What Are the Different Kinds of Chemotherapy Regimens?

Chemotherapy is a medicine for treating tumors. Chemotherapy drugs can kill tumor cells. These drugs can act on different aspects of tumor cell growth and reproduction, inhibiting or killing tumor cells. Chemotherapy is one of the main methods for treating tumors.

This entry describes the chemotherapeutic drugs related to chemotherapeutic drugs, which are therapeutic drugs for pathogenic microorganisms, parasites, certain autoimmune diseases, and diseases caused by malignant tumors.

Chinese name: Chemotherapy drugs
Foreign name: Chemotherapy drugs

Nature: medicine
Category: drug

Classification of chemotherapy drugs

The first is the traditional classification method: according to the source and chemical structure of the drug, it is divided into alkylating agents, antimetabolites, anticancer antibiotics, plants, hormones and miscellaneous. ?

The second is divided into cell cycle-specific drugs and cell cycle non-specific drugs according to the different effects of drugs on cell proliferation kinetics;

The third is based on the effect mechanism, which is divided into drugs that directly affect the tumor cells themselves and indirect effects by enhancing the body's immune function or endocrine system, such as righting Chinese medicine, immune stimulants, hormones and so on.

The above classification is of great guiding significance for the rational use of drugs in the clinic, but it is more complicated. For convenience, two types of drugs, cell cycle non-specific drugs and phase non-specific drugs, are collectively referred to as cell cycle non-specific drugs, including those in the traditional classification. Most alkylating agents and anticancer antibiotics; and the third class of drugs is called cell cycle specific drugs, including most of the anti-metabolic and plant anticancer drugs in the traditional classification.

Types of chemotherapy drugs

1. Alkylating agents: Alkylating agents act directly on DNA to prevent cancer cells from regenerating. These drugs are effective against chronic leukemia, malignant lymphoma, Hodgkin's disease, multiple myeloma, lung cancer, breast cancer, and ovarian cancer.

2. Antimetabolites: Antimetabolites 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 altering cell membranes. Antitumor antibiotics are cell cycle nonspecific drugs and are widely used in the treatment of cancer.

4. Plant-based anticancer drugs: Plant-based anticancer drugs are plant alkaloids and natural products, which can inhibit the action of mitosis or enzymes, thereby preventing protein synthesis necessary for cell regeneration. Plant anticancer drugs are often used in combination with other anticancer drugs for the treatment of a variety of cancers.

5. Hormones: Corticosteroids are used to treat cancers such as lymphoma, leukemia, and multiple myeloma. When hormones are used to kill or slow the growth of cancer cells, they can be thought of as chemotherapy drugs. Sex hormones are used to slow the growth of breast, prostate and endometrial cancers. It includes estrogen, anti-estrogens, progesterone and male hormones. Sex hormones behave differently from cytotoxic drugs and belong to the special category of chemotherapy.

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

Chemotherapeutic drug selection principle

First of all, according to the patient's pathological diagnosis and staging. Different pathological cell types have different sensitivities to chemotherapeutic drugs. Different pathological stages determine different treatment goals. Obviously, different drugs and doses should be selected;

Second, according to the division cycle of tumor cells, chemotherapeutic drugs are mainly divided into two categories, one is called cell cycle-specific drugs, and the other is called cell cycle non-specific drugs. These two types of drugs have their own different characteristics. The organic combination of these two types of drugs will enhance the effect of the effect and can have the greatest killing effect on cells in different cycle periods;

Third, choose chemotherapy drugs based on the patient's physical condition;

Fourth, add appropriate chemotherapy-sensitizing drugs and drugs to prevent side effects of chemotherapy, such as antiemetics and anti-allergic drugs;

Fifth, the choice of chemotherapy needs to take into account the financial situation of the patient.

Toxic effects of chemotherapy drugs

Antitumor chemotherapeutic drugs used in clinical practice have varying degrees of toxic and side effects, and some serious toxic side effects are the direct reason for limiting the dose or use of drugs. While killing tumor cells, they also kill cells of normal tissues, especially blood and lymphoid tissue cells in the human body, which have strong growth and development. And these cells and tissues are the body's important immune defense system, destroying the body's immune system, and cancer may develop rapidly and cause serious consequences. The toxic side effects of chemotherapy are divided into two types: near toxicity and long-term toxicity. Toxic reactions are divided into local reactions (such as local tissue necrosis, embolic phlebitis, etc.) and systemic reactions (including the digestive tract, hematopoietic system, immune system, skin and mucosal reactions, nervous system, liver damage, heart reaction, lung Toxicity, renal dysfunction, and other reactions). The long-term toxicity is mainly reproductive dysfunction, carcinogenesis and teratogenesis. In addition, chemotherapy can sometimes cause complications due to its toxic and side effects. Common infections, bleeding, perforation, and uric acid crystals are common.

Common side effects of chemotherapy drugs

Local response to chemotherapy

Some irritating chemotherapy drugs can cause severe local reactions when injected intravenously.

A. Phlebitis: manifested as pain and redness in the vein area used, and sometimes visible vein embolism and skin pigmentation along the vein.

B. Local tissue necrosis: When the irritating drug leaks into the skin, it can cause local histochemical inflammation, redness, swelling and pain, and even tissue necrosis and ulcer, which will last forever.

Chemotherapy drug myelosuppression

Most chemotherapeutic drugs have varying degrees of bone marrow suppression, and bone marrow suppression is often the dose-limiting toxicity of antitumor drugs. Myelosuppression can be manifested as a decrease in white blood cells, especially granulocytes, and platelets, red blood cells, and hemoglobin can be reduced in severe cases. Different drugs have different strengths, slowness, and length of the bone marrow, so the degree of response is different. Has fatigue, decreased resistance, susceptibility to infection, fever, bleeding and other manifestations.

Gastrointestinal toxicity

Most chemotherapeutic drugs can cause gastrointestinal reactions, including dry mouth, loss of appetite, nausea, vomiting, and sometimes oral mucositis or ulcers. Constipation, paralytic intestinal obstruction, diarrhea, gastrointestinal bleeding, and abdominal pain are also seen.

Chemotherapy drug immunosuppression

Chemotherapy drugs are generally immunosuppressive drugs, which have different degrees of inhibition on the body's immune function. The body's immune system plays a very important role in destroying residual tumor cells in the body. When the immune function is low, the tumor is not easy to be controlled, but instead Speed up the process of relapse or metastasis.

Chemotherapy drug nephrotoxicity

Some chemotherapeutic drugs can cause kidney damage, mainly manifested by acute necrosis of renal tubular epithelial cells, degeneration, interstitial edema, renal tubular dilatation, and renal failure in severe cases. Patients may have back pain; hematuria, edema, abnormal urine tests, etc.

Chemotherapy drug liver injury

The liver reaction caused by chemotherapy drugs can be acute and transient liver damage, including necrosis, inflammation, or long-term medication. Causes chronic liver damage, such as fibrosis, steatosis, granulomatous formation, and eosinophil infiltration. Clinical manifestations include abnormal liver function tests, pain in the liver area, hepatomegaly, and jaundice.

Chemotherapeutic cardiotoxicity

Clinical manifestations include arrhythmia, heart failure, and cardiomyopathy syndrome (patients show weakness, active dyspnea, paroxysmal nocturnal dyspnea, and heart failure may have fast pulses, fast breathing, liver enlargement, enlarged heart, pulmonary edema , Edema, pleural effusion, etc.), abnormal ECG.

Chemotherapy drug lung toxicity

A small number of chemotherapeutic drugs can cause lung toxicity, manifested by pulmonary interstitial inflammation and pulmonary fibrosis. Clinical manifestations include fever, dry cough, shortness of breath, and more acute onset, accompanied by increased granulocytes.

Chemotherapy drug neurotoxicity

Some chemotherapeutic drugs can cause peripheral neuritis, which manifests as numbness of fingers (toes), disappearance of tendon reflexes, paresthesia, and sometimes constipation or paralytic intestinal obstruction. Some drugs can produce central nervous system toxicity, mainly manifested as paresthesia, reduced vibration, limb numbness, tingling, gait disorders, ataxia, lethargy, and mental disorders.

Chemotherapy drug for hair loss

Some chemotherapeutic drugs can cause hair loss to varying degrees. Generally, only hair loss is mentioned, and sometimes other hair can be affected. This is the result of chemotherapeutic drugs damaging the hair follicles. The degree of hair loss is usually related to the concentration and dose of the drug.

Chemotherapy drugs other

Such as hearing loss, rash, facial or skin flushing, deformed nails, osteoporosis, bladder and urethral irritation, infertility, amenorrhea, sexual dysfunction, and male breast enlargement can also be caused by some chemotherapy drugs.

Chemotherapy drugs

Chemotherapy drug alkylating agent

1, Nimustine Ningdelang ACNU 25mg of this product is injected with 5ml of water for injection, 50mg is dissolved with 10ml of water for injection, and then diluted with physiological saline.

2, Carmustine, Carbachol BCNU, 125mg each time isotonic saline or glucose 250ml, intravenous injection 1-2h 125mg

3. Lomustine cyclohexyl nitrosourea CCNU severe vomiting capsules 40mg 100mg

4, cyclophosphamide cyclophosphine mustard CTX 400-1000mg / m2, after storage should not exceed 3h tablets 50mg injection 100mg 200mg

5, ifosfamide, ifosfamide and rosin IFO alone total amount of 7-10g / m2 for 3-5 days with renal insufficiency. Injection 0.5g1g 2g

6.Glyphosate mustard M-25 Stomostatin methylcyclonitrosourea Me-CCNU capsules 50mg

Chemotherapeutic drugs

1, Desflurane fluorotetralone

2, doxyfluridine 5'-DFUR pays special attention to bleeding tendency. It is contraindicated with antiviral sorifudine. Capsules 100mg200mg

3, 5-fluorouracilFluorouracil 5-FU

4, mercaptopurine 6-mercaptopurine 6-MP tablets 25mg 50mg

5, thioguanine thioguanine 6-TG

CD-DST treatment process 6, Ara-C, Ara-C, Ara-C The usual dose is 100mg // m2 each time, once every 12h for a total of 5-10 days; amphotericin B or digoxin can reduce the efficacy of injections 50mg 100mg

7, Fluguanosine Fluoride deoxynucleoside FNDR is a 5-FU replacement product, with 2-3 times higher efficacy and 5-6 times lower toxicity. It is mainly used for hepatic arterial infusion to treat primary liver cancer and colorectal cancer liver metastases 125-500mg each time, once a day. 250mg powder

8, Tegafurantin FT-207 is converted to 5-FU in vivo with low toxicity

9, gemcitabine Gemzer can improve the quality of life of patients with pancreatic cancer. The recommended dose is 1000mg // m2 for 30 minutes at rest, once a week for a total of 3 times, repeated every 4 weeks, and combined with CDDP.

10, Carmoflufluridinamine HCFU

11, hydroxyurea HU

12, methotrexate methotrexate MTX injection 5mg 0.1g 1.0g

13, Ufadine compound tegafur UFT is a compound preparation of FT-207 and uracil 1: 4

14.Acitabine cyclocytidine uses like Ara-C

Chemotherapy drugs antitumor antibiotics

1, Actinomycin D, Dactinomycin ACD, Vitamin K can reduce its potency. Leaked blood vessels have significant damage to soft tissues, and should be locally blocked with 1% procaine or 50-100 mg hydrocortisone local injection, at the same time Cold and wet external application. Injection 200g

2, Doxorubicin ADM intravenous injection, slowly infusion from the infusion jug. 40-60mg / m2 each time, divided into 2 days, once every 21 days. Heparin or 5-Fu can promote the precipitation of this product Avoid using the same infusion set.

3.Daunomycin, Daunomycin, Daunomycin DRN has great irritation to tissues and low bioavailability, and must be administered intravenously.

3, epirubicin Epirubicin EPI 60-80mg / m2 once every 3 weeks, a total of 3 times, repeated after 3 weeks. 5mg dissolved in 25ml isotonic saline, poured from a small infusion pot. Powder injection 10mg

4.Intravenous injection of mitomycin oriomycin MMC: once from an intravenous infusion pot, 20 mg / m2 each time, once every 6-8 weeks; 6-8 mg // m2 each time, combined with chemotherapy Once every 6 weeks. Antihypertensive, reserpine, chlorpromazine can strengthen or prolong the effect of this product, increase toxicity. Powder injection 2mg4mg and ADM or vinblastine drugs should be used with caution

5.Pelomycin and bleomycin PLM PEP are distributed at higher concentrations in the skin, lungs, lymph nodes, and esophagus. This product has a synergistic effect 30 minutes before radiotherapy.

6, Pingyangmycin, Bleomycin A5, Guangguang A5 PYM

7, Pirarubicin Pirarubicin THP THP-ADM

Chemotherapy drugs antitumor animal and plant medicines

1, Irinotecan CPT-11 In the early 24 hours, there may be syndromes such as increased sweat glands, lacrimal glands, salivary glands, blurred vision, spastic abdominal pain, diarrhea and other syndromes. In severe cases, atropine 0.25mg / 2h should be injected. When combined with 5-FU, be careful to avoid delay Diarrhea. It usually occurs on the fifth day after administration and lasts for an average of 4 days. Injectable 5ml / 100mg delayed diarrhea is dose-limiting toxicity with an incidence of about 80-90%

2, Hypertrine HHRT is mainly effective for acute myeloid leukemia and acute mononuclear leukemia

3.Hydroxycamptotheci static point: 6-8mg / m2 every day, 7-10 days in a row, repeated 21 days; or 10-12mg / m2, 2 times a week, 2 weeks off for 1 week, 3 weeks repeat

4.Changchun Ruibin Novelty NVB

5.The recommended dosage of paclitaxel and antaxol Taxol is 135mg / m2 continuous intravenous infusion for 3h. 12 and 6h before injection, dexamethasone 20mg; 30-60min before intravenous diphenhydramine 50mg and intravenous cimetidine Or ranitidine. 50mg ketoconazole and fluconazole can inhibit the activity of this product.

6.Taxotere

7, Topotecan HCI

8, Vincristine aldehyde Vinblastine VCR Intravenous injection: completed within 1 minute into the pot. Adult maximum dose 2mg. Powder injection 1mg

9.Cincinnati, Changchun

10, Vincristine VDS

11, Vinblastine Vinblastine VLB

12, Teniposide Viper VM-26 can enter the cerebrospinal fluid

13, Etoposide foot glycoside VP16 is dissolved in isotonic saline, the concentration should be between 0.1-0.4mg / ml, instillation for at least 30min. Capsules 50mg100mg.

Protect from light when injecting a 100mg intravenous drip.

14, elemene, acting on the S phase of cells, combined with other chemotherapeutics can enhance the efficacy and reduce the toxicity

Chemotherapy drugs antitumor hormones

1, Atamitan Rindin

2, Anastrozole Arimidex

3. Aluminutamine Aminosomnia can be used clinically to treat postmenopausal breast cancer. Tablets 250mg

4, Letrozole Femara is used with caution in premenopausal breast cancer.

5, Formestan Lantalone Lentaron must be injected deep into the muscles, premenopausal breast cancer is prohibited. Powder injection 250mg

6, Methoprogesterone MEC

7. Tamoxifen tamoxifen

8, breast cancer suppression TAM breast cancer hormone therapy started 3 days before chemotherapy and continued to 4 days after chemotherapy. To prevent deep venous thrombosis, aspirin 40mg should be taken together. Tablets 40mg

Chemotherapy Miscellaneous

1. Asparaginase ASP should be used for skin test 10-50IU before use. This product is dissolved in 0.1ml isotonic saline and observed for 5h. It is positive if redness and swelling appear. Injection 1000IU10000IU

2, Carboplatin Carboplatin CBP renal toxicity is significantly lower than PDD so do not need hydration. But encourage more water. Combined chemotherapy is better than single chemotherapy. Calculated according to Calvert formula. Each dose = AUC × (creatinine clearance + 25). The area under the AUC concentration-time curve is generally 5-7. Creatinine clearance (ml / min) = (140-age) × body weight / 72 × blood creatinine (mg / 100ml). The blood creatinine clearance of 100 mg women needs to be multiplied To 0.85.

3, cisplatin, cisplatin, DDP To prevent kidney toxicity, it needs to be fully hydrated: 12ml before the PDD isotonic glucose solution 2000ml intravenously: PDD daily isotonic saline or glucose 3000-3500ml, and potassium chloride, mannitol and Fast urine, maintain a daily urine output of 2000-3000ml. Pay attention to blood potassium and blood magnesium during treatment. Injection 10mg20mg30mg. Vomiting usually occurs in 1-2h, lasting 2-3 days. Strong antiemetics should be used together. Avoid light.

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

5, oxaliplatin platinum oxalate

6, Lexadine

7, Coplatin Oxa Eloxatin This product + LV + 5-FU is the best first-line treatment for advanced colorectal cancer. The recommended dose is 130-135mg / m2 each time, the rest point is 2-6 hours, once every 3 weeks. Calculated using Calvert formula. Total dose mg = AUC × (creatinine clearance +25). 5-FU should be used first when used with 5-FU. Powder injection 50mg 100mg should not be formulated with alkaline solution or sodium chloride. It should be used after use Intravenous irrigation.

8, Mitoxantronequinone dihydroanthraquinone MIT can be blue after use, urine is basket-green, feces are yellow-green. Injection 5mg10mg20mg30mg

9.Procarbazine methyl benzylhydrazine PCB

Chemotherapy drugs supplement selenium to prevent side effects of chemotherapy

The trace element selenium plays a role in resisting the side effects of radiotherapy and chemotherapy, and detoxifying and synergizing. ^[2]

Selenium can enhance immunity. Organs such as lymph nodes, liver, and spleen are high in selenium, and these tissues are where the immune cells are concentrated. Therefore, selenium supplementation can effectively improve the immunity of patients undergoing chemoradiotherapy, enabling them to successfully complete chemoradiotherapy.

Selenium can reduce the toxicity of chemotherapy drugs. Studies have shown that taking large doses of selenium before and after chemotherapy can reduce side effects such as lowering of white blood cells, nausea, vomiting, loss of appetite, severe hair loss, and nephrotoxicity, which can help increase the dose of chemotherapeutics reasonably for better results.

Selenium can reduce the resistance of chemotherapy drugs. Long-term chemotherapy, malignant tumor cells are prone to drug resistance. The use of chemotherapeutic drugs and high-dose selenium supplementation can significantly reduce the resistance of malignant tumor cells to chemotherapeutic drugs, making them always sensitive to chemotherapeutic drugs and easy to treat.

Selenium can remove harmful free radicals. Selenium is a strong antioxidant. The human body can supplement selenium in large doses during radiotherapy, which can quickly improve the body's antioxidant capacity, remove harmful free radicals, and reduce side effects during radiotherapy.

It should be noted that although selenium can have excellent resistance to the side effects of chemoradiotherapy. However, when selecting selenium supplementation, care must be taken not to add a large amount to avoid selenium poisoning ^[3] . According to the research by Mr. Tang Chuanzhong of Shandong Province Trace Elements Research Association, 100 micrograms of plant active selenium (selenium-enriched corn flour) contains selenomethionine, which has high activity and good absorption rate, is safe and has no side effects. Coming pain!

Precautions when injecting chemotherapy drugs:

(1) Before chemotherapy, understand the chemotherapy regimen and the irritation of each chemotherapy drug to avoid the occurrence of local venous reactions.
(2) Frequently massage the peripheral blood vessels of the extremities, rub the backs of hands and feet, etc. to increase local blood circulation and vascular elasticity and protect local blood vessels.
(3) If you feel pain or abnormal feeling during the injection, you should tell the nurse in time. You should not tolerate it so as to avoid complications caused by strong local irritation of the drug or inadvertent exudation of the drug solution.
(4) The injection must observe the local skin for pimples, redness, etc. If there is any abnormality, the nurse will deal with it in a timely manner.
(5) It is best not to take a hot bath within 24 hours after the injection. Do not wash the skin on the part of the injection. Avoid hot water when washing the face. Use cold water in summer and warm water in winter. If the local skin has a reaction or pain, Under the guidance of nurses, ice compresses, topical skin rubbing hydrocortisone loose urea ointment, hitoto ointment, etc. If necessary, the nurse will perform local closure and other treatments, and avoid local hot compresses.