What are some commonly used chemotherapy drugs?

Commonly Used Chemotherapy Drugs

Chemotherapy drugs are categorized into several major classes, with the most commonly used agents including anthracyclines (doxorubicin, epirubicin), taxanes (paclitaxel, docetaxel), platinum agents (cisplatin, carboplatin, oxaliplatin), antimetabolites (gemcitabine, capecitabine, fluorouracil, pemetrexed), and vinca alkaloids (vinorelbine, vinblastine, vincristine). 1

Major Drug Classes and Specific Agents

Anthracyclines

• Doxorubicin is a preferred first-line agent for metastatic breast cancer, typically dosed at 60-90 mg/m² every 3 weeks 1
• Epirubicin is used at 100-120 mg/m² in adjuvant breast cancer regimens (FEC100 or CEF120) 1
• Pegylated liposomal doxorubicin is categorized as a preferred single agent alternative 1

Taxanes

• Paclitaxel is administered at 135-175 mg/m² IV over 3 hours every 3 weeks for breast cancer and NSCLC 1
• Docetaxel is dosed at 75-100 mg/m² IV over 1 hour every 3 weeks across multiple indications including breast cancer, NSCLC, prostate cancer, gastric cancer, and head/neck cancer 1, 2
• Albumin-bound paclitaxel is a preferred alternative, particularly for patients with hypersensitivity reactions to standard taxanes 1

Platinum Agents

• Cisplatin is used at 75-100 mg/m² every 3-4 weeks in combination regimens for NSCLC, bladder cancer, gastric cancer, and head/neck cancer 1
• Carboplatin (dosed by AUC 5-6) is commonly substituted for cisplatin in patients with renal impairment (GFR <60 mL/min) 1
• Oxaliplatin is administered at 85 mg/m² IV over 2 hours every 2 weeks in FOLFOX regimens for colorectal cancer 1

Antimetabolites

• Gemcitabine is dosed at 1000 mg/m² weekly for 3 weeks every 4 weeks, often combined with cisplatin or carboplatin for NSCLC 1
• Capecitabine is given at 1250 mg/m² twice daily for 2 weeks every 3 weeks for breast and colorectal cancer 1
• Fluorouracil is administered as continuous infusion (500-1000 mg/m²/day for 4-5 days) in combination regimens for gastric and head/neck cancers 1
• Pemetrexed is used in NSCLC, particularly for non-squamous histology 1

Vinca Alkaloids

• Vinorelbine is dosed at 25-30 mg/m² weekly, often combined with cisplatin for NSCLC 1
• Vinblastine and vincristine are listed as other active single agents 1

Combination Regimens

Breast Cancer Combinations

• AC/EC: Doxorubicin or epirubicin with cyclophosphamide 1
• FAC/CAF: Fluorouracil, doxorubicin, cyclophosphamide 1
• FEC: Fluorouracil, epirubicin, cyclophosphamide 1
• TAC: Docetaxel with doxorubicin and cyclophosphamide for adjuvant node-positive disease 1
• Docetaxel/capecitabine: Preferred combination for metastatic disease 1

Lung Cancer Combinations

• Cisplatin/paclitaxel: 75 mg/m² each for chemotherapy-naive NSCLC 1
• Carboplatin/paclitaxel: Standard doublet for advanced NSCLC 1
• Gemcitabine/cisplatin: 1000 mg/m² gemcitabine with 100 mg/m² cisplatin 1
• Cisplatin/pemetrexed: Preferred for non-squamous NSCLC 1

Colorectal Cancer Combinations

• FOLFOX4: Oxaliplatin 85 mg/m² with leucovorin and fluorouracil bolus/infusion every 2 weeks 1
• FOLFIRI: Irinotecan 125 mg/m² with fluorouracil-leucovorin 1

Gastric and Head/Neck Cancer Combinations

• DCF: Docetaxel 75 mg/m², cisplatin 75 mg/m², fluorouracil 750 mg/m²/day for 5 days 1

Bladder Cancer Combinations

• GC (Gemcitabine/Cisplatin): Category 1 recommendation, non-inferior to MVAC with better toxicity profile 1
• Dose-dense MVAC: Methotrexate, vinblastine, doxorubicin, cisplatin with G-CSF support, superior to standard MVAC 1

Other Active Agents

• Cyclophosphamide: 500-600 mg/m² in combination regimens 1
• Irinotecan: 125 mg/m² weekly for colorectal cancer 1
• Topotecan: 1.5 mg/m²/day for 5 days every 3 weeks for small-cell lung cancer 1
• Etoposide: Oral administration (category 2B) 1
• Mitoxantrone: Listed as other single agent option 1
• Ixabepilone: Epothilone B analogue for taxane-resistant breast cancer 1

Critical Supportive Care Considerations

Antiemetic Prophylaxis

Highly emetogenic regimens (cisplatin ≥50 mg/m², AC combinations, cyclophosphamide >1500 mg/m²) require triple therapy: aprepitant 125 mg day 1 (80 mg days 2-3), dexamethasone 12 mg, and a 5-HT3 antagonist (category 1) 1

Moderately emetogenic regimens require 5-HT3 antagonist with dexamethasone, with or without aprepitant 1

Myelosuppression Management

• Docetaxel: Contraindicated if neutrophils <1500 cells/mm³; requires frequent blood count monitoring 2
• G-CSF support: Recommended for dose-dense regimens and high-risk patients 1
• Grade 3-4 neutropenia rates: 74% with docetaxel, 75% with paclitaxel, 57% with gemcitabine, 53% with FOLFOX 1

Hypersensitivity Precautions

• All patients receiving taxanes or platinum agents require premedication with oral corticosteroids 2
• Docetaxel is contraindicated in patients with history of severe hypersensitivity to polysorbate 80 2
• Desensitization protocols should be used for patients with prior allergic reactions who require re-treatment 1

Common Pitfalls

Avoid docetaxel if bilirubin >ULN or if AST/ALT >1.5× ULN with alkaline phosphatase >2.5× ULN, as hepatotoxicity significantly increases treatment-related mortality 2

Do not use standard MVAC for bladder cancer—it is inferior to both dose-dense MVAC and GC in terms of toxicity and/or efficacy 1

Carboplatin substitution for cisplatin in bladder cancer patients with poor performance status results in lower response rates (26-42% vs higher with cisplatin-based regimens) 1

Sequential single agents may be preferable to combination chemotherapy in metastatic breast cancer, as combinations provide minimal survival benefit with increased toxicity 1