MOA: Inhibits dihydrofolate reductase (DHFR) A/E: Myelosuppression, Stomatitis, Renal and GI toxicity
Permetrexed
MOA: Inhibits DHFR, TS, GART A/E: Myelosuppression, Hepatoxicity, GI toxicity
Cytarabine
MOA: Inhibition of DNA polymerase and incorparted into developing DNA A/E: Nausea + Vomiting, Myelosuppression, Oral +GI ulceration
Fluorouracil
MOA: Converts to: d-UMP - inhibits thymidylate synthetase and prevents synthesis of thymidyline; 5-dUTP - interferes with RNA polymerase A/E: Nausea + Vomiting, Myelosuppression, Oral + GI ulceration
Gemcitabine
MOA: S-phase specific inhibitor of DNA synthesis A/E: Myelosuppression, Alopecia, Various GI disturbances
DNA Alkylating Drugs
Cyclophosphamide Cisplatin
Cyclophosphamide
MOA: Cross-links DNA strands by forming covalent bonds betwwen alkyl groups of the drug and guanine bases of DNA A/E: Myelosuppression, Alopecia, Hemorrhagic cystitis, Nausea + Vomiting
Cisplatin
MOA: Forms intrastrand and interstrand covalent bonds with DNA bases A/E: Myelosuppression, Severe nausea + vomiting, Nephrotoxicity
Intercalating Drugs
Doxorubicin
Doxorubicin
MOA: Intercation of DNA but may also inhibit topoisomerase, and form of free radicals A/E: Myelosuppression, Cardiac damage, Dose-dependent nausea + vomiting, mucosa ulceration
Mitotic Inhibitors
Vincristine Vinblastine Paclitaxel
Vincristine and Vinblastine
MOA: Block microtubule aassembly and interferes with mitosis A/E: Vincristine - neurotoxicity, Vinblastine - myelosuppression
Paclitaxel
MOA: Block microtubule disassembly and interferes with mitosis A/E: Neurotoxicity, Myelosuppression, Alopecia
Topoisomerase Inhibitors
Etoposide Irinotecan
Etoposide
MOA: Inhibits topoisomerase II and prevents DNA replication A/E: Myelosuppression, Nausea + Vomiting, Alopecia
Irinotecan
MOA: Converted to active metabolite SN38 which inhibits topoisomerase I and prevents DNA replication A/E: Myelosuppression, Nausea + Vomiting