Anticancer drugs: classification, mechanisms and high-yield side effects
Anticancer drugs are a massive topic, but they become much easier to manage once you group them by how they attack the cell cycle. It's essentially a tactical war against rapidly dividing cells!
To give you a clear visual of where these drugs strike during the cell cycle, let me find a helpful diagram for you.
That diagram perfectly shows which drugs are phase-specific (like the antimetabolites in the S-phase) and which are non-specific (like alkylating agents).

This diagram illustrates where different classes of chemotherapy act. Notice how Antimetabolites target the S-phase, while Vinca alkaloids and Taxanes target the M-phase.
To make this easier to study, I've put together a master table of the most important drugs you'll encounter in your exams.
| Class | Mechanism of Action | Key Drugs | High-Yield Side Effects |
|---|---|---|---|
| Alkylating Agents | Cross-link DNA (CCNS) | Cyclophosphamide | Hemorrhagic cystitis (prevent with Mesna) |
| Busulfan | Pulmonary fibrosis, "Busulfan Tan" (hyperpigmentation) | ||
| Antimetabolites | Inhibit DNA synthesis (S-phase) | Methotrexate | Myelosuppression (rescue with Leucovorin), Mucositis |
| 5-Fluorouracil | Hand-foot syndrome | ||
| Cytotoxic Antibiotics | Free radical formation / Intercalation | Doxorubicin | Dilated Cardiomyopathy (prevent with Dexrazoxane) |
| Bleomycin | Pulmonary fibrosis, Skin hyperpigmentation | ||
| Plant Alkaloids | Microtubule inhibition (M-phase) | Vincristine | Peripheral neuropathy (Areflexia), Paralytic ileus |
| Paclitaxel | Hypersensitivity, Myelosuppression | ||
| Platinum Analogs | DNA cross-linking | Cisplatin | Nephrotoxicity, Ototoxicity, Severe vomiting |
| Topoisomerase Inhibitors | DNA strand breaks | Etoposide | Myelosuppression |
| Irinotecan | Severe diarrhea ("I run to the can") |
That table covers the "big hitters" you'll see in almost every exam. One thing to really lock in is the "Rescue/Prevention" agents, as examiners love to pair them with the toxic drugs:
To help you dive deeper into each class, I've pulled up some detailed lessons for you.
๐ Anticancer Drug Lessons
Those lessons will give you the deep dive you need for each class. To really lock in these side effects and mechanisms, let's pull up some flashcards for active recall.
๐๏ธ Anticancer Flashcards
Tap to study flashcards in the Oncourse app
It looks like my first search for flashcards was a bit too specific. Let me try a broader search for "chemotherapy" and "oncology pharmacology" to find the best cards for you.
๐๏ธ Anticancer Flashcards (Retry)
Tap to study 26 flashcards in the Oncourse app
That broader search worked! Those flashcards will help you test your memory on the specific toxicities and mechanisms we discussed.
Since there are so many drugs to keep track of, would you like to try a quick game of Synapses? It's a great way to practice grouping these drugs by their class or side effects so you don't mix them up in the exam!
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