Black box Flashcards
Sacituzumab Govitecan
Neutropénie (hold ANC < 150 ou NF, g-csf px secondaire)
Diarrhée (atropine/lopéramide)
Ind : Métastatic TN ca sein, 3e ligne
Ac attaché à SN-38
Lenalidomide
Embryo-fetal toxicity: (REMS)
Do not use lenalidomide during pregnancy. Lenalidomide, a thalidomide analogue, caused limb abnormalities in a developmental monkey study. Thalidomide is a known human teratogen that causes severe, life-threatening human birth defects. If lenalidomide is used during pregnancy, it may cause birth defects or embryo-fetal death. In females of reproductive potential, obtain 2 negative pregnancy tests before starting lenalidomide treatment. Females of reproductive potential must use 2 forms of contraception or continuously abstain from heterosexual sex during and for 4 weeks after lenalidomide treatment.
Hematologic toxicity:
Lenalidomide can cause significant neutropenia and thrombocytopenia. Eighty percent of patients with deletion 5q myelodysplastic syndromes had to have a dose delay/reduction during the major study. Thirty-four percent of patients had to have a second dose delay/reduction. Grade 3 or 4 hematologic toxicity was seen in 80% of patients enrolled in the study. Patients on therapy for deletion 5q myelodysplastic syndromes should have their complete blood cell counts monitored weekly for the first 8 weeks of therapy and at least monthly thereafter. Patients may require dose interruption and/or reduction. Patients may require use of blood product support and/or growth factors.
Venous and arterial thromboembolism:
Lenalidomide has demonstrated a significantly increased risk of deep vein thrombosis (DVT) and pulmonary embolism (PE), as well as risk of myocardial infarction and stroke in patients with multiple myeloma who were treated with lenalidomide and dexamethasone therapy. Monitor for and advise patients about the signs and symptoms of thromboembolism. Advise patients to seek immediate medical care if they develop symptoms such as shortness of breath, chest pain, or arm or leg swelling. Thromboprophylaxis is recommended and the choice of regimen should be based on an assessment of the patient’s underlying risk factors
Pomalidomide
Pregnancy: (REMS)
Pomalidomide is contraindicated in pregnancy. Pomalidomide is a thalidomide analogue. Thalidomide is a known human teratogen that causes severe birth defects or embryo-fetal death. In females of reproductive potential, obtain 2 negative pregnancy tests before starting pomalidomide treatment. Females of reproductive potential must use 2 forms of contraception or continuously abstain from heterosexual sex during and for 4 weeks after stopping pomalidomide treatment.
Thromboembolic events:
Deep venous thrombosis (DVT), pulmonary embolism (PE), myocardial infarction, and stroke occur in patients with multiple myeloma treated with pomalidomide. Prophylactic antithrombotic measures were employed in clinical trials. Thromboprophylaxis is recommended, and the choice of regimen should be based on assessment of the patient’s underlying risk factors
Thalidomide
Pregnancy: (REMS)
If thalidomide is taken during pregnancy, it may cause severe birth defects or embryo-fetal death. Thalidomide should never be used by females who are pregnant or who could become pregnant while taking thalidomide. Even a single dose (1 capsule [regardless of strength]) taken by a pregnant woman during pregnancy may cause severe birth defects.
TEV :
The use of thalidomide in multiple myeloma results in an increased risk of venous thromboembolism, such as deep venous thrombosis and pulmonary embolism. This risk increases significantly when thalidomide is used in combination with standard chemotherapeutic agents including dexamethasone. In 1 controlled trial, the rate of venous thromboembolism was 22.5% in patients receiving thalidomide in combination with dexamethasone compared with 4.9% in patients receiving dexamethasone alone (P = 0.002). Patients and physicians are advised to be observant for the signs and symptoms of thromboembolism. Instruct patients to seek medical care if they develop symptoms such as shortness of breath, chest pain, or arm or leg swelling. Consider thromboprophylaxis based on an assessment of individual patients’ underlying risk factors
Dinutuximab
Infusion reactions : serious, potentially life threatening (26%)
Neuropathies : 85%, sévère
Ind : Maintenance neuroblastome pédiatrique (avec gm-csf, isotrétinoine, IL2)
Enasidenib (Idhifa)
Syndrome différenciation : leucocytose. Possible utiliser hydrea
Idh2 inhibitor - lma
Tisagenlecleucel (kymriah)
CRS et ICANS
Anti cd19, lla b réfract ad 25 ans ou lnh rr
Pexidartinib
Ind : TGCT symptomatique avec limitations (tenosynovial giant cell tumor) fonctionnelles non éligible chx
Hépatotox : fatal liver injury
REMS turalio
Cabozantinib
Ind : medullary thyroid, RCC, HCC
Cible vegfr1-2-3, met, ret
Hémorrhagie
Perforation GI
Everolimus
Ind : sein métastatique, pNET, RCC, SEGA
Mtor inh
Infections
Lapatinib
Ind sein métastatique
Cible: egfr, her2
Hépatotox
Pazopanib
Ind : RCC, sarcome
Cible : egfr, pdgfr, ckit
Hépatotoxicité
Regorafenib
Ind : colon, gist
Cibles : vegfr, kit, ret, pdgfr, braf
Hépatotoxicité
Sonidegib
Ind : basal cell carcinoma
Cible : hh pathway
Embryofoetal death
Sunitinib
Ind : rcc, gist, pnet
Cible : pdgfr, vegfr
Hépatotoxicité
Vandetanib
Ind medullary thyroid
Cible egfr, vegfr, ret
Prolongation qtc - REMS
Pertuzumab-trastuzumab-hyaluronidase (phesgo)
Ind : peut être substitué si pertu-trastu
Cardiomyopathie
Toxicité pulmonaire
Toxicité embryo-foetale
Fam-trastuzumab deruxtecan nxki (enhertu)
Ind : ca sein méta ou non résecable her2+ (3e ligne)
ILD interstitial lung disease et Pneumonite
Toxicité embryo-foetale
Trastuzumab (herceptin)
Left ventricular dyafunction
Pertuzumab
Left ventricular dysfunction
Assess q12sems
Ado-trastuzumab-emtansine (tdm1, kadcyla)
Left ventricular dysfunction
Duvelisib
Pi3k inhibitor Ind : llc ou sll r/r, 3e ligne Infections Diarrhées Colite Réactions cutanées Pneumonite
Ponatinib
Occlusion vasculaire (IM, stroke, stenosis)
Veinous thromboembolic events
Heart failure
Hepatotoxicité
Nilotinib
Prolongation QTc
Ondansetron
32 mg
Tachyarythmies
Qtc prolong et tdp
Panobinostat
MM relapse/réfract Inhibiteur histone déacétylase Cardiac arrythmias, ischémie Diarrhée Check baseline puis prn : e-, ecg et lfts
Belantamab mafodotin
Monotx en RR MM 5e ligne
Liaison au BCMA (B cell maturation antigen)
REMS ocular toxicity
Examen opthalmique avant chaque visite et gouttes hydratantes qid
Thalidomide, lenalidomide, pomalidomide
REMS toxicité embryo-foetale
Limb abnormalities
Brexucabtagene autoleucel (kte-x19, tecartus)
Cart anti cd19
LMC RR (zuma2)
CRS et icans
Rems
Blinatumomab
R/R LLA
BiTE cible CD19 sur cell B
CRS
Neurotoxicité
Doxorubicine
Cardiomyopathie
Extravasation
Secondary malignancy (LMA, SMD)
Myelosuppression
Chlorambucil
Bone marrow suppression
Carcinogène (tératogène, mutagène)
Melphalan
Bone marrow suppression
Secondary malignancy (leucémie)
Hypersensitivity (injection) : anaphylaxie 2%
Ifosfamide
Bone marrow suppression
CNS toxicity: encéphalopathie, death
Hemorrhagic cystitis
Nephrotoxicity
Carmustine
Myelosuppression
Pulmonary toxicity : cumulatif >1400 mg/m2
Lomustine
Bone marrow suppression : thrombocytopénies
Streptozocin
Néphrotoxicité
Nausées/Vomissements
Secondary malignancies
Busulfan
Bone marrow suppression (seulement en GMO si utilisé IV)
Thiotepa
Myelosuppression (infections, bleeding)
Carcinogène
Dacarbazine
Bone marrow suppression
Hepatic effects : nécrose hépatique
Carcinogenic/teratogenic
Cisplatine
Myelosuppression
Nausea and vomiting
Nephrotoxicity
Peripheral neuropathy
Carboplatine
Bone marrow suppression
Vomiting
Hypersensitivity reactions: anaphylactic like
Oxaliplatine
Hypersensitivity/Anaphylactic reactions
Daunorubicine
Extravasation Bone marrow suppression Cardiomyopathy Hepatic impairment: ajuster en IH Renal impairment: ajuster en IR
Épirubicine
Cardiac toxicity
Secondary malignancy: LMA, SMD
Extravasation and tissue necrosis : ice
Bone marrow suppression
Idarubicine
Extravasation Cardiomyopathy Bone marrow suppression Hepatic impairment: ajuster IH Renal impairment: ajuster IR
Etoposide
Bone marrow suppression (infection, bleeding)
Mitoxantrone
Bone marrow suppression
Cardiotoxicity: Congestive heart failure. Dose max cumul 140 mg/m2
Secondary leukemia
Irinotécan
Diarrhea
Bone marrow suppression
Topotécan
Bone marrow suppression
Alcaloïdes de la vinca
Extravasation : hyaluronidase, compresses tièdes
Docetaxel
Increased mortality: si insuffisance hépatique
Hepatic function impairment: ne pas donner
Neutropenia
Hypersensitivity: polysorbate 80
Fluid retention
Paclitaxel
Hypersensitivity
Bone marrow suppression
Methotrexate IV
Hypersensitivity Pregnancy: tox embryo-foetale Bone marrow suppression: Renal impairment: peut impair l'élimination Hepatotoxicity Pneumonitis GI toxicity: diarrhée, mucosite Secondary malignancy: lymphomas Tumor lysis syndrome Dermatologic toxicity: fatal skin reactions Opportunistic infections: ppj Radiotherapy: concom peut augmenter risque soft tissue necrosis/ostéonécrose
Fludarabine
Bone marrow suppression
Autoimmune effects: AHAI, PTI, hémolyse
Neurotoxicity:
Combination with pentostatin: fatal pulmonary toxicity
Cetuximab
Cardiopulmonary arrest
Infusion reactions (Surtout Sud-est des USA = Tennesse, North Carolina, Arkansas)
