Which medications in the drug class Antineoplastics, Other are used in the treatment of Pediatric Non-Hodgkin Lymphoma?

Updated: Jun 14, 2018
  • Author: J Martin Johnston, MD; Chief Editor: Max J Coppes, MD, PhD, MBA  more...
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Answer

Antineoplastics, Other

Cancer chemotherapy is based on an understanding of tumoral cell growth and on how drugs affect this growth. After cells divide, they enter a period of growth (ie, phase G1), followed by deoxyribonucleic acid (DNA) synthesis (ie, phase S). The next phase is the premitotic phase (ie, G2), followed by mitotic cell division (ie, phase M).

Cell division rates vary for different tumors. Most common cancers grow slowly compared with normal tissues, and the growth rate may further decrease in large tumors. This difference allows normal cells to recover from chemotherapy more quickly than malignant cells do and is the rationale for current cyclic dosage schedules.

Antineoplastic agents interfere with cell reproduction. Some agents are cell cycle specific, whereas others (eg, alkylating agents, anthracyclines, cisplatin) are not phase specific.

Cellular apoptosis (ie, programmed cell death) is another potential mechanism of many antineoplastic agents.

Daunorubicin (Cerubidine)

Daunorubicin is an anthracycline. Its multiple mechanisms of action involve DNA intercalation, topoisomerase-mediated DNA strand breakage, and oxidative damage due to free radical production.

Doxorubicin (Adriamycin)

Doxorubicin is an anthracycline. Its multiple mechanisms of action involve DNA intercalation, topoisomerase-mediated DNA strand breakage, and oxidative damage due to free radical production.

Cytarabine

Cytarabine is an antimetabolite. A cytotoxic analogue of deoxycytidine, it interferes with DNA replication and repair by incorporating into DNA and inhibiting DNA polymerase.

6-mercaptopurine (6-MP, Purinethol)

This agent is a purine analog. Its metabolites are incorporated into DNA, inhibiting synthesis.

6-thioguanine (Tabloid)

This drug is a purine analogue. Its metabolites are incorporated into DNA, inhibiting synthesis

Methotrexate (Trexall)

Methotrexate is a cytotoxic folate antagonist. It inhibits dihydrofolate reductase.

Vincristine (Vincasar PFS)

Vincristine inhibits microtubule formation in the mitotic spindle, causing metaphase arrest.

Etoposide (VP-16, Toposar)

Etoposide inhibits topoisomerase, causing DNA strand breaks.

Cyclophosphamide

Cyclophosphamide alkylates and cross-links DNA.

Ifosfamide (Ifex)

Ifosfamide alkylates and cross-links DNA.

Carmustine (Gliadel, BiCNU)

Carmustine alkylates DNA and ribonucleic acid (RNA). It may also act by carbamoylation of enzymes.

L-asparaginase (Elspar)

L-asparaginase is an enzyme produced by Escherichia coli that catalyzes the conversion of L-asparagine to aspartic acid. L-asparagine is a nonessential amino acid for most normal tissues. Many lymphoid malignancies have low levels of asparagine synthase and, therefore, depend on the circulating pool of L-asparagine.

Nelarabine (Arranon)

Nelarabine is a prodrug of the deoxyguanosine analogue 9-beta-D-arabinofuranosylguanine (ara-G). It is converted to active 5'-triphosphate (ara-GTP), a T-cell–selective nucleoside analog. Leukemic blast cells accumulate ara-GTP, allowing for its incorporation into DNA; the result is inhibition of DNA synthesis and cell death.

Nelarabine has been approved by the US Food and Drug Administration (FDA) as an orphan drug to treat T-cell lymphoblastic lymphoma that is not responsive or is relapsing with at least 2 chemotherapy regimens.

Hydroxyurea (Hydrea, Droxia)

Hydroxyurea apparently inhibits DNA synthesis.


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