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Medicines used to treat cancer

The first major successes in the field of modern chemotherapy for oncological diseases were achieved in the 1940s, when during World War II they began to study in detail the effect on the body of chemical warfare agents: mustard gas, or bis (Ab-chloroethyl) sulfide, and nitrogen mustard, or trichloroethylamine. Even earlier (in 1919) it became known that nitrogen mustard causes leukopenia and bone marrow aplasia. Further studies have shown that nitrogen mustard has a specific cytotoxic effect on lymphoid tissues and has antitumor activity in lymphosarcoma in mice. In 1942, clinical trials of trichlorethylamine were begun, which marked the beginning of an era of modern tumor chemotherapy.
Soon, a number of derivatives of bis- (Ab-chloroethyl) -amine, or bis- (2-chloroethyl) -amine, were synthesized, and some of them were used as antitumor agents.
According to the mechanism of action, preparations of this group are considered as K alkylating substances, since they form covalent bonds (exhibiting an alkylating property) with nucleophilic compounds, including biologically important radicals such as phosphates, amines, sulfhydryl, imidazole groups, etc.
The cytotoxic and other effects of alkylating compounds are primarily due to the alkylation of the structural elements of DNA (purines, pyrimidines).
Following bis-A (b-chloroethyl) amines, cytostatic alkylating compounds of other chemical groups were obtained: ethyleneimines, alkyl sulfonates, triazenes.
In the early 60s, antitumor substances of another mechanism of action, Cantimetabolites, were discovered. Methotrexate, which has a structural similarity with folic acid and is its antimetabolite, has been shown to be effective in some human tumors, especially choriocarcinoma in women and acute leukemia.
Following this, antitumor properties of other antimetabolites were found: purine analogues (mercaptopurine, thioguanine) and pyrimidine (fluorouracil and its analogues, cytarabine, etc.).
Later, as antitumor agents, a number of antibiotics (adriamycin, olivomycin, dactinomycin, etc.), enzymes (L-asparaginase), some alkaloids (vinblastine - rosevin, vincristine), platinum preparations and a number of other compounds were used.
For the treatment of hormone-dependent tumors, a number of estrogenic, androgenic and gestagenic drugs (progestins), as well as estrogen antagonists (antiestrogens - tamoxifen, etc.) and androgen antagonists (antiandrogens - flutamide, etc.) have been widely used.
In recent years, endogenous antitumor compounds have begun to attract great attention. Efficiency was found in some types of interferon tumors (see), the antitumor activity of other lymphokines (interleukins - 1 and 2) is being studied.
Along with a specific inhibitory effect on tumors, modern antitumor agents act on other tissues and systems of the body, which, on the one hand, causes their side effects, and on the other hand allows them to be used in other areas of medicine.
One of the main side effects of most anticancer drugs is their inhibitory effect on the blood-forming organs, which requires special attention and precise regulation of the doses and regimen of the drugs. It should be borne in mind that the inhibition of hematopoiesis is enhanced with combination therapy - the combined use of drugs, radiation therapy, etc. Often there is a loss of appetite, diarrhea, alopecia and other side effects are possible. Some antitumor antibiotics have cardiotoxicity (adriamycin, doxorubicin, etc.), nephroid ototoxicity.
With the use of certain drugs, the development of hyperuricemia is possible (see Allopurinol).
Estrogens, androgens, their analogues and antagonists can cause hormonal disorders (often gynecomastia).
One of the characteristic features of a number of anticancer drugs is their immunosuppressive effect, which can weaken the body's defenses and facilitate the development of infectious complications. At the same time, in connection with this action, a number of antitumor agents (methotrexate, cyclophosphamide, cytarabine, prospidine, etc.) are used in some cases for therapeutic purposes in autoimmune diseases. At allograft organ transplantation and bone marrow transplantation, Kcyclosporin (see), K azathioprine (see), glucocorticosteroids are more often used.
U General contraindications to the use of anticancer drugs are severe cachexia, terminal stages of the disease, severe leukemia and thrombopenia.
The question of the use of these drugs during pregnancy is decided individually by U. As a rule, due to the danger of teratogenic effects, these drugs are not prescribed during pregnancy; Do not use them also when breastfeeding.
The use of anticancer drugs is carried out only as prescribed by the oncologist.
Recently, some new antitumor drugs have been additionally authorized.
The group of drugs used for the treatment of cancer includes drugs: