Miscellaneous Chemotherapy Agents
- Do not fit into a specific category
- Inhibit DNA, RNA, or protein synthesis
- Major toxicities:
- Hematopoiesis
- Metabolic functions
LIPID SOLUBLE |
Hydroxyurea |
ENZYMES |
Asparaginase (Erwinia, Escherichia coli, or Peg-asparaginase) |
Hydroxyurea
- Used in CML, melanoma, ovarian cancer, and in Sickle Cell Disease
- Common side effect is myelosuppression with a rapid drop in WBC
- Given orally on an empty stomach (1 hour before or 2 hours after eating)
Asparaginase
- Given primarily via the intramuscular route in patients with ALL
- 3 formulations available:
- E. coli asparaginase
- Peg-asparaginase ( E. coli slow release)
- Erwinia asparaginase (for patients who have had reactions to E. coli asparaginase)
- Side effects include:
- hypersensitivity with anaphylaxis
- coagulopathies with possible thrombus formation or bleeding
- hyperglycemia
- liver toxicities
- pancreatitis
- Patients need to be observed for reactions post administration
- E. coli and Erwinia asparaginase for 1 hour
- Peg-asparaginase for 3-5 hours
- Coagulations studies, glucose, amylase and lipase should be monitored during therapy
Retinoids
- Stimulate cell differentiation
- Suppress proliferation of cancer cells
See use of retinoids (Vitamin A analogues) in neuroblastoma
RETINOIDS |
13-cis-retinoic acid All-trans retinoic acid |
Antiangiogenic Agents
- New classification of cancer drugs
- Prevent the growth of new microvessels from capillary endothelial cells to the tumor.
- Major toxicities:
- GI
- Neurologic
- Birth defects (major complication. Routine pregnancy testing required in females of childbearing age who are receiving thalidomide).
ANTIANGIOGENIC |
Thalidomide Anti-vascular endothelial growth factor (VEGF) |
Hormonal Agents
- Bind with DNA/modifies transcription process
- Lyse lymphocytes in lymphoid malignancies
- Indirect effect on other malignancies
- Used in supportive care
- Major toxicities:
- Metabolic function (Cushing syndrome, obesity, insulin resistance and hyperglycemia)
- Bones (avascular necrosis of the femoral head and long term osteoporosis)
- Immunosuppression
- Personality changes
- Hypertension
- Stomach upset, gastritis, GI bleeding (administer with meals, may need an H2-receptor antagonist)
- Muscle weakness
- May mask fever or infection
- Patients should be instructed to reduce sodium and sugar intake
CORTICOSTEROIDS |
Prednisone Dexamethasone Hydrocortisone Methylprednisolone |
