Sandbox/00040

Class	Drug	Indication	Mechanism	Toxicity
Antitumor antibiotic	Bleomycin	Germ cell tumors, Hodgkin disease, and squamous cell cancers	Breaks DNA strand directly	Pulmonary fibrosis, exfoliation, myelosuppression (rare)
Antitumor antibiotic; anthracycline	Daunorubicin	AML and ALL	Free radical formation, topoisomerase II inhibition	Dialted cardiomyopathy, myelosuppression
Antitumor antibiotic; anthracycline	Doxorubicin	Breast carcinoma, adult sarcomas, pediatric solid tumors, Hodgkin disease, non-Hodgkin lymphomas, and ovarian cancer	Free radical formation, topoisomerase II inhibition	Dialted cardiomyopathy, myelosuppression, hyperpigmentation
Antitumor antibiotic	Mitomycin C	Adenocarcinomas of the stomach and pancreas; also used commonly in breast cancer and lung cancer	Inhibits DNA and RNA synthesis	Myelosuppression
Alkylating agent	Altretamine	Refractory ovarian carcinoma	—	Myelosuppression, neurologic toxicity
Alkylating agent	Bendamustine	CLL and B-cell non-Hodgkin lymphoma	—	Nausea, pyrexia, vomiting, hematologic abnormalities
Alkylating agent	Busulfan	Palliative treatment of chronic myelogenous leukemia	—	Myelosuppression, hyperpigmentation, elevated liver function tests
Alkylating agent	Carboplatin	Ovarian cancer, testicular cancer, squamous cell cancers of the head and neck and cervix, and lung cancer	Intrastrand and interstrand DNA cross-linking via association with the platinum molecule, leading to strand breakage	Hemorrhage; thrombocytopenia
Alkylating agent	Carmustine	Melanoma, stomach cancer, colon cancer, liver cancer, brain tumors, multiple myeloma, Hodgkin disease, lymphoma	Cell cycle–independent	Myelosuppression, hyperpigmentation, nephrotoxicity
Alkylating agent	Chlorambucil	CLL and low-grade lymphomas; also used for Waldenstrom macroglobulinemia, multiple myeloma, and hairy cell leukemia	Cell cycle–independent	Myelosuppression
Alkylating agent	Cisplatin	Testicular and ovarian cancer and transitional cell carcinoma	Intrastrand and interstrand DNA cross-linking via association with the platinum molecule, leading to strand breakage	Nephrotoxicity, neurotoxicity
Alkylating agent	Estramustine	Prostate cancer	Conjugate with estrogen-binding proteins to kill malignant cells through inhibition of tubulin polymerization	Decreased libido, nausea, vomiting
Alkylating agent	Ifosfamide	Recurrent germ cell tumors, adult sarcomas, lymphoma, Hodgkin disease, breast cancer, and ovarian cancer	Cell cycle–independent	Myelosuppression, hemorrhagic cystitis, and CNS toxicity
Alkylating agent	Lomustine	Brain tumors and Hodgkin disease	Cell cycle–independent	Myelosuppression, nausea, vomiting, anorexia, pulmonary fibrosis
Alkylating agent	Melphalan	Multiple myeloma, ovarian carcinoma	Cell cycle–independent	Myelosuppression, nausea, vomiting
Alkylating agent	Procarbazine	Hodgkin disease	Cell cycle–independent	Myelosuppression, nausea, vomiting
Alkylating agent	Thiotepa	Breast and ovarian carcinoma, as well as Hodgkin disease and non-Hodgkin lymphoma	Cell cycle–independent	Myelosuppression
Microtubule inhibitor	Docetaxel	Metastatic breast cancer and first- and second-line NSCLC	Inhibits the mitotic spindle apparatus by stabilizing tubulin polymers	Myelosuppression, edema and fluid accumulation, sensory or sensorimotor neuropathy, mucositis, diarrhea
Microtubule inhibitor	Ixabepilone	Metastatic or locally advanced breast cancer in patients after failure of an anthracycline and a taxane; as monotherapy for the treatment of metastatic or locally advanced breast cancer in patients after failure of an anthracycline, a taxane, and capecitabine	Inhibits the mitotic spindle apparatus by stabilizing tubulin polymers	Peripheral neuropathy, myelosuppression, hypersensitivity reaction, fatigue/ asthenia, myalgia/ arthralgia, alopecia, nausea, vomiting, stomatitis/mucositis, diarrhea, and musculoskeletal pain
Microtubule inhibitor	Paclitaxel	Salvage therapy in ovarian cancer and for breast cancer	Inhibits depolymerization of tubulin in the spindle apparatus, leading to apoptosis in cells undergoing mitosis	Myelosuppression, polyneuropathy, mucositis, hypertension, hypotension, premature contractions, and bradyarrhythmias
Microtubule inhibitor; vinka alkaloid	Vinblastine	Hematologic and solid neoplasms; most often used for Hodgkin disease, non-Hodgkin lymphoma, germ cell tumors, and breast cancer	Inhibits polymerization of tubulin in the spindle apparatus, leading to apoptosis in cells undergoing mitosis; G2-phase specific	Neurotoxicity, myelosuppression
Microtubule inhibitor; vinka alkaloid	Vincristine	Hodgkin disease and other lymphomas, acute leukemias, rhabdomyosarcoma, neuroblastoma, and Wilms tumor	Inhibits polymerization of tubulin in the spindle apparatus, leading to apoptosis in cells undergoing mitosis; G2-phase specific	Neurotoxicity, myelosuppression
Microtubule inhibitor; semisynthetic vinka alkaloid	Vinorelbine	Relapsed metastatic breast cancer and for NSCLC as a single agent or combined with a platinating agent	Inhibits polymerization of tubulin in the spindle apparatus, leading to apoptosis in cells undergoing mitosis; G2-phase specific	Neurotoxicity, myelosuppression
Antimetabolite	Capecitabine	Metastatic breast cancer and metastatic colorectal cancer	Metabolized to fluorouracil in the liver by carboxylesterase and cytidine deaminase, and then in turn in the peripheral tissues and tumor tissue by thymidine phosphorylase	Myelosuppression and palmar-plantar erythrodysesthesia
Antimetabolite	Cytarabine	Leukemias and lymphomas	Pyrimidine analog	Leukopenia, thrombocytopenia, megaloblastic anemia
Antimetabolite	Fludarabine	CLL; also used for low-grade lymphomas and AML	Purine analog	GI toxicity, myelosuppression
Antimetabolite	Fluorouracil	Colon, rectum, gastric, pancreas, and breast carcinomas	Pyrimidine analog; inhibitor of thymidylate synthase	GI toxicity, myelosuppression
Antimetabolite	Gemcitabine	Advanced pancreatic adenocarcinoma, NSCLC, and metastatic breast cancer	Cytidine (nucleoside) analog with S-phase specific cytotoxicity	Myelosuppression, nausea, vomiting
Antimetabolite	Hydroxyurea	Advanced pancreatic adenocarcinoma, NSCLC, and metastatic breast cancer	Inhibitor of ribonucleotide reductase	Myelosuppression, nausea, vomiting
Antimetabolite	Mercaptopurine (6-MP)	Acute lymphoblastic leukemia	Purine analog; S-phase specific	GI toxicity, myelosuppression
Antimetabolite	Methotrexate	Acute leukemias, lymphomas, breast cancer, bladder cancer, squamous cell cancers, and sarcomas	Inhibits dihydrofolate reductase; S-phase specific	GI toxicity, myelosuppression
Antimetabolite	Thioguanine	AML	Purine analog; S-phase specific	Leukopenia and thrombocytopenia
Plant alkaloid	Etoposide	Germ cell tumors and SCLC	Topoisomerase II inhibitor	GI toxicity, myelosuppression
Semisynthetic camptothecin	Irinotecan	Refractory or recurrent metastatic colon cancer	Topoisomerase I inhibitor	GI toxicity, myelosuppression