Pharmacology
Anticancer Drugs and Immunomodulators
Anticancer and immunosuppressant drugs for MBBS and NEET-PG: methotrexate, cyclophosphamide, doxorubicin, targeted therapy and calcineurin inhibitors, mapped to NMC codes.
MedNext Academy | 3 min read
Anticancer Drugs and Immunomodulators
Anticancer and immunosuppressant drugs for MBBS and NEET-PG: methotrexate, cyclophosphamide, doxorubicin, targeted therapy and calcineurin inhibitors, mapped to NMC codes.
This chapter covers the drugs used to treat cancer and to modulate the immune system. It includes the classical cytotoxic agents, targeted therapies such as tyrosine kinase inhibitors and monoclonal antibodies, hormonal agents, and the immunosuppressants used in transplantation and autoimmune disease.
High-yield: Anticancer Drugs and Immunomodulators
- Most cytotoxic drugs damage rapidly dividing cells, so the common toxicities are bone marrow suppression, mucositis, hair loss and infertility.
- Methotrexate inhibits dihydrofolate reductase; folinic acid rescue reduces its toxicity in high-dose regimens.
- Cyclophosphamide is activated in the liver and can cause haemorrhagic cystitis, prevented by mesna and hydration.
- Doxorubicin causes cumulative dose-dependent cardiotoxicity, limiting the total lifetime dose.
- Vincristine causes peripheral neuropathy, while vinblastine causes more marrow suppression.
- Bleomycin causes pulmonary fibrosis and has minimal marrow toxicity.
- Cisplatin is highly emetogenic and causes nephrotoxicity and ototoxicity, needing hydration and antiemetics.
- Tumour lysis syndrome after chemotherapy causes hyperkalaemia, hyperuricaemia and renal failure, prevented with hydration and allopurinol or rasburicase.
- Imatinib is a tyrosine kinase inhibitor that targets the BCR-ABL fusion in chronic myeloid leukaemia.
- Tamoxifen, a selective oestrogen receptor modulator, is used in oestrogen receptor positive breast cancer but raises endometrial cancer risk.
- Trastuzumab targets HER2 positive breast cancer and can cause cardiotoxicity.
- Rituximab is a monoclonal antibody against CD20 used in lymphomas and autoimmune disease.
- Ciclosporin and tacrolimus are calcineurin inhibitors used to prevent transplant rejection and are nephrotoxic.
- Corticosteroids and azathioprine are widely used immunosuppressants in autoimmune disease and transplantation.
Anticancer drug toxicities
- **Doxorubicin:** Cumulative cardiotoxicity limits lifetime dose.
- **Bleomycin:** Pulmonary fibrosis; spares the bone marrow.
- **Cyclophosphamide:** Haemorrhagic cystitis prevented by mesna and hydration.
- **Cisplatin:** Nephrotoxicity, ototoxicity and severe vomiting.
NMC competencies in this chapter
- **PH1.49:** Anticancer drugs and principles of chemotherapy
- **PH1.50:** Immunomodulators and immunosuppressants
Frequently Asked Questions
Why is folinic acid given with methotrexate?
Folinic acid rescue bypasses the block on dihydrofolate reductase in normal cells, reducing methotrexate toxicity in high-dose regimens.
How is haemorrhagic cystitis from cyclophosphamide prevented?
Its toxic metabolite acrolein irritates the bladder, so mesna and generous hydration protect the bladder lining.
What is the dose-limiting toxicity of doxorubicin?
Cumulative cardiotoxicity, which can cause heart failure, so the total lifetime dose is capped and cardiac function is monitored.
What is tumour lysis syndrome?
Massive cell breakdown after chemotherapy releases potassium, phosphate and urate, risking renal failure, and it is prevented with hydration and urate-lowering drugs.
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