Chemotherapy

 

 

Other Agents

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

 

 

 

 

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