A 50-year-old man undergoing chemotherapy for a malignant tumor develops megaloblastic anemia. This is likely caused by methotrexate inhibiting folate metabolism. Folic acid supplementation could have prevented the toxicity. Anthracyclines like doxorubicin can cause cardiac toxicity through free radical generation, sometimes requiring dexrazoxane treatment. Bleomycin can cause pulmonary fibrosis.

1. Cancer Chemotherapy-2 Dr. R. Senthil Kumar

2. Classification

16. Legend Drug Class Sub-class Prototype Drug Trimetrexate Pemetrexed Thioguanine Fludarabine Phosphate Cladribine Cytarabine Gemcitabine Capecitabine Antimetabolites Folic Acid Analogs Purine Analogs Pyrimidine Analogs Methotrexate Mercaptoguanine Fluorouracil

18. Antimetabolits: sites of drug action

19. Methotrexate

21. Mechanism of Resistance 1. Decreased drug transport 2. Altered DHFR 3. Decreased polyglutamate formation 4. Increased levels of DHFR

32. Vinblastine Vincristine Vinorelbine Teniposide Irinotecan Docetaxel Plant Alkaloids Vinca Alkaloids Podophyllotoxins Camptothecins Taxanes Vinblastine Etoposide Topotecan Paclitaxel

35. V in B lastine V in C ristine (oncovan) Uses ; (ABVD) Hodgkin’s disease Lymphomas Carcinoma B reast Testicular tumors Toxicity: B one marrow suppression, anorexia, nausea, vomiting & Diarrhea, Alopecia Uses : (MOPP) C hildhood leukemias C hildhood tumors-Wilm’s tumor, Neuroblastoma, Hodgkin’s disease Toxicity: Peripheral neuritis with Paresthesia, Muscle weakness ***Vincristine has marrow sparing effect

37. Topoisomerase inhibitors

47. Sex hormone antagonists

49. MOA of drugs

52. Contd..

54. Miscellaneous agents Asparaginase, imatinib, interferons, monoclonal antibodies

56. Contd..

62. FDA approved MAb