Introduction Mechanism induces apoptosis may target specific proteins over-expressed in cancer cells e.g. tyrosine kinase inhibitors imatinib (Gleevec) for chronic myelogenous leukemia gefitinib (EGFR inhibitor, Iressa) for lung, breast cancer erlotinib (EGFR inhibitor, Tarceva) for NSCLC and pancreatic cancer eliminates micrometastasis in lungs >98% necrosis with chemotherapy is good prognostic sign Resistance expression of multi-drug resistance (MDR) gene portends very poor prognosis cells can pump chemotherapy out of cell present in 25% of primary lesions and 50% of metastatic lesions Indications Integral component of treatment along with surgical resection in osteosarcoma (intramedullary and periosteal) Ewing's sarcoma/primative neuroectodermal tumor malignant fibrous histiocytoma dedifferentiated chondrosarcoma chemotherapy for soft tissue sarcoma is controversial Administration Preoperative chemotherapy given for 8-12 weeks Maintenance chemotherapy for 6-12 months Specific Agents & Antidotes Doxorubicin (Adriamycin) mechanism doxorubicin is an anthracycline antibiotic commonly used in oncological protocols functions as a cytostatic agent side effects cardiac toxicity leads to congestive heart failure dexrazoxane used to mitigate toxicity Agents and Antidotes mechlorethamine/cisplatin - give sodium thiosulfate doxorubicin/epirubicin - give dexrazoxane vinca alkaloids (vincristine/vinblastine) - give hot compress and hyaluronidase give cold compress for all other vesicants