(1) CYTOTOXIC DRUGS

DRUG CLINICAL USE Nitrogen Mustard MOPP regimen for Hodgkins Lymphoma Phosphoramide mustard Antitumor effect Sarcoma Bone Marrow transplantation Chronic B-cell lymphocytic leukemia and lymphoma Immunosuppressive therapy Bone Marrow transplantation Gliomas, Brain Tumor Multiple myeloma Bone Marrow transplant ABVD regimen for Hodgkins Lymphoma Gliomas Radiation therapy SIDE EFFECT Severe necrosis due to subcutaneous extravasation Hemorrhagic cystitis Hemorrhagic cystitis Mesna ANTIDOTE

ALKYLATING AGENTS
Mechlorethamine
(Bifunctional alkylation)

Cyclophosphamide Ifosfamide
(Monofunctional alkylation)

Melphalan Chlorambucil

Busulfan Nitrosoureas
(Carmustine (BCNU)

Venoocclusive disease of the liver Phenobarbital

Dacarbazine Temozolomide
(Oral analog of dacarbazine)

Flu-like syndrome of fever, malaise, mylagias

Acetaminophen predication

ANTIMETABOLITES
1. FOLIC ACID ANALOGS Methotrexate Inhibits DHFR enzyme S-phase specific High grade lymphomas and leukemia ALL Choriocarcinoma Non-hodgkin Lymphoma Osteosarcoma Leukemia Urine alkalinization Multi-folate antagonist Inhibits tumor enzymes st 1 line metastaic mesethelioma nd 2 line metastatic non-small cell lung cancer Accumulation in 3 spaces (Ascites Pleural effusion) Bone marrow suppression
rd

Leucovorin

Permetrexed

Vitamin B and Folic acid

2. PYRIMIDINE ANALOGS 5-FU

Inhibits Thymidilate Synthase Colorectal cancer Breast cancer Hand-foot syndrome Induction of remission of ALL Myelosyppression GI disturbances Conjunctivitis Myelosuppression

Capecitabine
(prodrug of 5-FU)

Leucovorin Inactivated by: Dihydropyrimidin e Dehydrogenase (DPD) in the liver

Cytarabine

Gemcitabine

Only effective drug against pancreatic cancer Mild chemotherapy drug (No alopecia) Induction of remission of ALL Induction of remission of AML Inhibits DNA polymerase, ligase, primase, ribonucleotide reeducates ---

3. PURINE ANALOGS Mercaptopurine Thioguanine Fludarabine Cladribine

Myelosuppression Myelosuppression Depletion of CD4 T-cells Depletion of CD4 T-cells

ANTIMITOTIC
1. Vinca Alkaloids Vincristine Binds to tubulin causing microtubule dissolution Non-Hodgkins lymphoma Neurotoxicity, numbness, tingling, loss of DTR, motor weakness, constipation Myelosuppression Mylelosuppression

Vinblastine Vinorelbine Vindesine

Hodgkins lymphoma Adjuvant and metastatic NSCLCA

2. Taxane Paclitaxel

Promotes microtubule formation (destabilization)

Breast cancer Lung cancer Ovarian cancer Metastatic NSCLCA Breast cancer Head and neck cancers Breast cancer

Neutropenia

Docetaxel

3. Epothilones

TOPOISOMERASE- INTERACTIVE AGENTS

1. Camptothecin Irinotecan Major excreation pathway glucuronidation by UGT1A1 for patients with Criggler Najar or Gilberts syndrome Ovarian cancer Non-hodgkins lumphoma ALL Glioblastoma Neuroblastoma Lymphomas, leukemias, breast cancer, sarcomas, SCLCA ALL and AML Breast cancer Acute non-lymphocytic leukemia, hormoneresistant prostate cancer Ovarian cancer, Lymphomas CARDIOTOXIC Acute diarrhea Delayed diarrhea Neutropenia Acute non-lymphocytic leukemia in children previously treated for ALL

Topotecan

2. Epipodophyllotoxin Etoposide Teniposide 3. Anthracyclines Doxorubicin

Daunorubicin Epirubicin Mitoxantrone Liposomal doxorubicin Bleomycin Mitomycin

Less cardiotoxic, less neutropenia

Pulmonary fobrosis Anal cancer

PLATINUM COMPOUNDS
Cisplatin Germ cell tumor Lung cancer Head and neck cancer Ovarian cancer Ovarian cancer Lung cancer GI cancer, Ovarian cancer Germ cell cancer Cervical cancer Pancreatic cancer ALL Nephrotoxicity Most emetogenic

Carboplatin Oxaliplatin

Less reactive than cisplatin, better tolerated Less neutropenia Less nephrotoxix, more neuropathic

L-asparaginase

Hypersenistivity reactions Mimimal Bone marrow and GI toxicity Hyperglycemia, Hypoalbuminemia, protein C and S deficiency

Mitotane

Adrenocortical carcinoma

(2) HORMONAL TREATMENT

DRUG Adrenocorticosteroids CLINICAL USE Promote apoptosis SIDE EFFECT Immunosuppresion Glucose intolerance Osteoporosis Water retention GI ulcers Bone mineral density, bone pains, increased fracture rates Musculoskeletal problems! ANTIDOTE

Aromatase Inhibitors

Prevent formation of estrogen from adrenal gland and adipose tissue For post-menopausal ER/PR+ breast cancer patients in adjuvant, neoadjuvant, metastatic setting Blocks estrogen receptors itself

Anti-Estrogen

GnRH analogs

Anti-androgen

Stimulates FSH and LH production by the pituitary gland then will late cause negative feedback inhibition Breast cancer Prostate cancer Binds to androgen receptors and causes complete androgen blockade

Thrombosis risk Endometrial CA Hot flashes, nausea, vomiting, menstrual irregularities Initial flare reaction

Decreased libido Hot flashes Gynecomastia Mastodynia Paradoxical stimulation of androgen receptors

(3) BIOLOGICAL RESPONSE MODIFIERS

DRUG

Interleukin-2

CLINICAL USE Expands T-cell response that is cytolytic for tumor cells Melanoma Renal cell carcinoma AML Filgrastim/ Lenograstim Expands population of neutrophil precursors Prophylaxis for chemotherapy induced neutropenia

SIDE EFFECT Hypotension Peripheral edema Azotemia

ANTIDOTE

G-CSF

Fever Chills

(4) TARGETED RESPONSE

DRUG CLINICAL USE Her2 receptor Vegf receptor Breast cancer Angiogenesis SIDE EFFECT CHF Hypersensitivity ANTIDOTE

MONOCLONAL ANTIBODIES
Traztuzimab Bevacizumab

Cetuximab

EGFR receptor EGFR receptor CD20 receptro

Panitumomab Rituximab

Colorectal cancer Head and neck cancer Colorectal cancer B-cell lymphomas

Hypertension, bleeding, proteinuria Hypersensitivity reactions Skin rashes Hypersensitivity reactions Hypersensitivity reactions Hypersensitivity reactions

TYROSINE KINASE INHIBITORS

Imatinib (Gleevec) Gefitinib Erlotinib Sunitinib Sorafenib Lapatinib Bcr-Abl TKO in CML CD 117 TKl in GIST EGFR TKl in NSCLCA EGFR TKl in NSCLCA Multikinase Renal and liver cancer Multikinase Renal and liver cancer EGFR and HER2 TKl Breast Head and neck cancer

Rashes Asthenia Weakness

PROTEOSOME INHIBITOR
Bortezomib Degrades proteosomes that denatures IKb Pancreatic neuroendocrine tumors Advanced renal cell cancer Advanced renal cell cancer

MTOR INHIBITOR
Everolimus

Temsirolimus

Intrathecal Administration Can cross Blood Brain Barrier

Methotrexate Cytarabine Nitrosoureas Temoxolomide Teniposide Hydroxyurea

Cytotoxic agent (Antimetabolite) Cytotoxic agent (Antimetabolite) Cytotoxic agent (Alkylating agent) Cytotoxic agent (Alkylating agent) Topoisomerase interactive agent