Antineoplastic
Generic and Trade Names
| Doxorubicin | Adriamycin | ||
| Cyclophosphamide | Cytoxan | ||
| Interferon | Betaseron | ||
| Mitomycin C | Mutamycin | ||
| Methotrexate | Rheumatrex, Folex, Mexate | ||
| Tamoxifen | Nolvadex | ||
| Paraplatin | Carboplatin | ||
| Platinol | Cisplatin | ||
| Procarbazine | Matulane |
Description:
An antineoplastic is an agent which prevents the growth of neoplasms, cells or tissues which develop without any structural organization and without any coordination with surrounding tissues. Unfortunately, these agents have toxic effects on both healthy as well as cancerous cells. Usually, they affect one or more stages of cell growth or replication. The agents that work on one specific phase of cell growth are called cell cycle specific agents, and those that are active on both proliferating and resting cells are called cycle nonspecific agents. (Facts and Comparisons 1999)
Mitomycin C is an example of an antineoplastic agent and it also acts as an immunosuppressive agent. It is used to treat tumors of the bladder and breast, and pancreatic adenocarcinomas. Mitomycin C inhibits the synthesis of DNA by cross-linking double stranded DNA through guanine and cytosine so cell reproduction cannot take place. It is cytotoxic.
Nutritional Considerations:
Separate calcium and magnesium supplements by at least 2 hours. (Pronsky 1999)
Women on antiestrogen therapy (i.e. Tamoxifen) showed increased levels of triglycerides and alpha-tocopherol although Beta-Carotene levels decreased among some of those receiving antiestrogens. (Potischman 1992)
The cytotoxic effects of antineoplastics, generally, (including Carboplatin, Cisplatin and Methotrexate) damage rapidly proliferating cells which leads to: stomatitis, glossitis and esophagitis.
It is most likely that vitamins influence the pharmacokinetics of cyclophosphamide or its metabolites. Antioxidants (A, C and E) and vitamin B complex (e.g. B 1 and B 6) have been evaluated. (Dostal, 1990)
Vitamin B12 binding capacity of proteins is inhibited. (Fenrych, 1993)
Synergism has also been demonstrated between beta carotene and anticancer alkylating agents such as melphalan and cyclophosphamide. Micronutrients such as beta carotene have been found to inhibit both major phases of carcinogenesis--initiation and promotion. (Shklar, 1993)
There is a tendency towards anorexia and gastrointestinal side effects can be severe, including: pain, nausea, vomiting, diarrhea and constipation. (Facts and Comparisons 1999)(Pronsky 1999)
Maintaining an adequate diet is a major problem.
Absorption of several nutrients may be reduced:
Calcium Fats
Folic acid vitamin B12 (Brinker 1998)
Methotrexate resembles folic acid in structure and thereby inhibits nucleic acid synthesis and restricts cellular growth. (AHFS Drug Information, 2000)
Herbal Considerations:
Oral estrogen supplementation may retard the metabolism of steroidal hormones in: licorice root. (Newall 1996)
Salicylate herbs (e.g. meadowsweet, European poplar, queen of the meadow or willow) may block renal tubular secretion of methotrexate similar to aspirin and other salicylates,thereby increasing the amount of active drug. (Facts 1999)
Echinacea purpurea, ginseng, milk thistle and ginger may increase drug toxicity. (Hacker 1984) (Kupin 1984)
References
AHFS Drug Information, 2000.
Angel, J.E. 1983. Physicians Desk Reference. Medical Economics Company, Inc. Oradell, New Jersey.
Brinker, Francis N.D. Herb Contraindications and Drug Interactions. 1998
Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer Company, 1999.
Dostal M & Schubert J: Further studies on protective effects of vitamins in cyclophosphamide-induced cleft palate. Int J Oral Maxillofac Surg, 1990 Oct, 19:5, 308-11.
Fenrych W: Inhibition of the vitamin B12 binding capacity of proteins by the hydrolysis product of cyclophosphamide. Pharmacol Toxicol, 1993 Jan, 72:1, 22-4.
Griffith, H. W. 1983. Complete Guide to Prescription and Non-Prescription. Fisher Publishing, Inc., Tucson.
Hijikata Y et al., Traditional Chinese medicines improve the course of refractory leukemic lymphoblastic lymphoma and acute lymphocytic leukemia: two case reports. Am J Chin Med, 1995, 23:2, 195-211.
Hacker B, Medon PJ Cytotoxic effects of Eleutherococcus senticosus Aqueous Extracts in Combination with N6- (delta 2- isopentenyl) adenosine and 1-beta-D-Arabinofuranosylcytosine Against L1210 Leukemia Cells. J Pharm Sci 1984 Feb; 73(2): 270-272.
Henderson MM: Nutritional aspects of breast cancer. Cancer, 1995 Nov, 76:10 Suppl, 2053-8.
Kupin VJ, Eleutherococcus and Other Biologically Active Modifiers in Oncology. Moscow, Medexport, 1984.
Lieberman, S. & Bruning, N.: The Real Vitamin & Mineral Book. Avery, NY.
Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health-care Professionals. London: The Pharmaceutical Press, 1996
Osol, Arthur. 1980. Remington's Pharmaceutical Sciences. Mack Publishing Company, Pennsylvania.
Potischman N et al., Effects of breast cancer treatments on plasma nutrient levels: implications for epidemiological studies. Cancer Epidemiol Biomarkers Prev, 1992 Nov-Dec, 1:7, 555-9.
Schilsky, R & Anderson, T: Hypomagnesemia secondary to Cisdiammine-chlorplatinum II administration. Ann. Int. Med. 1979, 90:929-932.
Sklar S. et al. Drug Therapy Screening System. Indianapolis: First Data Bank 99.1-99.2 editions.
Shklar G & Schwartz J: Oral cancer inhibition by micronutrients. The experimental basis for clinical trials. Eur J Cancer B Oral Oncol, 1993 Jan, 29B:1, 9-16
Yu, WK et al., Regulation of tamoxifen-mediated anti-tumor cytotoxicity by protein phosphatases and their role in synergy with combination of tamoxifen and TNF alpha. Cell. Pharmacol. 1995,2:15-22.
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