Anticancer Drugs: Cytotoxic Agents

Pharm Exam: Cancer

What is the definition of neutropenia in chemotherapy

absolute neutrophils < 500

What are the three major components of bone marrow suppression

neutropenia, thrombocytopenia, anemia

What digestive tract injuries occur with cytotoxic agents?

Stomatitis, nausea, vomiting, diarrhea

What are other common toxicities of chemotherapy?

Alopecia, reproductive injury, local injury from vescicants

What are alkylating agents made from?

Nitrogen mustard

Example of an alkylating agent?

cyclophosphamide

DLT of alkylating agents?

Bone marrow suppression

Other major toxicities of cyclophosphamide?

Acute hemorrhagic cyctitis, severe nausea and vomiting, alopecia

What are platinum compounds made from?

Platinum

Example of platinum compound

cisplatin

what cancers does cisplatin treat

testicular, breast, ovarian

DLT of cisplatin

kidney damage

other toxicities of cisplatin

severe nausea and vomiting lasting days, peripheral neuropathy

how do antimetabolites work

they mimic the molecules that cells need to grow

example of a folic acid analogue

Methotrexate

what does methotrexate treat

Non-hodgkins lymphoma and choriocarcinomas

DLT of methotrexate

Bone marrow suppression and pulmonary infiltrates

Example of anthracycline

doxorubicin

DLT of doxorubicin

cardiotoxicity (acute arrhythmias, delayed CHF up to 1 year later)

Other issues with doxorubicin

strong vesicant, turns urine and sweat red

example of a non-anthracycline antitumor antibiotic

Dactinomycin

DLT of dactiomycin

bone marrow suppression

what cancers does dactinomycin treat

wilms tumor, rhabdomyosarcoma

example of a vinca alkaloid

vincristine

DLT of vincristine

peripheral neuropathy

does vincristine suppress bone marrow?

No, so it is good for combo therapy

example of another vinca alkaloid

vinblastine

DLT of vinblastine

Bone marrow suppression

What cancers does Vinblastine treat

Lymphomas, testicular, breast, small cell lung, Kaposi sarcoma

example of a taxane

paclitaxel

DLT of paclitaxel

bone marrow suppression

What cancers does paclitaxel treat

early stage breast cancer, advanced/metastatic breast cancer

what severe hypersensitivity reactions can paclitaxel cause

dyspnea, hypotension, angioedema, urticaria

what do you do if a hypersensitivity reaction occurs during paclitaxel infusion

stop the infusion, give glucocorticoids, give diphenhydramine and famotidine

Example of a topoisomerase inhibitor

irinotecan

what cancers does irinotecan treat

ovanian, cervical, refractory small cell lung cancer

DLT of irinotecan

Bone marrow suppression

example of a miscellaneous cytotoxic agent

asparaginase

what cancer does asparaginase treat

Only acute myelogenous leukemia

major toxicities of asparaginase

severe n/v, fatal anaphylaxis, CNS depression, liver/kidney/pancreas damage

what emergency supplies must be available when giving asparaginase

epinephrine, famotidine, IV fluids, intubation supplies