Alkylating agents and platinum compounds
How alkylating agents and platinum compounds cross-link DNA, why cyclophosphamide needs mesna and cisplatin needs saline, how carboplatin is dosed with the Calvert formula, and the toxicities Paper 1 links to each mechanism.
Tier 2Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Alkylating agents attach alkyl groups to DNA bases, mainly the N7 position of guanine. Bifunctional agents form interstrand and intrastrand cross-links, which stop strand separation for replication and transcription.
- Platinum compounds are not true alkylators but act the same way: platinum binds N7 of adjacent guanines to form mostly intrastrand cross-links.
- Both are cell-cycle non-specific, so they kill resting cells too. That explains marrow toxicity, gonadal failure and secondary leukaemia.
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Sources
- eviQ cancer treatments onlineAU/NZCancer Institute NSW, 2026
- Australian Medicines HandbookAU/NZAustralian Medicines Handbook Pty Ltd, 2026
- Goodman & Gilman's The Pharmacological Basis of Therapeutics (14th ed.)McGraw Hill (Brunton and Knollmann, 2023), 2023
- Carboplatin dosage: prospective evaluation of a simple formula based on renal function (Calvert et al.)Journal of Clinical Oncology 1989;7:1748-56, 1989
- International consensus guideline for anticancer drug dosing in kidney dysfunction (ADDIKD)AU/NZeviQ, Cancer Institute NSW, 2022
- Integrating International Consensus Guidelines for Anticancer Drug Dosing in Kidney Dysfunction (ADDIKD) into everyday practiceeClinicalMedicine 2025, 2025
- eviQ ADDIKD: kidney function estimation for carboplatin dosing (COSA Annual Scientific Meeting abstract)AU/NZClinical Oncology Society of Australia, 2023
- The TRPM6/EGF pathway is downregulated in a rat model of cisplatin nephrotoxicity (Ledeganck et al.)PLoS One 2013;8:e57016, 2013
- MGMT gene silencing and benefit from temozolomide in glioblastoma (Hegi et al.)New England Journal of Medicine 2005;352:997-1003, 2005
- Last updated
- 14 November 2026
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