C H A P T E R 1 4
Antineoplastic agents
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information about each drug may be obtained in a
nursing drug guide. (See Figure 14.4 for sites of action of
the miscellaneous antineoplastic agents.)
CHAPTER SUMMARY
■■
Cancers arise from a single abnormal cell that
multiplies and grows.
■■
Cancers can manifest as diseases of the blood and
lymph tissue or as growth of tumours arising from
epithelial cells (carcinomas) or from mesenchymal
cells and connective tissue (sarcomas).
■■
Cancer cells lose their normal function (anaplasia),
develop characteristics that allow them to grow in an
uninhibited way (autonomy), have the ability to travel
to other sites in the body that are conducive to their
growth (metastasis) and can stimulate the production
of blood vessels to bring nutrients to the growing
tumour (angiogenesis).
■■
Antineoplastic drugs affect both normal cells and
cancer cells by disrupting cell function and division at
various points in the cell cycle; new drugs are being
developed, such as protein kinase inhibitors, to target
cancer cell–specific functions.
■■
Cancer drugs are usually most effective against cells
that multiply rapidly (i.e. proceed through the cell
cycle quickly). These cells include most neoplasms,
bone marrow cells, cells in the GI tract and cells in
the skin or hair follicles.
■■
The goal of cancer chemotherapy is to decrease the
size of the neoplasm so that the human immune
system can deal with it.
■■
Antineoplastic drugs are often given in combination
so that they can affect cells in various stages of the
cell cycle, including cells that are emerging from rest
or moving to a phase of the cycle that is disrupted by
these drugs.
■■
Adverse effects associated with antineoplastic therapy
include effects caused by damage to the rapidly
multiplying cells, such as bone marrow suppression,
which may limit the drug use; GI toxicity, with
nausea, vomiting, mouth sores and diarrhoea; and
alopecia (hair loss).
■■
Chemotherapeutic agents should not be used during
pregnancy or breastfeeding because they may result
in potentially serious adverse effects on the rapidly
multiplying cells of the fetus and neonate.
■■
The newest drugs developed as antineoplastic agents
target very specific enzyme systems or processes
used by the cancer cells but not by healthy human
cells. These drugs are not as toxic to the person as
traditional antineoplastic drugs.
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ONLINE RESOURCES
An extensive range of additional resources to enhance teaching
and learning and to facilitate understanding of this chapter may
be found online at the text’s accompanying website, located on
thePoint at
These include Watch and
Learn videos, Concepts in Action animations, journal articles,
review questions, case studies, discussion topics and quizzes.
WEB LINKS
Healthcare providers and students may want to consult
the following Internet sources:
Home page of the Cancer Council Australia.
Information on cancer including research, protocols
and new information.
Home page of Cancer Australia, Australian
Government.
TABLE 14.7
DRUGS IN FOCUS Miscellaneous antineoplastics (continued)
Drug name
Dosage/route
Usual indications
tretinoin (Vesanoid)
45 mg/m
2
per day PO for 30–120 days
Used to induce remission in APL; can cause
severe respiratory and cardiac toxicity, including
myocardial infarction and cardiac arrest
Actions:
promotes cell differentiation and the
repopulation of the bone marrow with normal
cells in people with APL
Special considerations:
GI toxicity,
pseudotumour cerebri (papilloedema, headache,
nausea, vomiting, visual changes), skin rash
and fragility may limit use in some people;
discontinue drug at first sign of toxic effects;
use for induction of remission only—then other
chemotherapeutic agents should be used
