Chemo basic principles and side effects

Question 1

Basic principles

Answer 1

Neoadjuvant or primary systemic therapy

Adjuvant

Palliative

Always administer in cycles since only a fraction of the cancer cells are killed in each cycle

Combination therapy is usually preferred.
Better response,
less individual drug toxicity and dose,
and less resistance.

Question 2

Side effects of chemo

Answer 2

Administration side effects
- Extravasation outside of the vessels causes tissue necrosis - use a permanent port or port catheter

• Anaphylaxis
• Phlebitis in i.v.

Bone marrow:
Neutropenia
- Neutropenic fever emergency. Broad spectrum
empiric antibiotics and antifungals.
- Agranulocytosis = less than 500 neutrophils per ml

Thrombocytopenia
- severe less than 20K per ul, needs transfusion when less than 10K per ul.

Anemia.

GI and mucosa.
- Mucositis of the gums, soft tooth brush, avoid spicy food.

Nausea - Ondansetron and Aprepitant

Diarrhea - Irenotecan
Constipation - platinums and taxanes.

Ileus - by Vinblastine.

Hair - allopecia
Nail discolorations and damage
Skin - hand foot syndrome.

Cardiac - Doxorubicin

Hepatobiliary cholestasis by many drugs

Cystitis, cyclophosphamide ifosfamide

Uric acid nephropathy

Infertility

Teratogenic

Neurologic - Chemo brain.

Peripheral neuropathy - platinums and taxanes.

Kidney toxicity. - platinums

Bleomycin - pulmonary fibrosis