Alkylating agents: how do they work?

The National Cancer Institute defines an alkylating agent as a variety of drug used to treat cancer by interfering with the motion of a cell’s deoxyribonucleic acid (DNA) and inhibiting tumor growth. Let’s take a better have a look at the mechanism of motion

How do alkylating agents work?

Alkylating agents prevent cell division and replication by damaging DNA. They act in all phases of the cell cycle and attack DNA in two ways.

1. : the drug is introduced between two base pairs within the DNA chain, creating an irreversible bond between them. It causes cytotoxic effects that may destroy or poison cells.
2. : The drug reacts with just one strand of the pair, separating it from its partner and ultimately causing it and the sugar attached to it to interrupt away from the DNA molecule. It can ultimately cause everlasting cell damage.

Types and examples of alkylating agents (Colvin, 2003)

Alkylating drugs are prescribed to treat a wide range of cancers, including brain, lung, breast, ovarian, and testicular; leukemia; lymphoma; Hodgkin’s disease; melanoma; multiple myeloma; and sarcoma (American Cancer Society, 2019). The list below comprises categories and examples of alkylating agents, but will not be exhaustive.

• : bendamustine, chlorambucil, cyclophosphamide, ifosfamide, mechlorethamine, melphalan
• : altretamine, thiotepa
• : dianhydrogalacititol, dibromodulcitol
• : busulfan, hepsulfan
• : carmustine, lomustine, streptozocin
• : dacarbazine, temozolomide

Nursing Considerations (Colvin, 2003)

Alkylating agents may cause serious uncomfortable side effects, especially at higher doses.

• Hematopoietic toxicity: suppression of granulocytes and platelets, immunosuppression
• Gastrointestinal toxicity: mucositis, stomatitis, esophagitis, diarrhea, nausea and vomiting
• Cardiac toxicity: rapid onset of severe heart failure
• Lung damage: interstitial lung inflammation and fibrosis, non-productive cough, shortness of breath, tachypnea and cyanosis
• Hepatotoxicity: jaundice, ascites, liver failure
• Renal toxicity: increased serum creatinine, severe renal failure
• Bladder toxicity: hemorrhagic cystitis that will result in massive hemorrhage
• Gonad damage
• Neurotoxicity: seizures, drowsiness, changes in consciousness
• Carcinogenesis
• Alopecia, hair loss

Full details could be present in the leaflet that comes with the drugs or within the Nursing2022 Medicines Manual + medicines updates.

AND
American Cancer Society. (2019, November 22). How chemotherapy drugs work: alkylating agents. American Cancer Society.
https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/chemotherapy/how-chemotherapy-drugs-work.

AND
Colvin, M. (2003). Alkylating agents. Holland-Frei’s cancer cure. 6^vol Edition. Hamilton. https://www.ncbi.nlm.nih.gov/books/NBK12772/

AND
National Cancer Institute (n.d.). Definition of alkylating agent. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/alkilating-agent

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