CAPhO Oncology Basics Cancer Drug Pharmacology Table
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Essentials Oncology Practise Essentials Oncology Basics Cancer Drug Pharmacology Table capho.org 1 acpho.org Essentials Oncology Practise Essentials Oncology Basics Cancer Drug Pharmacology Table Alkylating agents Adverse effects common to most agents in the class: myelosuppression, nausea, vomiting, alopecia, germ cell toxicity, infertility, secondary leukemias Nitrogen Mustards Drug Common Uses Adverse Effects Bendamustine TREANDA® Non-Hodgkin’s lymphoma, chronic lymphocytic leukemia Skin toxicity, flu-like symptoms Chlorambucil LEUKERAN® Chronic lymphocytic leukemia, lymphomas Pulmonary fibrosis Cyclophosphamide CYTOXAN® Lymphomas, breast and lung cancer Risk of hemorrhagic cystitis from acrolein (active metabolite) Estramustine EMCYT® Prostate cancer Cardiac toxicity, thromboembolism, gynecomastia Ifosfamide IFEX® Germ cell testicular cancer, sarcoma Analog of cyclophosphamide that also can cause hemorrhagic cystitis from acrolein (active metabolite) Meclorethamine (nitrogen mustard) MUSTARGEN® Cutaneous neoplasms (e.g. mycosis fungoides) Severe vesicant (IV), allergic contact dermatitis (topical) Melphalan ALKERAN® Multiple myeloma Pulmonary fibrosis Drug Common Uses Adverse Effects Thiotepa (TESPA, TSPA) Bladder cancer, malignant meningeal neoplasms Mucositis, skin rash Aziridines capho.org 2 acpho.org Essentials Oncology Practise Essentials Oncology Basics Cancer Drug Pharmacology Table Alkyl Sulfonates Drug Common Uses Adverse Effects Busulfan MYLERAN® Chronic myelogenous leukemia, conditioning for bone marrow transplants Pulmonary fibrosis, hyperpigmentation Drug Common Uses Adverse Effects Carmustine (BCNU, BiCNU®) Brain tumours, lymphomas, multiple myeloma Delayed myelosuppression (nadir at approx. 4 weeks), neurologic, pulmonary, hepatic and renal toxicity lomustine (CCNU, CeeNU®) Brain tumours, lymphomas, melanoma Delayed myelosuppression (nadir at approx. 4 weeks), neurologic, pulmonary, hepatic and renal toxicity Streptozocin ZANOSAR® Pancreatic cancer Altered glucose metabolism, pulmonary, hepatic and renal toxicity Nitrosureas capho.org 3 acpho.org Essentials Oncology Basics Oncology Practise Essentials Cancer Drug Pharmacology Table Alkylating-like agents Adverse effects common to the class: myelosuppression, nausea, vomiting, germ cell toxicity, infertility, secondary malignancies Platinum-Containing Compounds Drug Common Uses Adverse Effects Cisplatin PLATINOL® Ovarian, lung, testicular, bladder, head and neck cancers Ototoxicity, nephrotoxicity, neurotoxicity, severe nausea and vomiting, anemia, electrolyte disturbances Carboplatin PARAPLATIN® Ovarian and endometrial cancer Hypersensitivity, more myelosuppression than cisplatin but less nephrotoxicity, ototoxicity, nausea and vomiting Oxaliplatin ELOXATIN® Colon and rectal cancer Peripheral neuropathy (exacerbated by cold), pharyngolaryngeal dysesthesia, minimal nephrotoxicity and ototoxicity Drug Common Uses Adverse Effects Dacarbazine (DIC, DTIC) Sarcomas, metastatic melanoma, hodgkin’s disease Flu-like symptoms Procarbazine MATULANE® Brain tumours, lymphomas Disulfiram-like reaction with alcohol, interacts with tyramine-rich foods due to mild monoamine oxidase inhibition Temozolomide TEMADOL® Oral equivalent of dacarbazine Malignant gliomas Flu-like symptoms Other capho.org 4 acpho.org Essentials Oncology Practise Essentials Oncology Basics Cancer Drug Pharmacology Table Antitumour antibiotics Adverse effects common to most agents in this class: myelosuppression, cardiac toxicity extravasation, mucositis, nausea and vomiting, alopecia Anthracyclines Drug Common Uses Adverse Effects Daunorubicin (daunomycin) CERUBIDINE® Acute leukemias Red urine, radiation recall Doxorubicin ADRIAMYCIN® Lymphomas, breast, ovarian, endometrial, bladder and thyroid cancers and many more Red urine, radiation recall Liposomal doxorubicin CAELYX® Breast and ovarian cancers, kaposi’s sarcoma Red urine, radiation recall, infusion reactions (likely due to lipid component), palmar plantar erthyrodysesthesia Less cardiotoxicity than doxorubicin Epirubicin ELLENCE® Breast cancer Red urine, radiation recall Idarubicin IDAMYCIN® Acute leukemias Red urine, radiation recall Drug Common Uses Adverse Effects Mitoxantrone NOVANTRONE® Leukemias, prostate cancer Irritant Bleomycin BLENOXANE® Lymphomas, testicular cancer Hypersensitivity, pulmonary toxicity, skin reactions Dactinimycin (Actinomycin D) COSMEGEN ® Wilm’s tumour, ewing’s sarcoma, rhabdomyosarcoma, gestational trophoblastic neoplasms Rash, hepatotoxicity Mitomycin MUTAMYCIN® Bladder, breast and rectal cancer Acute bronchospasm has been reported when given concurrently with vinca alkaloid Other capho.org 5 acpho.org Essentials Oncology Practise Essentials Oncology Basics Cancer Drug Pharmacology Table Antimetabolites Adverse effects common to the class: bone marrow suppression Purine analogs Drug Common Uses Adverse Effects Fludarabine FLUDARA® Chronic lymphocytic leukemia, lymphomas Nausea and vomiting Mercaptopurine (6-MP) PURINETHOL® Acute leukemias Nausea and vomiting, diarrhea Thioguanine (6-TG) LANVIS® Leukemias Nausea and vomiting, stomatitis, liver damage Drug Common Uses Adverse Effects Azacitidine VIDAZA® Myelodysplastic syndrome, acute myeloid leukemia Nausea and vomiting, stomatitis, diarrhea Capecitabine (oral 5-fluorouracil prodrug) XELODA® Advanced breast, colorectal, and esophagogastric cancers Hand-foot skin reactions, nausea and vomiting, stomatitis, diarrhea Cytarabine CYTOSAR® Acute leukemias, lymphomas, CNS metastatic disease (crosses blood brain barrier) Nausea and vomiting, stomatitis, diarrhea Fluorouracil (5-FU) ADRUCIL® Colon, rectal, stomach, and breast cancers; fluorouracil cream is used topically for non-invasive skin cancers Myelosuppression is more common when administering the drug by rapid bolus injection, whereas GI toxicity and mucositis are more evident with prolonged infusion. Gemcitabine GEMZAR® Non-small cell lung cancer, bladder and pancreatic cancers Nausea and vomiting, stomatitis, diarrhea Pyrimidine analogs capho.org 6 acpho.org Essentials Oncology Practise Essentials Oncology Basics Cancer Drug Pharmacology Table Adenosine analogs Drug Common Uses Adverse Effects Cladribine (2-CdA) LEUSTATIN® Hairy cell leukemia and Waldenstrom’s Nausea and vomiting, fever, infections macroglobulinemia. Folate analogs Drug Common Uses Adverse Effects Methotrexate FOLEX® High dose regimens of methotrexate may be given to obtain a higher intracellular concentration of drug in treatments for malignant lymphomas and sarcomas. Neutropenia, thrombocytopenia, pulmonary fibrosis, nephrotoxicity, diarrhea, hepatotoxicity, stomatitis Pemetrexed ALIMTA® Mesothelioma and non-small cell lung cancer Rash, bone marrow suppression, diarrhea and mucositis are significantly reduced by supplementing with folic acid and vitamin B12 Raltitrexed TOMUDEX® Colorectal cancer Asthenia, Increased liver enzymes, diarrhea Drug Common Uses Adverse Effects Hydroxyurea HYDREA® Chronic myelogenous leukemia, polycythemia vera and essential thrombocytosis Flu-like symptoms, skin rashes Substituted ureas capho.org 7 acpho.org Essentials Oncology Practise Essentials Oncology Basics Cancer Drug Pharmacology Table Plant-derived agents Vinca alkaloids (Antimicrotubule agents) Drug Common Uses Adverse Effects Vincristine ONCOVIN® Lymphomas, leukemias and many more Constipation, paralytic ileus, neuropathy Vinblastine VELBAN® Hodgkin’s disease, testicular cancer Neuropathies, constipation, myelosuppression Vinorelbine NAVELBINE® Breast cancer and in NSCLC Neuropathies, constipation, myelosuppression Drug Common Uses Adverse Effects Docetaxel TAXOTERE® Breast, prostate and lung cancers Neutropenia, alopecia, peripheral neuropathies, peripheral edema, hypersensitivity Paclitaxel TAXOL® Ovarian, breast and lung cancers Neutropenia, alopecia, peripheral neuropathies, arthralgia/myalgia, hypersensitivity Nanoparticle, albumin-bound (nab) paclitaxel (ABRAXANE®) Metastatic breast cancer Neutropenia, alopecia, peripheral neuropathies, arthralgia/myalgia, less hypersensitivity than paclitaxel Drug Common Uses Adverse Effects Etoposide (VP-16) VEPESID® Lung, ovarian, testicular cancer, lymphomas Alopecia, myelosuppression, hypersensitivity, and infusion-related hypotensive changes Teniposide VUMON® Leukemias, lymphomas, neuroblastoma Hypertension with rapid infusion Taxanes (Antimicrotubule agents) Epipodophyllotoxins (Topoisomerase II inhibitors) capho.org 8 acpho.org Essentials Oncology Basics Oncology Practise Essentials Cancer Drug Pharmacology Table Camptothecin derivatives (Topoisomerase I inhibitors) Drug Common Uses Adverse Effects Irinotecan CAMPTOSAR® Metastatic colorectal and rectal cancers Diarrhea Topotecan HYCAMTIN® Ovarian cancer Myelosuppression, nausea and vomiting, alopecia, increased liver enzymes Miscellaneous antineoplastics Drug Common Uses Adverse Effects Asparaginase KIDROLASE®, ERWINASE® Leukemia, lymphoma Hepatotoxicity, hypersensitivity, nausea and vomiting, pancreatitis Mitotane LYSODREN® Adrenal cortical carcinoma Adrenal insufficiency (may require glucocorticoid and mineralocorticoid replacement) This table was developed by Rhonda Kalyn based on content from Alberta Health Services Oncology Basics for The Pharmacist and the following references. References 1. B.C. Cancer Agency. Drug monographs for all drugs listed in tables. Available at: http://www.bccancer.bc.ca/HPI/DrugDatabase/DrugIndexPro/. Accessed Apr/28, 2011. 2. Levine A. Chemotherapy. In: Eggert J, editor. Cancer Basics Pittsburgh, PA: ONS Publishing Division; 2010. p. 195-215. 3. Medina P. Pharmacology. American Colloge of Clinical Pharmacy Oncology Pharmacy Preparatory Review Course for Recertificiation. 2006th ed. Bethesda, MD 20814, USA: American Society of Health-System Pharmacists. p. 624-655. capho.org 9 acpho.org
