Chemotherapy cheat sheet

Platinums

Cisplatin, Carboplatin, Oxaliplatin

Cross-link DNA strands (G2 arrest) — classic radiosensitizers used concurrently with RT.

Cisplatin: nephrotoxicity (hydrate + replace magnesium), ototoxicity, severe nausea (high emetogenic). Carboplatin: thrombocytopenia. Oxaliplatin: cold-induced neuropathy.

Alkylators

Cyclophosphamide, Ifosfamide, Temozolomide, Carmustine (BCNU)

Transfer alkyl groups to DNA, causing cross-linking and strand breaks in all cell-cycle phases.

Myelosuppression, hemorrhagic cystitis (→ mesna), infertility, secondary malignancy risk. Temozolomide: daily 75 mg/m² during GBM RT (Stupp). BCNU: pulmonary toxicity.

Antimetabolites

5-FU, Capecitabine, Gemcitabine, Methotrexate, Pemetrexed, Cytarabine

Mimic endogenous bases and block DNA synthesis (S phase) — several are radiosensitizers.

Mucositis, diarrhea, hand-foot syndrome (capecitabine). Gemcitabine: potent radiosensitizer — severe toxicity with thoracic RT. Methotrexate: → leucovorin rescue; CNS toxicity with cranial RT.

Anthracyclines & antibiotics

Doxorubicin, Mitomycin-C, Bleomycin

Doxorubicin: DNA intercalation + topoisomerase II inhibition. Mitomycin: alkylator-like. Bleomycin: free-radical DNA strand breaks.

Doxorubicin: cumulative cardiotoxicity + radiation recall. Mitomycin: radiosensitizer (anal cancer CRT). Bleomycin: pulmonary fibrosis — a key caution with lung RT.

Topo I / II inhibitors

Etoposide, Topotecan, Irinotecan

Block topoisomerase I/II, trapping cleaved DNA complexes (S phase).

Myelosuppression. Etoposide: paired with cisplatin in lung CRT. Irinotecan: acute + delayed diarrhea (atropine / loperamide).

Vincas

Vincristine, Vinblastine

Bind tubulin and prevent microtubule spindle formation (M-phase arrest).

Vincristine: peripheral neuropathy, constipation — never intrathecal (fatal). Vinblastine: myelosuppression predominant.

Taxanes

Paclitaxel, Docetaxel

Stabilize microtubules, blocking mitosis (M-phase arrest) — also radiosensitizers.

Peripheral neuropathy, myelosuppression, hypersensitivity → premedicate (dexamethasone + antihistamine).

Checkpoint inhibitors

Pembrolizumab, Nivolumab, Atezolizumab

Block PD-1/PD-L1 (or CTLA-4) to release T-cell inhibition against tumor cells.

Immune-related adverse events: pneumonitis, colitis, hepatitis, thyroiditis, rash — managed with corticosteroids. Increasingly paired with RT.

Targeted agents

Trastuzumab, Bevacizumab, Erlotinib, Imatinib

Monoclonal antibodies or TKIs against specific drivers: HER2, VEGF, EGFR, BCR-ABL.

Trastuzumab: cardiotoxicity (avoid concurrent anthracycline). Bevacizumab: bleeding, hypertension, impaired wound healing. EGFR TKIs: rash, diarrhea.

Endocrine therapy

Tamoxifen, Anastrozole, ADT (leuprolide)

ER modulation (tamoxifen), aromatase inhibition (AIs), or androgen deprivation (ADT) for hormone-driven cancers.

Tamoxifen: VTE, endometrial cancer risk. AIs: arthralgia, bone loss. ADT: hot flashes, bone-density loss, fatigue — commonly combined with prostate RT.