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Types of Chemotherapy Drugs
Understanding the chemotherapy drugs you’re getting can help you feel more informed and prepared. Knowing the group that the chemo belongs to—and its exact name—can give you helpful context for why certain drugs are used, combined, or even substituted during treatment.
What are chemo groups?
Chemo drugs can be grouped by how they work, their chemical structure, and their relationships to other types of chemo. Some drugs work in more than one way and may belong to more than one group or class. These groupings help doctors choose drugs that:
- Target cancer in different ways
- Work well together
- Have manageable side effects
Ask your cancer care team to explain what kind of chemo you are getting, how it works, and, if you are getting more than 1 type, how they work together.
Your doctor may recommend substituting one chemo for another in the same class. This may happen if you’re having side effects or if there is a shortage of a certain drug.
Also, sometimes cancer cells develop resistance to a particular chemo causing it to stop working. If this happens, your doctor may recommend changing to another chemo. This may be a drug within the same class that works slightly differently,or it may be one from another class. Changing drugs can help kill cancer cells that no longer respond to the old drug and help prevent new resistance from happening.
Why exact drug names matter
Chemo medicines can have various names, including brand names and generic names. They may also be referred to by an abbreviation or as part of an acronym used for a specific chemo combination (regimen). This can be confusing, so ask your cancer care team to write down exactly what medications you’ll be getting.
Even when 2 types of chemo are in the same group or have similar names, they can act very differently in the body. Be sure you know the exact, full name of your chemo medicines when looking up side effects or other information.
How they work: Alkylating agents keep the cell from reproducing (making copies of itself) by damaging its DNA. These work in all phases of the cell cycle. While not true alkylating agents, platinum drugs (carboplatin, cisplatin, oxaliplatin) are often classified as alkylating agents because they also work by damaging cancer cell DNA, just in a different way.
Cancers treated: Alkylating agents are used to treat many different cancers, including cancers of the lung, breast, and ovary, as well as leukemia, lymphoma, Hodgkin disease, multiple myeloma, and sarcoma.
Side effects: Because these drugs damage DNA, they can affect the cells of the bone marrow, which make new blood cells. In rare cases, this can lead to myelodysplastic syndrome or acute leukemia. The risk of leukemia from alkylating agents is “dose-dependent,” meaning that the risk is small with lower doses, but goes up as the total amount of the chemo used gets higher. The risk of leukemia after getting alkylating agents is highest about 5 to 10 years after treatment.
Examples of alkylating agents include:
- Bendamustine
- Busulfan
- Carboplatin
- Chlorambucil
- Cisplatin
- Cyclophosphamide
- Dacarbazine
- Ifosfamide
- Mechlorethamine
- Melphalan
- Oxaliplatin
- Temozolomide
- Thiotepa
- Trabectedin
Nitrosoureas are a group of alkylating agents that are able to cross through the blood-brain barrier to reach cancer cells in the brain. Most other chemo types, including other alkylating agents, cannot cross the blood-brain barrier.
Cancers treated: These are useful in treating certain types of brain tumors.
Examples of nitrosoureas include:
- Carmustine
- Lomustine
- Streptozocin
How they work: Antimetabolites interfere with DNA and RNA by acting as a substitute for the normal building blocks of RNA and DNA. When this happens, the DNA cannot make copies of itself (replicate), and a cell cannot reproduce.
Cancers treated: Antimetabolites are commonly used to treat leukemias, cancers of the breast, ovary, and the intestinal tract, as well as other types of cancer.
Examples of antimetabolites include:
- Azacitidine
- 5-fluorouracil (5-FU)
- 6-mercaptopurine (6-MP)
- Capecitabine
- Cladribine
- Clofarabine
- Cytarabine
- Decitabine
- Floxuridine
- Fludarabine
- Gemcitabine
- Hydroxyurea
- Methotrexate
- Nelarabine
- Pemetrexed
- Pentostatin
- Pralatrexate
- Thioguanine
How they work: Anti-tumor antibiotics are not like the antibiotics used to treat infections. They work by changing the DNA inside cancer cells to keep them from growing and multiplying.
Anthracyclines
Anthracyclines are anti-tumor antibiotics that interfere with enzymes involved in copying DNA during the cell cycle. They bind with DNA so it cannot make copies of itself, and a cell cannot reproduce. (Enzymes are proteins that start, help, or speed up the rate of chemical reactions in cells.) They are widely used for a variety of cancers.
Examples of anthracyclines include:
- Daunorubicin
- Doxorubicin
- Doxorubicin liposomal
- Epirubicin
- Idarubicin
- Valrubicin
Side effects: A major concern when giving these drugs is that they can permanently damage the heart if given in high doses. For this reason, lifetime dose limits (also called cumulative dose) are often placed on these medicines.
Other anti-tumor antibiotics
Anti-tumor antibiotics that are not anthracyclines include:
- Bleomycin
- Dactinomycin
- Mitomycin-C
- Mitoxantrone (also acts as a topoisomerase II inhibitor, see below)
Topoisomerase inhibitors are also called plant alkaloids.
How they work: These interfere with enzymes called topoisomerases, which help separate the strands of DNA so they can be copied. (Enzymes are proteins that cause chemical reactions in living cells.)
Cancers treated: Topoisomerase inhibitors are used to treat certain leukemias, as well as lung, ovarian, gastrointestinal, colorectal, and pancreatic cancers.
Topoisomerase inhibitors are grouped according to which type of enzyme they affect:
Topoisomerase I inhibitors (also called camptothecins) include:
- Irinotecan
- Irinotecan liposomal
- Topotecan
Topoisomerase II inhibitors (also called epipodophyllotoxins) include:
- Etoposide
- Mitoxantrone (also acts as an anti-tumor antibiotic)
- Teniposide
Side effects: Topoisomerase II inhibitors can increase the risk of a second cancer.
Mitotic inhibitors are another type of plant alkaloid. They include taxanes and vinca alkaloids. They are compounds derived from natural products, such as plants.
How they work: These work by stopping cells from dividing to form new cells. They can damage cells in all phases by keeping enzymes from making proteins needed for cell reproduction.
Cancers treated: Mitotic inhibitors are used to treat many different types of cancer including breast, lung, myelomas, lymphomas, and leukemias.
Side effects: These may cause nerve damage, which can limit the amount that can be given.
Examples of mitotic inhibitors include the taxanes and vinca alkaloids.
Taxanes include:
- Cabazitaxel
- Docetaxel
- Nab-paclitaxel
- Paclitaxel
Vinca alkaloids include:
- Vinblastine
- Vincristine
- Vincristine liposomal
- Vinorelbine
Corticosteroids, often simply called steroids, are natural hormones and hormone-like medicines that are useful in the treatment of many types of cancer, as well as other illnesses. When used as part of cancer treatment, they are considered chemo.
Examples of corticosteroids include:
- Prednisone
- Methylprednisolone
- Dexamethasone
Steroids are also commonly used to help prevent nausea and vomiting caused by chemo. They are used before some types of chemo to help prevent severe allergic reactions, too.
Some chemo drugs act in slightly different ways and do not fit well into any of the other categories. Here are some examples:
- All-trans-retinoic acid
- Arsenic trioxide
- Asparaginase
- Eribulin
- Hydroxyurea
- Ixabepilone
- Mitotane
- Omacetaxine
- Pegaspargase
- Procarbazine
- Romidepsin
- Vorinostat
- Written by
- References
Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).
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Last Revised: May 15, 2025
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