Chemotherapy is one of the most common and widely discussed treatments for cancer. This involves sending drugs through our bloodstream to kill cancer cells and stop them from growing. But did you know that there are different types of chemotherapy drugs that work differently? Antimetabolites are one such special class of drugs. Although the name may sound complicated, the way they work is amazing. Today we are going to talk about these antimetabolites.
How do these antimetabolites kill cancer cells?
Simply put, what this drug does is trick the cancer cells, like giving them a fake key that looks the same as the real one.
To understand this, let's first look at how a cancer cell makes (divides) more cells. Like every cell in our body, cancer cells have something called DNA. Think of this as the cell's "instruction book" or "blueprint." This plan is what the cell does, and how it makes more copies of itself.
To build this DNA blueprint properly, the cell needs some essential basic ingredients. Just like building a house requires bricks and cement. We call these ingredients metabolites. These are mainly:
- Purines: These are essential building blocks of DNA and RNA.
- Pyrimidines: These are essential building blocks of DNA and RNA.
- Folic acid: This is a type of vitamin that provides energy for the process of cell division.
Now, here's what an antimetabolite drug does. This drug molecule is made very similar to the real ingredients (metabolites) mentioned above. So, when the cancer cell is trying to make its DNA, it uses this fake ingredient, the drug, thinking it's the real ingredient.
Imagine you are cooking rice. You think it is salt and you add some sugar that you see. What happens then? The taste and texture of the whole rice is messed up, right? Similarly, when a cancer cell uses this fake ingredient, its DNA blueprint is completely wrong. With the wrong blueprint, the cell cannot make more copies. Eventually, the cancer cell cannot divide again and dies.
What are the main types of antimetabolites?
Remember the three essential ingredients we talked about earlier? These drugs are divided into three main types, depending on which of those three components they target.
- Purine antagonists: These stop cancer cells from making purines.
- Pyrimidine antagonists: These stop cancer cells from making pyrimidines.
- Folic acid antagonists (antifolates): These prevent cancer cells from using folic acid to make DNA.
What types of cancer is this medicine used for?
Antimetabolite drugs are used to treat many types of cancer. Your doctor will decide which drug is best for you based on the type of cancer you have, its stage, and how you have responded to previous treatments. Some drugs are also used to treat other conditions (such as autoimmune diseases) in addition to cancer.
The table below lists some of the most commonly used antimetabolite drugs and the types of cancer they treat.
| Drug Name | Types of Cancers Treated |
|---|---|
| Fluorouracil (5-FU) | Breast, colon, stomach, pancreatic, and skin cancers |
| Capecitabine (Xeloda®) | Breast, colon, stomach, esophagus, and pancreatic cancer |
| Gemcitabine (Gemzar®) | Breast, lung (non-small cell), ovarian and pancreatic cancer |
| Methotrexate | Leukemia, lymphoma, breast, lung, head and neck cancer, bone cancer (osteosarcoma) |
| Cytarabine | Different types of leukemia (Acute myeloid, ALL, CML) |
| Hydroxyurea | Leukemia (CML), head and neck cancer |
How is this medicine administered to the body?
There are several ways to administer these medications, depending on the type of medication being administered.
- Intravenously (IV): This is the most common method. The medicine is given into the body as a saline solution through a cannula or chemo port placed in the arm or chest. This treatment may last for a few minutes, a few hours, or even a few days.
- As an injection: Some medications are also given as an injection into the fatty layer under the skin.
- Tablet form: Some antimetabolites are also available as tablets that can be swallowed.
- As a topical cream: The drug 5-FU, which is used to treat skin cancer (basal cell carcinoma), is also available as a topical cream.
What are the possible side effects of the treatment?
A common feature of chemotherapy drugs is that they target rapidly dividing cells. Cancer cells are a type of cell that divides very quickly. But the problem is, some healthy cells in our body also divide rapidly. For example:
- Hair follicle cells
- Cells in the mouth and digestive tract
- Skin cells
- Blood-forming cells
Antimetabolites drugs cannot distinguish between cancer cells and healthy cells. Therefore, these healthy cells can also be damaged. That is why side effects occur.
The most common side effects are:
- Tiredness and fatigue
- Hair loss
- Skin changes (e.g. rash )
- Nausea and vomiting
- Diarrhea (stomach ache)
- Appetite
But these side effects don't happen to everyone the same way. It depends on the medication you're given, the dosage, etc. So it's very important to talk to your doctor about this before starting treatment. There are now many medications to control the side effects.
What are the benefits and risks of this treatment?
Advantages:
The main benefit of antimetabolites is that they kill cancer cells and stop tumor growth. This can extend the life of someone living with cancer and make life easier by controlling symptoms.
Risks:
The main risk is the side effects we discussed earlier. Also, not all cancer treatments work the same for everyone. A particular drug may not work for your cancer. Over time, the cancer cells may become resistant to the drug, and the drug may become less effective. If this happens, your doctor may recommend a different chemotherapy drug or another treatment (e.g., radiation, immunotherapy).
If you are pregnant, breastfeeding, or have any other medical condition, be sure to inform your doctor before starting this treatment.
Take-Home Message
- Antimetabolites are a special type of chemotherapy drug that "tricks" cancer cells into stopping them from dividing.
- These drugs work by preventing cancer cells from getting the raw materials they need to make their DNA (genetic blueprint).
- These are used to treat many different types of cancer, such as breast, lung, and leukemia.
- Side effects such as hair loss and nausea can occur because this medication also affects healthy cells that divide rapidly.
- Learning about a treatment can be a little scary. But never be afraid to ask your doctor about the medication you're being given, its pros, cons, and side effects. Being well-informed is an important part of treatment.
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