Which medications in the drug class Antineoplastic Agents are used in the treatment of Pediatric Neuroblastoma?

Updated: Oct 09, 2017
  • Author: Norman J Lacayo, MD; Chief Editor: Max J Coppes, MD, PhD, MBA  more...
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Antineoplastic Agents

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

Cell division rate varies for different tumors. Most common cancers increase very slowly in size compared with normal tissues, and the rate may decrease further in large tumors. This difference allows normal cells to recover more quickly from chemotherapy than malignant cells; it is the rationale behind 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 also a potential mechanism of many antineoplastic agents.

Carboplatin (Paraplatin)

Alkylating agent. Interferes with metabolism of DNA by covalent binding.

Cisplatin (Platinol)

Mechanism of action is similar to other alkylating agents. Binds and cross-links DNA strands.

Cyclophosphamide (Cytoxan)

Immunosuppressant antineoplastic agent. Metabolism of cyclophosphamide by hepatic microsomal enzymes produces active alkylating metabolites, which probably damage DNA.

Doxorubicin (Adriamycin)

Causes DNA strand breakage mediated by effects on topoisomerase II. Intercalates into DNA and inhibits DNA polymerase.

Etoposide (VP-16, VePesid)

Interacts with topoisomerase II and produces single strand breaks in DNA. Arrests cells in late S or G2 phase.

Ifosfamide (Ifex)

Alkylating agent. Metabolic activation by microsomal liver enzymes produces biologically active intermediates that attack nucleophilic sites, particularly on DNA.

Melphalan (Alkeran)

Inhibits mitosis by cross-linking DNA strands.

Isotretinoin (13-cis-retinoic acid, Accutane)

Vitamin A derivative. Interacts with retinoic acid responsive elements on DNA, which results in gene activation and differentiation of target cells.

Thiotepa (Thioplex)

Ethyleneimine derivative alkylating agent. Action involves transfer of the alkyl group to amino, carboxyl, hydroxyl, imidazole, phosphate, and sulfhydryl groups within the cell, altering structure and function of DNA, RNA, and proteins.

Vincristine (Oncovin)

Mitotic inhibitor. This vinca alkaloid binds tubulin leading to its depolymerization, resulting in mitotic inhibition and metaphase arrest.

Topotecan (Hycamtin)

Inhibits topoisomerase I, inhibiting DNA replication.

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