Chapter 45: Antineoplastic Drugs Part 1: Cancer Overview and Cell Cycle–Specific Drugs

The content distinguishes between benign and malignant tumors while explaining carcinogenesis and the process of metastatic spread. Central to understanding antineoplastic therapy is the cell cycle, which consists of five distinct phases: the G0 resting phase, G1 and G2 growth phases, S phase where DNA synthesis occurs, and M phase representing mitosis. Cancer cells exploit dysregulated cell cycle control to achieve uncontrolled proliferation, and cell cycle–specific chemotherapeutic agents target these dividing cells at vulnerable points in their replication. The chapter covers several drug classes: antimetabolites such as methotrexate, cytarabine, fluorouracil, and gemcitabine that interfere with nucleotide synthesis and DNA replication; mitotic inhibitors including vinca alkaloids like vincristine and vinblastine that prevent spindle fiber formation; taxane agents such as paclitaxel and docetaxel that stabilize microtubules; topoisomerase inhibitors both type I and type II including etoposide, teniposide, irinotecan, and topotecan that prevent DNA unwinding necessary for replication; and antineoplastic enzymes like asparaginase and pegaspargase that deplete amino acids essential for tumor survival. The chapter emphasizes substantial toxicities associated with chemotherapy, including bone marrow suppression leading to myelosuppression, anemia, leukopenia, and thrombocytopenia; gastrointestinal effects such as mucositis and stomatitis; alopecia; nausea and vomiting; and life-threatening tumor lysis syndrome. Nursing care encompasses comprehensive assessment of baseline hematologic values and ongoing monitoring, vigilant infection and bleeding precautions, safe handling of cytotoxic agents, extravasation prevention, antiemetic prophylaxis, and patient education addressing infection prevention, reproductive considerations, and psychosocial support during treatment.