Antineoplastics

Antimetabolites

Methotrexate

Pure As Gold: Purines Adenine and Guanine

Pyrimidine = CUT: Cytosine, Uracil, Thymine

• Hexagonal pyrimidine (T, C, U) shape: methotrexate, 5-fluorouracil, and hydroxyurea block synthesis of thymidine (pyrimidine nucleoside)

• Blocking DNA: inhibition of thymidine synthesis (by MTX, 5-FU, and hydroxyurea) inhibits DNA synthesis

• Sushi phase: antimetabolites (e.g. MTX and 5-FU) and hydroxyurea block the S phase of the cell cycle (DNA synthesis)

• Dumplings: deoxyuridine monophosphate (dUMP - precursor to dTMP)

• Dumpling with "T" shaped chopsticks: deoxythymidine monophosphate (dTMP)

• "C" sushi on a bed of 4 leaves: methylated tetrahydrofolate (N5,N10 Methylenetetrahydrofolate)

• Transferring "C" sushi: thymidylate synthase (catalyzes the conversion of methylated THF -> DHF and the methylation of dUMP -> dTMP)

• 2 leaves: dihydrofolate (DHF)

• Adding 2 leaves: dihydrofolate reductase (reduces DHF back to THF)

• 4 leaves: tetrahydrofolate (THF)

• Adding "C" sushi: THF is re-methylated to continue cycle

Methotrexate

• Blocked leaf chef: MTX irreversibly blocks dihydrofolate reductase (inhibits synthesis of THF)

• Meat stix: methotrexate (MTX - cytotoxic folate analog)

• Cracked cancer crab: MTX treats a range of malignancies (e.g. leukemias, lymphomas, breast cancer, head and neck cancer, and lung cancer)

• Emptying uterus bag: MTX (with misoprostol) can be used as an abortifacient

• Ectopic key chain: MTX treats ectopic pregnancy

• Dumping mole: MTX treats invasive molar pregnancy, trophoblastic tumors, and choriocarcinoma

• Silvery scale kneepads: MTX treats psoriasis

• Rheumatoid lantern with flame for inflammation: MTX is a first line treatment for rheumatoid arthritis (disease modifying antirheumatic drug - DMARD)

• Torn antibody: MTX is useful for immunosuppressive therapy (e.g. treatment of IBD, SLE, vasculitis, dermatomyositis)

• Buildup of 2 leaf boats: inhibition dihydrofolate reductase (by MTX) causes increased levels of DHF

• Falling foliage: MTX can cause folate deficiency

• Blasting fireworks: MTX can cause megaloblastic anemia (due to folate deficiency)

• Fibrotic lung bonsai: MTX can cause pulmonary fibrosis (restrictive lung disease)

• Liver spot: MTX can cause hepatotoxicity

• Bald: MTX can cause alopecia

• Poking mouth: MTX can cause mucositis

• Depleted bone pan: MTX, 5-FU and hydroxyurea can cause myelosuppression and pancytopenia

• Immunosuppressed cane: MTX, 5-FU and hydroxyurea can cause immunosuppression and increased risk of infection

Leucovorin

• Lucky feline: leucovorin (folinic acid) therapy can reverse the toxic effects of MTX ("leucovorin rescue"). Same as THF, does not require DHF reductase, replaces methotrexate inside cells

5-FU

• Full guy: 5-fluorouracil (5-FU - a cytotoxic pyrimidine analog)

• Full guy binding carbon donator: 5-FU complexes with THF and inhibits thymidylate synthase (block thymidine production from dUMP to dTMP)]

• Cracked cancer crab: 5-FU has activity against many solid tumors (e.g. colorectal, breast, head and neck, liver, pancreas, and basal cell cancers)

• Buildup of dumpling plates: inhibition of thymidylate synthase (by 5-FU) causes increased levels of dUMP

• Stained pants: 5-FU can cause diarrhea by killing rapidly dividing GI epithelium

• Sensitive photos: 5-FU causes a variety of cutaneous complications (e.g. including photosensitivity and hyperpigmentation reactions

• Knocked over lucky feline: leucovorin (folinic acid) does not prevent toxicities of 5-FU

• Depleted bone pan: MTX, 5-FU and hydroxyurea can cause myelosuppression and pancytopenia

• Immunosuppressed cane: MTX, 5-FU and hydroxyurea can cause immunosuppression and increased risk of infection

Hydroxyurea

• U-D-P: uridine diphosphate (UDP - precursor to pyrimidine nucleosides)

• Crossed out OXY: ribonucleotide reductase (converts UDP -> deoxy-UDP), then converted to dUMP

• Hydro-rock area: hydroxyurea (ribonucleotide reductase inhibitor)

• Inhibited wait list waitress: hydroxyurea inhibits ribonucleotide reductase (blocked thymidine synthesis)

• Cracked crab: hydroxyurea has activity against solid and hematologic malignancies (e.g. AML, CML, and head and neck cancer)

• Zen sickle: hydroxyurea reduces veno-occlusive crises in sickle cell anemia

• Raised baby with hemoglobin coin: hydroxyurea increases fetal hemoglobin (HbF) levels (protects against polymerization of mutated HbS)

• Depleted bone pan: MTX, 5-FU and hydroxyurea can cause myelosuppression and pancytopenia

• Immunosuppressed cane: MTX, 5-FU and hydroxyurea can cause immunosuppression and increased risk of infection

Azathioprine

• Pentagon pedestal with 3 P hammers: phosphoribosyl pyrophosphate (PRPP) (5 point ribose sugar with 3 phosphate) → precursor to IMP

• Gargoyle imp: inosine monophosphate (IMP) intermediate purine nucleotide → precursor to AMP and GMP)

• “Pure As Gold”: AMP and GMP are purine nucleotides

• GruMPy statue: guanosine monophosphate (GMP - purine nucleotide)

• grAMPs statue: adenosine monophosphate (AMP - purine nucleotide)

• Aza-meralda: azathioprine (AZA - prodrug of the cytotoxic purine analog 6- mercaptopurine)

• CAPTured gypsy: 6-mercaptopurine (6-MP - cytotoxic purine analog)

• HiGh PRiesT: Hypoxanthine-guanine phosphoribosyl transferase (HGPRT)

• HiGh PRiesT aggrevating captive: HGPRT activates 6-MP

• Captive toppling imp: AZA/6-MP blocks synthesis of IMP → decreased purine nucleotide synthesis → blocked DNA and RNA synthesis

• “Stairs out”: AZA/6-MP blocks the S phase of the cell cycle (DNA synthesis)

• Cracked antibody archers and T knights: 6-MP treats hematologic malignancies (e.g. ALL)

• Torn antibody: AZA/6-MP is useful for immunosuppressive therapy (e.g. treatment of graft rejection, SLE, autoimmune hemolytic anemia)

• Rheumatoid lantern: AZA/6-MP can be used to treat refractory rheumatoid arthritis (disease modifying antirheumatic drug - DMARD)

• Inflamed colonic lanterns: AZA/6-MP can be used to treat inflammatory bowel disease (i.e. crohn's disease, ulcerative colitis)

• Depleted birdseed marrow: AZA/6-MP and mycophenolate can cause myelosuppression

• Immunosuppressed cane: AZA/6-MP can cause immunosuppression and increased risk of infection

• Squeezed pancreas sponge: AZA/6-MP can cause pancreatitis

• Liver stain: AZA/6-MP can cause hepatitis

• Pure nuns: allopurinol is a xanthine oxidase (XO) inhibitor

• XO breaks down 6-MP

• Collection of purine beads: inhibition of XO increases levels of purine analogs (e.g. 6-MP) → increased risk of side effects

• Quasi-mofetil: mycophenolate mofetil (IMP dehydrogenase inhibitor)

• Quasi-mofetil topples GruMPy statue: mycophenolate inhibits IMP dehydrogenase → decreased GMP synthesis → decreased lymphocyte proliferation

• Torn antibody: mycophenolate is useful for immunosuppressive therapy (e.g. treatment of graft rejection, SLE, myasthenia gravis)

• Rheumatoid lantern: mycophenolate can be used to treat rheumatoid arthritis (disease modifying antirheumatic drug - DMARD)

• Nauseated: mycophenolate can cause GI distress (nausea, diarrhea, cramping)

• Depleted birdseed marrow: AZA/6-MP and mycophenolate can cause myelosuppression

• Immunosuppressed cane: mycophenolate can cause immunosuppression and increased risk of infection

Cladribine

• Clad in bearskins: cladribine (cytotoxic purine analog)

• Purine shaped hammer: cladribine is a purine analog

• Cracked replication fork: cladribine, cytarabine, and gemcitabine inhibit DNA polymerase

• Stone Phase: antimetabolites (e.g. cladribine, cytarabine, gemcitabine) inhibit the S phase of the cell cycle (DNA synthesis)

• Hairy caveman: cladribine treats hairy cell leukemia

• Broken marrow: cladribine, cytarabine, and gemcitabine can cause myelosuppression

• Immunosuppressed cane: cladribine, cytarabine, and gemcitabine can cause immunosuppression and increased risk of infection

• Saber toothed tiger: cytarabine (cytotoxic pyrimidine analog)

• Pyrimidine shapes: cytarabine and gemcitabine are pyrimidine analogs

• Cracked replication fork: cladribine, cytarabine, and gemcitabine inhibit DNA polymerase

• Stone Phase: antimetabolites (e.g. cladribine, cytarabine, gemcitabine) inhibit the S phase of the cell cycle (DNA synthesis)

• Gems inside geode: gemcitabine (cytotoxic pyrimidine analog)

• Pyrimidine shapes: cytarabine and gemcitabine are pyrimidine analogs

• Cracked replication fork: cladribine, cytarabine, and gemcitabine inhibit DNA polymerase

• Stone Phase: antimetabolites (e.g. cladribine, cytarabine, gemcitabine) inhibit the S phase of the cell cycle (DNA synthesis)

• Scratched out antibody archers and T-cell swordsmen: cytarabine is only active against hematologic malignancies (e.g. AML, non-Hodgkin lymphoma)

• Cracked crab fossil on solid rocks: gemcitabine is active against both hematologic malignancies and solid tumors

DNA Antimetabolites

Cyclophosphamide, busulfan, nitrosoureas

• alkylating odyssy

• Cyclops polyphemus: cyclophosphamide (cytotoxic alkylating agent)

• Cross-linking ankle chains: alkylating agents donate an alkyl group → DNA cross-links (cell cycle NONspecific), N7

• Torn cancer crab: cyclophosphamide treats many hematologic and solid malignancies (e.g. leukemias and lymphomas, breast cancer, ovarian cancer)

• Torn antibody: cyclophosphamide is a potent immunosuppressive therapy (e.g. treatment of nephrotic syndrome, nephritic syndrome, vasculitis, autoimmune hemolytic anemia)

• Activating chrome bumper: cyclophosphamide is ACTIVATED by hepatic cytochrome P450 enzymes

• Broken marrow: cyclophosphamide can cause myelosuppression

• Red urine: cyclophosphamide can cause hemorrhagic cystitis

• Protective maze: coadministration of 2-mercaptoethanesulfonate (MESNA) prevents hemorrhagic cystitis. MESNA donates thiol group that inactivates toxic metabolite

• Cancer crab belt buckle: cyclophosphamide increases risk of bladder cancer (high grade transitional cell carcinoma)

• Inappropriately wet head: cyclophosphamide can cause hyponatremia due to SIADH

• Dried up fruit tree: cyclophosphamide can cause infertility and premature menopause

• Beautiful sirens: busulfan (cytotoxic alkylating agent)

• Severely depleted marrow: busulfan is useful as a conditioning agent prior to bone marrow transplantation

• Fibrotic lung pattern: busulfan can cause lung toxicity (e.g. acute lung injury, interstitial fibrosis, alveolar hemorrhage)

• Beautiful TAN sirens: busulfan can cause a hyperpigmentation reaction (“busulfan tan”)

• Centaurs: nitrosoureas (cytotoxic alkylating agents)

• Mustang: “-mustine” suffix of nitrosoureas (e.g. carmustine, lomustine)

• Striped zebra centaur: streptozotocin (nitrosourea - cytotoxic alkylating agent)

• Brain tree: nitrosoureas are highly lipophilic → cross BBB → treat brain tumors (e.g. glioblastoma multiform)

• Dizzy centaur: nitrosoureas can cause neurotoxicity (e.g. convulsions, dizziness, ataxia)

Cisplatin

• Platinum: cisplatin, carboplatin, oxaliplatin (cytotoxic platinum analogs)

• Cross-linked helix necklace: platinum analogs bind DNA and form intrastrand and interstrand cross-links, N7

• Crumpled crab: platinum analogs treat various solid malignancies (e.g. non-small cell lung cancer, small cell lung cancer, testicular cancer, ovarian cancer, bladder cancer)

• Ototoxic earrings: platinum analogs can cause ototoxicity → sensorineural hearing loss, tinnitus (especially cisplatin)

• Neuropathic gloves: platinum analogs can cause neurotoxicity → peripheral neuropathy (especially cisplatin)

• Nephrotoxic purse: platinum analogs can cause nephrotoxicity → acute kidney injury (especially cisplatin)

• Muddy drain tube: platinum analogs can cause acute tubular necrosis (ATN - muddy brown casts)

• Amethyst: amifostine (an organic thiophosphate) can prevent cisplatin-induced nephrotoxicity

• “Free, rare”: amifostine scavenges free radicals produced by cisplatin in the kidney

• Saline fluids: IV saline diuresis prevents cisplatin-induced nephrotoxicity

• Depleted bone jewelry box: platinum analogs can cause myelosuppression (especially carboplatin)

• Immunosuppressed cane: platinum analogs can cause immunosuppression and increased risk of infection (especially carboplatin)

Bleomycin

• Beluga whale: bleomycin (antitumor antibiotic)

• Oxide bubbles: bleomycin binds DNA and produces free radicals (superoxide, hydroxide)

• Broken double helix kelp: free radicals produced by bleomycin cause single and double strand breaks in DNA

• Galleon: bleomycin blocks the G2 phase of the cell cycle

• Cracked anticancer crab: bleomycin treats many hematologic and solid malignancies (e.g. Hodgkin and Non-hodgkin lymphoma, germ cell tumors, squamous cell carcinoma of the skin, cervix, and vulva)

• Lung coral: bleomycin can cause pulmonary toxicity (e.g. pneumonitis, pulmonary infiltrates)

• Hyperpigmented striae: bleomycin can cause skin toxicity (e.g. rash, exfoliation, hyperpigmentation, atrophic striae)

• Poking mouth: bleomycin (and anthracyclines) can cause mucositis and stomatitis

• Bald beluga: bleomycin can cause alopecia

• Santa Anthracycline: anthracyclines (antitumor antibiotics)

• Rubies: “-rubicin” suffix of anthracyclines (e.g. doxorubicin, daunorubicin)

• Oxide bubbles: anthracyclines produce free radicals (e.g. superoxide, hydroxide)

• Rubies inserting into helical seaweed: anthracyclines (e.g. doxorubicin) intercalate in DNA → block DNA and RNA synthesis

• Cracked cancer crab: anthracyclines (e.g. doxorubicin) treats a broad range of solid and hematologic malignancies

• Dilated heart ruby sacks: anthracyclines (e.g. doxorubicin) can cause cardiotoxicity (e.g. dilated cardiomyopathy). Free radicals

• Chelating the heart sack on deck: dexrazoxane (iron chelator) prevents anthracycline-induced cardiotoxicity

• Up on deck with razor: dexrazoxane (iron chelator)

• Depleted bone chest: anthracyclines (e.g. doxorubicin) and actinomycin D can cause myelosuppression

• Bald pirate: anthracyclines (e.g. doxorubicin) can cause alopecia

• Doll artifact: actinomycin D (antitumor antibiotic)

• Artifacts inserting into helical seaweed: actinomycin D intercalates in DNA → block DNA and RNA synthesis

• Child’s artifact: actinomycin D treats numerous pediatric malignancies (e.g. Wilms tumor, Ewing sarcoma, rhabdomyosarcoma)

• Bald doll: actinomycin D can cause alopecia

Etoposides

• Side of the tower: etoposide and teniposide (topoisomerase II inhibitors)

• Unwinding strands: topoisomerases relieve DNA supercoiling that occurs during DNA replication

• Grasping 2 strands: etoposide and teniposide inhibit topoisomerase II (double stranded breaks to relieve supercoiling)

• Both strands breaking: etoposide and teniposide prevent religation of the double strand break induced by topoisomerase II

• “Stairs out”: topoisomerase inhibitors block the S phase of the cell cycle (DNA synthesis)

• “Gone 2 forest”: topoisomerase inhibitors block the G2 phase of the cell cycle (double check and repair)

• Ripped cancer crab: etoposide and teniposide treat many solid and hematological malignancies (e.g. testicular cancer, small cell lung cancer, Hodgkin and non-Hodgkin lymphoma)

• Spilling bone luggage: topoisomerase inhibitors can cause myelosuppression

• Immunosuppressed cane: topoisomerase inhibitors can cause immunosuppression

• Losing hair: topoisomerase inhibitors can cause alopecia

• Toucan: topotecan and irinotecan (topoisomerase I inhibitors)

• Single ponytail strand: topotecan and irinotecan inhibit topoisomerase I (single strand nick to relieve supercoiling)

• Loose bird stool: topotecan and irinotecan can cause severe diarrhea

Vincristine

• Christine in vines: vincristine (cytotoxic vinca alkaloid)

• Breaking spindle vines: vinca alkaloids (e.g. vincristine, vinblastine) inhibit microtubule production and mitotic spindle assembly

• Blasting vines: vinblastine (cytotoxic vinca alkaloid)

• “M” shape in vines: drugs that affect microtubule function (e.g. vinca alkaloids, taxanes) block the M phase of the cell cycle (mitosis)

• Tarzan: taxanes (e.g. paclitaxel, docetaxel, cabazitaxel - cytotoxic plant alkaloids)

• Stabilizing the vine: taxanes enhance microtubule production and prevent their degradation → improper mitotic spindle function

• Cracked cancer crab: vinca alkaloids treat many hematologic and solid malignancies (e.g. leukemias, lymphomas, pediatric tumors, breast cancer, and germ cell cancer)

• Neuropathic stockings and gloves: vincristine can cause neurotoxicity (e.g. peripheral sensory neuropathy)

• Plunger: vincristine can cause autonomic dysfunction (e.g. paralytic ileus, constipation)

• Bald: vinca alkaloids (e.g. vincristine, vinblastine) can cause alopecia

• Broken marrow: drugs that affect microtubule function (e.g. vinca alkaloids, taxanes) can cause myelosuppression (especially vinblastine)

• Bald: taxanes (e.g. paclitaxel) can cause alopecia

• Neuropathic glove: taxanes can cause neurotoxicity (e.g. peripheral sensory neuropathy)

Kinase Inhibitors and Antibodies

• Broken nib: “-nib” suffix of small molecule kinase inhibitors (e.g. imatinib, erlotinib, vemurafenib)

• Inhibited tire swing: tyrosine kinase inhibitors (“-tinib” e.g. imatinib, erlotinib, sunitinib)

• Imitating: imatinib (small molecule tyrosine kinase inhibitor)

• British Earl: erlotinib (small molecule tyrosine kinase inhibitor)

• Rising sun: sunitinib (a small molecule tyrosine kinase inhibitor)

• Soaring eagle: sorafenib (a small molecule tyrosine kinase inhibitor)

• Venom: vemurafenib (a small molecule kinase inhibitor)

• Cracked crab: small molecule kinase inhibitors treat a variety of hematologic and solid malignancies (e.g. imatinib treats CML)

• Imitating: imatinib (small molecule tyrosine kinase inhibitor)

• Cracked crab: small molecule kinase inhibitors treat a variety of hematologic and solid malignancies (e.g. imatinib treats CML)

• Copious pink, white, and blue granules: chronic myeloid leukemia (CML) (increased levels of mature granulocytes - eosinophils, neutrophils, basophils)

• BREAKABLE: imatinib blocks the tyrosine kinase domain of the BCR/ABL fusion protein (in CML)

• Philadelphia, Pa: translocation between chromosomes 9 and 22 → BCR/ABL oncogene on chromosome 22 (Philadelphia chromosome)

• Congress kit: imatinib blocks the c-kit tyrosine kinase (in GIST)

• Crab buttons on belly: c-kit tyrosine kinase is found in gastrointestinal stromal tumors (GIST)

• Baggy pantaloons: imatinib can cause fluid retention → ankle and periorbital edema

• British Earl: erlotinib (small molecule tyrosine kinase inhibitor)

• Earl Geoffrey: erlotinib blocks the epidermal growth factor receptor (EGFR) tyrosine kinase

• Big lapel with crab badge: erlotinib treats solid tumors with EGFR overexpression (e.g. non-small cell lung cancer - NSCLC)

• Spotty rash: erlotinib can cause a papulopustular acneiform rash

• Muddy pantaloons: erlotinib can cause diarrhea

• Rising sun: sunitinib (a small molecule tyrosine kinase inhibitor)

• Soaring eagle: sorafenib (a small molecule tyrosine kinase inhibitor)

• Inhibiting vegetables: sunitinib and sorafenib inhibit the vascular endothelial growth factor receptor (VEGFR) tyrosine kinase

• Flank crab buckles: sunitinib and sorafenib treat cancer with VEGFR overexpression (e.g. renal cell carcinoma)

• Callused and sunburned: sunitinib and sorafenib can cause hyperkeratosis and skin

  rashes

• Bleeding wound: VEGF-targeted therapies (e.g. sunitinib, sorafenib) are associated with

  an increased risk of hemorrhage

• Venom: vemurafenib (a small molecule kinase inhibitor)

• B. Fra: vemurafenib blocks B-Raf kinase

• Disseminated ink: vemurafenib treats V600E BRAF positive malignant melanoma

Rituximab

• mab = antibody, monoclonal

• chimeric: still retains protein fragments from other animals

• monoclonal = from same cell line, target same antigen

• Tusks: cetuximab (monoclonal antitumor antibody)

• Coronation ritual: rituximab (antitumor monoclonal antibody)

• Beverage lady: bevacizumab (monoclonal antitumor antibody)

• Alms: alemtuzumab (monoclonal antitumor antibody)

• Tapestry weaver: trastuzumab (monoclonal antitumor antibody)

• Coronation ritual: rituximab (antitumor monoclonal antibody)

• Chimera sigil: rituximab and cetuximab are chimeric monoclonal antibodies (IgG)

• Pulling down antibody archer: rituximab depletes B cells (binds CD20), ADCC, treats CD20 positive non-hodgkins lymphoma

• Grabbing “XX” straps: rituximab binds CD20 on B-cells

• Chronic, worn out tapestry with antibody archers and T knights: rituximab treats chronic lymphocytic leukemia (CLL)

• Rheumatic lantern: rituximab treats rheumatoid arthritis (disease modifying antirheumatic drug - DMARD)

• Torn antibody: Rituximab is useful for immunosuppressive therapy (e.g. microscopic polyangiitis, Wegener’s granulomatosis)

• Immunosuppressed cane: Rituximab can cause immunosuppression, neutropenia, and increased risk of infection

• White laurel leaves: rituximab may be associated with a higher risk of progressive multifocal leukoencephalopathy (PML)

• Swollen cherub with ivy: monoclonal antibodies can cause an infusion reaction (e.g. headache, fever, skin rash, pruritus, dyspnea, hypotension) (cytokine release from B cells)

• Delayed onset poisoning: chimeric antibodies (e.g. rituximab) can cause serum sickness (e.g. fever, rash, arthralgia within 7-10 days) (deposition of immune complex, type 3) (immune system targeting mouse of antibody)

• Tusks: cetuximab (monoclonal antitumor antibody)

• Chimera sigil: rituximab and cetuximab are chimeric monoclonal antibodies (IgG)

• Giraffe: cetuximab binds the epidermal growth factor receptor (EGFR)

• Tire swing: EGFR is a receptor tyrosine kinase

• Cracked crab: cetuximab treats solid tumors (e.g. colorectal cancer, squamous cell carcinoma)

• Red spots: cetuximab can cause a papulopustular acneiform rash (EGFR expressed on skin)

• Delayed onset poisoning: chimeric antibodies (rarely cetuximab) can cause serum sickness (e.g. fever, rash, arthralgia within 7-10 days)

• Beverage lady: bevacizumab (monoclonal antitumor antibody)

• Chopped vegetables: bevacizumab binds VEGF

• Chopping vessels: bevacizumab inhibits growth of blood vessels in tumors (binds VEGF) (inhibit wound healing)

• Cracked crab: bevacizumab treats metastatic tumors (e.g. colorectal cancer, lung cancer)

• Wet center of retina pillow: bevacizumab treats wet macular degeneration

• Blood spatter: bevacizumab can cause bleeding

• Ice clots: bevacizumab increases the risk for thrombotic events, TIA, strokes, angina

• Perforating colon bag: bevacizumab can cause GI perforation (sudden abdominal pain)

• Alms: alemtuzumab (monoclonal antitumor antibody)

• Pulling down antibody archer and T knight: alemtuzumab depletes B and T cells (binds CD52)

• 52 pattern: alemtuzumab binds CD52 on B and T cells, ADCC

• Chronic tapestry with antibody archers and T knights: alemtuzumab treats chronic lymphocytic leukemia (CLL)

• Tapestry weaver: trastuzumab (monoclonal antitumor antibody)

• Her 2 babies: trastuzumab binds epidermal growth factor receptor 2 (HER2, c-erbB2)

• Tire swing: HER2 is a receptor tyrosine kinase

• Crab bra: trastuzumab treats HER2 positive breast cancer

• Unraveling heart: trastuzumab can cause cardiotoxicity (e.g. decreased LVEF, heart failure)