Chapter 14 Antineoplastic Drugs Copyright © 2015 Cengage Learning® Introduction • A healthy body needs cells to reproduce and grow in an orderly, regulated manner – Sometimes, conditions are altered in the body that trigger abnormal changes in the way the cells reproduce and grow • Can cause cell growth to become uncontrolled, leading to overproduction or impaired cellular development Copyright © 2015 Cengage Learning® 2 Introduction (cont’d.) • Unregulated growth can lead to abnormal cells, tissue, and tumor development – Tumors can be classified as either benign (non-cancerous) or malignant (cancerous) • Antineoplastics (“against new tissue formation”) – Agents that counteract the development, growth, or spread of malignant cells – Can treat various types of cancers Copyright © 2015 Cengage Learning® 3 Introduction (cont’d.) • What is chemotherapy? – Drugs and drug combinations used for palliative effects or for long-term or complete remissions in early treatment of cancer • Antineoplastic drugs are cytotoxic (destructive to cells), and especially to cells that are proliferating (reproducing rapidly) • Many antineoplastic agents also possess immunosuppressive properties Copyright © 2015 Cengage Learning® 4 Introduction (cont’d.) • Antineoplastic agent groups – Antimetabolites – Alkylating agents – Mitotic inhibitors – Antitumor antibiotics – Hormones and hormone modifiers – Biological therapies Copyright © 2015 Cengage Learning® 5 Introduction (cont’d.) – Targeted cancer therapies – Vaccines – Radioactive isotopes Copyright © 2015 Cengage Learning® 6 Introduction (cont’d.) • The following slides discuss various antineoplastic drugs – Refer to the chapter for specific side effects and contraindications Copyright © 2015 Cengage Learning® 7 Antimetabolites • Work by interfering with DNA synthesis, repair, and cellular replication – Used in the treatment of various malignancies, especially those involving rapidly proliferating neoplasms • Examples: methotrexate and fluorouracil Copyright © 2015 Cengage Learning® 8 Alkylating Agents • Can treat a wide range of cancers – Prevent growth by damaging DNA needed for reproduction • Examples: cisplatin and cyclophosphamide Copyright © 2015 Cengage Learning® 9 Mitotic Inhibitors • Mitosis is the process of cell division and reproduction – Mitotic inhibitors are often plant alkaloids and other compounds derived from natural products that block mitosis • Can treat many different types of cancer • Plant alkaloid examples: vinblastine, vincristine, and paclitaxel Copyright © 2015 Cengage Learning® 10 Antitumor Antibiotics • Can treat a wide variety of malignancies – Examples: doxorubicin, daunorubicin, bleomycin, daunorubicin, mitomycin, and others • Frequently used in combination with other drugs Copyright © 2015 Cengage Learning® 11 Hormones and Hormone Modifiers • Hormones – Corticosteroids: used primarily for their suppressant effect on lymphocytes • Hormone modifiers – Antiestrogen: hormonal therapy for metastatic estrogen receptor–positive breast cancer and palliative treatment – Antiandrogen: hormonal therapy in the treatment of endometriosis and metastatic prostate cancer Copyright © 2015 Cengage Learning® 12 Biological Therapies • Designed to repair, stimulate, or enhance cancer patients' natural immune systems – More effectively recognize and attack cancer cells • Active or direct and passive or indirect • Interferon alfa – Most widely used in cancer treatments – Complex combination of many proteins that boost immune system response Copyright © 2015 Cengage Learning® 13 Biological Therapies (cont’d.) • Colony-stimulating factors (CSFs) – Encourage bone marrow stem cells to divide and develop into red and white blood cells, and platelets • Monoclonal antibodies (MABs) – Exogenous (outside of body) antibodies genetically engineered in the laboratory – Designed to target only cancer cells, thereby sparing normal tissues Copyright © 2015 Cengage Learning® 14 Targeted Therapies • Block the growth and spread of cancer – Interfere with specific molecules involved in tumor growth and progression • Signal transduction inhibitors – Block specific enzymes and growth factor receptors that signal cancer cell proliferation Copyright © 2015 Cengage Learning® 15 Vaccines • Medicines that boost the immune system’s natural ability to protect the body against “foreign invaders” – Mainly infectious agents that may cause disease • Broad types of cancer vaccines – Preventive (or prophylactic) – Treatment (or therapeutic) Copyright © 2015 Cengage Learning® 16 Radioactive Isotopes • Used in the treatment of certain types of cancer – Sometimes the radioactive material is injected into the affected site or implanted in the body in the form of capsules, needles, or seeds – Health care practitioners caring for patients receiving radioactive isotopes must observe special precautions to prevent unnecessary radiation exposure Copyright © 2015 Cengage Learning® 17 Cautions and Responsibilities for Antineoplastic Drugs • Medications should be given on time and exactly as prescribed • Intravenous sites must be checked with great care • Intravenous fluids containing antineoplastic agents should not be allowed to get on the skin or into the eyes of the patient or administrator Copyright © 2015 Cengage Learning® 18 Cautions and Responsibilities for Antineoplastic Drugs (cont’d.) • Antiemetics should be immediately available and administered as prescribed • Careful and frequent oral hygiene is essential • Soft foods and cool liquids should be available to the patient as required • Accurate intake and output is important for adequate assessment of hydration Copyright © 2015 Cengage Learning® 19 Cautions and Responsibilities for Antineoplastic Drugs (cont’d.) • Careful observation and reporting of symptoms and side effects is essential • Aseptic technique is necessary to minimize the chance of infection • Careful assessment of vital signs is important • The health care practitioner and family must be informed and answer patient’s questions honestly Copyright © 2015 Cengage Learning® 20 Cautions and Responsibilities for Antineoplastic Drugs (cont’d.) • Careful attention to detail, astute observations, appropriate interventions, and compassion are an integral part of care during chemotherapy • The health care practitioner should: – Reassure the patient that someone will be available to help at all times – Identify all resources available for both the patient and their family Copyright © 2015 Cengage Learning® 21 Cytotoxic Drug Dangers to Health Care Personnel • Most cytotoxic drugs are toxic substances known to be carcinogenic, mutagenic, or teratogenic – Anyone who prepares, administers, or cares for patients receiving cytotoxic drugs should be aware of the dangers involved • Refer to the chapter for specific recommendations Copyright © 2015 Cengage Learning® 22