Chemotherapies, etc Flashcards
Bendamustine (Treanda)
Alkylating agent
IV
B-cell NHL, CLL
M, N, V, fatigue, hypersensitivity rxn, tumor lysis syndrome
Busulfan (Myleran or Busulfex)
Alkylating agent
IV
CML, HCT prep, polycythemia vera
M, N, V, D, mucositis, pulmonary symptoms, insomnia, dizziness, anxiety, alopecia
hepatic and adrenal insufficiency
Carboplatin (Paraplatin)
Alkylating agent
IV
Breast, cervix, endometrium, ovaries, bladder, esophagus, H&N, lung, sarcomas, germ cell
M, N, V, hypersensitivity rxn, mild alopecia
hypomagnesia, peripheral neuropathy, renal toxicity
Carmustine (BCNU)
Alkylating agent OR considered nitrosourea
IV
Brain, HD, NHL, MM, cutaneous T-cell lymphoma
M, N, V
Hepatic, renal and pulmonary toxicity
Chlorambucil (Leukeran)
Alkylating agent
Oral
CLL, HD, NHL, cancers of breast, ovaries and testes
N, V, skin rash, seizures in children
hyperuricemia, pulmonary toxicity
Cisplatin (Platinol, CDDP)
Alkylating agent
IV
H&N, esophagus, lung, stomach, ovaries, testes, cervix, bladder; NHL
M, N, V (acute and delayed), metallic taste
Renal toxicity, SIADH, ototoxicity (hearing loss), hypersensitivity rxn, peripheral nueropathy
hypomagnesemia, low calcium, hypokalemia
HYDRATION, receives fluids before and after infusion, must produce 250 mL urine before administration (SMH)
Cyclophosphamide (Cytoxan, CTX)
Alkylating agent
IV, oral, intrapleural
CLL, HD, NHL, MM, mycosis fungoides, lung, breast, endometrium, ovaries and testes, neuroblastoma, Wilms’, sarcomas
M, N, V, SIADH, alopecia
Bladder and cardiac toxicity
Dacarbazine (DTIC)
Alkylating Agent
IV
medullary thyroid, sarcoma, neuroblastoma, malignant melanoma, HD
M, N, V, flu-like symptoms (fever, chills)
CNS toxicity (neuroblastoma), photosensitivity (Melanoma)
Ifosfamide (Ifex)
Alkylating Agent
IV
H&N, Lung, bladder, cervix, germ cell, HD, NHL, sarcoma
M, N, V, anorexia, SIADH, alopecia
Bladder toxicity (hemorrhagic cystitis, dysuria), Neurotoxicity (seizure, lethargy)
Mechlorethamine (nitrogen mustard)
Alkylating agent
IV
CLL, CML, HD, NHL, mycosis fungoides, breast and lung
M, N, V, hyperuricemia, alopecia
Melphalan (Alkeran)
Alkylating agent
IV, oral
Breast, ovarian, neuroblastoma, polycythemia vera, MM, HCT prep
M, N, V, D, mucositis, hypersensitivity rxn
ice chips 30 mins before infusion to reduce risk of mucositis
Oxaliplatin (Eloxatin)
Alkylating agent
IV
M, N, V, D
Neurotoxicity (cold sensitivity, peripheral neuropathy, esophageal dysethesia (pins and needles/ discomfort)
Hepatic toxicity
Temozolomide (Temodar)
Alkylating Agent
Oral
astrocytoma, glioblastoma
M, N, V, D, headache, rash, constipation, photosensitivity, hepatic toxicity
Take on an empty stomach
Thiotepa (Thioplex)
Alkylating Agent
IV, IM, IT, SC
HD, NHL. bladder, breast, ovarian
M, N, V, mucositis, skin changes (bronzing of the skin)
Renal toxicity
Azacitidine (Vidaza)
Antimetabolite (acts as false metabolite, S- phase)
SC, IV
CML, MDS
M, N, V, D, fatigue, constipation
hypokalemia, renal toxicity
Capecitabine (Xeloda)
Antimetabolite (acts as false metabolite, S- phase), Pyrimidine antagonist
oral- take with food
Esophagus, pancreas, rectum, colon, mBreast
M, N, V, D, fatigue, increased bilirubin
Hand Foot syndrome
Cytarabine (ARA-C)- think blood
Antimetabolite (acts as false metabolite, S- phase), Pyrimidine antagonist
IV, SC, IT, IM
ALL, AML, Acute promyeloctic leukemia (APL), CML, NHL
M, N, V, mucositis, anorexia, acute pancreatitis, conjunctivitis, keratitis (inflamed cornea)
Neuro, hepatic, and pulmonary toxicity
Fludarabine (fludara)
Antimetabolite (acts as false metabolite, S- phase)
IV
CLL, NHL, acute leukemias
M, N, V, D
neurotoxicity
Fluorouracil (5- FU)
Antimetabolite (acts as false metabolite, S- phase), Pyrimidine antagonist
IV, topical
H&N, thymic, neuroendocrine, breast, stomach, GI, pancreas, hepatobiliary, colon and rectum, cervix, unknown primary
M, N, V, D, mucositis, taste changes, photosensitivity, cardiac toxicity
ice chips 30 mins before infusion to reduce risk of mucositis
hand foot syndrome
Gemcitabine (Gemzar)
Antimetabolite (acts as false metabolite, S- phase), Pyrimidine antagonist
IV
lung, breast, sarcoma, pancreas, ovaries, bladder, NHL
M, N, V, rash, flu-like symptoms
pulmonary toxicity
Hydroxyurea (Hydrea)
Antimetabolite (acts as false metabolite, S- phase)
Oral
H&N, ovaries, blood disorders, CML
M, N, V, D, mucositis
darkening or thickening of the nails
Mercaptopurine (6-MP)
Antimetabolite (acts as false metabolite, S- phase)
oral- NO dairy
ALL, APL, lymphoma, ulcerative colitis/ Crohn’s
M, N, V, D, mucositis
hepatic toxicity, hyperuricemia
Methotrexate (MTX)
Antimetabolite (acts as false metabolite, S- phase)
IM, IV, IT, Oral
H&N, osteosarcoma, breast, bladder, NHL, ALL, rheumatoid arthritis
M, N, mucositis- oral and GI ulcerations, photosensitivity
Renal and hepatic toxicity
Pemetrexed (Alimta)
Antifolate antimetabolite (acts as false metabolite, S- phase)
IV
lung cancer, mesothelioma
M, N, V, D, fatigue, rash
***Folic acid and vitamin B12 are used to minimize some of the side effects of pemetrexed.
Thioguanine (6- TG)
Antimetabolite (acts as false metabolite, S- phase)
Oral
AML, CML
M, N, V, D, mucositis
hepatic and renal toxicity
Bleomycin (Blenoxane)
Antitumor Antibiotic (blocks cell division by messing up DNA/ preventing RNA synthesis)
IV, SC, IM
H&N, melanoma, squam skin cancer, cervix, vulva and testes, HD, NHL, malignant pleural effusions
hyperpigmentation, nail and skin changes, hypersensitivity infusion rxn
pulmonary and renal toxicity
Dactinomycin (Actinomycin D)
-think peds
Antitumor Antibiotic (blocks cell division by messing up DNA/ preventing RNA synthesis)
IV
Ewing Sarcoma, rhabdomyosarcoma, Wilms tumor, testicular cancer
M, N, V, D, mucositis, anorexia, alopecia
Mitomycin- C (Mutamycin)
Antitumor Antibiotic (blocks cell division by messing up DNA/ preventing RNA synthesis)
IV
H&N, esophagus, lung, stomach, pancreas, bladder, anus
M, N, V, D, mucositis, anorexia, alopecia
pulmonary and renal toxicity
Daunorubicin (Daunomycin)
Anthracycline Antitumor Antibiotic (blocks cell division by messing up DNA/ preventing RNA synthesis)
IV
ALL, AML, APL
M, N, V, D, mucositis, anorexia, hyperuremia, red urine, hyperpigmentation, alopecia
cardiotoxicity
Doxorubicin (Adriamycin)
Anthracycline Antitumor Antibiotic (blocks cell division by messing up DNA/ preventing RNA synthesis)
IV
squam H&N, lung, breast, stomach, liver, ovaries, prostate, sarcomas, NHL, HD, MM, ALL, AML
M, N, V, D, mucositis, anorexia, hyperpigmentation, red- orange urine, alopecia
cardiotoxicity, hand foot syndrome
avoid black cohosh
Doxorubicin Liposomal (Doxil)
Anthracycline Antitumor Antibiotic (blocks cell division by messing up DNA/ preventing RNA synthesis)
IV
Aids- related kaposi sarcoma, breast, ovaries and other solid tumors
M, N, V, D, mucositis, hyperpigmentation, alopecia, red- orange urine, infusion rxn
cardiotoxicity, hand foot syndrome
Epirubicin (Ellence)
Anthracycline Antitumor Antibiotic (blocks cell division by messing up DNA/ preventing RNA synthesis)
IV
Breast
M, N, V, D, mucositis, red urine, alopecia, skin rash
cardiotoxicity
Idarubicin (Idamycin)
Anthracycline Antitumor Antibiotic (blocks cell division by messing up DNA/ preventing RNA synthesis)
IV
AML, ALL, CML, MDS
M, N, V, D, mucositis, red urine, alopecia, elevation of liver enzymes
cardiotoxicity, hand foot syndrome
Etoposide (Vespid, VP-16)
Epidophyllotoxin (Damages cells in late S/ early G2 phase, inhibits topoisomerase II)
IV, Oral
lung, stomach, uterus, bladder, prostate, germ cell, HD/ NHL
M, N, V, mucositis, anorexia, hypersensitivity rxn, alopecia, orthostatic HTN, yellowing of skin and eyes
metallic taste at infusion, Diarrhea ***
Teniposide (Vumon, VM- 26)
Epidophyllotoxin (Damages cells in late S/ early G2 phase, inhibits topoisomerase II)
IV
childhood ALL
M, N, V, hypotension, pulmonary toxicity
Paclitaxel (Taxol)
Taxane (M-phase, microtubule agent that prevents mitosis)
IV
H&N, esophagus, lung, breast, pancreas, ovaries, prostate, bladder
M, N, V, D, mucositis, alopecia, hypersensitivity rxn
arthralgia/ myalgia, peripheral neuropathy, swelling of feet and ankles
Docetaxel (Taxotere)
Taxane (M-phase, microtubule agent that prevents mitosis)
IV
H&N, lung, breast, stomach, pancreas, bladder, ovaries, prostate, sarcomas
M, N, V, D, mucositis, hair and skin changes, alopecia, hypersensitivity rxn, peripheral neuropathy
fluid retention syndrome
avoid black cohosh
Paclitaxel Protein Bound (Abraxane)
Taxane (M-phase, microtubule agent that prevents mitosis)
IV
NSCLC, breast, pancreas
M, N, V, D, mucositis, alopecia, eye problems, peripheral neuropathy
arthralgia/ myalgia, swelling of the feet and ankles
Vincristine (Oncovin)
Vinca Alkaloid (bind to protein tubulin, disrupt mitotic spindle formation, prevent mitosis)
IV
brain and thyroid cancers, neuroblastoma, Wilms’, Ewing Sarcoma, rhabdomyosarcoma, ALL, AML, HD, NHL
M, N, mucositis, taste changes, SIADH, hypersensitivity rxn, alopecia
abd cramps, constipation, jaw pain
Vinblastine (Velban)
Vinca Alkaloid (bind to protein tubulin, disrupt mitotic spindle formation, prevent mitosis)
IV
H&N, lung, breast, testes, bladder, sarcomas, ND, NHL, blood disorders
M, mucositis, stomatitis (sore mouth), HTN, alopecia
constipation, taste changes, jaw pain
Vinorelbine (Navelbine)
Vinca Alkaloid (bind to protein tubulin, disrupt mitotic spindle formation, prevent mitosis)
IV
NSCLC, breast, ovaries, HD
M, N, V, stomatitis, anorexia, alopecia, transient elevated liver function tests
Constipation
Targeted Therapy
Specific to tumor type or concentrate on a genetic change
falls into 2 categories- acts on specific genes or proteins in cancer cells OR acts on tissues/ environment r/t cancer growth
ex: Monoclonal antibodies and small- molecule drugs
Targeted Therapy Side Effects
Different side effects than chemo/ RT
vascular, coagulatory, dermatologic, immunologic, ocular, pulmonary toxicities
Monoclonal Antibodies
Target specific receptors on the outside of the cell to disrupt cell function and cause apoptosis
used alone of in conjunction with other therapies, can be used as vehicles for radioactive molecules (tositumomab)
includes immune checkpoint inhibitors like pembrolizumab (keytruda) and nivolumab (Opdivo)
BRAF V600E
Cell growth signaling protein
CD20
Ibrutumomab (Zevalin)
B-lymphocyte antigen CD20
IV
NHL, follicular lymphoma
M, Asthenia (weakness), infections, mild N/V, cough, dyspnea, infusion rxn
CD20
Rituximab (Rituxan)
B-lymphocyte antigen CD20
IV
NHL, CLL
M, mild N/V, tumor lysis syndrome, possible infusion rxn, skin rxn
EGFR
Cetuximab (Erbitux)
epidermal growth factor receptor
IV
mColorectal, NSCLC, squam H&N, squam skin
N, V, D, anorexia, pulmonary toxicity, skin rash, pruritis, possible infusion rxn
hypomagnesemia
EGFR
Panitumumab (Vectibix)
epidermal growth factor receptor
IV
colorectal
Diarrhea, pulmonary toxicity, acneiform skin rash, pruritis, possible infusion rxn, malaise
hypomagnesemia
ERBB2
Pertuzumab (Perjeta)
human epidermal growth factor receptor 2
IV
ERBB2+ breast cancer
M, N, V, D, rash, possible infusion reaction
ERBB2
Trastuzumab (Herceptin)
human epidermal growth factor receptor 2
IV
ERBB2+ breast cancer, gastric cancer
M (rarely), N, V, D (all mild), cardiotoxicity, pulmonary toxicity, possible infusion rxn
ERBB2
Ado- trastuzumab emantansine (Kadcyla)
human epidermal growth factor receptor 2
IV
ERBB2+ metastatic breast cancer
M, N, peripheral neuropathy, increased liver enzymes, decreased serum potassium, possible infusion rxn
PD-1/ PD- L1
Ipilimumab (Yervoy)
programmed cell death ligand 1
IV
melanoma
N, V, D, anemia, rash, pruritis, pulmonary symptoms
PD-1/ PD- L1
Nivolumumab (Opdivo)
programmed cell death ligand 1
IV
melanoma, NSCLS, renal cell cancer
M, N, V, C, colitis, pruritis, pulmonary symptoms, pneumonia
hyponatremia, hypokalemia, hypomagnesemia
PD-1
Pembrolizumab (Keytruda)
programmed cell death ligand 1, for tumors that express PD-L1
IV
melanoma, NSCLC, squam H&N, endometrial
Anemia, N, pruritis, pulmonary symptoms, increased liver enzymes
hyponatremia, hypoalbuminemia, hyperglucemia
RANKL
Denosumab (Xgeva OR Prolia)
receptor activated nuclear factor KappaB ligand
IV
Xgeva: bone mets, giant cell tumor of the bone
Prolia: osteoporosis with high risk of fracture
N, V, D, hypocalcemia, osteonecrosis of the jaw
CD52
Alemtuzumab (Campath)
IV
CLL
M, N, V, poss infusion rxn
VEGF
Vascular endothelial growth factor- small molecule drug, angiogenesis inhibitor
recognizes and binds to VEGF, thus stopping it from activating the VEGF receptor. This action helps to arrest endothelial cell proliferation and angiogenesis
Side Effects of Monoclonal Antibodies
infusion related symptoms- flushing, chills, fever, fatigue, headache, dyspnea, HTN/ hypotension
Muscular-skeletal side effects like aches and pains
skin- related changes like rash, facial erythema, hand foot syndrome
GI effects- mouth sores, N, V, D, decreased appetite
Small Molecule Drugs
Protein targeted agents or angiogenesis inhibitors
PTA- Uses small molecules that penetrate malignant cell membranes to interact with specific areas of the target proteins
AI- hinder formation of new blood vessels in primary and metastatic tumors
Side Effects of Angiogenesis Inhibitors
HTN, arterial thromboembolic events (MI, stroke, angina), nosebleeds, hematuria, GI bleeding, vaginal bleeding, GI perforation
Some people can develop hypothyroidism
Proteinuria occurs in 1/3 of patients treated with bevacizumab
Immunotherapy
AKA biotherapy or biological therapy
treatment to boost or restore the ability of the immune system to fight cancer infection
consists of substances made by the body or made in a lab
Ex. monoclonal antibodies, small molecule drugs or long lasting cancer vaccines (HPV and Hep-B)
Tyrosine Kinase Inhibitors
Tyrosine kinases are involved in tumor growth, angiogenesis, and metastasis
Ex. Imatinib (Gleevac), Crizotinib (Xalkori), Erlotinib (tarceva- avoid green tea)
mTOR Inhibitors
Mammalian target of rapamycin (mTOR) inhibitors: block angiogenesis by preventing the release of vascular endothelial growth factor (VEGF) and platelet- derived growth factor (PDGF), thus blocking tumor cell proliferarion and causing cell death
Ex. Temsirolimus (Torisel), Everolimus (affinitor)
Proteasome Inhibitors (think MM)
Inhibit breakdown of intracellular proteins and disrupt the proteasome pathway
Ex. Bortezomib (Velcade- MM, mantle cell lymphoma)
BRAF Inhibitors
target the mutant form of BRAF protein
Ex. Vemurafenib (Zelboraf)
Bevacizumab (Avastin)
mColorectal cancer, NSCLC, mBreast, glioblastoma, mrenal cell cancer
generalized weakness, pain, abdominal pain, N, V, reduced appetite, upper respiratory infection, low white cell count
Lenalidomide (Revlimide)
Ubiquitin E3 Ligase cereblon- interacts with and targets this enzyme to degrade Ikaros transcription factors IKZF1 and IKZF3.
Inhibits angiogenesis, tumor secreted cytokines, and tumor proliferation
MM, mantle cell lymphoma, MDS
N, V, C, D, rash, tiredness, fever, itching
Thalidomide (Thalomid)
Mechanism not fully understood- inhibits tumor angiogenesis and pro-inflammatory tumor secreted cytokines (TNF- a, IL1B, IL-6)
MM, RCC, glioblastoma multiforme
headache, dizziness, drowsiness, weakness, anxiety, agitation, confusion, tremors, muscle weakness, wt gain or loss, rash, dry skin
Nonspecific Immunotherapy
stimulates broad immune response
fatigue, N, V, D, flu- like symptoms, fever, chills, headache, arthralgias/ myalgias
Ex. Interferon- A, Interleukin-2
Chimeric Antigen Receptor T-cell Therapy (CAR-T)
Collects patients own T-cell lymphocytes and uses them to treat cancer.
Obtained through apheresis, genetically modded in a lab to have a CAR site on surface so they can recognize antigens on targeted tumor cells
S/E: cytokine release syndrome (N, headache, chills fatigue) and neuro symptoms like confusion, aphasia, weakness and seizures
Hormone Therapy
AKA endocrine therapy is used to treat horomone sensitive cancers
- stopping or reducing the body’s ability to produce hormones
- interfering with or blocking hormone receptors
- substituting chemically similar agents for active hormones but that can’t be used by the tumor
Selective Estrogen Receptor Modulators (SERMs)
nonsteroidal antiestrogen agents that compete with estrogen for binding to estrogen receptors
Ex: Tamoxifen citrate (Novaldex), Toremifene (Fareston), raloxifene (Evista)
SERM indications and side effects
Tamoxifen/ Toremifene: breast cancer
Raloxifene: osteoporosis or post- meno atrisk for breast cancer
Menstrual symptoms (hot flashes, sweating, nausea, menstrual irregularities, mood changes, dec libido, fatigue), thromboembolic complications, skin changes, rash, joint aches and pains
fluid retention and peripheral edema
wt gain
Aromatase Inhibitors
Block production of estrogen by inhibiting conversion of adrenal androgens to estrogen.
primarily used in post menopausal women because pre-menopausal produce too much aromatase to block.
used for breast cancer
ex anastrozole (arimidex), letrozole (femara), exemaestane (Aromasin)
Aromatase inhibitor side effects
hot flashes, arthralgias, mild N/V, asthenia, thromboembolic events, HTN (letrozole), fever, malaise, myalgias
Progesterones
possess antiestrogenic effects and inhibit the stability, availability and turn over of estrogen receptors
Ex. Megace (megesterol acetate)
Used in breast, endometrial, renal cell cancers
Prescribed as an app stimulant in cancer and HIV/ AIDS
Progesterone side effects
Wt gain (fluid retention)
thromboembolic events
N/V
menstrual bleeding, hot flashes, sweating and mood change
hyperglycemia
Antiandrogens
These bind to androgen receptors and block the effects of testosterone in androgen- sensitive cancer cells
Ex. Bicalutamide (casodex), Flutamide (Eulexin)
used to treat prostate cancer
Antiandrogen side effects
Wt gain
hot flashes, fatigue
decreased libido, impotence
bone pain
What are Luteinizing Hormone-releasing Hormone (LHRH) agonists
synthetic proteins which are similar to naturally occurring LHRH and signal the pituitary to stop producing luteinizing hormone. This results in the suppression of testosterone to manage the growth and spread of prostate cancer.
Can also be used to suppress ovarian function by interfering with ovarian signals to the pituitary to produce estrogen
Ex. Leuprolide acetate (Lupron) and goserelin (Zoladex)
LHRH agonist side effects
hot flashes, fatigues, headaches
bone pain, muscle weakness
decreased libido, impotence
gynecomastia
