Malignancy: Cytotoxics Flashcards
Oral mucositis/ a sore mouth is a common complication of cancer chemotherapy; it is most ofen associated with what 3 agents/classes?
Fluorouracil
Methotrexate
The Anthracyclines like doxorubicin (also cardio with these)
To prevent oral mucositis with fluorouracil what can be helpful?
Good oral hygiene (rinsing the mouth frequently and effective brushing of the teeth with a soft brush 2–3 times daily) is probably beneficial. For fluorouracil, sucking ice chips during short infusions of the drug is also helpful.
Once a sore mouth has developed, treatment is much less effective. What are the options?
Saline mouthwashes should be used but there is no good evidence to support the use of antiseptic or anti-inflammatory mouthwashes. In general, mucositis is self-limiting but with poor oral hygiene it can be a focus for blood-borne infection.
Patients most at risk of tumour lysis syndrome are those with what malignancies?
- Non-Hodgkin’s lymphoma (especially if high grade and bulky disease).
- Burkitt’s lymphoma
- Acute lymphoblastic leukamia
- Acute myeloid leukamia.
Sometimes those with solid tumours. Basically the more blood related ones in general.
What can be predisposing factors to developing tumour lysis syndrome other than the type of malignancy present? (3)
- Pre-existing hyperuricaemia
- Dehydration
- Renal impairment
The features of tumour lysis syndrome include what? (6)
- HYPERkalaemia
- HYPERuricaemia
- HYPERphosphataemia
- HYPOcalcaemia
- Renal damage
- Arrhythmias
Hyperuricaemia, which may be present in high-grade lymphoma and leukaemia, can be worsened by chemotherapy and is associated with acute renal failure.
What (common) xanthine oxidase inhibitor should be started 24 hours before treating such tumours?
Allopurinol
Patient should also remain adequately hydrated.
Febuxostat is also a xanthine oxidase inhibitor which can be used but it is seen less commonly and is started TWO days before.
The dose of what drugs may need to be reduced to 1/4 of their original dose if allopurinol needs to be given concomitantly?
The dose of mercaptopurine or azathioprine should be reduced if allopurinol needs to be given concomitantly.
Hyperuricaemia, which may be present in high-grade lymphoma and leukaemia, can be markedly worsened by chemotherapy and is associated with acute renal failure. If allopurinol is not used what are the two alternatives?
Febuxostat: 2 days before cytotoxic therapy.
Febuxostat is another xanthine oxidase inhibitor.
Rasburicase, a recombinant urate oxidase, is licensed for hyperuricaemia in patients with haematological malignancy. It rapidly reduces plasma-uric acid concentration and may be of particular value in preventing complications following treatment of leukaemias or bulky lymphomas.
All cyctotoxic drugs except for which TWO can cause bone-marrow suppression?
All cytotoxic drugs except vincristine sulfate and bleomycin cause bone-marrow suppression.
Note: Ciclosporin is an immunosuppresant (not cytotoxic) which does not cause bone marrow suppression).
Bone-marrow suppression typically occurs 7 to 10 days after the administration of a cytotoxic drug, but this can be delayed for what drugs? (3)
Carmustine
Lomustine
Melphalan
Peripheral blood counts must be checked before each treatment with a cytotoxic drug which can cause bone-marrow suppression and doeses reduced or therapy delayed if the bone-marrow has not recovered.
Fever in a neutropenic patient requires immediate broad-spectrum antibacterial therapy. What is neutropenia defined as?
Neutropenia is defined as a neutrophil count of less than 1.06x10^9/litre.
In selected patients, the duration and severity of neutropenia can be reduced by the use of what?
Recombinant human granulocyte-colony stimulating factors.
Filgrastim etc.
Regimens that do not contain an alkylating drug (e.g. cyclophosphamide, carmustine, platinum-based drugs, decarbazine) or procarbazine may have less effect on fertility.
Those that DO contain an alkylating agent or procarbazine can have what effect on male fertility?
May cause permanent male sterility.
There has been no increase in fetal abnormalities or abortion rate recorded in patients who remain fertile after cytotoxic chemotherapy.
Drugs used in cytotoxic therapy can be divided according to their emetogenic potential. What are the mildy emetogenic treatments? (5)
- Fluorouracil
- Etoposide
- Methotrexate (less than 100mg/m^2)
- Vinca alkaloids
- Abdominal radiotherapy
Drugs used in cytotoxic therapy can be divided according to their emetogenic potential. What are moderately emetogenic treatments? (5)
- Taxanes (paclitaxel)
- Doxorubicin
- Cyclophosphamide (intermediate and low doses)
- Mitoxantrone
- Methotrexate (100-1200mg/m^2)
Drugs used in cytotoxic therapy can be divided according to their emetogenic potential. What are the highly emetogenic treatments? (3)
- Cisplatin
- Dacarbazine
- Cyclophosphamide (high doses)
For patients at a low risk of emesis, pretreatment with what may be used? (2)
Dexamethasone or lorazepam.
Acute symptoms: For patients at a high risk of emesis, what type of drug is given dexamethaone and aprepitant? (what type of drug is aprepitant?)
For patients at high risk of emesis, a 5HT3-receptor antagonist, usually given by mouth in combination with dexamethasone and the neurokinin receptor antagonist aprepitant is effective.
For delayed symptoms associated with moderately emetogenic chemotherapy, a combination of what can be used?
For delayed symptoms associated with moderately emetogenic chemotherapy, a combination of dexamethasone and 5HT3-receptor antagonist is effective; for highly emetogenic chemotherapy, a combination of dexamethasone and aprepitant is effective. Rolapitant and metoclopramide hydrochloride are also licensed for delayed chemotherapy-induced nausea and vomiting.
For delayed symptoms associated with highly emetogenic chemotherapy, a combination of what is effective?
For delayed symptoms associated with moderately emetogenic chemotherapy, a combination of dexamethasone and 5HT3-receptor antagonist is effective; for highly emetogenic chemotherapy, a combination of dexamethasone and aprepitant is effective. Rolapitant and metoclopramide hydrochloride are also licensed for delayed chemotherapy-induced nausea and vomiting.
