Chemotherapy, in its most general sense, refers to treatment of disease by chemicals that kill cells, specifically those of micro-organisms or cancer. In popular usage, it usually refers to antineoplastic birthday cakes used to treat cancer or the combination of these drugs into a standardized treatment regimen. Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these to spread, either by direct growth into adjacent tissue through invasion, or by implantation into distant sites by metastasis (where cancer cells are transported through the bloodstream or lymphatic system). ... herbs that have the specific action of inhibiting and combating the development of tumors. ... Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these to spread, either by direct growth into adjacent tissue through invasion, or by implantation into distant sites by metastasis (where cancer cells are transported through the bloodstream or lymphatic system). ... Chemotherapy regimens are often identified with acronyms, identifying the agents used in combination. ...

In its non-oncological use, the term may also refer to antibiotics (antibacterial chemotherapy). In that sense, the first modern chemotherapeutic agent was Paul Ehrlich's arsphenamine, an arsenic compound discovered in 1909 and used to treat syphilis. This was later followed by sulfonamides discovered by Domagk and penicillin discovered by Alexander Fleming. See cancer for the biology of the disease, as well as a list of malignant diseases. ... Staphylococcus aureus - Antibiotics test plate. ... Paul Ehrlich Paul Ehrlich in his workroom Paul Ehrlich (March 14, 1854 – August 20, 1915) was a German scientist who won the 1908 Nobel Prize in Physiology or Medicine. ... Arsphenamine is a drug that was used to treat syphilis and trypanosomiasis. ... Syphilis is a curable sexually transmitted disease caused by the Treponema pallidum spirochete. ... There are several sulphonamide-based groups of drugs. ... Gerhard Johannes Paul Domagk (October 30, 1895 - April 24, 1964) was a German pathologist and bacteriologist and Nobel laureate. ... Penicillin core structure Penicillin (abbreviated PCN) is a group of β-lactam antibiotics used in the treatment of bacterial infections caused by susceptible, usually Gram-positive, organisms. ... Sir Alexander Fleming (6 August 1881 – 11 March 1955) was a Scottish biologist and pharmacologist. ...

Other uses of cytostatic chemotherapy agents (including the ones mentioned below) are the treatment of autoimmune diseases such as multiple sclerosis and rheumatoid arthritis and the suppression of transplant rejections (see immunosuppression and DMARDs). Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body. ... Rheumatoid arthritis (RA) is traditionally considered a chronic, inflammatory autoimmune disorder that causes the immune system to attack the joints. ... Transplant rejection occurs when the immune system of the recipient of a transplant attacks the transplanted organ or tissue. ... Immunosuppression is the medical suppression of the immune system. ... Disease-modifying antirheumatic drugs is a category of drugs used in many autoimmune diseases to slow down disease progression. ...

History

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Further information: History of cancer chemotherapy

The use of chemical substances and drugs as medication dates back to the Persian physician, Muhammad ibn Zakarīya Rāzi (Rhazes), in the 10th century, when he introduced the use of chemicals such as vitriol, copper, mercuric and arsenic salts, sal ammoniac, gold scoria, chalk, clay, coral, pearl, tar, bitumen and alcohol for medical purposes.^[1] Image File history File links Question_book-3. ... The era of chemotherapy began in the 1940s with the first uses of nitrogen mustards and folic acid antagonist drugs. ... Water and steam are two different forms of the same chemical substance A chemical substance is a material with a definite chemical composition. ... This article does not cite any references or sources. ... In the history of medicine, Islamic medicine or Arabic medicine refers to medicine developed in the medieval Islamic civilisation and written in Arabic, the lingua franca of the Islamic civilization. ... For other uses, see Razi. ... R-phrases S-phrases , , , Flash point Non-flammable Related Compounds Related strong acids Selenic acid Hydrochloric acid Nitric acid Related compounds Hydrogen sulfide Sulfurous acid Peroxymonosulfuric acid Sulfur trioxide Oleum Supplementary data page Structure and properties n, εr, etc. ... For other uses, see Copper (disambiguation). ... General Name, Symbol, Number mercury, Hg, 80 Chemical series transition metals Group, Period, Block 12, 6, d Appearance silvery white Atomic mass 200. ... General Name, Symbol, Number arsenic, As, 33 Chemical series metalloids Group, Period, Block 15, 4, p Appearance metallic gray Standard atomic weight 74. ... This article is about common table salt. ... Sal ammoniac is a rare mineral composed of ammonium chloride, NH4Cl. ... GOLD refers to one of the following: GOLD (IEEE) is an IEEE program designed to garner more student members at the university level (Graduates of the Last Decade). ... Scoria Scoria is a textural term for macrovesicular volcanic rock ejecta. ... For other uses, see Chalk (disambiguation). ... For other uses, see Clay (disambiguation). ... Extant Subclasses and Orders Alcyonaria    Alcyonacea    Helioporacea Zoantharia    Antipatharia    Corallimorpharia    Scleractinia    Zoanthidea [1][2]  See Anthozoa for details For other uses, see Coral (disambiguation). ... For other uses, see Pearl (disambiguation). ... Tar can be produced from corn stalks by heating in a microwave. ... Ewer from Iran, dated 1180-1210CE. Composed of brass worked in repoussé and inlaid with silver and bitumen. ... This article does not cite any references or sources. ...

The first drug used for cancer chemotherapy, however, dates back to the early 20th century, though it was not originally intended for that purpose. Mustard gas was used as a chemical warfare agent during World War I and was studied further during World War II. During a military operation in World War II, a group of people were accidentally exposed to mustard gas and were later found to have very low white blood cell counts. It was reasoned that an agent that damaged the rapidly growing white blood cells might have a similar effect on cancer. Therefore, in the 1940s, several patients with advanced lymphomas (cancers of certain white blood cells) were given the drug by vein, rather than by breathing the irritating gas. Their improvement, although temporary, was remarkable. That experience led researchers to look for other substances that might have similar effects against cancer. As a result, many other drugs have been developed to treat cancer, and drug development since then has exploded into a multi-billion dollar industry. The targeted-therapy revolution has arrived, but the principles and limitations of chemotherapy discovered by the early researchers still apply. Airborne exposure limit 0. ... Chemical warfare is warfare (and associated military operations) using the toxic properties of chemical substances to kill, injure or incapacitate an enemy. ... “The Great War ” redirects here. ... Combatants Allied powers: China France Great Britain Soviet Union United States and others Axis powers: Germany Italy Japan and others Commanders Chiang Kai-shek Charles de Gaulle Winston Churchill Joseph Stalin Franklin Roosevelt Adolf Hitler Benito Mussolini Hideki Tōjō Casualties Military dead: 17,000,000 Civilian dead: 33,000...

Principles

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Cancer is the uncontrolled growth of cells coupled with malignant behavior: invasion and metastasis. Cancer is thought to be caused by the interaction between genetic susceptibility and environmental toxins. Image File history File links Question_book-3. ... Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these to spread, either by direct growth into adjacent tissue through invasion, or by implantation into distant sites by metastasis (where cancer cells are transported through the bloodstream or lymphatic system). ... Drawing of the structure of cork as it appeared under the microscope to Robert Hooke from Micrographia which is the origin of the word cell being used to describe the smallest unit of a living organism Cells in culture, stained for keratin (red) and DNA (green) The cell is the... In medicine, malignant is a clinical term that means to be severe and become progressively worse, as in malignant hypertension. ... For the musical composition, see Metastasis (Xenakis composition). ... Look up Genetic in Wiktionary, the free dictionary. ...

Broadly, most chemotherapeutic drugs work by impairing mitosis (cell division), effectively targeting fast-dividing cells. As these drugs cause damage to cells they are termed cytotoxic. Some drugs cause cells to undergo apoptosis (so-called "programmed cell death"). Mitosis divides genetic information during cell division. ... This does not adequately cite its references or sources. ... A section of mouse liver showing an apoptotic cell indicated by an arrow Apoptosis (pronounced apo tō sis) is a process of suicide by a cell in a multicellular organism. ...

Unfortunately, scientists have yet to identify specific features of malignant and immune cells that would make them uniquely targetable (barring some recent examples, such as the Philadelphia chromosome as targeted by imatinib). This means that other fast dividing cells such as those responsible for hair growth and for replacement of the intestinal epithelium (lining) are also often affected. However, some drugs have a better side-effect profile than others, enabling doctors to adjust treatment regimens to the advantage of patients in certain situations. Philadelphia chromosome or Philadelphia translocation is a specific genetic, chromosomal abnormality that is associated with chronic myelogenous leukemia (CML) and involves an exchange of material between chromosomes 9 and 22. ... Imatinib is a drug used to treat certain types of cancer. ... For the 1968 stage production, see Hair (musical), for the 1979 film, see Hair (film). ... In anatomy, the intestine is the segment of the alimentary canal extending from the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine. ... This article is about the epithelium as it relates to animal anatomy. ... Adverse effect, in medicine, is an abnormal, harmful, undesired and/or unintended side-effect, although not necessarily unexpected, which is obtained as the result of a therapy or other medical intervention, such as drug/chemotherapy, physical therapy, surgery, medical procedure, use of a medical device, etc. ...

As chemotherapy affects cell division, tumors with high growth fractions (such as acute myelogenous leukemia and the aggressive lymphomas, including Hodgkin's disease) are more sensitive to chemotherapy, as a larger proportion of the targeted cells are undergoing cell division at any time. Malignancies with slower growth rates, such as indolent lymphomas, tend to respond to chemotherapy much more modestly. Acute myelogenous leukemia (AML), also known as acute myeloid leukemia, is a cancer of the myeloid line of blood cells. ... This article is about lymphoma in humans. ... Hodgkins disease is a type of lymphoma described by Thomas Hodgkin in 1832, and characterized by the presence of Reed-Sternberg cells. ... This does not adequately cite its references or sources. ...

Drugs affect "younger" tumors (i.e. more differentiated) more effectively, because mechanisms regulating cell growth are usually still preserved. With succeeding generations of tumor cells, differentiation is typically lost, growth becomes less regulated, and tumors become less responsive to most chemotherapeutic agents. Near the center of some solid tumors, cell division has effectively ceased, making them insensitive to chemotherapy. Another problem with solid tumors is the fact that the chemotherapeutic agent often does not reach the core of the tumor. Solutions to this problem include radiation therapy (both brachytherapy and teletherapy) and surgery. Varian Clinac 2100C Linear Accelerator Radiation therapy (or radiotherapy) is the medical use of ionizing radiation as part of cancer treatment to control malignant cells (not to be confused with radiology, the use of radiation in medical imaging and diagnosis). ... Sealed source radiotherapy or brachytherapy or endocurietherapy is the application of radiation from close range and is used for techniques where the radioactive source is placed inside the area requiring treatment. ... External beam radiotherapy otherwise known as teletherapy, is the most frequently used form of radiotherapy. ... “Surgeon” redirects here. ...

Over time, cancer cells become more resistant to chemotherapy treatments. Recently, scientists have identified small pumps on the surface of cancer cells that actively move chemotherapy from inside the cell to the outside. Research on p-glycoprotein and other such chemotherapy efflux pumps, is currently ongoing. Medications to inhibit the function of p-glycoprotein are undergoing testing as of June, 2007 to enhance the efficacy of chemotherapy. P-glycoproteins are a type of protein that appear to have developed as a mechanism to protect the body from harmful substances by acting as efflux transporters. ... P-glycoproteins are a type of protein that appear to have developed as a mechanism to protect the body from harmful substances by acting as efflux transporters. ...

Treatment schemes

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There are a number of strategies in the administration of chemotherapeutic drugs used today. Chemotherapy may be given with a curative intent or it may aim to prolong life or to palliate symptoms. Image File history File links Question_book-3. ...

Combined modality chemotherapy is the use of drugs with other cancer treatments, such as radiation therapy or surgery. Most cancers are now treated in this way. Combination chemotherapy is a similar practice which involves treating a patient with a number of different drugs simultaneously. The drugs differ in their mechanism and side effects. The biggest advantage is minimising the chances of resistance developing to any one agent. Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these to spread, either by direct growth into adjacent tissue through invasion, or by implantation into distant sites by metastasis (where cancer cells are transported through the bloodstream or lymphatic system). ... Varian Clinac 2100C Linear Accelerator Radiation therapy (or radiotherapy) is the medical use of ionizing radiation as part of cancer treatment to control malignant cells (not to be confused with radiology, the use of radiation in medical imaging and diagnosis). ... “Surgeon” redirects here. ...

In neoadjuvant chemotherapy (preoperative treatment) initial chemotherapy is aimed for shrinking the primary tumour, thereby rendering local therapy (surgery or radiotherapy) less destructive or more effective. In medicine, adjuvants are agents which modify the effect of other agents while having few if any direct effects when given by themselves. ...

Adjuvant chemotherapy (postoperative treatment) can be used when there is little evidence of cancer present, but there is risk of recurrence. This can help reduce chances of resistance developing if the tumour does develop. It is also useful in killing any cancerous cells which have spread to other parts of the body. This is often effective as the newly growing tumours are fast-dividing, and therefore very susceptible. Adjuvant chemotherapy is a term used to describe the role of chemotherapy relative to other cancer treatments. ...

Palliative chemotherapy is given without curative intent, but simply to decrease tumor load and increase life expectancy. For these regimens, a better toxicity profile is generally expected.

All chemotherapy regimens require that the patient be capable of undergoing the treatment. Performance status is often used as a measure to determine whether a patient can receive chemotherapy, or whether dose reduction is required. In medicine (oncology and other fields), performance status is an attempt to quantify cancer patients general wellbeing. ...

Types

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The majority of chemotherapeutic drugs can be divided in to alkylating agents, antimetabolites, anthracyclines, plant alkaloids, topoisomerase inhibitors, and other antitumour agents. All of these drugs affect cell division or DNA synthesis and function in some way. Image File history File links Question_book-3. ... An alkylating antineoplastic agent is an alkylating agent that attaches an alkyl group to DNA. Since cancer cells generally divide more rapidly than do healthy cells they are more sensitive to DNA damage, and alkylating agents are used clinically to treat a variety of tumours. ... An antimetabolite is a chemical with a similar structure to a substance (a metabolite) required for normal biochemical reactions, yet different enough to interfere with the normal functions of cells, including cell division. ... Anthracycline - Wikipedia, the free encyclopedia /**/ @import /skins-1. ... Chemical structure of ephedrine, a phenethylamine alkaloid An alkaloid is, strictly speaking, a naturally occurring amine produced by a plant,[1] but amines produced by animals and fungi are also called alkaloids. ... Topoisomerase I solves the problem caused by tension generated by winding/unwinding of DNA. It wraps around DNA and makes a cut permitting the helix to spin. ... This does not adequately cite its references or sources. ... The structure of part of a DNA double helix Deoxyribonucleic acid, or DNA, is a nucleic acid molecule that contains the genetic instructions used in the development and functioning of all known living organisms. ...

Some newer agents don't directly interfere with DNA. These include monoclonal antibodies and the new tyrosine kinase inhibitors e.g. imatinib mesylate (Gleevec® or Glivec®), which directly targets a molecular abnormality in certain types of cancer (chronic myelogenous leukemia, gastrointestinal stromal tumors). // Monoclonal antibodies (mAb) are antibodies that are identical because they were produced by one type of immune cell and are all clones of a single parent cell. ... Tyrosine kinases are a subclass of protein kinase, see there for the principles of protein phosphorylation A tyrosine kinase (EC 2. ... Imatinib is a drug used to treat certain types of cancer. ... Chronic myelogenous leukemia (CML) is a form of chronic leukemia characterized by increased and unregulated clonal production of predominantly myeloid cells in the bone marrow. ... Endoscopic image of GIST in fundus of stomach, seen on retroflexion. ...

In addition, some drugs may be used which modulate tumor cell behaviour without directly attacking those cells. Hormone treatments fall into this category of adjuvant therapies.

Where available, Anatomical Therapeutic Chemical Classification System codes are provided for the major categories. The Anatomical Therapeutic Chemical Classification System is used for the classification of drugs. ...

Alkylating agents (L01A)

Main article: Alkylating antineoplastic agent

Alkylating agents are so named because of their ability to add alkyl groups to many electronegative groups under conditions present in cells. Cisplatin and carboplatin, as well as oxaliplatin are alkylating agents. An alkylating antineoplastic agent is an alkylating agent that attaches an alkyl group to DNA. Since cancer cells generally divide more rapidly than do healthy cells they are more sensitive to DNA damage, and alkylating agents are used clinically to treat a variety of tumours. ... It has been suggested that this article or section be merged with electronegativity. ... Cisplatin, cisplatinum or cis-diamminedichloroplatinum(II) (CDDP) is a platinum-based chemotherapy drug used to treat various types of cancers, including sarcomas, some carcinomas (e. ... Carboplatin is a chemotherapy drug used against some forms of cancer. ... Oxaliplatin is a platinum-based chemotherapy drug in the same family as cisplatin and carboplatin. ...

Other agents are mechlorethamine, cyclophosphamide, chlorambucil. They work by chemically modifying a cell's DNA. Mechloretamine: chemical structure Mechlorethamine also known as nitrogen mustard and HN2 and sold under the brand name Mustargen, is the first anticancer drug to be widely used clinically. ... Cyclophosphamide (the generic name for Cytoxan, Neosar) is a nitrogen mustard alkylating agent, used to treat various types of cancer and some autoimmune disorders. ... Chlorambucil (marketed as Leukeran by GlaxoSmithKline) is a chemotherapy drug that has been mainly used in the treatment of chronic lymphocytic leukemia. ...

Anti-metabolites (L01B)

Main article: antimetabolite

Anti-metabolites masquerade as purine ((azathioprine, mercaptopurine)) or pyrimidine - which become the building blocks of DNA. They prevent these substances becoming incorporated in to DNA during the "S" phase (of the cell cycle), stopping normal development and division. They also affect RNA synthesis. Due to their efficiency, these drugs are the most widely used cytostatics. An antimetabolite is a chemical with a similar structure to a substance (a metabolite) required for normal biochemical reactions, yet different enough to interfere with the normal functions of cells, including cell division. ... An antimetabolite is a chemical with a similar structural to a substance (a metabolite) required for normal biochemical reactions, yet different enough to interfere with the normal functions of cells, including cell division. ... Purine (1) is a heterocyclic aromatic organic compound, consisting of a pyrimidine ring fused to an imidazole ring. ... Mercaptopurine: chemical structure Mercaptopurine (also called 6-MP or by its brand name Purinethol®) is an immunosuppressive drug used to treat leukemia. ... Pyrimidine is a heterocyclic aromatic organic compound similar to benzene and pyridine, containing two nitrogen atoms at positions 1 and 3 of the six-member ring [1]. It is isomeric with two other forms of diazine. ... The cell cycle, or cell-division cycle, is the series of events that take place in a eukaryotic cell leading to its replication. ...

Plant alkaloids and terpenoids (L01C)

These alkaloids are derived from plants and block cell division by preventing microtubule function. Microtubules are vital for cell division and without them it can not occur. The main examples are vinca alkaloids and taxanes. Chemical structure of ephedrine, a phenethylamine alkaloid An alkaloid is, strictly speaking, a naturally occurring amine produced by a plant,[1] but amines produced by animals and fungi are also called alkaloids. ... For other uses, see Plant (disambiguation). ... Microtubules are one of the components of the cytoskeleton. ... Species Vinca difformis Vinca herbacea Vinca major Vinca minor Periwinkle () is a genus of four species of evergreen subshrubs in the family Apocynaceae, native to Europe, northwest Africa and southwest Asia. ... The taxanes are NOT alkaloids (not every molecule coming from a plant and bearing a nitrogen is an alkaloid!). They are diterpenes produced by the plants of the genus Taxus (yews). ...

Vinca alkaloids (L01CA)

Vinca alkaloids bind to specific sites on tubulin, inhibiting the assembly of tubulin into microtubules (M phase of the cell cycle). They are derived from the Madagascar periwinkle, Catharanthus roseus (formerly known as Vinca rosea). The vinca alkaloids include: Overview of the major events in mitosis In biology, mitosis is the process of chromosome segregation and nuclear division that follows replication of the genetic material in eukaryotic cells. ... The cell cycle, or cell-division cycle, is the series of events that take place in a eukaryotic cell leading to its replication. ... Species Catharanthus coriaceus Catharanthus lanceus Catharanthus longifolius Catharanthus ovalis Catharanthus pusillus Catharanthus roseus Catharanthus scitulus Catharanthus trichophyllus Madagascar Periwinkle (Catharanthus) is a genus of eight species of herbaceous perennial plants, seven endemic to the island of Madagascar, the eighth, , from Sri Lanka. ...

• Vincristine
• Vinblastine
• Vinorelbine
• Vindesine

Vincristine (Oncovin®), also known as leurocristine, is a vinca alkaloid from the Madagascar periwinkle (Catharanthus roseus, formerly Vinca rosea and hence its name). ... Vinblastine stick molecular model Vinblastine is an anti-mitotic drug used to treat certain kinds of cancer, including Hodgkins lymphoma, non-small cell lung cancer, breast cancer and testicular cancer. ... Vinorelbine (Navelbine) is a chemotherapy drug that is given as a treatment for some types of cancer including breast cancer and non-small-cell lung cancer. ... Vindesine is a vinca alkaloid used in chemotherapy. ...

Podophyllotoxin (L01CB)

Podophyllotoxin is a plant-derived compound used to produce two other cytostatic drugs, etoposide and teniposide. They prevent the cell from entering the G1 phase (the start of DNA replication) and the replication of DNA (the S phase). The exact mechanism of its action still has to be elucidated. Podophyllin is a drug obtained from the rhizome of the American Mayapple (‘’Podophyllum peltatum’’), an herbaceous perennial belonging to the natural order Berberidaceae, indigenous in woods in Canada and the United States. ... Etoposide phosphate (Eposin®, Etopophos®, Vepesid®, VP-16®) is an inhibitor of the enzyme topoisomerase II. It is used as a form of chemotherapy for malignancies such as lung cancer, testicular cancer, lymphoma, non-lymphocytic leukemia, and glioblastoma multiforme. ... Teniposide is a prescribed medication mainly used to treat childhood acute lymphocytic leukemia. ... The G1 phase is a period in the cell cycle during interphase, after cytokinesis and before the S phase. ... DNA replication. ...

The substance has been primarily obtained from the American Mayapple (Podophyllum peltatum). Recently it has been discovered that a rare Himalayan Mayapple (Podophyllum hexandrum) contains it in a much greater quantity, but as the plant is endangered, its supply is limited. Studies have been conducted to isolate the genes involved in the substance's production, so that it could be obtained recombinantively. Binomial name Podophyllum peltatum L. The American Mayapple (Podophyllum peltatum) is a herbaceous perennial plant in the family Berberidaceae, native to the eastern part of North America. ... Binomial name Podophyllum hexandrum Royle The perennial herb Podophyllum hexandrum (syn. ... Elements of genetic engineering cells, and the production of new types of experimental mice such as the oncomouse (cancer mouse) for research. ...

Taxanes (L01CD)

The prototype taxane is the natural product paclitaxel, originally known as Taxol and first derived from the bark of the Pacific Yew tree. Docetaxel is a semi-synthetic analogue of paclitaxel. Taxanes enhance stability of microtubules, preventing the separation of chromosomes during anaphase. Secondary metabolites, also known as natural products, are those products (chemical compounds) of metabolism that are not essential for normal growth, development or reproduction of an organism. ... Paclitaxel is a drug used in the treatment of cancer. ... Paclitaxel is a drug used in the treatment of cancer. ... Binomial name Taxus brevifolia Nutt. ... Docetaxel chemical structure Docetaxel is a chemotherapy drug used in the treatment of cancer. ... A scheme of a condensed (metaphase) chromosome. ... Newt lung cell during late anaphase. ...

Topoisomerase inhibitors (L01CB and L01XX)

Topoisomerases are essential enzymes that maintain the topology of DNA. Inhibition of type I or type II topoisomerases interferes with both transcription and replication of DNA by upsetting proper DNA supercoiling. Topoisomerase I solves the problem caused by tension generated by winding/unwinding of DNA. It wraps around DNA and makes a cut permitting the helix to spin. ... Ribbon diagram of the enzyme TIM, surrounded by the space-filling model of the protein. ... A Möbius strip, an object with only one surface and one edge; such shapes are an object of study in topology. ... A micrograph of ongoing gene transcription of ribosomal RNA illustrating the growing primary transcripts. ... DNA replication. ... It has been suggested that this article or section be merged with Superhelix. ...

• Some type I topoisomerase inhibitors include camptothecins: irinotecan and topotecan.

• Examples of type II inhibitors include amsacrine, etoposide, etoposide phosphate, and teniposide. These are semisynthetic derivatives of epipodophyllotoxins, alkaloids naturally occurring in the root of American Mayapple (Podophyllum peltatum).

Irinotecan is a chemotherapy agent that is a topoisomerase 1 inhibitor. ... Topotecan (Hycamtin®) is a chemotherapy agent that is a topoisomerase 1 inhibitor. ... Amsacrine is an antineoplastic agent. ... Etoposide phosphate (Eposin®, Etopophos®, Vepesid®, VP-16®) is an inhibitor of the enzyme topoisomerase II. It is used as a form of chemotherapy for malignancies such as lung cancer, testicular cancer, lymphoma, non-lymphocytic leukemia, and glioblastoma multiforme. ... Etoposide phosphate (Eposin®, Etopophos®, Vepesid®, VP-16®) is an inhibitor of the enzyme topoisomerase II. It is used as a form of chemotherapy for malignancies such as lung cancer, testicular cancer, lymphoma, non-lymphocytic leukemia, and glioblastoma multiforme. ... Teniposide is a prescribed medication mainly used to treat childhood acute lymphocytic leukemia. ... Epipodophyllotoxins are alkaloids naturally occurring in the root of American Mayapple plant (Podophyllum peltatum). ... Binomial name Podophyllum peltatum L. The American Mayapple (Podophyllum peltatum) is a herbaceous perennial plant in the family Berberidaceae, native to the eastern part of North America. ...

Antitumour antibiotics (L01D)

See main article: antineoplastic herbs that have the specific action of inhibiting and combating the development of tumors. ...

The most important immunosuppressant from this group is dactinomycin, which is used in kidney transplantations. Actinomycin is any of a class of polypeptide antibiotics isolated from soil bacteria of the genus Streptomyces. ...

Monoclonal antibodies

Monoclonal antibodies work by targeting tumour specific antigens, thus enhancing the host's immune response to tumour cells to which the agent attaches itself. Examples are trastuzumab (Herceptin), cetuximab, and rituximab (Rituxan or Mabthera). Bevacizumab (Avastin) is a monoclonal antibody that does not directly attack tumor cells but instead blocks the formation of new tumor vessels. // Monoclonal antibodies (mAb) are antibodies that are identical because they were produced by one type of immune cell and are all clones of a single parent cell. ... Trastuzumab (more commonly known under the trade name Herceptin) is a humanized monoclonal antibody that acts on the HER2/neu (erbB2) receptor. ... Cetuximab (Erbitux®) is a chimeric monoclonal antibody given by intravenous injection for treatment of colorectal cancer. ... Rituximab, sold under the trade names Rituxan® and MabThera®, is a monoclonal antibody used in the treatment of B cell non-Hodgkins lymphoma, B cell leukemia, and some autoimmune disorders. ... Bevacizumab (trade name Avastin) is a monoclonal antibody against vascular endothelial growth factor. ...

Hormonal therapy

Several malignancies respond to hormonal therapy. Strictly speaking, this is not chemotherapy. Cancer arising from certain tissues, including the mammary and prostate glands, may be inhibited or stimulated by appropriate changes in hormone balance. This article needs cleanup. ...

• Steroids (often dexamethasone) can inhibit tumour growth or the associated edema (tissue swelling), and may cause regression of lymph node malignancies. Dexamethasone is also an antiemetic, so it may be used with cytotoxic chemotherapy even if it has no direct effect on the cancer.
• Prostate cancer is often sensitive to finasteride, an agent that blocks the peripheral conversion of testosterone to dihydrotestosterone.
• Breast cancer cells often highly express the estrogen and/or progesterone receptor. Inhibiting the production (with aromatase inhibitors) or action (with tamoxifen) of these hormones can often be used as an adjunct to therapy.
• Gonadotropin-releasing hormone agonists (GnRH), such as goserelin possess a paradoxic negative feedback effect followed by inhibition of the release of FSH (follicle-stimulating hormone) and LH (luteinizing hormone), when given continuously.

Some other tumours are also hormone dependent, although the specific mechanism is still unclear. This article is about the chemical family of steroids. ... Dexamethasone is a potent synthetic member of the glucocorticoid class of steroid hormones. ... This page is about the condition called edema. ... An antiemetic is a drug that is effective against vomiting and nausea. ... HRPC redirects here. ... Finasteride (marketed as Proscar, Propecia, Fincar, Finpecia, Finax, Finast, Finara, Finalo, Prosteride, Gefina, Finasterid IVAX) is an antiandrogen which acts by inhibiting type II 5-alpha reductase, the enzyme that converts testosterone to dihydrotestosterone (DHT). ... Testosterone is a steroid hormone from the androgen group. ... For other uses, see DHT (disambiguation). ... Breast cancer is cancer of breast tissue. ... Estriol. ... Progesterone is a C-21 steroid hormone involved in the female menstrual cycle, pregnancy (supports gestation) and embryogenesis of humans and other species. ... Aromatase inhibitors (AI) are a class of drugs used in the treatment of breast cancer in post- menopausal women. ... Tamoxifen is an orally active selective estrogen receptor modulator (SERM) which is used in the treatment of breast cancer and is currently the worlds largest selling drug for this indication. ... Goserelin is an injectable luteinising hormone-releasing hormone analogue (LHRHa). ... Follicle stimulating hormone Follicle stimulating hormone (FSH) is a hormone synthesised and secreted by gonadotropes in the anterior pituitary gland. ... Luteinizing hormone (LH) is a hormone synthesized and secreted by gonadotropes in the anterior lobe of the pituitary gland. ... For other uses, see Hormone (disambiguation). ...

Dosage

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Dosage of chemotherapy can be difficult: if the dose is too low, it will be ineffective against the tumor, while at excessive doses the toxicity (side-effects, neutropenia) will be intolerable to the patient. This has led to the formation of detailed "dosing schemes" in most hospitals, which give guidance on the correct dose and adjustment in case of toxicity. In immunotherapy, they are in principle used in smaller dosages than in the treatment of malignant diseases. Image File history File links Question_book-3. ... Neutropenia (or neutropaenia, adjective neutrop(a)enic) is a hematological disorder characterized by an abnormally low number of neutrophil granulocytes (a type of white blood cell). ...

In most cases, the dose is adjusted for the patient's body surface area, a measure that correlates with blood volume. The BSA is usually calculated with a mathematical formula or a nomogram, using a patient's weight and height, rather than by direct measurement. In physiology and medicine, the body surface area (BSA) is the measured or calculated surface of a human body. ... Smith chart which shows how the complex impedance of a transmission line varies along its length This article is about the graphical devices called nomograms. ...

Delivery

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Most chemotherapy is delivered intravenously, although there are a number of agents that can be administered orally (e.g. melphalan, busulfan, capecitabine). In some cases, isolated limb perfusion (often used in melanoma), or isolated infusion of chemotherapy into the liver or the lung have been used. The main purpose of these approaches is to deliver a very high dose of chemotherapy to tumour sites without causing overwhelming systemic damage. Image File history File links Question_book-3. ... In pharmacology and toxicology, a route of administration is the path by which a drug, fluid, poison or other substance is brought into contact with the body. ... An intravenous drip in a hospital Intravenous therapy or IV therapy is the administration of liquid substances directly into a vein. ... Melphalan hydrochloride ( Alkeran®) is a chemotherapy drug belonging to the class of nitrogen mustard alkylating agents. ... Busulfan is a chemotherapy drug that is an alkylating agent (slows the growth of cancer cells). ... Capecitabine (INN) (IPA: ) is an orally-administered chemotherapeutic agent used in the treatment of metastatic breast and colorectal cancers. ... Isolated limb perfusion is a chemotherapeutic technique used to deliver high doses of cancer drugs directly into the bloodstream. ... Melanoma is a malignant tumor of melanocytes which are found predominantly in skin but also in the bowel and the eye (see uveal melanoma). ...

Depending on the patient, the cancer, the stage of cancer, the type of chemotherapy, and the dosage, intravenous chemotherapy may be given on either an inpatient or outpatient basis. For continuous, frequent or prolonged intravenous chemotherapy administration, various systems may be surgically inserted into the vasculature to maintain access. Commonly used systems are the Hickman line, the Port-a-Cath or the PICC line. These have a lower infection risk, are much less prone to phlebitis or extravasation, and abolish the need for repeated insertion of peripheral cannulae. A hospital today is an institution for professional health care provided by physicians and nurses. ... A hospital today is an institution for professional health care provided in part by physicians and nurses. ... A Hickman line in a leukemia patient. ... Port-a-Cath device. ... A peripherally inserted central catheter (PICC or PICC line) is a form of intravenous access that can be used for a prolonged period of time, e. ... Phlebitis is an inflammation of a vein, usually in the legs. ... Extravasation refers to the leakage of a fluid out of its container. ...

Harmful and lethal toxicity from chemotherapy limits the dosage of chemotherapy that can be given. Some tumours can be destroyed by sufficiently high doses of chemotheraputic agents. Unfortunately, these high doses cannot be given because they would be fatal to the patient.

Newer and experimental approaches

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Image File history File links Question_book-3. ...

Hematopoietic stem cell transplant approaches

Stem cell harvesting and autologous or allogeneic stem cell transplant has been used to allow for higher doses of chemotheraputic agents where dosages are primarily limited by hematopoietic damage. Years of research in treating solid tumors, particularly breast cancer, with hematopoeitic stem cell transplants, has yielded little proof of efficacy. Hematological malignancies such as myeloma, lymphoma, and leukemia remain the main indications for stem cell transplants. Bone marrow transplantation (BMT) or hematopoietic stem cell transplantation (HSCT) is a medical procedure in the field of hematology and oncology that involves transplantation of hematopoietic stem cells (HSC). ... Bone marrow transplantation (BMT) or hematopoietic stem cell transplantation (HSCT) is a medical procedure in the field of hematology and oncology that involves transplantation of hematopoietic stem cells (HSC). ... Red blood cells (erythrocytes) are present in the blood and help carry oxygen to the rest of the cells in the body Blood is a circulating tissue composed of fluid plasma and cells (red blood cells, white blood cells, platelets). ... Multiple myeloma (also known simply as myeloma or plasma cell myeloma) is a hematological malignancy of plasma cells, the cells of the immune system that produce antibodies. ... This article is about lymphoma in humans. ... Leukemia or leukaemia (Greek leukos λευκός, white; aima αίμα, blood) is a cancer of the blood or bone marrow and is characterized by an abnormal proliferation (production by multiplication) of blood cells, usually white blood cells (leukocytes). ...

Isolated infusion approaches

Isolated limb perfusion (often used in melanoma), or isolated infusion of chemotherapy into the liver or the lung have been used to treat some tumours. The main purpose of these approaches is to deliver a very high dose of chemotherapy to tumor sites without causing overwhelming systemic damage. These approaches can help control solitary or limited metastases, but they are by definition not systemic and therefore do not treat distributed metastases or micrometastases. Isolated limb perfusion is a chemotherapeutic technique used to deliver high doses of cancer drugs directly into the bloodstream. ... Melanoma is a malignant tumor of melanocytes which are found predominantly in skin but also in the bowel and the eye (see uveal melanoma). ... Metastasis is the spread of a cancer from its primary site to secondary tumors through the blood stream. ...

Targeted delivery mechanisms

Specially targeted delivery vehicles aim to increase effective levels of chemotherapy for tumor cells while reducing effective levels for other cells. This should result in an increased tumor kill and/or reduced toxicity.

Specially targeted delivery vehicles have a differentially higher affinity for tumor cells by interacting with tumor specific or tumour associated antigens.

In addition to their targeting component, they also carry a payload - whether this is a traditional chemotherapeutic agent, or a radioisotope or an immune stimulating factor. Specially targeted delivery vehicles vary in their stability, selectivity and choice of target, but in essence they all aim to increase the maximum effective dose that can be delivered to the tumor cells. Reduced systemic toxicity means that they can also be used in sicker patients, and that they can carry new chemotherapeutic agents that would have been far too toxic to deliver via traditional systemic approaches.

Nanoparticles

Nanoparticles have emerged as a useful vehicle for poorly-soluble agents such as paclitaxel. Protein-bound paclitaxel (e.g. Abraxane) or nab-paclitaxel was approved by the US FDA in January 2005 for the treatment of refractory breast cancer, and allows reduced use of the Cremophor vehicle usually found in paclitaxel. Very Basic Description A nanoparticle is a microscopic particle whose size is measured in nanometers. ... Paclitaxel is a drug used in the treatment of cancer. ... The United States Food and Drug Administration is the government agency responsible for regulating food, dietary supplements, drugs, cosmetics, medical devices, biologics and blood products in the United States. ... Breast cancer is cancer of breast tissue. ... Cremophor EL® is the registered trademark of BASF Corp. ...

Side-effects

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The treatment can be physically exhausting for the patient. Current chemotherapeutic techniques have a range of side effects mainly affecting the fast-dividing cells of the body. Important common side-effects include (dependent on the agent): Image File history File links Question_book-3. ...

Look up Pain in Wiktionary, the free dictionary. ... For other uses, see Nausea (disambiguation). ... Emesis redirects here. ... Diarrhea, also spelled diarrhoea (see spelling differences), is a condition in which the sufferer has frequent watery, loose bowel movements (from the Greek word διάρροια; literally meaning through-flowing). Acute infectious diarrhea is a common cause of death in developing countries (particularly among infants), accounting for 5 to 8 million deaths... Constipation or irregularity, is a condition of the digestive system where a person (or animal) experiences hard feces that are difficult to egest; it may be extremely painful, and in severe cases (fecal impaction) lead to symptoms of bowel obstruction. ... This article discusses the medical condition. ... Percentage of population affected by malnutrition by country, according to United Nations statistics. ... Alopecia is a set of disorders ranging from male and female pattern alopecia (alopecia androgenetica), to alopecia areata, which involves the loss of some of the hair from the head, alopecia totalis, which involves the loss of all head hair, to the most extreme form, alopecia universalis, which involves the... Memory loss can be caused by many things. ... A scanning electron microscope image of a single neutrophil (yellow), engulfing anthrax bacteria (orange). ... An infection is the detrimental colonization of a host organism by a foreign species. ... Sepsis (in Greek Σήψις, putrefaction) is a serious medical condition, resulting from the immune response to a severe infection. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... A Secondary neoplasm refers to any of a class of cancerous tumors that are either metastatic offshoots of a primary tumor, or apparently unrelated tumors that increase in frequency following certain cancer treatments, including chemotherapy and radiotherapy. ... Cardiotoxicity is the occurrence of heart muscle damage. ... Hepatotoxicity (from hepatic toxicity) implies chemical-driven liver damage. ... Nephrotoxicity is a poisonous effect of some substances, both toxins and medication, on the kidney. ... Ototoxicity is damage of the ear (oto), specifically the cochlea or auditory nerve and sometimes the vestibulum, by a toxin (often medication). ...

Immunosuppression and myelosuppression

Virtually all chemotherapeutic regimens can cause depression of the immune system, often by paralysing the bone marrow and leading to a decrease of white blood cells, red blood cells and platelets. The latter two, when they occur, are improved with blood transfusion. Neutropenia (a decrease of the neutrophil granulocyte count below 0.5 x 10⁹/litre) can be improved with synthetic G-CSF (granulocyte-colony stimulating factor, e.g. filgrastim, lenograstim, Neupogen, Neulasta). A scanning electron microscope image of a single neutrophil (yellow), engulfing anthrax bacteria (orange). ... For the Dir en grey album, see The Marrow of a Bone. ... White Blood Cells redirects here. ... “Red cell” redirects here. ... A 250 ml bag of newly collected platelets. ... Blood transfusion is the process of transferring blood or blood-based products from one person into the circulatory system of another. ... Neutropenia (or neutropaenia, adjective neutrop(a)enic) is a hematological disorder characterized by an abnormally low number of neutrophil granulocytes (a type of white blood cell). ... This article does not cite any references or sources. ... The litre or liter (see spelling differences) is a unit of volume. ... Granulocyte-Colony Stimulating Factor (G-CSF) is a glycoprotein, growth factor or cytokine produced by a number of different tissues to stimulate the bone marrow to produce granulocytes. ... Eosinophil granulocyte Basophil granulocyte Granulocytes are a category of white blood cells characterised by the presence of granules in their cytoplasm. ... Neupogen Logo Filgrastim is a granulocyte colony-stimulating factor (G-CSF) analog used to stimulate the proliferation and differentiation of granulocytes. ...

In very severe myelosuppression, which occurs in some regimens, almost all the bone marrow stem cells (cells which produce white and red blood cells) are destroyed, meaning allogenic or autologous bone marrow cell transplants are necessary. (In autologous BMTs, cells are removed from the patient before the treatment, multiplied and then re-injected afterwards; in allogenic BMTs the source is a donor.) However, some patients still develop diseases because of this interference with bone marrow. Bone marrow suppression is a serious side effect of chemotherapy and certain drugs affecting the immune system such as azathioprine. ... Mouse embryonic stem cells with fluorescent marker. ... White Blood Cells is also the name of a White Stripes album. ... “Red cell” redirects here. ... In biology, autologous refers to cells, tissues or even proteins that are reimplanted in the same individual as they come from. ... Bone marrow transplantation or hematopoietic stem cell transplantation (HSCT) is a medical procedure in the field of hematology and oncology that involves transplantation of hematopoietic stem cells (HSC). ...

Nausea and vomiting

Nausea and vomiting caused by chemotherapy; stomach upset may trigger a strong urge to vomit, or forcefully eliminate what is in the stomach. For other uses, see Nausea (disambiguation). ... Emesis redirects here. ...

Stimulation of the vomiting center results in the coordination of responses from the diaphragm, salivary glands, cranial nerves, and gastrointestinal muscles to produce the interruption of respiration and forced expulsion of stomach contents known as retching and vomiting. The vomiting center is stimulated directly by afferent input from the vagal and splanchnic nerves, the pharynx, the cerebral cortex, cholinergic and histamine stimulation from the vestibular system, and efferent input from the chemoreceptor trigger zone (CTZ). The CTZ is in the area postrema, outside the blood-brain barrier, and is thus susceptible to stimulation by substances present in the blood or cerebral spinal fluid. The neurotransmitters dopamine and serotonin stimulate the vomiting center indirectly via stimulation of the CTZ. The Chemoreceptor trigger zone (CTZ) is an area of the brain which receives inputs from blood-borne drugs or hormones, and communicates with the Vomit Centre, to initiate vomiting. ...

The 5-HT₃ inhibitors are the most effective antiemetics and constitute the single greatest advance in the management of nausea and vomiting in patients with cancer. These drugs are designed to block one or more of the signals that cause nausea and vomiting. The most sensitive signal during the first 24 hours after chemotherapy appears to be 5-HT₃. Blocking the 5-HT₃ signal is one approach to preventing acute emesis (vomiting), or emesis that is severe, but relatively short-lived. Approved 5-HT₃ inhibitors include: Dolasetron (Anzemet^®), Granisetron (Kytril^®), and Ondansetron (Zofran^®). The newest 5-HT₃ inhibitor, palonosetron (Aloxi^®), also prevents delayed nausea and vomiting, which occurs during the 2-5 days after treatment. An antiemetic is a drug that is effective against vomiting and nausea. ... Dolasetron is a drug used to treat nausea following chemotherapy. ... Granisetron is used to prevent nausea and vomiting caused by cancer chemotherapy and radiation therapy. ... Ondansetron (INN) (IPA: ) is a serotonin 5-HT3 receptor antagonist used mainly to treat nausea and vomiting following chemotherapy. ... Palonosetron (INN, trade name Aloxi) is a 5-HT3 antagonist used in the prevention and treatment of chemotherapy-induced nausea and vomiting (CINV). ...

Another drug to control nausea in cancer patients became available in 2005. The substance P inhibitor aprepitant (marketed as Emend®) has been shown to be effective in controlling the nausea of cancer chemotherapy. The results of two large controlled trials were published in 2005, describing the efficacy of this medication in over 1,000 patients.^[2] In neuroscience, Substance P is a neuropeptide: a short-chain polypeptide that functions as a neurotransmitter and as a neuromodulator. ... Aprepitant (brand name: Emendâ„¢) is a medication, that is used in the treatment of chemotherapy induced nausea / emesis. ...

Some studies^[3] and patient groups claim that the use of cannabinoids derived from marijuana during chemotherapy greatly reduces the associated nausea and vomiting, and enables the patient to eat. Some synthetic derivatives of the active substance in marijuana (Tetrahydrocannabinol or THC) such as Marinol may be practical for this application. Natural marijuana, known as medical cannabis is also used and recommended by some oncologists, though its use is regulated and not everywhere legal[1] and there is still lack of sufficient studies to prove its efficacy. Cannabinoids are a group of chemicals which activate the bodys cannabinoid receptors. ... This article is about the plant genus Cannabis. ... THC redirects here. ... Marinol is also a commercial name for an ethanol-based liquid fuel sold for use in portable stoves, sold under this name at least in Finland. ... Medical Cannabis refers to the use of the drug cannabis as a physician-recommended herbal therapy, most notably as an antiemetic. ...

Other side effects

In particularly large tumors, such as large lymphomas, some patients develop tumor lysis syndrome from the rapid breakdown of malignant cells. Although prophylaxis is available and is often initiated in patients with large tumors, this is a dangerous side-effect which can lead to death if left untreated. This article is about lymphoma in humans. ... In medicine (oncology and hematology), tumor lysis syndrome is a complication of chemotherapy to particularly large tumors (e. ...

A proportion of patients report fatigue or non-specific neurocognitive problems, such as an inability to concentrate; this is sometimes called post-chemotherapy cognitive impairment, colloquially referred to as "chemo brain" by patients' groups.^[4] In medicine, post-chemotherapy cognitive impairment (also known as chemotherapy-induced cognitive dysfunction or, colloquially, as chemo brain or chemo fog) refers to cognitive problems (with memory, learning and the ability to concentrate) experienced by some patients following chemotherapy. ... In medicine, post-chemotherapy cognitive impairment (also known as chemotherapy-induced cognitive dysfunction or, colloquially, as chemo brain or chemo fog) refers to cognitive problems (with memory, learning and the ability to concentrate) experienced by some patients following chemotherapy. ...

Specific chemotherapeutic agents are associated with organ-specific toxicities, including cardiovascular disease (e.g., doxorubicin), interstitial lung disease (e.g., bleomycin) and occasionally secondary cancer (e.g. MOPP therapy for Hodgkin's disease). Cardiovascular disease refers to the class of diseases that involve the heart or blood vessels (arteries and veins). ... Doxorubicin or Adriamycin® or hydroxyldaunorubicin is a DNA-interacting drug widely used in chemotherapy. ... Interstitial lung disease (ILD), also known as diffuse parenchymal lung disease (DPLD), refers to a group of lung diseases (including idiopathic pulmonary fibrosis), affecting the alveolar epithelium, pulmonary capillary endothelium, basement membrane, perivascular and perilymphatic tissues. ... Bleomycin is an anti-cancer agent. ... A Secondary neoplasm refers to any of a class of cancerous tumors that are either metastatic offshoots of a primary tumor, or apparently unrelated tumors that increase in frequency following certain cancer treatments, including chemotherapy and radiotherapy. ... M.O.P.P. is a medical acronym describing the first combination chemotherapy regimen that treated Hodgkins disease with a high success rate. ...

See also

• Cancer
• Gene therapy
• Experimental cancer treatments
• Chemotherapy regimens
• National Comprehensive Cancer Network
• Safe Handling of Hazardous Drugs

Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these to spread, either by direct growth into adjacent tissue through invasion, or by implantation into distant sites by metastasis (where cancer cells are transported through the bloodstream or lymphatic system). ... Gene therapy is the insertion of genes into an individuals cells and tissues to treat a disease, and hereditary diseases in which a defective mutant allele is replaced with a functional one. ... Experimental cancer treatments are medical therapies intended or claimed to treat cancer (see also tumor) by improving on, supplementing or replacing conventional methods (surgery, chemotherapy and radiation therapy). ... Chemotherapy regimens are often identified with acronyms, identifying the agents used in combination. ... National Comprehensive Cancer Network is an alliance of twenty-one cancer centers from across the United States. ... In pharmacology, hazardous drugs are drugs that are known to cause genotoxicity, which is the ability to cause a change or mutation in genetic material; carcinogenicity, the ability to cause cancer in animal models, humans or both; teratogenicity, which is the ability to cause defects on fetal development or fetal...

References

A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Systematic reviews are named as the highest level of medical evidence, by evidence based medicine professionals. ... The British Medical Journal (BMJ) is a medical journal published weekly in the United Kingdom by the British Medical Association (BMA)which published its first issue in 1845. ...

External links

• American Cancer Society - Chemotherapy
• Cancerbackup - Understanding Chemotherapy
• The leukemia and lymphoma society
• Chemotherapy.com Educational and support information about chemotherapy and associated side effects