Anti-neoplastics

Author: Lorena K. Marra MS, FNP-C
Source Reference: Frandsen, G., & Pennington, S.S. ( $2025$ ). Abram's clinical drug therapy: Rationales for nursing practice ( $13^{th}$ ed.). Wolters Kluwer.

Oncology: Defined as the study of cancer and the treatment of the disease.
Cancer: A complex disease process characterized by the following features: - Uncontrolled cell growth. - Invasiveness into surrounding tissues. - Metastasis: The spread of cancer cells to distant sites. - Diverse etiologies, clinical manifestations, and treatments.

Primary Objectives of Pharmacotherapy: - To kill cancer cells. - To damage cancer cells. - To slow the growth rate of cancer cells. - To prevent or treat adverse effects associated with cancer or its treatment.
Medication Groups: - Traditional cytotoxic agents. - Biologic targeted therapies: These are also classified as cytotoxic. - Hormone inhibitors: Characterized as noncytotoxic; specifically function by slowing the growth of cancer cells that are stimulated by hormones. - Cytoprotectants: Medications specifically designed to reduce the adverse effects of cytotoxic medications.

Chemotherapy: The systemic use of medications to treat cancer, distinct from localized treatments like surgery or radiation.
Mechanism: Medications are designed to damage or kill cancer cells.
Combination Therapy: Most treatment regimens involve a combination of drugs which possess differing cellular actions.
Drug Resistance: Identified as a major problem in oncology; newer drugs are typically utilized after primary medications become ineffective.
Administration Schedules: - Usually administered in cycles. - Requires taking medications on a strictly prescribed schedule followed by a recovery period after each cycle.
Management Roles: - Regimens are managed by medical oncologists. - Medications must be administered by specially trained and certified nurses.

General Mechanism: Most of these drugs kill malignant cells by interfering with cell replication in some manner.
Timing: These agents act during the cell's reproductive cycle.
Target Tissue: Most active against cells that are rapidly dividing, which includes both normal and malignant cells.
Fractional Kill: Each individual dose kills a specific $\text{\%}$ of cells.
Resistance: Use of these drugs may induce the development of drug-resistant malignant cells.
Delivery: Differing routes of administration are used based on the drug and patient needs.

Hematologic Effects: - Anemia. - Neutropenia. - Thrombocytopenia. - Bleeding.
Gastrointestinal and Mucosal Effects: - Nausea and Vomiting (N/V). - Mucositis. - Anorexia.
Systemic Effects: - Alopecia (hair loss). - Fatigue.
Organ-Specific Damage: - Heart (cardiotoxicity). - Liver (hepatotoxicity). - Kidneys (nephrotoxicity). - Nerves (neurotoxicity).

Malignant Indications: - To cure neoplastic disease. - To relieve symptoms of neoplastic disease. - To induce and maintain remissions.
Nonmalignant Indications: - Rheumatoid arthritis. - Psoriasis.

Surgery: Used to excise localized tumors and to treat complications resulting from the cancer.
Radiation Therapy: Utilized either alone or in combination with other treatments.
Chemotherapy: - Used to eliminate or control the growth of the neoplasm. - Targeted at relieving symptoms and improving the patient’s quality of life.

Factors Influencing Drug Selection: - The type and stage of the cancer. - The established efficacy of a drug in treating a specific cancer type. - The patient's age and overall health status, with specific focus on liver and kidney function.
General Dosing Principles: - Doses must be carefully calculated to minimize toxicity. - Higher doses are usually found to be the most effective. - Standard calculation is based on the patient's body surface area (BSA).
Patient Factors for Consideration: - Functional status and nutritional status. - Blood count results. - Kidney and liver function profiles. - Dose Reductions: Necessary for patients with impairments that reduce the body's ability to eliminate the medications.

Biohazard Nature: Most medications in this class are carcinogenic, mutagenic, and teratogenic.
Pregnancy Precautions: Direct exposure must be avoided by those who are pregnant.
Handling Procedures: - Parenteral solutions are irritating to the skin and mucous membranes. - Avoid direct contact with the skin or the respiratory tract. - Hands must be washed thoroughly after drug administration.
Certification: Injectable medications must only be administered by certified professionals.

Alkylating Drugs (Nitrogen Mustard Derivatives): - Prototype: cyclophosphamide. - Action: Interfere with cell division.
Antimetabolites: - Prototype: methotrexate. - Action: Replace normal metabolites needed by the cell to synthesize DNA.
Antitumor Antibiotics: - Prototype: bleomycin. - Action: Inhibits DNA and prevents cell division.
Plant Alkaloids (Vinca Alkaloids): - Prototype: vincristine. - Action: Interfere with cell mitosis.
Antineoplastic Hormone Inhibitor (Selective Estrogen Receptor Modulators): - Prototype: tamoxifen.

Biologic Antineoplastic Drugs: - Monoclonal antibodies (e.g., alemtuzumab): Antigen binding makes the malignant cell more susceptible to destruction by the immune system. - Growth factor and tyrosine kinase inhibitors (e.g., erlotinib): Blocks receptors that stimulate cell proliferation. - Proteasome inhibitors (e.g., bortezomib): Causes cell death by inhibiting enzymes that regulate intracellular protein activity.
Continued Antineoplastic Hormone Inhibitor Drugs: - Antiestrogens. - Aromatase inhibitors: Specifically block estrogen-responsive breast cancer. - Antiandrogens: Used to treat prostate cancer by blocking testosterone. - Gonadotropin-releasing hormone agonists.
Cytoprotectant Drugs: Specifically administered to help reduce the side effects of therapy.