ANTI-TOXICITY DRUGS USED IN CANCER THERAPY
TOXICITIES OF ANTI-CANCER DRUGS:
1. Toxicities of alkylating agents:
- All alkylating agents are myelosuppressive, pulmonary fibrosis, sterility & secondary leukemias (less common with cyclophosphamide).
- In high dose, all alkylating agents cause veno-occlusive disease in liver (reversed by defibrotide).
|
Alkylating agents |
Distinctive toxicity |
|
Cyclophosphamide |
Alopecia, hemorrhagic cystitis, SIADH |
|
Nitrosoureas & ifosfamide |
Renal failure |
|
Nitrosoureas & mechlorethamine |
Local irritation & damage – Due to strong vesicant properties |
|
Ifosfamide |
Hemorrhagic cystitis, SIADH |
|
Busulfan |
Pulmonary fibrosis, hyperpigmentation, adrenal insufficiency |
|
Procarbazine |
Secondary leukemia, disulfiram-like-reaction, behavioral changes, CNS depression |
|
Cisplatin |
Emesis, nephrotoxicity, peripheral sensory neuropathy, ototoxicity |
2. Toxicities of anti-metabolites:
- All antineoplastic antimetabolites cause bone marrow suppression
|
Anti-metabolites |
Distinctive toxicity |
|
6-MP & 6-TG |
Hepatotoxicity |
|
Methotrexate |
Mucositis, hepatotoxicity |
|
5-FU |
Hand and foot syndrome, neurotoxicity |
|
Capecitabine |
Hand and foot syndrome, Hyperbilirubinemia |
|
Cytarabine |
Cerebellar ataxia |
|
Fludarabine |
Arthralgia |
|
Gemcitabine |
Diarrhea |
3. Toxicities of natural anticancer drugs:
- All natural anticancer products can cause bone marrow suppression except bleomycin & vincristine.
|
Natural anticancer drugs |
Distinctive toxicity |
|
Bleomycin |
Pulmonary fibrosis (Marrow sparing) |
|
Anthracyclines |
Cardiotoxicity |
|
Paclitaxel |
Peripheral neuropathy & hypersensitivity |
|
Docetaxel |
Peripheral neuropathy, Fluid retention |
|
Irinotecan |
Diarrhea |
|
Vincristine |
Peripheral neuropathy (Marrow sparing), SIADH. |
4. Toxicities of hormonal agents:
|
Hormonal agents |
Distinctive toxicity |
|
Flutamide |
Hot flushes, liver dysfunction |
|
SERMs |
Menopausal symptoms, fluid retention, thromboembolism, increased incidence of endometrial cancer |
|
Progestins |
Fluid retention |
|
Corticosteroids |
Fluid retention, hypertension, diabetes, increased susceptibility to infections |
|
GnRH agonists |
Transient flare-up reaction, hot flushes, impotence, gynecomastia, osteoporosis |
|
Aminoglutethimide |
Adrenal insufficiency, myelosuppression, rash |
|
Aromatase inhibitors |
Fatigue, hot flushes, arthralgia |
TREATMENT:
Anti-toxicity drugs for anti-cancer drugs:
|
Anti-toxicity drug |
Mechanism |
Indications |
|
Allopurinol |
Inhibit xanthine oxidase | Prevent hyperuricemia from tumor lysis syndrome |
|
Rasburicase |
Recombinant urate oxidase | Prevent hyperuricemia from tumor lysis |
|
Mesna (Sodium 2-mercapto ethane sulfonate) |
Neutralizing agent | Prevent hemorrhagic cystitis (due to ifosfamide) with high dose cyclophosphamide. |
|
Leucovorin |
Replete tetrahydrofolic acid | Rescue after high dose methotrexate |
|
Amifostine |
Prevent radiation-induced xerostomia & Cisplatin-induced nephrotoxicity. | |
|
Dexrazoxane |
Iron-chelator | Prevent cardiotoxicity due to anthracyclines |
|
Palifermin |
Keratinocyte growth factor | Prevent mucositis following chemotherapy |
|
Pilocarpine |
Cholinergic agonist | Radiation-induced xerostomia |
|
Pamidronate & Zolendronate |
Bisphosphonates | Hypercalcemia of malignancy |
|
Epoetin-alpha & Darbopoetin-alpha |
Erythropoietin | Anemia |
|
Filgrastim & PegFilgrastim Sargramostim |
G-CSF & GM-CSF respectively | Febrile neutropenia prophylaxis |
|
Oprelvekin |
IL-11 | Thrombocytopenia |
|
Ondansetron, Granisetron & Palonosetron |
Ondansetron – 5-HT antagonist
Granisetron & Palonosetron – 5HT3 antagonist |
Nausea & vomiting |
|
Aprepitant & Fosaprepitant |
NK-1 antagonist | Cisplatin-induced delayed vomiting |
Exam Important
- Drugs used to prevent toxicity of anti-cancer drugs include allopurinol, rasburicase, mesna, leucovorin, amifostine, dexrazoxane, palifermin, pilocarpine, pamidronate, filgrastim, sargramostim, ondansetron, granisetron, aprepitant& fosaprepitant.
- Anticancer drugs having highest emetogenic potential is cisplatin.
- Antineoplastic agent is an antifolate drug is Methotrexate.
- Aprepitant & Fosaprepitant are NK-1 antagonists used for cisplatin-induced delayed vomiting.
- Ondansetron is a 5-HT antagonist useful for treating vomiting.
- Granisetron & Palonosetron are 5HT3 antagonist.
- Sargramostim is a GM-CSF used for treating anti-cancer drug-induced neutropenia.
- Pamidronate is
- Mesna is sodium 2-mercapto ethane sulfonate, is useful for preventing hemorrhagic cystitis (due to ifosfamide).
- Vincristine causes peripheral neuropathy & SIADH.
- Anticancer drug bleomycin causes pulmonary fibrosis.
- 5-FU is an anticancer drug result in hand & foot syndrome.
- Cisplatin is responsible for emesis & nephrotoxicity.
- Procarbazine produces disulfiram-like-reaction.
- Busulfan can result in pulmonary fibrosis.
- Cyclophosphamide can cause hemorrhagic cystitis.
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