DRUG NAME Toxicities: Acute: Delayed: Subclass Enzyme/Antigen

Home , Edrecolomab, MOPP (chemotherapy), Pentostatin

H&HD ANTINEOPLASTIC DRUG CARD ASSEMBLY INSTRUCTIONS

Each of you should have 37 new cards:

11 white cards for miscellaneous drugs (2 DNA synthesis inhibitors, 1 enzyme, 3 signal transduction inhibitors, 1 proteosome inhibitor, 2 antiangiogenesis agents and 2 differentiating agents)

5 purple cards for drugs that suppress immune system function

14 pink cards for drugs that stimulate immune system function

and 5 pages of drug labels, which include enzyme and antigen stickers.

Overall, the cards should look like this:

CCS or Regimens Therapeutic Uses: CCNS

PK: DRUG NAME Toxicities: Acute: Delayed: Subclass Enzyme/antigen

To assemble the cards:

1. Apply the drug names to the appropriate cards:

Drugs that prevent DNA synthesis (orange labels): On orange cards: 5-FLUOROURACIL (5-FU), 6-MERCAPTOPURINE, 6-THIOGUANINE, AZATHIOPRINE, CYTARABINE, GEMCITABINE, METHOTREXATE On white cards: HYDROXYUREA, PENTOSTATIN Drugs that alter protein function (black labels on white cards): L-ASPARAGINASE, BORTEZOMIB, ERLOTINIB, GEFITINIB, IMATINIB

Angiogenesis inhibitors (red labels): ANGIOSTATIN and THALIDOMIDE (on white cards) and BEVACIZUMAB, INTERLEUKIN 12 and INTERFERON α (on pink cards)

Differentiating agents (brown labels on white cards): ARSENIC TRIOXIDE, TRETINOIN

Drug that suppresses immune system function AND inhibits hormone synthesis (purple and yellow label on purple card): AMINOGLUTETHIMIDE

Drugs that suppress immune system function (purple labels on purple cards): CYCLOSPORINE, DEXAMETHASONE, PREDNISONE, TACROLIMUS (FK506)

Drugs that stimulate immune system function (rose labels on pink cards): INTERLEUKIN-2 (IL-2) and TUMOR NECROSIS FACTOR α

Antibodies and fusion protein (pink labels on pink cards): ALEMTUZUMAB, CETUXIMAB, EDRECOLOMAB, DENILEUKIN DIFTITOX, GEMTUZUMAB, IBRITUMOMAB, RITUXIMAB, TOSITUMOMAB, TRASTUZUMAB

2. Write subclass designators onto the front of the immunosuppressor (purple) cards: Glucocorticoids: AMINOGLUTETHIMIDE, DEXAMETHASONE, PREDNISONE Antibiotics: CYCLOSPORINE, TACROLIMUS and on the fusion protein (white) card: Fusion protein: DENILEUKIN DIFTITOX

3. Put enzyme and antigen stickers on the cards as follows: DHFR: METHOTREXATE Thymidylate synthase: 5-FLUOROURACIL PNP, HGPRT: 6-MERCAPTOPURINE, 6-THIOGUANINE, AZATHIOPRINE Ribonucleotide reductase: PENTOSTATIN, HYDROXYUREA 26S Proteosome BORTEZOMIB Tyrosine kinase: ERLOTINIB, GEFITINIB, IMATINIB CD52: ALEMTUZUMAB EGFR CETUXIMAB 17-1A EDECOLOMAB CD33: GEMTUZUMAB CD20: IBRITUMOMAB ***first radiolabelled antibody approved!, RITUXIMAB, TOSITUMOMAB HER2 (ErbB2): TRASTUZUMAB IL-2 receptor DENILEUKIN DIFTITOX

4. Write CCNS/CCS designations onto the appropriate cards (it's only critical for the CCS drugs, since this terminology is typically applied to the traditional antineoplastic agents, rather than the newer agents):

CCNS CCS L-asparaginase Cetuximab Methotrexate Erlotinib Edrecolomab 5-Fluorouracil Imatinib Gemtuzumab 6-Mercaptopurine Gefitinib Ibritumomab 6-Thioguanine Bortezomib Rituximab Cytarabine Aminoglutethimide Tositumomab Gemcitabine Dexamethasone Trastuzumab Pentostatin Cyclosporine Angiostatin Hydroxyurea Prednisone Bevacizumab Azathioprine Tacrolimus Interleukin 12 Interleukin-2 Thalidomide Interferon α Denileukin diftitox Tumor necrosis factor α Bortezomib Alemtuzumab Arsenic trioxide

5. Write the regimen designations onto the appropriate cards: CHOP: prednisone CMF: methotrexate, 5-fluorouracil FAC: 5-fluorouracil MOPP: prednisone 6. I’d also suggest that you write in the following therapeutic uses, since we will spend very little time on this during the lecture (this is also the order in which the drugs will be presented in lecture or in the CML module): METHOTREXATE acute lymphoblastic leukemia in children, meningeal leukemia or lymphoma, Burkitt’s and other non-Hodgkin’s lymphomas, choriocarcinoma, breast, head and neck, ovarian and bladder cancer 5-FLUOROURACIL GI cancers, breast cancer, ovarian cancer, head and neck cancer AZATHIOPRINE acute leukemias 6-MERCAPTOPURINE acute leukemia esp. acute granulocytic leukemia 6-THIOGUANINE acute leukemia esp. acute granulocytic leukemia CYTARABINE acute granulocytic leukemia GEMCITABINE metastatic pancreatic cancer, non-small cell lung cancer PENTOSTATIN hairy cell leukemia HYDROXYUREA myeloproliferative disorders, including chronic granulocytic leukemia and essential thrombocytosis, metastatic malignant melanoma AMINOGLUTETHIMIDE breast and prostate cancer DEXAMETHASONE brain metastases, prostate cancer, multiple myeloma PREDNISONE acute leukemia, lymphomas, myeloma and other hematologic cancers, as well as in advanced breast cancer; adrenocortical carcinoma; childhood acute lymphoblastic leukemia; Hodgkin’s disease CYCLOSPORINE relapsed or resistant leukemias; adjunct to BMT TACROLIMUS relapsed or resistant leukemias; adjunct to BMT INTERLEUKIN-2 metastatic renal cell carcinoma and malignant melanoma INTERFERON α α hairy cell leukemia, chronic myelogenous leukemia, malignant melanoma and Karposi’s sarcoma, hemangiomas in infants (phase III clinical trials) TUMOR NECROSIS FACTOR α malignant melanoma and soft tissue sarcoma of the extremities ALEMTUZUMAB B-cell chronic lymphocytic leukemia (B-CLL) BEVACIZUMAB colon cancer CETUXIMAB advanced colorectal cancer that has metastasized GEMTUZUMAB CD33-positive acute myeloid leukemia (AML) EDRECOLOMAB colon cancer RITUXIMAB CD20 positive, B-cell non-Hodgkin’s lymphoma TOSITUMOMAB CD20 positive, B-cell non-Hodgkin’s lymphoma IBRITUMOMAB CD20 positive, B-cell non-Hodgkin’s lymphoma TRASTUZUMAB metastatic breast cancer (tumors overexpressing the HER2 protein) EDECOLOMAB colon cancer DENILEUKIN DIFTITOX cutaneous T-cell lymphoma INTERLEUKIN 12 neuroblastoma, renal cell carcinoma, malignant melanoma, breast cancer THALIDOMIDE Kaposi’s sarcoma, brain, bone and colon cancer, small cell lung cancer, multiple myeloma TREINOIN acute promyelocytic leukemia ARSENIC TRIOXIDE acute promyelocytic leukemia IMATINIB chronic myeloid leukemia, gastrointestinal stomal tumour (GIST) ERLOTINIB non-small cell lung cancer GEFITINIB non-small cell lung, bowel, stomach, ovarian, prostate and breast cancer BORTEZOMIB multiple myeloma L-ASPARAGINASE childhood acute leukemias

7. Since I suspect we’ll be short of time in this lecture, I’ve given you the pharmacokinetic and toxicity information in the handout. Obviously, you can transfer the info from the handout to the cards if you want.

8. Put the cards into the order that they will be introduced in the lecture (see part 6, or check your main handout; thalidomide will be last!).

9. AMINOGLUTETHIMIDE, CYCLOSPORINE, DEXAMETHASONE, PREDNISONE and TACROLIMUS will not be discussed in detail in this class, as they are more completely discussed in Dr. Regal’s lectures. The cards are provided so you won’t forget that these agents are also used in cancer chemotherapy!