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Cancer Chemotherapy

Description

step 1 Pharmacology Mind Map on Cancer Chemotherapy, created by Jeff Amos on 26/08/2014.
Jeff Amos
Mind Map by Jeff Amos, updated more than 1 year ago
Jeff Amos
Created by Jeff Amos over 9 years ago
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Resource summary

Cancer Chemotherapy
  1. Principles
    1. indicated for cancers that are not amenable to surgery or radiation therapy
      1. supplemental treatment to prevent metastasis following surgery or radiation
        1. Log Kill Hypothesis
          1. first order kinetics
            1. kills constant fraction of cancer cells
            2. Mechanisms
              1. Interfere with cell proliferation or promote apoptosis
                1. Inhibit DNA synthesis or alter DNA structure
                  1. Cell-Cycle Specific or Cell-Cycle Nonspecific
                  2. Combination Therapy
                    1. Principles of Drug Selection
                      1. individual anticancer activities
                        1. different mechanisms of action
                          1. different toxicities
                          2. Advantages
                            1. provide maximal killing with lower toxicity
                              1. Effective against heterogeneous cell populations
                                1. Reduces chance of resistance clones
                                2. Examples
                                  1. ABVD
                                    1. CHOP
                                      1. MOPP
                                        1. CMF
                                          1. FEC
                                        2. Limitations
                                          1. Drug Resistance
                                            1. Toxicities
                                          2. Alkylating Agents
                                            1. cell cycle non-specific
                                              1. Mechanism of Action
                                                1. produce strong electrophiles through the formation of carbonium or ethyleneiomonium ion intermediates
                                                  1. forms covalent linkage by alkylaation of nucleophilic moieties present in DNA
                                                  2. Binds to **N7 of guanine, N1 + N3 A, N3 C, O6 G
                                                  3. Resistance
                                                    1. decreased permeability
                                                      1. increased rates of metabolism
                                                        1. enhanced DNA repair
                                                          1. Increased production of glutathione
                                                            1. inactivates alkylating agents
                                                          2. Nitrogen Mustards
                                                            1. Mechlorethamine
                                                              1. Therapeutics
                                                                1. Hodgkin's Lymphoma (MOPP)
                                                                  1. cutaneous T-cell Lymphoma
                                                                  2. Toxicity
                                                                    1. nausea and vomiting
                                                                      1. myelosuppression
                                                                    2. Cyclophosphamide and Ifosfamide
                                                                      1. Therapeutics
                                                                        1. C: ALL, CLL, non-Hodgkin's, breast, lung, ovarian
                                                                          1. I: sarcoma and testicular
                                                                          2. Toxicity
                                                                            1. Nausea, vomiting, myelosuppression
                                                                              1. Hemorrhagic Cystitis
                                                                                1. acrolein in urine
                                                                                  1. treat with hydration and MESNA
                                                                            2. Nitrosoureas
                                                                              1. Carmustine and Lomustine
                                                                                1. lipophilic
                                                                                  1. cross the blood-brain barrier
                                                                                  2. Toxicity
                                                                                    1. Nausea, vomiting, myelosuppression
                                                                                      1. Renal Toxicity
                                                                                        1. Pulmonary Fibrosis
                                                                                    2. Triazenes
                                                                                      1. Dacarbazine and Temozolomide
                                                                                        1. Therapeutic Uses
                                                                                          1. D: ABVD, Hodgkin's Disease, malignant Melanoma
                                                                                            1. T: malignant gliomas, combo with radiation therapy
                                                                                            2. Toxicity
                                                                                              1. Nausea, vomiting, myelosuppression
                                                                                                1. Flu-like symptoms (fever, fatigue)
                                                                                            3. Platinum Analogs
                                                                                              1. Cisplatin, Carboplatin, Oxaliplatin
                                                                                                1. No carbonium ion intermediates
                                                                                                  1. covalently bind to nucleophilic sites
                                                                                                  2. Therapeutics
                                                                                                    1. Cis: testicular, ovarian, cervical, bladder, head and neck, lung, combos
                                                                                                      1. Carb: ovarian
                                                                                                        1. Ox: gastric and colorectal (with 5-FU)
                                                                                                        2. Toxicity
                                                                                                          1. Cis: renal toxicity, ototoxicity, peripheral neuropathy
                                                                                                            1. Carb: myelosuppression
                                                                                                              1. Ox: peripheral sensory neuropathy (cold induced acute peripheral neuropathy), neutropenia
                                                                                                        3. Antimetabolities
                                                                                                          1. Mechanism
                                                                                                            1. structural analogs of endogenous metabolites
                                                                                                              1. replace and compete with nucleotides
                                                                                                              2. Cell-Cycle specific Drugs
                                                                                                                1. Folate Analogs
                                                                                                                  1. Methotrexate
                                                                                                                    1. folic acid anatagonist
                                                                                                                      1. inhibits dihydrofolate reductase
                                                                                                                        1. Required for thymidine and purine biosynthesis
                                                                                                                      2. Therapeutics
                                                                                                                        1. ALL
                                                                                                                          1. Burkitt's Lymphoma
                                                                                                                            1. Breast, ovary, head and neck, bladder
                                                                                                                              1. Cannot penetrate the CNS
                                                                                                                                1. Osteosarcoma
                                                                                                                                2. Toxicity
                                                                                                                                  1. Myelosuppression and spontaneous hemorrhage
                                                                                                                                    1. oral ulceration and stomatitis
                                                                                                                                      1. Renal toxicity through crystallization
                                                                                                                                        1. Hepatotoxicity
                                                                                                                                          1. Defective oogenesis or spermatogenesis
                                                                                                                                          2. Mechanism of resistance
                                                                                                                                            1. reduced drug uptake
                                                                                                                                              1. Decreased affinity of DHFR
                                                                                                                                                1. Increased production of DHFR
                                                                                                                                              2. Pemetrexed
                                                                                                                                                1. Targets DHFR and thymidylate synthase
                                                                                                                                                  1. Used for colon, pancreatic, mesothelioma and non-small cell lung
                                                                                                                                                2. Pyrimidine Analogs
                                                                                                                                                  1. 5-Fluorouracil
                                                                                                                                                    1. pro-drug conversion to 5-FdUMP and 5-FdUTP
                                                                                                                                                      1. inhibits thymidylate synthetase (blocks synthesis of thymidine)
                                                                                                                                                        1. incorporates into RNA, interferes with function
                                                                                                                                                        2. Therapeutics
                                                                                                                                                          1. breast, colorectal, gastric, head and neck, cervical and pancreatic cancer
                                                                                                                                                            1. Topical to treat basal cell carcinomas
                                                                                                                                                              1. Capecitabine
                                                                                                                                                                1. metastatic breast and colorectal cancer
                                                                                                                                                                  1. 5'-dFdU
                                                                                                                                                                2. Toxicity
                                                                                                                                                                  1. Gastric toxicity (why it is IV)
                                                                                                                                                                    1. anorexia and nausea, myelosuppression
                                                                                                                                                                      1. Hand-Foot Syndrome
                                                                                                                                                                        1. Cardiac Toxicity
                                                                                                                                                                      2. Cytarabine
                                                                                                                                                                        1. analog of 2'-deoxycytidine
                                                                                                                                                                          1. converted to Ara-CMP, then Ara-CTP
                                                                                                                                                                            1. Competes with dCTP
                                                                                                                                                                          2. Therapeutics
                                                                                                                                                                            1. AML
                                                                                                                                                                              1. ALL and CLL
                                                                                                                                                                              2. Toxicity
                                                                                                                                                                                1. myelosuppression and GI tract toxicity
                                                                                                                                                                                2. S-phase specific
                                                                                                                                                                                3. Gemcitabine
                                                                                                                                                                                  1. analog of deoxycytidine
                                                                                                                                                                                    1. altered to dFdCMP then dFdCDP or dFdCTP
                                                                                                                                                                                      1. inhibits DNA sythesis
                                                                                                                                                                                        1. dFdCDP inhibits ribonucleotide reductase
                                                                                                                                                                                          1. dFdCTP causes DNA synthesis termination
                                                                                                                                                                                      2. cell cycle nonspecific
                                                                                                                                                                                        1. Therapeutics
                                                                                                                                                                                          1. pancreatic cancer
                                                                                                                                                                                            1. non-small cell lung cancer, ovarian, bladder, esophageal, head and neck
                                                                                                                                                                                            2. Toxicities
                                                                                                                                                                                              1. Myelosuppression
                                                                                                                                                                                                1. Flu like symptoms
                                                                                                                                                                                            3. Purine Analogs
                                                                                                                                                                                              1. 6-Mercaptopurine
                                                                                                                                                                                                1. reduces purine levels, inhibiting DNA and RNA synthesis
                                                                                                                                                                                                  1. metabolized by HGPRT to TIMP
                                                                                                                                                                                                    1. blocks first step in purine synthesis
                                                                                                                                                                                                      1. blocks AMP and xanthinylic acid from inosinic acid
                                                                                                                                                                                                        1. converted to thio-guanine ribonucleotides
                                                                                                                                                                                                          1. inhibit DNA and RNA synthesis
                                                                                                                                                                                                        2. Therapeutics
                                                                                                                                                                                                          1. ALL
                                                                                                                                                                                                          2. Toxicities
                                                                                                                                                                                                            1. bone marrow suppression
                                                                                                                                                                                                              1. hepatotoxicity from prolonged use
                                                                                                                                                                                                                1. Allopurinol use
                                                                                                                                                                                                                  1. blocks xanthine oxidase
                                                                                                                                                                                                                    1. causes elevated levels of mercaptopurine
                                                                                                                                                                                                                2. Mechanism of Resistance
                                                                                                                                                                                                                  1. reduced conversion of 6-MP to active nucleotide (decreased expression of HGRPT)
                                                                                                                                                                                                                    1. decreased drug transport
                                                                                                                                                                                                              2. DNA Intercalating Agents
                                                                                                                                                                                                                1. AKA anti-tumor antibiotics
                                                                                                                                                                                                                  1. from Streptomyces
                                                                                                                                                                                                                  2. DNA through intercalation
                                                                                                                                                                                                                    1. block DNA and RNA synthesis
                                                                                                                                                                                                                      1. causes DNA strand breaks
                                                                                                                                                                                                                      2. Dactinomycin
                                                                                                                                                                                                                        1. Mechanism
                                                                                                                                                                                                                          1. intercalates between G-C forming dactinomycin-DNA complex
                                                                                                                                                                                                                            1. interferes with DNA-dependent RNA polymerase
                                                                                                                                                                                                                              1. single strand breaks
                                                                                                                                                                                                                            2. Therapeutics
                                                                                                                                                                                                                              1. pediatric tumors: Wilm's tumor, rhabdomyosarcoma, Ewing's sarcoma
                                                                                                                                                                                                                              2. Toxcitiy
                                                                                                                                                                                                                                1. Severe hematopoietic suppression with pancytopenia
                                                                                                                                                                                                                                  1. GI symptoms
                                                                                                                                                                                                                                2. Anthracyclins
                                                                                                                                                                                                                                  1. reduce intermediates that donate electrons, forming superoxide
                                                                                                                                                                                                                                    1. forms destructive hydroxyl radical that cleaves DNA
                                                                                                                                                                                                                                    2. Toxicity
                                                                                                                                                                                                                                      1. irreversible dose-limiting cardiotoxicity (cardiomyopathy)
                                                                                                                                                                                                                                        1. Myelosuppression and GI symptoms
                                                                                                                                                                                                                                        2. Therapeutics
                                                                                                                                                                                                                                          1. Daunorubicin and Idarubicin
                                                                                                                                                                                                                                            1. AML
                                                                                                                                                                                                                                            2. Doxorubicin
                                                                                                                                                                                                                                              1. sarcomas, breast and lung, malignant lymphomas
                                                                                                                                                                                                                                              2. Epirubicin
                                                                                                                                                                                                                                                1. metastatic breast cancer and gastric cancer
                                                                                                                                                                                                                                            3. Bleomycin
                                                                                                                                                                                                                                              1. Mechanism
                                                                                                                                                                                                                                                1. contains 2 copper chelating peptides
                                                                                                                                                                                                                                                  1. forms free radicals
                                                                                                                                                                                                                                                    1. causes single and double strand breaks
                                                                                                                                                                                                                                                  2. Acts during G2
                                                                                                                                                                                                                                                  3. Therapeutics
                                                                                                                                                                                                                                                    1. testicular tumors (with vinblastine or etoposide)
                                                                                                                                                                                                                                                      1. squamous cell carcinomas and lymphomas
                                                                                                                                                                                                                                                      2. Toxicity
                                                                                                                                                                                                                                                        1. minimally myelo- and immunosuppressive
                                                                                                                                                                                                                                                          1. used in combination with other drugs
                                                                                                                                                                                                                                                          2. Pulmonary Toxicity
                                                                                                                                                                                                                                                            1. Cutaneous toxicity
                                                                                                                                                                                                                                                              1. Hyperthermia, headache, nausea, vomiting
                                                                                                                                                                                                                                                          3. Microtubule Inhibitors
                                                                                                                                                                                                                                                            1. block assembly and disassembly of MTs
                                                                                                                                                                                                                                                              1. functions in metaphase
                                                                                                                                                                                                                                                                1. Vinca Alkaloids
                                                                                                                                                                                                                                                                  1. Vinblastine and Vincrstine
                                                                                                                                                                                                                                                                    1. Mechanism
                                                                                                                                                                                                                                                                      1. bind to tubulin and block ability to polymerize
                                                                                                                                                                                                                                                                      2. Therapeutics
                                                                                                                                                                                                                                                                        1. Vinblastine
                                                                                                                                                                                                                                                                          1. with Bleomycin and cisplatin for metastatic testicular cancers
                                                                                                                                                                                                                                                                            1. Part of ABVD (adriamycin [doxorubicin], bleomycin, vinblastine and dacarbazine)
                                                                                                                                                                                                                                                                              1. Hodgkin's Lymphoma
                                                                                                                                                                                                                                                                            2. Vincristine
                                                                                                                                                                                                                                                                              1. with glucocorticoids for childhood ALL
                                                                                                                                                                                                                                                                                1. Hodgkin's and non-Hodgkin's Lymphoma (MOPP)
                                                                                                                                                                                                                                                                              2. Toxicity
                                                                                                                                                                                                                                                                                1. Vinblastine
                                                                                                                                                                                                                                                                                  1. myelosuppresion, GI
                                                                                                                                                                                                                                                                                  2. Vincristine
                                                                                                                                                                                                                                                                                    1. Dose-limiting neurotoxicity (peripheral neuropathy)
                                                                                                                                                                                                                                                                                      1. low toxicity in the bone
                                                                                                                                                                                                                                                                                2. Taxanes
                                                                                                                                                                                                                                                                                  1. Mechanism
                                                                                                                                                                                                                                                                                    1. promote polymerization and stabilize MTs
                                                                                                                                                                                                                                                                                      1. prevent breakdown
                                                                                                                                                                                                                                                                                    2. Therapeutics
                                                                                                                                                                                                                                                                                      1. Paclitaxel and Docetaxel
                                                                                                                                                                                                                                                                                        1. metastatic breast, ovarian, lung, head and neck.
                                                                                                                                                                                                                                                                                        2. Docetaxel
                                                                                                                                                                                                                                                                                          1. hormone-refractory prostate cancer
                                                                                                                                                                                                                                                                                        3. Toxicity
                                                                                                                                                                                                                                                                                          1. Neutropenia, peripheral neuropathy, hypersensitivity
                                                                                                                                                                                                                                                                                      2. Topoisomerase Inhibitors
                                                                                                                                                                                                                                                                                        1. Topoisomerase mediate DNA strand breakage and resealing
                                                                                                                                                                                                                                                                                          1. Topo I breaks and seals single stranded
                                                                                                                                                                                                                                                                                            1. Topo II breaks and seals double stranded DNA
                                                                                                                                                                                                                                                                                            2. Epipodophyllotoxins
                                                                                                                                                                                                                                                                                              1. Etoposide and Teniposide
                                                                                                                                                                                                                                                                                                1. Mechanism
                                                                                                                                                                                                                                                                                                  1. inhibit Topo II, causing DNA damage
                                                                                                                                                                                                                                                                                                  2. semisynthetics of podophyllotoxin
                                                                                                                                                                                                                                                                                                    1. Therapeutics
                                                                                                                                                                                                                                                                                                      1. Etoposide
                                                                                                                                                                                                                                                                                                        1. testicular carcinoma, lung cancer, non-Hodgkin's Lymphoma
                                                                                                                                                                                                                                                                                                        2. Teniposide
                                                                                                                                                                                                                                                                                                          1. ALL
                                                                                                                                                                                                                                                                                                        3. Toxicity
                                                                                                                                                                                                                                                                                                          1. dose-limiting myelosuppression (neutropenia)
                                                                                                                                                                                                                                                                                                            1. Oral Mucositis
                                                                                                                                                                                                                                                                                                        4. Camptothecin Analogs
                                                                                                                                                                                                                                                                                                          1. Mechanism
                                                                                                                                                                                                                                                                                                            1. inhibit Topo I
                                                                                                                                                                                                                                                                                                            2. Therapeutics
                                                                                                                                                                                                                                                                                                              1. Irinotecan
                                                                                                                                                                                                                                                                                                                1. advanced colon cancer
                                                                                                                                                                                                                                                                                                                  1. lung, ovarian, cervical, brain tumors
                                                                                                                                                                                                                                                                                                                  2. Topotecan
                                                                                                                                                                                                                                                                                                                    1. ovarian and small cell lung cancer
                                                                                                                                                                                                                                                                                                                  3. Toxicity
                                                                                                                                                                                                                                                                                                                    1. severe neutropenia and severe diarrhea
                                                                                                                                                                                                                                                                                                                2. Hormones and Antagoists
                                                                                                                                                                                                                                                                                                                  1. used for hormone dependent neoplasms
                                                                                                                                                                                                                                                                                                                    1. breast and prostate cancer
                                                                                                                                                                                                                                                                                                                    2. glucocorticoids
                                                                                                                                                                                                                                                                                                                      1. treat lymphocytic leukemias and lymphomas
                                                                                                                                                                                                                                                                                                                        1. Mechanism
                                                                                                                                                                                                                                                                                                                          1. inhibit mitosis in lymphocytes
                                                                                                                                                                                                                                                                                                                          2. no immunosuppression and well tolerated
                                                                                                                                                                                                                                                                                                                            1. Therapeutics
                                                                                                                                                                                                                                                                                                                              1. Prednisone
                                                                                                                                                                                                                                                                                                                                1. ALL
                                                                                                                                                                                                                                                                                                                                  1. part of MOPP and CHOP for Hodgkin's and non-Hodgkin's, multiple myeloma and CLL
                                                                                                                                                                                                                                                                                                                                  2. Dexamethasone
                                                                                                                                                                                                                                                                                                                                    1. Dexamethasone
                                                                                                                                                                                                                                                                                                                                      1. in conjuction with radiation therapy
                                                                                                                                                                                                                                                                                                                                        1. reduces edema to brain and spinal cord tumors
                                                                                                                                                                                                                                                                                                                                  3. Estrogen antagonists
                                                                                                                                                                                                                                                                                                                                    1. breast cancer
                                                                                                                                                                                                                                                                                                                                    2. Androgen antagonists
                                                                                                                                                                                                                                                                                                                                      1. prostate cancer
                                                                                                                                                                                                                                                                                                                                      2. Selective Estrogen-Receptor Modulators
                                                                                                                                                                                                                                                                                                                                        1. Tamoxifen
                                                                                                                                                                                                                                                                                                                                          1. competes with estradiol for ER binding
                                                                                                                                                                                                                                                                                                                                            1. Therapeutics
                                                                                                                                                                                                                                                                                                                                              1. ER-positive metastatic breast cancer or adjuvant therapy following primary breast tumor excision
                                                                                                                                                                                                                                                                                                                                                1. prevention of breast cancer in high-risk patients
                                                                                                                                                                                                                                                                                                                                                2. Toxicity
                                                                                                                                                                                                                                                                                                                                                  1. hot flushes, hair loss, nausea, vomiting
                                                                                                                                                                                                                                                                                                                                                    1. increase risk of endometrial cancer and thromboembolic events
                                                                                                                                                                                                                                                                                                                                                3. Selective Estrogen-Receptor Downregulators
                                                                                                                                                                                                                                                                                                                                                  1. Fulvestrant
                                                                                                                                                                                                                                                                                                                                                    1. Mechanism
                                                                                                                                                                                                                                                                                                                                                      1. binds to ER, preventing dimerization
                                                                                                                                                                                                                                                                                                                                                        1. Reduces number of ER molecules
                                                                                                                                                                                                                                                                                                                                                        2. Therapeutics
                                                                                                                                                                                                                                                                                                                                                          1. postmenopausal women with ER-positive metastatic breast cancer
                                                                                                                                                                                                                                                                                                                                                      2. Aromatase Inhibitors
                                                                                                                                                                                                                                                                                                                                                        1. inhibit aromatase enzyme, causing estrogen decrease
                                                                                                                                                                                                                                                                                                                                                          1. Aminoglutethamide
                                                                                                                                                                                                                                                                                                                                                            1. weak inhibitor
                                                                                                                                                                                                                                                                                                                                                              1. significant toxicity
                                                                                                                                                                                                                                                                                                                                                              2. Anastrozole
                                                                                                                                                                                                                                                                                                                                                                1. potent and selective inhibitor
                                                                                                                                                                                                                                                                                                                                                                  1. ER-positive breast cancer in postmenopausal women
                                                                                                                                                                                                                                                                                                                                                                2. Prostate Cancer Treatments
                                                                                                                                                                                                                                                                                                                                                                  1. Leuprolide (Lupron) and Goserelin (Zoladex)
                                                                                                                                                                                                                                                                                                                                                                    1. GnRH analogs
                                                                                                                                                                                                                                                                                                                                                                      1. inhibit release of LH and FSH
                                                                                                                                                                                                                                                                                                                                                                        1. Decreased Testosterone Production
                                                                                                                                                                                                                                                                                                                                                                    2. Complete androgen ablation therapy involves combination of GnRH analogs and AR blockers
                                                                                                                                                                                                                                                                                                                                                                      1. Flutamide and Bicalutamide
                                                                                                                                                                                                                                                                                                                                                                        1. nonsteroidal androgen-receptor blockers
                                                                                                                                                                                                                                                                                                                                                                          1. compete for androgen receptor and prevent its translocation to nucleus
                                                                                                                                                                                                                                                                                                                                                                    3. Miscellaneous Agents
                                                                                                                                                                                                                                                                                                                                                                      1. Hydroxyurea
                                                                                                                                                                                                                                                                                                                                                                        1. inhibits ribonucleside diphosphate reductase
                                                                                                                                                                                                                                                                                                                                                                          1. converts ribonucleosides to deoxyribonucleosides
                                                                                                                                                                                                                                                                                                                                                                          2. Therapeutics
                                                                                                                                                                                                                                                                                                                                                                            1. myeloproliferative neoplasms, polycythemia vera and essential thrombocythemia
                                                                                                                                                                                                                                                                                                                                                                          3. Retinoids
                                                                                                                                                                                                                                                                                                                                                                            1. treats acute promyelocytic leukemia
                                                                                                                                                                                                                                                                                                                                                                              1. induces differentiation in leukemic promyelocytes
                                                                                                                                                                                                                                                                                                                                                                              2. Arsenic Trioxide
                                                                                                                                                                                                                                                                                                                                                                                1. treats relapsed APL
                                                                                                                                                                                                                                                                                                                                                                                2. Thalidomide
                                                                                                                                                                                                                                                                                                                                                                                  1. treats multiple myeloma and myelodysplastic syndromes
                                                                                                                                                                                                                                                                                                                                                                                  2. Interferons
                                                                                                                                                                                                                                                                                                                                                                                    1. IF alpha for hairy cell leukemia, CML, AIDS relate Kaposi's sarcoma
                                                                                                                                                                                                                                                                                                                                                                                    2. Tyrosine Kinase Inhibitors
                                                                                                                                                                                                                                                                                                                                                                                      1. Imatinib
                                                                                                                                                                                                                                                                                                                                                                                        1. inhibits Abl kinase, PDGFR and c-kit
                                                                                                                                                                                                                                                                                                                                                                                          1. treats CML and GI tumor
                                                                                                                                                                                                                                                                                                                                                                                          2. Gefitinib and Erlotinib
                                                                                                                                                                                                                                                                                                                                                                                            1. inhibit EGFR tyrosine kinase
                                                                                                                                                                                                                                                                                                                                                                                              1. treats non-small cell lung cancer
                                                                                                                                                                                                                                                                                                                                                                                            2. Monoclonal Antibodies
                                                                                                                                                                                                                                                                                                                                                                                              1. Rituximab
                                                                                                                                                                                                                                                                                                                                                                                                1. targets CD20 B-cell antigen
                                                                                                                                                                                                                                                                                                                                                                                                  1. Treats non-Hodgkin's Lymphoma
                                                                                                                                                                                                                                                                                                                                                                                                  2. Trastuzumab
                                                                                                                                                                                                                                                                                                                                                                                                    1. antibody against HER2/neu
                                                                                                                                                                                                                                                                                                                                                                                                      1. treats HER2/neu-overexpressing breast cancer
                                                                                                                                                                                                                                                                                                                                                                                                      2. Cetuximab
                                                                                                                                                                                                                                                                                                                                                                                                        1. antibody against EGFR1 (ErbB1
                                                                                                                                                                                                                                                                                                                                                                                                          1. approved for EGFR-positive colorectal cancer
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