Oncology side effects

Question 1

What drugs cause cardiac dysfunction?

Answer 1

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.

Question 2

Which chemo causes lung toxicity?

Answer 2

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

Question 3

Which chemo is associated with bladder toxicity

Answer 3

Cyclophosphamide and ifosfamide haemorrhagic cystitis

Give hydration, diuresis, and concurrent administration of Mesna

Question 4

What chemo causes tubular injury

Answer 4

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.

Question 5

How does mesna work?

Answer 5

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

Question 6

What is the most common cause of hypercalcaemia when there is malignancy?

Answer 6

Humoral effects caused by parathyroid hormone related peptide.

Question 7

MOA cyclophosphamide

Answer 7

Alkylating agent- cross linking of DNA

Question 8

Side effects cyclophosphamide

Answer 8

Haemorrhagic cystitis
TCC bladder
Myelosupression

Question 9

MOA Bleomycin

Answer 9

Cytotoxic antibiotic- degrades preformed DNA

Question 10

Side effect favourite bleomycin

Answer 10

lung fibrosis

Question 11

MOA doxorubicin

Answer 11

Cytotoxic antibiotic

Stabilises DNA- topoisomerase II complex and inhibits DNA and RNA synthesis

Question 12

Favourite SE doxorubicin

Answer 12

Cardiomyopathy

Question 13

MOA methotrexate

Answer 13

Inhibits dihydrofolate reductase and thymidylate synthesis

Question 14

Sid effects methotrexate

Answer 14

myelosupression
mucositis
liver fibrosis
lung fibrosis

Question 15

5-FU MOA

Answer 15

Antimetabolite
Pyrimidine analogue inducing cell cycle arrest and apoptosis by blocking thymidylate synthase

Works during S phase

Question 16

5-FU favourite side effects?

Answer 16

Myelosupression
Mucositis
Dermatitis

Question 17

6-MP MOA

Answer 17

Purine analogue that is activated by HGPRTase, decreasing purine synthesis

Question 18

6-MP side effect

Answer 18

myelosupression

Question 19

Cytarabine MOA

Answer 19

Antimetabolite

Pyrimidine antagonist- interferes with DNA synthesis during S phase, inhibits DNA polymerase

Question 20

Cytarabine SE

Answer 20

Ataxia

Myelosupression

Question 21

Vincristine, vinblastine MOA

Answer 21

Inhibits microtubule formation

Question 22

Vincristine SE

Answer 22

Reversible peripheral neuropathy

Parslytic ileus

Question 23

Vinblastine SE

Answer 23

Myelosupression

Question 24

Docetaxel MOA

Answer 24

prevents microtubule depolymerisation and disassembly, decreasing free tubulin

Question 25

SE docetaxel

Answer 25

Neutropaenia
Interstitial pneumonia, pulmonary oedema
glove and stocking sensory loss; motor ok- delay, dose reduce or cease depending on severity

Question 26

Cisplatin SE

Answer 26

Ototoxicity - tinnitus and high frequency hearing loss
Peripheral neuropathy
Hypomagnesaemia

Question 27

Cisplatin MOA

Answer 27

DNA cross linking

Question 28

Hydroxyurea MOA

Answer 28

Inhibits ribonucleotide reductase, decreasing DNA synthesis

Question 29

Hydroxyurea SE

Answer 29

myeloupression

Question 30

Oxaliplatin neurotoxicity describe!

Answer 30

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

Question 31

After 5 years or a prolonged time, what three cancers can pop back?

Answer 31

Renal
Breast
Melanoma

Question 32

What is the mechanism of loss of heterozygosity at vHL locus causing RCC in VHL?

Answer 32

Loss of inhibition of VEGF (mediated by a molecule called HIF being upregulated)