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Chemotherapy drugs

This entry is made by Project of Compilation and Application of Scientific Terms in "Popular Science China" Encyclopedia to examine.

Chemotherapy is a kind of drug to treat tumor. Chemotherapy drugs can kill tumor cells. These drugs can act on different aspects of tumor cell growth and reproduction, inhibit or kill tumor cells. Chemotherapy is one of the main means to treat tumor at present.

This term introduces chemotherapeutic drugs, which are used to treat pathogenic microorganisms parasite , some Autoimmune disease Therapeutic drugs for diseases caused by malignant tumors.

Chinese name: Chemotherapy drugs
Foreign name: Chemotherapy drugs

Nature: Medical Science
Category: drugs

Classification of chemotherapeutic drugs

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The first is the traditional classification method: according to the source and chemical structure of drugs, they are divided into alkylating agents, antimetabolic drugs, anti-cancer antibiotics, plants, hormones and miscellaneous drugs.?

Second, according to the different effects of drugs on cell proliferation kinetics Cell cycle specific drugs and Cell cycle nonspecific drugs ；?

Third, according to the therapeutic mechanism, it can be divided into drugs directly acting on the tumor cells themselves and indirectly acting by enhancing the immune function or endocrine system of the body, such as traditional Chinese medicine for strengthening the body, immune stimulators, hormones, etc.

The above classification pairs Clinical rational drug use It has great guiding significance, but it is complicated. For convenience, cell cycle non-specific drugs and phase non-specific drugs are generally called cell cycle non-specific drugs, including most alkylating agents and anti-cancer antibiotics in the traditional classification; The third class of drugs is called Cell cycle specific drugs , including most of the antimetabolic and plant anticancer drugs in the traditional classification.

Types of chemotherapeutic drugs

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1. Alkylating agent: Alkylating agent acts directly on DNA to prevent cancer cell regeneration. This kind of drug is effective for chronic leukemia Malignant lymphoma, Hodgkin's disease, multiple myeloma, lung cancer, breast cancer and ovarian cancer have curative effects.

2. Antimetabolic drugs: Antimetabolic drugs interfere with the synthesis of DNA and RNA, and are used to treat chronic leukemia, breast cancer, ovarian cancer, gastric cancer, and colorectal cancer.

3. Antitumor antibiotics: Antitumor antibiotics interfere with DNA by inhibiting the action of enzymes and mitosis or changing cell membrane. Antitumor antibiotics are cell cycle non-specific drugs, which are widely used in the treatment of cancer.

4. Plant anticancer drugs: plant anticancer drugs are all alkaloids and natural products, which can inhibit mitosis or enzyme action, thus preventing protein synthesis necessary for cell regeneration. Plant anticancer drugs are often combined with other anticancer drugs for the treatment of a variety of cancer.

5. Hormones: corticosteroids are used to treat lymphoma leukemia And multiple myeloma. When hormones are used to kill cancer cells or slow the growth of cancer cells, they can be regarded as chemotherapy drugs. Sex hormones are used to slow the growth of breast cancer, prostate cancer and endometrial cancer. It includes estrogen, anti estrogen, progesterone and androgen. The action mode of sex hormones is different from that of cytotoxic drugs, belonging to a special category of chemotherapy.

6. Immune agents: Immune agents can stimulate the immune system of cancer patients to recognize and attack cancer cells more effectively. They belong to the special category of chemotherapy^[1] 。

Selection principle of chemotherapy drugs

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First, according to the patient's pathologic diagnosis And staging. Different pathological cell types have different sensitivity to chemotherapy drugs. Different pathological stages determine different therapeutic purposes. Obviously, different drugs and doses should be selected;

Second, according to the division cycle of tumor cells, chemotherapy drugs are mainly divided into two categories, one is called cell cycle specific drugs, and the other is called Cell cycle nonspecific drugs 。 These two types of drugs have different characteristics. If these two types of drugs are organically combined, the effect will be enhanced, and they can have the greatest killing effect on cells in different cycle periods;

Third, choose chemotherapy drugs according to the patient's physical condition;

Fourth, add appropriate chemosensitivity enhancing drugs and drugs to prevent side effects of chemotherapy, such as antiemetics and anti allergy drugs;

Fifth, the choice of chemotherapy scheme should also consider the economic situation of patients.

Toxic and side effects of chemotherapy drugs

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The anti-tumor chemotherapy drugs used in clinic have different degrees of toxic and side effects, and some serious toxic and side effects are the direct reason for limiting drug dosage or use. They kill not only tumor cells, but also normal tissue cells, especially the blood and lymph tissue cells that grow vigorously in the human body., These cells and tissues are important to the human body Immune defense If the immune system of the human body is destroyed, cancer may develop rapidly and cause serious consequences. The side effects of chemotherapy can be divided into near toxicity and long-term toxicity. Toxic reactions can be divided into Local reaction (such as local tissue necrosis, embolic Phlebitis And systemic reactions (including digestive tract hemopoietic system , immune system, skin and mucosa reaction, nervous system, liver function damage, heart reaction, pulmonary toxicity reaction, renal dysfunction and other reactions). Long term toxicity mainly includes reproductive dysfunction, carcinogenesis, teratogenicity, etc. In addition, due to its toxic and side effects, chemotherapy can sometimes cause complications, such as infection, bleeding, perforation uric acid Crystallization, etc.

Common toxic and side effects

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Local reaction

Some highly irritating chemotherapeutic drugs can cause serious local reactions when injected intravenously.

A. Phlebitis : Pain, redness and sometimes visible in the vein used Venous embolism And along veins Skin pigmentation Etc.

B. Local tissue necrosis: when strong irritant drugs leak into the skin, it can cause local histochemical inflammation, redness, swelling, pain, even tissue necrosis and ulcer, which will not heal for a long time.

Myelosuppression

Most chemotherapy drugs have different degrees of bone marrow suppression, and bone marrow suppression is often dose limiting toxicity of anti-tumor drugs. In the early stage, myelosuppression can be manifested as leukopenia, especially granulocytopenia. In severe cases, platelet red blood cell , hemoglobin can be reduced. Different drugs have different effects on bone marrow in terms of strength, speed and length, so the degree of reaction is different. At the same time, patients may also have fatigue, decreased resistance, susceptibility to infection, fever, bleeding and other manifestations.

Gastrointestinal toxicity

Most chemotherapy drugs can cause gastrointestinal reactions, such as dry mouth, loss of appetite, nausea, vomiting, and sometimes Oral mucositis Or ulcers. Constipation Paralytic ileus Diarrhea, gastrointestinal bleeding and abdominal pain can also be seen.

Immunosuppression

Chemotherapy drugs are generally immunosuppressive drugs, which can inhibit the immune function of the body to varying degrees. The body's immune system plays an important role in eliminating the remaining tumor cells in the body. When Low immune function When the tumor is not easy to be controlled, it will speed up the process of recurrence or metastasis.

Nephrotoxicity

Some chemotherapy drugs can cause Kidney injury The main manifestations are acute necrosis and degeneration of renal tubular epithelial cells, interstitial edema, dilation of renal tubules, and renal failure in severe cases. Patients may have low back pain; hematuria , edema, abnormal urination test, etc.

Liver injury

The liver reaction caused by chemotherapy drugs can be acute and transient liver damage, including necrosis, inflammation, or long-term drug use. It causes chronic liver damage, such as fibrosis, steatosis, granuloma formation, eosinophil infiltration, etc. The clinical manifestations are Liver function test Abnormality, liver pain Hepatomegaly 、 Yellow gangrene Etc.

cardiotoxicity

Clinical manifestations include arrhythmia heart failure Cardiomyopathy syndrome (the patient shows weakness, active dyspnea, paroxysmal nocturnal dyspnea, and heart failure may have rapid pulse, rapid breathing, hepatomegaly Cardiomegaly 、 pulmonary edema , edema and Hydrothorax ), abnormal ECG.

Pulmonary toxicity

A few chemotherapy drugs can cause pulmonary toxicity, which is manifested as interstitial inflammation and pulmonary fibrosis. The clinical manifestations include fever, dry cough, dyspnea, multiple acute onset, and granulocytosis.

neurotoxicity

Some chemotherapy drugs can cause Peripheral neuritis , manifested as numbness of fingers (toes), disappearance of tendon reflex, abnormal sensation, and sometimes constipation or Paralytic ileus 。 Some drugs can produce central neurotoxicity, which is mainly manifested by sensory abnormalities, decreased sense of vibration Numbness of limbs , tingling, gait disorder Ataxia , lethargy, mental disorder, etc.

alopecia

Some chemotherapy drugs can cause hair loss to varying degrees. Generally speaking, hair loss is the only problem. Sometimes other hairs can also be affected, which is the result of chemotherapy drugs damaging hair follicles. The degree of hair loss is usually related to the concentration and dosage of drugs.

other

Such as hearing loss, skin rash, facial or skin flushing, nail deformation, osteoporosis, bladder and urinary tract irritation, infertility amenorrhoea 、 sexual dysfunction Male breast enlargement can also be caused by some chemotherapy drugs.

Common chemotherapeutic drugs

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Alkylating agent

1. Nimustine and Deran ACNU 25mg of this product is dissolved in 5ml of injection water, 50mg of this product is dissolved in 10ml of injection water, and diluted with normal saline before static point or Arterial injection Powder injection 25mg50mg

2, Carmustine Each time 125mg of BCNU is used alone, 250ml of isotonic saline or glucose is added, and 125mg of BCNU is injected intravenously for 1-2h

3, Lomustine CCNU Serious Vomiting Capsule 40mg 100mg

4. Cyclophosphamide cyclophosphamide CTX 400-1000mg/m2, which should not be stored for more than 3h after preparation 50mg tablet injection 100mg 200mg

5. The total amount of ifosfamide, ifosfamide and lesheng IFO used alone is 7-10g/m2 for 3-5 days with renal insufficiency Inject 0.5g1g 2g

6. M-25 Smustine Me-CCNU capsules 50mg

Antimetabolic drug

1. Deoxyfluoroguanosine Teflon

2. Doxyfluridine 5 '- DFUR Special attention Bleeding tendency It is forbidden to use together with antiviral solivudine Capsule 100mg 200mg

3, 5-Fluorouracil 5-FU fluorouracil

4, Mercaptopurine 6-Mercaptopurine 6-MP Tablets 25mg 50mg

CD-DST treatment process

5. Thioguanine, thioguanine 6-TG6, cytarabine, cytosine arabine, Ara-C, common dose: 100mg/m2, once every 12h, 5-10 days in total; Amphotericin B or digoxin can reduce the efficacy Injection 50mg 100mg

7. Fluoroguanosine Fluoroguanosine FNDR is a substitute for 5-FU, which is 2-3 times more effective and 5-6 times less toxic. It is mainly used for hepatic artery perfusion therapy Primary liver cancer and colorectal cancer Liver metastasis, 125-500mg each time, once a day Injection powder 250mg

8. Tigafuranfludine FT-207 is converted into 5-FU in vivo, with low toxicity

9. Gemzer of gemcitabine and gemcitabine can improve the quality of life of patients with pancreatic cancer. The recommended dose is 1000mg/m2 for 30 minutes, once a week, three times in total, repeated every four weeks, mostly in combination with CDDP Powder injection 200mg 1000mg, no refrigeration

10. Carmofluorinamide HCFU

11, hydroxyurea HU

12. Methotrexate Methotrexate MTX injection 5mg 0.1g 1.0g

13. The UFT of Youfuding compound tegafur is FT-207 and the UFT of uracil is 1:4 to get the compound preparation

14, Ansitabin Cytidine is used like Ara-C

Antineoplastic antibiotic

1. Actinomycin D, gentamicin ACD, vitamin K can reduce its potency. The leaking blood vessel will cause significant damage to the soft tissue. It should be immediately sealed with 1% procaine, or injected with 50-100mg hydrocortisone locally, and applied cold and wet externally Injection 200 μ g

2. Doxorubicin and doxorubicin ADM are injected intravenously, and slowly flushed in from the small infusion bottle. 40-60mg/m2 each time, given in 2 days, once every 21 days. Heparin or 5-Fu can promote the precipitation of this product and avoid the use of the same infusion set

3. Daunorubicin Positive dingmycin Doxomycin DRN is highly irritating to tissues and has low bioavailability. It must be administered intravenously

3. Epirubicin Epirubicin EPI 60-80mg/m2 once every three weeks, 3 times in total Weeks later Repeat. 5mg and dissolve it in 25ml isotonic saline, and flush it from the infusion jug Powder injection 10mg

4. Mitomycin (MMC) intravenous injection: 20mg/m2 from intravenous infusion jug, once every 6-8 weeks; 6-8mg/m2 from combined chemotherapy, once every 4-6 weeks. Jiangyaling, reserpine, and chlorpromazine can enhance or prolong the effect of this product and increase the toxicity Powder injection 2mg4mg and ADM or Vinblastine Be cautious when using similar drugs together

5. Pellomycin and pileomycin PLM PEP are distributed in skin, lung lymph gland Esophagus. 30 minutes before radiotherapy, this product has synergistic effect

6. Pingyangmycin bleomycin A5 Zhengguangmycin A5 PYM

7, pirarubicin THP THP-ADM

Antineoplastic drugs of animal and plant ingredients

1. In the early 24 hours of irinotecan CPT-11, there may be syndrome such as increased salivary gland secretion of sweat gland and lacrimal gland, blurred vision, spastic abdominal pain, diarrhea, etc. In severe cases, atropine 0.25mg/2h should be injected. When combined with 5-FU, attention should be paid to avoid aggravating delayed diarrhea. Most cases occur on the fifth day after administration, lasting for 4 days on average Delayed diarrhea of 5ml/100mg injection is dose limiting toxicity, and the incidence rate is about 80-90%

2. Harringtonine HHRT mainly affects acute granulocytes leukemia And acute Monocytic leukemia Good curative effect

3. Hydroxycamptothecin intravenous solution: 6-8mg/m2 per time per day, 7-10 consecutive days, repeated for 21 days, or 10-12mg/m2 per time, twice a week, two weeks off, three weeks repeated

4, Changchun Ruibin Novibben NVB

5. Paclitaxel, Antaisu The recommended dose of Taxol is 135mg/m2 each time for continuous intravenous infusion for 3h. Take dexamethasone 20mg 12 and 6h before injection; 50 mg diphenhydramine and cimetidine or ranitidine were injected intravenously 30 to 60 minutes ago The injection of 50mg ketoconazole and fluconazole can inhibit the activity of this product

6. Taxotere

7. Topotecan HCI

8, vincristine Aldehyde group Vinblastine VCR intravenous injection: completed within 1 minute after entering the pot. The maximum adult dose is 2mg Powder injection 1mg

9, Changchun Dixin Siaike

10, Vincamide VDS

11. Vinblastine VLB

12. Teniposide Weimeng VM-26 can enter cerebrospinal fluid

13, etoposide Etoposide VP16 is dissolved in isotonic saline, the concentration should be between 0.1-0.4mg/ml, and the infusion should last at least 30min Capsule 50mg 100mg

Avoid light when injecting 100mg intravenous drip

14. Elemene, which acts on the S phase of cells, can increase efficacy and reduce toxicity in combination with other chemotherapy drugs

Antitumor Hormones

1, Atamitanenin

2, anastrozole Arimidex

3. Amlumide Amiodarone Elipten is used for clinical treatment menopause after breast cancer . Tablets 250mg

4. Letrozole Femara should be used with caution for premenopausal breast cancer

5. Formestane and lantalon Lentaron should be injected into deep muscle, and should not be used for premenopausal breast cancer Powder injection 250mg

6, Metaprogesterone MECOX MA

7, Tamoxifen tamoxifen

8. Breast cancer inhibiting TAM breast cancer hormone treatment starts 3 days before chemotherapy and continues to 4 days after chemotherapy. To prevent deep vein thrombosis, 40 mg aspirin should be taken together Tablets 40mg

sundry

1. Asparaginase ASP should be subject to skin test of 10-50IU before use. This product should be dissolved in 0.1ml isotonic saline and observed for 5h. If there is red and swollen plaque, it is positive Injection 1000IU10000IU

2. Carboplatin CBP Nephrotoxicity It is obviously lower than PDD, so hydration is not necessary. But more water is encouraged. Combined chemotherapy is better than single chemotherapy. Calculated according to Calvert formula, each dose=AUC × (creatinine clearance rate+25) The area under the AUC concentration time curve is generally 5-7. Creatinine clearance rate (ml/min)=(140 age) × body weight/72 × Blood creatinine (mg/100ml). The creatinine clearance rate of 100mg female blood for injection should be multiplied by 0.85

3, Cisplatin In order to prevent renal toxicity, cisplatin DDP needs to be fully hydrated: 2000ml of isotonic glucose solution is dropped 12 hours before PDD; 3000-3500ml of isotonic saline or glucose is given to PDD daily, and potassium chloride, mannitol and furosemide are used to maintain the daily urine volume of 2000-3000ml. During the treatment, attention should be paid to blood potassium and magnesium The injection 10mg, 20mg, 30mg. Vomiting usually occurs in 1-2h and lasts for 2-3 days. A powerful antiemetic must be used together. The intravenous drip should be kept away from light

4, Dacarbazine Azemimide DTIC is mainly used to treat malignant melanoma Injection 200mg

5, oxaliplatin oxaliplatin

6. Losadine

7. Coppoxa Eloxatin+LV+5-FU is the best first-line treatment for advanced colorectal cancer. The recommended dose is 130-135mg/m2 each time, 2-6 hours of intravenous drip, and once every 3 weeks. Calvert formula is used to calculate the total dose mg=AUC × (creatinine clearance rate+25) When used with 5-FU, 5-FU should be used first Powder injection 50mg 100mg should not be prepared with alkaline solution or sodium chloride. After use, it should be rinsed intravenously

8. Mitoxantrone Dihydroanthraquinone After MIT, the sclera can be blue, urine is blue green, and feces is yellow green Injection 5mg 10mg 20mg 30mg

9, Propcarbazide Methyl benzylhydrazine PCB

Selenium supplement protects against side effects of chemotherapy

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Trace element selenium plays a certain role in resisting the side effects of radiotherapy and chemotherapy, detoxification and synergism.^[2]

Selenium can enhance immunity. Human lymph nodes, liver, spleen and other organs have high selenium content, and these tissues are the concentration of immune cells. Therefore, selenium supplementation can effectively improve the immunity of patients with radiotherapy and chemotherapy, so that they can successfully complete radiotherapy and chemotherapy.

Selenium can reduce the toxicity of chemotherapy drugs. Research shows that taking large doses of selenium before and after chemotherapy can reduce leukopenia, nausea, vomiting Anorexia , severe hair loss, nephrotoxicity and other side effects, which helps to reasonably increase the dosage of chemotherapy drugs to achieve better efficacy.

Selenium can reduce the drug resistance of chemotherapy drugs. Long term chemotherapy, malignant tumor cells are prone to drug resistance. High dose selenium supplementation while using chemotherapy drugs can significantly reduce the drug resistance of malignant tumor cells to chemotherapy drugs, making them always sensitive to chemotherapy drugs and easy to treat.

Selenium can eliminate harmful free radicals. Selenium is a strong antioxidant. When the human body supplements selenium in large doses during radiotherapy, it can rapidly improve the antioxidant capacity of the body, eliminate harmful free radicals, and reduce the side effects of radiotherapy.

It should be noted that although selenium can have excellent resistance to the side effects of radiotherapy and chemotherapy. However, attention should also be paid to the selection of selenium supplements, which should not be supplemented in large quantities to avoid selenium poisoning^[3] 。

Precautions when injecting chemotherapy drugs:

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(1) Before chemotherapy, it is necessary to understand the chemotherapy drug regimen and the irritation of each chemotherapy drug to avoid local venous reaction.

(2) Frequently massage the peripheral blood vessels of the limbs, rub the back of the hands and feet, etc., to increase the local blood circulation and blood vessel elasticity, and protect the local blood vessels.

(3) If you feel pain or have abnormal feeling during the injection, you should tell the nurse in time. You can't bear it reluctantly, so as to avoid complications caused by the strong irritation of the drug to the local area or the inadvertent seepage of the drug solution.

(4) For drug injection, observe whether there are papules, redness and other conditions on the local skin. If there are abnormalities, the nurse will give timely and appropriate treatment.

(5) It is better not to take a hot bath within 24 hours after the injection. Do not scald the local skin after the injection. Avoid too hot water when washing the face. Cool water can be used in summer and warm water can be used in winter. If the local skin has reaction or pain, ice can be applied under the guidance of the nurse, and hydrocortisone urea ointment and Hirudoid ointment can be applied to the local skin, If necessary, the nurse will conduct local sealing and other treatment, and local hot compress is strictly prohibited.

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