Chemotherapy Flashcards
Verzenio (abemaciclib) taken by mouth for breast cancer. What should you inform your patient of.
Most common side effect is diarrhea
Other: nausea, vomiting, consitpation, mucositis, anorexia
take by mouth at the same time each day, with or without food
AC : Adriamycin (doxorubicin) + Cytoxan (cyclophosphamide)
Breast
most common: nausea/vomiting
less common: diarrhea, mucositis, anorexia
Doxorubicin (Adriamycin)
Part of AC for breast cancer and RCHOP
liver, lung, ovaries, prostate, gastric, NHL< HL, MM, ALL, AML, SCC, head/neck, sarcoma
most notable: nausea and vomiting
less notable: diarrhea, mucositis, anorexia
Other: red urine, cardiac toxicity, hand-foot
Cyclophosphamide (Cytoxan)
Lung, ovaries, testes, CLL, NHL, MM, part of AC for breast and RCHOP
most notable: nausea, vomiting
less notable: anorexia, diarrhea, mucositis
Toxicities: Cardiac, SIADH, Bladder/hemorrhagic cystitis –> hydration (3 L oral/day), empty bladder Q3 hr when awake—> Mensa given with high doses to prevent hemorragic cycstitis
increases effect of anticoagulants–> may need to be decreased
ABVD: Adriamycin (doxorubicin), bleomycin, vinblastine, dacarbazine
Hodgkin lymphoma
most common: nausea, vomiting, constipation
less common: diarrhea, mucositis, anorexia, taste changes
Doxorubicin (Adriamycin)
Part of AC for breast cancer and RCHOP
liver, lung, ovaries, prostate, gastric, NHL< HL, MM, ALL, AML, SCC, head/neck, sarcoma
most notable: nausea and vomiting
less notable: diarrhea, mucositis, anorexia
Other: red urine, cardiac toxicity, hand-foot
Bleomycin (Blenoxan)
HD, NHL, head/neck, squamous cell cancers of skin, cervix, vulva, testes, melanoma, malignant pleural effusions
most notable: mucositis
less notable: n/v, anorexia
toxicities: pulmonary, renal
Vinblastine (Velban)
Bladder, breast, testes
mucositis, stomatitis, constipation taste changes
Methotrexate (MTX)
NHL, ALL, bladder, breast, head/neck, osteosarcoma, gastric, lung
most notable: mucositis, GI ulcerations
less notable: nausea, anorexia, diarrhea, vomiting
Avoid folic acid during treatment (per old book) Avoid alcohol
Toxicities: renal, hepatic
DTIC (dacarbazine)
HD, melanoma, neuro, sarcomas, medullary thyroid cancer
side effects: nausea, vomiting, anorexia
Toxicity: central nervous system
Armidex (anastrozole)
Breast Cancer
most common: increased appetite, weight gain
less common: nausea, vomiting
long-term: decreased bone mineral density and hyperlipidemia
Tecentriq (atezolizumab)
metastatic urothelia, NSCLC, breast, melanoma
most notable: diarrhea
less notable: anorexia, nausea, constipation, vomiting
Bexoratene (Targretin)
Oral med, take with foods
Interactions: grapefruit juice increases concentrations and toxicities
Limit Vit A to < or equal to 1,500 IU/day to avoid possible drug toxicity
Inlyta (axitinib)
PO for advanced renal cell
most notable- diarrhea
less notable: anorexia, n/v, constipation, heartburn, HTN
CYP3A4 inducers (decrease drug activity)–> St.Johns Wort, Phenobarbital
CYP3A4 inhibitors (increase drug activity)–> grapefruit juice, Ketocanozole, erythromycin
Vidaza (azacitidine)
CML, MDS
most notable: nausea, diarrhea, constipation
less notable: vomiting, anorexia
Bendeka or Treanda (bendamustine)
B-cell lymphoma, NHD, CLL
Nausea, vomiting, diarrhea
Temozolomide (Temodar)
PO-Take on an empty stomach (1 hour before or 2 hours after meals or at bedtime) to reduce stomach upset.
astrocytoma, glioblastoma, brain tumors
More notable- nausea, diarrhea, taste changes
less notable- anorexia, mucositis
Sorafenib (Nexavar)
PO- without food 1-2 hours before eating
Renal cell, Thyroid, hepatocellular
more notable- diarrhea
less notable- anorexia, nausea, vomiting, constipation
CYP3A4 inducers (decrease drug activity)–> St.Johns Wort, Phenobarbital , dexamethasone
Tarceva (Erlotinib)
PO- on empty stomach–> 1 hour before or 2 hours after eating
metastatic NSCLC, unresectable pancreatic
side effects: diarrhea, n/v, poor appetite, fatigue
CYP3A4 inducers (decrease drug activity)–> St.Johns Wort, Phenobarbital
CYP3A4 inhibitors (increase drug activity)–> grapefruit juice, Ketocanozole, erythromycin
Tamoxifen (Novaldex)
PO- same time each day with full glass of water
Breast and ovarian
nausea
Milk Thistle should be used with caution
Avastin (bevacizumab)
biosimilar= Mvasi
metastatic colorectal, breast, renal cell, glioblastoma, NSCLC
Nutrition side effects: abdominal pain, nausea, vomiting, anorexia, mucositis, diarrhea, constipation
other: HTN
Imatinib (Gleevec)
PO- with large glass of water after a meal
If pills are hard to swallow, pt may dissolve in apple juice, then followup by large glass of water
CML, gastrointestinal stromal tumor (GIST), MDS, ALL
most notable: nausea and vomiting
Less notable: diarrhea, anorexia, constipation
CYP3A4 inducers (decrease drug activity)–> St.Johns Wort, Phenobarbital
CYP3A4 inhibitors (increase drug activity)–> grapefruit juice, Ketocanozole, erythromycin
Palbociclib (Ibrance)
PO- whole with water within 30 min of meal
postmenopausal breast, ER+, HER2- advanced
more notable: nausea, diarrhea
less notable: mucositis, anorexia, vomiting
Capecitabine (Xeloda)
PO- after food within 30 min of meal
Colorectal, breast, esophageal, gastric, hepatobiliary, NET, pancreatic, ovarian, falopian, peritoneal
most notable: diarrhea, mucositis
less notable: n/v, anorexia, constipation
Notes: altered coagulation when taken with warfarin–> monitor closely
Vit B6 (50-100 mg) 2-3x/day may reduce incidence and severity of hand-foot syndrome
CAPOX: capecitabine (xeloda), Oxaliplatin
Colorectal
most notable: diarrhea, cold sensitivity, mucositis
less notable: abdominal cramping, anorexia, n/v, taste changes
Carboplatin (Paraplatin)
breast, bladder, cervix, esophagus, Head/neck, lung ovarian, sarcoma
most notable: nausea, vomiting, taste changes
less notable: diarrhea, constipation, mucositis
other: hypomagnesemia, renal toxicity
Cisplatin (Platinol, CDDP)
Bladder, cervix, esophagus, head and neck, lung, prostate, ovaries, gastric, testes, HNL
Major side effect: nausea and vomiting
less notable: taste changes, anorexia
other: rigorous oral hydration is necessary to prevent nephrotoxicity.
causes low magnesium, low calcium, low potassium, SIADH, ototoxicity, peripheral neuropathy
Elderly, those with impaired renal function and hypomagnesmia at baseline are at risk.
Mannitol may be given with Cisplatin to reduce renal toxcitity
Carfilzomib (Kyprolis)
MM
most notable- diarrhea
less notable: n/v, constipation, anorexia
Carmustine (BCNU)
Brain, HL, NHL, MM, cutaneous T-cell lymphoma
nutrition side effects: nausea, vomiting
toxicities: renal, hepatic, pulmonary
Cetuximab (Erbitux)
metastatic colorectal, NSCLC, squamous cell of head/neck and skin
most notable: Nausea, vomiting, diarrhea, anorexia
less notable: mucositis
Monitor serum magnesium and calcium levels closely for drops –> at risk populations are elderly and those who have previously been on oxaliplatin
Toxicity: pulmonary
CyBorD
Cyclophosphamide- IV or PO
Bortezomid- IV
Dexamethazone - PO
MM
most notable: Nausea, vomiting
less notable: diarrhea, mucositis, xerostomia, constipation, anorexia
other: hyperglycemia
Cyclophosphamide (Cytoxan)
Lung, ovaries, testes, CLL, NHL, MM, part of AC for breast and RCHOP
most notable: nausea, vomiting
less notable: anorexia, diarrhea, mucositis
Toxicities: Cardiac, SIADH, Bladder/hemorrhagic cystitis –> hydration (3 L oral/day), empty bladder Q3 hr when awake—> Mensa given with high doses to prevent hemorragic cycstitis
increases effect of anticoagulants–> may need to be decreased
Velcade (bortezomid)
MM, mentle cell lymphoma
most notable: diarrhea
Less notable: fatigue, n/v, constipation, anorexia
other: neuropathy
food drug interactions: Avoid green tea especially in capsule form,
CYP3A4 inhibitors/inducers may alter drug activity (St.Johns Wort, Grapefruit juice)
Dexamethasone (Decadron)
used to prevent allergic reactions, treatment of nausea, used in leukemia, lymphoma, MM
hyperglycemia, increased appetite, insomnia, heartburn, muscle weakness
RCHOP
Rituxan, Cytoxan, Adriamycin (doxorubincin), Oncovin, and Prednisone
NHL
most notable: nausea, constipation
Less notable: mouth sores, xerostomia, diarrhea, taste changes, anorexia
Rituximab (Rituxan)
part of RCHOP
NHL, CLL
mild nausea, vomiting
Cyclophosphamide (Cytoxan)
Lung, ovaries, testes, CLL, NHL, MM, part of AC for breast and RCHOP
most notable: nausea, vomiting
less notable: anorexia, diarrhea, mucositis
Toxicities: Cardiac, SIADH, Bladder/hemorrhagic cystitis –> hydration (3 L oral/day), empty bladder Q3 hr when awake—> Mensa given with high doses to prevent hemorragic cycstitis
increases effect of anticoagulants–> may need to be decreased
Doxorubicin (Adriamycin)
Part of AC for breast cancer and RCHOP
liver, lung, ovaries, prostate, gastric, NHL< HL, MM, ALL, AML, SCC, head/neck, sarcoma
most notable: nausea and vomiting
less notable: diarrhea, mucositis, anorexia
Other: red urine, cardiac toxicity, hand-foot
Vincristine (Oncovin)
leukemia, HL, NHL
constipation (may need stool softeners), abdominal cramps, nausea, taste changes, mucositis
CYP3A4 inducers (decrease drug activity)–> St.Johns Wort, Phenobarbital
CYP3A4 inhibitors (increase drug activity)–> grapefruit juice, Ketocanozole, erythromycin
Prednisone (Deltazone)
part of RCHOP
Hyperglycemia, increased appetite, heartburn, insomnia, muscle weakness, impaired wound healing
Cytarabine (Cytostar-U, ARA-C)
ALL, AML, CML, NHL
side effects: n/v, mucositis, anorexia, acute pancreatitis
Toxicities: neuro (lethargy, confusion), hepatic, pulmonary
Daratumumab (Darzalex)
MM
Nausea, anorexia, diarrhea, minimal risk for vomiting
Denosumab (Prolia and Xgeva)
Prolia- osteoporosis with high fracture risk
xgeva- bone mets
nausea, vomiting, diarrhea, hypocalcemia, osteonecrosis of jaw
Doxorubicin liposomal (Doxil)
AIDS related Kaposi’s sarcoma, breast, ovarian, other solid tumors
most notable: mucositis
less notable: nausea, vomiting, diarrhea
Other: red/orange urine, cardiotoxicity, hand-foot
Etoposide (Vepesid, VP-16)
lung, testicular, bladder, prostate, gastric, uterine, HL, NHL, brain tumors, Ewing’s Sarcoma
side effects: nausea, vomiting, mucositis, diarrhea, metallic taste during infusion
interactions: grapefruit and exotic oranges (Seville oranges, blood oranges)
Everolimus (Affinitor)
Renal, pancreatic, neuroendocrine, ER+ advanced breast
most notable: mucositis, esophagitis
less notable: diarrhea, N/V, anorexia
PO, with or without food
CYP3A4 inducers (decrease drug activity)–> St.Johns Wort, Phenobarbital
CYP3A4 inhibitors (increase drug activity)–> grapefruit juice, Ketocanozole, erythromycin
Exemestane (Aromasin)
breast
side effects: increased appetite, mild nausea, osteoporosis
Filgrastim (Neupogen and Zarxio)
Neutropenia prevention–> stimulates WBC production
side effect: nausea
Fulvestrant (Faslodex)
breast
nutrition related side effects not common but may include: N/V, constipation, diarrhea
Hydroxyurea (Hydrea)
PO- with water, may be dissolved in water
CML, essential thrombocytosis, melanoma, head and neck with radiation, refractory ovarian
side effects: N/V, diarrhea, mucositis, anorexia
Ipilimumab (Yervoy)
Melanoma
most notable: diarrhea
less notable: N/V
Lanreotide (somatuline depot injection)
Gastrointestinal, pancreatic, and neuroendocrine tumors
side effects: nausea, diarrhea
Lenalidomide (Revlimid)
PO: Swallow whole with water
MM, mentle cell lymphoma, MDS
most notable: diarrhea
less notable: N/V, constipation
Lenvatinib (Lenvima)
PO- with water, may be dissolved in water with or without food
Renal, thyroid, hepatocellular, advanced endometrial
most notable: diarrhea, nausea, vomiting
less notable: anorexia, mucositis, constipation, taste changes, dry mouth
other: HTN
Letrozole (Femeara)
PO- with or without food
Breast
increased appetite, wt gain
other: osteoporosis
Leuprolide (Lupron Depot)
Prostate, breast, ovarian, endometrial
no nutrition related side effects
Mitomycin-C (mutamycin)
Anus, bladder, breast, esophagus, head/neck, lung, pancreas, stomach
nausea, vomiting, mucositis, diarrhea, anorexia
Toxicities: pulmonary, renal
Nivolumab (Opdivo)
Melanoma, NSCLC, renal, classic HL, recurrent SCC of head and neck, SCLC, heptocellular, esophageal, gastric
most notable: diarrhea, colitis
less notable: N/V, constipation
Novaldex (Tamoxifen)
PO- with water, same time each day
breast, ovarian
nausea
Avoid antacids within 2 hours of taking
CYP3A4 inducers (decrease drug activity)–> St.Johns Wort, Phenobarbital
CYP3A4 inhibitors (increase drug activity)–> grapefruit juice, Ketocanozole, erythromycin
TCHP
Taxotere (doxetaxel)
Carboplatin
Herceptin
Perjeta
Breast
more notable: nausea, diarrhea, taste changes
less notable: anorexia, mucositis
Docetaxol (Taxotere)
part of TCHP
Bladder, breast, lung, prostate, stomach, Head and neck
most notable: diarrhea
less notable: nausea, vomiting, mucositis
other: peripheral neuropathy
Carboplatin (Paraplatin)
breast, bladder, cervix, esophagus, Head/neck, lung ovarian, sarcoma
most notable: nausea, vomiting, taste changes
less notable: diarrhea, constipation, mucositis
other: hypomagnesemia, renal toxicity
Pertuzumab (Perjeta)
part of TCHP
breast
nausea, vomiting, taste changes, anorexia
Trastuzumab (Herceptin or Kanjinti)
Part of TCHP
HER2+ breast, gastric
most notable: diarrhea
Less notable: nausea, vomiting
toxicities: cardio, pulmonary
Paclitaxel (Taxol)
Breast, ovarian, lung, bladder, prostate, melanoma, esophageal
most notable: diarrhea
less notable: N/V, mucositis
other: swelling of feet and ankles, peripheral neuropathy
NO MILK THISTLE
Paclitaxel protein bound (Abraxane)
Pancreas, breast, NSCLC, ovarian, fallopian, peritoneal
more notable:N/V, diarrhea, mucositis, anorexia
Less notable: constipation, taste alterations
Panitumumab (Vectibix)
Colorectal
diarrhea, nausea, vomiting
Pegfilgrastim (Neulasta)
biosimilar (Ziextenzo)
neutropenia prevention; stimulate WBC production
side effects: bone pain,
Pembrolizumab (Keytruda)
Melanoma, NSCLC, SCC, head and neck, endometrial
more notable: diarrhea
Less notable: nausea, vomiting, constipation, anorexia
Pemetrexed (Alimta)
Lung, mesothelioma
Nausea, vomiting, diarrhea, mucositis
Note: Folic acid (350-1000 ug PO 1 week prior to 1st treatment, continue daily throughout and post treatment.
Vit B12 1000 ug IM given every 3 cycles begin 1 week prior to treatment.
Procarbazine (Mutulane)
PO
HL, NHL, MM, melanoma, lung
more notable: nausea, vomiting
less notable: anorexia, mucositis, constipation, diarrhea
Note: Low-tyamine diet needed to prevent Hypertensive crisis
Foods that should be avoided if a patient is taking Procarbazine (Mutulane)
aged fermented foods:cheeses, yeast or meat extracts, fava or broad bean pods, smoked or picked meat, poultry, or fish, fermented sausage ( bologna, sausage, pepperoni), unfresh meat, or over-ripe fruit.
No alcohol, do not drink large amounts of caffeine- coffee, tea, chocolate
Regorafenib (Stivarga)
PO with low fat meal <30% of calories coming from fat
colorectal and heptocellular carcinoma
decreased appetite, nausea, mucositis, other: increased liver enzymes, hand-foot syndrome, decreased sodium, decreased calcium and phos
Some examples of an appropriate breakfast for a patient taking Regorafenib (Stivarga)
2 slices of white toast with 1 tablespoon of low-fat margarine and 1 tablespoon of jelly, and 8 ounces of skim milk (319 calories and 8.2 grams of fat)
or
1 cup of cereal, 8 ounces of skim milk, 1 slice of toast with jelly, apple juice, and 1 cup of coffee or tea (520 calories and 2 grams of fat)
Gemcitabine (Gemzar)
pancreas, lung, ovary, breast, bladder, NHL, sarcoma
most notable: nausea, vomiting, and diarrhea
less notable: mucositis, anorexia
Toxicity: Pulmonary
FOLFOX
Folinic acid (Leucovorin)
Flourouracil (5-FU)
Oxaliplatin
Colorectal
Nausea, vomiting, diarrhea, mucositis, anorexia, taste changes, cold sensitivity
Folinic acid (Leucovorin)
“FOL” in FOLFOX, FOLFIRINOX, and FOLFIRI
Colorectal, Head and neck, esophageal, GI cancers
N/V- rare
used to rescue from Methotrexate toxicity
Fluorouracil (5-FU)
Part of: FOLFOX, FOLFIRINOX, and FOLFIRI
Colorectal, gastrointestinal, head and neck, pancreas, stomach, ovaries, and unknown primary
most notable side effects: diarrhea, mucositis
less notable: N/V, taste changes, anorexia
Other: cardiotoxicity, hand-foot sydnrome
Notes: cyrotherapy for bolus to reduce mucositis
Vit B6 (50-100mg) 2-3 x/day may reduce hand/foot syndrome
Oxaliplatin (Eloxatin)
part of FOLFIRINOX, FOLFOX
Colorectal, pancreatic
most notable: N/V, cold intolerance, laryngopharyngeal dysethesia
less notable: diarrhea, anorexia, mucositis, constipation
other: neurotoxicity (neuropathy), hepatic toxicity
other: Vit B6 (50-100mg) 2-3 x/day may reduce hand/foot syndrome
FOLFIRI
Folinic acid (Leucovorin)
Flourouracil (5-FU)
Irinotecan (Campostar)
Colorectal
Nausea, vomiting, diarrhea, mucositis, anorexia, taste changes
Irinotecan (Campostar)
part of : FOLFIRI, and FOLFIRINOX
metastatic colon/rectum
most notable: diarrhea
less notable: N/V, anorexia, taste changes, mucositis, constipation
toxicity- hepatic
FOLFIRINOX
Folinic acid (Leucovorin)
Flourouracil (5-FU)
Irinotecan (Campostar)
Oxaliplatin
Pancreatic
nausea, vomiting, diarrhea, mucositis, anorexia, taste changes, cold sensitivity
St. Johns wort should be avoided with these chemotherapy agents.
Imatinib (Gleevec) and irinotecan
Milk thistle should be avoided with these chemotherapy agents
Rifampicin, Erlotinib, Paclitaxel
These two oral chemotherapies need to be taken on an empty stomach 1 hour before meal or 2 hours after.
Tarceva and Temodar and Nexavar
Mannitol
given with Cisplatin to reduce renal toxicity
These chemotherapy agents should be taken after food or meal (within 30) minutes of eating.
Capecitabine (Xeloda), Imatinib (Gleevec), and Palbociclib (Ibrance), Bexartoten (Targentin)
These need to be taken on an EMPTY stomach
Erlotinib (Tarceva)
Temozolomid (Temodar)
Sorafenib (Nexavar)
Chlorabucil (Leukeran)
Busulfan (Myleran
Oral Methotrexate
Dabrafenib (Tafinlar)
These need to be taken on am empty stomach, 1 hour before or 2 hours after eating
Tarceva, Temodar, Nexavar
