{"entity":{"id":"alkylating-agent","kind":"term","name":"Alkylating agents and antimetabolites","aka":["alkylating","alkylator","alkylators","alkylating agent","alkylating agents","alkylating chemotherapy","antimetabolite","antimetabolites","fluoropyrimidine","fluoropyrimidines","nucleoside analogue","purine analogue","vinca alkaloid","vinca alkaloids","vinca","5-FU","purine analogues"],"tldr":"The two oldest chemotherapy families: alkylators (cyclophosphamide, temozolomide, melphalan) glue DNA strands together so cells cannot copy them; antimetabolites (5-FU, capecitabine, methotrexate, gemcitabine) are fake building blocks that jam DNA synthesis.","summary":"Alkylating agents descend from mustard gas (nitrogen mustard, 1946): cyclophosphamide anchors lymphoma and breast regimens and lymphodepletion, temozolomide treats glioblastoma, melphalan and busulfan are transplant conditioning, and platinum drugs act similarly. Antimetabolites include fluoropyrimidines (5-FU, capecitabine, S-1) in gastrointestinal and breast cancer, methotrexate and cytarabine in leukaemia, gemcitabine in pancreatic and bladder cancer and pemetrexed in non-squamous lung cancer. Alkylators are mutagenic and cause secondary leukaemia and infertility; antimetabolite toxicity depends on enzymes such as DPD (5-FU) and can be reduced by pre-treatment genotyping.","asOf":"2026-09-09","wikipedia":"https://en.wikipedia.org/wiki/Alkylating_antineoplastic_agent","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Alkylating_antineoplastic_agent"}],"tags":[],"related":["secondary-malignancy","conditioning-regimen","lymphodepletion","folfox-family"],"cancers":[],"sections":["chemotherapy"],"technologies":["cytotoxic-chemotherapy"],"targets":[],"drugs":["cyclophosphamide","fluorouracil","methotrexate","gemcitabine","temozolomide","melphalan"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"category":"Treatment jargon"},"route":"/terms/alkylating-agent/","neighbours":{"term":[{"id":"conditioning-regimen","kind":"term","name":"Conditioning regimen (myeloablative, reduced-intensity)","route":"/terms/conditioning-regimen/"},{"id":"folfox-family","kind":"term","name":"FOLFOX, FOLFIRI, FOLFIRINOX and CAPOX","route":"/terms/folfox-family/"},{"id":"lymphodepletion","kind":"term","name":"Lymphodepletion before CAR-T","route":"/terms/lymphodepletion/"},{"id":"secondary-malignancy","kind":"term","name":"Secondary malignancy (therapy-related cancer)","route":"/terms/secondary-malignancy/"}],"section":[{"id":"chemotherapy","kind":"section","name":"Chemotherapy","route":"/fronts/chemotherapy/"}],"technology":[{"id":"cytotoxic-chemotherapy","kind":"technology","name":"Cytotoxic chemotherapy","route":"/technologies/cytotoxic-chemotherapy/"}],"drug":[{"id":"cyclophosphamide","kind":"drug","name":"Cyclophosphamide","route":"/drugs/cyclophosphamide/"},{"id":"fluorouracil","kind":"drug","name":"Fluorouracil (5-FU)","route":"/drugs/fluorouracil/"},{"id":"gemcitabine","kind":"drug","name":"Gemcitabine","route":"/drugs/gemcitabine/"},{"id":"melphalan","kind":"drug","name":"Melphalan (including hepatic delivery system)","route":"/drugs/melphalan/"},{"id":"methotrexate","kind":"drug","name":"Methotrexate","route":"/drugs/methotrexate/"},{"id":"temozolomide","kind":"drug","name":"Temozolomide","route":"/drugs/temozolomide/"}],"biomarker":[{"id":"mgmt-promoter-methylation","kind":"biomarker","name":"MGMT promoter methylation","route":"/biomarkers/mgmt-promoter-methylation/"}]}}