Treatment of Cancer Flashcards
4 phases of the cell cycle
G1 phase: RNA & protein synthesis, cell growth, DNA repair
S phase: DNA completely replicated
G2 phase: additional synthesis of RNA, protein & specialized DNA
M phase: mitosis
Alkylating agents
One of the first class of drugs discovered
Directly damage DNA to keep the cell from reproducing
Work in all phases of the cell cycle
Cyclophosphamide (Cytoxan)
Cyclophosphamide (Cytoxan) Side Effects
Hemorrhagic cystitis
Metabolic products of cytoxan secreted into the urine
Bladder mucosa may become damaged
Need to increase fluid intake before and after infusion and empty bladder frequently
Can lead to Leukemia long term
Alkylating agents: Nitrogen mustards
Cyclophosphamide (Cytoxan)
Alkylating agents: Platinum analogs
Cisplatin (Platinol)
Cisplatin (Platinol) Side Effects
Nephrotoxicity:
Patients must be vigorously hydrated prior, during and after cisplatin administration
Monitor electrolytes and renal function
Neurotoxicity:
Peripheral neuropathy
Ototoxicity that can lead to deafness
(Amifostine is given IV to protect against nephro/neurotoxicity from Cisplatin)
Antimetabolites
Interfere with DNA and RNA growth by substituting for the normal building blocks of RNA and DNA
Damage cells during the S phase, when the cell’s chromosomes are being copied
Classes of antimetabolities
Folate antagonists: Methotrexate (MTX, Trexall)
Purine analogs: Mercaptopurine (6-MP, Purinethol)
Pyrimidine analogs: Fluorouracil (5-FU), Gemcitabine (Gemzar)
Methotrexate (MTX; Trexall) Anticdote
Leucovorin is given to reverse the toxic effects
Mitotic inhibitors
They work by stopping mitosis in the M phase of the cell cycle but can damage cells in all phases by keeping enzymes from making proteins needed for cell reproduction
Toxicities: myelosuppression, anaphylactic reactions, peripheral neuropathy
Mitotic inhibitors: Vincristine (Oncovin)
Neuropathy
Paresthesias in the fingers and toes (mild)
Symptoms can move distal to proximal and result in significant weakness
Constipation is the most common symptom of autonomic neuropathy (Start on stool softners at the beginning of therapy)
Anthracyclines
Cardiotoxicity – leading to systolic CHF
Need a baseline MUGA scan
Most commonly associated with Doxorubicin (Adriamycin)
Topoisomerase inhibitors
These drugs interfere with topoisomerases, which help separate the strands of DNA so they can be copied during the S phase
Topoisomerase II inhibitors can increase the risk of a second cancer (acute myelogenous leukemia (AML))
Misc: Bleomycin (Blenoxane) Side Effects
Edema of the interphalangeal joints and hardening of the skin on the palms and soles of the feet
Anaphylactic or serum sickness like reaction
Pulmonary fibrosis**
Hypotensive reaction
