Bleomycin

Drug type: Bleomycin is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug.  This medication is classified as an "antitumor antibiotic." (For more detail, see "How this drug works" section below).

What this drug is used for:

• Used in the treatment of squamous cell cancers, melanoma, sarcoma, testicular cancer, Hodgkin's and non-Hodgkin's lymphoma.
• Also used to treat pleural effusion (build up of fluid in the space between the lining of the lung and the chest wall).

Side effects:

The following side effects are common:

• Fever and chills (see flu-like symptoms).
• Skin reactions: redness, darkening of the skin, stretch marks on the skin, skin peeling, thickening of the skin, ulceration. 
• Nail thickening, nail banding (see skin reactions).
• Hair loss.
• Nausea and vomiting. 
• Poor appetite and weight loss.
• Mouth sores.
• Lung problems: pneumonitis, rarely pulmonary fibrosis. The incidence of lung problems increases with age and pre-existing lung conditions. There is a maximum lifetime dose of bleomycin. Your health care professional will monitor the amount of bleomycin you receive as well as your lung function during treatment.
• Occasionally this can cause "radiation recall" effect.  (see skin reactions)

Less Common but significant side effects may include:

• Vascular effects leading to heart attack or stroke - potentially life-threatening conditions, or Raynaud's phenomenon (a disorder of the small blood vessels that feed the skin, most commonly affecting the hands and feet).
• Severe allergic reaction (anaphylaxis) immediate or delayed for several hours.  You will be monitored closely for any signs of allergic reaction (rash, flushing, lowered blood pressure, difficulty breathing).

How this drug works:

Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue. "Normal" cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition.  Cancerous cells lose this ability. Cancer cells no longer have the normal checks and balances in place that control and limit cell division.  The process of cell division, whether normal or cancerous cells, is through the cell cycle.  The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division).

The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division.  Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division. If the cells are unable to divide, they die.  The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink. They also induce cell suicide (self-death or apoptosis).

Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific.  Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific.  The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective.  This is why chemotherapy is typically given in cycles.

Chemotherapy is most effective at killing cells that are rapidly dividing.  Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The "normal" cells will grow back and be healthy but in the meantime, side effects occur.  The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss.  Different drugs may affect different parts of the body.

Bleomycin is classified as an antitumor antibiotic.  Antitumor antibiotics are made from natural products produced by species of the soil fungus Streptomyces.  These drugs act during multiple phases of the cell cycle and are considered cell-cycle specific.  There are several types of antitumor antibiotics:

• Anthracyclines:  Doxorubicin, Daunorubicin, Mitoxantrone, and Idarubicin.
• Chromomycins:  Dactinomycin and Plicamycin.
• Miscellaneous:  Mitomycin and Bleomycin.

Etoposide

Drug type:  Etoposide is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug.  This medication is classified as a "plant alkaloid" and "topoisomerase II inhibitor."  (For more detail, see "How this drug works" section below).

What this drug is used for:

• Testicular, bladder, prostate, lung, stomach, and uterine, cancers.  Hodgkin's and non-Hodgkin's lymphoma, mycosis fungoides, Kaposi's sarcoma, Wilm's tumor, rhabdomyosarcoma, Ewing's sarcoma, neuroblastoma, brain tumors.
• It also may be given as high-dose therapy in bone marrow transplant setting.

Side effects: The following side effects are common: Low white blood cell count. (This can increase your risk for infection). Low platelet count (This can increase your risk of bleeding). Nadir: Meaning low point, nadir is the point in time between chemotherapy cycles in which you experience low blood counts. Onset: 5-7 days Nadir: 7-14 days Recovery: 21-28 days Hair loss Menopause (chemotherapy induced) Loss of fertility.  Meaning, your ability to conceive a child may be affected by etoposide. Discuss this issue with your health care provider.  Nausea and vomiting (especially at high-doses) Low blood pressure (if the drug is infused too fast) Less common but significant side effects: Mouth sores (especially at high doses) Diarrhea (especially at high doses) Poor appetite Radiation recall (see skin reactions) Other side effects: Metallic taste during infusion of drug Inflammation at injection site Peripheral neuropathy (numbness in your fingers and toes) may occur with repeated doses. This is a rare side effect but can be irreversible.  Report numbness or tingling of feet or hands to your health care provider. Delayed effects: There is a slight risk of developing a blood cancer such as leukemia years after taking etoposide.  Talk to your doctor about this risk. How this drug works: Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue.   "Normal" cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition.  Cancerous cells lose this ability.  Cancer cells no longer have the normal checks and balances in place that control and limit cell division.  The process of cell division, whether normal or cancerous cells, is through the cell cycle.  The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division). The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division.  Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division.  If the cells are unable to divide, they die.  The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink.  They also induce cell suicide (self-death or apoptosis). Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific.  Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific.  The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective.  This is why chemotherapy is typically given in cycles. Chemotherapy is most effective at killing cells that are rapidly dividing.  Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The "normal" cells will grow back and be healthy but in the meantime, side effects occur.  The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss.  Different drugs may affect different parts of the body. Etoposide belongs to a class of chemotherapy drugs called plant alkaloids.  Plant alkaloids are made from plants.  The vinca alkaloids are made from the periwinkle plant (catharanthus rosea). The taxanes are made from the bark of the Pacific Yew tree (taxus).  The vinca alkaloids and taxanes are also known as antimicrotubule agents. The podophyllotoxins are derived from the May apple plant. Camptothecan analogs are derived from the Asian "Happy Tree" (Camptotheca acuminata).  Podophyllotoxins and camptothecan analogs are also known as topoisomerase inhibitors.  The plant alkaloids are cell-cycle specific.  This means they attack the cells during various phases of division. Vinca alkaloids: Vincristine, Vinblastine and Vinorelbine Taxanes:  Paclitaxel and Docetaxel Podophyllotoxins:  Etoposide and Tenisopide Camptothecan analogs: Irinotecan and Topotecan Topoisomerase inhibitors (such as etoposide) are drugs that interfere with the action of topoisomerase enzymes (topoisomerase I and II). Topoisomerase enzymes control the manipulation of the structure of DNA necessary for replication. Topoisomerase I inhibitors:  Ironotecan, topotecan Topoisomerase II inhibitors:  Amsacrine, etoposide, etoposide phosphate, teniposide Cisplatin Trade names: Platinol®, Platinol®-AQ Other names: CDDP

Drug type:  Cisplatin is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug.  This medication is classified as an "alkylating agent."   (For more detail, see "How this drug works" section below).

What this drug is used for:

• Used to treat testicular, ovarian, bladder, head and neck, esophageal, small and non-small cell lung, breast, cervical, stomach and prostate cancers.  Also to treat Hodgkin's and non-Hodgkin's lymphomas, neuroblastoma, sarcomas, multiple myeloma, melanoma, and mesothelioma.

Side effects:

The following side effects are common:

• Nausea and vomiting. Nausea may last up to 1 week after therapy. Anti-nausea medication is given before the infusion, and a prescription is also given for use after.  
• Kidney toxicity, effects on kidney function are dose related, observed 10-20 days after therapy, and are generally reversible.
• Blood test abnormalities: (low magnesium, low calcium, low potassium).
• Low white blood cells (this may put you at increased risk for infection).
• Low red blood cells (anemia).

Nadir: Meaning low point, nadir is the point in time between chemotherapy cycles in which you experience low blood counts.

Onset: 10 days
Nadir: 14-23 days
Recovery: 21-39 days

Less common but significant side effects:

• Peripheral neuropathy: Although less common, a serious side effect of decreased sensation and paresthesia (numbness and tingling of the extremities) may be noted. Sensory loss, numbness and tingling, and difficulty in walking may last for at least as long as therapy is continued. These side effects may become progressively more severe with continued treatment, and your doctor may decide to decrease your dose.  Neurologic effects may be irreversible.
• High frequency hearing loss.  Ringing in the ears.
• Loss of appetite
• Taste changes, metallic taste
• Increases in blood tests measuring liver function.  These return to normal once treatment is discontinued. (see liver problems).
• Hair loss
• Your fertility, meaning your ability to conceive or father a child, may be affected by cisplatin.  Please discuss this issue with your health care provider.

How this drug works:

Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue.   "Normal" cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition.  Cancerous cells lose this ability.  Cancer cells no longer have the normal checks and balances in place that control and limit cell division.  The process of cell division, whether normal or cancerous cells, is through the cell cycle.  The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division).

The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division.  Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division.  If the cells are unable to divide, they die.  The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink.  They also induce cell suicide (self-death or apoptosis).

Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific.  Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific.  The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective.  This is why chemotherapy is typically given in cycles.

Chemotherapy is most effective at killing cells that are rapidly dividing.  Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The "normal" cells will grow back and be healthy but in the meantime, side effects occur.  The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss.  Different drugs may affect different parts of the body.

Cisplatin is classified as an alkylating agent.  Alkylating agents are most active in the resting phase of the cell.  These drugs are cell cycle non-specific.  There are several types of alkylating agents.

• Mustard gas derivatives:  Mechlorethamine, Cyclophosphamide, Chlorambucil, Melphalan, and Ifosfamide. 
• Ethylenimines:  Thiotepa and Hexamethylmelamine.
• Alkylsulfonates:  Busulfan.
• Hydrazines and Triazines:  Procarbazine, Dacarbazine and Temozolomide. 
• Nitrosureas:  Carmustine, Lomustine and Streptozocin.  Nitrosureas are unique because, unlike most chemotherapy, they can cross the blood-brain barrier.  They can be useful in treating brain tumors.
• Metal salts:  Carboplatin, Cisplatin, and Oxaliplatin.