Oncology: Chemo/MAb Agents

Question 1

Ifosfamide

Answer 1

• Alkylating agent
• Produces acrolein that concentrates in bladder and can cause hemorrhagic cystitis
• Mesna (Mesnex): chemoprotectant given prophylactically for this risk; ALWAYS co-administered

Question 2

Cyclophosphamide

Answer 2

• Alkylating agent
• Produces acrolein that concentrates in bladder and can cause hemorrhagic cystitis
• Mesna (Mesnex): chemoprotectant given prophylactically for this risk; SOMETIMES co-administered (high-dose regimens)

Question 3

Carmustine

Answer 3

Alkylating Agent

Question 4

Busulfan

Answer 4

Alkylating Agent

-SE: Pulmonary toxicity

Question 5

Cisplatin

Answer 5

• Platinum-based compound
• Highest incidence of CINV
• Causes cumulative nephro and ototoxicity
• Amifostine (Ethyol) - given as chemoprotectant for nephrotoxicity risk
• Confirm doses >100 mg/m^2/cycle with prescriber

Question 6

Carboplatin

Answer 6

• Platinum-based compound

- Uses Calvert formula to calculate dose

Question 7

Platinum-Containing Compound Information

Answer 7

• Box warning: anaphylactic rxns (increased with repeat exposures), renal and ototoxicity
• SE: peripheral neuropathy (cumulative, dose-related)

Question 8

Doxorubicin

Answer 8

• Anthracycline
• Causes N/V: prescribe antiemetics
• Potent vesicant
• Red discoloration of urine/saliva/tears/etc
• Lifetime Dose: 450-550 mg/m^2
• Dexrazoxane (Totect): antidote for extravasation and cardioprotectant; Zinecard only used for cardioprotection
• Myelosuppression risk

Question 9

Mitoxatrone

Answer 9

• Anthracycline

- Blue discoloration of urine/sclera/etc

Question 10

Anthracycline

Answer 10

• ALL have cardiotoxicity
• ALL have box warnings: Myocardial toxicity
• ALL are strong vesicants (Doxorubicin with specific antidote)

Question 11

Irinotecan

Answer 11

• Topoisomerase I Inhibitor
• Acute cholinergic sxs: flushing, sweating, diarrhea
• Treat DELAYED diarrhea with loperamide
• ACUTE diarrhea with atropine
• Box warning: early and late diarrhea

Question 12

Etoposide

Answer 12

• Topoisomerase II Inhibitor
• Can cause infusion-related hypotension when given IV
• Refrigerate capsules

Question 13

-Bleomycin

Answer 13

• Topoisomerase II Inhibitor
• Not myelosuppressive
• Max lifetime dose: 400 units (pulmonary toxicity)
• Box warning: Pulmonary fibrosis
• SE: Allergic rxn

Question 14

Vincristine

Answer 14

• Vinca Alkaloid
• Associated with more CNS toxicity (neuropathy)
• Capped at 2mg/dose
• Intrathecal administration can cause paralysis and death (Prepare in small IV bag instead of syringe)
• Warm compress and hyaluronidase for extravasation

Question 15

Vinblastine

Answer 15

• Vinca Alkaloid
• More bone marrow suppression
• Intrathecal administration can cause paralysis and death
• Warm compress and hyaluronidase for extravasation

Question 16

Vinca Alkaloid Information

Answer 16

• Box warning: vesicants, for IV administration ONLY

- SE: Peripheral sensory neuropathy, autonomic neuropathy

Question 17

Doxetaxel

Answer 17

• Taxane
• Premedicate for HSR with steroids x3d prior to tx
• Can cause severe fluid retention

Question 18

Paclitaxel

Answer 18

• Taxane
• Doesn’t require premedication for HSR
• Okay to use PVC bag/tubing
• Use 0.22 micron filter

Question 19

Taxane Information

Answer 19

• Box warning: severe allergic rxn
• Allergic rxn are due to solvent system, not the drug
• Use non-PVC bag and tubing
• Give BEFORE platinum-containing compound (reduces taxane elimination)

Question 20

5-FU

Answer 20

• Fluorouracil, Pyrimidine analog antimetabolite

- Given with leucovorin to increase efficacy

Question 21

Xeloda

Answer 21

• Capecitabine, Pyrimidine analog antimetabolite
• Oral prodrug of 5-FU
• DPD deficiency increases risk of severe toxicity
• Take with food

Question 22

Pyrimidine Analog Antimetabolite SE

Answer 22

• Hand-foot syndrome
• Diarrhea
• Mucositis

Question 23

Trexall

Answer 23

• MTX, Folate Antimetabolite
• Leucovorin used as rescue in high-dose regimens
• Levoleucovorin is also a rescue option
• Hydration and IV Na-bicarbonate must be given to alkalize urine and decrease nephrotoxicity risk
• NSAIDs and salicylates decrease its clearance

Question 24

Glucarpidase

Answer 24

• Antidote for MTX
• Lowers levels of MTX when toxicity/overdose is occurring
• Used when hydration/alkalization isn’t adequate

Question 25

Folate Antimetabolite Information

Answer 25

• Box Warning: Myelosuppression, renal damage, hepatotoxicity, GI toxicity, teratogenic
• SE: Nephrotoxic, hepatotoxic, nausea, mucositis

Question 26

Avastin

Answer 26

• Bevacizumab
• Targets VEGF
• Impairs wound healing: don’t administer for 28 days before or after surgery
• Box warning: severe/fatal bleeding, GI perforation

Question 27

Herceptin

Answer 27

• Trastuzumab
• Targets HER2
• Must test for HER2 overexpression to use
• Monitor LVEF (ECG or MUGA scan)
• NOT interchangeable between conventional and Ado-formulation

Question 28

Cetuximab

Answer 28

• Targets EGFR
• Must test for KRAS wildtype to use
• SE: Acneiform rash
• Rash usually occurs early and means patient is expected to have better response to drug
• Avoid sunlight, use sunscreen, topical steroids and abx can be used to reduce skin damage

Question 29

Rituxin

Answer 29

• Rituximab
• Targets CD antigens, inhibits them
• Premedicate with Benadryl, APAP, and steroid

Question 30

Gleevec

Answer 30

• Tyrosine kinase inhibitor, used in CML
• Must be BCR-ABL positive to use
• SE: Fluid retention
• Take with food