Anti-Cancer Drugs😍

Anti-Cancer Drugs

Anti-cancer Drugs which do NOT cause Bone Marrow Suppression

• Christians () blew () with chlorine () and asparagus ()

1. Cytotoxic

2. Targeted

Classification

NEW DRUGS

Biologic Drugs (Autoimmune / Inflammatory)

Anticancer Small-Molecule Inhibitors

Cytotoxic Drugs

Common Adverse Effects

• BM Suppression

• Alopecia

• Mucositis → Diarrhea

• Hyperuricemia

• Nausea and vomiting (CINV)

1. Alkylating Agents

• Mnemonic: Must (mustine drugs) buy Mighty (mitomycin c,melphalan) Car (Procarbazine) Bus (Busulfan) Cycle (cyclophosp) from Temu () → ↓↓ Price →→ ↓↓ H+ (Temu → alkylating agent)

Drugs:

• If – Ifosfamide

• Bus – Busulfan

• Not – Nitrosoureas
• Carmustine (BCNU)
• Lomustine (CCNU)
• Semustine (Methyl CCNU)

• Present – Procarbazine

• Take – Temozolomide

• My – Melphalan, Mitomycin C

• Cycle – Cyclophosphamide

Important Points Regarding Alkylating Agents

Hemorrhagic cystitis

• Caused by cyclophosphamide and ifosmide

• Metabolite responsible is acrolein
• travel in cycle → acral rashes → acrolein

• Prevented by Mesna

• Treatment is steroids

Drugs Causing Pulmonary Fibrosis

Mnemonic: 

Antifibrotic agent

• Pirfenidone

• Used in Idiopathic pulmonary fibrosis (IPF)

• IPF vannal tell pt → drink feni → ur done (fenidone)

2. Antimetabolites

• These are S Phase Specific

• Folic acid function
• In Methotrexate
• Supplementation
• In Purine and Pyrimidine drugs
• Potentiate action

a. Drugs affecting Folic Acid Metabolism

• Example: Methotrexate

• Act by inhibiting dihydrofolate reductase enzyme

• of Methotrexate:
• Choriocarcinoma - D.O.C
• Rheumatoid arthritis - D.O.C

• S/E
• Bone marrow suppression
• Pemetrexed > Methotrexate

• toxicity treatment
• Folinic acid (Leucovorin or Citrovorum) +
• Vitamin B12 injection for Pemetrexed

b. Drugs Affecting Purine Metabolism

• 6 - Mercaptopurine: Hepatotoxic

• 6 - Thioguanine: Hepatotoxic

• Fludarabine:
• DOC for CLL
• Mnemonic: Flood → Call

• Cladribine, Pentostatin
• ⛔ ADA
• NOTE: SCID
• ADA deficiency

• Lesch Neyhan syndrome
• ⛔ HGPRT

c. Drugs Affecting Pyrimidine Metabolism

 

• Capecitabine: 
• Prodrug
• Hand and foot syndrome
• Capecitabine > 5-Fluorouracil [5-FU]

• 5-Fluorouracil [5-FU]

• Gemcitabine: 
• DOC for Pancreatic carcinoma
• Pancreas is a gem

• Cytarabine: 
• Cause cerebellar side effects
• Sit when ataxia (cerebellar s/e)

In Ca Colon

• FOLFOX
• Folinic Acid + 5FU + Oxaliplatin

• FOLFIRI
• Folinic Acid + 5FU + Irinotecan

3. Drugs Acting on Mitotic Spindle

• Specific for M-Phase of cell cycle
1. Formation ⛔
• Vincristine
• Marrow sparing anticancer drug
• Vinblastine

S/E for both

• Peripheral neuropathy
• SIADH
2. Breakdown ⛔
• Paclitaxel

• Mnemonic:
• Win (vincristine, vinblastine) a Packet (Paclitaxel) → by rotating spindle

4. Topoisomerase Inhibitors

• Topoisomerase I inhibitors
• Irinotecan
• Used for colorectal carcinoma
• Cholinergic Side effects

• Topoisomerase II inhibitors
• Etoposide
• Anthracyclines
• Doxorubicin
• Donorubicin
• Epirubicin
• S/E
• All Cause Cardiotoxicity
• Reduced by giving Dexrazoxane (Iron scavenger)
• Red urine
• Radiation recall dermatitis
• Radiation from red ruby from anthra caused cardiotoxic

• Mnemonic: Top (Topoisomerase) → Irene (Irenetecan) nte top sidilott (Etoposide) poi → ruby (Donorubi……) kandu

Side effects

• Cytarabine
• Cerebellar toxicity

• Anthracyclines & Actinomycin D, Gemcitabine
• Radiation recall dermatitis
• erythematous rashes in areas previously radiation exposed areas

Cisplatin

• S/E Triad
1. Ototoxicity
2. Nephrotoxicity
• It particularly affects the reabsorption in the distal tubules, causing:
• Hypomagnesemia
• Hypokalemia
• Hypocalcemia
• Hypophosphatemia
• Prevention
• 1-2 L NS → Chloride diuresis → inactivate cisplatin
• then Mannitol → to throw Cisplatin from body
• then Amifostine → to reduce side effects of radiotherapy
• Mnemonic: Sis nu Plate kodukk → Amikk first (Amfostine) kodukk
3. Max Nausea & Vomiting
• Rx for N & V

Type	Drug of Choice
Early CINV < 24 hours	5HT3 Antagonists - Ondansetron - Granisetron - Palonosetron
Delayed CINV > 24 hours	NK1 / Substance P Antagonists - Aprepitant - Rolapitant
ㅤ	• Dexamethsone

Nail pigmentation causing drugs

• Phenothiazines
• Chlorpromazine
• Used for DM and DI
• S/E: SIADH, Disulfiram like reaction

• Chloroquine

• Minocycline

• Queen meena for magazine → put nail lacquer

Minocycline:

• Given for acne

• Leads to blue-black pigmentation on acne scars

• Black thyroid

• Due to deposition of iron chelates with minocycline

• Also leads to lupus-like reaction

• Mnemonic: Meena de mugath blue black vann

TARGETED ANTICANCER DRUGS

A. SMALL MOLECULES

Immune Checkpoint Mechanism and Inhibitors

• Normal Function:
• PD-1: Receptor on T-cells.
• PDL-1: Ligand on normal cells.
• Interaction inhibits T-cells → Prevents attack on normal cells.
• This is called the immune checkpoint.

• Immune Checkpoint Inhibitors:
• Monoclonal antibodies against PD-1 or PDL-1.
• Block interaction → Reactivate T-cells.
• T-cells kill tumor cells.

• Adverse Effect:
• May cause autoimmune diseases.
• Example: Autoimmune hepatitis.

• Drugs
• Mnemonic: “L → umab”
• Mnemonic: New Drugs Act At Immune Check Point

Non Small Cell Lung Ca

• If Mutation absent
• Chemotherapy (Cisplatin + Etoposide) +
• ICP Inhibitors (Pembrolizumab/Atezolizumab)
  OR
• Double ICP Inhibitors
• Nivolumab + Ipilimumab

IMMUNOSUPPRESSANTS

Breast Cancer chemotherapy drugs:

Others

• Hydroxyurea
• Polycythemia Vera
• Essential Thrombocythemia
• Sickle Cell Disease
• MOA: ⛔ Ribonucleotide Reductase

• Multiple Myeloma:
• Bortezomib + Lenalidomide + Dexamethasone