Anticancer Drugs: Classification, Mechanisms & Toxicity Simplified | Dr. Priyanka Sachdev

hello everyone very good evening to all of you I welcome you all for today's session so am I clearly visible audible everything is good to go uh let me confirm I guess it's good to go right can you see can you hear okay thank you thank you so much for confirming so I welcome you all for today's session very good evening to all of you and today is a very important day very special day why because today we are going to study I mean continue the integrated on and we are coming to

pharmacology we have already started the integrated modules in Prof Buster life progator batch right in these integrated modules the first module we have started is with oncology we have completed oncology in pathology we have completed neoplasia and pathology we have understood the pathogenesis of cancer okay and we have completed the microbiology oncology I mean we have studied the organisms which cause cancer and now today we will study the treatment of cancer that is in

Pharmacology I am going to teach you anti-cancer drug most of the students find this topic very difficult but believe me I will make it a cakewalk for you I will compact the entire chapter in six pages so be with me for the next 2 and a half hour okay after 2 and half hour just take away take take away six pages from me and that six pages will be emed in your mind during the session only and Sol any question any University exam question long question short

question or any McQ based on any app any platform you will be able to solve all the questions that's my challenge okay so let's start it without wasting any further time let me share my screen with you and come on the topic okay so I guess you can see my screen also okay so let's start it uh it's a very important topic and very interesting also now you will understand the importance of integration I always insist okay so let's start it you will understand now so you can't understand my topic for

today is anti-cancer drug okay so the drug drugs which are used to treat the cancer you can't understand them unless and until you don't understand cancer in pathology if you understand why cancer occur or rather how cancer occur then only you will be able to understand its treatment better okay so first of all before coming on the drugs what is cancer I will teach you anti-cancer drug first you tell me what is cancer I guess you already know what is cancer we have

completed this in the pathology right so cancer is Progressive persistent purposeless I mean uncontrolled cell division if there is uncontrolled cell division of any tissue any organ in human body that leads to cancer we have already seen in pathology this diagram we are just revising it so that we can have a better understanding of the anti-cancer drug okay I told you what is the difference between normal drug and cancer drug uh normal cell and cancer cell what is the difference you can see

both are cells in both the cells normal cell as well as cancer cell you can see a growth receptor this is a growth receptor okay all the cells in human body have growth receptor so when the growth factor is coming can you see this is growth factor when growth factor is coming binding with the growth receptor it is giving the signal or the stimulus to the cell okay then only this cell will divide and do the mitosis otherwise normal cell cannot do the mitosis my

point is that normal cell can divide only under stimulus or only under signal my point is that in normal cell the mitosis is under control it is known as controlled mitosis because when growth factor is coming only then the cell is dividing otherwise it's not dividing the mitosis is under control see the other cells in the other cell you can see the growth factor is absent stimulus is absent no stimulus no growth factor still it's able to do the mitosis in absence of growth factor on cation of

growth factor still it's able to do the mitosis so it do not need any Factor any signal any stimulus to do the mitosis I mean to say mitosis is uncontrolled so this cell keep on dividing from 1 to two 2 2 to 4 4 to 8 8 to 16 16 to 32 likewise a bunch of cell is formed and that is known as cancer how many of you got it I guess everyone um understood it okay so now we will come we will come on the topic anti-cancer drug so you can see this is normal cell as I told you in

normal cells the cell division is under control so it will divide only when the physiological stimulus that is growth factor is present but in neoplastic cell the cell division is uncontrolled it keep on dividing even in absence of growth factor that is the basics I hope you got it now let's come on pharmacology let's come on our topic anti cancer drug as the name indicate what is anti-cancer drug a drug that kills the cancer cell so we want to kill these these cancer cell which are

showing uncontrolled mitosis so all those drugs which either kill the cancer cell or if it is unable to kill modify their growth any of these drugs are known as anti-cancer drugs okay but you know drugs don't Have Eyes suppose a human being any of the human being is having cancer any part of the body and that person is given chemotherapy I mean anti Cancer drugs to treat the cancer now Cancer drugs are going inside either orally or IV or via any route okay they can be oral they can be IV okay

intramuscular via any road they are going in the body after going in the body they have only one purpose they will kill the cells which are rapidly dividing any cell which is rapidly dividing they will kill it they will kill it so Mo tumor cells are rapidly dividing so most of them kill the tumor cell but in human body also there are certain normal cells which divide rapidly okay so they will kill that cells also that's why that's why the non- selective anti-cancer drugs The

non- Selective chemotherapy have very common wide spectrum of the side effects so we have to study the side effects of all the anti-cancer drugs because you understood what is the problem so in human body Suppose there is a cancer suppose in human body body this is a human this human is having cancer one of the cancer I will take the same example as I always take suppose this is a female and having breast cancer these are the cancer cells in the breast which

are showing uncontrolled mosis so I mean to say these cells are rapidly dividing highly dividing rapidly dividing cells now we are giving chemotherapy we are giving chemotherapy chemotherapy to treat the patient that is anti-cancer drugs so these drugs are going inside the body so this is the blood vessel in the blood vessel these drugs are going now these drugs have only one target whosoever cell is dividing rapidly kill that cell so definitely they will kill

these cells definitely but in human body also there are certain normal cells also which are rapidly dividing for example the hair follicles okay and that's why the anti-cancer drugs kill the hair follicle cells and that's why the person become Bal during chemotherapy although it's reversible so that is alopecia okay or the skin cell or the mucosa cell or the intestinal cell or or most important the bone marrow cells the bone marrow hematop politic stem cells you know they

are highly dividing highly dividing cancer cell can't differentiate normal and cancer cell cancer drugs I mean Cancer drugs can't differentiate is it a normal cell or is it a cancer cell cancer drug anti-cancer drug I mean anti-cancer drug kill all those cells which are rapidly dividing whether it's cancer cell or whether it's a normal cell that is the point that's why anti-cancer drugs have many side effects how many of you got it give me a thumbs up if you got it can we go ahead okay

now both normal cell as well as cancer cell follow the four phases in a cell cycle I guess everyone know there are four phases in cell cycle do you know yes or no h there are four phases in cell cycle you know that or you don't know uh there are four phases G1 s G2 M what does s and m stand for S stand for synthesis it's a phase in which synthesis is taking place and what is m m is a phase in which mitosis is taking place G1 is before s so this is known as

presynthetic phase and G2 is before uh M it is known as premitotic phase so there are four phases G1 is presynthetic then s is synthetic then G2 is premitotic and M is mitotic so there are four phases which occurs in the sequence G1 followed by S followed by G2 followed by m so learn synthetic phase and mitotic phase a phase before synthetic phase is presynthetic Phase a phas before mitotic phase is premitotic phase and after that again the cell is having two choices

either it re-enter in the next cell cycle or it will go in a resting stage that is g g0 g0 is the resting stage so these are the five phases in a cell cycle okay so when a cell is doing the cell cycle these five phases has to be passed I mean to say this whenever a cell is dividing into two can you see this is a normal cell see first first see it is a normal cell how it is dividing into two how it is dividing so first the cytoplasm is duplicating appreciate and then the nucleus is

dividing so in presynthetic Phase cytoplasm doubles in synthetic phase everything doubles in mitosis it is the nucleus which is dividing so these are the four phases in the mitosis the most important phase is mitosis there are five further phases in mopas prophase um prophase metaphase anaphase and tase okay so prophase preprophase metaphase anaphase and tase you can see these are the five phases in the mitosis I will teach you the drugs now so I will teach you those drugs are specific in any of

the face or they are non-specific okay this is the mitosis this is how mitosis takes place I mean the nucleus is dividing into two portion this is how the cell divide you can see the nucleus is dividing into two portion with the help of spindles I guess everyone know how does mitosis take place you have learned the steps of the mitosis you know prophase metaphase anaphase telophase so what is happening during metaphase this is metaphase and anaphase you can see the spindles are formed and

the nucleus is dividing into two portion appreciate the spindles so now with this overview let's start the drugs you are ready to start the chapter you got the overview so let's start the chapter I'm teaching you first of all the classification of anti-cancer drugs so first of all you should be aware of the name of the drugs how many drugs are available what is their classification then one by one we will pick them we will see their detail and we will fill them in our Master charts so in the end

we will compact the entire chapter in just six Master charts and we will write each and every detail whatever in in that Master chart only we will try to accommodate okay so let's start it first of all I would like to tell you the classification the classification of anticancer drug we divide anti cancer drug into three categories cytotoxic drug hormonal drug and targeted drugs okay one by one we will see their classification cytotoxic drugs are the drugs that kill cells I mean that kills

rapidly dividing cells to be specific that kill rapidly dividing cells in human body so definitely they will kill cancer cell because cancer cells are rapidly dividing but along with cancer cell they kill normal cells also which divide rapidly not all normal cell that's why these cells have these drugs have very high side effects the cytotoxic drugs have very wide spectrum of side effects very wide spectrum okay hormonal drugs are specific hormone in nature and the reverse of cytotoxic drug

is targeted drug targeted drug will go to a specific Target and they show their action at that particular cancer cell only in that particular organ they don't have side effects or very least side effects so targeted drugs don't have but unfortunately we don't have targeted therapy available for all cancer for most of the cancer 90% of the cancer we are having cytotoxic drug therapy targeted therapy we have discovered only in few of them we are yet to discover in

all okay so this is the broad broad classification one by one we will take the category so let's start with cytotoxic drugs how many cytotoxic drugs are there in our syllabus first you learn the classification Cy toxic drugs are the drugs these are the drugs that are killing the cell that are killing the cancer cell and normal cell any cell which is rapidly dividing that is the definition so how many cytotoxic drugs are there so in our syllabus there are eight eight categories of cytotoxic

drugs eighth one is misenus so you can say seven categories are there I will teach you seven today only all seven so there are seven or eight categories the first one is alkylating Agent the most important the ultra important alkylating agent the second is Platinum containing compounds the third one is antimetabolites fourth is microt Tibu damaging agents topoisomer is two inhibitor Topo isomer is1 inhibitor there are certain antibiotics which act as anti-cancer why antibiotics because

they are obtained from microorganism they are antibiotics they are antibiotics also but they are anticancer also and there are certain miscellaneous drugs so these are the eight categories I will teach you all today only under a fixed set of heading in comparative table it will fit in your mind it will embe in your mind believe okay these are further divided like alkylating agent have further five types you have to study their five types in detail alkylating agent nitrogen

mustards alky sulphonate nitroso uras triin and methy Hydro methy hydrogen I will teach you all five that is based on their chemical composition all of them are alting agent but the chemical in some of them mustard you know nitrogen mustard is there in some of them sulphonate group is there in some of them Uria Nitro UA is there likewise based on their chemical composition they are of five type okay so I will teach you all all five categories in detail so biggest chapter today the biggest

portion of today's session will be alting drugs you know it's very five categories we have to study okay Platinum we don't have any further category antimetabolite are further divided into three category purine antagonist pyramidan antagonist and folate antagonist we have to study the three antagonist folate antagonist purine antagonist and pyamid antagonist okay microtubular damaging agents further we divide into two categories winka alkaloids which are obtained from

plants and taxines I will teach you all first you have to accustom with these names if you don't know the names how you will directly jump on their mechanism of action uses and adverse effect so basically you have to learn all these drugs in a comparative table you should know their mechanism of action General properties uses adverse effects that's it the most important among these four is mechanism of action mechanism of action you should understand at your level at ambs level

you should know the mechanism of action of each of them okay General properties is there phoc kinetics important which is given orally which is given IV and any important Point regarding them okay which can cross BBB like that and uses and adverse effect you have to learn okay uh that is cytotoxic drugs I will tell you everything don't worry okay that is cytotoxic drug let me show you in the form of the table you can see these are the cytotoxic drugs how many

drugs are there eight you can see 4 plus 4 total eight categories so let me show you the cytotoxic drug eight categories number one alkylating agent number two Platinum contain complexes number three an metabolite okay number four microt Tibu damaging agents five topoisomerase inhibitor six topoisomerase inhibitor that is two that is one seven antibiotic and eight misenus so these are the eight categories one by one we will take them and see their detail one by one I'm not

reading the name of the drugs you should see each of the category is having multiple drugs I will teach you each and every drug today only right now okay so these are the cytotoxic we are having eight now we further divide them into two types okay now how many um phases are there in cell cycle I told you in the cell cycle there are four phases G1 s G2 and M now some of these eight there are eight categories of cytotoxic drugs some of them some of them are non-specific for the cell cycle they act

on any of the phase but some of them are specific for the cell cycle phase they act either only on M phase or on S phas so we are further dividing these eight into two categories what are the two categories cell CLE specific drugs cell cycle specific chemotherapy drugs okay these are known as cell cycle specific CCS these anti-cancer drugs kill only dividing cell okay in one of the phase either in S phase or in M phase or G1 or G2 I mean one of the four phase it will

kill okay I will tell you which of them drugs are there so out of these eight category antimetabolite some of the antibiotic micral U damaging agent and Topo isomer 2 these four are cell cycle specific the remaining four the remaining four are cell cycle non-specific cell cycle non-specific means they kill dividing as well as resting cell so I taught you there are I'm teaching you anti-cancer drug okay anti-cancer drugs are the drugs which kill cancer cell we divide them in three

categories the first one is cytotoxic drug which I'm teaching you right now the second is hormonal therapy that I will give you a list in the end and targeted therapy again I will give you a list in the end so these two are not we have to see the details we have to just see the list but cytotoxic we have to see the details in cytotoxic we are having eight categories you have to learn the eight categories 1 2 3 4 5 6 7 8 most important in them is the first category alkylating agents alkylating

agents are the uh first category okay alkylating agent is the first category the second one is the Platinum containing compound then there is winka alkaloid Topo isomerase one inhibitor Topo isas 2 inhibitor and others misenus is there you know so these are the eight among the eight category four of them act on particular phas of cell cycle so we call them cell cycle specific anti-cancer drugs and some of them they are non-specific for the cell cycle they kill dividing cell as well as resting

cell so we call them cell cycle non-specific so you should divide them which four are cell cycle specific you should have a look and which of them are cell cycle nonp specific so you can divide them like this only this also so at some places you get your McQ which of them is cell cycle specific alting agent which of them is cell cycle non-specific anticancer drug like that okay so this was the classification of cytotoxic drug this was the classification of cytotoxic

drug now I'm coming on hormonal drugs the second one is the hormonal drugs so there are nine hormonal drugs in our syllabus these all are hormones normal hormones in human body but we've used them as a therapy to treat certain cancer I will tell you which hormone we use in which cancer to treat it so glucocorticoids estrogen sums and SDS you know what is sum what is SD what is sum selective estrogen receptor modulator what is s selective estrogen receptor down regulator so both of them

are selective estrogen selective estrogen receptor one are modulator one are down regulator so one are sum one are SS Aroma inhibitor anti-androgen five Alpha reductase inhibitor G&R analogon and prostaglandins okay uh progestins I mean these all we use as a therapy in certain cancer these are hormonal drugs either they are hormone by themselves or they inhibit the synthesis of certain hormones at certain steps so I will teach you these now finally these are the hormonal drugs and

finally we are having the third category Target therapy I told you target therapy is specific it is specific of uh uh one of the cancer I mean it will it will show their action on one of the cell on of I mean one type of cell in human body they don't have any side effects so these are the targeted therapy in targeted therapy you don't have to go in the detail you have to just learn that which Target therapy is utilized in uh which cancer that's it so only few

targeted therapies are available okay these are the targeted therapy so let's start our session with cytotoxic drugs with this introduction can we start okay uh canu uh you can write down this classification also this classification I found more useful that's why I'm teaching you this okay uh I will share the notes also if you say I will share it in the PDF also in the PDF this one is given I guess okay so let's start it can we start give me a thumbs up everyone can we start so I'm

starting so this is total classification of anti-cancer drugs in front of your eyes so there are eight type of cytotoxic drug nine type of hormonal drug and five type of targeted therapy first of all my request to all of you to learn the classification of anti-cancer drug because most of the time if if you are a second prop student you simply get a question a five mark question a 10 write down the classification your question always start like this write down the classification of anticancer Dr

and one of them they will ask you the detail along with this classification they will ask you write down the mechanism of action uses and adverse effect of alkylating agent or mechanism of action uses and adverse effect of platinum containing compound or mechanism of action uses adverse effect of targeted therapy like that okay so you always get the first question as write down the classification so it is a must it is something you can't skip okay anti-cancer drugs we divide them in

three category cytotoxic drugs okay hormonal drugs and targeted therapy in cytotoxic drug we are having eight categories in hormonal we are having nine type of hormonal and in targeted there are five six that how many you can learn it's good there are five six important at your level you should learn so this is the complete classification but I I want you to see the details of cytotoxic in much uh with much importance because this is the most important SE which is frequently Asked

ji your exam so let's start with cytotoxic drug so I'm starting with cytotoxic this is complete classification in front of you okay these are cytotoxic drugs you can see the eight categories 1 2 3 4 5 6 7 8 learn it these are the hormonal it is having total nine category You Can Count they are nine in number and these are the targeted targeted are four five are important so please learn this classification okay you should write this class classification on a big paper

or a sheet and stick it on your wall okay complete classification at one place if you want at the end once I will teach you complete Pharma in these three months I will share you all classifications together okay it will be a downloadable small booklet you can say the classification booklet which will be nearly 30 40 pages okay you should take the print out of these 30 40 pages and stick somewhere so that frequently you see them now so you it will hit in your

mind that which drunk belong to which category so you have to learn 30 40 classification in your syllabus this is the classification one of them anti-cancer drug it is most important you should learn it cytotoxic drug hormonal drug targeted drug 8 95 you should know the categories let's start it let's proceed now can we proceed now let's proceed now uh toxicity of anti-cancer drug cytotoxic drug I'm starting with cytotoxic drug first of all I will teach you cytotoxic drug okay

so let's talk about its toxicity first okay how many of you are second Prof students if you are a second Prof student you frequently get long question or sometimes short question also on one of the anti-cancer drug okay so they ask you three things regarding that mechanism of act action uses and adverse effect of toxicity whatever you say the meaning is same adverse effect of toxicity of that drug now I am Telling You generalized toxicity okay so all drugs you know whatever Cy toxic drug

come in your syllabus they are having General toxicity and specific toxicity General toxicity something that is shown by all drugs all drugs so if you don't know the specific toxicity of that particular drug it's okay at least write down the 10 General 10 General side effects in all drugs it's fitting you don't even have to read the name of the drug whatever drug they are asking you can say these 10 side effects are caused by all cytotoxic anti Cancer drugs that's why we call them General side

effects or general toxicity but specific you have to learn specific that which drug causes what okay these 10 are General you have to write down in every every drug so first I'm teaching you the toxicity General and I will enumerate the specific then I will start the anticancer TR so my point is that if you are a second Prof ambius student and in your exam a long question or short question is coming on toxicity of any of the cytotoxic drug I have enumerated many cytotoxic drug if any of them is

asked in your exam first of all you enumerate these 10 General toxicity and after that whatever drug is asked write down the specific toxicity of that particular drug then you are going to get full marks but if you don't know the specific it's okay you are writing the general at least you will get 34 marks or half marks you will pass okay so that is the point so General are important why General toxicities are toxicities which are shown by all anti-cancer drugs I told you anti-cancer drugs can't

differentiate normal cell and cancer cell this is a cancer cell this is a normal cell I have shown you these diagrams previously also normal cell divide under uh control here the mitosis is under control and cancer cell the mitosis is uncontrolled okay in both of them mitosis is there so anti-cancer drug is a drug that kill highly dividing cell whether it's a cancer cell or whether it's a normal cell it kill all the cell any cell which is dividing anti cancer don't have eyes so it can

differentiate it's a cancer cell I have to kill it it's my own body cell I don't have to kill it no cancer cell knows only one rule whosoever cell is dividing kill that kill that so that's why they have General toxicity General toxicity is based on this so same story is WR anti-cancer drugs kill rapidly dividing normal cell also along with the cancer cell and that's why they produce toxicity how many of you got it so this is the table of the toxicity this is the

table of the toxicity of cytotoxic drugs General toxicity specific toxicity in general toxicity there are 10 General toxicity which you can enumerate in all drugs whatever drug asked in your exam write down these 10 first and then these are the specific one you don't have to write these all specific drugs have the specific toxicity I will teach you these 10 and these six one by one then we will move on individual drugs how many of you with me learning understanding so can we

start the general toxicity can I start the general toxicity of anticancer drug let's start general toxicity of anti-cancer drug so how many General toxicities are there 10 10 let's enumerate them and see their details it's very easy first is bone marrow suppression then imuno suppression G it toxicity skin and hair gonets fetus hyper urmia hyper uric acid hyper calcemia hyper calcium cardiotoxicity oh sorry carcinogenicity and mutagenicity so it's first you have

to learn these 10 if you are in second Prof if you are preparing for your competitive exam uh you just focus on the mcqs based on them okay so first one is bone marrow toxicity what is bone marrow why God has given us bone marrow we are having the bone marrow now bone marrow arrow is the organ in which blood cells are synthesized in human how many blood cells are there we are having three type of blood cells we are having rbcs we are having wbcs and we are having platelets these are our three

blood cells where these three are synthesized these three are synthesized in the bone marrow inside the bone marrow we are having a precursor cell that is known as hematop partic stem cell that is the grandfather of all blood cell the super grandfather you know the ancestor you can say the ancestor of all blood cell is hematopoetic stem cell hematopoetic stem cell is known as HSC this is cd34 positive the marker of hematopoetic stem cell is cd34 it's an McQ okay it's cd34

cell positive okay it's a hematop stem cell it will differentiate into three series erythroid series myoid series and you know megalite so here rbcs are formed from the hematop stem cell wbcs are formed and plat late are formed all three cells are formed from hematop stem cells okay so these precursor cells keep on dividing keep on dividing and form multiple precursors in the series multiple precursors in the series multiple precursors in the series I will teach you all the precursors when I

teach you hematology and pathology when I teach you leukemias and lymphomas I will teach you everything for now you should learn that there are multiple precursors here don't learn their names okay but ultimately RBC WBC and pler form my point is that bone marrow is a highly dividing organ I mean inside which the cells are super divided cells keep on dividing to form rbcs wbcs and plated you see it's constantly dividing the half life of RBC is 120 days the half life of all five type of WC there

are five type of WC neutrophil eosinophil basophil lymphocyte the half life of all of them is different half life of plate is all different so you know bone marrows keep on producing these cell so it's a rapidly dividing organ okay now suppose this person have cancer unfortunately this person is having cancer to treat the cancer we have given one of the Cho therapy drug so this is the chemotherapy drug entering in the blood we have given either oral or IV intramuscular so this

is the chemotherapy drug in the um in the blood what this drug know this drug know only one rule div uh kill all dividing cell so it is killing cancer cell yeah I agree but it is killing the bone marrow precursors also it is killing the so rbcs are not formed or less formed wbcs are not formed or less formed platelet are not formed or less formed so basically this person will have anemia on treatment leukemia not Li leucopenia on treatment and thrombocytopenia on treatment when we

are treating this person with chemotherapy the person will have sever anemia because of the anemia less rbcs means anemia because of the anemia person presents with fatigue because of less WBC person will have frequent infection because WBC are the Army defense mechanism Army is less so frequent infection and platelets are to control the bleeding okay so platelets are less thrombocytopenia is there this person presents with frequent bleeding even without injury or trivia injury so

these are the side effects due to bone marrow seption how many of you got it so bone marrow separation you can appreciate this is a hematop stem cell it is leading to formation of RBC WBC as well as plat late if the anti-cancer drug is killing the precursors present in the bone marrow all the precursors so less RBC less WBC and less plate will be there so patient have anemia leucopenia and thrombocytopenia so basically the patient is having pancytopenia pancytopenia you can say because of

anemia patient presents with fatig because of leucopenia patient presents with infection and because of thrombocytopenia the patient presents with bleeing so that is the first most common side effect of all cytotoxic gr so chemotherapy is very difficult you know because these all side effects patient have to face on therapy that's why people get afraid when they are came to know that they have cancer so they know ke now we have to take the treatment that is chemotherapy that is

costly also and that is having severe side effects so yes side effects are there okay so bone marrow suppression was the first side effect second side effect is imuno suppression okay how to reduce bone marrow um suppression by the way amate means reduce can we reduce this side effect yes if plat late are less give platelet transfusion if wbcs are L patient is having frequent infection you can give granulo side Colony stimulating Factor these are the colony stimulating factors so more wbcs

are formed if rbcs are less you can give arthop poitin and if all of them are severely SE L less or even zero count they become zero count sometime so we have to do B marrow transplant to save the patient okay so we are giving you know so patient is having cancer so we have to give the chemotherapy but if we are giving the chemotherapy the deadly side effect is occurring that is bone marrow separation sometimes bone marrow separation is life-threatening and to

save the person we have to do bone marot transplant so these are the precautions or these are the preventions or methods via which we can reduce the side effect coming on the second side effect the second side effect is immunosuppression okay the anti-cancer drugs there are certain anticancer drugs which kill lymphocytes lymphocytes are our main Army you know BNT lymphocytes God has given us two type of soldiers in our army okay I will teach you in Immunology

there are two type of soldiers in our army B lymy and T lymy so there are anti-cancer drugs which kill specifically

lymphocytes are not much guiled but lymphocytes are mainly guiled so they are supressed okay the Army is gone so these persons are at high risk of opportunistic infection okay so here pancytopenia is not occurring only lymphopenia is occurring getting my point that is imuno supression the third is Git You know the git humans have git starting from Esopus it start from Esopus the git start from ESOP figus and uh it ends on the anal anal canol it ends on the anal canol this is our

complete git you can say so this is this is complete Git You know God has given a lining the mucosal lining on complete git on complete git we are having mucosa in the esophagus we are having Sous mucosa the remaining all git we are having colar I guess everyone knows that it's very uh basic okay so this this mucosa is rapidly dividing this mucosa is rapidly keep on dividing and shedding new cells come lining of git keep on changing I mean shedding occurs and it

keep on dividing suppose this person have cancer okay this person have cancer this is the blood vessel of this person to treat it we are giving an anti-cancer drug so this is the anti-cancer drug here anti- cancer drug can't differentiate between the normal cell and cancer cell so of course it will kill the cancer cell I agree I do agree but it will kill the mucosal lining of the git also number one it will kill the mucosal lining so this person will have ulcers on treatment the person can have

ulcers because mucosa will be breached at some place okay bleeding will be there ulcer will be there ulcers on the mouth especially on the lips in the oral cavity inside the stomach that can happen okay now in the brain we are having a vomiting Center ctz you know ctz vomiting Center is there in the brain some of these drugs can cross you know ctz is the area which is not covered by BBB blood brain barrier so here any drug can go okay the drugs which can cross BBB only those drugs can

enter the brain but ctz is the area in the brain which is not covered by Blood brain barrier I guess you know that so all the anti-cancer drugs can go to the ctz and stimulate the vomiting Center that's why the patient on chemotherapy frequently vomit vomiting is a very frequent side effect so two things happen number one anti-cancer drug they stimulate the ctz and vomiting uh area in the brain in the brain that is a central action and peripheral AC this is Central action and peripheral action

they affect the mucosal lining of the G because of which person have nausea vomiting and person have ulcers also the person have person have necrosis of the epithelia and that's why stomatitis oral mucositis diara and ulcers so stomatitis can you see stomatitis is the lesion on the Buckle mucosa ulcer on the Buckle mucosa or the lips it is known as stomatitis you can see mucositis the mucosa is inflamed complete mucosa is inflamed person can't eat anything okay diarrhea is very frequent because

intestinal mucosa is gone okay V are gone and ulcers in the stomach or anywhere El are very frequent this is due to the peripheral action and the central action the central action the ctz is stimulated that's why frequently the person NOA and vomiting on chemotherapy on chemotherapy all chemotherapy drugs induce vomiting which which of the all the chemotherapy drugs or cytotoxic drugs which one is most otogenic maximum vomiting occurs with which one it's an McQ maximum vomiting

occurs with cisplatin you please learn this name you get McQ on that so CIS platin is the drug which is most Imogen maximum vomiting occurs with cisplatin when I will teach you individual drugs I will repeat it but please learn it cisplatin is most emetogenic how to reduce vomiting this is very you know tedious for the patient the patient is on medicine the patient already have a trauma that I'm having cancer patient is another trauma that I'm taking the treatment which is very costly and all

okay sometime it's not very costy but patient is taking the treatment and side effects are vomiting frequently patient vomits on treatment vomiting is not due to cancer vomiting is due to the treatment of the cancer that is it is a side effect of the anti-cancer drug so to control vomiting we usually give five HD3 antagonist okay 5 ht3 serotonin 5 H3 antagonist onen cetron we frequently give we frequently give onen cetron or granisetron onen cetron apart from that

we can give metalor promite or dexas but most frequently we give onanon that is 5 s23 the next unit I will teach you autocoids from Monday onwards you will understand what are these five HD3 antagonist and what is their mechanism how they decrease vomiting or treat vomiting so we give it prophylactically only before we give cancer drug anti-cancer drug we give onen cetron okay um as a ctail and then we will give the anticancer drug so vomiting will be less or vomiting will not be there so we

prevent it okay so you can see here I have given you a table which is showing the hematogenic potential of various cancer drugs anti-cancer drugs what is hematogenic potential uh the tendency to cause the vomiting so these are the drugs having Highest hematogenic Potential these are the drugs having moderate hematogenic potential and these are the drugs having mild hematogenic potential so whenever we give these drugs to the patient patient don't complain much of vomiting

but whenever we give these drugs to any patient these are anti-cancer drugs okay um whenever we are giving these drugs patient frequently complain of the vomiting among them CIS platin is the most emetogenic people are you there give me a thumbs up so that is the next side effect I told you I told you three side effects in long bone marrow suppression in which all three cell lines are gone RBC WBC platelet second imuno suppression in which only wbcs are gone RBC and plate are not much affected

the third I told you git in the git in the git I told you Central as well as peripheral effect mind it in the central effect I told you cide area vomiting Center that's why vomiting otogenic otogenic means vomiting and the peripheral effect the lining of the git is affected so patient have stomatitis ulcers okay mucositis that is due to peripheral effect now coming the side effect on the skin and hair you know skin cells and hair hair follicles are rapidly dividing cell again the same

story anti-cancer drugs don't have eyes so this is the blood vessel and this is the anti-cancer drug to treat a cancer so it knows only one rule kill the cell that is dividing so cancer cells are dividing these are the cancer cells so this drug definitely will kill the cancer cell but in a human the hair follicles are also dividing and the skin cells are also dividing okay so this drug will kill the hair follicles also and the skin cells also along with cancer along with cancer cells so these

so we want to kill cancer cells it's good but we do not want to kill the hair follicles and the skin cell that will be the side effect so anti-cancer cell damage the hair follicle patient have alopecia loss of hair and that is cos cosmetically a big trouble to the cancer patient imagine a lady who is having a long hair beautiful hair she suddenly got to know that I'm having breast cancer and she is on treatment she have started the chemotherapy after first or

maximum second chemotherapy her hairs are falling like anything she's touching the hairs and the you know complete cluster is coming and she's having the Pates of alpia so we advise the patient that you know hair fall will definitely occur so you shave you shave the head before the chemotherapy start it will be better you know it will be um aesthetically better otherwise hair will fall here and there everywhere it will be very dirty or messy so you do the Shaving before you start the

chemotherapy or at least after the first dose of the chemotherapy because it's going to happen alpia so sometime we suggest the patients like that so alopecia but we conso them that it's reversible once we stop the therapy hairs will again come it's okay it will be reversible so again the hair growth will be there and that will be normal the skin cells will also die and that will lead to dermatitis and skin rushes okay so hair and skin the next is gonad the next is gonads in the gonads in male

testes sperms are formed in female inside ovaries OVA are formed and they are rapidly dividing they the gonet cells are rapidly dividing the gonets have the gonadal cells that are rapidly dividing so again the same story anti-cancer drug don't differentiate normal cell and cancer cell it kill all cell who is rapidly dividing so of course anticancer drug cell will kill the cancer cell but it will kill the sperms also and oval also so it will kill that gidal cells in male and female

respectively so males will have oligospermia or aspermia and that's why infertility in male females will have a manoria okay and uh the OVA will be damaged and that's why infertility so male and female both have infertility while on treatment while while on treatment we don't advise them to conceive also whether it's a reproducing reproducing age male or reproducing age female we advise them uh don't conceive when the person is on chemotherapy even one year after the completion of the therapy

because many chemotherapy drugs are mutagenic and teratogenic so we don't advise them to con conceive while they are on chemotherapy whether the male or or the female so fifth side effect is goed the next is the fetus imagine a lady is already pregnant they were the teenage or they were the reproducing age male and female but they have the cancer but they are not conceived yet imagine a poor lady I mean a Pity lady who is already pregnant and during pregnancy

she came to know that she have cancer that can be a possibility okay we have seen a spectrum of cancer I worked in an enco Center and I have seen what what cases of cancer the rare of the rarest cancer I have seen I have worked in an apex Institute of cancer that's why um I know these things in much detail anyways so coming imagine a pregnant lady who is pregnant and during pregnancy she came to know that she is having B of the malignancy that can be a possibility so

what to do so first advice we will advise them to abort to abort and take the treatment but suppose she is not able to abort okay and pregnancy is at suppose second trimester or third trimester and abortion although it's a choice but the family is not convinced or that lady is not convinced she want to continue the pregnancy and she want to take the treatment also so we will give the anti-cancer drug of course we want to save the lady we want to save that female so we will give the

anticancer drug but and you know fetus the fetus the cells inside the fetus are highly dividing again anti-cancer drug don't know the rule anti- cancer drug know only one rule whatever cell is dividing damage that kill that so definitely anti-cancer drug is going to kill the fetus and abortion will happen or teratogenic effects will happen so we most of the time we advise that whenever a pregnant lady uh came to know that she is having cancer the first thing we advise about she can have further

pregnancy in future but once her life is lost she cannot have the life again pregnancy can again she can plan in future when she become well so we consel like that so this is the effects on the fetus the next is hyperuricemia okay what does anticancer drug do anti-cancer drug kill cell whether cancer cell or normal cell but they kill cell you know whenever a cell is ruptured anticancer cell rupture the cell so this is a cell inside the cell there is a nucleus

whether it's a cancer cell or whether it's a normal cell cancer cell or normal cell all cells have nucleus so whenever a cell get ruptured it is killed by the anti-cancer cell uh anti-cancer drugs so the nucleus from the nucleus uric acid will be produced okay n nucleus uh component will metabolite into the uric acid purins and paramin will convert into the uric acid so excessive cell killing will lead to hyper uremia in the blood you are getting my point uric acid

which is more in the blood that will get deposited at two place number one at the Joint spaces that will produce gout okay uric acid in the cium in the joint spaces that will produce gout and uric acid will go and deposit in the kidney producing uric acid stones in the kidney so that can be the problem Suppose there is a lady there is a person there is a human who is having any cancer to treat that cancer we are giving aggressive chemotherapy because you know that

cancer is very aggressive the person need aggressive chemotherapy that aggressive chemotherapy is killing the cancer cell like anything millions of cancer cells are getting raptured so nuclear products are converting into uric acid so the blood of that human contain abundant of uric acid from the blood uric acid will go where it will deposit in the cium producing gout okay so person will have pain in the joints especially uh the first joint which is involved is the great to okay you can

see first metat Taro corpal joint metatarsal metatarso tarsal joint the first one that is gr to so this is the first joint where the uric acid get deposited or it can deposit in the kidney producing the stones so that that can be prevented by good hydration alopurinol and corticosteroid that is hyper uricemia the next is hyper calcemia hypercalcemia now hypercalcemia is increased calcium in the blood that can be due to malignancy or that can be due to anti-cancer drug okay that can be

due to certain anticancer drugs what they do uh they dissolve the bone you know bones contain calcium bones contain calcium now sometimes the bone can have the metastasis bone can have the metastasis because of any of the primary malignancy so when the bone have the mats the calcium from the bone will leak into the blood the calcium and the blood will have high calcium that is hypercalcemia normal calcium level of blood is 9 to 11 milligram per Des if it is more than 11 it's hypercalcemia

it's hypercalcemia okay that can be treated with hydration bisphosphonates or corticosteroid the next is carcinogenicity what we are uh what I'm teaching you right now what I'm teaching you right now anti- cancer drug what are anticancer drug these are the drugs used to treat cancer what I'm saying you right now anti-cancer drug can cause cancer you say mam are you mad what you are saying anti-cancer drug cause cancer no ma'am no you are wrong anti-cancer drug are used to treat cancer yes yes

both lines are correct anti-cancer drugs are the drugs that used to treat cancer but certain anti-cancer drugs cause secondary cancer also they can cause cancer also so certain anti-cancer drug what does they do they they kill the cell now so they kill our immune cells also that uh give the defense against cancer you know the they they kill the Army now they are killing the humoral immunity so humoral immunity normally protect us from the cancer so that immunity is also gone because anticancer

D drugs are killing all the cells they kill the humoral immunity cells also okay which gives protection for the neia so when the patient is on treatment or years after treatment patient can have secondary cancer I'm not talking about metastasis metastasis is somewhat different you know there are certain pity patients we have seen in our life which have two or three malignancies primary sec I mean primary malignancies three different malignancies in their life one life multiple malignancies I'm

not talking about Mets of the first one M of the first one that is the same sequel I'm talking about separate malignancies that can happen in some syndromes also it happen Okay so secondary cancers will happen years after the use of the cytotoxic drug that can happen Okay the last one is mutagenic uh anti-cancer drugs are very strong drugs and that can produce mutations in the DNA that can produce so these are the 10 General side effect okay there are 10 General side effects

of all anti-cancer drug so whenever the side effect of any of the anticancer drug is asked to you you can write down these 10 uh General the first one is bone marrow suppression the second one is imuno supression the third one is git in the G Central action that is vomiting vomiting Center ctz and peripheral action that is Ulcer stomatitis mucositis the next is skin and hair in the hair loss of hair alopecia baldness but that's reversible in the skin there is necroses rashes you know and I've

told you all you just enumerate them and you can explain them in your own words how many of you got it so please write down the 10 General toxicity or general side effects of all anticancer drugs I'm having one question for you read the question it's very easy and please everyone do participate at Max you will be wrong it's okay I have not put the timer I guess I will end the poll I forgot to put the timer you just do in 16 15 seconds after 15 seconds I will

end it the timer is 1 minute I will not give you 1 minute read the question the following anticancer drug has high otogenic potential otogenic potential means vomiting the tendency to cause the vomiting vomiting as a side effect so all anti-cancer drugs have tendency to cause the vomiting because they stimulate the ctz but maximum is in cisplatin so all of you are right very good very correct so mohammadin Ishu and uh udai P you are first to write very good very

good okay uh I will wait for 20 more seconds I cannot end this poll how to end it before time I don't know I will not touch anything it will end by itself after 20 seconds okay okay we can see the screen meanwhile we will continue so sis platin is the correct answer here mhm sis platin is the correct answer just a second give me a second okay it's

gone okay so we will continue so I told you the general toxicities and now I will come on specific toxicities specific toxicities is caused by specific drug so the main main drug toxicity we will see okay main main one so the first toxicity is hemic cytis hemic cytis it is caused by cyclophosphamide cyclophosphamide hemic cytis is caused by cyclophosphamide you can see this what is hemic cytis is the bladder you know there are ulcers in the bladder so cyclophosphomide is a drug

that produces ulcers in the bladder so there is bleeding in the bladder and the bleeding will come in the urine and the urine will be red in color it will be smoky in color because of humic syrtis so whenever we start the patient on cyclophosphamide this is the most common side effect it um occurs okay hemic citis occurs with cyclophosphamide please learn that megaloblastic anemia it occurs with methoxide you know what what is megaloblastic anemia the rbcs is

of increased size and the neutrophils is multilobed what are the normal loopes in the neutrophil I guess you know in a neutr 3 to five Loops are normal 3 to five but if the neutr contain the nucleus of the neutrophil contain more than five loopes it is known as hypers segmented you count here 1 2 3 4 5 6 7 I can see seven seven Loops so it's a hypers segmented neutr so RBC increase in size and the neutr become hper segmented I will teach you although this in pathology also okay so that is

megaloblastic anemia it is the most common side effect of methot trit I will teach you in methot it also we will revise because methot Trix it is the drug that inhibit the synthesis of folic acid folic acid in the cancer cell as well as in normal cell also folic acid deficiency leads to megastic anemia so that is a thing uh nephrotoxicity is basically caused by cystin cistin that is most otogenic also it also causes nephrotoxicity neuropathy is caused by pristin and pexel neuropathy and

pulmonary fibrosis and skin rashes is caused by blasin and Bulan both are BB so you have to learn the specific specific one we will revise all these again when I will teach you the individual drugs cardiotoxicity is caused by doxorubin and donor robis okay cardiotoxic is caused so one by one these are the specific one we will revise them again under individual drugs these are the general one these are the specific one so if the long question is coming on toxicity of anticancer drug

you have to enumerate the general toxicity the specific toxity generally you have to enumerate all 10 if possible and the specific one how many you can remember you can enumerate them but you have to write that which toxity is caused by which drug you cannot just enumerate it you cannot say hemic cystitis you have to tell hemic cystitis is caused by which drug cyclophosphamide you can't see only megastic anemia it is caused by which drug methot triade nephrotoxicity is caused by which one

cisplatin neuropathy is caused by VIN Christin and pexel Pulmonary Fibrosis is caused by bomin and Bulan and cardox is caused by donor robis and doobin okay so you have to enumerate the specific drug also now can I start the individual drug with this introduction till now we we have seen only two things we have started the lecture since 1 hour but we have seen the classification and we have seen the toxicity or side effect till now we have completed two topics and now

I am starting individual drugs how many of you are ready give me a thumbs up everyone who is live let's start individual drugs can I start we will make the tables now can we start let's start so let's start with the cytotoxic drug three drugs are there in our syllabus cytotoxic drugs hormonal drugs and targeted drugs but the most important hormonal and targeted you have to just see the table you don't have to go in the detail but cytotoxic is the biggest chunk you are having and that

you have to cover in detail so let's start the cytotoxic drug how many category we have to study in cytotoxic drug we have to study the eight categories eight categories I will teach you all one by one let's start the cytotoxic drugs so in the eight categories I'm starting with the first category the alkylating agent which is further of five type so let's start the alkylating agent so basically from these I'm starting cytotoxic drug in the cytotoxic drug I'm starting the first

category that is alkylating Agent okay so let's start alkylating agents hello everyone I hope you found this concept clear and easy to understand if you had like to dive deeper into this topic and master it with f length lectures you can subscribe my app that is mlife by Dr Priyanka so join me for the live sessions where we break down the complex topics in a way that makes them simple and high yield for exams see you inside [Music]