Chemotherapeutics

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Criteria for Cancer Growth

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Evading apoptosis, self-sufficiency in growth signals, insensitivity to anti-growth signals, tissue invasion and metastasis, limitless replicative potential and sustained angiogenesis

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Cell-Cycle Specific (CCS) drugs

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drugs that act on a specific phase of the cell cycle. more effective on tumors with high-growth fraction and are schedule dependent (duration and timing)

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Cell-Cycle Non Specific (CCNS) drugs

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drugs that act on all phases of the cell cycle. are effective on tumors with high and low growth fraction

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growth fraction

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indicates the percentage of cells that are actively dividing.

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K1-67

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A protein used by pathologist as a cellular marker for cellular proliferation. Is expressed in the G1, G2, S and M phases of the cell-cycle but is absent in the G0 phase

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Tumor Lysis Syndrome

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a condition characterized by a series of metabolic complications observed shortly after chemotherapy in patients with significant tumor burden. Is commonly observed in Lymphomas and leukemias. Effects include hyperkalemia, hyperphosphatemia, hypocalcemia and hyperuricemia. Hyperuricemia may lead to acute uric acid nephropathy (allopurinol is given as a prophylatic)

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Toxicity of Anticancer drugs

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rapidly proliferating cells such as bone marrow, mucosa of the GI, hair follicles and gonads are the most sensitive. Because bone marrow is the most common, it is the dose limiting factor where the objective is to avoid excessive neutropenia and thrombocytopenia.

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Delivery of Antineoplastic drugs

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PO, IV, and regional administration in the intraperitoneal, intrapleural, and intratechal,

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3 types of resistance to chemotherapy

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Primary, acquired, and multidrug. This is how recurrence of a cancer. Combination regimens are used to thwart resistance

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Properties that effect the resistance to the mechanisms of action

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increased nucleic acid repair mechanisms, production of chemicals that trap the drug and changes in target proteins

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Properties that effect the resistance to the intracellular concentration

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decreased production of prodrugs, increased inactivation of drugs, and decreased accumulation due to decreased transport and increased export

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Antimetabolites

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CCS drugs which include Folate Antagonists, Pyrimidine analogs and purine analogs

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Methotrexate

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A folate antagonist which is S-phase specific and inhibits the DHFR. Indications for acute lymphoblastic leukemia, lymphoma, choricocarcinoma and breast cancer. Toxicities include bone marrow and microvesicular fatty change in liver.

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Reasons for Resistance to Methotrexate

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decreased transport into cancer cells, decreased metabolism to polyglutamine forms, altered interaction with DHFR, increased breakdown of polyglutamates and increased efflux from the cell. Trimetrexate may be given since it lacks glutamate moiety, can cross plasma membrane independently of reduced folate carrier and does not require polyglutamylation to inhibit DHFR for cell retention

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Leucovorin Rescue

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Active form of B vitamin complex folate that enters normal cell and rescues them from the toxic effects of methotrexate

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Pyrimidine and Purine analogs

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Fluorouracil, Cytarabine, and 6-mercaptopurine. S phase specific

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Fluorouracil

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pyrimidine analog which prevents dTMP synthesis. Indicated for breast, colon, and pancreatic cancers. Toxicities include irreversible myelosuppression, photosensitvity, GI irritation, and alopecia

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Cytarabine

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a purine and pyrimidine analog that inhibits DNA synthesis. Indicated for acute leukemias. Toxicities include myleosuppression and GI irritation.

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6-Mercaptopurine

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Prodrug that inhibits the purine synthesis. Indicated for acute leukemias, chronic myelogenous leukemia (CML), and non-hodgkin Lymphoma. Toxicities include myleosuppression and hepatotoxicity.

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Alkylating Agents

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NCCS drugs which include nitrogen mustards, nitrosoureas, platinum compounds, and triazenes. Add alkyl groups to electronegative groups. Stop tumor growth by cross-linking guanine nucleobases in DNA

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Nitrogen Mustards

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Includes cyclophosphamide, busulfan and chlorambucil. Indicated for non-hodgkin lymphoma, chronic myeloid leukemia, and breast and ovarian cancer

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Nitrosoureas

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Include carmustine, lomustine, semustine. Are very effective in crossing the Blood Brain Barrier which makes them good for brain tumors. CNS toxicity includes ataxia and dizziness

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O-6 Alkylguanine Alkyltransferase

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Major mechanism of resistance to nitrogen mustards and nitrosoureas where it inactivates the alkyl attachment.

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Toxicity from Nitrogen mustards and nitrosoureas

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hematopoietic, gastrointestinal, gonadal damage and alopecia

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Platinum Compounds

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Includes cisplatinum, carboplatinum, oxaliplatin, and tetraplatin where the agents add strong chemical bonds in nucleic acids and proteins. Indicated for testicular, bladder and ovarian cancers. Toxicities include renal, ototoxicity, and GI

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Triazenes

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Includes procarbazine and dacarbazine which metabolize to reactive intermediates that decompose to produce methyl-diazonium which methylates DNA. Indicated for hodgkin lymphona, brain tumors and melanoma. Toxicities include bone marrow suppression, sterility, and immunosuppression

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Antibiotics

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Doxorubican, mitoxantrone, and bleomycine. Target topoisomerase to cause DNA damage

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Doxorubican

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Anitbiotic Administrated IV, It intercalates in DNA producing free radicals which damage DNA. Is indicated for Hodgkin Lymphona, Breast, endometrial, lung, and ovarian cancers. Toxicities include cardiotoxicity, bone marrow suppression and alopecia

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mitoxantrone

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an antibiotic administrated IV, indicated for metastatic prostate cancer. Toxicities include immunosuppression, cardiomyopathy, and GI.

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Bleomycin

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Antibiotic that generates free radicals that inhibits thymidine incorporation in DNA. G2 specific, indicated for hodgkin lymphona and testicular cancer. Toxicities include pulmonary fibrosis, hyperpigmentation and moderate immunosuppression

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Prednisone

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A synthetic glucocorticoid hormone that triggers apoptosis and may work only on non-dividing cells. Indicated for chronic lymphocytic leukemia and hodgkin lymphoma. Toxicities include cushing syndrome (acne, osteoporosis, hypertension, hyperglycemia, and psychosis), immunosuppression and cataracts

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Vincristine and Vinblastine

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Plant Alkaloids-binds to tubulin and block polymerization of microtubules and is M phase specific. VBL is indicated for hodgkin lymphoma and VCR is indicated for wilms tumors, choricocarcinoma and neuroblastoma. Toxicities include bone marrow suppression, neurotoxicity and paralytic ileus.

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Paclitaxel and Docetaxel

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Plant alkaloids used to stabilize tubulin to such an extent that mitosis is disrupted which triggers apoptosis. Paciltaxel is indicated for ovarian, prostate and breast cancer. Docetaxel is indicated for breast cancer, non-small cell lung cancer and prostate cancer. Toxicity is bone marrow suppression.