Chemotherapy drug list

Drugs used for chemotherapy are known by various names. You may hear the same drug referred to by its generic name, abbreviation, or one of several brand names, depending on which doctor, nurse, or pharmacist you are talking to. The list below gives the most common names used for chemotherapy drugs and tells you what name is used in this chapter so you can easily find it on the following pages of detailed information.

Name

Look Under

Name

Look Under

Adriamycin

Doxorubicin

Hydroxyurea

Hydroxyurea

All-trans-retinoic acid

Tretinoin

Hydrea

Hydroxyurea

ARA-C

Cytarabine

Imatinib mesylate

Imatinib mesylate

Asp

L-Asparaginase

L-Asp

L-Asparaginase

ATRA

Tretinoin

L-Asparaginase

L-Asparaginase

Cerubidine

Daunorubicin

Mercaptopurine

Mercaptopurine

Cyclophosphamide

Cyclophosphamide

Methotrexate

Methotrexate

Cytarabine

Cytarabine

Mexate

Methotrexate

Cytoxan

Cyclophosphamide

MTX

Methotrexate

Cytosar

Cytarabine

Oncovin

Vincristine

Cytosine arabinoside

Cytarabine

PEG-asparaginase

L-asparaginase

Daunomycin

Daunorubicin

Prednisone

Prednisone

Daunorubicin

Daunorubicin

Purinethol

Mercaptopurine

Decadron

Prednisone

Rubidomycin

Daunorubicin

Dexamethasone

Prednisone

STI-571

Imatinib mesylate

DMR

Daunorubicin

Tretinoin

Tretinoin

DNR

Daunorubicin

VePesid

Etoposide

Doxorubicin

Doxorubicin

VCR

Vincristine

Droxia

Hydroxyurea

Vincristine

Vincristine

Elspar

L-Asparaginase

VP-16

Etoposide

Etoposide

Etoposide

6-MP

Mercaptopurine

Gleevec

Imatinib mesylate

6-TG

6-Thioguanine

Hydrocortisone

Hydrocortisone

6-Thioguanine

6-Thioguanine

L-Asparaginase (L-a-SPARE-a-gin-ase), PEG-Asparaginase

Also called: Asp, L-ASP, Elspar How given: Intramuscular injection

How it works: These drugs are enzymes that block protein production in cancer cells to prevent them from reproducing.

Types: There are two types of L-asparaginase: E. coli asparaginase and Erwinia asparaginase.

Precaution: Occasionally a child will have a severe allergic reaction to L-asparaginase. It is important that the drug be given by trained medical personnel who have emergency equipment available. The child should be monitored at the clinic for 20 to 30 minutes after receiving the drug in case a reaction occurs. If a child does have a reaction to E. coli asparaginase, Erwinia asparaginase may be used for the next dose. If a reaction occurs again, asparaginase therapy is usually discontinued.

Common side effects:

• Loss of appetite and weight

• Abdominal cramps

• Nausea and vomiting

Infrequent side effects:

• Allergic reaction, including swelling, difficulty breathing, rash

• Jaundice (yellow skin and eyes)

• Confusion or hallucinations

• Convulsions

• Swelling of feet or legs

• Unusually frequent urination

High blood pressure

• Kidney or liver damage

• Pancreatitis

• Excessive bleeding

Meagan had no problem with the L-asparaginase other than that the shots in her thigh were painful. This was before EMLA was available. I'd recommend that parents put EMLA on two hours before the shot to reduce the pain.

A couple of hours after Preston's third dose of L-asparaginase his leg began to swell up around the injection site. His leg grew to three times its normal size. The doctors switched him to a different kind of L-asparaginase for all subsequent doses, and he had no further problems.

A day after Brent received his last L-asparaginase dose, he began to have intense pain in his kidney area and began to pass blood in his urine. After his arrival at the hospital, his kidneys shut down and he stopped breathing. He was in the ICU on a ventilator and received kidney dialysis for a week. The doctors thought that he had a rare reaction to L-aparaginase which caused tiny blood clots in his kidneys. His kidneys function normally now, but he developed a seizure disorder as a result of the trauma to his brain.

Very few children have serious side effects from asparaginase. But for those who do, it can be both frightening and life-threatening.

Cyclophosphamide (Sye-kloe-FOSS-fa-mide)

Also called: Cytoxan How given: IV injection

How it works: Cyclophosphamide is an alkylating agent that disrupts DNA in cancer cells, preventing reproduction.

Precaution: The child should drink lots of water or be given large amounts of IV fluids while taking Cytoxan to prevent damage to the bladder. Mesna may be given as a precaution to prevent bladder irritation. Antinausea drugs should be given before and for several hours after this drug is administered.

Common side effects:

• Low blood counts (myelosuppression)

• Nausea, vomiting, and diarrhea

• Loss of appetite (anorexia)

Hair loss that is not permanent (alopecia)

• Mouth sores (stomatitis)

Infrequent side effects:

• Bleeding from the bladder (hemorrhagic cystitis)

• Cough or shortness of breath (dyspnea)

Skin rash, dryness, and darkening of the skin (hyperpigmentation)

• Metallic taste during injection of the drug

• Blurred vision

• Irregular or absent menstrual periods in girls (temporary)

• Permanent sterility in post-pubertal boys (rare at routine ALL doses, more common at BMT doses)

Erica just could not tolerate the Cytoxan. She had continuous vomiting. At one point she had lost more than one third of her body weight. Our HMO wouldn't authorize using ondansetron (a very effective antinausea drug) because it was so expensive.

Christine breezed through the Cytoxan infusions. She would go to Children's in the afternoon, they would give her lots of IVfluids, and then ondansetron a half hour before the Cytoxan. She would sleep through the night with absolutely no nausea, because they were so good about giving her the ondansetron all night and the next morning. It was harder on me, because I had to wake up every two hours to change her diaper so that the nurse could weigh it to make sure she was passing enough urine.

Cytarabine (Sye-TARE-a-been)

Also called: ARA-C, Cytosar, cytosine arabinoside

How given: IV, intrathecal, or subcutaneous injection

How it works: Cytarabine kills cancer cells by disrupting DNA.

Common side effects:

• Low blood counts (myelosuppression)

• Nausea, vomiting, and diarrhea

• Loss of appetite (anorexia)

• Hair loss that is not permanent (alopecia)

• Mouth sores (stomatitis)

• Redness and irritation of the eyes (conjunctivitis)

Infrequent side effects:

• Fever with or without chills

• Yellow skin or eyes (jaundice)

• Lethargy and excessive sleepiness (somnolence)

• Flu-like symptoms, including bone and joint pain

• Numbness or tingling of fingers and toes (peripheral neuropathy)

I told my daughter's oncologist how happy I was that she had not had any severe nausea after her first few doses of ARA-C. His only reply was, "It's cumulative." Within an hour, on the long drive home, she was vomiting constantly We became ensnared in a two-hour traffic jam. She ran out of clean clothes, so for two hours, I repeatedly carried her to the side of the road, a naked, bald, 25-pound 4-year-old with tubing hanging from her chest, and supported her as she dry-heaved. The people in the cars around us were in tears, and kept asking if there was anything they could do to help. I just focused on comforting her, and getting her home to that vial of ondansetron in our fridge.

Daunorubicin (Daw-no-ROO-bi-sin)

Also called: Daunomycin, DMN, DNR, Cerubidine, Rubidomycin How given: IV injection or infusion over several days

How it works: An antibiotic that prevents DNA from forming, thus preventing cancer cells from multiplying.

Precaution: Daunorubicin is a red color, and may turn urine red for a day or two after each dose. This is normal.

Common side effects:

• Myelosuppression (low blood cell counts)

• Nausea and vomiting

Infrequent side effects:

• Burning pain and swelling if any drug leaks into skin

• Shortness of breath

My son didn't have any problems from daunorubicin, but I sure worried about heart damage. I went to a conference and learned that the cut-off dose was below what he had on the protocol. I requested an echocardiogram, and his heart function was normal.

Dexamethasone (Dex-a-METH-a-sone)

See Prednisone.

Doxorubicin (Dox-o-ROO-bi-sin)

Also called: Adriamycin, Doxil, Rubex How given: IV injection or infusion

How it works: An antibiotic that prevents DNA from forming, thus preventing cancer cells from multiplying.

Precaution: Doxorubicin is a red color, and may turn urine red for a day or two after each dose. This is normal.

Common side effects:

• Myelosuppression (low blood cell counts)

• Nausea and vomiting

Infrequent side effects:

• Loss of appetite

• Burning pain and swelling if any drug leaks into skin

• Shortness of breath

• Fever and chills

• Abdominal pains

• Dark or bloody stools

• Darkening or ridging of nails

The Adriamycin just burned right through my son. He never got mouth sores, but he sure had problems at the other end. They had him lie on his stomach with the heat lamp on his bare bottom. His whole bottom was blistered so badly that it looked like he'd been in a fire. They used to mix up what they called "Magic Butt Paste," and I'll never forget the recipe: one tube Nystatin cream, one tube Desitin, and Nystatin powder. It was like spackle that they would just slather on. He had a lot of gastrointestinal bleeding, too, so he was continuously getting platelets. That's when they decided that he wouldn't have the delayed intensification phase.

Other than red urine and the expected low counts, hair loss, and nausea, Christine had no problems from her many doses of Adriamycin.

Etoposide (E-TOE-poe-side)

Also called: VP-16, VePesid, Etopophos, Toposar

How given: Intravenous (IV), pills by mouth (PO)

How it works: Etoposide prevents DNA from reproducing and also causes death of dividing cells.

Common side effects:

• Low blood counts (myelosuppression)

• Loss of appetite (anorexia)

• Nausea and vomiting

• Hair loss that is not permanent (alopecia)

Infrequent side effects:

• Low blood pressure (hypotension)

• Shortness of breath (dyspnea)

• Numbing of fingers and toes (peripheral neuropathy)

• Fever with or without chills

• Secondary cancers (new cancers that occur years after initial treatment)

Hydroxyurea (Hi-DROX-ee-yoo-REE-ah)

Also called: Droxia How given: Pills by mouth

How it works: Hydroxyurea has an action that is not well understood, but it is thought to work by stopping DNA production.

Common side effects:

• Low blood counts (myelosuppression)

• Skin rash, itching, darkening of the skin (hyperpigmentation)

• Redness of the skin in areas of prior radiation (radiation recall)

Infrequent side effects:

• Nausea, vomiting, and diarrhea

• Loss of appetite (anorexia)

• Fever, chills, and flu-like symptoms

Headache, drowsiness, dizziness

• Disorientation, hallucinations

Drew has been on hydroxyurea for about two years. It is a pill that they can take long term. He is being weaned off it now because of sores (mouth and leg). They are very, very slow to heal.

Imatinib mesylate

Also called: Gleevec, STI-571

How given: Pills by mouth. Should be taken with food and water. Do not take with grapefruit juice.

How it works: This drug inhibits an enzyme (tyrosine kinase) produced in the cancer cells of most people with CML and in some with ALL.

Common side effects:

• Fluid retention

• Low blood counts (myelosuppression)

• Muscle cramps

• Can cause birth defects if taken while pregnant

Uncommon side effects:

• Hemorrhage

Constipation

Mercaptopurine (Mer-kap-toe-PYOOR-een)

Also called: 6-MP, Purinethol How given: Pills by mouth

How it works: An antimetabolite that replaces part of the backbone of DNA.

Common side effects:

• Myelosuppression (low blood cell counts)

• Loss of appetite

Infrequent side effects:

• Nausea and vomiting

• Jaundice (yellow skin or eyes)

My son was diagnosed with Pre B ALL He is currently in long-term maintenance and doing very well. During interim maintenance he had a severe drop in all counts. This was labeled as pancytopenia. His marrow shut down. When this first happened all counts were at rock bottom, and they thought he had relapsed. He tested positive for a condition called thiopurine methyltransferase (TPMT). Basically, the full dosage of 6TG was poisoning him. He is currently being treated at 50 percent of the drug and being monitored through bimonthly CBCs. The doctor will slowly increase the dosage to maintain a desired ANC if needed.

Methotrexate (Meth-o-TREX-ate)

Also called: Methotrex, MTX

How given: Pills by mouth (PO), intravenous (IV), intrathecal (IT)

How it works: Methotrexate is an antimetabolite that replaces nutrients in the cancer cell, causing cell death.

Precautions: Children should not be given extra folic acid in vitamins, or the methotrexate will not be effective.

Common side effects:

• Low blood cell counts (myelosuppression)

• Extreme sun sensitivity (photosensitivity)

• Headache, tingling pain down legs, and spinal irritation (when given intrathecally)

Infrequent side effects:

• Mouth sores (stomatitis)

• Hair loss that is not permanent (alopecia)

• Nausea and vomiting

• Loss of appetite (anorexia)

Fever with or without chills Temporary liver damage Temporary kidney damage Shortness of breath and dry cough Temporary or permanent nervous system damage Neurotoxicity which can cause learning disabilities

Hints for parents: Most of the common side effects of this drug are temporary and reversible. Mouth sores can be quite painful, and your child may not eat or drink well at this time. Always remember to have your child use sunscreen when he plays outside (SPF 30 or higher). Minor skin rashes can be treated effectively with over-the-counter cortisone cream. When given as high-dose therapy, this drug requires administration of a reversing (antidote) agent called leucovorin. It is critical that your child begin the leucovorin at the correct time to prevent serious, possibly irreversible, side effects.

My daughter had serious problems with rashes during maintenance. The doctors thought she had developed an allergy to the weekly methotrexate. She often would be covered with rashes that looked like small, red circles with tan, flaky skin inside. They were extremely itchy and unattractive. We spent hundreds of dollars at the dermatologist trying various prescription remedies. None worked. In desperation, I went to our local herbalist and asked if she had anything totally nontoxic, which would help the rash but not affect her chemotherapy. She sold me a small tub of salve made from olive oil, vitamin E oil, and calendula flowers. We checked with my daughter's oncologist before using it. It totally cured the rash after two days and worked each time that the rash reappeared. What a relief!

Carl was on an experimental IV high-dose methotrexate protocol funded through the National Institutes of Health. Side effects ranged from nausea and vomiting to diarrhea, sore bones, mood swings, and disorientation.

My son developed learning disabilities from his high-dose methotrexate protocol. He received tutoring through high school and is doing extremely well in college.

Prednisone (PRED-ni-sone) and Dexamethasone (Dex-a-METH-a-sone)

These two steroids are grouped together because they are closely related chemically and have similar action and side effects. Dexamethasone is given in high doses as a chemotherapy drug and in low doses to prevent nausea. To see the side effects of dexamethasone when it is used as an antinausea drug, look under "Drugs Given to Prevent Nausea."

Also called: Dexamethasone is also called Decadron.

How given: Pills by mouth, liquid by mouth, IV

How they work: These drugs are hormones that kill lymphocytes.

Precaution: Every parent interviewed described problems that their child had while on prednisone. The side effects ranged from very mild to severe, but were universal. At high doses, prednisone creates major behavioral problems in children, which gradually subside after the drug is stopped.

Common side effects:

• Increased appetite

• Food obsessions

• Increased thirst

Indigestion

• Fluid retention

• Round face and protruding belly

Sleeplessness

• Nightmares

• Nervousness, restlessness, hyperactivity

• Loss of potassium

• Hypersensitivy to lights, sound, motion

• Extreme irritability

Infrequent side effects:

Decreased or blurred vision Seeing halos around lights Increased sweating Weakness with loss of muscle mass Muscle cramps or pain Swelling of feet or lower legs High blood pressure High blood sugar Hallucinations

Aseptic necrosis (destruction of blood supply to bones)

Judson was a hyper, high-strung child who became extremely hyperactive when he was on prednisone. My recommendation for other parents dealing with this difficult side effect is to run—don't walk—to your nearest library or bookstore and get some books on hyperactive behavior in children. It is important that parents understand this problem and learn to deal with it in a loving way. Remember, too, that this side effect will go away when the prednisone is out of the child's system. Judd would be hyperactive for the entire two weeks, desiring to eat every fifteen minutes or so, making noises constantly, itching all over, sleeping less, having a terrible temper, and losing his fine motor and concentration skills.

During this time he would develop bad behavior because we could not parent him the way we would normally. A few days after his prednisone ended, we would become very firm and structured in our parenting, and he would return to his normal behavior patterns. My son has been in remission ten years, has never exhibited abnormal hyperactivity since ending chemotherapy, and is a well-adjusted teen and an excellent student.

Meagan is very emotionally labile after only two doses of prednisone. She is very frustrated, quick to anger, hits, screams. For those five days we try to stay home, and this helps to decrease the stimulation. We plot it out on the calendar in advance so that we can plan accordingly. I think the kids deserve some tender, loving care while taking prednisone. Of course, I don't allow the hitting, but I do try hard not to aggravate the situation when she is on prednisone. I can see how she is uncomfortable being out of control, but she just can't help it.

Prednisone sends Stephan into a whirlwind of emotions. Sometimes he seems especially happy, and the rest of the time he is in tears at the drop of a hat. We explained to Stephan that the pill can make him feel this way, and it's okay to tell us, "I'm grumpy and I need to be alone for awhile." He gets physical side effects, too. He takes prednisone five days a month, and, like clockwork, on Day 6 he gets itchy, on Day 7 he aches all over, on Day 8 he has severe back, chest, arm, and leg pain, and on Day 9 he starts to feel better.

Preston didn't act out while on prednisone; instead he became depressed and too compliant. He spent most of his time moodily cooking himself food and eating. We bought a second wardrobe of sweat pants with elastic waists so that he would be comfortable.

Rachel had a dual personality on prednisone. She would be fine one minute and then fly into a rage. One time, she literally had an argument with herself. She asked to watch a tape, and then for twenty minutes she argued with herself over whether she should watch the tape. It was painful to watch.

Prednisone and dexamethasone were the worst drugs for Katy. When she was on for a month straight, she hallucinated horrible things. She'd scream that boys were chasing her or that her heart had stopped beating. She'd sob that I was melting and would disappear She'd dig her fingers into my arm begging me to help her. She sometimes did this all night, and nothing consoled her. She slept very little while taking prednisone. She would eat an entire loaf of bread, and always asked to have "butter spread on it like icing on a cake." She has never once said that since ending treatment.

Jeremy never slept well when he was on prednisone. He had nightmares of doctors chasing him through the hospital halls. He had a lot of night sweats and was hungry all night and day. He slept with a loaf of bread, and when we would go places, he always carried a can of Campbell's chicken soup and a can opener. He desperately needed to make sure that he would never be without food.

When you add steroids to a teen boy's already hyped up emotional level, you get ignition. My son was age 14 to 19 when taking steroids. It helped to talk to him about how it would change how he feels and thinks. After a while, he could describe how he was becoming more agitated and wanted to stay in his room alone. He really didn't like being crabby and angry and would voluntarily isolate himself. I suggested ways for him to control his environment while on the steroids so things wouldn't irritate him as much. He also knew that that rules of behavior did not change just because he was on steroids.

Jody just seemed a little high when on prednisone. He was crazy for food but didn't have any behavior problems. He had lots of energy.

Prednisone caused "moon" face, swollen stomach, dark circles under his eyes, and vomiting. Considering Carl was only two and a half when he was going through this, it was difficult to explain the side effects to him. The best we could do was make him as comfortable as possible, stay with him, and make sure he had the blankets and stuffed animals he really loved.

John began prednisone when he was 14 months old, and he began to swell immediately. His moods would swing quickly from happy to sad, but he continued to sleep through the night, and he remained a happy child.

6-Thioguanine (Thigh-oh-GWAN-neen)

Also called: 6-TG

How given: Pills taken by mouth

How it works: Antimetabolite that replaces part of the backbone of DNA.

Precaution: In some cases, 6-TG has caused liver problems. If your child's abdomen rapidly enlarges, call your doctor immediately.

Common side effects:

• Myelosuppression (low blood cell counts)

• Nausea and vomiting

Infrequent side effects:

• Enlarged liver (venoocclusive disease)

• Jaundice (yellow skin or eyes)

• Loss of appetite

Tay's abdomen slowly began to enlarge and then it suddenly went from a little bloated to huge. He looked pregnant, and his abdomen was rock hard. He gained ten pounds in one day—from 55 to 65 pounds. It affected his white, red, and platelet counts. Tay was taken off all meds. He was given potassium by mouth, albumen by IV, and several blood and platelet transfusions. It was very scary! He also ran a fever off and on, and we were in the hospital for days. Once his abdomen shrank and his counts stayed steady we went home.

Tretinoin (tree-tin-O-in)

Also called: All-trans-retinoic acid, ATRA, Vesanoid How given: Capsules by mouth

How it works: Tretinoin is used to treat APL. It works against the genetic product that is formed by the fusion of certain genes. It causes the leukemia cells to differentiate, and this allows them to mature, which slows down and eventually stops them from continuing to divide and grow.

Common side effects:

• Retrinoic-acid-APL syndrome (fever, shortness of breath, fluid in lungs, weight gain)

• Increased white blood cell count

• Birth defects if given to pregnant teens or women

Infrequent side effects:

• Increased sweating

• Visual disturbances

• Abdominal pain

Vincristine (Vin-CRIS-teen)

Also called: Oncovin, VCR How given: IV injection

How it works: Vincristine is an alkyloid derived from the periwinkle plant. It causes cells to stop dividing.

Precautions: Care should be taken to prevent leakage of vincristine from the IV site. The child may need to be started on a program to prevent constipation.

Note: The side effects of vincristine are most pronounced during induction and consolidation when it is given weekly. It is generally better tolerated during maintenance when it is given monthly.

Common side effects:

• Severe constipation

• Pain (may be severe) in jaw, face, back, joints, and/or bones

• Foot drop (child has trouble lifting front part of foot)

• Numbness, tingling, or pain in fingers and toes

• Extreme weakness and loss of muscle mass

• Drooping eyelids

• Pain, blisters, and skin loss if drug leaks during administration

Infrequent side effects:

• Dizziness and light-headedness

• Inappropriate production of anti-diuretic hormone

Hints for parents: This drug is given weekly for a number of weeks. Start a stool softener when your child begins treatment with this drug and give it consistently. Jaw pain is an early and temporary side effect, but it is often severe enough to warrant an oral narcotic. Watch your childs gait and strength, especially going up and down stairs and performing fine-motor activities, such as coloring, writing, or buttoning clothes. Report problems in these areas to your physician promptly so that appropriate dose modifications may be made and/or physical therapy started.

Erica (diagnosed at age 1) once had a vincristine burn on her arm at the IV site. It was red when we went home from the clinic, but by the second day it was badly burned. She developed a blister as big as a half dollar, which left a bad scar. It hurt and was sensitive for a long time. She also developed severe foot drop (she could not lift up the front part of her foot) and fell a lot.

Preston (diagnosed age 10) had an awful time from vincristine. He would develop cramping in his lower legs, and would just curl up in bed, in great pain. It would start a couple of days after he received the vincristine, and would last a week. I would massage his legs, use hot packs, and give him Tylenol. I would have to carry him into the clinic, because he couldn't walk. I did some research and discovered that when the bilirubin is high, the child can't excrete the vincristine and therefore the toxicity is increased. We lowered his vincristine dose and got him into physical therapy.

Vincristine incapacitated Katy. She couldn't walk, lift her head, or open one eyelid. She had trouble swallowing and stayed in bed for weeks during induction and consolidation. I read the package insert for vincristine and discovered that the manufacturer recommended that vincristine be given at least 12 to 24 hours before asparaginase to minimize toxicity. Katy's protocol required that both drugs be given at the same time. I negotiated with the doctors and had her schedule changed so that these two drugs were given on different days. She was soon back on her feet, but still, after a year off treatment, she has generalized muscle weakness and problems with balance.

Soon after diagnosis at age 51/2, Robby became so weak in the hospital that he stopped walking. He did not walk for at least a week, maybe more. When Robby did walk, he was up on his toes. I kept asking the doctors about it, and they poohpoohed it, saying it was just the vincristine. Finally, I took Robby to the pediatrician, who was horrified at how bad his feet had gotten. We immediately started daily physical therapy and major exercises and got traction boots to wear at night.

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