Chapter 46: Antineoplastic Drugs Part 2: Cell Cycle–Nonspecific and Miscellaneous Drugs

Alkylating agents including mechlorethamine, cyclophosphamide, ifosfamide, cisplatin, carboplatin, and busulfan operate by creating cross-linkages between DNA strands, disrupting genetic replication, and triggering programmed cell death through multiple pathways. These medications treat leukemias, lymphomas, and cancers of the breast, ovary, lung, and bladder but carry significant risks including bone marrow suppression, kidney damage, neurological toxicity, hemorrhagic bladder inflammation, lung scarring, and pronounced gastrointestinal distress. Cisplatin requires substantial fluid replacement to protect renal function, while extravasation of nitrogen mustards results in severe tissue destruction. Cytotoxic antibiotics derived from Streptomyces organisms—comprising anthracycline drugs such as doxorubicin, daunorubicin, and epirubicin alongside bleomycin, dactinomycin, mitomycin, and mitoxantrone—interfere with DNA structure through intercalation, suppress topoisomerase II enzyme function, and produce reactive oxygen species that fragment genetic material and induce apoptosis. These agents effectively treat hematologic malignancies, lymphomas, breast cancer, and soft tissue sarcomas but produce myelosuppression, hair loss, mouth ulceration, and particularly dangerous cardiac complications, with doxorubicin requiring ongoing cardiac monitoring and possible cardioprotective intervention with dexrazoxane. Bleomycin presents unique pulmonary toxicity requiring respiratory assessment. The chapter introduces targeted antineoplastic approaches including bevacizumab for blocking new blood vessel formation, hydroxyurea for radiosensitization and DNA synthesis inhibition, imatinib for chronic myeloid leukemia through tyrosine kinase inhibition, mitotane for adrenal cancer, and octreotide for neuroendocrine tumors, demonstrating the shift toward mechanism-based therapies. Hormonal antineoplastic strategies utilize estrogen receptor antagonists, aromatase inhibitors, androgen antagonists, gonadotropin-releasing hormone agonists, and progestin agents for breast and prostate cancers. Nursing practice emphasizes comprehensive patient assessment of renal, hepatic, cardiac, and pulmonary baseline function; vigilant monitoring for bone marrow effects, chemical extravasation, and oncologic emergencies; patient education regarding hydration protocols, infection control, reproductive considerations, symptom management; and adherence to rigorous safety procedures for handling potent vesicant medications.