NCM 106 - PHARMACOLOGY

CHAPTER 6: ANTICANCER DRUGS

➔ If given in high dose for long term therapy, it
ANTICANCER damages bone marrow which may cause
Acute Myeloid Leukemia

➔ Also known as the antineoplastic or

cytotoxic drugs FIVE DIFFERENT CLASSES
➔ These are medications that are effective in
the treatment of malignant or cancerous NITROGEN MUSTARD
cells.
➔ Do not affect just cancer cells; instead, the ● Used as a part of combination regimens
drugs affect both cancer and normal cells. in treatment of Hodgkin and
Non-hodgkin’s lymphoma and as
palliative chemotherapy in lung and
CELL CYCLE
breast cancers
➔ It is important to understand the cell cycle ● Drugs include:
for you to fully understand and ○ Bendamustine
comprehend the use of anticancer drugs ○ Chlorambucil
and also to know where these drugs act ○ Estramustine
on these specific cell cycles. ○ Ifosfamide
○ Mechlorethamine HCl
CELL CYCLE-NONSPECIFIC ANTICANCER ○ Melphalan
DRUGS (CCNS) ○ Cyclophosphamide

➢ CYCLOPHOSPHAMIDE
- These drugs act during ANY phase of the ● Can be given IV or PO
cell cycle including the G0 phase ● This medication is a severe
- All phases include: G0, S Phase, G2, M vesicant that causes tissue
Phase, G1 Phase necrosis if it infiltrates into the
- These includes alkylating drugs, tissue
antitumor, antibiotics, and hormones ● Patient should be well hydrated
when taking this drug to prevent
CELL CYCLE-SPECIFIC ANTICANCER hemorrhagic cystitis
DRUGS (CCS)

NITROSOUREAS
- These drugs act in a SPECIFIC phase of
a cell cycle
- They are most effective against rapidly ● Effective in the treatment of brain cancer
growing cancer since these drugs cross the blood brain
- These includes antimetabolites, some barrier
alkylating drugs, and vinca alkaloids ● Drugs include:
○ Carmustine
○ Lomustine
○ Streptozocin
GROUPS UNDER ANTICANCER DRUGS
➢ ALKYLATING DRUGS ALKYL SULFONATES
➢ ANTIMETABOLITES
➢ ANTITUMOR ANTIBIOTIC
➢ PLANT ALKALOIDS ● Used for the treatment of myelogenous
➢ HORMONES AND HORMONAL leukemia
ANTAGONISTS ● Drug example: Busulfan
○ Administered orally, intravenous
formulation is also available
ALKYLATING DRUGS
TRIAZINES
➔ One of the largest groups of anticancer
drugs ● Used to treat metastatic malignant
➔ MOA: damage the cell’s DNA by cross melanoma
linkage of DNA strands, abnormal base ● Drugs include:
pairing or DNA strand breaks thus ○ Dacarbazine
preventing of the reproduction of cancer ○ Temozolomide
cells
➔ MOA: blocks the cell cycle phase: G1, S,
ETHYLENIMINES
G2, M, and most effective in G0 phase
(CCNS)

BRAGAT, JOHN MICHAEL N. – BSN 2L

UCB – COLLEGE OF NURSING
 NCM 106 - PHARMACOLOGY
CHAPTER 6: ANTICANCER DRUGS
● Used in the treatment of breast and ○ Fludarabine
ovarian cancer ○ Mercaptopurine
● Drugs include: ○ Nelarabine
○ Thiotepa ○ Pentostatin
○ Altretamine ○ Thioguanine

PURINE ANALOGUES
ANTIMETABOLITES
● Used for the treatment of head and neck
➔ MOA: interfere with various substances cancer
needed for normal cell function ● Drug example:
○ Hydroxyurea
➔ CCS; Takes effect during S phase of the cell
cycle (when DNA synthesis and metabolism
take place) All drugs under antimetabolites have the same MOA.
➔ Classified based on substances they They just differ with the areas that they act on.
interfere:
◆ Folic Acid Antagonists
◆ Pyrimidine analogues
ANTITUMOR ANTIBIOTICS
◆ Purine Analogues
◆ Ribonucleotide Reductase Inhibitors ➔ MOA: interfere with DNA and RNA
(Enzyme Inhibitors) transcription of cancer cells
➔ They are similar to natural antibiotics,
however
➔ They do not treat infections
FOLIC ACID ANTAGONISTS
➔ Used to treat leukemias and many solid
tumors
● Used to treat malignant and
non-malignant conditions
● Drugs include:
○ Pemetrexed ANTHRACYCLINES
○ Methotrexate
● Drugs include:
➢ METHOTREXATE
○ Daunorubicin
● Affects cells with high metabolic
○ Epirubicin
rates
○ Idarubicin
● Can be used in ectopic pregnancy
○ Doxorubicin
because this can cause apoptosis
of fetal cells
➢ DOXORUBICIN
● Used to treat many solid and
PYRIMIDINE ANALOGUES
hematogenous tumors except for
acute Myelogenous Leukemia
● Used in the treatment of breast, ● Administered intravenously
colorectal, GI, head and neck cancer ● Monitor for cardiotoxicity
● Drugs include:
○ Azacytidine OTHERS
○ Capecitabine
○ Cytarabine
● Drugs include:
○ Floxuridine
○ Dactinomycin
○ Gemcitabine HCl
○ Mitomycin
○ 5-Fluorouracil
○ Bleomycin
➢ 5-FLUOROURACIL
➢ BLEOMYCIN
● Administered intravenously for
● Affect cells during G2 phase
solid tumors
● Administered topically for
superficial basal cell carcinoma
and actinic keratosis
PLANT ALKALOIDS
PURINE ANALOGUES
➔ Called plant alkaloids because they are
● Used for hairy cell leukemia derived from plants
● Drugs include: ➔ MOA: block cell division at the m phase of
○ Cladribine the cell cycle
○ Clofarabine

BRAGAT, JOHN MICHAEL N. – BSN 2L

UCB – COLLEGE OF NURSING
 NCM 106 - PHARMACOLOGY
CHAPTER 6: ANTICANCER DRUGS

CLASSIFICATIONS
CORTICOSTEROIDS
VINCA ALKALOIDS
● Suppress the inflammatory process
associated with tumor growth
● Are considered antimicrotubule
● Drug Example:
compound
○ Prednisone
● Derived from periwinkle plant
● Drugs include:
ESTROGENS
○ Vinblastine
○ Vinorelbine
○ Vincristine ● Used to slow the growth of hormone
dependent tumors
TAXANES ● Drug example:
○ Estrogen Conjugate
● Also considered as antimicrotubule
ANTIESTROGENS
compound
● Derived from the yew tree
● Drugs include: ● Block the effects of estrogen thus slowing
○ Docetaxel or shrinking cancers
○ Palitaxel ● Drugs include:
○ Fulvestrant
EPIPODOPHYLLOTOXINS
AROMATASE INHIBITORS
● The only plant alkaloids that act on S
phase of the cell cycle ● Stops the enzyme aromatase from
● Derived from apple trees converting the hormones estrogen thus
● Drugs include: suppressing postmenstrual synthesis of
○ Etoposide estrogen and slowing tumor growth
○ Teniposide ● Used in treatment of hormonally sensitive
breast cancer for women who had their
CAMPTOTHECIN ANALOGUES ovaries removed.
● Drugs include:
○ Anastrozole
● Are water soluble and have a broad range
○ Letrozole
of antitumor properties
○ Exemestane
● Derived from Chinese tree
● Drugs include:
GONADOTROPIN-RELEASING HORMONE
○ Irinotecan
○ Topotecan ANALOGUES OR ANTAGONISTS

RETINOIDS ● Suppress the secretion of follicle-

stimulating hormone and luteinizing
● Regulator for cell reproduction, hormone from the pituitary gland
proliferation, and differentiation ● Drugs include:
● Given orally or topically ○ Leuprolide
● Derived from Vitamin A ○ Goserelin
● Drug example:
○ Bexarotene PROGESTINS

● Used for renal and endometrial cancers

HORMONES AND HORMONAL ● Drugs include:
○ Hydroxyprogesterone caproate
ANTAGONISTS ○ Megestrol
○ Medroxyprogesterone acetate
➔ Although hormones are not considered true
chemotherapeutic agents, several classes ANTIANDROGENS
of hormonal agents are used in the
treatment of cancer. These hormones do ● Block the effects of testosterone thus
not work in the same ways as standard slowing or shrinking cancers
● Drugs include:
chemotherapy drugs.
○ Bicalutamide
➔ MOA: mask the cancer cells and prevent ○ Flutamide
them from producing hormones

BRAGAT, JOHN MICHAEL N. – BSN 2L

UCB – COLLEGE OF NURSING
 NCM 106 - PHARMACOLOGY
CHAPTER 6: ANTICANCER DRUGS
ADVERSE REACTIONS AND
NURSING RESPONSIBILITIES
(ANTICANCER DRUGS)
ANEMIA (LOW RBC COUNT)
● Assess for fatigue, SOB, hypotension,
increased heart rate and respiratory rate,
oliguria.
● Schedule rest periods of the patient.
● Administer oxygen as prescribed.
● Elevate the head of the bed to facilitate
breathing.
● Assist patients with daily activities.
● Cluster nursing activities.
LEUKOPENIA (LOW WBC COUNT)
● Limit visitors. (The patient is prone to
infection and some visitors might carry
infections to patients. So, put on the door
of the patient “reverse isolation”)
● Routine monitoring the body temperature.
(to check if there is an ongoing fever
which is a symptom of infection)
● Provide infection control guidelines such
as medical handwashing, wearing of
PPEs
THROMBOCYTOPENIA
(LOW PLATELET COUNT)
** at risk of bleeding
● Apply pressure to injection sites.
● Instruct patients to avoid contact sports.
● Encourage the use of soft bristled
toothbrushes (since the gums are highly
vascularized)
● Provide ice chips if gum bleeding is
present (to promote vasoconstriction)
ANOREXIA
● Provide small, frequent feeding that is
high in calories and protein.
● Schedule rest and eating periods.
● Provide hard candies or ice chips to
relieve bitter taste.
NAUSEA AND VOMITING
● Administer antiemetic as ordered.
● Minimize noise, stimulation, and odors.
● Assist in frequent mouth care.
DIARRHEA
● Provide a low residue diet
● Increase fluid intake.
● Limit spicy, fatty, salty foods, whole
grains, fresh fruits and vegetables.
BRAGAT, JOHN MICHAEL N. – BSN 2L
UCB – COLLEGE OF NURSING
MUCOSITIS (STOMATITIS)
● Avoid the use of commercial
mouthwashes that contain alcohol. (this
will further erode the mucus lining of the
patient)
● Encourage the use of soft bristled
toothbrushes
● Offer ice chips and ice pops to relieve
pain.
ALOPECIA
● Inform the patient that this is only
temporary
● Offer the use of scarves, wigs, hats, or
turbans.
● Listen to the patient's body disturbances
concerns.
● Provide positive reinforcements.
FATIGUE
● Plan ways together with the patient as to
how to conserve energy.
● Schedule rest periods.
● Cluster nursing activities.
● Provide a well-balanced diet.
● Assist in performing mild exercises.
INFERTILITY
● Inform the patient that this may be
permanent and pretreatment counseling
is advised.
● This is an effect of chemotherapeutic
agents.
DRUG ADMINISTRATION
➔ Protect drugs from sunlight. Use light proof
IV tubing or wrap the IV line and bottle with
carbon paper (because these medications
are light sensitive; light may decrease drug
potency.)
BIOLOGIC RESPONSE
MODIFIERS
➔ Immunotherapies
➔ BRMs consist of substances naturally made
in the body and those developed in
laboratory.
➔ These are medications that are used to
enhance, direct or restore the immune
system.
➔ They are also used to treat the cancer or
the side effects caused by other cancer
treatments.
 NCM 106 - PHARMACOLOGY
CHAPTER 6: ANTICANCER DRUGS
every 2 weeks
EFFECT TO IMMUNE SYSTEM ○ Week 1 and 2: 62.5mcg
every other day
● Enhance the immune system’s ability to kill ○ Week 3 and 4: 125 mcg
abnormal cells. every other day
○ Week 5 and 6: 187.5 mcg
● Change cancer cells to make them behave
every other day
like normal cells.
● Inhibit normal cells from changing to cancer INTERFERON GAMMA
cells.
● Enhance the body’s ability to repair or ● Used for the treatment of chronic
replace damaged cells granulomatous disease and
● Prevent the cell from metastasizing osteoporosis
● Drug example:
○ Interferon gamma given
BRMs INCLUDE: subcutaneously

➢ INTERFERONS
➢ COLONY-STIMULATING FACTORS
➢ INTERLEUKIN 2
➢ KERATINOCYTE GROWTH FACTOR
INTERFERONS
● Are found naturally in the body and also
produced in the laboratory
● Work directly on cancer cells to slow their
growth or cause cancer cells to behave
more like normal cells
● TWO TYPES:
○ Type I – Interferon alpha,
Interferon beta
○ Type II – Interferon gamma
INTERFERON ALPHA
● MOA: bind to cell receptors for
biologic activities followed by
activation of tyrosine kinase
● Drug example:
○ Interferon alpha-2b
➢ INTERFERON ALPHA 2-B
● Used for the treatment of hairy cell
leukemia, AIDS-related Kaposi
sarcoma, malignant melanoma,
and non Hodgkin lymphoma
● Given through intravenous
intramuscular or subcutaneous
route
INTERFERON BETA
● MOA: inhibits the proinflammatory
cytokines responsible for
triggering the autoimmune
reaction
● Indicated for the treatment of
multiple sclerosis
● Drug example:
○ Interferon beta-1b
➢ INTERFERON BETA 1-B
● Administered subcutaneously
● Incremental titration is required
COLONY-STIMULATING FACTORS
● These are proteins that stimulate the
growth, maturation, and differentiation of
bone marrow stem cells.
● MOA: promote the growth of stem cells
and blood cells (since chemotherapy
depletes normal stem cells and blood
cells)
OTHER FUNCTIONS:
● Decrease the length of posttreatment
neutropenia
● Permit the delivery of higher doses of
chemotherapy drugs (because it
minimizes myelosuppressive toxicity, thus
allowing the delivery of higher doses)
● Reduce bone marrow recovery time after
transplantation
● Enhances macrophage or granulocyte
tumor-, virus-, and fungus-destroying
abilities
● Prevent severe thrombocytopenia after
myelosuppressive therapy.
OTHER FUNCTIONS:
➢ Erythropoietin stimulating agents
➢ Granulocyte colony stimulating factor
➢ Granulocyte-Macrophage Colony
Stimulating Factor
ERYTHROPOIETIN STIMULATING
AGENTS
● MOA: stimulates production of
erythropoietin
● Erythropoietin is produced by the kidney
and stimulates the production of red blood
cells in the bone marrow
● Used if blood transfusion is not an option
DRUGS
● Epoetin alfa
● Darbepoetin alfa
SIDE EFFECTS
● Flu like symptoms

BRAGAT, JOHN MICHAEL N. – BSN 2L

UCB – COLLEGE OF NURSING
 NCM 106 - PHARMACOLOGY
CHAPTER 6: ANTICANCER DRUGS
● Rash ● Cardiac tamponade
● Myalgia ● Anaphylactoid reactions
● Cephalgia
● Cough
● Urticaria INTERLEUKIN2 2

ADVERSE EFFECTS ● Aka Lymphokines

● Naturally produced by T-lymphocytes
● Myocardial infarction ● MOA: increase the growth and activity of
● Stroke T cells and B cells
● Venous thromboembolism ● Drug example:
● Red cell aplasia ○ Aldesleukin
● Encephalopathy
➢ ALDESLEUKIN
GRANULOCYTE COLONY ○ Administered intravenously or
STIMULATING FACTORS subcutaneously
○ Used for metastatic renal cancer
● MOA: stimulates production of GCS-F
● Naturally produced by macrophages, CONTRAINDICATION
endothelium, and other immune cells
● Used for chronic neutropenia in
chemotherapy ● Angina
● Cardiac arrhythmias
DRUGS ● Cardiac disease
● Cardiac tamponade
● Filgrastim ● Coma
● Pegfilgrastim ● GI bleeding
● GI perforation
SIDE EFFECTS ● MI
● Nausea ● Organ transplant
● Vomiting ● Psychosis
● Arthralgia ● Pulmonary disease
● Alopecia ● Renal failure
● Diarrhea ● Respiratory insufficiency
● Fever ● Seizure
● Fatigue ● Ventricular tachycardia
● Skin rash

ADVERSE EFFECTS
NURSING INTERVENTIONS (BIOLOGIC
● Splenomegaly
● Thrombocytopenia RESPONSE MODIFIERS)
● MI
● Assess for cardiac events such as ECG
● Acute respiratory distress syndrome
changes.
(ARDS)
● Monitor appropriate labs according to
● Capillary Leak syndrome
established protocol for the specific
GRANULOCYTE-MACROPHAGE immunotherapy such as CBC,
electrolytes, renal and hepatic function,
COLONY STIMULATING FACTORS and glucose
● MOA: stimulates the production of ● Assess for bleeding and infection.
GM-CSF ● Examine the skin closely at each visit.
● Naturally produced by bone marrow, B ● Actively listen to patient and caregiver
and T lymphocytes, and monocytes concerns.
● Drug Example:
○ Sargramostim
TARGETED THERAPY DRUGS
SIDE EFFECTS
● Arthralgia TARGETED THERAPY
● Myalgia
● Diarrhea ● Specific, deliberate, and cytostatic
● Fatigue
● Considered the cornerstone of precision
● Chills
● Cephalgia medicine because it directs the treatment
● Malaise according to the person’s genes and
proteins
ADVERSE EFFECTS ● 3 approaches available in target therapies:
● Pleural effusion

BRAGAT, JOHN MICHAEL N. – BSN 2L

UCB – COLLEGE OF NURSING
 NCM 106 - PHARMACOLOGY
CHAPTER 6: ANTICANCER DRUGS
○ Comparing individual proteins in
● Intractable bleeding
cancer cells with those of normal ● Pulmonary hemorrhage
cells ● GI perforation
○ Identifying mutant protein cells that ● Reversible Posterior
can cause cancer progression Leukoencephalopathy Syndrome
○ Looking for abnormal chromosomes ● Hypertensive crisis
present in cancer cells but not in ● Nephrotic Syndrome
● Thrombotic Microangiopathy
normal cells
● Although this is the cornerstone of precision
medicine, it also has its limitations, which EPIDERMAL GROWTH FACTOR
include: RECEPTOR (EGFR)- TK INHIBITORS
○ Cancer do not have sufficient
quantities of the specific molecular ● Largest class of targeted therapy drugs
targets will not respond to targeted ● MOA: blocks EGFR thus inhibition of cell
division and proliferation
therapy
● Drugs include:
○ Mutating cancer cells and becoming ○ Osimertinib
drug resistant ○ Gefitinib
○ Difficulty developing drugs for some
identified targets ➢ GEFITINIB
○ Given orally
○ Used in managing locally or
TARGETED THERAPY DRUGS advanced metastatic non-small
cell lung cancer
● Molecular targeted drugs or precision
medicines SIDE EFFECTS
● MOA: block the growth and spread of ● Diarrhea
cancer by interfering with specific molecules ● Skin reactions
involved in tumor growth, progression and ● Anorexia
spread ● Vomiting
● Elevated transaminases
● Produce less damage to normal cells
● Acne
compared to chemotherapy ● Pruritus
● Nail disorder
● Targeted Therapy includes:
○ Angiogenesis Inhibitors
○ Epidermal Growth Factor Receptor
(EGFR)- TK Inhibitors
TYROSINE KINASE AND
○ Tyrosine Kinase Inhibitors MULTIKINASE INHIBITORS
○ Multikinase Inhibitors ● MOA: block the action of kinases
○ Monoclonal Antibodies (MAbs) ● This is because kinases turn on signal
○ Proteasome Inhibitors transduction pathways which promote cell
division. There is absence of cell division
● TKI drugs include:
ANGIOGENESIS INHIBITORS
○ Alectinib
● Vascular Endothelial Growth Factor ○ Imatinib mesylate
Receptor Inhibitors ○ Nilotinib
● MOA: prevent new blood vessels from ● MKI drugs include:
forming ○ Dasatinib
○ Sorafenib
➢ ZIV-AFLIBERCEPT (VEGFR) ○ Sunitinib
○ Given intravenously in
combination with 5-Fluorouracil, SIDE EFFECTS
leucovorin and irinotecan for the ● Anemia
treatment of colorectal cancer ● Fatigue
● Constipation
SIDE EFFECTS ● Edema
● Diarrhea ● Elevated creatinine phosphokinase
● Dizziness
● Asthenia ADVERSE REACTIONS
● Weight loss ● Hepatotoxicity
● Dehydration ● Pneumonitis
ADVERSE EFFECTS ● Dysrhythmias
● GI bleeding
BRAGAT, JOHN MICHAEL N. – BSN 2L
UCB – COLLEGE OF NURSING
 NCM 106 - PHARMACOLOGY
CHAPTER 6: ANTICANCER DRUGS
visit. (because there may be skin
MONOCLONAL ANTIBODIES (MAbs) alterations)
● Assess for cardiac events such as ECG
● Administered intravenously because the changes.
GI tract could alter the drug structure and ● Monitor for signs of infection and
render it inactive bleeding.
● Drugs include: ● Monitor for laboratory results such as
○ Alemtuzumab creatinine levels, CBC, blood urea
○ Bevacizumab nitrogen.
○ Cetuximab ● Maintain strict aseptic technique.
○ Ibritumomab tiuxetan ● Monitor for fluid intake and output, weight,
○ Panitumumab and nutritional intake during therapy.
○ Trastuzumab
(They carry a black box warning upon purchase
regards to their harmful effects such as dermatologic
toxicity and infusion reactions)
REFERENCE:
SIDE EFFECTS
● Bronchospasm ELSEVIER PHARMACOLOGY BOOK
● Dermatitis
● Nail disorders University of Cebu - Banilad
College of Nursing
ADVERSE REACTIONS
● Airway obstruction NOTES:
● Anaphylactic shock
● Bone marrow suppression
● Exfoliative Dermatitis

PROTEASOME INHIBITORS
● MOA: promote accumulation of proteins
that promote programmed cell death
● Proteasomes are multienzymes that
degrade proteins intracellularly. The
degraded proteins can accumulate and
disrupt a cell’s physiologic properties such
as regulating transcriptions, cell adhesion,
apoptosis, and progression of mitosis
● Drugs include:
○ Bortezomib
○ Carfilzomib
○ Ixazomib
○ Temsirolimus

SIDE EFFECTS
● Rash
● Nausea
● Edema
● Dyspnea
● Pain
● Diarrhea

ADVERSE REACTIONS
● Hypertensive crisis
● Weakness
● Hyperglycemia
● Anorexia

NURSING INTERVENTIONS
(TARGETED THERAPY DRUGS)
● Examine the patient’s skin closely at each

BRAGAT, JOHN MICHAEL N. – BSN 2L

UCB – COLLEGE OF NURSING