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As an Anti-Cancer Agent

     It is known that mustard gas can cause cancer in individuals who have been exposed to it. However, with recent technological innovations, scientists have found a way to utilize this very compound to help cure cancer. Victims had a low white blood cell count, due to the fact mustard gas would attack the white blood cells as well as the bone marrow (breakdown process known as aplasia).

     Research studies beginning in 1946, began to show that N-mustard (the same compound as mustard gas, except the sulphur (S) atom in mustard gas is replaced by a nitrogen (N) atom [Figure 2]) reduced tumour growth in mice. This took place in a process whereby 2 strands of DNA are linked together by a molecule of nitrogen mustard.

     Nitrogen mustards have become a pinnacle chemical in the modern chemotherapy treatments; mainly used in treating cancer of the lymph glands, also known as Hodgkin’s disease.

Figure 2 The chemical composition difference between mustard gas and N-mustard. The difference is highlighted in red.

Figure 3 Another image comparing the structures of mustard gas and N-mustard. The yellow atom is the sulphur atom of the mustard gas, and the blue atom the nitrogen of the N-mustard.

Nitrogen mustard is an anticancer drug classified as an alkylating agent.

It is used in regimen for the treatment of both Hodgkin’s and Non-Hodgkin’s lymphoma. It has also been used in care for lung and breast cancers.  Additionally, it is used as a lotion for skin lesions (abnormal skin) that are caused by mycosis fungoides (MF).

The drug is administered via intravenous therapy. The mechlorethamine drug must be administered this way because it does not exist in pill form. The nurse or doctor administering the IV must be highly trained, because if the solution were to escape from the vein, it would cause medical problems on the inside of the body. The complications would mimic the effects of mustard gas on the body, but may not necessarily be as severe. The dosage and schedule of this treatment is determined based on the patient’s individual and personal needs. A similar but diluted solution of nitrogen mustard is used for the treatment of skin lesions.

When undergoing nitrogen mustard treatment, patients may suffer from various side effects.

The following occur in 30%+ of cases:

• Low blood counts – white blood cell, red blood cell and platelet levels lowered

         o   This may lead to an increase in risk of infection, anemia, and/or bleeding.

• Nausea and vomiting – patients are given anti-nausea drugs before drug administration, this lasts usually for only a couple hours after initial exposure to drug
• Hair loss
• Mouth sores
• Darkened veins – the veins used for IV administration tend to darken in colour
• Skin irritation with topical use – redness, dryness, irritation
• Loss of fertility

The following are less common and occur in approximately 10-29% of cases:

• Fever
• Diarrhoea
• Loss of appetite
• Metallic taste
• Ringing in ears
• Abnormal blood levels
• Increased uric acid levels
• Potential to develop leukemia

Patients undergoing nitrogen mustard treatment are encouraged to abstain from pregnancy and breast-feeding. Doctors will perform routine checks to ensure other organs are performing normally.

Nitrogen mustard is an alkylating agent, which means that they function by adding an alkyl group (C_nH_2n+1) to DNA. Cancer cells are particularly prone to DNA damage, and thus these agents are capable of damaging these cancerous cells. They are also cytotoxic, which means that they also attack healthy cells which is what causes some of the adverse effects listed above.

It has been found to be most active when the cell is in its resting phase, thus classifying as a cell cycle non-specific drug. This means that the drug is effective in causing apoptosis (cell suicide) while the cell is in its resting phase and not while the cell is actually undergoing cell division.

There are several types of alkylating agents, where mustard gas derivatives, ethylenimines, alkylsulfonates are a few of the types included in the list.