Oncologic Medications

Categories:

  • General
    • New Afib in cancer patients is associated with increased risk of HF and VTW
  • Common Groups
    • ABVD
      • Adriamycin, Bleomycin, Vinblastine, Dacarbazine
      • Hodgkin Lymphoma
    • BEACOPP
      • Bleomycin, Etoposide, Adriamycin/doxorubicin, Cyclophosphamide, Oncovorin/vincristine, Procarbazine, Prednisone
      • Hodgkin Lymphoma
    • FOLFOX
      • Leucovorin, Fluorouracil, Oxaliplatin
    • R-CHOP
      • Rituximab, Cyclophosphamide, Hydroxy-doxorubicin, Oncovorin/Vincristine, Prednisone
  • Cancer-related Cachexia
    • Hypercatabolic state characterized by appetite and weight loss with a disproportionate loss of skeletal muscle
    • Treatment
      • Progesterone analogs (Megestrol acetate, Medroxyprogesterone) and corticosteroids (Dexamethasone)
        • PAs preferred in pts with longer life expectancies
  • 5-Fluorouracil (5-FU)
    • MOA: Direct Inhibitor of pyrimidine synthesis (blocks thymidylate synthase), thereby blocking protein and DNA synthesis
      • Leucovorin increases 5-FU effectiveness
    • Anti-metabolite
      • Inflammation resolves about 2 weeks after treatment discontinuation
    • SE: Myelosuppression and Photosensitivity, Palmar-plant erythrodysesthesia (hand-foot syndrome), cerebellar toxicity
  • 6-Mercaptopurine (6-MP)
    • Anti-metabolite, metabolized by xanthine oxidase (inhibited by allopurinol)
      • Side effects are worse when on allopurinol (stop or reduce)
      • Thiopurine
    • SE: Myelosuppressive, Hepatotoxic, Interacts with allopurinol
    • Azathioprine
      • Converted to 6-MU and also metabolized by xanthine oxidase, also interacts with allopurinol
  • Alemtuzumab (Lemtrada)
    • Anti-CD52
    • Use: CLL, MS
  • All-Trans Retinoic Acid (ATRA)
    • MOA: Inhibits transcriptional repression by PML-RARa
    • Tretinoin
    • Formulation of Vitamin A, targeted therapy for Acute Promyelocytic Leukemia (M3 variant)
      • Causes immature myeloblasts to differentiate into mature myelocytes
    • Combined with an Anthracycline (Daunorubicin, Idarubicin) for best results
    • SE: Rashes, Teratogenic, DIC
  • Aromatase Inhibitors
    • Anastrozole, letrozole, and vorozole
    • Block formation of new estrogen (good for metastatic disease)
    • Give Calcium and Vitamin D supplements, Get DEXA
      • Bisphosphonates or denosumab if osteoporotic
    • Increased risk of osteoporosis and fracture
    • SE: Arthralgia, joint stiffness and bone pain in 33%, Vaginal dryness, sexual dysfunction, CV events, hyperlipidemia, and higher risks of osteoporosis and fractures
  • Axitinib (Inlyta)
    • Use: RCC
  • Bevacizumab (Avastin)
    • Anti-VEGF
    • Use: Colorectal cancer, renal cell carcinoma, non-small cell lung cancer
    • SE: PRES syndrome
  • Bleomycin
    • Antitumor antibiotic used in testicular cancer and Hodgkin’s Lymphoma
    • No myelosuppression (vs. Busulfan)
      • Induces free radical formation and cause breaks in DNA
    • SE: Severe Pulmonary Fibrosis, Fever, and hypersensitivity
  • Bortezomib (Velcade)
    • MOA: Proteasome inhibitor
    • SE: Peripheral Neuropathy, Herpes Reactivation
      • Prophylactic acyclovir or valacyclovir
  • Busulfan
    • Alkylates DNA
    • Pulmonary Fibrosis and myelosuppression
  • Capecitabine (Xeloda)
    • Adjuvant for colon cancer
    • SE: Palmar-plant erythrodysesthesia (hand-foot syndrome)
  • Caplacizumab (Cablivi)
    • Monoclonal antibody
    • Use: Severe TTP
  • Cetuximab (Erbitux)
    • Anti-EGFR
    • Stage IV colorectal cancer, head and neck cancers
    • SE: Pustular acneiform eruptions (severe), pulmonary toxicity
  • Chemotherapy-Induced Cardiotoxicity
    • Type I
      • Associated with Anthracyclines
        • Daunorubicin
        • Doxorubicin (Adriamycin, Doxil)
        • Idarubicin
        • Generate free radicals to intercalate DNA
          • Causes severe tissue necrosis
      • Myocyte Necrosis and destruction w/fibrosis
        • Progression to overt clinical heart failure
        • Less likely to be reversible
      • SE: Dilated Cardiomyopathy with chronic use
        • Antitumor Antibiotic, myelosuppression, alopecia, severe gastric upset secondary to colonic mucositis
        • Total cumulative dose is most strongly related to risk
      • Antidote is Dexrazoxane
        • Iron-chelating agent used for cardiac protection
    • Type II
      • Associated with Trastuzumab
      • Myocardial stunning/hibernation w/o myocyte destruction
      • Asymptomatic LV systolic dysfunction
      • More likely to be reversible
  • Cyclophosphamide (Cytoxan)
    • Covalently links DNA at guanine N-7
    • SE: Hemorrhagic Cystitis, SIADH (hyponatremia), bladder carcinoma, myelosuppression, sterility (acrolein, metabolite causes all the damage)
      • Cystitis can be treated with 2-Mercaptoethanesulfonate (Mensa) which binds the metabolite acrolein (bladder irritant), fluids
      • Alkylating agents put patient at risk for developing secondary cancer (Acute Leukemia)
  • Dactinomycin
    • Intercalates DNA
    • Used in Wilms’ Tumor, Ewing Sarcoma, Rhabdomyosarcoma
  • Dasatinib (Sprycel)
    • Tyrosine Kinase Inhibitor
    • Used in CML
    • SE: pulmonary hypertension
  • Daunorubicin (Cerubidine)
    • Anthracyclines
    • Generate free radicals to intercalate DNA
      • Causes severe tissue necrosis
    • SE: Dilated Cardiomyopathy with chronic use, Mucositis, stomatitis
      • Antitumor Antibiotic, myelosuppression, alopecia, severe gastric upset secondary to colonic mucositis
      • Total cumulative dose is most strongly related to risk
    • Antidote is Dexrazoxane
      • Iron-chelating agent used for cardiac protection
  • Doxorubicin (Hydroxydaunomycin)
    • SE: Mucositis, stomatitis
  • Eculizumab
    • MOA: Monoclonal antibody against C5, blocks cleavage and blocks formation of the C5-9 complex
      • Used in Paroxysmal nocturnal hemoglobinuria
  • Elotuzumab
    • MOA: Activating NK cells to kill MM cells, Targets SLAMF7
  • Erlotinib
    • SE: Pustular acneiform eruptions (weak), pulmonary toxicity
  • Folinic Acid (Leucovorin)
  • Gefitinib
    • SE: Pustular acneiform eruptions (weak)
  • Hydroxyurea
    • MOA: Inhibits ribonucleotide reductase, decreasing DNA synthesis
    • Use: Essential Thrombocytopenia, PCV
  • Ibrutinib (Imbruvica)
    • Tyrosine Kinase Inhibitor, binds BTK
    • Metabolized by CYP3A4
      • Increases digoxin levels
    • Use: CLL, B-cell Lymphoma
    • SE: Increased rates of Atrial Fibrillation (up to 16%) – Don’t use CCBs
  • Imatinib (Gleevec)
    • MOA: Blocks ATP binding to tyrosine kinase active site
    • Use: CML, GIST
      • Blocks BCR-ABL fusion
    • Can be held without significant change in labs, may hold for entire pregnancy without problems
    • SE: Nausea
  • Ifosfamide
    • SE: hemorrhagic cystitis
  • Lenalidomide (Revlimid)
  • Methotrexate
    • MOA: Folate Antagonist (Dihydrofolate Reductase Inhibitor)
      • Converts oxidized folate back into its reduced form to be used in pyrimidine synthesis
        • Can be bypassed/fixed by Leucovorin (N5-formyltetrahydrofolate)
      • used in Rheumatoid Arthritis also
      • Stops DNA and protein synthesis hindering S-phase
    • SE: Myelosuppression and Abortifacient, Hepatotoxicity, stomatitis, cytopenia
  • Microtubule Inhibitors
    • Taxols/Taxanes
      • MOA: Inhibit microtubule degradation
        • Bind polymerized microtubules and stabilize the mitotic spindle so it can not break down
        • Inhibiting dynein
        • Cell phase: M phase
      • SE: Some myelosuppression
      • Paclitaxel (Taxol)
        • Nab-paclitaxel (Abraxane)
      • Docetaxel (Taxotere)
    • Vinca Alkaloids
      • MOA: Inhibits microtubule production and assembly
        • Bind B-tubulin and block polymerization, therefore the mitotic spindle cannot form
        • Inhibit kinesin
        • Cell phase: M phase
      • Use: Hematologic and solid malignancies
      • SE: Alopecia, Paralytic ileus/constipation
      • Vincristine:
        • Use: Non-Hodgkin
        • SE: Peripheral Neuropathies (Neurotoxic), Alopecia
          • Stocking and glove distribution
          • Areflexia, peripheral neuritis, motor symptoms less commonly
          • Autonomic dysfunction
          • Paralytic ileus/constipation
          • Some myelosuppression usually mild
      • Vinblastine
        • Use: Hodgkin
        • SE: Profound Bone Marrow Suppression, Alopecia
  • Mitomycin
    • Antitumor Antibiotic
    • SE: Hemolytic Uremic Syndrome
  • Nilotinib
    • SE: Coronary insufficiency
  • Nitrosoureas

    • Can cross BBB to treat brain cancer
    • SE: pulmonary fibrosis
    • Carmustine
    • Lomustine
    • Semustine
    • Streptozocin
  • Panitumumab (Vectibix)
    • SE: Pustular acneiform eruptions (severe)
  • Platinum Drugs
    • General
      • Prevent nephrotoxicity with Amifostine
      • Magnesium wasting (hypomagnesemia)
    • Carboplatin
      • Platinum Alkylating Agent
        • Hydrate well to protect the kidneys, highly emetogenic (give something for vomiting)
      • SE: Myelosuppression is main/dose limiting SE
        • Less other SE than Cisplatin
          • Ototoxicity and Nephrotoxicity
          • Less nephrotoxic than Cisplatin
    • Cisplatin
      • Platinum Alkylating Agent
        • Prevents replication of tumor cells by causing intra-stand links within DNA
      • SE: Myelosuppression, Peripheral Neuropathies (stocking glove), Nephrotoxic (ATN), Ototoxic, electrolyte abnormalities, Tinnitus, N/V
        • Less nephrotoxic with aggressive hydration
    • Oxaliplatin
      • SE: Peripheral Neuropathies (stocking glove), transient cold hypersensitivity
        • No cold items for several days after infusions
  • Ponatinib
    • SE: Coronary insufficiency
  • Purine Analogs

    • MOA: Cytotoxic purine analog
      • Inhibits DNA polymerase Alpha and Beta
    • SE: Immunosuppression
    • Cladribine/Pentostatin
      • Used in symptomatic hairy cell leukemias
  • Pyrimidine Analogs

    • MOA: Cytotoxic pyrimidine analog
      • Inhibits DNA polymerase Alpha and Beta
    • SE: Immunosuppression/Myelosuppression
    • Gemcitabine (Gemzar)
      • Used in hematologic and solid tumors, small-cell
      • SE: Severe Pulmonary Fibrosis, Hemolytic Uremic Syndrome
    • Cytarabine (Ara-C)
      • Aka Arabinofuranosyl Cytidine
      • Used in Non-M3 AML, non-Hodgkin Lymphoma hematologic cancers only
      • Cell Cycle: S phase
      • SE: Megaloblastic Macrocytic anemia, cerebellar toxicity
  • Radiation
    • MOA: Damages DNA, preventing tumor cell division or directly killing the cells
      • Can decrease the tumor size or kill any existing tumor cells
    • SE: Slower wound healing, fibrosis, ulcerations, strictures, irritation, neurologic deficits, BM suppression, 2ndary cancers (sarcomas, thyroid cancer, CML)
    • Goals: First line in some tumors
      • Eradicate smaller tumors
      • Sensitize cancer cells to radiation therapy
  • Selective Estrogen Receptor Antagonist (SERM)
    • Tamoxifen
      • Antagonist in the breasts, Agonist in the Endometrium and bone
      • SE: Deep Venous Thrombosis (DVT), hot flashes, endometrial cancer risk, teratogenic
    • Raloxifene
      • Antagonist in the breasts and endometrium, agonist in bone (osteoporosis treatment)
      • No increased risk for cancer
      • SE: Deep Venous Thrombosis (DVT), hot flashes
  • Sunitinib (Sutent)
    • SE: PRES syndroms
  • Thalidomide (Thalomid)
  • Topoisomerase Inhibitors
    • Cell Cycles affected: S, G2
    • MOA: Eukaryotic Topoisomerase I Inhibitors
      • Topotecan
        • Used in ovarian and small cell lung cancer
      • Irinotecan
        • Used in Colon cancer
      • SE: Severe/Life-threatening Diarrhea
    • MOA: Eukaryotic Topoisomerase II Inhibitors
      • Etoposide
      • Teniposide
      • Inhibits relegation of double strand breaks caused by topoisomerase II
      • Used in a regimen with bleomycin and cisplatin for testicular masses, small cell lung cancer, Hodgkin and non-Hodgkin Lymphoma
      • SE: Alopecia, myelosuppression, Immunosuppression
  • Trastuzumab
    • MOA: Anti-HER2/neu antibody
      • Binds HER2 on tumor surface and induces receptor internalization
    • Use: HER2 (+) Breast cancer, Gastric cancer
    • SE: Type II Cardiotoxicity, pulmonary toxicity, oligohydramnios
      • Avoid pregnancy for 7 months last dose
  • Tretinoin
    • Formulation of Vitamin A, targeted therapy for Acute Promyelocytic Leukemia (M3 variant)
    • SE: Rashes, Teratogenic
  • Vincristine (Oncovorin)

results matching ""

    No results matching ""