1. 16
Antineoplastic Agents

2. Cancer Second most common cause of death in United States
Most common types: breast, prostate, lung, colorectal
Characterized by uncontrolled cellular division, hyperplasia, local tissue invasion, and metastasis
Two types of tumor: benign and malignant

3. Naming Benign and Malignant Tumors
Benign tumors: names are created by adding –oma to name of cell type
Adenoma: benign tumor of glandular origin
Malignant: names often contain word carcinoma
Adenocarcinoma: malignant cancer of glandular origin

4. Benign Tumors Benign: cells resemble cells from which they developed
Slow growing
Seldom metastasize; rarely recur once removed

5. Malignant Tumors Malignant: atypical appearance
Proliferate rapidly; become more and more atypical
Invade and destroy surrounding tissues
Induce formation of new blood vessels (angiogenesis) to supply tumor with blood

6. Malignant Cancer Terms
Sarcoma: malignant growth of muscle or connective tissue
Carcinoma in situ: cancer limited to epithelial cells where it begins

7. 7 Warning Signs of Cancer
Change in bowel or bladder habits
Sore that does not heal
Unusual bleeding or discharge
Thickening or lump in breast or elsewhere
Indigestion or difficulty swallowing
Obvious change in wart or mole
Nagging cough or hoarseness

8. Topic of Cancer

9. Neoplasms Arise from four tissue types Epithelial Connective Muscle
Nerve

10. Oncogenes Develop from normal genes: proto-oncogenes
Protooncogenes are present in all cells and regulate normal cell function, including cell cycle.
Genetic alteration of the protooncogene may activate oncogenes.
Alteration caused by carcinogenic agents.

11. Tumor Suppressor Genes
Normally function to regulate and inhibit inappropriate cellular growth and proliferation

12. Cell Cycle G0: Resting, dormant stage
G1: Cell makes proteins to prepare for division (18–30 hours)
S: DNA synthesis occurs (18–20 hours)
G2: Occurs just before cell splits (2–10 hours)
M: Mitosis (30–60 minutes)

13. Figure 16-1 The four steps of the cell cycle.

14. Chemotherapy
Use of chemical agents to interact with cancer cells to stop or control growth
Primary: used alone to cure
Palliative: used to ease disease’s effects
Adjuvant: used before or after radiation or surgery
Neoadjuvant: given in preoperative setting to reduce tissue damage, decrease tumor size, or destroy micro metastases

15. Chemotherapy Agents Characterized by mechanism of action or origin
Many agents target rapidly proliferating cells at selective or multiple sites of cell cycle.
Agents with selective activity: cell cycle phase-specific
Agents may target cellular synthesis of DNA, RNA, and proteins.

16. Five Primary Cancer Therapies
Surgery: treatment of choice for many solid tumors; local treatment
Radiation therapy: local treatment
Chemotherapy: systemic treatment
Immunotherapy: stimulates host’s immune system
Hormonal therapy: systemic treatment

17. Response to Treatment Cure: free of disease
Complete response: disappearance of cancer with no evidence of new disease for at least 1 month after treatment
Partial response: 50% or greater decrease in tumor size or other cancer markers; no evidence of disease for at least 1 month

18. Response to Treatment Stable disease: no change in tumor size
Progression of disease

19. Chemotherapy Routes of Administration
Oral: becoming more popular because of ease of use
Intramuscular
Subcutaneous
Intravenous

20. Alkylating Agents: Uses
Greatest value in treating slow-growing cancers
Cell cycle phase–nonspecific: act directly on DNA causing cross-linking of DNA strands, abnormal base pairing, or strand breaks
Five types: nitrogen mustards, ethyleneimines, alkyl sulfonates, nitrosoureas, temozolomide

21. Alkylating Agents: Adverse Effects
Dose-limiting toxicity to bone marrow and intestinal mucosa
Common: alopecia, toxicity to reproductive system
Serious: pulmonary fibrosis and venoocclusive liver disease, renal failure, central neurotoxicity

22. Alkylating Agents: Contraindications
Do not use in pregnancy (teratogenic).
May interact with antidepressants, other anticancer medication, warfarin, vaccines, aspirin, and vitamins

23. Procarbazine Interactions
Procarbazine can produce an acute disulfiram-like reaction (flushing, headache, acute vomiting, and chest or abdominal pain) if combined with alcohol.
Taking procarbazine with tyramine-containing foods (aged cheese, chocolate, wine, etc.) can cause life-threatening elevation of blood pressure.

24. Alkylating Agents: Patient Information
Teach patients about symptoms and signs of bone-marrow depression.
Advise patients to avoid contact with people who have colds or other infections.
Reassure patients that hair will regrow after treatment.

25. Antimetabolites: Uses
Cell cycle phase–specific: replace natural substances such as DNA molecules that are required for cell metabolism and protein synthesis
Treat myelocytic leukemia, lymphocytic leukemia, non-Hodgkin’s lymphoma, metastatic breast and colorectal cancer, keratoses, basal cell carcinomas, meningeal leukemia, head and neck cancers

26. Antimetabolites: Adverse Effects
Common: anorexia, nausea and vomiting, headache, hearing loss, sleep disorders, depression, bone-marrow depression, dyspnea, epistaxis, edema, GI disturbances, alopecia, myelosuppression, hyperuricemia
Serious: hepatotoxicity, severe leukopenia, bone marrow aplasia, thrombocytopenia

27. Antimetabolites: Contraindications
Avoid in first trimester of pregnancy; in lactating women; and in patients with acute infectious diseases, severe bone-marrow depression, and renal dysfunction
Interact with allopurinol, warfarin, and drugs used to treat ulcerative colitis

28. Antimetabolites: Patient Information
Advise patients that these drugs may cause bone-marrow suppression and damage to GI lining.

29. Green Tea: Antioxidant
Studies suggest green tea may reduce the incidence of a variety of cancers, including those of the colon, pancreas, and stomach.
Green tea contains high levels of polyphenols, which have antioxidant and chemopreventive properties.

30. Table 16-1 Common Agents Used in the Treatment of Cancer

31. Table 16-1 (continued) Common Agents Used in the Treatment of Cancer

32. Table 16-1 (continued) Common Agents Used in the Treatment of Cancer

33. Table 16-1 (continued) Common Agents Used in the Treatment of Cancer

34. Table 16-1 (continued) Common Agents Used in the Treatment of Cancer

35. Table 16-1 (continued) Common Agents Used in the Treatment of Cancer

36. Table 16-1 (continued) Common Agents Used in the Treatment of Cancer

37. Mitotic Inhibitors: Uses
More effective in S- and M-phases of cell cycle
Inhibit DNA and RNA synthesis
Used to treat breast, bladder, ovarian, testicular, and lung cancers; leukemias; and lymphomas

38. Mitotic Inhibitors: Adverse Effects
Common: nausea and vomiting, diarrhea, alopecia, dizziness, weakness, headache, depression, stomatitis, anemia, hyperpigmentation of nails, tongue, or oral mucosa

39. Mitotic Inhibitors: Contraindications
Do not use in severe cardiac disease, hypocalcemia, bleeding disorders, myelosuppression, or pregnancy.
Interact with phenytoin, erythromycin, and itraconazole

40. Mitotic Inhibitors: Patient Information
Tell patients that severe bone-marrow depression and GI damage may occur.
Tell them to avoid coffee, spicy foods, fruits, and raw vegetables if diarrhea occurs.

41. Toxicity in Elderly Patients
Older adults are at higher risk for adverse effects of antineoplastic agents.
Lower dosages are administered.
Creatinine clearance is used to monitor renal function in elderly patients.

42. Hormonal Therapy: Uses
Act by blocking hormone production or action
Highly selective
Treat acute lymphocytic leukemia and reproductive tract cancers

43. Hormonal Therapy: Adverse Effects
GI disturbances
Impaired fertility
Menstrual irregularities

44. Hormonal Therapy: Contraindications
Most hormones are contraindicated during pregnancy.
Interactions occur with tamoxifen, alcohol, St. John’s wort, zinc, magnesium, vitamin B, and thyroid supplements.

45. Hormonal Therapy: Patient Information
Warn patients that these agents are contraindicated in pregnancy and that strict contraception should be used during and for 3–4 months after treatment.
Some sources advise both men and women to avoid conceiving for 2 years after treatment.

46. Infertility
Instruct patients that infertility may occur with antineoplastic agents and may not be reversible.

47. Antitumor Antibiotics: Uses
Work by inhibiting DNA and RNA synthesis
Treat breast, ovary, testicular, cervical, head, neck, penis, and bone cancers; Wilms’ tumor, choriocarcinoma, solid tumors, monocytic leukemia, lymphoblastic and myeloblastic leukemias, and lymphomas

48. Antitumor Antibiotics: Adverse Effects
Common: bone-marrow suppression, stomatitis, GI upset, alopecia, pulmonary fibrosis
Serious: renal impairment (mitomycin)

49. Antitumor Antibiotics: Contraindications
Should not be used in patients with heart, kidney, and liver disease
Some agents interact with digoxin, aspirin, heparin, warfarin, or NSAIDs.
Some agents cause toxicity when used together.

50. Antitumor Antibiotics: Patient Information
Advise patients about signs and symptoms of bone-marrow depression.
Instruct patients to report cardiac abnormalities.

51. Interferon alfa-2b (Intron A): Uses
Work by targeting and purifying specific proteins
Treats kidney cancers, lymphoma, and melanoma

52. Interferon alfa-2b: Adverse Effects
Common: nausea and vomiting, weight gain, fluid retention
Serious: kidney, liver, lung, and nerve damage

53. Interferon alfa-2b: Contraindications
Safe use during pregnancy, lactation, or in children younger than 18 is not established.
Use cautiously in severe, preexisting cardiac, renal, or hepatic disease, pulmonary disease, diabetes mellitus, or those prone to ketoacidosis.
Interacts with theophylline and zidovudine

54. Interferon alfa-2b: Patient Information
Teach patients how to reconstitute and administer these agents.
Warn patients not to change brands.
Advise woman not to breast feed.
Instruct patients to expect adverse effects and to report severe adverse effects.

55. Interferon Administration
All changes in interferon administration must be directed by a physician.
Instruct patients to not change administration times or doses of these drugs.