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62 Cards in this Set
- Front
- Back
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Tamoxifen
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(Tam Nolvodex® Tamofen)
Anti-estrogen properties—interferes w/action of estrogen Estrogen binds to estrogen receptor, leading to cell proliferation Some breast cancer cells are estrogen receptor positive and are very sensitive Tamoxifen binds to the estrogen receptor, preventing estrogen from binding; nor does the estrogen receptor bind to its co-factors Leads to decrease in DNA synthesis and decrease in estrogen response + decrease in mRNA synthesis Leads to accumulation of cells in G0 & G1 phase Cytostatic, not cytotoxic Only works with Estrogen positive breast cancer! Tumor Activity Prevention and treatment of breast cancer (metastatic or non) Melanoma Some efficacy in pancreatic cancer ADR/Toxicities Hot flashes, mild to moderate nausea, thrombocytopenia, leucopenia, vaginal bleeding, weight gain, alopecia Low occurance of depression, dizziness, headache, skin rash <1% of pts develop endometrial & uterine cancer |
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NSCLC Advanced Disease Guidelines: 1st line therapy
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Non-specific platinum based cytotoxic combo. Only benefits fit, elderly fit. Single agent therapy in PS 2 pts.
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NSCLC ADG: 2nd line therapy
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Single agent docetaxel, pemetrexed, or TK inhibitors, erlotinib.
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NSCLC ADG: 3rd line therapy
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Erlotinib
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SCLC Staging
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Limited: confined to one hemithorax and regional lymph nodes
Extensive: disseminated beyond these bounds to bone, liver, marrow, and CNS |
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SCLC Treatment
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Limited: cisplatin/eoposide with radiation.
Extensive: Pt agent/etoposide=standard |
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Mesothelioma: treatment
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Surgery-best attempt at cure.
Chemo: cisplatin+pemetrexed Some response w/single agents Radiation: post-op, palliative |
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Pemetrexed
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(Altima): antifolate agent. Mesothelioma
Avoid NSAID use in renal impairment, don't use in pts w/CrCl < 45ml/min. Premedicate w/dexamethasone, folate, & vit B12 (q 9 wks) Tox: myelosuppression, rash, fever, infection, ... |
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NSCLC chem regimens
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Cisplatin is mainstay, used w/vinorelbine, etoposide and vinblastine
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NSCLC staging (T)
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T1: < or equal to 3 cm
T2: > 3 cm T3: invasion of chest wall...or atelectasis or obstructive pneumonitis. T4: malignant pleural effusion |
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Histological types of NSCLC
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Adenocarcinoma (45-55%): peripheral in origin
Squamous cell (30-40%): smokers, centrally located Large cell carcinoma: grows quickly, ded |
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CRC Risk Factors
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1 or more 1st deg. relatives < 45 y/o w/CRC. Smoking, obesity.
Diet, polyps, p53 gene, |
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Breast Cancer Screening Guidelines
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BSE explained after age 20 (limitations and benefits)
CBE recommended q 3 years in 20's & 30's Mammogram: yearly after age 40 |
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Cervical Cancer Screening Guidelines
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Begins 3 years after vaginal intercourse starts, no later than 21 y/o. Yearly pap smear or liquid based q 2 years. At 30 y/o if 3 neg. paps in a row, can get screened q 2-3 years. Age 70 and up: 3 neg. paps in a row plus normal for 10 years or total hysterectomy, can opt to stop screening.
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CRC Screening Guidelines
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After 50 years old: choose FOBT or FIT annually, flex sigmoidoscopy q 5 years, FOBT or FIT annually + flex sigmoidoscopy q 5 years, double contrast barium enema q 5 years, or colonoscopy q 10 years
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Prostate Cancer Screening Guidelines
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Avg risk men 50 y/o and up w/10 year life expectancy: DRE + PSA
High risk men: (african descent & family hist) start at 40-45 years old |
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CRC Staging
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Dukes A-D; TNM I-IV
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CRC Treatment Regimens
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5-FU/LV infusion is better than bolus
FOLFIRI (5-FU + irinotecan) infusion-better than IFL (bolus) FOLFOX-includes oxaloplatin |
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Irinotecan
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Topoisomerase I inhibitor
activity against untreated metastatic CRC & 2nd line treatment after 5-FU failure. DLT's: diarrhea & neutropenia genetic polymorphism UGT-1A1 |
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Oxaliplatin
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(Eloxatin)
DLT: neurotoxicity |
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Capecitabine
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(Xeloda) 5-FU prodrug; oral
efficacy similar to 5-FU/LV bolus & infusion more hand & foot than 5-FU |
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Cetuximab
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(Erbitux) chimeric MAB against EGFR
common skin reaction, martha stuart in jail 6-10 grand a bag |
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Bevacizumab
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(Avastin) humanized MAB against VEGF
hypertension and proteinuria |
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Panitumumab
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(Vectibix) human MAB against EGFR
skin reactions, opthalmic effects (eyelashes) FDA approved w/o increase in survival; increase in response only |
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Mechloroethamine
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(nitrogen mustard, mustragen)
Soluble in water and alcohol Tumor activity—part of MOPP Brochogenic carcinoma Lung cancer Sarcoma Lymphomas Sometimes used in metastatic cancer MOA Becomes a strong electrophile⇒results in carbonium ion intermediates Form complexes with target molecules Alkylate DNA⇒form inter-strand & intra-strand cross links Available as: Undiluted 10mg vial Stored @ room temp After dilution, 1mg/mL Diluted ~15min before administration Dosage 0.4mg/kg⇒single dose 0.1mg/kg⇒daily for four days 0.8mg/kg⇒leukopenia occurs Takes four to six weeks for bone marrow recovery at standard doses Toxicities: Myelosuppresion is a dose-limiting toxicity ↓lymphcytes after 24 hours ↓platelets after 6-8 days Severe thrombocytopenia may occur Inflammation at site of injection⇒may be dose limiting for some patients Alopecia Nausea Severe vomiting for up to eight hours Metallic taste, oral ulcers, diarrhea, amenorrhea, reduced spermatogenesis, weakness, drowsiness, fever, headaches, hyperuricemia, rare allergic rxns Not teratogenic, but still not given during pregnancy Precautions: Wear gloves & use eye Do not inhale the powder Avoid contact w/skin or eyes |
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Cyclophosphamide
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(cytoxan, CTX, CPM, neosar)
Chemistry: cyclic phophamide ester of nitrogen mustard Tumor activity Wide spectrum of use (including arthritis) Used often as a combo drug Used for: Lymphoid tumors Ewings sarcoma Osteogenic sarcoma Wilm’s tumor Retinoblastoma Breast cancer (w/ CMF, AC, or CAF) Lung cancer Ovarian cancer Endometrial cancer ALL, AML, CML, CLL All sorts of brain tumors Available as: Oral 25mg & 50mg tabs Injectable 100, 200, 500gms up to 2gms Stable prior to dilutition Stable for one day at room temp once diluted, six days @4C MOA Not reactive Body activates it (microsmal ixidation in liver) 4-OH cyclosphamide; in equilibrium with aldocyclophosphamide Diffuses from hepatocyte into plasma Decomposes at site of target cells to phosphoramide mustard (forms the bonds w/DNA) and acrolem Acrolem is responsible for inflammation of urinary bladder Ie, bladder toxicity Can be decreased if pt receives Mesna (Mesnex) Sulfahydryl compound that binds to acrolem and the resulting compound is non-toxic Better tolerated orally Dose depends on type of malignancy & what other drugs are being used w/it Toxicity Leukopenia—dose limiting toxicity Myelosuppression Bone marrow recovery in 2-3 weeks Was earlier thought to be a platelet sparing drug, but higher doses can cause thrombocytopenia Inflammation of urinary bladder Bladder carcinoma Fibrolytic or small bladder Alopecia GI problems at high doses Inflammation at injection site Cardiac toxicity at very high doses |
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Melphalan
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(alkerin, L-PAM, phenyl alanine mustard)
Treats: Myeloma—bone marrow cancer Ovarian cancer—sometimes given intraperitoneally Breast cancer Testicular Multiple myeloma MOA L and D isomer; d isomer has activity Similar to nitrogen mustard (alkylating agent) Taken up by carrier-mediated transport system as it has an amino acid like structure Non-cell phase specific (as are all alkylating agents) ROA Oral or IV AR Leukopenia or thrombocytopenia are dose-limiting side effects Thrombocytopenia occurs 14-21 days after dosing Nausea & vomiting at large doses (absent in lower doses) Alopecia, dermatitis, pulmonary fibrosis, rash, itching, chest pain. ] No renal or hepatic fx (?) |
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Carmustine
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(BCNU, BiCNU)
Nitrosourea Highly lipid soluble, crosses BBB Degraded quickly MOA Alkylating agent ROA IV or as wafers—gliadel wafers (mainly used for treating neoblastoma) ARs Anemia, diarrhea, low WBC, thrombocytopenia, kidney or liver damage, difficulty swallowing |
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Cisplatin
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(Platinol, DDP, PDD, CACP, CDOP)
Number one cancer drug today Cis diamminedichloroplatinum Planar organic compound soluble in both water and alcohol Only the cis form is active Tumor activity Testiclular cancer (w/bleomycin, venblastine, etoposide) Nearly curative, even in advanced states of testicular cancer Lymphomas Ovarian cancer (w/taxol, cyclophosphamide, or adriamycin) Squamous cell carcinoma Head and neck cancer Bladder cancer Endometrial cancer (most effective in stage III or less) If pts relapse, cisplatin may not be effective MOA Metal based drugs (As, Hg, Au, Pt)—Pt most effective Alkylating agent When cisplatin is administered in plasma, it remains chlorinated Upon entering the cell membrane, it encounters a low-chloride concentration⇒Cl disassociates and H2O takes its place Once hydrated, the molecule is highly reactive⇒interacts with cellular components Actually binds to RNA more fully than DNA, but the DNA binding is what causes cytotoxicity Forms intra-strand cross links (ie, links the same strand)~90% Favorably binds guanine nucleotides Shorthand: Disturbs the tertiary structure of DNA Inhibits DNA fx Though not dependent on cell phase, it works best in G2 phase, inhibiting DNA repair ARs Nephrotoxicity—renal tubular damage Less so if pt is hydrated Hypersensitivity, wheezing, hypotension, facial edema Ototoxicity High frequency sounds are heard Or hearing loss Less so if pt is hydrated Mild myelosuppression Hyperuricemia N/V⇒may limit the pt acceptance Peripheral neuropathy (loss of feeling in hands, feet, and legs) Possible paralysis |
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Carboplatinum
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(paraplatinum)
Less reactive than cisplatinum Well tolerated by pts as compared to cisplatinum Less nausea, neurotoxicity, ototoxicity, & nephrotoxicity ADR Myelosuppression—dose limiting toxicity |
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Oxaloplatinum
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(Eloxatin)
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Temozolomide
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• Other Names
o Temodar • Group o Alkylating agent • Mechanism of Action o Interrupts DNA replication through methylation of guanine o Inhibits DNA, RNA, and protein synthesis • Chemistry o Demethylated to active intermediate→MTIC (monomethyl triazeno imidazole carboxamide) • Has the same metabolite as dacarbazine o Dose not require the liver for activation, but is degraded to MTIC at normal physiological pH • Availability o After oral administration it is rapidly absorbed o 100% bioavailable on an empty stomach o Crosses BBB→can achieve therapeutic concentrations in cerebrospinal fluid and brain tumor tissues • Uses o Brain tumors o Brain metastases o Melanoma • Side Effects o Headache o Fatigue o Vomiting→Moderate o Myelosuppression o Neutropenia o Thrombocytopenia o Myalgia o Back pain o Diplopia/Double Vision o Lymphopenia→Low lymphoctes in chronic dosing • Take on empty stomach |
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Dacarbazine
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• Other Names
o DTIC • Group o Alkylating agent • Mechanism of Action o Interrupts DNA replication through methylation of guanine o Inhibits DNA, RNA, and protein synthesis o Does not cause DNA cross-linking • Chemistry o Demethylated to active intermediate→MTIC (monomethyl triazeno imidazole carboxamide) • Has the same metabolite as Temozolomide o Requires liver for activation (P450 enzymes) • Availability o Poorly absorbed o Administered IV o Poorly penetrates CNS • Uses o Melanoma o Soft-tissue sarcomas o Brain tumors o Hodgkin’s disease • Side Effects o Myelosuppression o Vomiting→Highly o Flu-like syndrome o Fever o Myalgia/Muscle Pain o Malaise/General discomfort o Facial flushing o Photosensitivity→Caution with sun exposure • Balmer CM, Valley AW, Iannucci A. Cancer Treatment and Chemotherapy. In: DiPiro JT, Talbert RL, Yee GC, et all, eds. Pharmacotherapy: A Pathophysiological Approach. Sixth Edition. The McGraw-Hill Companies, 2005: 2307-2308. |
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Ifosfamide
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• Other Names
o Ifex • Group o Alkylating agent • Mechanism of Action o Nitrogen mustard derivative o Closely related in structure, clinical use, and toxicity to cyclophosphamide o Cross-links DNA strands • Chemistry o Must be activated by hepatic enzymes o Activated to ifosfamide mustard o A metabolite, Acrolein, is responsible for some toxicity • Availability • Uses o Testicular cancer o Soft-tissue sarcomas o Non-Hodgkin’s lymphoma o Non-small-cell lung cancer o Cervical cancer o Head cancer o Neck cancer • Side Effects o Hemorrhagic cystitis→ALWAYS given with mesna/medication adjuvant (used to reduce the incidence of hemorrhagic cystitis and hematuria) and hydration o Nephrotoxicity→Tubular acidosis o Potassium, magnesium, and phosphate wasting (especially in high doses) o Myelosuppresion o CNS effects→Somnolence, confusion, disorientation, cerebellar symptoms (sensory perception and motor control) o Moderate emetogenic o Alopecia Balmer CM, Valley AW, Iannucci A. Cancer Treatment and Chemotherapy. In: DiPiro JT, Talbert RL, Yee GC, et all, eds. Pharmacotherapy: A Pathophysiological Approach. Sixth Edition. The McGraw-Hill Companies, 2005: 2305-2307. |
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Lomustine
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All information taken from Micromedex®
Brand name: Ceenu® Classes: Alkylating Agent Antineoplastic Agent Nitrosourea Administration: Oral tablet FDA Approved Indications: Hodgkin's disease, secondary therapy in combination with: Mitoxantrone Vinblastine And others Intracranial tumor Non-FDA Approved Indications: Carcinoma of breast Colorectal cancer Lung cancer Malignant melanoma Non-Hodgkin's lymphoma Mechanism of Action: Cell-cycle nonspecific antineoplastic agents Probably act in the late G1 or early S phase Involves alkylation of DNA Prevention of the repair of DNA Alteration of the structure of RNA and the structure and function of many proteins and enzymes Adverse Effects: Nausea Vomiting Thrombocytopenia Leukemia Teratogenicity Alopecia Hepatotoxicity Myelosuppression, Delayed 4-5 weeks; cumulative Nephrotoxicity Neurotoxicity Optic atrophy Pulmonary fibrosis, Possibly delayed Pulmonary infiltrate, Possibly delayed Antimetabolites Compounds which are chemically similar to endogenous co-factors and metabolic precursors⇒have important fx in biosynthesis of nucleic acids The anti-metabolites have structural differences that are very small But a significant difference in fx Inhibit key enzymes and alter cell fx by being incorporated into DNA & RNA Activity occurs during “S” phase Bone marrow and GI tract cells constantly divide; thus major toxicities are found at these sites However, a therapeutic advantage exists because tumor cells divide to a greater extent 3 classes Antifolates methotrexate Pyrimidine analogs 5-fluorouricil Purine analogs 6-mercaptopurine Thioguanine |
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Methotrexate
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(MTX, amethopterin, folex, mexate)
Discovered by rational drug design Slightly soluble in water Injectable form ~pH 8.5 ANALOG OF FOLIC ACID Tumor activity Broad spectrum, used in combination w/other drugs ALL, AML, choriocarcinoma (arises from the outermost layer of the fetus), lymphomas, osteogenic sarcoma, head and neck cancer, lung cancer, breast cancer, ovarian cancer, myeloma MOA Folates exist in different forms in mammalian cells Core of folates is the same⇒folic acid Folic acid, in oxidized state, is not useful In order to act as a co-enzyme, folate needs to be reduced Folate⇒dihydrofolate⇒tetrahydrofolate—transfers single carbon units in metabolic processes MTX has a high affinity for dihydrofolate reductase; MTX binds to the enzyme, preventing dihydrofolate from being reduced Kills cells in “S” phase Taken up by a carrier protein thanks to glutamate Destroyed in the lysosome However, resistance can occur via 3 mechanisms: Impaired transport into the cell Decreased polyglutamation Amplification of dihydrofolate reductase If given concurrently with leucovorin (folinic acid), the dose of MTX can be increased ROA Orally or injectable ADR Bone marrow toxicity—Dose limiting toxicity GI toxicity Leukopenia, thrombocytopenia, anemia Renal failure and hepatic failure at high doses Alopecia, dizziness, blurred vision, chills, fever Toxic to embryo (has been used as an abortion agent) |
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Pyrimidine Analog
5-Fluorouricil |
(fuorouracil, adrucil, 5-FU, Ejudex) (FDURC more potent—straight to DNA)
Fluorinated pyimidine (5th Carbon) True anti-metabolite; produces multiple biochemical lesions Inhibits thymidine nucleotide synthesis Can be incorporated into DNA & RNA Treats: Advanced breast cancer (w/CMF) Oral cancer, GI tract cancer, colon cancer Topical tx: cure for basal cell carcinoma MOA Inhibits nucleotide synthesis & becomes incorporated into RNA & DNA Synthesis and translation will now not occur correctly (thymadine nucleotide synthesis) Available as: Solution: clear yellow soln; stored at room temp, protected from light Topical cream, 5%==>results in 2-3 days for basal cell carcinoma PO⇒usually not given this way, low bioavailability ADRs Gastrointestinal Toxicity⇒dose limiting toxicity (n/v, diarrhea) Myelosuppression⇒pts w/low platelet counts are poor candidates for this therapy Dermatological toxicity: alopecia, partial loss of nails, hypopigmantism of nails, rash, sunlight sensitivity Neurotoxicity: headache, visual disturbance, cerebullar ataxia⇒clumsiness, staggering, word pronunciation Hypotension |
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Capecitabime
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(Xeloda)
Used in metastatic breast cancer (if cancer resistant to taxol and anthrocycline) Converted (eventually) to 5-fluorouracil ROA Orally ADME Carboxyl transferase converts to DFCR & DFUR dThdPase more present in cancer cells than others ADR N/V, fever, diarrhea, loss of appetite, hand-body syndrome |
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Mercaptopurine
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(purinethol, 6-MP, 6-mercaptopurine, purine-6-thiol)—all about the sulfur
Yellow powder, insoluble in water, soluble in alcohol Discovered by Hitchings & Elion, in 1954; received Nobel Prize MOA Hypoxanthene:guanine phosphoribesyl transferase (HGIRTase) Inhibits guaning biosynthesis Not active in and by itself; activated by HGIRTase 6-MP reacts w/PRPP via HGIRTase⇒forms 6-MP-ribose phospotase (or TIMP) TIMP inhibits DNA synthesis (adenines & guanines) TIMP blocks adenosine metabolism TIMP not incorporated into DNA, and it blocks the formation of adenosine and guanine, thus limiting what is incorporated into DNA Used in ALL w/POMP P=6-MP O=VC M=MTX P=prednisone Lymphomas ROA IV or PO ADR Mild myelosuppresion N/V Dry Rash, fever, jaundice (1/3 of pts—may be dose limiting, but reversible; monitor LFTs) |
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Hydroxyuria
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(hydria, HU, HUR)
White powder, soluble in water (H2N-CO-NH-OH) ROA Oral, 500mg caps Tumor activity Leukemia, ovarian, head ‘n’ neck, renal cell carcinoma, melanoma Very effective in advanced stage carcinoma MOA Inhibits DNA synthesis by inhibiting Ribonucleotide reductase Damages DNA directly Works in S phase of cell cycle (S phase specific) Natural Plant Alkaloids Majority of substances used to treat cancer are natural products Anthrocycline (adriomycin, doxorubicin, epirubicin, epirubicin, idarubicin) Have cardiac toxicity Though mitoxanthine has less cardiotoxicity |
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ADR
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(streptomyces, pencilino; adriomycin, doxorubicin)
Discovered by researcher of Pharmatailia⇒soil sample from Adriatic Sea Red pigmented powder, water insoluble, RED DEVIL Tumor Activity Sarcomas, carcinomas, leukemia, lymphomas (ie, broad range) Less active in leukemia Used both singly and as combination tx Breast cancer w/cyclophosphamide & vincrastine & prednisone Ovariane w/cyclophasphamide & cisplatnum Lung cancer Osteogenic sarcoma Ewings sarcoma Soft tissue sarcoma w/cisplatinum & ifosfamide thyroid, endometrial, testicular, cervical, prostate, head and neck, myeloma Dexil (another form of doxorubicin) Liposomal (kapasi’s sarcoma) MOA Intercalation w/DNA No covalent bonding, but docks between base pairs Produces kink in DNA⇒kills cell Affects DNA & RNA synthesis Causes single-strand breaks in DNA Inhibits topo-isomerase II activity Increases free radical production Responsible for cardiotoxicity Apoptosis Interaction w/cell membrane Critical rxn, but not sufficient to cause cell death Not effective below 15 degrees centigrade ROA Doxorubicin HCl IV: 10mg, 50mg….200mg vials Protect from light ADR/toxicities Extravasation (aka, Adriamycin Flare) May be reduced by adding an ice bag to the injection site Hepatic fx Myelosuppression—may be dose limiting GI disturbances Allopecia Cardiotoxicity Lifetime cumulative dose ~550mg/m2 |
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Daunarubicin
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(rubidomycin, cerubidine; analog of adriamycin/doxorubicin)
Differ by OH group Tumor Activity Leukemia Some pediatric tumors Kaposi’s sarcoma (the liposomal product, anyways) MOA Similar to doxorubicin Toxicities/ADR Myelosuppression Allopecia, rash Cardiotoxicity for daunarubicin>doxorubicin Idarubicin Analog of daunamycin (lack OCH3 group) More lipophilic than doxorubicin Less cardiotoxic Epirubicin Even less cardiotoxic, used in many cancers Mitoxantron & Mitomycin Similar MOA, used in many cancers, and lesser cardiotoxicity |
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Bleomycin
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Bhushan’s drug of choice (blomoxane, BLM, Bleo)
Lung and skin toxicity Antibiotic; streptomyces verticillum (1974) 13 different types; Bleomycin A¬2=70% Bleomycin B2=most of the rest Soluble in water, glycopeptides Tumor activity Squamous cell carcinoma Cervical, skin, vaginal, rectal, testicular, & lung Testicular: If only bleo, response rate is ~30% If bleo + vinblastine ~90% If bleo + vinblastine + DDP ~100% MOA Inhibits cell division in both prokaryotic and eukaryotic cells Inhibits DNA, RNA, and protein synthesis (mostly DNA) Blocks cell in early G2 phase Intercalates w/DNA Has metal coordination site Fe, O⇒causes DNA damage Toxicity/ADR—unique Produces very little myelosuppression Very little GI, liver, CNS, kidney toxicity Skin & lung toxicity, however…. Bleomycin hydrase inactivates bleomycin Skin and lungs have low levels of this enzyme⇒toxicities And now for something completely different: microtubules Protein polymers responsible for cellular strength and cellular movement Major component in tubulin 2 subunits: alpha and beta Arranged as head and tail⇒together form a protofilament Protofilaments arrange in a tube/ hollow structure and are in equilibrium with free polymers Different signals can cause tubule growth or contraction Especially ion concentration w/in a cell (Mg++, GTP) Back to subject: Vinca alkaloids—anti-mitotic drugs Disturb microtubule:tubulin balance⇒increase depolymerized tubulin concentration⇒the tubulin dimers then form paracrystaline aggregates, which can not re-form microbules⇒affects M phase of cell cycle Usually begin with letter “v”⇒vincristine, vinblastine, vindesine, vinorelbine, & colchecine Microtubule antagonists Isolated from Catheranthus rosea (periwinkle plant or vinca rosa)⇒Vb,Vc Vincrastine (vincasar, oncovin, LCR, VCR) Tumor activity: Breast cancer, sarcomas, neuroblastoma, lymphomas Check handout for ADRs |
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Vinblastine
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(velban, vinca leukoblastine, velba, vlb)
Tumor activity: Breast cancer: w/MTX or alone Lymphomas, testicular (w/cisplatinum & bleomycin), ovarian, chronic myelocytic leukopenia Check handout for ADRs |
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Vinorelbine
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(navelbine)
Semi-synthetic analogue of vinblastine Tumor activity Lung, breast, ovarian, cervical, mesothelioma MOA Binds tubulin But lower affinity for axonal (axons) microtubules than vinca alkaloids Ie, lower neurotoxicity Interferes w/nucleic acid synthesis Ie, specific for S & M ADR/toxicities Myelosuppression Mild peripheral neuropathy (Numbness or tingling in extremeties) Skin discoloration at injection site Alopecia, rash, anxiety |
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Colchecine
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Extracted from Meadow Saffron
MOA (vinca alkaloid) Tumor Activity Prostate Hepatocarcinoma (appears to work very well) Taxols act by binding microtubules directly & preventing elongation Taxol Derived from the bark of the yew tree Tumor activity Ovarian and breast cancer ADR Myelosuppression Neurotoxicity Remember the drugs: Make your own table (mechanical learning); then memorize. |
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Topoisomerase inhibitors
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Topoisomerases untangle selected regions of DNA
Allows transcription, replication, & DNA to fx Temporarily breaks DNA and then re-seals it Topoisomerase I Causes single-strand breaks Does not cross DNA strand Topoisomerase II Double strand breaks Crosses DNA strand Action: Binds DNA forming a non-covalent, reversible bond (non- cleavable complex)—later forms cleavable complex Enzyme cuts DNA on both strands DNA reseals, topoisomerase II un-binds Topoisomerase inhibitors bind to the non-cleavable complex, rendering the cutting enzyme ineffective Affects transcription and all DNA fx Prevents activation of protein kinase P-34CDC2—activated in G2 phase Thus, cells are stuck in the G2 phase as CDC2 has a very important role in progression from G2 to M phase |
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Etoposide
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(VP-16—methyl group) & Tenoposide (VM-26—sulfur ring)
Isolated from mayapple plant (mandrake-podophyllotoxin extract) See handout for this |
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Camptotecan & Irinotecan
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also topoisomerase inhibitors
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Tamoxifen
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(TAM, Nolvodex, Tamofen, Tamoxifen citrate)
Anti-estrogen properties—interferes w/action of estrogen Estrogen binds to estrogen receptor, leading to cell proliferation Some breast cancer cells are estrogen receptor positive and are very sensitive Tamoxifen binds to the estrogen receptor, preventing estrogen from binding; nor does the estrogen receptor bind to its co-factors Leads to decrease in DNA synthesis and decrease in estrogen response + decrease in mRNA synthesis Leads to accumulation of cells in G0 & G1 phase Cytostatic, not cytotoxic Only works with Estrogen positive breast cancer! Tumor Activity Prevention and treatment of breast cancer (metastatic or non) Melanoma Some efficacy in pancreatic cancer ADR/Toxicities Hot flashes, mild to moderate nausea, thrombocytopenia, leucopenia, vaginal bleeding, weight gain, alopecia Low occurance of depression, dizziness, headache, skin rash <1% of pts develop endometrial & uterine cancer Some historical stuff for Hormone Tx 19th century discovery of Thomas Beatson—interested in relation of ovaries to breast milk production—rabbits stopped producing milk after removal of ovaries; tried it on humans who had advanced breast cancer⇒reduction in size of tumors |
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Selective Estrogen-Receptor Modulators
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(SERMs)
Tamoxifen, Evista, Ferrasten Bind to Estrogen receptors and prevent further estrogen actions |
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Aromatase Inhibitors
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Aromasin, Femara, Arimidex, Megace
Prevent production of estrogen in adrenal glands |
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Biologic Response Modifiers
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Herceptin
Bind to certain proteins on breast cancer cells, preventing their growth |
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Herceptin
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(trastuzumab)
Targets HER2 receptor (25-33% of breast cancers have this receptor) These pts are not responsive to standard cancer chemo Test for HER2 receptor: Use antibodies on biopsy samples Slows growth and spread of cells (cytostatic); also approved for advanced metastatic breast cancer; also increases the effects of some chemo agents, decreases immune system responses If given singly, regular chemo response is ~29%; herceptin + chemo (taxol) ~45% ROA IV ADR/toxicities Chills, fever, N/V, cardiomyopathy (pts treated w/antrocyclines are not good candidates for herceptin therapy) |
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Zoladex, Faslodex
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Treat breast cancers that are dependent on estrogen for survival
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Zoladex
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(goserelin acetate)
Synthetic form of L HRH Blocks the release of estrogen |
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Faslodex
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(fulvestrant)
Effective for women who are resistant to tamoxifen Destroys estrogen receptors |
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Leuprolide
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(lupron, viadur⇒leuprolide acetate implant)
Synthetic nanopeptide Analogue of gonadotropin releasing hormone (GnRH) Used especially in prostate cancer When given males, ↓[testosterone] Initial dose actually ↑[testosterone], but ↓quickly In 2-4 weeks, [testosterone] reaches castrate levels Females ↓[estrogen] Most prostate cancers rely on testosterone Toxicities/ADRs Aches and pains, headache, hot flashes, irritation @injection site, shrinking of testes, breast enlargement in males; may ↑[cholesterol]; may cause temporary sterility in males |
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Flutamide
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(eulexin, euflex)
Synthetic hormone w/similar binding profile but different effects than testosterone Androgen antagonist Shuts down androgen responsive pathways Sometimes used to treat acne Tumor activity Prostate cancer Other “ide” drugs also exist in this class Toxicities/ADR Diarrhea, nausea, breast tenderness, impotence |
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Zevulin
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(Ibritumomab)
FDA approval in 2002 for tx of lymphomas w/CD 20 Ag. Ab that binds In 111 or Y-90 covalently Ab (this drug) binds to the CD 20Ag, and then the radioactive element attached to the Ab kills the cell Toxicities/ADR N/V, diarrhea, thrombocytopenia Malignancies may develop due to this drug |
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Arsenic Trioxide
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(Trisenox)
Used by Greeks and Romans long, long ago. Also used in 19th century to treat syphilis and sometimes for leukemias; had severe side effects and were banned. Re-approved by FDA for tx of leukemia in 1998 (orphan drug) Tumor Activity Acute Promyolecytic Leukemia (1500 new cases/year in US) Due to Chromosomal translocation (from chromosome 15 to 17) AML (+gleevec) MOA Not understood Causes apoptosis, some morphological changes, results in degradation of PML-RAR-Alpha (protein due to the chromosomal translocation) ADR/Toxicities N/V, diarrhea, fatigue, rash, cough, headache, dizziness Talkin’ ‘bout Gleevac⇒treatment for chronic myelogenous leukemia 1960⇒Abnormal chromosome (Philadelphia chromosome) found 1973⇒discovered that it’s a translocation between chromosome 22 & 9 1982⇒proto-oncogene BCR-ABL discovered 1984-1987⇒chromosome 22 produces ABL gene problem; linked to BCR gene 1990⇒BCR-ABL gene identified as cause of CML in mice 1993⇒First STI571 lab studies begin 1998⇒First human experiments 1999⇒first results 2001⇒FDA approves Gleevac for tx of CML ABL is normally regulated, but when bound to BCR it becomes unregulated Incidence: 4500 people/year in US, usually people who are “middle aged” or older Gleevec (STI571, Imatinib mesylate) is a molecularly targeted drug OK, I’m missing a few drugs here; blame Bald Bull from Mike Tyson’s Punch Out. |
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Avastin
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(Bevacizumab) Monoclonal Ab
VEGF Blood vessels shrink Interferes with growth of blood vessels Anti-angiogenic agent Tumor Activity Breast cancer, lung, colon, rectal Side Effects/ADR Headache, fatigue, wound healing complications/bleeding Sutent Multi-kinase inhibitor PDGFR & VEGFR Anti-angiogenic Tumor Activity Advanced Renal Carcinoma GI tumors |
