Anticancer

Drugs ?

Dr.lokendra Sharma
Associate Professor
Department of Pharmacology

Treatment options of cancer:?

No Treatment: Before 1940
Surgery: before 1955
Radiotherapy: 1955~1965
Chemotherapy: after 1965
Immunotherapy and Gene therapy

Cell Cycle

Cell Cycle Specific Agents

Antimetabolites
Bleomycin
Podophyllin Alkaloids
Plant Alkaloids

Cell Cycle Non-Specific

Agents
Alkylating Agents
Antibiotics
Cisplatin
Nitrosoureas

Cell cycle effects of anticancer drugs

CCS
CCS
Drugs
CCNS Drugs
Chemotherapy
Drugs
G1 - S

Etoposide

Platinum compounds

Antimetabolites

Alkylating agents

G2 M

Bleomycin
Etoposide
(Ref Harrison
17th/525)

Anthracyclines
Dactinomycin

Vinca alkaloids
Taxanes
Ixabepilone
Estramustine

Mitomycin
Camptothecins

Goals of Therapy ?
Cure or induce prolonged remission
so that all macroscopic and
microscopic features of the cancer
disappear
Acute Lymphoblastic Leukaemia
Wilm`s tumor, Ewing`s sarcoma etc.
In children, Hodgekin`s lymphoma, testicular
teratoma and choriocarcinoma

Goals of Therapy ?

Palliation:
Shrinkage of evident tumour,
Alleviation of symptoms and
prolongation of life
Breast cancer, ovarian cancer,
endometrial carcinoma,
CLL, CML,
Small cell cancer of lung and NonHodgekin lymphoma

Goals of Therapy ?
Insensitive or less sensitive but life
may be prolonged
Cancer esophagus, cancer stomach,
sq. cell carcinoma of lung,
melanoma,
pancreatic cancer,
myeloma,
colorectal cancer

Aim of Therapy contd.

Adjuvant therapy:
For mopping up of residual cancer cells
including metastases after Surgery,
Radiation and immunotherapy etc.

Routinely used now

Mainly in solid tumours

General Principles
Analogous with Bacterial chemotherapy
differences are

Selectivity of drugs is limited

No or less defence mechanism Cytokines
adjuvant now

All malignant cells must be killed to stop

progemy
Subpopulation cells differ in rate of
proliferation and susceptibility to
chemotherapy

General Principles
Drug regimens or combined cycle
therapy after radiation or surgery
Complete remission should be the
goal
Formerly single drug now 2-5
drugs in intermittent pulses
Total tumour cell kill
COMBINATION CHEMOTHERAPY

COMBINATION CHEMOTHERAPY
- SYNERGISTIC ?
Drugs which are effective when used
alone
Different mechanism of action
Differing toxicities
Different mechanism of toxicities
Synergistic biochemical interactions
Optimal schedule by trial and error
method
More importantly on cell cycle specificity

Classification ?

According to chemical structure and sources of drugs

Alkylating Agents, Antimetabolite, Antibiotics, Plant Extracts,

Hormones and Others

According to biochemistry mechanisms of anticancer action:

Block nucleic acid biosynthesis

Direct influence the structure and function of DNA

Interfere transcription and block RNA synthesis

Interfere protein synthesis and function

Influence hormone homeostasis

According to the cycle or phase specificity of the drug:

Cell cycle nonspecific agents (CCNSA) & Cell cycle specific agents
(CCSA)

Block nucleic acid (DNA, RNA)

biosynthesis
Antimetabolites:
Folic Acid Antagonist: inhibit dihydrofolate
reductase (methotrexate)
Pyrimidine Antagonist: inhibit thymidylate
synthetase (fluorouracil) ; inhibit DNA polymerase
(cytarabine)
Purine Antagonist: inhibit interconversion of purine
nucleotide (6-mercaptopurine and 6-Thioguanine)
Ribonucleoside Diphosphate Reductase
Antagonist: (hydroxyurea)

Influence :Structure & Function of

DNA
Alkylating Agent: mechlorethamine,
cyclophosphamide, ifosfamide, chlorambucil,
Mephalan, Busulfan, Nitrosoureas and Thio-TEPA
Platinum: cis-platinium, carboplatin and
imatinib
Antibiotic: bleomycin and mitomycin C
Topoismerase inhibitor: camptothecin
analogues and podophyllotoxin and antibiotics
like actinomycin D, daunorubicin and
doxorubicin

Sites of Antineoplastic Action ?

PALA = N-phosphonoacetyl-L-aspartate; TMP = thymidine monophosphate.

Clinical Considerations ?
Early intensive start . helpful
Complete remission.. goal
Combined chemotherapy useful
..delayed emergence of resistance
Combined chemotherapy ..curative
Treatment must continue past the
time when cancer cells can be
detected using conventional
techniques

Resistance ?
Intrinsic:
malignant melanoma, renal cell cancer, and
brain cancer, exhibit primary resistance
Acquired:
Single drug:
change in the genetic apparatus amplification or
increased expression of one or more specific
genes
Multidrug resistance:
Resistance variety of drugs exposure to a single variety
of drug
increased expression of a normal gene (the MDR1 gene)
for a cell surface glycoprotein (P-glycoprotein) involved in
drug efflux

Toxicities ?
Harmful to normal tissues too
Steep dose response curve
Low therapeutic index
Particularly harmful to rapidly
multiplying normal tissues: GI
mucosa, Bone Marrow, RE system and
gonads and hair cells
Effects are in dose dependent manner

Toxicities ?

Bone marrow depression limits treatment

Buccal mucosa erosion high epithelial turnover
(stomatitis, bleeding gums)
GIT: Diarrhoea, shedding of mucosa, haemorrhage
Nausea, vomiting CTZ direct stimulation
Skin: alopecia
Gonads: oligospermia, impotence, amenorrhoea
and infertility
Lymphoreticular system: Lymphocytopenia and
inhibition of lymphocyte function loss of host
defense mechanism susceptibility to infections
Carcinogenicity
Teratogenicity and Hyperuricemia

Distinctive Toxicities of Alkylating Agents ?

Drug

Toxicity

Cyclophosphamide

Alopecia, Hemorrhage cystitis, SIADH

Ifosfamide

Hemorrhagic cystitis, SIADH

Busulfan

Pulmonary fibrosis, Hyper pigmentation,

Adrenal insufficiency

Procarbazine

Secondary leukemias, Disulfiram like

reaction, behavioral changes, CNS
depression

Cisplatin

Emesis, Nephrotoxicity, Peripheral

sensory neuropathy, ototoxicity

Countering the Toxicities ?

Intermittent therapy
Folinic acid rescue
Systemic Mesna (sodium-2-mercaptoethane
sulfonate) administration and irrigation by
acetylcysteine detoxify toxic metabolites
Ondansetron
Hyperurecaemia: uricosuric agents like
allopurinol
Platelet and granulocyte transfusion
Granulocyte colony stimulating factors (GMCSF/G-CSF) recovery of garnulocytopenia

Drugs used to prevent toxicity of Anti cancer drugs

Drug

Mechanism

Indications

Allopurinol

Inhibit xanthine oxidase

Prevent hyperuricemia from tumor

lysis syndrome

Rasburicase

Recombinant urate oxidase

Prevent hyperuricemia from lysis

Mesna

Neutralizing agent

Prevent hemorrhagic cystitis due to

ifosfamide and high dose
cyclophosphamide

Leucovoring

Replete Tetrahydrofolic acid

Rescue after high dose methotrexate

Amifostine

Prevent radiation induced

xerostomia and

Prevent radiation induced

xerostomia and cisplatin induced
nephrotoxicity

Dexrazoxane

Iron chelator

Prevent cardiotoxicity due to

anthracyclines

Palifermin

Keratinocyte growth factor

Prevent mucositis following

chemotherapy

Pilocarpine

Cholinergic agonist

Radiation induced xerostomia

Pamidronate and
Zolendronate

Bisphosphonates

Hypercalcemia of malignancy

Drugs used to prevent toxicity of

Anti cancer drugs
Drug

Mechanism

Indications

Epoetin alpha
and darbopoetin
alpha

Erythropoietin

Anemia

Filgrastim, pegfilgrastim

G-CSF and

Febrile neutropenia prophylaxis

Sargramostim

GM - CHF

Oprelvekin

IL-11

Thrombocytopenia

Ondansetron

5-HT3 antagonist

Nausea and vomiting

NK 1 antagonist

Cisplatin induced delayed vomiting

Granisetron
Palonosetron
Aprepitant

Interfere Protein Synthesis

Antitubulin:
vinca alkaloids (vincristine and
vinblastin) and taxanes (paclitaxel and
docetaxel)
Bind tubulin, destroy spindle to produce
mitotic arrest
Influence amino acid supply:
L-asparaginase
.

Some Alkylating Agents used in cancer Chemotherapy

Agent

Route of
Admin.

Cancer where preferred

Delayed Toxicity

1. Busulphan

Oral

CML, PV

BMD, bleeding, skin

pigmentation adrenal
insufficiency, pulmonary
fibrosis

2. chlorambucil

Oral

CLL, PV

BMD, bleeding

3.
Cyclophosphamide

Oral, i.v

All, NHL, PV, Carcinoid

tumour, Neurobalstoma

BMD, bleeding,
hemorrhagic, cystitis

4. Melphalan

Oral

Multiple myeloma

BMD, Bleeding

5. Mechlorethamine

i.v.

Hodgkins disease

BMD, alopecia, Diarrhea

oral ulcer leukaemia

6. Cisplatin

i.v.

CA tests, ovary, cervix, lung,

head & neck, thyroid,
Melanoma

Renal damage, ototoxicity,

neuropathy, BMD

7. Dacarbazine

i.v.

Melanoma, Hodgkins disease

BMD

8. Carmustine
(BCNU)

i.v.

Brain tumours

Leukopaenia,
thrombocytopaenia

9. Lomustine
(CCNU)

Oral

Brain tumours

Leukopaenia,
thrombocytopaenia

10. Thiotepa

i.v.

CA bladder (early) & Ovary

BMD

Tyrosine Kinase Inhibitors

Drug

Inhibit TK activated

Indication

Axitinib

VEGFR 1,2,3

Advanced renal cell carcinoma

Bosutinib

Abl bcr, src

CML

Crizotinib

c-MET, ALK

Non small cell lung carcinoma

Cabozantinib

c-MET, VEGFR-2

Medullary carcinoma thyroid

Dasatinib

abl -bcr

CML

Erlotinib

EGFR

Non small cell lung carcinoma

Pancreatic carcinoma

Geftinib

abl-bcr, c- KIT, PDGF

Non small cell lung carcinoma

Imatinib

her-2/neu, erb-B2

CML GIST

Lapatinib

abl-bcr

Breast carcinoma

Nilotinib

VEGFR-1,2,3 PDGFR
c-KIT

CML

Pazopanib

abl-bcr

Advanced renal cell carcinoma

Tyrosine Kinase Inhibitors

Drug

Inhibit TK activated

Indication

Regorafenib

VDGFR2, TIE2

Colorectal carcinoma GIST

Ruxolitinib

JAK 1,2

Myelofibrosis

Sorafenib

VEGFR, PDGFR RAF

Renal cell carcinoma

Hepatocellular carcinoma

Sunitinib

VEGFR, PDGFR c- KIT, FLT-3 RET

Renal cell carcinoma,

Pancreatic neuroendocrine
tumors GIST

Tofacitinib

JAK

Rheumatoid arthritis

Vandetanib

VEGFR, EGFR

Medullary carcinoma
thyroid

Vemurafenib

BRAF

Maliganant melaonma

Monoclonal Antibodies
S.
No.

Monoclonal antibody

Targeted
against

Indication

Comments

Rituximab

CD - 20

Non hodgkin lymphoma

Alemtuzumab

CD - 52

Low grade lymphomas and

CLL

Trastuzumab

HER 2/neu

Breast Carcinoma

Can cause
cardiotoxicity

Cetuximab and
panitumumab

EGFR

EGFR positive metastatic

colorectal carcinoma

Cause rash,
Hypomagnesemia and
tnterstitial lung
disease

Bevacizumab

VEGF

Metastatic colorectal
carcinoma

Combined with 5 - FU

Gemtuzumab

CD-33

CD-33 Positive AML

Linked to
calicheamicin

I131 Tositumomab
Y90 Ibritumomab
tiuxetan

CD-20

Relapsed lymphomas

Conjugated with
radioisotopes

Denileukin diftitox

Recurrentcutaneous T-cell
lymphoma

Recombinant IL 2
plus diphtheria toxin

Therapy of choice for various cancers

S. No.

Diagnosis

Treatment of choice

All

Induction: Vincristine + Prednisolone+Daunorubicin+

Asparaginase+Intrathecal Methotrexate
Consolidation: Hyper-CVAD alternated with
cytarabine+Methotrexate

AML

Cytarabine+Daunorubicin/Idarubicin

CML

Imatinib

CLL

FCR or Fludarabine

Hairy cell leukemia

Cladribine

Hodgkin disease

ABVD

Non hodgkin
lymphoma

CHOP-R

Multiple Myeloma

Bortezomib+Dexamethasone+Lenalidomide

Waldenstrom
macroglobulinemia

FCR

10

Polycthemia vera

Hydroxyurea

Therapy of choice for various cancers

S. No.

Diagnosis

Treatment of choice

11

Non small cell lung

cancer

Cisplatin + Vinorelbine Bevacizumab

12

Small cell lung

cancer

Cisplatin + Etoposide

13

Mesothelioma

Cisplatin + Pemetrexed

14

Head and neck cancer Cisplatin + 5-FU

Some antimetabolites used in cancer chemotherapy

Agent

Route
of
admin.

Cancer (s) where

preferred

Delayed toxicity

1. Cytarabine

i.v.

AML

BMD, nausea, Vomiting

stomatitis ataxia
(cerevellar)

2. 5- Fluorouracil

i.v.

Carcinoma head &

neck, Stomach colon,
breast

BMD, Oral and GI

ulceration, nausea,
diarrhoea,
neurotoxicity, *hand
and foot syndrome

3. 6Mercaptopuine

Oral

All

BMD, Hyperuricaemia,
immunosuppression,
hepatotoxicity

4. Methotrexate

Oral

All, choriocarcinoma,
osteogenic sarcoma

BMD, vomiting, oral &

GI ulcers hepatotoxicity
(acute & chronic)

5. Thioguanine

Oral

AML

BMD, Hyperuricaemia

Some natural products in cancer chemotherapy

Agent

Cancer (s) where preferred

Delayed toxicity

Antibiotics
1. Bleomycin

Carcinoma testis, malignant

effusion (intracavity)

Alopecia, oedema of hand,

pulomonary fibrosis, stomatitis

2. Dactinomycin

Wilms tumour

Alopecia, BMD, Stomatitis, Oral

ulcer

3. Daunorubicin

AML

Alopecia, BMD, Cardiomyopathy

4. Doxorubicin

HL, NHL, neuroblastoma,

Carcinoma thyroid, stomach,
carcinoid tumouir, sarcomas,
osteogenic sarcoma

Alopecia, BMD, Cardiomyopathy,

stomatitis

5. Mitomycin

Carcinoma stomach

Thrombocytopaenia, leukopaenia

6. Streptozotocin
(sreptozocin)

Insulinoma

Renal damage, hypoglycaemia,

hyperglycaemia, liver damage,
BMD, fever eosinophilia,
nephrogenic diabetes insipidus

Some natural products in cancer chemotherapy

Agent

Cancer (s) where

preferred

Delayed toxicity

Plant Alkaloids
1. Docetaxel

Advance case of
carcinoma breast

Neurotoxicity, fluid retention,

neutropaenia

2. Etoposide

Carcinoma testis,
choriocarcinoma

Alopecia, BMD

3. Paclitaxel

Carcinoma breast, ovary

BMD, peripheral neuritis

4. Vinblastine

HD

Alopecia, BMD, Loss of reflex

5. Vincristine

ALL, NHL

Alopecia, BMD, Peripheral

neuritis

6. Vinorelbine

Carcinoma lung

BMD, fatigue, constipation,

hyporeflexia paresthesia

Miscellaneous agents including monoclonal antibodies in cancer chemotherapy

Agent

Route of admin.

Cancer(s) where used

Delayed toxicity

1. Asparaginase

i.v.

All in child

Hepatotoxicity, mental
depression,
pancreatitis

2. Cisplatin

i.v.

CA testis, ovary,
cervix, lung, head &
neck, thyroid,
melanoma

Renal damage,
otoxicity neuropathy,
BMD

3. Hydroxyurea

Oral

CML, AML (blast

crisis)

BMD

4. Mitotane

Oral

Adrenocortical
carcinoma

Adrenal insufficiency,
diarrhoea, lethargy,
skin rash (transient)

5. Mitoxantrone

Oral

Aml

BMD, cardiotoxicity,
alopecia

6. Imatinib

Oral

CML (chronic phase)

& blast crisis

Fluid retention
(periorbital and ankle
oedema), diarrhoea,
myalgia

7. Trastuzumab

i.v.

Carcinoma breast
(metaastatic)

BMD,
cardiomyopathy, pulm.
Toxicity, cardiac
failure

Hormones, their antagonists and related agents in

cancer chemotherapy
Agent

Route of admin

Cancer(s) where
preferred

Delayed toxicity

Corticosteroids
Hydrocortisone
Prednisone

Oral
Oral

All, CLL, NHL, HL

Multiple myeloma

Fluid retention,
Hypertension, diabetes
mellitus, susceptibility
to infection, moon
face

Androgens
Testosterone

i.m.

Premenopausal breast
cancer (oestrogen
receptor positive)

Fluid retention
masculinization

Oestrogens
Diethylstilboesterol

Oral
Oral

Carcinoma prostate,
Postmenopausal breast
cancer (oestrogen
receptors negative)

Feminization, Fluid
retention

i.m.
Oral

Carcinoma
endometrium

None

Ethinyloestradiol
Progestins
Hydroxyprogesterone
Medroxyprogesterone

Influence hormone
homeostasis
Estrogens and estrogen antagonistic drug
(EE, SERM-tamoxifene)
Androgens and androgen antagonistic
drug (flutamide and bicalutamide)
Progestogen drug (hydroxyprogesterone)
Glucocorticoid drug (prednisolone and
others)
Gonadotropin-releasing hormone
inhibitor: nafarelin, triptorelin
aromatase inhibitor: Letrozole and
anastrazole

Hormones, their antagonists and related agents in

cancer chemotherapy
Agent

Route of admin

Cancer(s) where
preferred

Delayed toxicity

Antiandrogen
Flutamide

Oral

Carcinoma prostate

None

Antiandrogen
Tamoxifen

Oral

Carcinoma breast
None
(early stage, metastatic
after surgery)

Others GnRH Agonist

Goserelin
Leuprolide

Carcinoma prostate

None

s.c)
s.c.)

Aromatase Nhibitors
Aminogulutethimide

Oral

Metastatic breast
cancer

None

Peptide hormone
Inhibitor

s.c.

Carcinoid tumour

None

Choice of drug in some malignancies where the response of chemotherapy is very

good
Cancer

Treatment of choice

1. Acute lymphocytic leukaemia

Induction: Vincristine + presnisone

Maintenance: Methotrexate + Mercaptopurine +
Cyclophosphamide

2. Hodgkins disease stage I and II

Stage III and IV

Radiotherapy
Doxorubicin +
bleomycin+vinblastine+dacarbazine

3. Non Hodgkins disease

Cyclophosphamide + doxorubicin + vincristine +

prednisolone

4. Choriocarcinoma

Methotrexate + folic acid or cisplatin + etoposide

5. Cancer testis

Bleomycin + cisplatin+ etoposide

6. Wilms tumour

Surgery + radiotherapy followed by vincristine +

dactinomycin

Choice of drug in some malignancies where the

response
of
chemotherapy
is
good
Cancer
Treatment of choice

1. Acute myeloid leukaemia

Cytarabine + idarubicin/daunorubicin

2. Chronic lymphocytic
leukaemia

Chlorambucil + prednisone (if indicated) +

fludarabine or cytarabine alone or in combination
with other drugs

3. Chronic myelogenous
leukaemia

Busulfan or interferon, imatinib (bone marrow

transplatation in selected patients)

4. Multiple myeloma

Melphalan + prednisone

5. * Carcinoma breast stage 1

Tomoxifen after breast surgery

6. Endometrial carcinoma

Progestins or tamoxifen

7. Carcinoma cervix

Radiation + cisplatin (localized),

cisplatin/carboplatin (metastatic)

8. Carcinoma prostate

GnRh agonist or oestrogen + androgen anatagonist

(flutamide)

Choice of drug in some malignancies where the

response of chemotherapy is average
Cancer

Treatment of choice

1. Carcinoma breast stage II to

IV

Cyclophosphamide + methotrexate + 5-FU or

Transtuzumab + prednisone + antioestrogen

2. Carcinoma ovary

Cisplatin or carboplatin + paclitaxel + interferom

3. Carcinoma thyroid

Radioidine (I131), doxorubicin, cisplatin

4. Carcinoma stomach

5-FU + doxorubicin + mitomycin

5. Carcinoma colon

5-FU + leucovorin + irinotecan

6. Osteogenic sarcoma

Doxorubicin or methotrexate with leucovorin after

surgery

7. Melanoma

Dacarbazine, cisplatin, interferon

Choice of drug in some malignancies where the

response of chemotherapy in unsatisfactory
Cancer

Treatment of choice

1. Carcinoma lung

Etopise + cisplatin, vinorelbine

2. Carcinoma head and

neck

5-fu+cisplatin or cisplatin + paclitaxel

3. Carcinoma adrenal
gland

Mitotane

4. Carcinoid tumour

Doxorubicin + cyclophospamide or 5FU + octreotide

5. Polycythaemia vera

Busulfan, chlorambucil or
cyclophospamide

Alkylating Agents
Mechanism of Action:
Nitrogen mustards inhibit cell reproduction
binding irreversibly nucleic acids (DNA)
After alkylation, DNA is unable to replicate
no synthesize proteins and essential cell
metabolites
Consequently, cell reproduction inhibited cell
eventually dies inability maintain metabolic
functions.

Nitrogen Mustards
Mechlorethamine:
Uses: IV
MOPP (Mechlorethamine oncovine-prednisolone and
procarbazine) in Hodgekin`s lymphoma and disease
ADRs: Severe Vomiting, myelo and immunosuppression
Extravasation severe local toxicity

Cycolphosphamide:
Transformed active aldophosphamide and
phospharamide
orally
Used Hodgkin's lymphoma, breast and ovary cancers
Ifosphamide longer half life and used mainly testicular
tumour

Nitrogen Mustards contd.

Chlorambucil: orally, active against
lymphoid tissues (Ch. Lymphatic leukaemia
and non-Hodgkin's lymphoma)
Busulfan: orally, active against CML
Carmustine: IV, effective against brain
tumors and Hodgkin's lymphoma
Dacarbazine: Different from other alkylating
agents action against RNA and protein
synthesis
Used Melanoma and Hodgkin's lymphoma

Antimetabolites
Folic acid Antagonists: MTX
Purine Antagonists: 6MP and 6TG
Pyrimidine
Antagonists:
5FU
cytarabine

and

General Characteristics:
Antimetabolites S phase-specific drugs
structural analogues of essential metabolites and
that interfere with DNA synthesis.
Myelosuppression dose-limiting toxicity

Methotrexate Folate
Antagonist
MOA:
Structures MTX and folic acid similar
MTX actively transported mammalian cells and
inhibits dihydrofolate reductase
the enzyme that normally converts dietary folate
to the tetrahydrofolate form required for thymidine
and purine synthesis

Leucovorin rescue:
Administered as a plan in MTX therapy
Leucovorin (Folinic acid) is directly converted to
tetrahydrofolic acid - production of DNA cellular
protein inspite of presence of MTX
Used to rescue bone marrow and GIT mucosal cells

Methotrexate contd.
Kinetics:
orally/IM /IV intrathecally
absorption
CSF entry - intrathecal
Indications:

good

oral

Choriocarinoma - was the first demonstration of curative

chemotherapy
Tumors of head and neck
Breast cancer
Acue lymphatic leukemia
Meningeal metastases of a wide range of tumors

Purine Antagonists 6MP,

6TG
6-Mercapapurine (6-MP) and others
Exact mechanisms uncertain inhibit
purine base synthesis
Used in childhood Acute lymphatic
Leukaemia for maintenance and remission
combination MTX choriocarcinoma
Metabolized xanthine oxidase (inhibited
by allopurinol) and allopurinol dose has to
be adjusted to or 1/4th
Well tolerated, mild myelosuppression ,
hepatotoxicity on long term administration

Antimetabolites (Pyrimidine
Antagonists) - 5 FU
MOA:
Fluorouracil analogue of thymine
Converted to 5-fluoro-2deoxy-uridine
monophosphate (5-FdUMP)
5-FdUMP inhibits thymidylate synthase and
blocks conversion of deoxyuridilic acid to
deoxythymidylic acid failure of DNA
synthesis

Indications: solid tumors, especially

breast, colorectal, and gastric tumors
and squamous cell tumors of the head
and neck

Antibiotics
Anthracyclines (doxorubicin and dau norubicin),
Dactinomycin, Bleomycin, and mitomycin
Anthracyclines:
Enters themselves into DNA and causes DNA break
Activates TopoisomeraseII and cause break in DNA
strands
Generates excess free radicals causing production of
superoxide damage to DNA
Known to damage cardiac cells also (unique)
Resistance developes due to increased eflux of drug
Uses: Doxo- Breast, ovary, lung, [prostate and acute
lymphatic leukaemia
Dauno- ALL and AML

1. Which of the following is a radioprotector?

a. Colony stimulating factor
b. Amifostine
c. Cisplatin
d. Methotrexate
(b)
2. Topical mitomycin-C is used in
a. Sturge-Weber syndrome
b. Laryngotracheal stenosis
c. Endoscopic angiofibroma
d. Skull base osteomyelitis
(b)

3. Which group of anticancer drugs Temozolomide belong to

a. Oral alkylating agent
b. Antitumor Antibiotic
c. Antimetabolite
d. Mitotic Spindle Inhibitor
(a)
4. Methotrexate is used for the management of all of these conditions except
a. Rheumatoid arthritis
b. Psoriasis
c. Sickle cell anemia
d. Organ transplantation
(c)

5. Which of the following drug is used for the is treatment of sickle cell anemia?
a.Hydroxyurea
b. Cisplatin
c. Paclitaxel
d. Carboplatin
(a)
6. Use of tamoxifen in carcinoma of breast patients does not lead to the following
side effects
a. Thromboembolic events
b. Endometrial carcinoma
c. Cataract
d. Cancer in opposite breast
(d)

7. All of the following are true regarding ifosfamide EXCEPT

a. Metabolised by cytochrome p450 enzymes
b. Less neurotoxic than cyclophosphamide
c. Chloracetaldehyde is the metabolite of ifosfamide
d. It is a nitrogen mustard
(b)
8. Alkalinisation of urine ameliorates the toxicity of which of the following drugs?
a. Arabinoside-cytosine
b. Ifosfamide
c. Cisplatin
d. Methotrexate
(d)

11. Pulmonary fibrosis is seen with

a. Bleomycin
b. Cisplatin
c. Methotrexate
d. Actinomycin D
(a)
12. Which of the following drug is used in the treatment of estrogen
dependent breast carcinoma?
a. Tamoxifen
b. Methotrexate
c. Paclitaxel
d. Adriamycin (a)

13. Methotrexate resistance is due to:

a. Depletion of Folate
b. Overproduction of DHFRase
c. Overproduction of Thymidylate kinase
d. Decreased DHFRase
(b)
14. Hemorrhagic cystitis is caused by
a. Cyclophosphamide
b. 6 Mercaptopurine
c. 5 Fluorouracil
d. Busulfan
(a)

15. Thalidomide is used in all of the following except

a. HIV associated peripheral neuropathy
b. HIV associated aphthous (mouth) ulcers
c. Behcet syndrome
d. Erythema Nodosum Leprosum
(a)
16. Most common dose-limiting toxicity of cancer chemotherapy is
a. Gastrointestinal toxicity
b. Neurotoxicity
c. Bone marrow suppression
d. Nephrotoxicity
(c)

17. Which of the following parameters is not monitored in a patient on methotrexate

therapy?
a. Liver function tests
b. Lung function test
c. Eye examination
d. Hemogramz
(c)
18. All of the following are true about thalidomide except
a. Used in pregnancy as anti-emetic but withdrawn due to teratogenicity
b. Can be used in multiple myeloma as primary treatment as well as in refractory disease
c. Causes euphoria and diarrhea
d. Can be used in erythema nodosum leprosum
(c)

19. Which of the following drug acts by inhibiting tyrosine kinase activated by
EGF receptor as well as HER2?
a. Imatinib
b. Geftinib
c. Erlotinib
d. Lapatinib
(d)
20. Tyrosine kinase inhibitors are first line treatment in
a. Gastrointestinal stromal tumors
b. Receptor mediated neuroendocrine tumors
c. Breast cancer
d. Renal cell carcinoma
(a)

 21. Drug locally used for tracheal stenosis is

a. Mitomycin C
b. Doxorubicin
c. Bleomycin
d. Clindamycin
(a)
22. Cetuximab (an EGFR antagonist) can be used in
a. Palliation in head and neck cancer
b. Anal canal carcinoma
c. Gastric carcinoma
d. Lung carcinoma
(a)

23. Most emetogenic anticancer drug is

a. Cisplatin
b. Carboplatin
c. High dose cyclophosphamide
d. High dose methotrexate
(a)
24. Cerebellar toxicity is seen with
a. Cisplatin
b. Cytarabine
c. Bleomycin
d. Actinomycin D
(b)

25. All are alkylating agents, except

a. 5-Fluorouracil
b. Melphalan
c. Cyclophosphamide
d. Chlorambucil
(a)
26. Which of the following can be given orally?
a. Cytosine arabinoside
b. Cisplatin
c. Doxorubicin
d. Mesna
(d)

27. In treatment of osteosarcoma, all of the following are used EXCEPT

a. High dose methotrexate
b. Cyclophosphamide
c. Vincristine
d. Doxorubicin
(c)
28. 'Hand and Foot' syndrome can be caused by
a. Cisplatin
b. Vincristine
c. Capecitabine
d. Mitomycin-C
(c)

29. Which of the following anti-cancer drugs is cell cycle specific?

a. Ifosfamide
b. Melphalan
c. Vinblastine
d. Cyclophosphamide
(c)
30. Topical mitomycin-C is used in
a. Sturge-Weber syndrome
b. Laryngotracheal stenosis
c. Endoscopic angiofibroma
d. Skull base osteomyelitis
(b)

31. Amifostine is protective to all EXCEPT

a. Salivary glands
b. Skin
c. CNS
d. GIT
(c)
32. Bleomycin toxicity affects which type of cells
a. Type-I pneumocytes
b. Type-II pneumocytes
c. Endothelial cells
d. Pulmonary alveolar macrophages
(b)

33. SIADH is caused by all EXCEPT

a. Vincristine
b. Vinblastine
c. Actinomycin D
d. Cyclophosphamide
(c)
34. Imatinib is used in the treatment of?
a. Chronic myelomonocytic leukemia
b. Myelodysplastic syndrome
c. Acute lymphoid leukemia
d. Gastro intestinal stromal tumors
(d)

35. Sustained neutropenia is seen with?

a. Vinblastine
b. Cisplatin
c. Carmustine
d. Cyclophosphamide
(c)
36. Rituximab is used in all EXCEPT
a. Non Hodgkin lymphoma
b. Paroxysomal nocturnal hemoglobinurea
c. Rheumatoid arthritis
d. Systemic lupus erythematosis
(b)

39. Which of the following anticancer drug is excreted by lungs?

a. 5-Fluorouracil
b. Cyclophosphamide
c. Doxorubicin
d. Cisplatin
(a)
40. Which of the following drugs is used for the treatment of refractoty
histiocytosis?
a. High dose methotrexate
b. High dose cytarabine
c. Cladribine
d. Fludarabine
(c)

41. Thalidomide, used for multiple myeloma, is

a. Associated with diarrhea
b. Characterized by enantiomeric intercon-versions
c. Metabolized extensively by hepatic CYP system
d. Safe for use in pregnant females
(b)
42. A patient on treatment for leukemia, develops chest pain, pulmonary infiltrates
and pleural effusion. The likely causeis.
a. Daunorubicin
b. Hydroxyurea
c. Cytarabine
d. Tretinoin
(d)

43. Mechanism of action of paclitaxel is

a. Topoisomerase inhibition
b. Increases the polymerization of tubulin
c. Inhibits protein synthesis
d. Alkylation of DNA
(b)
44. Which antineoplastic drug is a peptide?
a. Bleomycin
b. Asparteme
c. Valinomycin
d. Dactinomycin
(a)

45. Leucovorin is used to decrease the toxicity of

a. Methotrexate
b. Mercaptopurine
c. Thio-TEPA
d. Cytosine arabinoside
(a)
46. All-trans-retinoic acid is used in treatment of
a. Acute promyelocytic leukemia
b. A.L.L.
c. CML
d. Transient myeloproliferative disorder
(a)

47. Treatment of choice for chronic myeloid leukemia is

a. Imatinib
b. Hydroxyl-urea
c. Interferon-alpha
d. Cytarabine
(a)
48. Which of the following anticancer drugs can cause hypercoagulable state?
a. 5-FU
b. L-asparaginase
c. Melphalan
d. Carmustine
(b)

49. Anticancer drug causing SIADH as an adverse effect is

a. Vincristine
b. Paclitaxel
c. Dacarbazine
d. Cyclophosphamide
(a)
50. Which of the following anticancer drugs acts by hypomethylation?
a. Gemcitabine
b. 5-FU
c. Decitabine
d. Homoharringotonine
(c)

51. High dose methotrexate is used for the treatment of

a. Osteosarcoma
b. Rhabdomyosarcoma
c. Retinoblastoma
d. Ewing's sarcoma
(a)
52. Which of the following drugs is topoisomerase 1 inhibitor?
a. Doxorubicin
b. Irinotecan
c. Etoposide
d. Vincristine
(b)

53. All of the following anticancer agents cause bone marrow suppression
EXCEPT
a. Chlorambucil
b. Daunorubicin
c. Doxorubicin
d. Flutamide
(d)
54. All the following are hormonal agents used against breast cancer EXCEPT
a. Letrozole
b. Exemestane
c. Taxol
d. Tamoxifen
(c)

55. Which is the most active single chemotherapeutic agent in the treatment of
leiomyosarcoma?
a. Adriamycin
b. Daunorubicin
c. Methotrexate
d. Cisplatin
(a)
56. Gemcitabine is effective in
a. Head and neck cancers
b. Pancreatic cancer
c. Small-cell lung cancer
d. Soft tissue sarcoma
(b)

57. All of the following statements about methotrexate are correct EXCEPT
a. Folinic acid enhances the action of methotrexate
b. Methotrexate inhibits dihydrofolate reductase
c. Non-proliferative cells are resistant to methotrexate
d. Methotrexate is used in the treatment of psoriasis
(a)
58. Mesna is given with cyclophosphamide to
a. Increase absorption
b. Decreased excretion
c. Ameliorate hemorrhagic cystitis
d. Decrease metabolism
(c)

59. A 35 yr old patient is having carcinoma lung with a past history of lung
disease. Which of the following drugs should not be given?
a. Vinblastine
b. Bleomycin
c. Mithramycin
d. Adriamycin
(b)
60. Arsenic is useful in the treatment of
a. Acute promyelocytic leukemia
b. Myelodysplastic syndrome
c. Transient myeloproliferative disorder
d. All of the above
(a)

61. Which of the following is an anti-metabolite?

a. Methotrexate
b. Cyclosporine
c. Etoposide
d. Vinblastine
(a)
62. Mechanism of action of imatinib mesylate is
a. Increase in metabolism of P glycoprotein
b. Blocking the action of P glycoprotein
c. Blocks the action of chimeric fusion protein of bcrabl
d. Non-competitive inhibition of ATP binding site
(c)

63. Which of the following drugs is associated with untoward side effect of renal tubular
damage?
a. Cisplatin
b. Streptozocin
c. Methysergide
d. Cyclophosphamide
(a)
64. Which of the following chemotherapeutic agents is associated with secondary
leukemia?
a. Vinblastine
b. Paclitaxel
c. Cisplatin
d. Bleomycin
(c)

65. The drug imatinib acts by the inhibition of

a. Tyrosine kinase
b. Glutathione reductase
c. Thymidylate synthetase
d. Protein kinase
(a)
66. The new drug pemetrexed useful in breast cancer belongs to which of the
following category of the drugs?
a. Antitumor agent
b. Alkylating agent
c. Hormonal agent
d. Antimetabolite
(d)

71. Sodium 2-mercapto ethane sulfonate is used as a protective agent in

a. Radiotherapy
b. Cancer chemotherapy
c. Lithotripsy
d. Hepatic encephalopathy
(b)
72. Pulmonary fibrosis is a common complication after treatment with
a. 6-Mercaptopurine
b. Vincristine
c. Bleomycin
d. Adriamycin
(c)

73. A patient receiving allopurinol requires dose reduction of

a. 6-Meracaptopurine
b. Cyclophosphamide
c. 6-Thioguanine
d. Climetidine
(a)
74. Which of the following are alkylating agents?
a. Cyclophosphamide
b. Ifosfamide
c. Methotrexate
d. Vincristine
(a)

75. Anticancer drugs of plant origin is/are

a. Vincristine
b. Isotretinoin
c. Bleomycin
d. Methotrexate
(a, b)
76. Alkylating agents are
a. Vincristine
b. Actinomycin-D
c. Chlorambucil
d. 5-Fluorouracil
e. Cyclophosphamide
(c, e)

77. Which of the following drugs are anticancer antibiotics?

a. Vancomycin
b. Actinomycin D
c. Bleomycin
d. Mithramycin
e. Vincristine
(b, c, d)
78. Metaphase arrest is caused by
a. Griseofulvin
b. Vincristine
c. Paclitaxel
d. Colchicine
e. Etoposide
(b, c, d)

79. The mechanism of anticancer action of fluorouracil is

a. Cross linking of double stranded DNA and the resulting inhibition of DNA
replication and transcription
b. Cytotoxicity resulting from a metabolite that interferes with the production of dTMP
c. Irreversible inhibition of dihydrofolic acid reductase
d. Selective action on DNA polymerase
(b)
80. A cell cycle specific anticancer drug that acts mainly in the M phase of the cycle is
a. Cisplatin
b. Etoposide
c. Methotrexate
d. Paclitaxel
(d)

81. Maintenance of high urinary pH is important during methotrexate treatment

because
a. Bladder irritation is reduced
b. It decreases renal tubular secretion of methotrexate
c. Leucovorin toxicity is increased in a dehydrated patient
d. Methotrexate is a weak acid
(d)
82. All of the following statements about methotrexate are true Except
a. It is cell cycle specific and kills in the S phase
b. Its toxicity primarily affects bone marrow and epithelial structures
c. Folic acid reverses its toxic effects
d. It is the drugs of choice for choriocarcinoma
(c)

83. Mechanism of action of vincristine in the treatment of All is

a. Inhibition of topoisomerase II to cause breaks in DNA strands
b. Alkylation and cross linking DNA strands
c. Inhibition of DNA mediated RNA synthesis
d. Inhibition of polymerization of tubulin to form microtubules
(d)
84. All of the following statements about vincristine are true EXCEPT
a. It acts by inhibiting mitosis
b. Its prominent adverse effect is peripheral neuropathy
c. It does not suppress bone marrow
d. It is a drug of choice for solid tumors
(d)

85. All of following statements about are true about mercaptopurine EXCEPT
a. It is metabolized by xanthine oxidase
b. It does not cause hyperuricemia
c. Its dose should be reduced when allopurinol is given concurrently
d. It is an active metabolite of azathioprine
(b)
86. Which of the following immunosuppressants is not used for the treatment of
cancers?
a. Cyclophosphamide
b. Cyclosporine
c. Methotrexate
d. 6-Mercaptopurine
(b)

87. Which of the following drugs is not used in prostate carcinoma?

a. Finasteride
b. Diethylstilbesterol
c. Testosterone
d. Flutamide
(c)
88. Pentostatin acts by inhibiting
a. RNA dependent DNA polymerase
b. Aldolase
c. Adenosine deaminase
d. Adenylyl cyclase
(c)

89. Hand and foot syndrome is an adverse effect of

a. 5-Fluorouracil
b. Bleomycin
c. Etoposide
d. Actinomycin D
(a)
90. Side effects of cisplatin include all of the following EXCEPT
a. Nausea and vomiting
b. Nephrotoxicity
c. Blindness
d. Ototoxicity
(c)

91. Most common side effect of 5-fluoracil is

a. G.I. toxicity
b. Bone marrow depression
c. Cardiotoxicity
d. Neurotoxicity
(a)
92. Sterility is caused by
a. Vinca alkaloids
b. Alkylating agents
c. Antimetabolites
d.Actinomycin Ds
(b)

99. Neoadjuvant chemotherapy is used in all except

a. Esophageal carcinoma
b. Breast carcinoma
c. Thyroid carcinoma
d. Non- small cell carcinoma of lung
(c)
100.Which of the following anticancer drugs can cross blood brain barrier?
a. Cisplatin
b. Nitrosourea
c. Vincristine
d. Vinblastine
(b)

101. Which of the following drugs produce significant nephrotoxicity?

a. Cisplatin
b. Carboplatin
c. Vinblastine
d. Vincristine
(a)
102. Phocomelia is due to teratogenic effects of
a. Thailidomide
b. Chlopromazine
c. Methotrexate
d. Carbamzepine
(a)

103. Folinic acid counteracts the toxicity of

a. Doxorubicin
b. Methotrexate
c. Cyclophosphamide
d. Fluorouracil
(b)
104. Which of the following antineoplastic and immunosuppressant drugs is a
dihydrofolate reductase inhibitor?
a. Methotrexate
b. Adriamycin
c. Vincristine
d. Cyclophosphamide
(a)

105. Toxicity of nitrogen mustards can be decreased by

a. Amifostine
b. Folinic acid
c. GM-CSF
d. MESNA
(c)
106. Which one of the following alkaloids is used as anticancer agent?
a. Vincristine
b. Papaverine
c. Ephedrine
d. Atropine
(a)

107. The antimalignancy drug which is potentially cardiotoxic is

a. Doxorubicin
b. Bleomycin
c. Fluorouracil
d. Dacarbazine
(a)
108. The drug of choice in choricarcinoma is
a. Methotrexate
b. Actinomycin D
c. Vincristine
d. 6-thioguanine
(a)

109. Stocking and glove neuropathy is seen in

a. Vinblastine
b. Paclitaxel
c. Etoposide
d. Mitroxantrone
(b)
110Drug that is radioprotective is
a. Paclitaxel
b. Vincristine
c. Etoposide
d. Amifostine
(d)

111. Hemorrhagic cystitis is caused by

a. Cyclophosphamide
b. Ifosfamide
c. Vincristine
d. Adriamycin
(b)
112. Which of the following anti-cancer drug is cell cycle specific?
a. Cyclophosphamide
b. Vincristine
c. Nitrogen mustard
d. Doxourubicin
(b)

113. Which of the following anticancer drug is not S-phase specific?

a. Methotrexate
b. Meracaptopurine
c. Ifosfamide
d. Thiouanine
(c)
114. All are alkylating agents except
a. Cyclophosphamide
b. Lomustine
c. Busulfan
d. Zalcitabine
(d)

115. Chemotherapy is not useful in

a. Chondrosarcoma
b. Wilms tumor
c. Choriocarcinoma
d. All
(a)
116. Cisplatin does not cause
a. Cardiomyopathy
b. Nephrotoxicity
c. Neuropathy
d. Tinnitus
(a)

117. Cyclophosphamide can cause

a. Hemorrhagic cystitis
b. Cardiomyopathy
c. Neuropathy
d. Convulsions
(a)
118. Which of the following is not an early adverse effect of methotrexate?
a. Hepatic fibrosis
b. Myelosupression
c. Nausea
d. Stomatitis
(a)

119. Which of the following is not an antineoplastic antibiotic?

a. Actinomycin D
b. Doxorubicin
c. Bleomycin
d. Spiramycin
(d)
120. All cause myelosuppression except
a. Docetaxel vincristine
b. Vincristine
c. Methotrexate
d. Irrnotecan
(b)

121. Leucovorin rescue is related to

a. Methotrexate toxicity
b. Cyclophosphamide toxicity
c. Oncovin toxicity
d. Cisplatin toxicity
(a)
122. Which of the following causes peripheral neuritis?
a. Methotrexete
b. Vincristine
c. Busulfan
d. Cyclophosphamide
(b)

123. The drug of choice for chronic myeloid leukemia, is

a. Chlorambucil
b. Busulfan
c. Vincristine
d. Procarbazine
(b)
124. Proliferation independent agents include all the following except
a. Vincristine
b. Carmustine
c. Melphalan
d. Cyclophosphamide
(a)

125. People with high risk for development of breast cancer should be treated by
prophylactic admini-stration of
a. Tamoxifen
b. Aminoglutethimide
c. Diethyistibesterol
d. Flutamide
(a)
126. Which of the following is widely used in the management of carcinoma breast?
a. Actinomycin D
b. Bleomycin
c. Doxorubicin
d. Dacarbazine
(c)

127. Rituximab is used in

a. Hodgkin,s disease
b. Acute myeloid leukemia
c. Non-Hodgkin lymphoma
d. Multiple myeloma
(c)
128. Allopurinol potentiates action of
a. Azathioprine
b. Busulfan
c. Actinomycin
d. Procarbazine
(a)

129. Alkylating agengts include

a. Doxorubicin
b. Cholorambucil
c. Vinblastine
d. Busulfan
e. Methotrexate
(b, d)

69. Sterile hemorrhagic cystitis is caused by

a. Busulfan
b. Ketoprofen
c. Methicillin
d. Cyclophosphamide
(d)
70. A 50 year old woman, Hema has been diagnosed with locally advanced breast cancer
and recommended for chemotherapy. She has five years history of myocardial infarction
and congestive heart failure. Which antineoplastic drug should be best avoided?
a. Anthracycline
b. Alkylating agent
c. Platinum compound
d. Bisphosphonates
(a)

67. Which of the following statements is FALSE regarding vincristine?

a. It is an alkaloid
b. Its use is associated with neurotoxicity
c. It does not cause alopecia
d. It is a useful drug for induction of remission in acute lymphoblastic leukemia
(c)
68. A patient with cancer developed extreme degree of radiation toxicity. Further history
revealed that the dose adjustment of a particular drug was missed during the course of
radiotherapy. Which of the following drugs required a dose adjustment during
radiotherapy in order to prevent radiation toxicity?
a. Vincristine
b. Dactinomycin
c. Cyclophosphamide
d. 6- Mercaptopurine
(b)

37. Ifosfamide belongs to which group of anticancer drugs?

a. Alkylating agents
b. Antimetabolites
c. Mitotic inhibitors
d. Topoisomerase inhibitors
(a)
38. A 56 year old female presented with breast carcinoma and she was prescribed
herceptin (trastuzumab). Which of the following statements regarding this drug is
true?
a. It is an antibody produced entirely from mouse containing no human component.
b. It is a monoclonal antibody produced by injecting her-2 antigen
c. It is a polyclonal antibody
d. It is a monoclonal antibody containing only human component
(b)

93. Which of the following is a common side effect of cisplatin

a. Diarrhea
b. Vomiting
c. Pulmonary fibrosis
d. Alopecia
(b)
94. The antimetabolite X inhibits DNA polymerse and is one of the most active drugs in the
treatment of leukemia. Although myelo-suppression is done limiting, the drug may also
cause cerebellar dysfunction, including ataxia and dysarthria. Which of the following can
be X?
a. Bleomycin
b. Cytarabine
c. Mercaptopurine
d. Methotrexate
(b)

95. Which of the following antineoplastic drugs should not be administered to a chronic
alcoholic patient due to risk of development of disulfiram like reaction?
a. Dacarbazine
b. Procarbazine
c. Melphalan
d. Hydroxyurea
(b)
96 Roopa devi, a 65 year old female with overian cancer is being treated with cisplatin based
chemotherapy. All of the following are used to limit the toxicity of cisplatin except
a. N-acetylcysteine
b. Slow rate of infusion
c. Chloride dieresis
d. Amifostine
(a)

97. Roopmati, A 56 year old femal with lymph node positive breast cancer was treated with systemic
chemotherapy. Four weeks later, she developed frequent urination, suprapublic pain, dysuria and
hematuria. Which of the following could have prevented this patients condition?
a. Folinic acid
b. Mesna
c. Dexazoxane
d. Amifostine
(b)
98. Sunder, a ypung male was diagnosed as suffering from acute myeloid leukemia. He was started on
induction chemotherapy with doxorubicin based regiments. Induction regimen was successful. Two
months later, he presents to opd with swelling of both the feet and breathlessness on climbing the stairs.
He also complains the he had to wake up many times because of breathlessness. Which of the following is
most likely responsible for this patients symptoms?
a. Restrictive cardiomyopathy
b. Hypertrophic cardiomyopathy
c. Dilated cardiomyopathy
d. Pericardial fibrosis
(c)

 It is important to remember that antimetabolites such as

cytarabine, 5-FU do not cause acute toxicity
Most of the hormones and hormone antagonist do not
cause acute toxicity
All alkylating agents such as chlorambucil
cyclophosphamide, melphalan etc cause nausea and
vomiting as acute toxicity.
Most of the natural products such bleomycin vincristine
and vinbalstine etc used for cancer chrmotherapy cause
nausea and vomiting as acute toxicity

Substances used to reduce the toxicity of anticancer drugs

1. Leukovorin/citrovorum factor folinic acid
2. Xanthine oxidase inhibitor allopurinol
3. Colony stimulating factor for Neutrophils filgrastim &
sargramostim, For RBCs darbopoetin &
erythropoietin.
4. Thiophosphate cytoprotectants amifostine
5. Acrolein conjugator, mesna, acetylcysteine
6. Iron chelator, Dexrazoxane
7. Thrombopoietic factor, Oprelvekin, Thrombopoietin.

thanks