Below is a comprehensive, patient-friendly overview of chemotherapy drugs, grouped by their mechanism of action or chemical class. While we focus on those often seen in hematologic (blood) cancers, many of these agents are also used in solid tumors. This list is extensive but not fully exhaustive, as chemotherapy continues to evolve. As always, this content is for educational purposes only and should not replace professional medical advice.

1. Alkylating Agents

Alkylating agents damage DNA by adding alkyl groups to DNA bases, causing breaks in the DNA strands or faulty replication.

  1. Cyclophosphamide (Cytoxan)
    • Widely used in lymphomas, leukemias, multiple myeloma, and in combination regimens (e.g., CHOP, R-CHOP).
    • Side Effects: Bladder irritation (hemorrhagic cystitis), low blood counts, hair loss.
  2. Ifosfamide
    • Similar mechanism to cyclophosphamide. Used in some lymphomas and solid tumors.
    • Side Effects: Bladder irritation (requires adequate hydration and mesna), low blood counts.
  3. Melphalan
    • Commonly used for multiple myeloma (often before autologous stem cell transplant).
    • Side Effects: Low blood counts, mouth sores, nausea.
  4. Busulfan
    • Used in chronic myelogenous leukemia (CML) and as part of conditioning regimens for bone marrow transplant.
    • Side Effects: Low blood counts, possible lung toxicity (pulmonary fibrosis).
  5. Bendamustine
    • Has properties of both alkylating agents and antimetabolites. Common for chronic lymphocytic leukemia (CLL) and indolent lymphomas.
    • Side Effects: Low blood counts, infusion reactions, rash.
  6. Procarbazine
    • Part of the older MOPP regimen for Hodgkin lymphoma.
    • Side Effects: Low blood counts, neurological effects, dietary restrictions (avoid tyramine-rich foods).

2. Platinum Compounds

Platinum drugs form platinum-DNA adducts, distorting the DNA structure and blocking DNA replication and transcription.

  1. Cisplatin
    • Used in various cancers, including some leukemias/lymphomas (often in salvage regimens).
    • Side Effects: Kidney toxicity (nephrotoxicity—requires good hydration), ototoxicity (hearing loss), severe nausea/vomiting.
  2. Carboplatin
    • Similar to cisplatin but generally fewer kidney and ear issues.
    • Side Effects: Low blood counts, less severe nausea than cisplatin but can still be significant.
  3. Oxaliplatin
    • Mostly in solid tumors (e.g., colorectal cancer), less common in blood cancers but sometimes used off-label.
    • Side Effects: Peripheral neuropathy (cold-induced), low blood counts.

3. Antimetabolites

Antimetabolites mimic natural substances (like nucleotides, folates) needed for DNA/RNA synthesis, disrupting cancer cell replication.

  1. Methotrexate
    • Folate analog blocking DNA synthesis; used in leukemias, lymphomas (especially high-dose to prevent CNS involvement), and osteosarcoma.
    • Side Effects: Low blood counts, liver toxicity, mouth sores, kidney toxicity at high doses (requires leucovorin rescue).
  2. Cytarabine (Ara-C)
    • Resembles cytidine, causing DNA chain termination. Key drug in acute myeloid leukemia (AML) and sometimes in lymphomas.
    • Side Effects: Low blood counts, conjunctivitis (at high doses), cerebellar toxicity.
  3. 5-Fluorouracil (5-FU)
    • Mimics uracil, interfering with RNA/DNA formation. Common in solid tumors; rarely used in some lymphoma regimens.
    • Side Effects: Mouth sores, diarrhea, low blood counts, hand-foot syndrome (with continuous infusion).
  4. Capecitabine
    • Oral prodrug converting into 5-FU in the body.
    • Side Effects: Similar to 5-FU (hand-foot syndrome, diarrhea, mouth sores).
  5. Gemcitabine
    • Blocks DNA synthesis, used in various cancers (solid and some lymphomas).
    • Side Effects: Low blood counts, flu-like symptoms, liver enzyme elevation.
  6. Fludarabine
    • Purine analog used in CLL, indolent lymphomas, and in certain AML regimens (like FLAG-IDA).
    • Side Effects: Profound immunosuppression, low blood counts, higher infection risk.
  7. Cladribine
    • Used in hairy cell leukemia and some other indolent lymphoproliferative disorders.
    • Side Effects: Immunosuppression, low blood counts, possible fever.

4. Antitumor Antibiotics (Anthracyclines & Others)

These drugs intercalate into DNA, inhibit topoisomerase II, and/or generate free radicals damaging DNA.

  1. Doxorubicin (Adriamycin)
    • Backbone in many lymphoma regimens (e.g., CHOP), also used in leukemias and solid tumors.
    • Side Effects: Heart toxicity (cardiomyopathy), low blood counts, hair loss, “red urine” discoloration.
  2. Daunorubicin
    • Similar to doxorubicin; key drug in AML and ALL induction therapies.
    • Side Effects: Heart toxicity, low blood counts, mouth sores.
  3. Idarubicin
    • Another anthracycline used in AML (7+3 regimen).
    • Side Effects: Same anthracycline concerns (heart toxicity, low blood counts).
  4. Epirubicin
    • Similar mechanism to doxorubicin, slightly different toxicity profile; mostly used in solid tumors.
    • Side Effects: Heart toxicity (though slightly less than doxorubicin), low blood counts.
  5. Bleomycin
    • Used in Hodgkin lymphoma (e.g., ABVD) and testicular cancer.
    • Side Effects: Lung toxicity (pulmonary fibrosis), skin changes, fever.

5. Topoisomerase Inhibitors

Topoisomerase II Inhibitors

  1. Etoposide (VP-16)
    • Common in lymphoma, some leukemias, and many solid tumor regimens.
    • Side Effects: Low blood counts, secondary leukemias with long-term use, hair loss.
  2. Teniposide
    • Similar to etoposide, used in ALL and some brain tumors.
    • Side Effects: Low blood counts, risk of secondary cancers, mucositis.

Topoisomerase I Inhibitors

  1. Irinotecan
    • More in solid tumors (colorectal), though sometimes in lymphomas.
    • Side Effects: Diarrhea (can be severe), low blood counts, nausea/vomiting.
  2. Topotecan
    • Used in ovarian cancer, small cell lung cancer, rarely in leukemias/lymphomas.
    • Side Effects: Low blood counts, mouth sores.

6. Mitotic Inhibitors (Plant Alkaloids)

Vinca Alkaloids (Block microtubule assembly)

  1. Vincristine (Oncovin)
    • In CHOP for lymphoma, also used in ALL regimens (e.g., Hyper-CVAD).
    • Side Effects: Peripheral neuropathy (numbness/tingling), constipation, low blood counts.
  2. Vinblastine
    • Part of ABVD for Hodgkin lymphoma.
    • Side Effects: More bone marrow suppression than vincristine, also neuropathy.
  3. Vinorelbine
    • Mostly used in certain solid tumors, though can appear in lymphoma salvage regimens.
    • Side Effects: Low blood counts, neuropathy.

Taxanes (Stabilize microtubules, halting cell division)

  1. Paclitaxel (Taxol) / Docetaxel
    • More common in solid tumors (breast, lung, ovarian), but sometimes used in lymphoma salvage.
    • Side Effects: Neuropathy, low blood counts, possible infusion reactions.

7. Miscellaneous Agents

  1. L-Asparaginase / Pegaspargase
    • Targets ALL cells by depleting asparagine, an essential amino acid for leukemia cells.
    • Side Effects: Pancreatitis, allergic reactions, liver dysfunction, blood clotting abnormalities.
  2. Hydroxyurea
    • Lowers blood cell counts quickly in leukemias (especially high WBC counts), myeloproliferative disorders.
    • Side Effects: Low blood counts, GI upset, mouth sores.
  3. Mitomycin C
    • Cross-links DNA; used in various solid tumors, occasionally in salvage lymphoma regimens.
    • Side Effects: Bone marrow suppression, kidney/lung toxicity at higher doses.
  4. Trabectedin (Yondelis)
    • Derived from sea squirt; mostly for soft tissue sarcomas and ovarian cancer, rarely used in blood cancers.
    • Side Effects: Low blood counts, liver enzyme elevation, infusion reactions.

8. Common Combination Regimens (Examples)

Chemotherapies are often combined to enhance cancer cell kill and reduce resistance.

  • CHOP: Cyclophosphamide, Hydroxydaunorubicin (doxorubicin), Oncovin (vincristine), Prednisone (for non-Hodgkin lymphoma).
  • ABVD: Adriamycin (doxorubicin), Bleomycin, Vinblastine, Dacarbazine (for Hodgkin lymphoma).
  • 7+3: Cytarabine (7 days) + Daunorubicin (3 days) for AML induction.
  • Hyper-CVAD: Cyclophosphamide, Vincristine, Adriamycin, Dexamethasone for ALL; alternates with high-dose methotrexate and cytarabine.
  • MOPP: Mustargen (mechlorethamine), Oncovin (vincristine), Procarbazine, Prednisone (an older Hodgkin lymphoma regimen).

9. Key Points for Patients

  • Side Effects: Includes myelosuppression (low blood counts), hair loss, nausea/vomiting, mouth sores, and organ toxicities (heart, lungs, kidneys, liver).
  • Monitoring: Blood tests (CBC, liver/kidney function), imaging, or ECG (for heart health) may be done regularly.
  • Supportive Care: Use of antiemetics, growth factors (e.g., G-CSF), blood transfusions, or hydration can mitigate adverse effects.
  • Dose Adjustments: May be necessary based on response or side effects; your healthcare team customizes your regimen to optimize benefits and reduce harms.
  • New Research: The field of chemotherapy is constantly evolving. Targeted therapies, immunotherapies, and novel agents may be combined with or replace traditional chemo in some cases.

Disclaimer

This extensive list of chemotherapeutic agents is provided for general educational purposes and does not replace professional medical guidance. Treatment plans vary based on cancer type, stage, genetic markers, patient health, and new clinical research. Always consult a qualified oncologist or hematologist for personalized recommendations.

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