Colon Cancer Toxicities Flashcards
Understand toxicities of commonly used colon cancer agents
FOLFOX6 regimen
5-FU
Leucovorin
Oxaliplatin
std of care for adjuvant stage III and high risk stage II
FOLFIRI regimen
5-FU
Leucovorin
Irinotecan
for metastatic, stage IV disease
if K-RAS and/or N-RAS positive, which drugs CAN’T you use?
cetuximab
panitumumab
(resistance is conferred by these mutations)
5-FU
mucositis & diarrhea
(better if you only do IV infusion, and not IV push/bolus)
hand/foot syndrome
(better if you decrease the dose)
myelosuppression
(better if you only do the IV infusion and not the IV push/bolus)
Oxaliplatin
Hypersensitivity: late with drug accumulation
(treat with epi, corticosteroids, antihistamines)
Laryngeal Spasm: early in tx
(pre-treat with lorazepam .5 - 1 mg IV/PO)
Sensory neuropathy (DLT) (better if you decrease the dose)
N/V/D
Myelosuppression
Irinotecan
Diarrhea: early
(premed with atropine 0.125 mg)
Diarrhea: late
(treat with loperamide, call MD if goes on > 24 hrs)
Transient LFT and Tbili increase
Myelosuppression
Capecitabine
Hand/foot syndrome
(reduce with socks/gloves and lotions/emollients)
Diarrhea
Increased LFTs and Tbili (monitor)
Myelosuppression
Bevacizumab
GI perforation: BOWEL BREAK
(do not give this drug if patient has had surgery within 28 days)
Decreased wound healing: BOO BOOs
Risk of arterial thromboembolism: BLOOD BLOB
Hypertension: BP
(don’t use this med if BP >160/100)
Proteinuria
(do UA prior to dose, do not give if 2+)
Infusion reaction
Cetuximab
Acneform skin rash (DLT)
(prophylax with skin moisturizer and sunscreen)
(treat with hydrocortisone 1% cream OR doxy 100mg PO BID, can reduce or d/c dose)
Infusion reaction
(premed with diphenhydramine IV)
Hypomagnesemia
Panitumumab
Acneform skin rash (DLT)
(prophylax with skin moisturizer and sunscreen)
(treat with hydrocortisone or doxycycline BID, d/c or reduce dose if doesn’t get better)
Infusion reaction (do not need premeds)
Hypomagnesemia
