This document provides an overview of anticancer drugs, including their classification, mechanisms of action, and examples. It discusses 10 main classes of anticancer drugs: alkylating agents, platinum coordination complexes, antimetabolites, microtubule damaging agents, topoisomerase inhibitors, antibiotics, miscellaneous cytotoxic drugs, targeted drugs, and hormonal drugs. For each drug class and some examples, it describes indications, dosages, and mechanisms of inhibiting cancer cell growth and proliferation. The document concludes with nursing responsibilities in administering these drugs and educating patients.

1. Anticancer drugs
PREPARED BY:
USHA RANI KANDULA,
ASSISTANT PROFESSOR,
DEPARTMENT OF ADULT HEALTH NURSING,
ARSI UNIVERSITY,ASELLA,ETHIOPIA,
SOUTH EAST AFRICA.

2. Definition
• Anticancer drugs, which inhibit the growth of cancer
cells by killing them or modifying their growth.
• These drugs also used in conjunction with surgery and
radiotherapy.

3. Classification
(Group- cytotoxic drugs)

4. Group- cytotoxic drugs
1. Alkylating agents
2. Platinum coordination
complexes.
3. Antimetabolites
4. Microtubule damaging
agents
5. Topoisomerase –II
inhibitors .
6.Topoisomerase–I
inhibitors .
7. Antibiotics .
8.Miscellaneous cytotoxic
drugs.
9. Targeted drugs .
10. Hormonal drugs.

5. 1. Alkylating agents
Mechlorethamine
Cyclophosphamide
Ifosfamide
Chlorambucil
Melphalan
Busulfan
Dacarbazine
Procarbazine

6. Mechanism of action
• Alkylating agents involve reactions with guanine in
DNA.
• These drugs add methyl or other alkyl groups onto
molecules where they do not belong.
• This in turn inhibits their correct utilization by base
pairing and causes a miscoding of DNA.

7. Mechlorethamine
• It has cytotoxic and radiomimetic action ( ionizing
radiations).
• Dose : 0.1 mg/kg IV daily for 4 days.

8. Cyclophosphamide
• It has immunosuppressant properties.
• Dose : 2-3 mg / kg/ day orally or 10-15 mg/kg IV.

9. Chlorambucil
• It is slow acting agent , active on lymphoid tissue.
• Dose : 4-10 mg daily for 3-6 weeks then -
• 2 mg daily for maintenance.

10. Melphalan
• It is used in ovarian cancer.
• Dose : 10 mg daily for 7 days. Or
• 6 mg / day for 2-3 weeks.

11. Busulfan
• It is used in case of chronic leukemia.
• Dose : 2-6 mg / day orally.

12. Dacarbazine
• It is used in case of malignant melanoma.
• Dose : 3.5 mg / kg / day IV for 10 days repeated after
4 weeks.

13. 2. Platinum coordination complexes
Cisplastin
Oxaliplatin

14. Mechanism of action
• platinum-based antineoplastic agents
cause crosslinking of DNA.
• The resultant crosslinking inhibits DNA
repair and/or DNA synthesis in cancer cells.

15. Cisplatin
• It is used in case of testicular and ovarian carcinoma.
• Dose : slow IV 50-100mg.

16. Oxaliplatin
• It is used in colorectal cancer, gastroesophageal and
pancreatic cancer.
• Dose : 85 mg IV every 2 weeks.

17. 3. Antimetabolites
Methotrexate
6-mercaptopurine
5-fluorouracil
Capecitabine
Cytarabine

18. Mechanism of action
• Antimetabolites impair DNA replication , either by
altered nucleotides or
• by depleting the supply of deoxynucleotides needed for
DNA replication and cell proliferation.

19. Methotrexate
• It is highly efficacious antineoplastic drug.
• It has immunosuppressant action.
• It is used in breast, bladder, head and neck cancers.
• Dose: 15-30mg / day for 5days orally.

20. Mercaptopurine
• It is highly effective antineoplastic agent.
• It is used in acute leukemia, choriocarcinoma.
• Dose: 2.5 mg/kg/day and half dose for maintenance.

21. 5-flurouracil (5-FU)
• It is used for colon, rectum, stomach, pancreas,
liver,urinary bladder and head and neck malignancies.
• Dose : 500mg/IV infusion over 1-3 hours weekly for
6-8 weeks
or
• 12mg /kg/day IV for 4 days followed by 6mg /kg/IV on
alternate days.

22. Cytarabine
• It is used for leukemias.
• Dose: IV 100mg once or twice for 5-10days
or
• Continuous infusion over 5-7 days.

23. 4.Micro tubule damaging agents
Vincristine
Vinblastin
Paclitaxel
Estramustine

24. Mechanism of action
• Anti-microtubule agents are plant-derived chemicals
that block cell division by
preventing microtubule function.
• Microtubules are an important cellular structure
composed of two proteins; α-tubulin and β-tubulin.

25. Vincristine
• It is used for wilms’ tumor, neuroblastoma and
carcinoma of the lung.
• Dose : 1.5-2 mg IV weekly .

26. Vinblastine
• It is used for neuroblastoma, breast and testicular
cancer.
• Dose : 0.1-0.15 mg/kg/IV weekly 3 doses.

27. Paclitaxel
• It is used in metastatic ovarian and breast carcinoma,
advanced head and neck cancer, small cell lung cancer,
esophageal cancer, prostate cancer.
• Dose: 135-175 mg by infusion over 3 hour and
repeated every 3 weeks.

28. Estramustine
• It is used in case of anvanced and metastatic prostate
cancer.
• Dose : 4-5mg/kg orally three times daily.

29. 5.Topoisomerase – II inhibitors
• Etoposide :
• It is used in testicular tumors, lung cancer, carcinoma
of the bladder and stomach.
• Dose : 50-100mg / day IV for 5 days
• Or
• 100-200mg /day orally.

30. Mechanism of action
• Topoisomerase inhibitors are chemical compounds
that block the action of topoisomerase(topoisomerase I
and II), which are enzymes that control the changes
in DNA structure by catalyzing the breaking and
rejoining of the phosphodiester backbone of DNA
strands during the normal cell cycle.

31. 6.Topoisomerase – I inhibitors
Topotecan
Irinotecan

32. Topotecan
• It is used in combination with cisplastin for cervical
cancer, metastatic cancer of the ovary and small cell
lung cancer.
• Dose : 1.5mg over 30 min daily for 5 days every 3
weeks.

33. Irinotecan
• It is used for metastatic / advanced colorectal
carcinoma and also cancer of lung , cervix, ovary and
stomach.
• Dose : 125 mg IV over 90 min weekly for 4 weeks.

34. 7.Antibiotics
Actinomycin-D
Doxorubicin
Epirubicin
Mitomycin C

35. Mechanism of action
• Antibacterials, are a type of antimicrobial drug used in
the treatment and prevention of bacterial infections.
• They may either kill or inhibit the growth of bacteria.

36. Actinomycin-D
• It is used in wilms’ tumor, and testicular carcinoma.
• Dose: 15 mg/kg IV daily for 5 days.

37. Doxorubicin
• It is used for lymphoblastic leukemia and breast,
thyroid, ovary,bladder, lung cancer.
• Dose : 30- 50mg IV for 3 days then repeated every 3-4
weeks.

38. Epirubicin
• It is used for breast cancer, gastroesophageal,
pnacreatic, hepatic, and bladder carcinoma.
• Dose : 60-90 mg/IV over 5min, repeated at 3weeks,
total dose 900 mg .

39. Mitomycin
• This drug is combined with 5-Flu and radiation to treat
resistant cancers of stomach, cervix, colon, rectum,
breast etc.
• dose: 10mg infused IV in one day and repeated after
6weeks.

40. 8.Miscellaneous
Hydroxy urea
Tretinoin

41. Hydroxy urea
• It is used for leukemia.
• Dose : 20-30 mg /kg daily or 80mg /kg twice weekly.

42. Tretinoin
• It is used for leukemia.
• Dose : 45 mg / Day .

43. 9.Targeted drugs
Imatinib
Gefitinib
Erlotinib
Cetuximab
Bevacizumab
Sunitinib

44. Mechanism of action
• As a form of molecular medicine, targeted therapy
blocks the growth of cancer cells by interfering with
specific targeted molecules needed
for carcinogenesis and tumor growth,rather than by
simply interfering with all rapidly dividing cells (e.g.
with traditional chemotherapy).

45. Imatinib
• It is used in malignancy.
• Dose : 400mg / day with meals.
• In chronic cases – 600-800mg/day.

46. Gefitinib
• It is used in lung cancer.
• Dose : 250 mg /day orally.

47. Erlotinib
• It is combined with gefitinib for advanced metastatic
pancreatic cancer.
• Dose : 100-150 mg OD one hour before or 2 hours
after meals.

48. Bevacizumab
• It is used in combination with 5-FU for metastatic
colorectal cancer.

49. Sunitinib
• It is used in metastatic renal cell carcinoma and GI
tumor.

50. 10.Hormonal drugs
Glucocorticoids
Estrogen
Antiandrogens
Gonadotropin releasing hormone (GnRH) agonists,
Progestins

51. Mechanism of action
• It involves the manipulation of the endocrine
system through exogenous administration of
specific hormones, particularly steroid hormones, or
drugs which inhibit the production or activity of such
hormones (hormone antagonists).

52. Glucocorticoids
• It is used for leukemia and lymphomas, controlling
malignancy and chemotherapy associated
complications.
• Eg: prednisolone/ dexamethasone most commonly
used drugs.

53. Estrogen
• They help to reduce symptoms in carcinoma prostate.
• Eg: fosfestrol 600-1,200 mg IV initially and for
maintenance 120-240 mg orally.

54. Gonadotropin – releasing hormone (GnRH)
agonists.
• They used in combination with antiandrogens.
• They have palliative effect in advanced estrogen/
androgen-dependent carcinoma breast/ prostate.

55. Progestin
• They are used in palliative treatment of metastatic
carcinoma of breast.

56. Nursing responsibilities
• Weekly assess-------
• complete blood count
• Platelet count
• With hold drug if WBC in < 4,000 or platelet count is
<75,000.

57. • Strict asepsis and protective isolation is to be
maintained if WBC levels are low.
• Assess intake and out put ratio and inform the
physician if urine out put falls below 30ml/hr.

58. • Monitor body temperature q4h as it may indicate
beginning infection.
• Assess for liver function test before and during therapy
as per the need.

59. • Assess for
• bleeding,
• yellowing skin,
• sclera,
• dark urine,
• edema in feet,
• pain in joints and stomach
• as well as the inflammation of mucosa and breaks in
the skin.

60. • Regularly check the I.V site for irritation and phlebitis.
•
• Provide comprehensive oral hygiene, using careful
technique and soft bristle brush.

61. Patient education
• Teach the client and family members
• -to report the signs of infection and anemia.
• - to report if any bleeding occurs.
• -to use mouth wash.

62. Thanking you