common toxicities in systemic anticancer treatment Flashcards
what are the hormone sensitive tumors
sex hormone positive:
breast cancer
endometrial cancer
prostate cancer
TSH positive :
differentiated thyroid cancer
steroids:
lymphoma
leukemia
what are the AE of steroids
GOT steroids
gastritis
Elevation of blood glucose
osteoporosis with prolonged use
what are the diffeerent typees of hormonal therapies
selective estrogen receptor modulator - Tamoxifen and Raloxifen
Aromatase inhibitors
GnRH agonists
Anti-Androgens - flutamide
what are the types of aromatase inhibiitors
Letrozole.
Anastrozole.
Exemestane
what ar the types of GnRh agonsits
Leuprolide, goserelin, triptorelin and histrelin
what are the AE associated with Tamoxifen
tamoxifen - selective oestrogen receptor modulator
Hot flushes
VTE
Endometrial carcinoma
what are the management strategies for thee AE of tamoxifen
Hot flushes - life style changes and SSRI , paroxetine and fluxetine to be avoided - opt for Venlafaxine
VTE- caution with other risk factors and treat accordingly
Endometrial carcinoma - routine screening is not recommended, investigate any irregular vaginal bleeding in premenopausal patients or any postmenopausal bleeding with endometrial biopsy
management of cardiovascular events , arthralgia and osteoporosis , sexual dysfunction in tamoxifen use
CVD - routinee sccreeniing , checkk HTN, lipids and metabolic syndrome
Osteoprosis - BMD follow up , administration of Vitt D 800 iu and CA 1200 iu , exeersice and NSAIDs
Sexual dysfunction - biopsychosocial approach , education
lubricants and lidocaiine
mngmnt of toxicities in ET in prostate cancer
CVD and embolic events - life style modification , consider GnRh agonists if significantly affected
osteoporosis - as with females
Sexual dysfunction - including decreased libido, erectile dysfunction , consider intermittent ET drug therapy with phosphodiesterase 5 inhibitors
what are the common AEs associated with targeted therapies
Anti-EGFR: erlotinib gefitinib
skin toxicity tx: skin moisturizers
Anti VEGF : bevacizumab
Bleeding
HTN
VTE
delayed wound healing
GI perforation
what is the treatment for AE due to anti-VEGF ?
for HTN : daily BP measurements
the goal is less than 150/100
treat with ACE inhibitors and angiotensin II receptor blocker
severe HTN of over 200/100 is an indication for permanent treatment cessation
for GI perforation - discontinue bevicazimub for 60 days before surgery and can continue again 28 days after the surgery
what are thee AEs of immuno-therapy
pneumonitis
hepatitis
thyroid dysfunction
what aree the classifications of AE associated with systemic anti cancer treatments according to timing
immediate adverse effects - within 30 minutes
short term adverse effect - within hours to days
medium to long term adverse effects - after 7 days of administration
what are the types of immediate adverse effects ?
local site reaction - local irritation , thrombophlebitis
systemic reactions - flushing, hypotension, anaphylaxis
what are the types of short term adverse effects ?
gastrointestinal side effects - mucositis , nausea and vomiting , constip diarrhea and anorexia
hematopoetic side effects - myelosuppression causing cytopenia
most important short term adverse side effects
tumor lysis syndrome
what canceers aree highly associatedd with TLS
leukemia and lymphoma
what are the labs for TLS
in sensitive bulky tumors
hyperuricemia,
hyperkalemia - arrythmia
hyperphosphatemia - kiidney affection
hypocalcemia.
what are the medium to long term adverse effects
alopecia
liver dysfunction
nephrotoxicity
cardiac toxicity
gonadal damage
pulmonary fibrosis
Tx for TLS
hydration in prophylaxis and in treatment
along with allopurinol
dialysis may need to be initiated
what are the types of cardiotoxicity associated with cancer treatment
cardiotoxicity type I and type II
type I - early irreversible and dose dependent
type II - delayed reversible and dose independent
cancer treatments associated with type I vs type II cardiotoxicity
type I - chemoth such as doxorubicin (anthracycline )
type II - targeted such as trastuzumab (herceeptin )
methods off prevention of cardiotoxicity in cancer treatment
1- avoid anthracyclines in the elderly
2- proper dose calculation
3- avoid adding 2 cardioitoxic agents together - ( radiotherapy and anthracyclines
or
trastuzumab and anthracyclines )
3- use of beta blockers and acee inhibitors
when should trastizumab be discontinued ?
if LEVF is reduced by 10% or more
or if it reaches a level below 55%
treatment of cytopenia
1- Dose reductions or modifications of chemoth/ prompt ttt in acute leukaemias.
2- If thrombocytopenia is due to hypersplenism then perform splenectomy.
3- Use of growth factors (GFs).
4- If severe transfusion therapies are needed.
tx of anemia duee to cancer ?
1- pRBCs transfusion
2- Vit B12, Fe
3- rHuEPO
what is febrile neutropenia ?
Defined as Fever > 38.5° C on two or more occasions with neutropenia < 500/mL
associated with herpetic lesions and sites of absceess
treatment for grade I+II diarrhea vs grades above II diarrhea
grade I and II :
1- Oral hydration
2- Dietary modifications (e.g. eliminating all lactose-containing products and high-osmolar dietary supplements)
3- Anti diarrheal as Loperamide (GI morphine receptors +++)
Grades above II :
1- Hospital admission & IV fluids
2- Anti diarrhea as Octreotide
3- Antibiotics (e.g. fluoroquinolone).
4- These patients should be evaluated with CBC, electrolytes & a stool work-up evaluation for blood, Cl.difficile, Salmonella, E.coli, Campylobacter and infectious colitis
