Week 9 Chap. 36

• Cell cycle specific
• G₁ phase: Post mitotic gap - production of enzyme for DNA synthesis
• S phase: synthesis - the DNA doubles
• G₂ phase: premitotic gap - RNA synthesis for later mitosis
• M phase: Mitosis - cell division produces tow identical cells
• G₀ phase: resting - cells remain in this phase or return to the cycle for replication

• Cell cycle non specific
• work best in the G₀ resting stage to disrupt cancer cells

• cause cross-linking of DNA strands, abnormal base pairing, or DNA strand breaks, thus preventing the cell from dividing.
• Kill cells in various and multiple phases of cell cycle.
• Most effective in G₀ phase.
• Affective against leukemias, lymphomas, multiple myeloma, solid tumors (breast, ovary, uterus, lung, bladder, and stomach)
• Includes: Mustard gas derivatives, ethylenimines, alkylsulfonates, hydrazines and triazines, nitrosoureas, metal salts.
• Comon side effects are: N&V, hemorrhagic cyxtitis, alopecia, anemia, leukopenia, thrombocytopenia, bone marrow suppression (anemia, leukopenia, thrombocytopenia), secondary malignancies, sterility.

• disrupt metabolic processes and can inhibit enzyme synthesis.
• CCS, exert effects in the S phase (DNA synthesis and metabolism) of the cell cycle
• Include: folic acid antagonists, pyrimidine antagonists, purine antagonists, adenosine deaminase inhibitors.
• Used to treat acute leukemia, brest cancer, head and nect cancer, lung cancer, osteosarcome, and non-hodkins lymphoma
• %-FU and flosuridine are considered CCNS as well as CCS
• General side effects: bone marrow suppression (anemia, leukopenia, thrombocytopenia), stomatitis, N&V, alopecia, hepatic and renal dysfunction.
• Stomititis is an early sign of toxicity and should be reported to the physician.

• Inhibit protein and RNA synthesis and bind DNa, causing fragmentation.
• Classified as CCNS drugs (Bleomycin is an exception and acts on the G₂
• Used for many cancers including leukemia, and many solid tumors.
• Adverse Reactions:alopecia, N&V, stomatitis, leukopenia, and thrombocytopenia. Capable of causing vesication (blistering of tissue).
• Lifetime does on bleomycin is 400units/m²

• Derived from natural products that are CCS and block cell division at the M phase of the cell cycle.
• Adverse Reactions:leukopenia, allergic reactions, partial to complete alopecia, constipation, N&V, diarrhea, phlebitis, Damage peripheral nerve fibers and may cause reversible or irreversible neurotoxicity (decrease in muscular strength, numbness, tingling of fingers and toes, constipation, motor instability) Loss of deep tendon reflexes, muscle weakness, joint pain and bone marrow depression.
• vincristine (Oncovin)

• anticancer drugs packaged inside synthetic fat globules called liposomes
• Fatty coating helsp the chemotherapy drug remain in system longer, decreases side effects (hair loss, N&V, cardiac tocicity,
• Increases duration of therapeutic effects

• antiinflammatory agents that suppress the inflammatory process that occurs as a result of tumor growth
• may block steroid specific receptors receptors on the surface of cells, which slows the growth fraction of the tumor
• AR: sense of euphoria, fluid retention, potassium loss, increased risk of infection, increase in blood sugar, increased fat distribution, muscle weakness, increased bleeding tendency

• Estrogen, androgen (or hormone like agents
• Slow the growth of hormone dependent tumors (prostate cancer, breast cancer)
• Estrogen therapy is a palliative treatment used to decrease the progression of breast/prostate cancer
• Progestins treat breast cancer, endometrial carcinoma, renal cancer - act by shrinking the cancer tissues - may cause fluid retention and thrombotic disorders
• Androgens treat advanced breast cancer in premenopausal women - promotes regression of tumors - may cause masculine secondary sex characteristics

Luteinizing hormone releasing hormone agonists supress the secretion of FSH and lrteinizing hormone from the pituitary gland.

• useful in treating men with hormone responsive prostate cancer that has metastasized
• bind to androgen receptors and block the effects of dihydrotestosterone on the prostate cancer cells

block the peripheral conversion of androgens to estrogens, supressing the postmenopausal synthesis of estrogen and slowint tumor growth.

• aument the natural ability of the immunie system
• Include:
• Cytokines - proteins in cells that use chemical signals to mediate immunity inflamation and hemotopoiesis, made by recomvinant DNA technology. Provide antiviral, antiproliferative and immunomodulatory effects that are used to combat cancer
• Monoclonal antibodies - agents that recognize proteins on specific cancer cells
• Vaccines - Hep B (liver cancer) HPV (cerical cancer