Page 1285 - Hall et al (2015) Principles of Critical Care-McGraw-Hill

892 PART 7: Hematologic and Oncologic Disorders

Newer agents of considerable interest are the targeted therapies DNA synthesis in the tumor cells which overexpress their target (ie,
and biologic response modifiers. Unique to this class of agents is their ABL, EGFR, HER1/EGFR).
specificity for tumor cells, thus limiting the toxic side effects that are Some agents cannot be easily clarified into the above groups due to
dose limiting for the traditional cytotoxic chemotherapeutic agents. unique mechanisms of action. For example, all-trans-retinoic acid or
Biological response modifiers (BRMs), or biologicals, accounted for 44% tretinoin is an agent which induces malignant myeloid cells to differenti-
of cancer therapy sales in 2006, exceeding those of traditional cytotoxic ate, thereby decreasing the population of highly proliferative immature
agents. BRMs modulate a host’s immune response resulting in antitu- cells. Hydroxyurea is a synthetic enzyme that inhibits conversion of RNA
1
mor effects. Examples include interferon alfa, tumor necrosis factor, and to DNA, leading to cell death in rapidly dividing cells. Thalidomide, after
interleukin 2. Targeted therapies are developed through recombinant being withdrawn from the market for its teratogenic effects, has been rein-
DNA technology, proteins closely mimicking those that naturally occur troduced along with its derivative lenalidomide, for cancer therapy due to
in humans are engineered to mediate antitumor effects. These agents antiangiogenic and immunomodulatory properties. Glucocorticoids are
include cytokines, monoclonal antibodies, and fusion proteins. Tyrosine useful for their ability to suppress mitosis in lymphocytes. For a summary
2,3
kinase inhibitors disrupt signal transduction, gene transcription, and of antineoplastic agents and their disease targets, please refer to Table 95-1.

TABLE 95-1 Classification of Chemotherapeutic Agents
Chemotherapy Class Subclass Individual Agents Example Disease Targets
Alkylating agents Nitrogen mustards Cyclophosphamide, ifosfamide Hodgkin and non-Hodgkin lymphomas; ALL; CLL; MM; neuroblastoma; breast; ovar-
ian; cervical; testicular; lung; sarcoma
Melphalan MM; breast; ovarian
Chlorambucil CLL; Hodgkin and NHL
Ethylenimine derivative Thiotepa Bladder; breast; ovarian
Alkyl sulfonate Busulfan CML
Nitrosoureas Carmustine Primary brain tumor; melanoma; Hodgkin; NHL
Streptozotocin Carcinoid; insulinoma
Hydrazine Procarbazine Hodgkin
Triazenes Dacarbazine Melanoma; sarcoma; glioma; Hodgkin
Temozolomide Astrocytoma; melanoma
Metal salts Cisplatin, carboplatin, oxaliplatin Ovarian; testicular; bladder; esophageal; colon; lung
Antimetabolites Purine analogs Mercaptopurine ALL; AML
Fludarabine Hairy cell leukemia; CLL; NHL
Nelarabine T-cell leukemia and lymphoma
Clofarabine Pediatric ALL
Pyrimidine analogs 5-FU (fluorouracil), capecitabine Head and neck; esophageal; stomach; pancreas; colon; breast
Cytosine arabinoside (cytarabine, Ara-C) ALL; AML; NHL
Gemcitabine Lung; pancreatic; ovarian; breast
Antifolates Methotrexate ALL; choriocarcinoma; osteogenic sarcoma; H&N; breast; bladder; lung
Pemetrexed Lung; mesothelioma
Antibiotics Bleomycin Cervical; testicular; Hodgkin; NHL
Dactinomycin Testicular; choriocarcinoma; rhabdomyosarcoma; Kaposi
Mitomycin Stomach; anal; esophageal; lung; bladder; breast
Anthracyclines Daunorubicin AML; ALL
Doxorubicin, liposomal doxorubicin Breast; GU; thyroid; stomach; lung; bladder; sarcoma; Hodgkin; NHL; acute leuke-
mia; neuroblastoma
Idarubicin AML; ALL; CML in blast crisis
Epirubicin Breast; gastric
Mitoxantrone Breast; prostate; AML
Enzymes L-asparaginase ALL
Vinca alkaloids Vinblastine, vinorelbine Breast; testicular; lung; Hodgkin; NHL
Vincristine ALL; NHL; Hodgkin; neuroblastoma; rhabdomyosarcoma
Taxanes Paclitaxel, docetaxel Ovarian; breast; bladder; lung; H&N
Camptothecins Topotecan, irinotecan Ovarian; colon; lung
Epipodophyllotoxins Etoposide Testicular; breast; lung; AML; Hodgkin, NHL; Kaposi
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