Anticancer drugs REVISION NOTES
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This document provides a classification and overview of various anticancer drugs. It divides the drugs into categories such as alkylating agents, antimetabolites, plant alkaloids, antitumor antibiotics, hormonal drugs, and miscellaneous drugs. For each drug category and individual drugs, it describes the mechanism of action, common uses, side effects, and other relevant information. The document aims to comprehensively summarize the different types of chemotherapy agents used to treat cancer.
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Anticancer drugs REVISION NOTES
- 4. Classification Alkylating agents Antimetabolites Plant alkaloids Anti tumour Abx Hormonal Miscellaneous • Folic acid antagonist • Mitotic inhibitors • anthracyclines • Bortezomib • L asparaginase • Thalidomide • Hydroxyurea • Epigenetic anticancer drugs • Doxorubicin • Donorubicin • Mitoxantrone • MTX • Pemetrexed • Ralitrexed • Lomitrexol • Vinca • Taxane • Eribulin • Epothilones(i xabepilone) • Blemomycin • Mitomycin • Dactinomycin (actinomycin D) • Purine antagonist • Topoisomerase inhibitors • Topotecan • Irinotecan• 6MP • 6TG • Pyrimidine antagonist • 5 FU • Cytrabine • Capecitabine
- 5. • Cell cycle specific Cell cycle non specific In actively dividing cells in G0 G2 Bleomycin • Alkylating agents • Antitumour antibiotics (except bleomycin) • Cisplatin & other platinum compounds S –G2 Epipodophyllotoxin M Vinca Taxanes Epothilone Eribulin Ixabepilone S Antimetabolites Hydroxyurea Camptothecins
- 10. Interstrand linkage • Therapeutic effect Intrastrand linkage • Responsible for S/E 2* leukemia
- 11. • Sterility and secondary leukemias are distinctive adverse effects of alkylating agents.
- 12. N2 mustard Nitrosurea Alkyl sulfonate Triazenes • Mechlorethamine • Chlorambucil • Melphalan • Cyclophosphamide • Lomustine • Carmustine • Streptozocin • Busulfan • Dacarbazine • Temozolamide
- 16. Drugs activated by CYP450 • Cyclophosphamide • Ifosphamide • Procarbazine • Dacarbazine
- 18. Mechlorethamine Chlorambucil Melphalan Cyclophosphamide • Only IV • Contact with tissue can cause vesication • Earlier used in cutaneous T cell lymphoma • Selective for lymphoid tissue • Used CLL NOT ASSOCIATED WITH ALOPECIA Prodrug
- 21. Mesna is used to treat hemorrhagic cystitis
- 22. Uses
- 26. MOPP old regimen • Mechlorethamine • Oncovin • Procarbazine causes secondary leukemia • Prednisolone 2 * leukemia in alkylating agent is AML And is treated with cytarabine
- 32. Busulfan • Bonemarrow suppression lasting for days • Used as preparatory agent for BM transplantation
- 33. Temozolamide • Alkylating agent used in Rx of glioblastoma multiforme
- 34. Resistance to alkylating agent • Detoxification with glutathione • Increased DNA repair • Decreased permeability to the cell
- 35. Platinum compounds • Platinum compounds have free electrons in their outer orbit combines with N7 residue of guanine
- 45. Cisplatin nephrotoxicity • Reduced by saline infusion • Amifostine may be used if repeated use is needed
- 46. Carboplatin • Less nephrotoxic Does not require saline over load • Used in patients • Less nausea • Less neurotoxicity • Less ototoxicity
- 47. Anti tumour Abx
- 48. All are cell cycle non specific except bleomycin
- 50. Doxorubicin reddish discolouration of urine
- 51. Daunorubicin ruby coloures urine
- 54. Radiation recall • d/t anthracycline
- 55. • Doxo – daunorubicin irreversible cardiomyopathy • Free radical mediated injury cardiomyopathy • Mitoxantrone • Congener of doxorubicin • Reversible cardiomyopathy
- 56. • Free radical scavenger used to prevent anthracycline induced cardiomyopathy • DEXROXASAZONE
- 58. Mitoxantrone bluish discolouratio n of urine
- 59. Mitoxantrone uses • Immunosuppressive • Multiple sclerosis • Hormone refractory prostate ca
- 60. Bleomycin (only cell cycle specific anti tumour Abx)
- 61. Bleomycin combines with Fe2+
- 63. Bleomycin hydrolase is absent in skin streaks of hyperpigmentation
- 64. Act preferentially on hypoxic cells S/E • Myelosuppression • Hemolytic uremic syndrome • Delayed bronchospasm
- 67. • Mitomycin is also used in ca anus along with 5 FU
- 69. Actinomycin -D • Inserted in narrow groove of DNA • interfere with DNA & RNA Synthesis
- 70. Anti metabolites
- 71. • Antimetabolites • Interfere with DNA synthesis • act on S phase
- 73. Folate antagonist Purine analogue Pyrimidine analog • MTX • Pelmtrexed • Ralitrexed • Lomitrexol • 6MP • 6TG • Fludarabine • Cladiribine • Nelorabine • 5FU • Cyotarabine • Capecitabine • Gemcitabine
- 74. Purine analog • 6 mercaptopurine (6MP) • 6 thioguanine (6TG) • Fludarabine • Cladaribine
- 75. 6 MP • Is used in the treatment of ALL • S/E • Bone marrow depression • Lymphocyte depletion
- 77. 6MP is metabolised by xanthine oxidase • When Allopurinol (a xanthine oxidase inhibitor ) is given dose 6MP & azathioprine has to be reduced • Allopurinol decreases metabolism of 6MP by XO increased 6MP thrombocytopenia
- 79. Azathioprine • Analogue of 6MP • Prodrug of 6MP • Used as immunosuppressant
- 80. 6TG • Not metabolised by XO • No dose reduction required when given along with allopurinol • No thrombocytopenia
- 81. Resistance to 6TG & 6MP • Deficiency of HGPRTase
- 83. Cladarabine • DOC for hairy cell leukemia • AS IT IS RESISTANT TO DEGRADATION BY ADENOSINE DEAMINASE • Treatment of choice for hairy cell leukemia is Cladribine in dose of 0.14 mg/kg daily for 7 days. • CONTINOUS IV INFUSION • Cladribine is a nucleoside analogue and relatively nontoxic. • Other drug used In Hairy cell leukemia: • a. Pentostatin (nucleoside leukemia) • b. Interferon α. • Steroids have no role in hairy cell leukemia. Splenectomy is indicated in cases with cytopenia not responding to therapy.
- 85. Pentostatin • Purine analog • The mechanism of action of is by inhibition of adenosine deaminase (ADA). • It is an antineoplastic drug which is used in the treatment of Hairy Cell Leukemia. • DOC is cladarbine
- 86. Fludarabine • DOC for CLL • Combined with cyclophosphamide & rituximab • FCR regimen in CLL • Fludarabine • Cyclophosphamide • Rituximab
- 87. Pyrimidine analogues • 5-flurouracil • Capecitabane • Cytarabine • Gemcitabane
- 90. 5 flurouracil
- 91. • Leucovorin augments action of 5FU
- 92. Low level of DPD 5FU TOXICITY Because of high first pass metabolism it is orally inactive
- 93. USES • Hepatocellular carcinoma • Liver cells depend on uracil • Head and neck ca • Cisplatin + 5FU • GI tumours • Anal cancer • 5 FU +mitomycin • Colorectal carcinoma • FOLFOX • FOLinic acid • 5Fu • OXaliplatin • FOLFIRI • FOLinic acid • 5Fu • IRInotecan
- 94. Drug regimen in colorectal carcinoma FOLFOX • 5FU • Leucovorin • Oxaliplatin FOLFIRI • 5FU • Leucovorin • Irinotectan XELOX • Capecitabine • Leucocorin • Oxaliplatin
- 95. 5 FU is used malignancies of GIT from mouth to anal canal Malignancies Drugs used Ca esophagus Ca stomach • Cisplatin + 5 FU Ca colon • Oxaliplatin + 5 FU Ca anus • Mitomycin + 5 FU
- 96. S/E of 5FU • Anorexia & nausea • Earliest manifestation • Hand foot syndrome • Acute coronary vasospasm • a/c chest pain
- 97. Hand foot syndrome in 5 FU • Erythematous • Lesions in palmo plantar surfaces • Seen more commonly with capecitrabine (oral analogue of 5FU) • d/t accumaltion of drug in pressure areas
- 98. Gemcitabane • Doc for pancreatic malignancy (metastatic also) • Also used in nonsmall cell lung ca ,ovarian , lung or bladder ca • S/E • Myelosuppression
- 99. Decitabine & 5- azacytidine • inhibits DNA methyl transferase hypomethylation • 5- azacytidine myelodysplasia
- 101. Cytarabine • Continuous IV infusion for 7 days • Cytarabine + daunorubicin AML
- 103. s/e of cytarabine • Potent myelosuppression • High doses of cytarabine cerebellar neurotoxicity ataxia • Intrathecal injection cerebral toxicity
- 104. Folate anagonist • Methotrexate • Pemetrexed
- 105. Methotrexate • Acts in S phase • Cell cycle specific • Resistant to non proliferating cells
- 106. • MTX • DOC in • Choriocarcinoma • Osteosarcoma
- 110. • Mechanisms of methotrexate resistance • I. Impaired transport of methotrexate into cells • II. Production of altered forms of DHFR that have decreased affinity for the inhibitor • III. Increased concentrations of intracellular DHFR through gene amplification or altered gene regulation • IV. Decreased ability to synthesize methotrexate polyglutamates
- 112. Used for (METROGIL PC) • Multiple sclerosis • Ectopic preganancy • Trophoblastic d/s –>choriocarcinoma • Rheumatoid arthritis • Osteosarcoma high dose • Granulomatosis wegeners (GVHD) • Immunosuppresant GVHD (Transplant rejection ) • Lymphoma ALL • Psoriasis • Crohns d/s
- 113. s/e of MTX • Myelosuppression • At low doses megaloblastic anemia • At high doses pancytopenia • Myelosuppression can be treated with leucovorin • Also get collected in 3rd spaces like pleural & peritoneal cavity get reabsorbed into circulation prolonged myelosuppression • Pulmonary toxicity • Seizure on intrathecal injection • Hepatotoxicity • Nephrotoxicity
- 114. High dose MTX with leucovorin • MTX is transported by active process in tumour cells • Osteosarcoma • Lack active transport of MTX in to osteosarcoma cells • Enters passively requires high doses of MTX • In normal cells • Also enters by passive diffusion • Leucovorin (N5 N10 methylene THF)is given to rescue normal cells • Donot enter osteosarcoma cells as they lack transporter for transport
- 115. High dose of MTX with leucovorin is used in • Osteosarcoma • CNS lymphoma • ALL • NHL • Head & neck tumour
- 116. Folinic acid (Leucovorin, citrovorum factor) • is an active coenzyme form which does not need to be reduced by DHFRase before it can act. • Methotrexate is a DHFRase inhibitor; its toxicity is not counteracted by folic acid, but antagonized by folinic acid. • Folinic acid is expensive and not needed for the correction of simple folate deficiency for which folic acid is good enough.
- 117. Leucovorin effects • Rescue normal cells form effect of MTX • Increases efficacy of 5FU
- 118. MTX excreted by tubular secretion • Competes with other drugs secreted by tubular secretion • Piperacillin (penicillin) • NSAID • Cisplatin
- 119. MTX excreted by tubular secretion
- 120. MTX in renal failure
- 121. Glucarpidase • recombinant carboxypeptidase • Breaks down MTX into inactive metabolites • Used in MTX toxicity
- 123. Hepatotoxicity & cirrhosis • On low dose & log term use
- 125. Less potent inhibitor of DHFR
- 126. Mitotic inhibitors
- 127. • Vinca alkaloids • Vincristine • Vinblastine • Taxanes • Estramustine • ixabepilone • eribulin
- 129. Affect microtubule formation in spindle formation Vinca alkaloids • During metaphase • Fail to polymerise Taxanes • During M phase • Extremely strong • Fail to depolymerise
- 132. Vinka alkaloids
- 133. Vinca alkaloids
- 134. • d/t defective spindle formation hair is also affected alopecia • Vinblastine bone marrow suppression • Vincristine peripheral neuropathy
- 137. Vinca alkaloids Vinblastine Vincristine Vinorelbine Dose limiting BM suppression Peripheral smear BM supreesion Elimination Hepatic Hepatic Hepatic SIADH + ++++ +
- 138. Taxanes • Binds to βtubulin & increases its affinity towards α tubulin increase microtubule formation
- 140. Taxanes Paclitaxel Docetaxel More neuropathy More neutropenia More hypersensitivity Less hypersensitivity Cardiotoxic Not cardiotoxic
- 141. Paclitaxel • Obtained from plant alkaloid terpenoid (yew tree)
- 142. • It is a complex diterpine taxane obtained from bark of the Western yew tree, which exerts cytotoxic action by a novel mechanism. • It enhances polymerization of tubulin: a mechanism opposite to that of vinca alkaloids. • The microtubules are stabilized and their depolymerization is prevented. • This stability results in inhibition of normal dynamic reorganization of the microtubule network that is essential for vital interphase and mitotic functions. • Abnormal arrays or ‘bundles’ of microtubules are produced throughout the cell cycle. • Cytotoxic action of paclitaxel emphasizes the importance of tubulin microtubule dynamic equilibrium. • The approved indications of paclitaxel are metastatic ovarian and breast carcinoma after failure of first line chemotherapy and relapse cases. • It has also shown efficacy in advanced cases of head and neck cancer, small cell lung cancer, esophageal adenocarcinoma and hormone refractory prostate cancer
- 143. Estramustine • Estramustine • Combination of estrogen + mustard gas (mechlorethamine) • Antimitotic drug • Used in treatment of prostatic carcinoma • s/e • Estrogenic s/e • Gynaecomastia • Impotence
- 144. Ixabepilone • Advanced breast carcinoma • Antimitotic • Inhibit spindle depolymerisation
- 145. Eribulin non productive tubulin aggregates Used in Ca breast
- 147. • Topoisomerase I inhibitor • Camptothecans obtained from camptotheca acuminate tree • Irinotecan • Topotecan • Topoisomerase II inhibitor • Epipodophyllotoxins • Etoposide • Teniposide
- 148. Epipodophyllotoxins • Etoposide • Teniposide • Cellcycle specific • Acts in G2 phase • In S-G2 transition • Cause secondary leukemia AML with mixed lineage leukemia • After 2- 3yrs • Absence of myelodysplastic period preceding leukemia
- 149. Etoposide • As a part of BEP regimen • Used for testicular cancer /kaposis / NHL • Bleomycin • Etoposide • Platinum compound (cisplatin)
- 151. Topotecan Irinotecan Active drug Pro drug Elimination renal Elimination hepatic Dose limiting bone marrow suppression Dose limiting diarrhea
- 153. • Irinotecan is metabolised to SN 38 cholinergic action dose dependant diarrhea • Rx with loperamide
- 155. Monoclonal Ab & tyrosine kinase inhibitors
- 159. Bevacizumab • Bevacizumab is a monoclonal antibody against VEGF and is used as an anti-angiogenic drug. • Metastatic colorectal carcinoma • Used for DIABETIC RETINOPATHY • It is mainly used for colorectal carcinoma and is used off-label by intravitreal injection to slow progression of neovascular macular degeneration.
- 160. Rituximab anti CD20 B cell lymphoma
- 161. Cetuximab
- 162. Cetuximab • EGFR positive metastatic colorectal carcinoma
- 163. Trastuzumab
- 164. Eculizumab humanized against c5 used in PNH
- 165. Eculizumab used in PNH
- 166. Infliximab • IgGl chimeric monoclonal antibody against TNF a • Infliximab is an injectable antibody that blocks the effects of tumor necrosis factor alpha (TNF- alpha). • infliximab is used for treating • the inflammation of Crohn's disease and • rheumatoid arthritis. • Reiters syndrome
- 168. Other TNF α drugs • Adalimumab • Golimumab • certolizumab • Etanarcept
- 171. • Anti-TNF alpha drugs / infliximab • contraindicated in patients • who are pregnant, • those with active infection. • with heart failure. • SLE • Infliximab can produce SLE like illness and hence is avoideD. SLE produced by this drug often involves lungs and pleurA. It is treated by corticosterioids
- 172. Adalimumab • Human • Anti TNF a
- 173. Certolizumab • Humanised fab Anti TNF a linked 2 molecules of PEG
- 176. Omalizumab for bronchial asthma • Against IgE
- 179. Retinoic acid • Used in acute promyelocytic leukemia • In RA resistatnt type arsenic trioxide is used
- 181. Imatinib • Inhibit tyrosine kinase • At ATP binding site of abl bcr tyrosine kinase • CML • C-KIT positive GIST
- 183. IMATINIB IS USED IN cml & GIST
- 186. Geftinib erlotinib • Inhibit tyrosine kinase activated by EGF • Food increases absorption of erlotinib by 100 % • Used in • Non small cell carcinoma of lung • Pancreatic carcinoma • s/e • Rash • Diarrhea
- 187. Lapatinib • Lapatinib is an orally active chemotherapeutic agent used for treatment of solid cancers. It is considered to be a dual inhibitor of tyrosine kinase enzyme domains. It blocks HER2 and EGFR. • Main advantage of the drug is its oral administration. The drug has recently been approved by FDA in combination with capecitabine for transtuzumab resistant patients of breast cancer over expressing HER2/neu receptors (Mnemonics: Lapatinib is used in breast lump (breast cancer).We all have two breast so act on both the receptor)
- 188. Miscellaneous
- 189. L asparaginase esp in ALL • leukemia cells are deficient in L- asparagine synthase & depend on supply of L asparagine from medium • Used for Rx of leukemia & lymphoma •
- 190. • L-Asparaginase - vincristine and prednisone along with L- asparaginase and Adriamycin give 95-98% complete response in ALL • Side effects -liver damage, pancreatitis, CNS symptoms, anaphylaxis
- 191. S/E of asparaginase • Hypersensitivity • Hyperglycemia • Thrombosis deficient AT III proteinC • Bleeding • Pancreatitis
- 192. Hydroxyurea • Inhibits ribonucleotide reductase • 100 % oral availability • radiosensitizere • Used in • Polycythemia • Anemia sickle cell anemia • Increases amount of HbF which is resistant to sickling • CML • Essential thrombocytosis
- 195. Epigenetic modifier drugs HDac inhibitor Methylation inhibitor Vorinostat Romidepsin Azacytidine Decitabine Zibularine
- 196. Histone deacetylase inhibitors • Vornistat / romidepsin/belinostat • Cutaneous T cell lymphoma
- 197. Mitotane medical adrenalectomy • Used in adrenocortical carcinoma
- 198. Plicamycin • Used in metastatic testicular ca (like bleomycine /vinblastine) • Hypercalcemia of pergancy
- 199. Thalidomide • Used in multiple myeloma & melanoma • Mainly inhibits angiogenesis & TNF a • Lenalidomide • More potent & non teratogenic • Pomalidomide • New analogue
- 200. • Clinical uses of thalidomide • AIDS related aphthous ulcers • AIDS related wasting syndrome • Multiple myeloma and other solid tumors like AIDS-related Kaposi's sarcoma • Prevention of graft versus host disease (GVHD) after transplantation • Rheumatoid arthritis • Ankylosing spondylitis • Crohn's disease and Behcet's syndrome • Erythema nodosum leprosum • For patients with chronic ENL the usual initial dosage of 200 mg twice a day. It can be gradually tapered to a maintenance dosage of 50 to 100 mg/day.
- 201. • Adverse reactions to thalidomide • Teratogenicity • Peripheral neuropathy • Drowsiness • Skin rashes • Constipation
- 202. Proteasome inhibitor • Bartezomib • Used in multile myeloma
- 204. Bortezomib • Proteasome inhibitor down regulation of NF kB • NFkB promotes cell survival • Used in MM • A/E • Thrombocytopenia • Peripheral neuropathy • Anemia neutropenia • Diarrhea
- 205. Demileukin difitox
- 206. Hormones
- 208. Ca endometrium
- 218. Vomiting • This is due to CTZ stimulation as well as generating the emetogenic stimuli from upper GIT as well as other areas. • The drugs can be classified depending on their emetogenic potential as follows • A. High emetogenic – cisplatin, mustine, cyclophosphamide, actinomycin D, dacarbazine, lomustine. • B. Moderate – carboplatin, cytarabine, procarbazine, vinblastine, doxorubicin, daunorubicin, ifosfamide, 6-mercarptopurine. • C. Mild – bleomycin, chlorambucil, busulfan, fluorouracil, 6-thioguanine, hydroxyurea,vincristine, methotrexate, etoposide and l-asparaginase.
- 219. • Cisplatin as it highly emetogenic • It is given slowly IV infusion
- 220. • Drugs which are effective in chemotherapy induced vomiting: • A. 5-HT3 receptor antagonists – granisetron, palanocetron, ondansetron etc. • B. NK1 antagonists (Substance P antagonist): Aprepitant • C. Dexamethasone
- 221. Bone marrow suppression High Low • Alkylating agent • Antimetabolite • Anthracyclines • Asparaginase • Bleomycin • Gefitinib • Vincristine • Hormonal agents
- 222. Marrow sparing • Bleomycin • Vincristin • L –asparaginase
- 223. Rx of BM suppression
- 225. Oprelvekin (IL 11)used in CTx induced thrombocytopenia
- 226. Romiplostim used in Rx of ITP Thrombopoetin receptor mimetic agent
- 227. Filagrastim G CSF
- 228. Secondary leukemia • Alkylating agent • With in 4-5 years • Etoposide • With in 1-3 years (early onset)
- 229. Hemorrhagic cystitis • Caused by cyclophosphamide • Treated with mesna
- 230. Neurotoxicity • Alkylating agents & vinca • Sensory neuropathy • Oxaliplatin • Taxane • Topotecan • Capecitabine • Cerebellar • 5FU • Cytarabine
- 231. Cardiotoxic anticancer drugs • Anthracycline • Trastuzumab • Bevacisumab • Imatinib • Dasatinib • Sunitinb • Taxanes • ATRA
- 232. Radiosensitiser Radiation protecctors Metronidazole 5FU Actinomycin D Gemcitabine Hydroxyurea Amifostine
- 233. Amifostine • cytoprotective drug forming a thiol metabolite. • protective to salivary glands (reduces xerostomia) and GIT (prevents esophagitis). • Its xerostomia preventing action can also be considered to be protective to skin.
- 234. Amifostine is a prodrug • Activated to active compound in all tissues by enzyme • Enzyme absent in brain not protective to brain
- 235. Amifostine • Uses • Cisplatin induced nephropathy • Radiation induced xerostomia • S/E • Hypocalcemia
- 236. Radiosensitisers • Makes cell more susceptible to radiation • Cisplatin • Gemcitabane • Hydroxyurea • 5 FU
- 237. Hairy cell leukemia • Cladiribine • Pentostatin HL • ABVD NHL • CHOP –R CLL • FCR regimen Fludarabine Cyclophosphamide Rituximab CML • Imatinib Multiple myeloma • Bortezomib • Lenalidomide • Dexamethsone Polycythemia • Hydroxyurea
- 238. CTx of lung ca Non small cell carcinoma Cisplatin + paclitaxel /gemcitabine Small cell carcinoma Cisplatin + etoposide Mesothelioma Pemetrexed
- 239. 5 FU is used malignancies of GIT from mouth to anal canal Malignancies Drugs used Ca esophagus Ca stomach • Cisplatin + 5 FU Ca colon • Oxaliplatin + 5 FU Ca anus • Mitomycin + 5 FU
- 240. CTx other abdominal ca Bladder ca Gemcitabine +cisplatin Pancreatic ca Gemcitabine + cisplatin RCC Sunitinib HCC Sorafenib Adrenal ca Mitotane
- 241. CTx of sarcoma Osteosarcoma Doxorubicin HDM-L Soft tissue sarcoma Doxorubicin Kaposis Doxorubicin
- 242. CTx of genital ca • Ovarian ca • Cervical ca • Uterine ca Cisplatin + paclitaxel • Choriocarcinoma MTx • Testicular ca • Cisplatin causes nephrotoxicity • Etoposide • Bleomycin pulmonary toxicity • Prostate ca LHRH agonist Anti androgens
- 243. Rx of ALL Induction • Vincristine • Donorubicin • Asparaginase • Prednisolone Maintenance • 6MP • Methotrexate If Ph + add dasatinib
- 244. Rx of AML – M3 • Promyelocytic leukemia • ATRA (all trans retinoic acid ) • Arsenic trioxide • A/E • Hyperglycemia • Leukocyte maturation syndrome • QT prolongation • Elevated liver enzymes
- 245. Rx of head & neck cancer • 5FU • Cisplatin • Docetaxel
- 246. Drugs given by continuous infusion Cell cycle specificity & short t1/2 To reduce toxicity Cytarabine Bleomycin Cladiribine Myelosuprression by 5 FU Cardiac toxicity by doxorubicin Pulmonary toxicity of bleomycin Emesis by cisplatin Reasons are
- 247. MDR gene associated with resistance to multiple anticancer drugs
- 248. • MDR gene codes for PgP efflux of multiple anticancer drug
- 249. PgPump causes efflux of antineoplastic drug