Drug of Choice in Carcinoma

Drugs by Anatomical Region

Wife is Pembrolizumab

5 FU	All except Gastric and Urogenital	ㅤ	ㅤ
Cisplatin	Head and neck	Set ur head straight	Cetuximab
ㅤ	Esophagus	ㅤ	ㅤ
ㅤ	Gastric	ㅤ	ㅤ
ㅤ	Urogenital except Prostate	BEG Penis, No Problem (neeru @ penis/urogenital)	ㅤ
Temozolomide	Brain from Temu	ㅤ	ㅤ
Colorectal	Call - phone	ㅤ	ㅤ
Anal	Mighty anal	ㅤ	ㅤ

Retinoblastoma	Vision Eye Cancer	VEC
Lung ca	End Smoking	EC
Liver	Sorry Liver for drinking alcohol	S
Kidney	ㅤ	P
Osteosarcoma	If so, Maapu	MAP
Malignant pheochromocytoma	Very dangerous cancer	VDC
Pancreatic	Folding Pan	FOLFIRINOX

Leukemia


graph TD
    A[Acute Leukemia] --> B(ALL);
    A --> C(AML);

    B -- Treatment --> B1["Vincristine (V) Prednisolone (P) Asparaginase (A) Daunorubicin (D)"];

    C -- Treatment --> C1["Cytarabine (Ara-C) + Idarubicin or Daunorubicin"];
    C -- Check Mutation --> D{FLT-3 mutation?};
    D -- Yes --> E[Add Midostaurin FLT3 Kinase Inhibitor];
    D -- No --> C1;

    %% Styling (Optional)
    style B fill:#f9f,stroke:#333,stroke-width:2px
    style C fill:#f9f,stroke:#333,stroke-width:2px
    style D fill:#ccf,stroke:#333,stroke-width:2px



flowchart TD
    A["Chronic Leukemia"] --> B["CML"] & C["CLL"]
    B --> D["1st generation: <br>Imatinib (DOC): (CML and GIST)"]
    C --> J["Fludarabine"] & K["Cyclophosphamide"] & L["Rituximab"]
    D --> n2["No response"]
    D --- n5@{ label: "<span style=\"font-size:\"><span style=\"padding-left:\">Inhibit enzymatic</span><span style=\"padding-left:\">Site on Tyrosine</span><span style=\"padding-left:\">Kinase</span></span>" }
    n2 --> F["2nd Generation: Dasatinib, Nilotinib, Bosutinib"]
    F --> n3["No response"]
    F --- n5
    n3 --> H["3rd Generation: T315I Mutation: Ponatinib"]
    H --> n4["Asciminib (or) Omacetaxine: Inhibits BCR-ABL Protein"]
    H --- n5
    n4 --> n6@{ label: "<span style=\"--tw-scale-x:\">Inhibit allosteric site</span><span style=\"--tw-scale-x:\">on Tyrosine</span><span style=\"--tw-scale-x:\">Kinase</span>" }
    n5@{ shape: rect}
    n3@{ shape: rect}
    n6@{ shape: rect}

Hodgkin’s Lymphoma

Regimen	Drugs	No Response
ABVD	Adriamycin, Bleomycin, Vinblastine, Dacarbazine	Nivolumab, Pembrolizumab

Non Hodgkin’s Lymphoma

Category	Drugs
Low Grade	Fludarabine, Cyclophosphamide, Rituximab
High Grade (RCHOP)	Rituximab, Cyclophosphamide, Hydroxydaunorubicin, Oncovin, Prednisolone

Others:

Drugs of choice:	Leukemia
Cladribine	Hairy Cell leukemia
Hydroxyurea	Polycythemia vera
ㅤ	Essential Thrombocythemia
ㅤ	Sickle cell disease
Bortezomib + Lenalidomide + Dexamethasone	Multiple myeloma
Nivolumab	Melanoma
Ipilimumab	Late stage Melanoma
Pembrolizumab	Endometrial Carcinoma

SIDE EFFECTS OF ANTI CANCER DRUGS

Anatomical Region	Toxicity	Drugs	Prevention/Treatment
Head	Neurotoxicity (SIADH)	Vincristine	-
ㅤ	Cerebellar Toxicity	Cytarabine	-
ㅤ	Ototoxicity	-	-
ㅤ	Max Nausea & Vomiting	Cisplatin	-
ㅤ	Nephrotoxicity	Cisplatin	a. 1-1.5 Ltr NS + Cl- Diuresis b. Mannitol c. Amifostine Inactivate Cisplatin
Lungs	Pulmonary Fibrosis	Bleomycin, Busulfan	-
Heart	Cardiotoxicity	Doxorubicin, Daunorubicin, Trastuzumab	Dexrazoxane
Liver	Hepatotoxicity	6MP/6TG, Methotrexate	-
ㅤ	Can cause cirrhosis in	-	Rheumatic Arthritis, Psoriatic Arthritis
Gastrointestinal Tract	Diarrhea	Irinotecan	Loperamide
ㅤ	Hemorrhagic Cystitis	Ifosfamide > Cyclophosphamide	Prevented: Mesna

Side Effects of Anticancer Drugs

Chemotherapeutic Agent	Indication
Alkylating agents (bind to DNA)	ㅤ
Nitrosoureas (carmustine [BCNU], lomustine [CCNU])	Brain tumors
Cyclophosphamide	Lymphomas, Hodgkin’s disease, hematologic malignancies, non-Hodgkin’s lymphoma
Chlorambucil	Chronic lymphocytic leukemia
Mechlorethamine	Lymphomas, Hodgkin’s disease
Decarbazine	Melanoma, Hodgkin’s disease, non-Hodgkin’s lymphoma, sarcomas
Procarbazine	Hodgkin’s disease
Platinum analogues (cross-link DNA)	ㅤ
Cisplatin	Carcinoma ovary, testes, cervix
Carboplatin	Carcinoma ovary, bone-marrow transplantation
Oxaliplatin	ㅤ
Antimetabolites (analogues of normal cellular nutrients)	ㅤ
Methotrexate	Carcinoma breast, head and neck, acute lymphoblastic leukemia
6-Mercaptopurine	ㅤ
5-Fluorouracil	Carcinoma breast, cervix, head and neck, GI tract
Antimicrotubule (disrupt the mitotic spindle/microtubule inhibitor)	ㅤ
Vinca alkaloids (vincristine, vinblastine)	Hematologic malignancies, breast, kidney, testes, head and neck cancers
Topoisomerase inhibitors (bind to and inhibit topoisomerase enzyme: etoposide, topotecan)	Hematologic malignancies, lung, bladder, prostate, and testicular cancers
Antibiotics (interfere with the synthesis of nucleic acids: doxorubicin, dactinomycin, plicamycin, mitomycin, bleomycin)	Various solid tumors