In this Chapter:
34.1. Alkylating agents and related compounds
34.2. Antimetabolites
34.3. Antibiotics
34.4. Plant derivatives
34.5. Hormones and hormone antagonists
34.6. Enzymes
34.7. Cytokines
34.8. Monoclonal antibodies
34.9. Protein kinase inhibitors
Chemotherapeutic agents play an important role in the treatment of neoplastic diseases. The arsenal of drugs comprises a lot of preparations, which are effective not only for the treatment of hematological diseases (hemoblastosis) but also in the management of malignani tumors. Unfortunately, antineoplastic drugs that are currently available are not effective enough. As a rule, they are capable of inducing temporary remissions rather than inducing a complete recovery. Only a few neoplastic diseases (for example, choriocarcinoma of the uterus, acute lympholeukaemia in children, Hodkin's disease, chronic myeloleykemia, testicular carcinoma and skin carcinoma without metastases) may be cured completely by means of drug therapy (Table 34.1).
One of the limiting aspects in the treatment of neoplasms with drugs is the development of a resistance of the neoplastic cells to the drugs. This process can be to a certain degree delayed via the concurrent use of the drugs with different mechanisms of action.
The limitations of a majority of current antineoplastic drugs lies also in their low selectivity towards malignant cells. Usually, the application of cytotoxic agents is accompanied by severe adverse and toxic effects, with the actively proliferating tissues (bone marrow, intestinal mucous membrane) being particularly affected. A number of preparations have a negative influence on the reproductive glands (they may cause
Table 34.1. Efficacy of chemotherapeutic agents useful for the treatment of some solid malignant tumors and hematologic malignancies
Cure is possible by means of chemotherapy | Chemotherapy gives a high rate of regression and prolongation of life expectancy; cure occurs in less than 10% of patients | Tumor regression achieved in 20-50% of patients; prolongation of life expectancy is rare | Low sensitivity to chemotherapy |
Choriocarcinoma of the uterus Burkitt's lymphoma Acute lymphocytic leukemia in children Testicular carcinomas Hodkin's disease Chronic myeloleukemia | Acute leukemias Multiple myeloma Erythremia Ewing's sarcoma Prostatic carcinoma Ovarian carcinoma Pulmonary small cell carcinoma Uterus body carcinoma Wilms' tumor Embryonic rhabdomyosarcoma in children Lymphosarcoma Retinoblastoma | Carcinoma of the stomach and colon Chronic leukemias Neuroblastoma in children Melanoma Breast carcinoma Squamous cell carcinoma of the head and neck Laryngeal carcinoma Carcinoma of the urinary bladder Sarcoma of soft tissues Osteogenic sarcoma1 Glioblastoma Corticosteroma | Non-small cell carcinoma of the lung Esophagus carcinoma Liver carcinoma Carcinoma of the pancreas Thyroid gland carcinoma Renal carcinoma Cervix carcinoma Carcinoma of the vagina |