Oncology Flashcards
bleomycin lifetime cumulative dose
400 units (pulmonary toxicity)
doxorubicin lifetime cumulative dose
450-550 mg/m3 (cardiotoxicity)
cisplatin lifetime cumulative dose
dose per cycle not to exceed 100 mg/m3 (nephrotoxicity)
vincristine lifetime cumulative dose
single dose capped at 2 mg (neuropathy)
Neurotoxicity
Nitrosoureas: Lomustine, Carmustine
Nephrotoxic/Otoxic
Platinum-Based: Cisplatin, Carboplatin
-amifostine can be given prior to cisplatin to prevent nephrotoxicity
Mucositis
methotrexate and flurouracil
-lidocaine viscous
-if candida infection occurs due to incr risk: nystatin suspension, clomitrazole troche
Pulmonary fibrosis
Bleomycin, Busulfan, Carmustine, Lomustine
Cardiotoxic
Doxorubicin and other anthracyclines
HER2 inhibitors, fluorouracil
-do not exceed cumulative dose, and give dexraoxane to select patients before doxorubicin
Autoimmune syndromes (widespread)
immunotherapy targeting CTL-4 or PDL-1: ipillmumab, atezolizumab, durvalumab, nivolumab, pembrolizumab
Hemorrhagic cystitis
ifosfamide and cyclophosphamide
-Mesna can be given prophylactically (almost always) with Ifosfamide (sometimes cyclophosphamide) to reduce the risk
Peripheral neuropathy
vinca alkaloids (vincristine, vinblastine, vinorelbine) and taxanes (paclitaxel, docetaxel), platinums (cisplatin, oxaliplatin)
myelosuppression
almost all chemotherapy drugs except: asparaginase, bleomycin, vincristine, most mAb, and many TKis
Nausea and vomiting
cisplatin, cyclophosphamide, ifosfamide
diarrhea
irinotecan, capecitabine, fluoruracil, methotrexate
-IV/PO fluid hydration, anti motility medications
-irinotecan: atropine
constipation
vincristine
oxaliplatin
cold-mediated sensory neuropathy - avoid cold temperatures and cold beverages
leucovorin
-given with fluorouracil to enhance efficacy
-given with Methotrexate after high doses to decrease myelosuppression and mucositis
Uridine triacetate
antidote for flurouracil or capecitabine
-use within 96 hours for an overdose or to treat severe, life threatening or early onset toxicity
Glucarpidase
antidote to decrease excessive methotrexate levels due to acute renal failure
CSFs
-Filgrastim (Neupogen), Pegfligrastim (Neulasta)
-bone pain
dx of febrile neutropenia
oral temp of 101 (38.3) x 1 reading or oral temperature of 100.4 (38) sustained for > 1 hr
Low-risk ( ANC < 500 for < 7 days)
oral antipseudomonal abx
-ciprofloxacin or levofloxacin + augmentin or clindamycin if allergic to penicillins
High risk (ANC < 100 for > 7 days, presence of comorbidities, evidence of renal or hepatic impairment)
intravenous anti-pseudomonal beta-lactams
-cefepime, ceftazidime, meropenem, imipenem/cilstatin, zosyn
ESAs
shorten survival and increase tumor progression
-palliation only and not for curative intent
-only for patients with non-myeloid malignancies where anemia is due to chemo
-must be a minimum of two additional months of planned chemotherapy
-initiate only when Hgb < 10 g/dL
-use the lowest dose needed to avoid RBC transfusions
acute CINV
5-HT3-RA
NK1 receptor antagonists
dexamethasone
olanzipine
Delayed CINV
NK1-RA, corticosteroids, palonosetron, olanzapine
anticipatory CINV
benzos: start the evening prior to chemo to alleviate anxiety and n/v
5-HT3 RA
-setron
ondansetron, granisetron, palonosetron
NK1-RA
aprepitant, fosaprepitant, rolapitant
high emetic risk
3 or 4 drugs
-NK1-RA + 5HT3 RA + olanzapine + dexamethasone
-palonosetron + olanzapine + dexamethasone
-NK1-RA + 5HT3 RA + dexamethasone
moderate emetic risk
2 or 3 drugs
low emetic risk
1 drug (any except NK1-RA)
Irinotecan
causes cholinergic excess, including acute diarrhea with abdominal cramping
-atropine: prevent acute diarrhea
-pilocarpine: for dry mouth
Hand-foot syndrome
occurs following treatment with capecitabine and fluorouracil
-cooling hands/feet with cold compress
-aquaphor
TLS
allopurinol or rasburicase (do not use in G6PD deficiency)
Hypercalcemia of malignancy
-hydration with normal saline and loop diuretic
-calcitonin (Miacalcin)
-IV bisphosphonates: Zoledronic acid (Zometa)
-Denosumab (Xgeva)
treatment of immunologic reactions
acetaminophen (650 mg PO) and diphenhydramine (IV or PO)
major vesicants
anthracyclines (dexrazoxane) and vinca alkaloids (hyaluronidase)
-apply cold compresses (except for vinca alkaloids or etoposide use warm compress)
Breast Cancer: Hormone-sensitive
Premenopausal women:
- tamoxifen (SERM)
Postmenopausal women:
- anastrozole
HER2
-trastuzumab (herceptin)
prostate cancer
- GnRH agonists (Leuprolide, Goserelin)
-dcr bone density: supplement calcium/vitamin D
-tumor flare > prevent with concurrent use of antiandrogen
-hot flashes, impotence, gynecomastia, bone pain - GnRH antagonist
-osteoporosis risk
-no tumor flare - antiandrogens
BSA
square root of (ht in cm) * (wt in kg)/3600
alkylating agents (hemorrhagic cystitis)
cyclophosphamide , ifosfamide, busulfan, carmustine
platinum-based compounds (nephrotoxicity and high emetic)
cisplatin, carboplatin, oxaliplatin
-anaphylactic reactions - risk increases with repeated doses
anthracyclines (cardiotoxicity)
doxorubicin and mitoxantrone
topoisomerase I inhibitors (diarrhea)
irinotecan
topoisomerase II inhibitors (pulmonary fibrosis)
bleomycin
Vinca Alkaloids (peripheral sensory and autonomic neuropathies - constipation)
-Vincristine (CNS toxicity than others)
-Vinblastine and vinorelbine (myelosupression)
-vesicants –> use warm compress and hyaluronidase
Taxanes (peripheral sensory neuropathies)
-severe infusion-related hypersensitivity reactions
-paclitaxel, docetaxal
-use non-PVC bag (except abraxane) with 0.22 micron flter
Pyrimidine analog antimetabolites
-5-FU > given with leucovorin to help increase efficacy
-capecitabine (Xeldoa) > oral prodrug of 5-FU, DPD deficiency
-hand-foot syndrome, diarrhea, mucositis
DPD deficiency
-capecitabine
-increases the risk of severe toxicity
folate antimetabolites
-methotrexate
-with high doses leucovorin must be given as a rescue
-hydration and IV sodium bicarb must be given to alkalinize the urine and decrease the risk of nephrotoxicity
-glucarpidase is an antidote that works quickly to lower methotrexate levels
-do not give with NSAIDs or salicylates
VEGF receptor inhibitor (-ci)
bevacizumab and ramucirumab
-HTN, proteinuria
-thrombosis or hemorrhage
-imapired wound healing
EGFR inhibitor (-tu)
cetuximab and panitumumab
-skin toxicity
-rash
HER2 receptor inhibitors (-tu)
Traztuzumab and pertuzumab
-cardiotoxicity and teratogenic
Antigen-specific binding (-tu)
Rituximab and Brentuximab (ADC)
-bone marrow suppression
-reactivation of dormant viruses
immune system agents (-li)
ipilimumab and pembrolizumab
-immune mediated reactions, colitis, hepatic toxicity, thyroid dysfunction, myocarditis
TKi: CML
Imatinib (Gleevec)
-must be BCR-ABL positive to use (Philadelphia chromosome)
TKi: melenoma/BRAF inhibitors
must be V600E or V600K positive to use
TKi: NSCLC/EGFR inhibitors
must be EGFR mutation-positive to use (exon 19 or 21)
TKi: NSCLC/ALK inhibitors
must be ALK positive to use
common toxicities of TKi
hypothyroidism, QT prolongation, hepatotoxicity, diarrhea
Gleevec and Xeloda
take with food or 1 hour after a meal
Arimidex and tamoxifen
take without regards to food
