The anticancer drugs either kill cancer cells or modify their growth. However, selectivity of majority of drugs is limited and they are one of the most toxic drugs used in therapy.
ANTICANCER DRUGS
The anticancer drugs either kill cancer cells or modify their
growth. However, selectivity of majority of drugs is limited and they are one
of the most toxic drugs used in therapy.
Treatment of malignant diseases with drugs is a rather recent
development—started after 1940 when nitrogen mustard was used, but progress has
been rapid, both in revealing patho-biology of the diseases and in discovery of
new drugs. In addition, attempts have been made to define optimal combinations,
treatment strategies and patient support measures. Cancer chemotherapy is now
of established value and a highly specialized field; only the general
principles and an outline will be presented here.
In addition to their
prominent role in leukaemias and lymphomas, drugs are used in conjunction with
surgery, radiotherapy and immunotherapy in the combined modality approach for many solid tumours, especially
metastatic. In malignant diseases, drugs are used with the aim of:
1. Cure Or
Prolonged Remission Chemotherapy is the primary
treatment modality that can achieve cure or prolonged remission in:
In
Children
Acute leukemias
Wilm’s tumour
Ewing’s sarcoma
Retinoblastoma
Rhabdomyosarcoma
Other Ages
Choriocarcinoma
Hodgkin’s disease
Lymphosarcoma
Burkitt’s lymphoma
Testicular teratomas
Seminoma
Mycosis fungoides
2. Palliation Gratifying results are obtained (shrinkage of
evident tumour, alleviation of symptoms) and life is prolonged by chemotherapy
in:
Breast cancer
Chronic lymphatic
leukemia
Ovarian carcinoma
Chronic myeloid
leukemia
Endometrial carcinoma
Non-Hodgkin lymphomas
Myeloma
Head and neck cancers
Prostatic carcinoma
Lung (small cell) cancer
Many other malignant
tumours are less sensitive to drugs—life may or may not be prolonged by
chemotherapy. Tumours that are largely refractory to presently available drugs
are:
Colorectal carcinoma
Malignant melanomas
Carcinoma pancreas
Bronchogenic carcinoma
Carcinoma stomach
Carcinoma esophagus
Hepatoma
Renal carcinoma
Sarcoma
3. Adjuvant Chemotherapy Drugs are used to mop up any residual
malignant cells (micro metastases) after surgery or radiotherapy. This is
routinely employed now.
Classification
A.Drugs acting directly on cells (Cytotoxic drugs)
1. Alkylating agents
Nitrogen mustards:
Mechlorethamine
(Mustine HCl)
Cyclophosphamide,
Ifosfamide,
Chlorambucil,
Melphalan
Ethylenimine: Thio-TEPA
Alkyl sulfonate: Busulfan
Nitrosoureas: Carmustine (BCNU), Lomustine
(CCNU), Triazine Dacarbazine (DTIC)
2.
Antimetabolites
Folate antagonist: Methotrexate (Mtx)
Purine antagonist: 6-Mercaptopurine (6-MP),
6-Thioguanine (6-TG), Azathioprine, Fludarabine
Pyrimidine antagonist: 5-Fluorouracil (5-FU), Cytarabine
(cytosine arabinoside)
3. Vinca alkaloids: Vincristine (Oncovin), Vinblastine
4. Taxanes: Paclitaxel, Docetaxel
5. Epipodophyllotoxin: Etoposide
6. Camptothecin analogues: Topotecan, Irinotecan
7. Antibiotics: Actinomycin D
(Dactinomycin), Doxorubicin, Daunorubicin (Rubidomycin), Mitoxantrone,
Bleomycins, Mitomycin C
8. Miscellaneous: Hydroxyurea, Procarbazine, L-Asparaginase,Cisplatin,
Carboplatin, Imatinib
B. Drugs altering hormonal milieu
1. Glucocorticoids: Prednisolone and others
2. Estrogens: Fosfestrol, Ethinylestradiol
3. Selective estrogen receptor modulators: Tamoxifen, Toremifene
4. Selective estrogen receptor down regulators: Fulvestrant
5. Aromatase inhibitors:
Letrozole, Anastrozole, Exemestane
6. Antiandrogen: Flutamide, Bicalutamide
7. 5-α reductase: Finasteride, inhibitor Dutasteride
8. GnRH analogues: Nafarelin, Triptorelin
9. Progestins: Hydroxyprogesterone acetate, etc.
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