Drugs Used for Cancer Treatment
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Cancer and the Use of
Antineoplastic Agents
 Treatment requires combination of surgery,
radiation, chemotherapy, and immunotherapy
 Recent developments enhance role of
antineoplastic agents in therapy
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Cancer Cases and Deaths
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Phases of Cell Growth
 Mitosis: phase of cellular proliferation in
which cells divide into two equal daughters
Cells are either in the non-proliferative stage
(G0), or in the first gap phase (G1)
Phase G1: pre-synthetic phase in which the
cell manufactures needed enzymes to
prepare for DNA synthesis
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Phases of Cell Growth (cont.)
Phase G2: post-synthetic phase in which
the cell prepares for mitosis by producing
RNA and specialized proteins
 Mitosis divides the cell into two G1
daughter cells
 G1 cells may advance again to S phase or
pass into a non-proliferative stage (G0)
 S phase: stage of active synthesis of two
sets of DNA
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Phases of Cell Growth (cont.)
http://www.youtube.com/watch?v=Q6ucKWIIFmg
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Cell Cycle and Effects of Drugs
 Cell cycle–specific
 Drug is selectively toxic when the cell is in a specific
phase of growth—schedule dependent
 Effective against malignancies that proliferate
rapidly
 Cell cycle–nonspecific
 Active throughout the cell cycle
 More effective against slowly proliferating
neoplastic tissue
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Drug Therapy for Cancer
 Goals for chemotherapy : administering a dose large
enough to be lethal to cancer cells but small enough to
be tolerable for normal cells
 Control of the disease (arresting of tumor)
 Goal for palliation: alleviation of symptoms if cancer is
beyond control
 Goal for prophylaxis: prophylactic measures if patient is
a known risk for developing cancer
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Nursing Assessments
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History of risk factors
Dietary habits
Preexisting health problems
Adaptation to diagnosis
Psychomotor functions
Safety
Symptoms of pharmacologic adverse effects
Physical and sexual assessment
Pain
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Nursing Interventions
Care plan is based on assessment data and individual
needs of patient:
 Monitor VS
 Examine lab tests
 Monitor for development of emergencies
 Monitor hydration and electrolyte status
 Report early signs of infection
 Nausea and vomiting are common
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Nursing Interventions (cont.)
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Pre-administer antiemetic; report poor control,
Monitor for changes in bowel movements
Meticulous oral hygiene for stomatitis
Report bleeding
Give pain medications at intervals to maintain
maximum pain control
 Nutritional needs
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Nursing Interventions (cont.)
 Encourage patient/family to discuss concerns with
support group
 Allow patient to make choices on her/his care
 Sexual needs: discuss birth control during
chemotherapy and/or sperm storage
 Vascular access devices
 Skin care to prevent skin breakdown
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Patient Education
 Neutropenia: discuss hand washing; avoiding infected
individuals; no fresh flowers, vegetables, pets, items
with free-standing water, those receiving
immunizations
 Pain: report pain that is new or not controlled, take
medications at prescribed intervals to obtain
maximum relief
 Anemia: space activities and rest
 Thrombocytopenia: monitor for bleeding episodes;
avoid sharps, ASA, anticoagulants
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Drug Class: Alkylating Agents
 Actions: Highly reactive chemical compounds that
bond with DNA molecules, preventing separation of
the double-coiled DNA molecules which are necessary
for cellular division
 Uses: Treatment of chronic lymphocytic leukemia,
ovarian cancer, brain tumors, multiple myeloma,
Hodgkin’s disease, Non-Hodgkin’s lymphoma,
 Serious adverse effects: Bone marrow depression,
nephrotoxicity
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Drug Class: Antimetabolites
 Actions: Inhibit key enzymes in the biosynthetic
pathways of DNA and RNA synthesis
 Uses: Treatment of breast cancer; colon cancer; hairy
cell leukemia, lymphomas, acute lymphocytic
leukemia, myelodysplastic syndromes
 Serious adverse effects: Bone marrow depression,
petechiae, hepatotoxicity, dermatitis, stomatitis
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Drug Class: Natural Products
 Actions: Cell cycle–specific agents block formation of
the mitotic spindle during mitosis, inhibiting cell division
 Uses: Treatment of Hodgkin's disease; non-Hodgkin’s
lymphoma; acute lymphocytic leukemia; Kaposi’s
sarcoma; ovarian, breast, testicular cancers
 Serious adverse effects: Bone marrow depression,
peripheral neuropathy, hepatotoxicity
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Drug Class:
Antineoplastic Antibiotics
 Actions: Bind to DNA, inhibiting DNA or RNA synthesis
 Uses: Hodgkin’s disease, non-Hodgkin’s lymphoma;
squamous cell, head and neck, testicular cancers;
Wilms’ tumor; rhabdomyosarcoma; Ewing’s and
osteogenic sarcoma; acute lymphocytic leukemia;
acute myeloid leukemia
 Serious adverse effects: Bone marrow depression,
hepatotoxicity, stomatitis, cardio toxicity
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Drug Class: Hormones
 Actions: Reduce edema secondary to radiation therapy
and act as palliative therapy; temporarily suppress
fever, diaphoresis, and pain
 Uses: Estrogens and androgens used in malignancies of
sexual organs
 Serious adverse effects: Gynecomastia, hot flashes,
diarrhea, pelvic pain, edema, hepatitis, thrombosis,
hyperglycemia
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Drug Therapy for Cancer
 Targeted anticancer agents
 Act on pathways that provide growth and survival
advantages for cancer cells
 Not associated with toxicities common with
cytotoxic chemotherapy
 Chemoprotective agents
 Reduce toxicity of chemotherapeutic agents to
normal cells
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Drug Therapy for Cancer (cont.)
 Bone marrow stimulants: trigger recovery of bone
marrow cells
 Davepoetin and epoetin stimulate bone marrow to
produce RBCs to treat anemia
 Filgrastim, pegfilgrastim stimulate production of
neutrophilic white blood cells
 Oprelvekin stimulates platelet production
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Audience Response Question-1
 By which method does cell cycle–specific treatment
therapy work?
A.
B.
C.
D.
Treating cancer cells at their vulnerable cell
reproductive stage
Affecting a cancer cell throughout its entire life cycle
Inhibiting slowly growing cancer cells
Targeting key pathways that provide growth to
cancer cells
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Audience Response Question-2
 Which bone marrow stimulant increases the
production of white blood cells?
A.
B.
C.
D.
Filgrastim (Neupogen)
Epoetin alpha (Epogen)
Darbepoetin (Aranesp)
Oprelvekin (Neumega)
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Audience Response Question 3
 A patient has developed thrombocytopenia following
a round of chemotherapy. The nurse should instruct
the patient to:
A.
B.
C.
D.
use an electric razor to shave.
wash his hands frequently.
plan his activities to allow rest time.
report temperature elevations.
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Audience Response Question 4
 A patient has been taking an alkylating agent for
chemotherapy to treat ovarian cancer. The care plan
mentions observing for nephrotoxicity during
treatment. The nurse should monitor for
development of:
A.
B.
C.
D.
jaundiced skin and sclera.
decreased urine output.
increased liver enzymes.
frequent bleeding episodes.
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Audience Response Question 5
 Which type of cancer is the leading cause of cancerrelated death in women?
A.
B.
C.
D.
Breast
Colon
Lung
Ovary
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