Pharmacology Cheat Sheet
Cancer Therapy and Immune Control
Anticancer pharmacology for NEET-PG: vinca vs taxane, methotrexate rescue, 6-MP allopurinol interaction, doxorubicin cardiotoxicity, and checkpoint inhibitor irAEs.
MedNext Academy | 3 min read
Clinically reviewed by Dr Shameer Deen, MBBS, MS, MRCS
Cancer Therapy and Immune Control
Anticancer pharmacology for NEET-PG: vinca vs taxane, methotrexate rescue, 6-MP allopurinol interaction, doxorubicin cardiotoxicity, and checkpoint inhibitor irAEs.
Anticancer drugs and immunomodulators covering cytotoxic chemotherapy, targeted therapy, immune checkpoint inhibitors, and immunosuppressants.
High-yield lines
- Cell cycle-specific drugs kill only dividing cells and are schedule-dependent, while non-specific drugs kill in any phase and are dose-dependent.
- Vinca alkaloids prevent microtubule polymerisation, whereas taxanes prevent depolymerisation of an over-stable spindle.
- Vincristine causes neurotoxicity with little marrow suppression, while vinblastine causes marked bone marrow suppression.
- Cyclophosphamide is a prodrug whose metabolite acrolein is toxic to the bladder, prevented by mesna and hydration.
- Leucovorin (folinic acid) rescues normal cells after high-dose methotrexate, and glucarpidase is used in methotrexate overdose.
- Allopurinol inhibits xanthine oxidase and diverts 6-mercaptopurine to its active pathway, causing severe myelosuppression, so the 6-MP dose must be reduced.
- Doxorubicin causes cumulative, irreversible cardiotoxicity, with lifetime dose usually limited to about 450 to 550 mg/m2, and dexrazoxane is cardioprotective.
- Bleomycin causes cumulative interstitial pulmonary fibrosis as its dose-limiting toxicity.
- Cisplatin is nephrotoxic, ototoxic, and the most emetogenic platinum, whereas carboplatin is mainly myelosuppressive.
- Imatinib was the first molecular targeted therapy, inhibiting the BCR-ABL kinase from the Philadelphia chromosome in chronic myeloid leukaemia.
- Trastuzumab cardiotoxicity is reversible and non-cumulative, unlike the irreversible cumulative cardiotoxicity of doxorubicin.
- Tamoxifen is an oestrogen antagonist in breast but an agonist in the uterus, raising endometrial cancer risk.
- Immune checkpoint inhibitors cause autoimmune immune-related adverse events that can affect any organ and are managed with corticosteroids.
- Tacrolimus causes new-onset diabetes and neurotoxicity, while cyclosporine uniquely causes gum hyperplasia and hirsutism, and both are nephrotoxic.
Mapped competency codes
- PH1.49
- PH1.50
Continue into the full chapter
This summary maps to PH12-anticancer-drugs-and-immunomodulators.
Frequently Asked Questions
How do vinca alkaloids and taxanes differ?
Vinca alkaloids prevent microtubule polymerisation, while taxanes prevent depolymerisation of an over-stabilised spindle.
What is the antidote for high-dose methotrexate toxicity?
Leucovorin (folinic acid) for rescue, and glucarpidase in established overdose.
Why must 6-mercaptopurine be reduced with allopurinol?
Allopurinol inhibits xanthine oxidase, diverting 6-MP to its active pathway and causing severe myelosuppression.
How does trastuzumab cardiotoxicity differ from doxorubicin?
Trastuzumab cardiotoxicity is reversible and non-cumulative, whereas doxorubicin causes irreversible, cumulative, dose-dependent myocyte loss.
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