Chapter 53: Antineoplastic Drugs Part 2 – Nonspecific & Miscellaneous Agents

CCNS drugs, which include alkylating drugs and cytotoxic antibiotics, kill cancer cells regardless of the specific phase of the cell growth cycle. Alkylating agents, such as nitrogen mustards (like cyclophosphamide) and platinum compounds (like cisplatin), prevent cancer cell reproduction by altering the chemical structure of DNA through alkylation. These drugs are associated with dose-limiting toxicities, notably bone marrow suppression, nephrotoxicity (especially cisplatin), neurotoxicity, and hemorrhagic cystitis (cyclophosphamide). Cytotoxic antibiotics, including the anthracycline doxorubicin, block DNA synthesis via a process called intercalation and may generate free radicals. A significant risk with anthracyclines is severe cardiovascular toxicity, necessitating careful monitoring of cumulative doses and cardiac ejection fraction. Other agents covered include miscellaneous antineoplastics—such as bevacizumab, an angiogenesis inhibitor that prevents new blood vessel formation by targeting vascular endothelial growth factor (VEGF), and imatinib, a targeted therapy for chronic myeloid leukemia—as well as hormonal drugs (like tamoxifen and antiandrogens). Essential nursing implementation focuses on patient safety given the extreme toxicity of these drugs, including strict adherence to cytotoxic handling protocols, managing severe adverse effects, continuous monitoring of IV sites to prevent devastating extravasation (tissue leakage), and anticipating life-threatening complications like immunosuppression resulting from nadir. Prophylactic measures, such as aggressive intravenous hydration, are often required to prevent or minimize toxicity, particularly nephrotoxicity and hemorrhagic cystitis.