Abstract

The inception of cancer treatment with chemotherapeutics began in the 1940s with nitrogen mustards that were initially employed as weapons in World War II. Since then, treatment options for different malignancies have evolved over the period of last seventy years. Until the late 1990s, all the chemotherapeutic agents were small molecule chemicals with a highly nonspecific and severe toxicity spectrum. With the landmark approval of rituximab in 1997, a new horizon has opened up for numerous therapeutic antibodies in solid and hematological cancers. Although this transition to large molecules improved the survival and quality of life of cancer patients, this has also coincided with the change in adverse effect patterns. Typically, the anticancer agents are fraught with multifarious adverse effects that negatively impact different organs of cancer patients, which ultimately aggravate their sufferings. In contrast to the small molecules, anticancer antibodies are more targeted toward cancer signaling pathways and exhibit fewer side effects than traditional small molecule chemotherapy treatments. Nevertheless, the interference with the immune system triggers serious inflammation- and infection-related adverse effects. The differences in drug disposition and interaction with human basal pathways contribute to this paradigm shift in adverse effect profile. It is critical that healthcare team members gain a thorough insight of the adverse effect differences between the agents discovered during the last twenty-five years and before. In this review, we summarized the general mechanisms and adverse effects of small and large molecule anticancer drugs that would further our understanding on the toxicity patterns of chemotherapeutic regimens.

Highlights

  • Received: 3 December 2021The term “cancer” is usually associated with negative memories, hardships, and challenges by the society despite the progress that has been made over the past decades in treating different types of malignancies

  • The complete cure with chemotherapy results roughly in about 5% of cancer patients, it is commonly administered to a significant number of patients with the appearance of myriad unwanted/adverse effects

  • This review offers an overview of diverse toxicities of these anticancer drug molecules, and a better understanding of these toxicities may facilitate future treatment decision in cancer patients

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Summary

Introduction

The term “cancer” is usually associated with negative memories, hardships, and challenges by the society despite the progress that has been made over the past decades in treating different types of malignancies. Similar to many small oncological drug molecules, paclitaxel has an issue with protein binding This can lead to an enormous variability of effect as well as change the effect of other medications. The complete cure with chemotherapy results roughly in about 5% of cancer patients, it is commonly administered to a significant number of patients with the appearance of myriad unwanted/adverse effects. These toxicities arise due to the resistance of tumor cells to chemotherapy and because of the similarity between cancer cells with normal cells in terms of structure and function [5]. This review offers an overview of diverse toxicities of these anticancer drug molecules, and a better understanding of these toxicities may facilitate future treatment decision in cancer patients

History of Cancer Chemotherapy Drugs
Highlights of Chemotherapeutic Drugs and Their Adverse Drug Effects
Antimetabolites
Alkylating Agents
Anthracyclines
Topoisomerase I Inhibitor
Anthracenedione
Vinca Alkaloids
Taxanes
Androgen Receptor Antagonists
CYP17A Inhibitors
Aromatase Inhibitors
EGFR Antagonists
BCR-ABL Inhibitors
VEGF Receptor Antibody
VEGF Inhibitors
Proteasome Inhibitors
Immunomodulatory Small Molecules
Immune Checkpoint Inhibitors
Bispecific Monoclonal Antibody
Antibody–Drug Conjugates
Cytotoxin–Protein Conjugate
Dermatologic Toxicities
Cardiotoxicities
Peripheral Neuropathy
Pulmonary Toxicities
Hepatotoxicity
Nephrotoxicity
Role of Pharmacogenomics in Differential Toxic Effects
Findings
Summary
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