Lung Cancer Toxicities

Question 1

Cisplatin

Answer 1

nephrotoxicity
(pre and post 1 - 2 L NaCl, Mg and K repletion as needed)

Highly emetogenic: acute and delayed

Neurotox: watch for peripheral neuropathy
(this is dose dependent)

Ototox

Bone Marrow Suppression: mild/moderate

Question 2

Carboplatin

Answer 2

myelosuppression (DLT)

Moderate emetogenecity

Hypersensitivity
(risk increases with more cycles, can result in rash/anaphylaxis, in which case you would add diphenyhydramine, famotidine, and dex, as well as slow the infusion rate)

Question 3

Gemcitabine

Answer 3

Myelosuppression (DLT)

Rash: pruritic maculopapular

Flu-like sx

Moderate Emetogenic

Peripheral edema

Transaminitis

Question 4

Vinorelbine

Answer 4

DO NOT GIVE INTRATHECALLY

Neuropathy (constipation and urinary retention can occur too)

Myelosuppression
(especially high in combo with cisplatin)

Vesicant
(treat with hyaluronidase + heat packs)

Bowel obstruction 
(treat with aggressive bowel regimen)

Question 5

Pemetrexed

Answer 5

Fatigue (DLT)

Skin rash
(prophylax with dex starting 1 day prior)

Myelosuppression
(give folic acid 1 week prior to first dose and 21 days after last dose, as well as vitamin B12 1 week prior and then q3cycles

Avoid if CrCl < 45 mL/min

Do not take with NSAIDs, because it might increase tox by decreasing pemetrexed clearance.

Question 6

Erlotinib

Answer 6

Acneiform rash means it’s working!!: within 1 week of treatment
(prophylax with moisturizer and use sunscreen if going outside;
Treat Mild: topical hydrocortisone or Clindamycin gel x14 days max

Treat Moderate: topical steroids + doxy/minocycline BID

Treat Severe: moderate + dose reduction

Can cause N/V/D

COUNSEL: take 1 hour before or 2 hours after food

Needs to have gut acidity do NOT take with PPIs, and space H2RAs and antacids.

Can increase LFTs and Tbili

Can cause tiredness

Dose change required if current smoker

Question 7

Crizotinib

Answer 7

Fatigue (DLT)

Visual disturbances: starts 2 weeks after tx & should be mild and go away
(report retinal floaters to MD)

Increased ALT

Question 8

Pembrolizumab, atezolizumab, nivolumab

Answer 8

autoimmune:
colitis
rash
hepatitis

DDI with immunosuppressants