alkylating agents

Question 1

name some examples

Answer 1

dacarbazine, procarbazine
ifosfamide, cyclophosphamide
cyclophosphamide
lamustine, estramustine, carmustine

Question 1

dacarbazine - mild, medium or high emotogenicity potential?

Answer 1

high
(CCD - high dose cyclophosphamide, cisplatin, dacarbazine)

Question 2

contraception and conception cyclophosphamide

Answer 2

Females of childbearing potential should use effective contraception during treatment and for at least 12 months after last treatment

Male patients should use effective contraception during treatment and for at least 6 months after last treatment if their partner is of childbearing potential.

Question 3

mesna is routinely given with these two to reduce urothelial toxicity

Answer 3

ifosfamide
cyclophosphamide

Question 4

do they cause bone marrow suppression

Answer 4

yes

Question 5

true or false - treatment if associted with increased incidence of secondary malignancies

Answer 5

true, as with all cytotoxic therapy

Question 6

this urinary metabolite of cyclophosphamide can cause haemorrhiagic cystitis

Answer 6

acrolein

Question 7

how can you prevent haemorrhagic cystitis with cyclophosphamide

Answer 7

increase fluid intake for 24-48h after iv injection

mesna can help prevent cystitis when high dose therapy (>2g IV) is used or when pt at high risk of cystitis e.g. pelvic irradiation

Question 8

MOA

Answer 8

damage DNA, preventing cancer cells from dividing

Question 9

cyclophosphamide is inactive until it is

Answer 9

metabolised by liver

Question 10

interactions of cyclophosphamide

Answer 10

hyponatraemia: ADs, loop and thiazide, NSAIDS
live vaccines
myelosuppression

Question 11

ifosfamide contraception

Answer 11

Manufacturer advises adequate contraception during and for at least 6 months after treatment in men or women.

Question 12

when would you give mesna

Answer 12

with ifosfamide

with cyclophosphamide if high-dose therapy (e.g. more than 2 g intravenously) is used or when the patient is considered to be at high risk of cystitis (e.g. because of pelvic irradiation).

Question 13

patient has has urothelial toxicity before with cyclophosphamide. are they CI for future treatment

Answer 13

no, give mesna to reduce risk

Question 14

What are the strategies for managing hemorrhagic cystitis in patients taking cyclophosphamide?

Answer 14

hydration esp 24-48h after iv treatment
mesna

Question 15

Why do alkylating agents increase the risk of secondary malignancies?

Answer 15

Because they cause DNA mutations by damaging DNA, increasing the risk of secondary cancers, particularly leukemia.