Table 1 Classification, mechanism of action, most common side effects of chemotherapeutic agents, and targeted cancers
From: Review of cancer therapies for the perioperative physician
Class | Drug | Mechanism of action | Targeted cancer | Common side effects |
|---|---|---|---|---|
Alkylating agent | Nitrogen mustards — chlorambucil, cyclophosphamide, ifosfamide, chlormethine, melphalan Alkylsulfonates — busulfan Nitrosoureas — streptozocin, carmustine, lomustin Triazines — dacarbazine Ethylenimines — thiotepa, altretamine Platinums — cisplatin, carboplatin, oxaliplatin Hydrazine — methylhydrazine-benzamine, procarbazine | Replace the alkyl group with hydrogen atoms in DNA so the cancer cells cannot repair | Leukemia, multiple myeloma, sarcoma, lung, breast, and ovarian cancer. Nitrosoureas cross the blood‐brain barrier useful for treating brain tumors | Bone marrow suppression, dose‐dependent risk of leukemia, renal failure, liver failure, cardiomyopathy, pulmonary fibrosis, peripheral neuropathy |
Antimetabolites | Folic acid antagonist — methotrexate, pemetrexed, praxatrexate Pyrimidine antagonist — 5‐fluorouracil (5‐FU), decitabine, floxuridine, capecitabine, gemcitabine, cytarabine Purine antagonist — 6-mercaptopurine, 6-thioguanine Adenosine deaminase inhibitor — cladribine, fludarabine, nelarabine, pentostatin, hydroxyurea, nelarabine, clofarabine, azacytidine | Deplete nucleotides inhibiting DNA replication of the cancer cells | Leukemia, breast, ovarian, gastrointestinal tract, lung, pancreatic, bladder, sarcoma, head, and neck cancers | Pancytopenia, increase in liver function test, kidney failure,‐pulmonary edema, cardiac toxicity |
Antitumor antibiotics | Anthracyclines — doxorubicin, daunorubicin, idarubicin, epirubicin, valrubicin Non‐anthracyclines — bleomycin, dactinomycin, mitomycin | Antibiotics that inhibit enzymes required for DNA synthesis | Breast, ovarian, prostate, germ cell, sarcoma, lung, liver, bladder, thyroid, lymphoma, leukemia, neuroblastoma, Wilms | Cardiomyopathy, pulmonary fibrosis, renal, and hepatobiliary toxicity |
Topoisomerase inhibitors | Type 1 (camptothecins) — topotecan, irinotecan Type 2 (epipodophyllotoxin s) —etoposide, teniposide, mitoxantrone | Inhibit the enzyme topoisomerase — which inhibits DNA synthesis | Leukemia, lung, ovarian, GI tract, colon, pancreatic | Type 2 increases the risk of second cancer |
Plant alkaloids | Taxanes — placitaxel, docetaxel Vincas — vinblastine, vincristine, vinorelbine | Inhibit mitosis | Breast, lung, multiple myeloma, leukemia, lymphoma | Dose-dependent nerve damage Pulmonary Cardiac and hepatobiliary toxicity |
Corticosteroids | Prednisone, dexamethasone methylprednisolone | Anti‐inflammatory inhibits protein synthesis | Leukemia, lymphoma, multiple myeloma | Adrenal insufficiency, myopathy, decreased wound healing |