DRUG PROPERTIES YOU NEED TO KNOW

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jfitzake@d.umn.edu www.d.umn.edu/~jfitzake Page 1 of 8 DRUG PROPERTIES YOU NEED TO KNOW 1. Mechanism of action a. chemical class b. resistance 2. Pharmacokinetics 3. Therapeutic uses 4.

1 Page 1 of 8 DRUG PROPERTIES YOU NEED TO KNOW 1. Mechanism of action a. chemical class b. resistance 2. Pharmacokinetics 3. Therapeutic uses 4. Major side effects/toxicities DIFFERENCES ARE IMPORTANT!!!! A 56-year-old man with non-hodgkin s lymphoma underwent a successful course of therapy with the CHOP regimen Which of of the following classes of of anticancer drugs is is cell cyclenonspecific (CCNS) and used in in the CHOP regimen? A) A) Alkylating agents B) B) Vinca alkaloids C) C) Antimetabolites MECHANISM D) D) Glucocorticoids E) E) Plant alkaloids THERAPEUTIC USES CHOP Cyclophosphamide Doxorubicin Vincristine (Oncovin) Prednisone A 56-year-old man with non-hodgkin s lymphoma underwent a successful course of therapy with the CHOP regimen During the second course of of treatment, this patient developed hemorrhagic cystitis. The most likely causitive agent is: is: A) A) Bleomycin B) B) Cyclophosphamide C) C) Doxorubicin TOICITY D) D) Prednisone E) E) Vincristine

2 Page 2 of 8 DRUGS YOU NEED TO KNOW (organized by chemical class = card colour) ALKYLATING AGENTS BUSULFAN CARMUSTINE (BCNU) CYCLOPHOSPHAMIDE DACARBAZINE LOMUSTINE (CCNU) MECHLORETHAMINE MELPHALAN THIOTEPA NATURAL PRODUCTS ALEMTUZUMAB ANGIOSTATIN BEVACIIMAB BLEOMYCIN CETUIMAB CYCLOSPORINE DACTINOMYCIN DAUNORUBICIN DOORUBICIN DENILEUKIN DIFTITU EDRECOLOMAB ERYTHROPOIETIN ETOPOSIDE (VP-16) FILGRASTIM GEMTUZUMAB IBRITUMOMAB INTERFERON α INTERLEUKIN 2 INTERLEUKIN 11 INTERLEUKIN-12 IRINOTECAN L-ASPARAGINASE MITOMYCIN C PACLITAEL RITUIMAB SARGRAMOSTIM (GM-CSF) TACROLIMUS (FK506) THROMBOPOIETIN TOSITUMOMAB TRASTUZUMAB TUMOUR NECROSIS FACTOR α VINBLASTINE VINCRISTINE IMMUNOSUPPRESSANT STEROIDS AMINOGLUTETHIMIDE DEAMETHASONE PREDNISONE MISCELLANEOUS AMSACRINE ARSENIC TRIOIDE BORTEZOMIB CARBOPLATIN CISPLATIN DASATINIB ERLOTINIB GEFITINIB HYDROYUREA IMATINIB MESNA NILOTINIB PENTOSTATIN PROCARBAZINE THALIDOMIDE TRETINOIN METABOLITES & ANTIMETABOLITES 5-FLUOROURACIL 6-MERCAPTOPURINE 6-THIOGUANINE ALLOPURINOL AZATHIOPRINE CYTARABINE (ARA-C) GEMCITABINE LEUCOVORIN METHOTREATE HORMONES and RELATED AGENTS ABARELI AMINOGLUTETHIMIDE ANASTROZOLE BICALUTAMIDE EEMESTANE FLUTAMIDE LETROZOLE GOSERELIN LEUPROLIDE LETROZOLE TAMOIFEN TOREMIFENE

3 Page 3 of 8 ACTION (label colour) SITE MECHANISM DRUG I. Block nucleotide synthesis (both purines and pyrimidines) Inhibit dihydrofolate reductase Methotrexate Prevent DNA synthesis II. Block purine synthesis III. Block pyrimidine synthesis Pseudofeedback inhibition of PNP and PRPP Inhibit thymidylate synthase Azathioprine 6-Mercaptopurine 6-Thioguanine 5-Fluorouracil IV. Block generation of deoxyribonucleotides Inhibit ribonucleotide reductase Hydroxyurea Pentostatin (indirect) V. Block DNA synthesis Inhibit DNA polymerase Cytarabine Gemcitabine Disrupt DNA, prevent DNA repair and/or interfere with RNA synthesis I. Crosslink DNA II. Intercalate or form adducts with DNA Alkylating agents Miscellaneous Anthracycline antibiotics Others Free radical generation Busulfan Carmustine (BCNU) Cyclophosphamide Dacarbazine Lomustine (CCNU) Melphalan Mechlorethamine Thiotepa Carboplatin Cisplatin Mitomycin C Daunorubicin Doxorubicin Dactinomycin Bleomycin III. Cause DNA strand breaks Form topoisomerase II- DNA complexes Inhibit topoisomerase I Amsacrine Etoposide Irinotecan Generate H 2 O 2 (??) Procarbazine Interrupt mitosis I. Disrupt spindle formation Terminate spindle assembly Enhance spindle formation Vincristine Vinblastine Paclitaxel

4 Page 4 of 8 I. Immunosuppressives Glucocorticoids Aminoglutethimide Dexamethasone Prednisone Antibiotics Cyclosporine Tacrolimus Immune system modulators II. Immune system stimulants Cytokines Monoclonal antibodies Interleukin 2 Interleukin 11 Interferon α Tumour necrosis factor α Alemtuzumab Cetuximab Denileukin diftitux Edrecolomab Gemtuzumab Ibritumomab Rituximab Trastuzumab Interfere with protein synthesis or function I. Deplete L-asparagine L-asparaginase II. Signal transduction (tyrosine kinase) inhibitors Block bcr-abl Block EGFR Dasatinib Imatinib Gefitinib Erlotinib Gefitinib III. Inhibit proteosome Bortezomib Prevent angiogenesis Angiostatin Bevacizumab Interleukin-12 Interferon α Thalidomide Induce Retinoids Tretinoin differentiation Miscellaneous Arsenic trioxide I. Decrease LH and FSH secretion GnRH agonists GnRH antagonist Goserelin Leuprolide Abarelix Interfere with hormone function II. Anti-androgens III. Prevent estrogen synthesis Inhibit aromatase Bicalutamide Flutamide Aminoglutethimide Anastrazole Exemestane Letrozole IV. Anti-estrogens SERMS Tamoxifen Toremifiene SERD Fulvestrant

5 Page 5 of 8 ORGANIZATION OF ANTINEOPLASTICS ACCORDING TO PROTEIN FUNCTION PROTEIN NORMAL ACTION ANTINEOPLASTIC Adenosine deaminase Conversion of adenosine to inosine PENTOSTATIN Adenine phosphoribosyltransferase Aromatase L-asparaginase bcl-abl (non-receptor tyrosine kinase) Calcineurin CD20 (B-lymphocyte restricted differentiation antigen Bp35) CD33 (gp67, p67) CD52 Salvage enzyme for reconversion of purines Convert androstenedione to estrone Hydrolysis of asparagine to aspartic acid and ammonia Activation of transcription factors via cascade pathway Activates NF-AT (activation factor for cytokine genes) Transmembrane protein found on pre- B and mature B lymphocytes Sialic acid-dependent cytoadhesion molecule expressed by monocytic/myeloid lineage cells CAMPATH-1 antigen; GPI-anchored protein expressed at high levels on thymocytes, lymphocytes, monocytes, and macrophages Purine analogs AMINOGLUTETHAMIDE, EEMESTANE L-ASPARAGINASE IMATINIB CYCLOSPORINE TACROLIMUS IBRITUMOMAB RITUIMAB GEMTUZUMAB ALEMTUZUMAB Cyclophilin Inhibits calcineurin CYCLOSPORINE Cytochrome P450 DNA Polymerase Dihydrofolate reductase (DHFR) Hydroxylation of aromatic and aliphatic compounds Copies DNA templates during DNA replication Converts dihydrofolate to tetrahydrofolate CYCLOPHOSPHAMIDE PROCARBAZINE DAUNORUBICIN DOORUBICIN CYTOSINE ARABINOSIDE METHOTREATE EGFR Binds epidermal growth factor ERLOTINIB, GEFITINIB FK-binding protein Inhibits calcineurin TACROLIMUS Glutathione peroxidase Oxidizes glutathione DAUNORUBICIN DOORUBICIN P-glycoprotein Drug transport out of cells Multidrug resistance HER2 Transmembrane protein overexpressed in breast cancer TRASTUZUMAB

6 Page 6 of 8 ORGANIZATION OF ANTINEOPLASTICS ACCORDING TO PROTEIN FUNCTION (cont d) Hypoxanthine-guanine phosphoribosyl transferase (HGPRT) 26S Proteosome Ribonucleotide reductase S-adenosyl-homocystein hydrolase Topoisomerase I Topoisomerase II Salvage enzyme for recoversion of purines Large protein complex that degrades ubiquitinated proteins Reduces nucleoside diphosphates to deoxy forms Hydrolyses S-adenosylhomocystein to adenosine and homocystein Binds to DNA and makes temporary breaks. Causes 2 nd half of double helix to pass through the break, and then reseals it. 6-MERCAPRTOPURINE 6-THIOGUANINE BORTEZOMIB GEMCITABINE HYDROYUREA Purine analogs PENTOSTATIN IRINOTECAN AMSACRINE DAUNORUBICIN DOORUBICIN ETOPOSIDE Thymidylate synthase TMP synthesis 5-FLUOROURACIL anthine oxidase Converts xanthine to uric acid 6-MERCAPTOPURINE HIGH (>90%) RELATIVE EMETIC POTENTIAL OF ANTINEOPLASTIC DRUGS MODERATELY HIGH (60-90%) MODERATE (30-60%) MODERATELY LOW (10-30%) Cisplatin Carmustine Asparaginase Bleomycin Androgens Mechlorethamine Cyclophosphamide Daunorubicin Etoposide Busulfan Dactinomycin Doxorubicin Hydroxyurea Estrogens Lomustine Fluorouracil Melphalan Progestins Mitomycin C 6-Mercaptopurine Methotrexate Vinblastine LOW (<10%)

7 Page 7 of 8 Renal Toxicity Tumor lysis syndrome treat with allopurinol and vigorous oral hydration CISPLATIN proximal tubular damage resulting in magnesium and calcium loss treat by decreasing dose based on GFR, supplement with saline DRUG Protein Loss Toxin Buildup TYPE OF DAMAGE Ions and Water Reversible? Carmustine No Cisplatin Usually Cyclophosphamide Yes Lomustine No Methotrexate Yes Mitomycin No Vincristine Yes Neurotoxicity CISPLATIN can also cause dose related ototoxicity and a segmental demyelination resulting in a bilateral, symmetric peripheral neuropathy DRUG Asparaginase Carmustine Encephalopathies Autonomic Neuropathies Peripheral Neuropathies Cisplatin Arachnoiditis Cytarabine (IT) Etoposide 5-FU Methotrexate (IT) Procarbazine Vinblastine Vincristine

8 Page 8 of 8 Hepatotoxicity DRUG Elevated Liver Enzymes Jaundice TYPE OF DAMAGE Hepatic Fibrosis Hepatitis, Necrosis Venocclusive Disease Asparaginase Azathioprine Busulfan Carmustine Cyclophosphamide Daunorubicin Mercaptopurine Methotrexate Mitomycin C 6-Thioguanine Cardiac Toxicity Acute: supra or ventricular tachycardias, transient decrease in ejection fractions Chronic: decreasing cardiac function over time (dose and schedule dependent) Risk factors: mediastinal radiation, history of hypotension, heart disease Ventric. Dysrhythm ECG changes Doxorubicin Daunorubicin Bleomycin + + Cisplatin + + Nitrogen Mustards ++ Spasm/ angina 5-Fu Methotrexate + Amsacrine DRUG CHF Cardiomyopathy Myo/pericarditis Bradycardia Hypotension Paclitaxel

DRUGS YOU NEED TO KNOW

jfitzake@d.umn.edu Page 1 of 7 DRUGS YOU NEED TO KNOW ALKYLATING AGENTS (blue cards) BUSULFAN CARMUSTINE (BCNU) CYCLOPHOSPHAMIDE DACARBAZINE LOMUSTINE (CCNU) MECHLORETHAMINE MELPHALAN THIOTEPA NATURAL