Chapter 39 Antineoplastic Agents Department of Pharmacology, Yunyang Medical College Lu Juan( 卢娟 )

Teaching outline TTo master the categories of antineoplastic drugs and the basic mechanisms. TTo understand the principles of combination of antineoplastic drugs, the pharmacologic actions, clinical applications and adverse reactions.

Overview Cancer incidence and treatment measures The development history of cancer chemotherapy Novel anticancer drug

1.Systemic tumor 2.Some solid tumor which have good effect to chemotherapy 3.the consolidation and adjuvant therapy as post-operation and radiotherapy 4.the palliative treatment of Late, extensive transfer and recurrent tumors 5.Neo-adjuvant chemotherapy the adaptation syndrome of antineoplastic drugs:

Five-year survival rate % Before chemotherapy post chemotherapy Choriocarcinoma 20 85~90 Malignant mole 20 >90 Acute leukemia 0 50 …

眼科检查：双眼瞳孔区可见白色反光，双眼底可见肿瘤

Pharmacological Basis

1 、 Proliferating cell population ---Targeting of therapy Rapidly growing tumors, the GF is greater, and sensitive to drugs. 2 、 Group of non-proliferating cells Including three parts of quiescent cells, no proliferation cells (already differentiated cells) and dead cells, in which quiescent cells are not sensitive to drugs is a source of tumor recurrence. composition of tumor cells : GF ( growth fraction ) Proliferating cell population Whole-cell group GF =

Cell cycle, including ： Resting (G 0 phase) Proliferating cycle: Presynthesis(G 1 phase) DNA synthesis(S phase) Premitotic(G 2 phase) Mitosis(M phase)

G 2 (19%) M(2%) S (39%) G 1 (40%) no proliferation cells Dead cells (G 0 ) Proliferating cell population sensitive to drugs. Group of non-proliferating cells a source of tumor recurrence.

一． the relationship between Cell proliferation cycle and the anti-cancer drugs

Classification of antineoplastic agents  cell cycle specific agents, CCSA  cell cycle non-specific agents, CCNSA According to the role of cycles or phases

G 2 (19%) M(2%) S (39%) G 1 (40%) no proliferation cells Dead cells (G 0 ) Proliferating cell population sensitive to drugs. Group of non-proliferating cells a source of tumor recurrence.

二． The relationship between biochemistry and antineoplastic agents

Classification of antineoplastic agents According to the biochemical mechanism of action  Drugs that affecting nucleic acid biosynthesis  Drugs that damaging structure and function of DNA directly  Drugs that inhibiting synthesis of RNA by interfering with transcription process  Drugs that affecting synthesis and functions of proteins  Drugs that affecting the balance of hormones  Other

Classification of antineoplastic agents  Alkylating agents  Antimetabolites  antitumor antibiotics  plant alkaloids  Hormonal agents According to the chemical structure and source

三． A dverse reactions

（一） Recent toxicities 一 common toxicities bone marrow depression——is the most common serious adverse reactions Gastrointestinal reactions Hair follicle damage

（二） Recent toxicities 一 Specific toxicities Renal toxicity and bladder toxicity Pulmonary toxicity Cardiotoxicity Neurotoxicity Ototoxicity Immunosuppression Hepatotoxicity

（三） Long-term toxicity Infertility, mutagenic, teratogenic carcinogenesis ： Second primary tumor

Commonly used anti-cancer drugs 一． Alkylating agents （ cell cycle non- specific agents ） cyclophosphamide 二． Antimetabolites （ cell cycle specific agents ） methotrexate,MTX

三． antitumor antibiotics （ cell cycle non-specific agents ） ADM 四． plant alkaloids vinblastine,VLB vincristine,VCR

Camptothecine

Podophyllotoxin

paclitaxel

五． Hormones 六． other

四． The principles of using drugs

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