Oncology side effects Flashcards
What drugs cause cardiac dysfunction?
Anthracyclines (doxorubicin, idarubicin, epirubicin)
-monitor cumulative dose and serial evaluation of LV function because late toxicity is dose dependent.
Trastuzumab causes reduced LVEF that is not dose dependent. Usually reversible after cessation of drug and aggressive medical management.
Involved field radiation therapy causes premature coronary artery disease and valvular stenosis.
Which chemo causes lung toxicity?
Bleomycin- causes ACUTE PNEUMONITIS and also PULMONARY FIBROSIS late effect.
Need to recognise early so that can treat with corticosteroids (bleomycin induced pneumonitis).
Limit cumulative dose to less than 400 IU reduces risk, also stopping if DLCO drops by 25% or more
never re-challenge
Sometimes if getting steroids and had radiation therapy and then stop the steroid suddenly can induce pneumonitis.
Everolimus causes pneumonitis
Erlotinib/gefitinib- ILD especially if smoker or pre-existing lung disease- cease drug and may need to give steroids
Which chemo is associated with bladder toxicity
Cyclophosphamide and ifosfamide haemorrhagic cystitis
Give hydration, diuresis, and concurrent administration of Mesna
What chemo causes tubular injury
Cisplatin- minimise with hydration, diuresis, and mesna
High dose methotrexate- monitor methotrexate levels, give leucovorin support (folinic acid), forced hydration with diuresis of alkaline urine.
How does mesna work?
In blood, mesna is oxidized to dimesna which in turn is reduced in the kidney back to mesna, supplying a free thiol group which binds to and inactivates acrolein, the urotoxic metabolite of ifosfamide and cyclophosphamide
What is the most common cause of hypercalcaemia when there is malignancy?
Humoral effects caused by parathyroid hormone related peptide.
MOA cyclophosphamide
Alkylating agent- cross linking of DNA
Side effects cyclophosphamide
Haemorrhagic cystitis
TCC bladder
Myelosupression
MOA Bleomycin
Cytotoxic antibiotic- degrades preformed DNA
Side effect favourite bleomycin
lung fibrosis
MOA doxorubicin
Cytotoxic antibiotic
Stabilises DNA- topoisomerase II complex and inhibits DNA and RNA synthesis
Favourite SE doxorubicin
Cardiomyopathy
MOA methotrexate
Inhibits dihydrofolate reductase and thymidylate synthesis
Sid effects methotrexate
myelosupression
mucositis
liver fibrosis
lung fibrosis
5-FU MOA
Antimetabolite
Pyrimidine analogue inducing cell cycle arrest and apoptosis by blocking thymidylate synthase
Works during S phase
5-FU favourite side effects?
Myelosupression
Mucositis
Dermatitis
6-MP MOA
Purine analogue that is activated by HGPRTase, decreasing purine synthesis
6-MP side effect
myelosupression
Cytarabine MOA
Antimetabolite
Pyrimidine antagonist- interferes with DNA synthesis during S phase, inhibits DNA polymerase
Cytarabine SE
Ataxia
Myelosupression
Vincristine, vinblastine MOA
Inhibits microtubule formation
Vincristine SE
Reversible peripheral neuropathy
Parslytic ileus
Vinblastine SE
Myelosupression
Docetaxel MOA
prevents microtubule depolymerisation and disassembly, decreasing free tubulin
SE docetaxel
Neutropaenia
Interstitial pneumonia, pulmonary oedema
glove and stocking sensory loss; motor ok- delay, dose reduce or cease depending on severity
Cisplatin SE
Ototoxicity - tinnitus and high frequency hearing loss
Peripheral neuropathy
Hypomagnesaemia
Cisplatin MOA
DNA cross linking
Hydroxyurea MOA
Inhibits ribonucleotide reductase, decreasing DNA synthesis
Hydroxyurea SE
myeloupression
Oxaliplatin neurotoxicity describe!
Acute within hours to days; most patients; cold induced paraesthesia of hands feet and perioral. Lasts a week.
Can get pharyngolaryngeal dysthesia- feel cannot breathe. Resolves in 24 hours. Obs and tests all ok.
Chronic neurotoxicity- glove and stocking sensory loss
After 5 years or a prolonged time, what three cancers can pop back?
Renal
Breast
Melanoma
What is the mechanism of loss of heterozygosity at vHL locus causing RCC in VHL?
Loss of inhibition of VEGF (mediated by a molecule called HIF being upregulated)
