ONCO PHARMACOLOGY

Drug Class /
Classification

MITOTIC
SPINDLE
POISONS

Taxane,
Antimicrotubu
le agent

Plant
Alkaloids

Drugs
Paclitaxel (Taxol)
Docetaxel (Taxotere)
Etoposide (Toposar), Teniposide
(Vumon), Vinblastine (Velban),
Vincristine (VCR [Oncovin]),
Vindesine (Eldisine), Vinorelbine
(Navelbine)

Mode of Action
Arrest metaphase by
inhibiting tubulin
depolymerization
Arrest metaphase by
inhibiting mitotic
tubular formation
(spindle); inhibit DNA
and protein
synthesis

Cell-Cycle
Specificity

Cell cycle
Specific (M
Phase) /
Mitosis

Side Effects
Bradycardia,
hypersensitivity
reaction, bone marrow
suppression, alopecia,
neuropathies
Bone marrow
suppression (mild with
VCR), neuropathies
(VCR), stomatitis

5-Fluorouracil (5-FU)
Gemcitabine (Gemzar)
ANTI-METABOLITE

ALKYLATING
AGENTS

Platinum
Analog

OTHERS: 5-Azacytadine, capecitabine

(Xeloda), Cytarabine (DepoCyt,
Tarabine), edatrexate fludarabine
(Fludara), hydroxyurea (Droxia,
Hydrea), cladribine( Leustatin), 6mercaptopurine (Purinethol),
methotrexate (Trexall, Rheumatrex),
pentostatin (Nipent), 6-thioguanine
(Tabloid)

Carboplatin (Paraplatin)
Cisplatin (Platinol-AQ)

Nonclassi
c
alkalatin
g agent

Dacarbazine (DTIC-Dome)
Cyclophosphamide (Cytoxan)

Interferes with the

biosynthesis of
metabolites or
nucleic acids
necessary for RNA
and DNA synthesis

Alter DNA structure

by misreading DNA
code, initiating
breaks in the DNA
molecule, crosslinking DNA strands

Cell cycleSpecific (S
phase)

Cell cyclenon-specific

Nausea, vomiting,
diarrhea, bone marrow
suppression, proctitis,
stomatitis, renal toxicity
(methotrexate),
hepatotoxicity

Bone marrow
suppression, nausea,
vomiting, cystitis
(cyclophosphamide,
ifosfamide), stomatitis,
alopecia, gonadal
suppression, renal
toxicity (cisplatin)

Ifosfamide (Ifex)
Platinum
Analog

Oxaliplatin (Eloxatin)
OTHERS: Busulfan (Busulfex, Myleran),
chlorambucil (Leukeran),
Hexamethylene amine or altretamine
(Hexalen), melphalan (Alkeran),
nitrogen mustard (Mustargen), thiopeta
(Thioplex)

Doxorubicin (Adriamycin)
ANTI-TUMOR
ANTIBIOTICS

NITROSOUREAS

OTHERS: Bleomycin (BLM, Blenoxane),

dactinomycin (Cosmegen),
daunorubicin (DaunoXome), idarubicin
(Idamycin), mitomycin (Mutamycin),
mitoxantrone (Novantrone), plicamycin
(Mithracin)

Carmustine (BCNU [BiCNU,

Gliadel]), lomustine or CCNU
(CeeNU), semustine (methyl CCNU
[MeCCNU]), streptozocin (Zanosar)

TOPOISOMERASE I
INHIBITORS

Irinotecan (Camptosar), Topotecan

(Hycamtin)

HORMONAL AGENTS

Androgens & anti-a, estrogens &

anti-e, progestins & anti-p,
aromatase inhibitors, luteinizing
hormone-releasing hormone
analogues, steroids

MISCELLANEOUS

Asparaginase (Elspar), procarbazine

Interfere with DNA

synthesis by binding
DNA; prevent RNA
synthesis

Cell cycle non-specific

Bone marrow
suppression, nausea,
vomiting, alopecia,
anorexia, cardiac toxicity
(daunorubicin,
doxorubicin)

Similar to the
alkylating agents;
cross the blood-brain
barrier

Cell cycle non-specific

Delayed and cumulative

myelosuppression,
especially
thrombocytopenia, n/v

Cell cyclespecific (S
phase)

Bone marrow
suppression, diarrhea,
n/v, hepatotoxicity

Cell cycle non-specific

Hypercalcemia,
jaundice, inc. appetite,
masculinization,
feminization, sodium &
fluid retention, n/v, hot
flashes, vaginal estrogen
dryness

Varies

Anorexia, n/v, bone

Induce breaks in the

DNA strand by
binding to enzyme
topoisomerase I,
preventing cells from
dividing
Bind to hormone
receptor sites that
alter cellular growth;
block binding of
estrogens to
receptor sites (Antie); inhibit RNA
synthesis; suppress
aromatas of P450
system, which
decreases level
Unknown or too

AGENTS

(Matulane)

Prepared by: Arnold L. De Guzman Jr., RN

Nursing 12th Edition

marrow suppression,
hepatotoxicity,
anaphylaxis,
hypotension, altered
glucose metabolism

complex to
categorize

Source: Brunner & Suddarth's Medical-Surgical

ONCO PHARMACOLOGY
Drugs

Paclitaxel
(Taxol)

Toxicity

Toxicity Notes

Myelosuppression

Dose-limiting neutropenia with nadir at day 810 and recovery by day 1521.

Hypersensitivity Reaction

20%40%: Characterized by generalized skin rash, flushing, erythema, hypotension,

dyspnea, and/or bronchospasm.

Neurotoxicity

Neurotoxicity mainly in the form of sensory neuropathy with numbness and

paresthesias. Motor and autonomic neuropathy observed at high doses.

Cardiotoxicity

30%: Transient asymptomatic sinus bradycardia. Other rhythm disturbances are seen,
including Mobitz type I, Mobitz type II, and third-degree heart block, as well
as ventricular arrhythmias.

Alopecia
Mucositis and/or diarrhea
Hepatic Function/ Serum
Electrolytes
Onycholysis
Myelosuppression
Fluid retention syndrome

Docetaxel
(Taxotere)

Nearly all patients: Loss of total body hair

30%40%: Mild to moderate nausea and vomiting, usually of brief duration.
Transient elevations in serum transaminases, bilirubin, and alkaline phosphatase
Receiving >6 courses on the weekly schedule. Not seen with the every-3-week
schedule
Neutropenia, Thrombocytopenia and anemia
Weight gain, peripheral and/or generalized edema, pleural effusion, and ascites

Skin changes

Maculopapular skin rash and dry, itchy skin. Most commonly affect
forearms and hands

Alopecia

80% of patients

Mucositis and/or diarrhea

Mild to moderate
nausea and vomiting, usually of brief duration.

Peripheral neuropathy
Generalized fatigue and
asthenia
Hepatic Function/ Serum
Electrolytes
Vesicant

(less commonly observed)

Arthralgias and myalgias also observed
Reversible elevations in serum transaminases, alkaline phosphatase, and bilirubin.
Phlebitis and/or swelling can be seen at the injection site

5Fluorouracil

Myelosuppression
Mucositis and/or diarrhea
Hand-foot syndrome (palmarplantar erythrodysesthesia)
Neurologic toxicity
Cardiac symptoms
Eye Changes
Skin changes
Taste Affectation

Neutropenia and thrombocytopenia more common than anemia

Nausea and vomiting are mild and rare
Tingling, numbness, pain, erythema, dryness, rash, swelling, increased pigmentation,
nail changes, pruritus of the hands and feet, and/or desquamation
Somnolence, confusion, seizures, cerebellar ataxia, and rarely encephalopathy.
Chest pain, EKG changes, and serum enzyme elevation
Blepharitis, tear-duct stenosis, acute and chronic conjunctivitis
Dry skin, photosensitivity, and pigmentation of the infused vein
Metallic taste in mouth during IV bolus injection

Myelosuppression
Nausea and vomiting
Flu-like syndrome
Gemcitabine
(Gemzar)

Hepatic function
Pulmonary toxicity
Infusion reaction
Mild proteinuria and hematuria
Skin Changes
Myelosuppression
Nausea and vomiting
Renal toxicity

Carboplatin
(Paraplatin)

Peripheral neuropathy
Liver Function
Allergic reaction
Reproductive changes

Cisplatin
(Platinol-AQ)

Nephrotoxicity

Nausea and vomiting

Myelosuppression
Neurotoxicity
Ototoxicity
Hypersensitivity reactions
Ocular toxicity
Liver Function
Taste Affectation
Vascular events
Reproductive changes
Alopecia

Leukopenia more common than thrombocytopenia

70%: mild to moderate n/v; 15%-20%: Diarrhea and/or mucositis
20%: fever, malaise, chills, headache, and myalgias; 40%: Fever, in the absence of
infection (6-12 hours post txt)
Transient hepatic dysfunction with elevation of serum transaminases and bilirubin
Mild dyspnea and drug-induced pneumonitis. ARDS has been reported rarely
flushing, facial swelling, headache, dyspnea, and/or hypotension
Maculopapular skin rash generally involving the trunk and extremities and pruritus.
Alopecia is rarely observed
significant and dose-limiting. Thrombocytopenia is most commonly observed
Delayed nausea and vomiting can also occur, albeit rarely
Significantly less common
less than 10% of patients. Patients older than 65 years and/or previously treated with
cisplatin may be at higher risk for developing neurologic toxicity.
Mild and reversible elevation of liver enzymes, particularly alkaline phosphatase and
SGOT
skin rash, urticaria, and pruritus. Bronchospasm and hypotension are uncommon
Amenorrhea, azoospermia, impotence, and sterility.
35%40%. Effects on renal function are dose-related and usually observed at 1020
days after therapy. Generally reversible. Electrolyte abnormalities, mainly
hypomagnesemia, hypocalcemia, and hypokalemia, are common. Hyperuricemia
rarely occurs.
acute (within the first 24 hours) and delayed (>24 hours). Early form begins within 1
hour of starting cisplatin therapy and may last for 812 hours. The delayed form can
last for 35 days
25%30%. with WBCs, platelets, and RBCs equally affected. Leukopenia and
thrombocytopenia are more pronounced at higher doses. Coombs-positive hemolytic
anemia rarely observed.
Peripheral sensory neuropathy. Paresthesias and numbness in a classic stocking-glove
pattern. Loss of motor function, focal encephalopathy, and seizures also observed.
Neurologic effects may be irreversible
with high-frequency hearing loss and tinnitus
facial edema, wheezing, bronchospasm, and hypotension. Occur within a few minutes
of drug administration.
optic neuritis, papilledema, and cerebral blindness. Altered color perception may be
observed in rare cases
Transient elevation in LFTs, mainly SGOT and serum bilirubin
Metallic taste of foods and loss of appetite.
myocardial infarction, arteritis, cerebrovascular accidents, and thrombotic
microangiopathy. Raynauds phenomenon has been reported
Azoospermia, impotence, and sterility

Hormones

Inappropriate secretion of antidiuretic hormone (SIADH)

Cyclophosph
amide
(Cytoxan)

Myelosuppression

Mainly leukopenia, Thrombocytopenia may occur

Bladder toxicity

5%-10%: hemorrhagic cystitis, dysuria, and increased urinary frequency

(Uroprotection with mesna and hydration must be used)

Nausea and vomiting

Alopecia
Reproductive changes
Cardiotoxicity
secondary malignancies
Immunosuppression
SIADH
Hypersensitivity reaction
Myelosuppression
Bladder toxicity

Ifosfamide
(Ifex)

Nausea and vomiting

Neurotoxicity
Alopecia
Hormones
Reproductive changes
Terato/muta/carnino-genic
Neurotoxicity
Nausea and vomiting
Diarrhea

Oxaliplatin
(Eloxatin)

Myelosuppression
Allergic reaction
Hepatotoxicity
RPLS (Reversible Post.
Leukoencepalopathy
Syndrome)

Skin and nails may become hyperpigmented

Amenorrhea with ovarian failure. Sterility may be permanent.
with high-dose therapy
acute myelogenous leukemia and bladder cancer, especially in patients with
chronic hemorrhagic cystitis.
with an increased risk of infections
with rhinitis and irritation of the nose and throat
Mainly leukopenia and to a lesser extent thrombocytopenia

hemorrhagic cystitis, dysuria, and increased urinary frequency. Chronic

fibrosis of bladder leads to an increased risk of secondary bladder cancer.
Uroprotection with mesna and hydration must be used to prevent bladder
toxicity.
Usually occurs within 36 hours of therapy and may last up to 3 days.
Anorexia is fairly common
lethargy, confusion, seizure, cerebellar ataxia, weakness, hallucinations,
cranial nerve dysfunction, and rarely stupor and coma
>80%; Skin rash, hyperpigmentation, and nail changes are occasionally
seen
Syndrome of inappropriate secretion of antidiuretic hormone (SIADH)
Amenorrhea, oligospermia, and infertility
Mutagenic, teratogenic, and carcinogenic.
8-%-85%: acute toxicity - peripheral sensory neuropathy with distal paresthesias,
visual and voice changes, often triggered or exacerbated by cold. Dysesthesias in
the upper extremities and laryngopharyngeal region with episodes of difficulty
breathing or swallowing are also observed. 15% - >50%: chronic toxicity - risk of
impairment in proprioception and neurosensory function. REVERSIBLE

65%
Relatively mild with thrombocytopenia and anemia more common than
neutropenia
facial flushing, rash, urticaria, and less frequently, bronchospasm and
hypotension. In rare cases, anaphylactic-like reactions can occur.
with sinusoidal injury resulting in portal hypertension, ascites,
splenomegaly, thrombocytopenia, and varices.
headache, lethargy, seizures, visual disturbances, and encephalopathy

Myelosuppression
Nausea and vomiting
Mucositis and/or diarrhea
Cardiotoxicity
Doxorubicin
(Adriamycin)

Strong Vesicant
Skin changes
Alopecia
Urine changes
Allergy / HSR

leukopenia more common than thrombocytopenia or anemia.

50%: mild
Common
Acute: first 2-3 days as arrhythmias and/or conduction abnormalities, EKG
changes, pericarditis, and/or myocarditis; Chronic: dilated
cardiomyopathy associated with congestive heart failure
Extravasation can lead to tissue necrosis and chemical thrombophlebitis
at the site of injection
Hyperpigmentation of nails, rarely skin rash, and urticaria. Radiation
recall skin reaction can occur at prior sites of irradiation. Increased
hypersensitivity to sunlight
Universal but usually reversible within 3 months after termination of
treatment
Red-orange discoloration of urine. Usually occurs within 12 days after
drug administration
Allergic, hypersensitivity reactions are rare.