NURS 435- Chemotherapy



Anticancer Drugs: 4 major classes

Cytotoxic: kill cells directly
Hormones and hormonal antagonists
Biologic response modifiers
Targeted drugs


-Leading cause of Death
-565,650 Americans died from cancer in 2008
-Children ages 1-14, cancer is leading cause of death
-Women: breast, lung colorectal
-Men: prostate, lung and colorectal
-3 modalities for treatment: surgery, radiation and drug therapy

Challenges to Chemotherapy

-Toxicity to normal cells
-Cure Requires 100% cell kill
-Absence of Early Detection (exception pap smear)
-Solid Tumors Respons Poorly
-Drug Resistance


Cytotoxic most common form of treatment.
-Began in 1942 with nitrogen mustards
-Many advances
-High cure rate with Hodgkin's disease and some leukemia

Intermittent Chemotherapy

When cytotoxic anticancer drugs are administered intermittently, normal cells have time to repopulate between rounds of therapy

Combination Chemotherapy

-Suppression of Drug Resistance
-Increased Cancer Cell Kill
-Reduced injury to normal cells

Optimizing Dosing Schedules

Drugs must also be administered according to schedules that maximize beneficial benefits

Cytotoxic Anticancer Drugs

Alkylating agents
-Nitrogen mustards, nitrosourease and other compounds
-Interact with DNA
-Reaction my occur at any time in the cell cycle
-Development of resistance is common
-Highly toxic: Neutropenia, thrombocytopenia, bone marrow suppression

Regional Drug Delivery

Intra-arterial delivery: treat solid tumors. High concentration of drug close to the tumor
Intrathecal delivery: used to bypass the blood brain barrier

Major Toxicities

Bone Marrow Suppression
Digestive Tract Injury
-Stomatitis - inflammation of the oral mucosa
-Nausea and Vomiting
-Reproductive Toxicity

Mitotic Inhibitors

Act during M phase to prevent cell division

Platinum Compounds: Cisplatin

-kills cells by forming cross links between strands of DNA.
-Approved for metastatic testicular and ovarian cancer. Also for advanced bladder cancer
-Off label for lung cancer and head/neck cancer
-Dose limiting toxicity is renal damage
-Required excessiv


-Analogs of natural metabolites
-Able to disrupt metabolic processes
-Effective only against cells that are active participants in the cell life
-Folic Acid Analogs: Methotrexate
-Pyrimidine analogs: Fluorouracil (treatment for solid tumors)
-Purine Analo

Antitumor Antibiotics

-Only used to treat cancer : not infection
-Injure cells through direct interaction with DNA
-Poor GI absorption
-IV administration
-Causes severe bone marrow suppression and may lead to cardiotoxicity. ACE inhibitors may improve the symptoms of Cardiomyo

Mitotic Inhibitor: Vinca Alkaloids (Oncovin)

-Bone marrow sparing
-Ideal for combination chemotherapy including Hodgkin's, non-Hodgkins, leukemia, kaposi sarcoma, breast cancer and bladder cancer.
-Toxicity: peripheral neuropathy

Mitotic Inhibitor: Taxanes (Taxol)

-First line therapy for advanced ovarian cancer and non-small cell lung cancer.
-Toxicity: hypotension, angioedema, urticaria


-Used in combination with other agents to treat cancers arising from lymphoid tissue
-Directly toxic
-Minimal toxicity
-Long term side effects

Drugs for Breast Cancer: Anti-estrogens

Tamoxifen: blocks estrogen receptors

Drugs for Prostate Cancer

-Standard treatment for advanced prostate cancer is androgen deprivation
-Lowering testosterone production
-Blocking testosterone receptors
-Does not cure disease, but can slow progression
-Side effects hot flushes, impotence, reduced libido, decreased mu

Drugs for Breast Cancer: Trastuzumab (Herceptin)

-IV treatment of metastatic breast cancer to inhibit cell proliferation and promote antibody-dependent cell death.

Drugs for Breast Cancer: Aromatase Inhibitors

Anastrozole (Arimidex): first line oral treatment for early or advanced ER positive breast cancer. Drug deprives breast cancer cells of estrogen

Drugs for Breast Cancer

Aromatase inhibitors
Trastuzumab (Herceptin)
Cytotoxic Drugs

Targeted Anticancer Drugs

-Designed to bind with specific molecules to alter tumor growth
-Causes little or not injury to normal cells
-Serious side effects