation | drug is an irritant | ovarian cancer, breast cancer, mutiple myeloma | myelosuppression, N/V, mucositis, hand-foot, infusion related reactions
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| irinotecan | Inhibit topoisomerase I which results in DNA single stranded breaks-S phase specific | acute and delayed diarrhea | colorectal, lung cancer | myelosuppression(DLT), N/V mucositis, alopecia, Diarrhea(DLT), cholinergic syndrome
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| topotecan | Topoisomerase II inhibitor by forming ternary complexes w/ it which results in Double stranded DNA breaks-G2 phase specific | lymphoma, ovarian, cervical, testicular, gastric, and lung cancers | myelosuppression(DLT), mucositis, Diarrhea(mild), elevated transaminases
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| etoposide Vp-16 | Topoisomerase II inhibitor by forming ternary complexes w/ it which results in Double stranded DNA breaks-G2 phase specific | 50mg capsules are available-bio availability is 50% | testicular cancer, acute leukemia, lymphoma, lung cancer, ovarian cancer | myelosuppression(DLT), N/V, alopecia, mucositis, secondary AML, infusion related reactions
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| Paclitaxel | Taxane agent-bind tubulin creating dysfunctional microtubules resistant to depolymerization. M phase specific | Give dexamethasone, H1 and H2 antagonist to treat hypersensitivities | breast, ovarian, lung,bladder,prostate, esophageal, head and neck disorders, Kaposi's sarcoma | myelosuppresion(DLT), mucositis, alopecia, hypersensitivity reactions(cremophor), neuropathy, myalgias, arthralgias, hepatotoxicity, EKG abnormalities
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| Docetaxel | Taxane agent-bind tubulin creating dysfunctional microtubules resistant to depolymerization. M phase specific | given w/ 3 days of dexamethasone for prophylaxis of edema & prevent infusion reactions | breast cancer, ovarian cancer, NSCLC, prostate cancer | myelosuppression, mucositis, alopecia, neuropathy, peripheral edema, myalgias, fatigue, hepatoxicity, infusion related reactions
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| albumin-bound paclitaxel | Taxane agent-bind tubulin creating dysfunctional microtubules resistant to depolymerization. M phase specific | no El Cremophor, decreased risk of reactions. NO need for traditional premedications produced via nanotechnology | breast cancer | myelosuppression, alopecia, neuropathy, myalgias, hepatoxicity, EKG abnormalities
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| Ixabepilone | Epothilone agent-resembles taxanes-bind tubulin creating dysfunctional microtubules resistant to depolymerization. M phase specific | pre-meds H1 and H2 antagonist | metastatic breast cancer who have progressed on anthracyclines and taxanes |
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| Bevacizumab | HUMANIZED-monoclonal antibody-vascular endothelial growth factor, which initiates angiogenesis(forms new blood vessels) | documented improvement in survival w/ chemo in metastatic colon and breast cancers | colon, NSCLC, breast, ovarian | bleeding, thrombosis, HTN, infusion reactions, nephrotic syndrome, impaired wound healing, Gi perforations
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| traztuzumab | HUMANIZED-monoclonal antibody-her-2-neu, which is expressed on breast carcinomas | benefit as a single agent and in combination w/ chemo | Her2/neu overexpressing breast cancer | infusion reactions, cardiomyopathy(w/ anthracyclines), diarrhea
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| Rituximab | CHIMERIC-monoclonal antibody-B-cell surface marker CD20, which is against lymphoma cells | active in both indolent and agressive NHL, start infusion slow and then increase | NHL,CLL, immunologic diseases(ITP) | infusion reactions, mild myelosuppression
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| Cetuximab | CHIMERIC- monoclonal antibody-epidermal growth factor receptor | used as single or combo therapy w/ irinotecan in colorectal cancer | colorectal, head and neck | infusion reactions, aceneform rash, diarrhea, asthenia, paronychia, hypmagnesemia
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| Panitumumab | FULLY HUMAN-monoclonal antibody--directed against Epidermal growth factor receptor | used only as a single agent | colorectal cancer | decreased infusion reactions, acneform rash, diarrhea, asthenia, paronychia, hypomagnesemia
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| Imatinib | Tyrosine Kinase Inhibitor-inhibits Bcr-Abl tyrosine kinase,which is product of philadelphia chromosome in CML | many drug interaction-CYP3A4 | CML, ALL(Ph+), GIST | myelosuppression, nausea, diarrhea, edema, rash, hepatotoxicity
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| Erlotinib | Tyrosine Kinase Inhibitor-epidermal growth factor receptor such as in lung cancer | mild benefit in patients who have failed standard treatment | lung cancer | fatigue, diarrhea, acneform rash, nausea
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| Lapatinib | Tyrosine Kinase Inhibitor-Inhibits epidermal growth factor receptor (HER1 and HER2/neu-breast carcinomas | many drug interactions-CYP3A4 | breast cancer | fatigue, diarrhea, rash, nausea, hepatotoxicity
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| Bortezomib | Proteosome inhibitor | promotes apoptosis | relapsed multiple myeloma and relapsed or refractory mantle cell lymphoma | thrombocytopenia, fatigue, peripheral neuropathy, neutorpenia, diarrhea
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| Thalidomide/Lenalidomide | not fully understood, Immune modulation?? | must register in STEPS program-contraceptions, filled w/in 7 days, 4 weeks at a time | multiple myeloma | teratogenic, DVT, somnolence, rash, neuropathy, constipation, and dizziness/hypotension
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| Cyclophosphamide | Akylating agent-Form covalent bond w/ cancer DNA, which prevents unwinding and replication of DNA. Cell cycle non-specific | metabolized to active species. drug increases anticoagulation effect and decreases digoxin plasma levels. Phenobarbital and phenytoin increase rate of drug metabolism to toxic metabolites | leukemia, lymphoma, multiple myeloma, sarcomas, bone, breast and ovarian cancers | myelosuppresion(DLT), N/V, alopecia, Amenorrhea, SIADH, Hemorrhagic cystitis(acrolein damages bladder), Cardiotoxicity
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