Oncology: Chemotherapy (CTX)

Chemotherapy (CTX)

Definition
  • Definition: Chemical Medications Used to Kill Rapidly-Growing Cells
  • Inhibits Mitosis or Induces DNA Damage
  • Often Many Drugs are Used Together as a Regimen
    • Ex: FOLFOX in Colon Cancer (Folinic Acid, 5-FU & Oxaliplatin)
  • Side Effects Mn
Chemotherapy Classification
  • Alkylating Agents – Inhibit DNA Replication by Creating an Unstable Alkyl Group
  • Antimetabolites – Inhibits DNA Replication
  • Antimicrotubular Agents
  • Others:
    • Antibiotics
    • Enzymes
Chemoprotective Agents
  • Definition: Drugs Used to Moderate the Side Effects of Chemotherapy Treatments
  • Leucovorin (Folinic Acid)
    • Use: Reverse Side Effects of Methotrexate (“Rescue Therapy”)
    • Side Effects: Worsens Toxicity of 5-FU
  • Amifostine
    • Use: Prevents Nephrotoxicity from Cisplatin & Carboplatin
  • Mesna
    • Use: Prevents Hemorrhagic Cystitis from Cyclophosphamide
  • Dexrazoxane
    • Use: Prevents Cardiotoxicity from Doxorubicin
  • Granulocyte Colony-Stimulating Factor (GCSF/Neupogen/Granix)
    • Use: Neutrophil Recovery After Chemotherapy
    • Side Effects: Sweet’s Syndrome – Acute Febrile Neutropenic Dermatitis

Chemotherapy Agents

Alkylating Agents

  • Alkyl Sulfonates:
    • Busulfan
      • Side Effects: Pulmonary Fibrosis
  • Nitrogen Mustards:
    • Cyclophosphamide
      • Binds Cyclophilin & Inhibits Calcineurin
      • Side Effects: Gonad Dysfunction, SIADH & Hemorrhagic Cystitis (Tx: Mesna)
    • Ifosfamide
    • Bendamustine
  • Nitrosoureas:
    • Carmustine
    • Lomustine
  • Platinum Analogs:
    • Carboplatin
      • Side Effects: Myelosuppression
    • Cisplatin
      • Side Effects: Nephrotoxic, Neurotoxic & Ototoxic
    • Oxaliplatin
      • Side Effects: Peripheral Neuropathy
    • Triazanes:
      • Dacarbazine
      • Procarbazine

Antimetabolites

  • Cytidine Analogs:
    • Gemcitabine
    • Azacytidine
    • Decitabine
  • Folate Antagonists (Dihydrofolate Reductase Inhibitor):
    • Methotrexate (MTX)
      • Side Effects: Myelosuppression & Nephrotoxicity
  • Purine Analogs:
    • Cladribine
    • Clofarabine
    • Nelarabine
    • Mercaptopurine (6-MP)
  • Pyrimidine Analogs:
    • Fluorouracil (5-FU)
      • Side Effects: Myelosuppression
    • Capecitabine (Oral 5-FU)

Antimicrotubular Agents

  • Taxanes:
    • Pacitaxel
    • Docetaxel
    • Cabazitaxel
  • Topoisomerase I Inhibitors:
    • Irinotecan
      • Side Effects: Diarrhea, N/V & Neutropenia
    • Topotecan
  • Topoisomerase II Inhibitors:
    • Doxorubicin
      • Side Effects: Cardiotoxicity
    • Idarubicin
    • Etoposide
  • Vinca Alkaloids
    • Vinblastine
      • Side Effects: Myelosuppression
    • Vincristine
      • Side Effects: Peripheral Neuropathy & Neurotoxic

Other Agents

  • Bleomycin
    • Mechanism: Antibiotic Also Inhibits DNA Synthesis
    • Side Effects: Pulmonary Fibrosis
  • Hydroxyurea
    • Mechanism: Inhibits Ribonucleoside Diphosphate Reductase
    • Side Effects: Myelosuppression
  • Tretinoin
    • Mechanism: Vitamin A Derivative Also Targets RAR-Alpha

Mnemonics

Chemo-Tox Man