Chemotherapy
Chemotherapy is the use of pharmacological agents (Table 21.1) to treat malignant or other proliferative diseases. It may be given orally, by intravenous bolus, prolonged subcutaneous or intravenous injection/infusion or intrathecally. It may be a single agent or combination of chemotherapy-utilizing drugs with different, preferably synergistic, modes of action, with limited or no overlapping toxicity, and aimed at delaying emergence of drug resistance. Chemotherapy drugs are often given as a cycle of a few days’ treatment every 3–6 weeks to allow normal cells, especially of the bone marrow and gastrointestinal tract, to recover from toxicity. Extravasation into tissues can cause severe local reactions. Intravenous chemotherapy is usually given through a central line or through a tunnelled intravenous catheter (e.g. Hickman’s) or indwelling chamber (e.g. Port-a-Cath).
Table 21.1 Chemotherapy agents
| DNA binding | |
| Anthracyclines | Other |
| Daunorubicin | Mitoxantrone |
| Hydroxydaunorubicin | Bleomycin |
| Idarubicin | |
| Alkylating agents | |
| Cyclophosphamide | Melphalan |
| Ifosfamide | Nitrosoureas (BCNU, CCNU) |
| Chlorambucil | Busulfan |
| Mitotic inhibitors | |
| Vincristine | |
| Vindesine | |
| Vinblastine | |
| Antimetabolites | |
| Methotrexate | Cytosine arabinoside |
| Mercaptopurine | Hydroxycarbamide |
| Azathioprine | |
| Inhibitors of DNA repair enzymes | |
| Epipodophyllotoxins e.g. etoposide | |
| Antipurines | |
| Fludarabine | |
| Deoxycoformycin | |
| 2-Chlorodeoxydenosine | |
| Proteosome inhibitor | |
| Bortezomib | |
| Others | |
| Corticosteroids | |
| l-Asparaginase | |
| Biological agents: interferon, thalidomide, lenalidomide, pomalidomide | |
| Monoclonal antibodies | |
| Rituximab | Anti-CD20 (benign and malignant B lymphoid disorders) |
| Ofatumumade | |
| Alemtuzumab | Anti-CD52 (lymphoproliferative disorders) |
| Gemtuzumab | Anti-CD33 (AML) |
| Brentazumab | Anti-CD30 (Hodgkin’s lymphoma) |
