2015 Antineoplastics

1. Cancer Cells

2. Bone marrow (most common dose-limiting complication)

3. GI mucosa (nausea and vomiting)

4. Hair follicles (alopecia)

5. Taste buds (resulting in dysgeusia)

6. "Radiation recall reaction" - erythema and desquamation of the skin at sites of prior (or simultaneous) radiation therapy
   • most commonly associated with anthracycline antibiotics (esp. DOXORUBICIN) but can occur with any cytotoxic drug
     • others that produce this reaction in >10% of patients: 5-FLUOROURACIL/CAPECITABINE, DACTINOMYCIN, HYDROXYUREA, METHOTREXATE and PACLITAXEL
7. Fetus (absolute contraindication in pregnancy)

Cancer chemotherapeutics are typically given in CYCLES to allow normal cells time to recover from the treatment. Unfortunately, stopping the drug therapy also allows any remaining cancer cells to recover and develop resistance.

In order to reduce the impact of the recovery/resistance problem, the key principles to antineoplastic drug therapy are:

• use high doses (including increasing doses during treatment; called DOSE ESCALATION)
• minimize recovery intervals (see the discussion under cell kill hypothesis)
• employ sequential scheduling during combination chemotherapy

• Target processes
• Tissues affected
• Cell cycle specificity
• Cell kill hypothesis
• Factors affecting outcome
• Drug resistance
  • Contributing causes
  • Mechanisms
  • Multidrug resistance
• Mechanisms of action