Alkylating Agents - Aliphatic + Aromatic Nitrogen Mustards
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What drug is an aliphatic nitrogen mustard?
aromatic nitrogen mustard?
- Aliphatic - Mustine aka chlormethine
- Aromatic - Chlorambucil and Melphalan
How does mustine (chlormethine) work against cancer cells?
Intermediate alkylates guanine on DNA and then creates interstrand cross-link in DNA
What are some common mechanisms of resistance with mustine?
- 1) Increased DNA repair
- 2) Decreased trasnport of the alkylating drug
- 3) Increased production of glutathione and glutathione-associated proteins
True or False. Moderate doses of mustine can produce severe bone marrow depression w/ leukopenia and thrombocytopenia.
False. Excessive doses can however
How must mustine be administered?
Must be delivered through fast running IV infusion. It is also prone to extravasation if not careful
How does chlorambucil and melphalan work?
Alkylates guanine on DNA via SN1 with carbocation. No intermediate is formed
True or False. Chlorambucil is one of the slowest acting and least toxic nitrogen mustards
What is a toxicity of melphalan even when you stop the drug?
Delayed bone marrow toxicity
Chlorambucil is used for what types of cancer?
CLL (chronic lymphocytic leukopenia), non-Hodgkins lymphoma and ovarian cancer
Cyclophosphamide is a pro-drug.
- It is oxidized in the liver to form two products:
- phosphoramide mustard & acolein
What is cyclophosphamide's MOA?
Oxidation in the liver gives rise to an active metabolite - phosphoramide mustard - which forms INTER-STRAND DNA links.
Cyclophosphamide is used for which types of cancer?
- Breast cancer, ovarian cancer, non-Hodgkin's lymphoma, CLL, soft tissue sarcoma, neuroblastoma, Wilm's tumor.
- *It is also used as an immunosuppressant.
What are the adverse fx associated with cyclophosphamide?
- - N&V
- - Alopecia
- - *Hemorrhagic cystitis - prevented with adequate hydration and Mesna*
Cyclophosphamide is considered to have mild toxicities.
Why is cyclophosphamide occassionally responsible for causing hemorrhagic cystitis?
- It's other metablite - acrolein - is a potent electrophile that reacts with nucleophiles on the surfaces of cells that line the bladder.
- * Mesna acts as a sacrificial nucleophile *
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