Series of Pharmacology lectures to undergraduate medical students, based on illustrations and hints that aid studying from standard textbook.

1. CHEMOTHERAPY
HIGHLIGHTS
MOHAMED BAHR; MD, PHD
Anticancer Drugs

2. Mohamed Bahr; MD, PhD
CANCER
CHEMOTHERAPY

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4. Mohamed Bahr; MD, PhD

5. Mohamed Bahr; MD, PhD

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7. Mohamed Bahr; MD, PhD
I. ALKYLATING
AGENTS (CCNS)
Cyclophosphamide, Busulphan – Nitrosoureas – Cisplatin.
They are chemical substances containing highly reactive
groups (alkyl). They transfer these active groups to various
cellular constituents, mainly DNA, proteins and enzymes
decreasing their synthesis and/ or function.

8. Mohamed Bahr; MD, PhD

9. Mohamed Bahr; MD, PhD
II. ANTIMETABOLITES
(S PHASE)
They are structural analogs of naturally occurring metabolites
competing with them for enzyme systems → ↓ DNA and RNA
synthesis.
A. 6- Mercaptopurine (purine antagonist)
Decreases purine synthesis → ↓ DNA and RNA synthesis.
B. Methotrexate (folic acid antagonist)
Inhibits DHFR → ↓ H4F synthesis → ↓ DNA and RNA synthesis.

10. Mohamed Bahr; MD, PhD

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12. Mohamed Bahr; MD, PhD
III. NATURAL
PRODUCTS
A. Plant alkaloids: (Vinblastine, Vincristine) (M phase)
They are mitotic spindle poisons → mitotic arrest.

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B. Antibiotics
Bind to DNA → fragmentation of its strands → ↓ DNA
synthesis.
Bleomycin (G2 - M)
Dactinomycin - Adriamycin - Mitomycin - Doxorubicin (CCNS)

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C. Camptothecins (topoisomerase I inhibitors) (CCNS)
Irinotecan - Topotecan

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D. Epipodophyllotoxin (topoisomerase II inhibitor) (G1–S
phase)
Etoposide

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E. Taxanes (M phase)
Paclitaxel

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F. Enzymes (L- asparaginase)
↓ Blood asparagine → deprives tumor cells of this amino acid
which is essential for protein synthesis.

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G. Interferons
See Before

32. Mohamed Bahr; MD, PhD
IV. HORMONES AND
ANTAGONISTS
Corticosteroids in leukemia and lymphomas.
Testosterone in cancer breast.
Estrogen in cancer prostate.
Hormone receptors agonists and antagonists:
(estrogen/tamoxifen), (testosterone/cyproterone, flutamide).
GnRH agonists (leuprolide and goserelin) for prostate and
breast tumors.

33. Mohamed Bahr; MD, PhD

34. Mohamed Bahr; MD, PhD

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V. MISC
Protein tyrosine kinase inhibitors: Imatinib
Immunomodulators: Thalidomide

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ADVERSE EFFECTS
A. GENERAL
Bone marrow depression: leucopenia, thrombocytopenia or pancytopenia.
Hair loss.
GIT disturbances: vomiting, diarrhea and GIT ulcers.
Hyperuricemia (due to destruction of ↑number of tumor cells).
Immunosuppression: liability to infections and delayed healing of wounds.
Gonadal damage: sterility, amenorrhea and azospermia.
Teratogenicity and mutagenicity.
Secondary malignancy.

38. Mohamed Bahr; MD, PhD

39. Mohamed Bahr; MD, PhD
B. SPECIFIC
Cyclophosphamide: hemorrhagic cystitis.
Busulphan: interstitial pneumonitis and pulmonary fibrosis.
Methotrexate: hepatotoxic, nephrotoxic, neurotoxic & folate
deficiency
Vinca alkaloids: peripheral and autonomic neuropathy.
Bleomycin: pulmonary fibrosis – skin pigmentation.

40. Mohamed Bahr; MD, PhD
REFERENCES
Lippincott’s Illustrated Reviews, 5th ed.
Color Atlas of Pharmacology, 2nd ed.
Goodman and Gilman's The Pharmacological Basis of
Therapeutics, 12th ed.