Oncology Drug List

(1-2-13)
You are responsible for the mechanisms and side effects of single drugs. The bolded ones are the most important exemplars of each class.

Drug class Antineoplastic

Sub-class Alkylating agents

Generic name Bendamustine

Brand name

Toxicities / Special considerations Common alkylator; causes intra-strand and interstrand cross-links between DNA bases. Common alkylator :myelosuppression including thrombocytopenia, anemia, granulocytopenia, alopecia, gonadal dysfunction, mucositis (= irritation of gut lining), second neoplasms, and pulmonary fibrosis. Toxicity:heme>>>>renal/neuro ; dose by AUC Common alkylator; cross blood brain barrier Common alkylator; oral bioavailability Toxicity:renal>neuro / oto>heme Attenuate renal toxicity by hydration Common alkylator; Prodrug: active alkylator produced as a result of hepatic metabolism; metabolites bladder toxic therefore high doses use MESNA for bladder protection; High doses: cardiac toxicity Used in curative regimens for non-Hodgkins lymphoma CHOP: Cyclophosphamide + doxorubicin + vincristine + prednisone CVP: Cyclophosphamide + vincristine + prednisone Common alkylator; very emetogenic Similar to cyclophosphamide in mechanism but more favorable activity in certain disease types e.g. sarcoma. REQUIRE bladder protection with MESNA at all doses. Encephalopathic especially with renal compromise. Fanconi syndrome, azotemia also common Common alkylator; oral bioavailable; cross blood brain barrier

RIBOMUSTIN; TREANDA

Busulfan

BUSULFEX, MYLERAN

Carboplatin
Carmustine Chlorambucil

PARAPLATIN BCNU LEUKERAN PLATINOL

Cisplatin

Cyclophosphamide

CYTOXAN

Dacarbazine

DTIC

Ifosfamide

IFEX, MITOXANA

Lomustine (CCNU)
1

The particular brand name does not suggest or recommend use of any drug; it is only provided to give an appreciation of common brand names Common alkylator toxicities: myelosuppression including thrombocytopenia, anemia, granulocytopenia, alopecia, gonadal dysfunction, mucositis (= irritation of gut lining), second neoplasms, and pulmonary fibrosis.

Melphalan Mechlorethamine Oxaliplatin Procarbazine Temozolomide

ALKERAN MUSTARGEN ELOXATIN MUTALANE TEMODAR

Common alkylator; oral bioavailable Parent drug of the class; common alkylator toxicity; vesicant; emetogenic Toxicity: neuro>>heme>>>>>renal Common alkylator; neurotoxic with altered mood, somnolence Common alkylator; oral bioavailability; cross blood brain barrier

Antibiotics

Bleomycin

BLEOCIN, BLENOXANE

Dactinomycin

COSMEGEN

Renal clearance therefore reduce dose in renal compromise; dose related pulmonary toxicity; late recall on exposure to high PO2 or with radiation; Raynauds hypersensitivity therefore precede with test dose Curative regimens ABVD (Adriamycin + bleomycin + vinblastine + dacarbazine) for Hodgkins and PEB (Cisplatin + etoposide + bleomycin) for germ cell neoplasms Myelosuppression; Nausea / vomiting; Mucositis; Diarrhea; Vesicant-avoid extravasation; Radiation recall Curative pediatric neoplasm regimens

Topo II Inhibitors

Daunorubucin Doxorubicin or
hydroxy-daunorubicin Epirubicin Etoposide Mitoxantrone Idarubicin

DAUNOMYCIN, CERUBIDINE, RUBIDOMYCIN ADRIAMYCIN; DOXIL ELLENCE EPTOPHOS NOVANTRONE

Common anthracycline toxicities: myelosuppression; vesicant; mucositis; gastrointestinal (nausea; diarrhea) dose related cardiac toxicity; interaction with radiation therapy Common anthracycline but more mucositis on a dose per dose basis than dauno Common anthracyclinetoxicities Myelosuppression, alopecia Related to anthracyclines but somewhat less cardiotoxic; also myelosuppression, mucositis, gastrointestinal Common anthracycline but less cardiotoxic on a weight basis

Antibodies (mAbs)

Alemtuzumab

CAMPATH

Bevacuzimab Cetuximab Rituximab Trastuzumab

AVASTATIN, AVASTIN ERBITUX RITUXAN HERCEPTIN

Ipilimumab

YERVOY

Anti CD52; use in CLL, T cell leukemias; infusion reaction (chills, fever, shortness of breath +/hypotension) tumor lysis syndrome Anti Vascular Endothelial Growth Factor; bleeding, clotting, hypertension, proteinuria, seizures / altered mental status, perforated viscus Anti EGF receptor; diarrhea, rash Anti CD20; use in B cell lymphomas; Infusion reaction (chills fever, shortness of breath +/- hypotension) Anti-erbB2; Infusion reaction (chills, fever, shortness of breath +/- hypotension); cardiac toxicity Anti-CTLA4; stimulate immunity; infusion reactions (chills, fever, shortness of breath +/- hypotension); exaggerated autoimmunity esp hepatic and gut dysfunction

Antimetabolites

Decitabine, Azacitidine

DACOGEN, VIDAZA ARABINOSIDE C, ARA-C FLUDARA ADRUCIL GEMZAR PURINETHOL

Cytarabine(cytosine
arabinoside) Fludarabine

Fluorouracil Gemcitabine
Mercaptopurine

Methotrexate

TREXALL

Pentostatin

NIPENT

Nucleosides: Myelosuppression and hypomethylate DNA at low doses Nucleoside: Myelosuppression, nausea, rash, mucositis, ocular irritation and cerebellar toxicity other CNS at high doses Nucleoside: Myelosuppression, CNS and neuro; immunosuppression and rare hemolytic anemia Pyrimidine analog: Myelosuppression, mucositis, CNS at high doses Nucleoside: Myelosuppression; hand-foot syndrome Purine analog: Myelosuppression, nausea, uncommon hepatic Antifolate: Mucositis, myelosuppression; renal clearance therefore enhanced toxicity at increased Cr; renotoxic by direct effect on tubules and by precipitation at high doses; inhibit dihydrofolate reductase therefore rescue with reduced folates especially leucovorin Adenosine deaminase inhibitor therefore increase dATP pools and inhibit production of other dNTPs and

Pemetrexed

ALIMTA

induce apoptosis in T lymphocyte lineage; renal, CNS toxicity Antifolate but also target additional enzymes of purine and pyrimidine synthesis; give with low doses of B12 and folate

Anti-microtubular

Docetaxel Ixabepilone

TAXOTERE IXEMPRA TAXOL, ONXEL 2 (ABRAXANE ) VELBAN ONCOVIN NAVELBINE

Paclitaxel Vinblastine (in ABVD) Vincristine

Vinorelbine

Myelosuppression; neuropathy; vascularleak syndrome = fluidretention Myelosuppression, neuropathy Myelosuppression, neuropathy; vascularleak syndrome = fluidretention Myelosuppression, neuropathy Neuropathy>myelotoxicity Myelosuppression; neuropathy

Growth/CS factors

Erythropoietin (epoetin)
Filgrastim (r-metHuG-CSF) G-CSF or GM-CSF Sargramostim (rHuGMCSF)

EPOGEN, PROCRIT NEUPOGEN (see filgrastim; sargramostim) LEUKINE

Clotting if to Hgb> 10 ?promote tumor growth Fever, chills, bone pain ; exacerbation of inflammatory states Somewhat higher incidence of fever

HDAC Inhibitor

Romidepsin
Vorinostat

ISTODAX ZOLINZA

Cardiac; myelosuppression Nausea; myelosuppression; clotting

Suspension of protein-bound drug,

Hormonal oncologics

Anastrazole
Bicalutamide Diethylstilbestrol (DES) Exemestane Flutamide Fulvestrant

ARIMIDEX CASODEX

Aromatase inhibitor: Bone loss; fatigue Androgen receptor antagonist; Bone loss Estrogen receptor antagonist: Bone loss; thromboses Aromatase inhibitor: Bone loss; fatigue Androgen receptor antagonist: nausea Indirect estrogen receptor antagonist; Bone loss Hypothalamic stimulator of continuous LH release therefore lose normal pulsatile release and effectively decrease net LH release Aromatase antagonist: bone loss, musculoskeletal fatigue LikeGoserelin Progesterone-related side effects : fluid retention, constipation

AROMASIN EULEXIN FASLODEX ZOLADEX (LHRH analog) FEMARA (LHRH analog) LUPRON MEGACE ANDROID NILANDRON (in CHOP and CVP)

Goserelin Letrozole
Leuprolide Megestrol Methyltestosterone Nilutamide

Prednisone Tamoxifen

NOLVADEX

Glucocorticoid excess: hyperglycemia, fluid retention gastric irritation Cushings syndrome, increased opportunistic infections; myopathy; CNS changes Bone loss, thrombogenic with deep venous and large organ thromboses; uterine neoplasms as partial agonist in uterus

Topoisomerase-I inhibitors

Irinotecan
Topotecan

CAMPTOSAR HYCAMTIN

Myelosuppression, nausea, diarrhea (acute diarrhea treat with anti-cholinergic; late diarrhea with loperamide); Dose according to UGT allele status Myelosuppression, nausea

Tyrosine kinase inhibitors (TyrK-I)

Crizotinib Dasatinib

XALKORI SPRYCEL TARCEVA IRESSA GLEEVEC

Erlotinib
Gefitinib

Imatinib

Anti-ALK (anaplastic lymphoma kinase)/c-MET/HGFR; nausea, vomiting, or diarrhea Targets include BCR/ABL, Srd, c-Kit, ephrin receptors, other TKs, but not EGFR or Her2 Anti EGF-R ; diarrhea, rash Anti EGF-R : diarrhea, rash Anti bcr-abl: fluid retention, hepatic,

Nilotinib

TASIGNA NEXAVAR

Sorafenib Sunitinib
Boustinib Ponatinib Vemurafenib Other oncologics Bortezomib

SUTENT BOSULIF ZELBORAF proteasome inhibitor VELCADE HYDREA REVLIMID THALOMID

myelosuppression; rare cardiac Inhibits the kinases (BCR-ABL, KIT, LCK, EPHA3, EPHA8, DDR1, DDR2, PDGFRB, MAPK11 and ZAK Multi-target with prominent Anti raf, VEGF-R: rash, diarrhea, hypertension, rare hepatic; clotting / bleeding proteinuria ALSO: hand-foot syndrome Multi-target with prominent Anti VEGF-R: rash, diarrhea, hypertension, rare hepatic; clotting / bleeding proteinuria Recurrent CML CML with T315I mutation B-RAF mutated melanoma Thrombocytopenia, neuropathy Myelosuppression, mucositis Immune modulator for myeloma, myelodysplasia Cytopenias, thrombosis, edema Immune modulator for myeloma, Cytopenias, thrombosis, edema

Hydroxyurea
Lenalidomide Thalidomide

Antidote to folic acid antagonists Anti-emetic therapy

Leucovorin
Aprepitant Dexamethasone(steroid) Dolasetron Granisetron Ondansetron Palonosetron (LA)

ISOVORIN ; SODIOFOLIN

Potentiate 5FU toxicity ; ImproveMethotrexatetoxiciy

EMEND DECADRON ANZEMET KYTRIL ZOFRAN ALOXI Cushings syndrome; can also be used as an oncologic therapeutic

Additional hematologic

Arsenic Trioxide IL-2 -Interferon Tretinoin (all-transPROLEUKIN INTRON-A VESANOID, RETIN-A,

Unique use in acute promyelocytic leukemia: Prolonged QT syndrome, hepatic, renal Fever, infusion reactions with hypotension and vascular leak syndrome Fever Unique use in acute promyelocytic leukemia;

retinoic acid) * UMM Medical Reference: http://www.umm.edu/medref/

Increased intracranial pressure; cutaneous; rare hepatic

You are responsible for the mechanisms and side effects of single drugs. The bolded ones in the second list are the most important exemplars of each class.

ALPHABETICAL LIST

interferon Alemtuzumab Anagrelide

INTRON-A CAMPATH AGRYLIN ARIMIDEX EMEND (see Cytarabine) VIDAZA RIBOMUSTIN; TREANDA AVASTATIN, AVASTIN (see carmustine) CASODEX BLEOCIN; BLENOXANE VELCADE MYLERAN PARAPLATIN BCNU ERBITUX LEUKERAN Cyclophosphamide, hydroxy(doxo)rubicin, ONCOVIN (vincristine), prednisone PLATINOL ACCUTANE XALKORI Cyclophosphamide, vincristine, prednisone CYTOXAN ARABINOSIDE C, ARA-C DTIC

Additional hematologic Antibiotics Additional hematologic Hormonal Oncologics Anti-emetic therapy Antimetabolites Alkylating agents Antibodies (mAbs) (VEGF) Hormonal Oncologics Antibiotics-oncologics Proteasome inhibitor Alkylating agents Alkylating agents Alkylating agents Antibodies (mAbs) Alkylating agents

Anastrazole
Aprepitant ARA-C Azacitidine Bendamustine

Bevacuzimab
BCNU Bicalutamide

Bleomycin (and in ABVD)

Bortezomib Busulfan

Carboplatin
Carmustine

Cetuximab
Chlorambucil CHOP

Cisplatin Cis-retinoic acid

Cirzotinib CVP

Alkylating agents Additional hematologic Anti-ALK (anaplastic lymphoma kinase Alkylating agents Antimetabolites Alkylating agents

Cyclophosphamide Cytarabine(cytosine arabinoside) Dacarbazine

Dactinomycin Dasatinib

COSMEGEN SPRYCEL CERUBIDINE; DAUNOMYCIN; RUBIDOMYCIN DACOGEN DECADRON TAXOTERE ANZEMET ADRIAMYCIN; DOXIL ELLENCE TARCEVA EPOGEN; PROCRIT EMCYT AROMASIN NEUPOGEN FLUDARA ADRUCIL EULEXIN FASLODEX LEUKINE (see Sargramostim) IRESSA GEMZAR ZOLADEX KYTRIL HYDREA IFEX; MITOXANA

Daunorubucin
Decitabine Dexamethasone (steroid) Diethylstilbestrol (DES) Docetaxel Dolasetron

Antibiotics-oncologics Tyrosine kinase inhibitor, but NOT EGFR or Her2 Antibiotics-oncologics, Topo II Inhibitors Antimetabolites Anti-emetic therapy Hormonal Antitubulin Anti-emetic therapy Antibiotics-oncologics, Topo II Inhibitors Antibiotics-oncologics Tyrosine kinase inhibitors(EGFR) Growth factors Hormonal Oncologics Hormonal Oncologics Growth factor Antimetabolites Antimetabolites Hormonal Oncologics Hormonal Oncologics Growth factors Tyrosine kinase inhibitors(EGFR) Antimetabolites Hormonal Oncologics (LHRH analog) Anti-emetic therapy Other oncologics Alkylating agents

Doxorubicin (hydroxydaunorubicin)
Epirubicin

Erlotinib Erythropoietin (epoetin)

Estramustine Exemestane Filgrastim (r-metHuG-CSF) Fludarabine

Fluorouracil
Flutamide Folinic acid (see leucovorin) Fulvestrant

GCSF
Gefitinib

Gemcitabine Goserelin
Granisetron

Hydroxyurea
Ifosfamide

IL-2

PROLEUKIN GLEEVEC IXEMPRA CAMPTOSAR FEMARA ISOVORIN ; SODIOFOLIN LUPRON

Imatinib
Ixabepilone

Additional hematologic Tyrosine kinase inhibitors, BCRABLhematologic Antimicrotubular Topoisomerase I inhibitors Hormonal Oncologics Antidote to folic acid antagonists;

Irinotecan Letrozole Leucovorin

Leuprolide Lomustine (CCNU)

Potentiator of 5FU toxicity

Hormonal Oncologics (LHRH analog) Alkylating agents

Mechlorethamine
Megestrol

MUSTARGEN MEGACE ALKERAN PURINETHOL TREXALL; RHEUMATREX ANDROID NOVANTRONE TASIGNA NILANDRON ZOFRAN ELOXITIN TAXOL; ONXEL (ABRAXANE ) ALOXI NIPENT (in CHOP or CVP) MUTALANE
3

Alkylating agents Hormonal Oncologics Alkylating agents Antimetabolites Antimetabolites Hormonal Oncologics Antibiotics-oncologics Tyrosine kinase inhibitors Hormonal Oncologics Anti-emetic therapy Alkylating agents Antitubulin Anti-emetic therapy Antimetabolites Adjunctive medication Alkylating agents

Melphalan
Mercaptopurine

Methotrexate
Methyltestosterone Mitoxantrone Nilotinib Nilutamide

Ondansetron Oxaliplatin Paclitaxel

Palonosetron (LA) Pentostatin

Prednisone Procarbazine

Rituximab Romidepsin Sargramostim (rHuGM-CSF) Sorafenib Sunitinib Tamoxifen

Topotecan Toremifene

RITUXAN ISODAX LEUKINE NEXAVAR SUTENT NOLVADEX HYCAMTIN FARESTON TEMODAR HERCEPTIN RETIN-A; VESANOID

Antibodies (mAbs)(CD20) HDAC Inhibitor Growth factor Tyrosine kinase inhibitors (VEGF) Tyrosine kinase inhibitors (VEGF) Hormonal Oncologics Topoisomerase I inhibitors Hormonal Oncologics Alkylating agents Antibodies (mAbs) (HER -2neu) Additional hematologic

Temozolomide Trastuzumab Tretinoin (ATRA= All trans retinoic

acid)

Vinblastine Vincristine
Vinorelbine

VELBAN ONCOVIN NAVELBINE

Antitubulin Antitubulin Antitubulin