Oncology Therapeutics Flashcards
Capecitabine
5-FU prodrug
Diarrhea, hand-foot syndrome
Give with food to decrease nausea
Avoid aluminum/magnesium antacids
Sun protection
CYP 2C9 interaction, warfarin concerns
Fluorouracil (5-FU)
Dihydropyrimidine dehydrogenase deficiency are more likely to experience toxicity
Mucositis, diarrhea,
Bolus - myelosuppression
Continuous - hand foot, mucositis, diarrhea
Need sun protection
Cytarabine
Ocular toxicity, profound myelosuppression, CNS toxicity if they start writing smaller and smaller
Vesicant
Vesicant cause tissue damage
Bendamustine CCC DDD MM Taxanes Vinca alkaloids
Cytarabine Vinca alkaloids (vincristine, vinblastine, vinorelbine) Paclitaxel Carmustine (BCNU) Mechlorethamine Bendamustine Cisplatin Doxorubicin, daunorubicin, mitoxantrone Dactinomycin
Gemcitabine
Yellow gem
Dose limiting myelosuppression
Dose reduce if elevated bilirubin
Elevated LFT enzymes
Azacitidine
Fresh AAA
Short stability, so fresh bags must be prepared every 2-3 hours
Fever
Hypoalbuminemia pts caution for hepatic coma
Acyclovir and antifungal prophylaxis
Decitabine
AE: thrombocytopenia, neutropenia
Antibiotic prophylaxis
Hematopoietic growth factors needed
Fludrabine
Fever
CNS toxicity: blindness, coma, death
Prophylaxis against opportunistic infections
Cladribine
Lymphopenia (myelosuppression)
Fever
Prophylaxis against opportunistic infections
Pentostatin
Pen Prophylaxis
Immunosuppression expected prophylaxis
Prophylaxis for opportunistic infections
Dose reduction in renal impairment
Methotrexate
For high doses of MTX, start sodium bicarbonate drip to alkinalize urine and prevent renal toxicity
Monitor hematology (myelosuppression), renal, hepatic, pulmonary function
DDI with protein bound drugs
NSAIDS decrease renal function and MTX clearance
Common interaction with Bactrim (trimethoprim is an antifolate)
Leucovorin
Reduced form of folic acid
Administer 24-48 hours after MTX doses >100mg/m2
Glucarpidase
Inactivates methotrexate useful if renal failure
Do not administer with leucovorin, wait 2 hours
Pemetrexed
Trex dex
Dose limiting neutropenia
Dexamethasone 4mg BID x 3 days to prevent/improve rash
Folate and Vit B supplement 1 week before and continue throughout therapy to decrease hematologic side effects, mucositis, and diarrhea
Plant derivatives
All are 3A4 substrates
affected by 3A4 inhibition
Vincalkaloids Taxanes Epotholones Camptothecans (irinotecan) Podophyllotoxins
VinCristine
Constipation due to neurotoxicity
Dose limiting neurotoxicity
Do NOT administer intrathecally
VinBlastine
BlastM
Bronchospasm
Myelosuppression
Monitor CBC w/differential
Vinorelbine
Vinca alkaloids peripheral neuropathy
Myelosuppression
Monitor CBC
Paclitaxel
Alopecia, peripheral neuropathy, myalgia, cardiac toxicity, hypotension
Nano - more sensory neuropathy
Use non-PVC(polyvinyl chloride) tubing
Premedicate with diphenhydramine, H2RA, and dexamethasone
Docetaxel
Dose premedicate D C
Dose limiting myelosuppression
Mucositis
Increased Liver LFT enzymes
Fluid retention
Corticosteroid and diphenhydramine premedicate to prevent hypersensitivity reaction and fluid retention
Use non-PVC tubing and bags
Cabazitaxel
Do not use in hepatic impairment
Premedicate with diphenhydramine and corticosteroids
Muse non-PVC tubing and bags
Ixabepilone
Neuropathy
Use DEHP-free tubing/bags
Lactated ringers only
Premedicate with diphenhydramine and steroid
Etoposide
Dose limiting myelosuppression
Concentration dependent stability issues
Use non-PVC tubing
Irinotecan
Early onset Diarrhea within 24hrs (I ran to can)
And delayed onset
Prevent/Treat early diarrhea with IV atropine NOT lomotil
Treat delayed onset with loperamide 4mg and 2mg q 2h until no bowel movement in 12 hours
Dose limiting myelosuppression and diarrhea
Nausea and vomiting
D5W diluent
Dose reduce with elevated bilirubin
Topotecan
TT renal
Dose limiting myelosuppression
Anemia: 50% require blood transfusion
Dose reduce in renal impairment
Erbulin mesylate
Prolongs QT interval
NO dextrose in the tubing or lines
Use normal saline
Carmustine (BCNU)
High dose: severe N/V
Dose limiting hepatotoxicity and pulmonary toxicity
Neurotoxicity
Lifetime dose limit: 1400mg/m2
Non-PVC tubing
Lomustine
Delayed myelosuppression (nadir 24-60days)
Take on empty stomach
Cyclophosphamide
Dose limiting myelosuppression
Hemorrhagic cystitis (bladder toxicity)
Secondary neoplasm
Frequent urination due to acrolein
Adequate hydration (3L/day) needed Administer drug in morning
Monitor urine output and urinalysis
Ifosfamide
Dose-limiting hemorrhagic cystitis
CNS toxicity: hallucinations
Must be administered with Mesna and continued after ifosfamide
Mechlorethamine (nitrogen mustard)
Pain in injection
Melphalan
MM
Administer orally on empty stomach
Mucositis
Bendamustine
Lymphocytopenia
Metabolized through CYP1A2
Monitor renal function
Procarbazine
PP carbz food
Dose-limiting N/V
Administer with food or after a meal
Photo sensitivity
DDI: tyramine foods (beer, fermented cheese) SSRI, alcohol
Temozolamide
TE Time Empty
Take same time daily to decrease N/V
Take on empty stomach
Dose limiting myelosuppression
Thiotepa
Dose limiting cognitive impairment
Ocular toxicity, Fever
Cisplatin
SEVERE Nausea/Vomiting
Renal toxicity, ototoxicity, peripheral neuropathy, anemia
Mix in saline, cis saline
Decrease renal toxicity with amifostine
Carboplatin
Platelet myelosuppression
Ototoxicity, nephrotoxicity
Dose = AUC x (GFR+25) 25 is no renal Cl
Oxaliplatin
Dose limiting peripheral neuropathy
Cold sensitivity
Prevention with gabapentin
Dilute/flush with Dextrose!
Anthracene derivatives
-rubi - red urine
And mitoxantrone
Vesicant
Doxorubicin
Irreversible cardiac damage
Total lifetime dose 500mg/m2
Reduce cardio toxicity with dexrazoxane
Daunorubicin
Lifetime dose 500mg/m2
Red urine
Epirubicin
EpiHepiFree
Lines must be flushed with a heparin free solution
5-FU is incompatible with epirubicin
Total lifetime dose: 900mg/m2
Mitoxantrone
Blue green color majoring urine, sclera, skin,
increase CV toxicity
Lifetime dose 160mg/m2
Bleomycin
Irreversible pulmonary toxicity
Lifetime dose 400 units
Use test dose, Do not Premedicate
Monitor pulmonary function
Dactinomycin
Vesicant
Pegylated-Aspariginase
PegPro
PEG formulation decreases dose and frequency of administration (q2 weeks)
Prolonged Prothrombin time
Decrease in fibrinogen and clotting factors
Test dose recommended
Monitor coagulation parameters
Hydroxyurea
Discard white powder floating on top
Take with food to decrease N/V
Corticosteroids
Can kill your lymphocytes and result in opportunistic infections
Total WBC may increase
AE: GI irritation, hyperglycemia, mood change, muscle weakness, immunosuppression, appetite change, adrenal corticoid insufficiency
Tamoxifen, toremifene
1st tamoxifen (also available for prevention) 2nd line toremifene
AE: DVT, elevated LFT, hot flashes, endometrial cancer
Fulvestrant
For breast cancer resistant to tamoxifen
Administer in gluteal muscle monthly
Anastrozole, letrozole, exemestane
Used in POSTmenopausal estrogen receptor positive breast cancer
AE: bone pain, muscle aches, osteoporosis
Abiraterone
Inhibit CYP 17 testosterone synthesis
Take on empty stomach
10 fold increase with food
99% protein bound, caution phenytoin
AE: peripheral edema, joint pain, hypokalemia, hypertension
DDI: inhibitor of 1A2, 2D6, and Pgp
Monitor blood pressure, potassium monthly
Flutamide, nilutamide
Flutamide- hepatotoxicity
Nilutamide - interstitial pneumonitis
Decreased libido, hot flashes, gynecomastia
Enzalutamide
For castrate resistant Prostate cancer
Fatigue, asthenia, seizures
GnRH agonists
Decrease LH/FSH to castration levels of testosterone (combo with flutamide)
Megestrol
For weight gain
Arsenic trioxide
Weight gain secondary to fluid retention
Dose-limiting peripheral neuropathy
Differentiation syndrome (30-50%), respiratory distress, pulmonary infiltrates, hypotension Treat with steroids
Retinoids (vitamin A)
AE: headache Differentiation syndrome (pulmonary infiltrate, pleural effusion, weight gain, hypotension ) treat with steroids
Bortezomib
Severe diarrhea
Dose limiting peripheral neuropathy
Thalidomide
Teratogenic use double contraception
Peripheral neuropathy
High rate of DVT with dexamethasone
Lenalidomide
Teratogenic use 2 contraception. Condom
Dose limiting DVT (increases with dex)
Neuropathy
Prophylaxis with aspirin for renal function
Pomalidomide
Take on empty stomach
Neuropathy, DVT
DDI: 3A4, pgp
Imatinib
Take orally with food and glass of water (to reduce N/V)
Periorbital and lower limb edema
Severe increase in LFTs, hepatotoxicity
DDI: 3A4 metabolism
Nilotinib
Take on empty stomach BID
QT prolongation
Monitor ECG
DDI: 3A4, 2C9, pgp
Gefitinib
Diarrhea, mucositis
Acneform rash
Avoid sun
3A4 interactions
Erlotinib
ER Empty Rash PPI
Take on empty stomach (2 hour buffer)
Rash
PPI contraindicated!
Avoid sun
Afatinib
Take on empty stomach
Rash
DDI pgp
Avoid sun
Sunitinib
VEGF - think vascular, cardiac, bleeding
Take baseline ejection fraction
Bleeding
Avoid sun
VEGF
Sunitinib
Sorafenib
Pazopanib
Bevacizumab
Ziv-aflibercept
Sorafenib
Take without food
Avoid sun
DDI: 3A4, UGT1A9 (increases irinotecan)
Bleeding, HTN, VEGF
Lapatinib
LLVEF
Avoid in women with low LVEF ejection
Diarrhea
Plantar palmar erythrodysethesia
Rash
Anemia
3A4
Take on empty stomach
Pazopanib
Diarrhea, hepatotoxicity
Hypertension, change in hair color
Take on empty stomach
Crizotinib
Nausea/Vom/Diarrhea, vision changes
Resistance develops early
Ceritinib
Replace if crizotinib resistance
Take on empty stomach
Hyperglycemia, diarrhea, increased LFT
N/V, increased creatinine, abdominal pain
QT prolongation
Monitor glucose, electrolytes, EKG
3A4, avoid with PPI, H2RA (decrease bioavailability)
Vemurafenib and debrafenib
Arthralgia, rash, pyrexia (Fever)
Hyperglycemia (dabrafenib)
DDI: warfarin, 3A4
Trametinib
TQT
Take on empty stomach
QT prolongation, peripheral edema
Ibrutinib
IInfection
Take with glass of water at night to decrease diarrhea
Infections are common
Monitor CBC, infection
Avoid sun
Indelalisib
Hyperglycemia
Monitor blood glucose, CBC, diarrhea/pulmonary symptoms
Palbociclib
PPE
Neutropenia, pulmonary embolism
Take with food
Monitor CBC, PE, infection
3A4
Everolimus
Hyperglycemia, infections, pneumonitis
High fat intake decreases absorption!
Vismodegib
Muscle spasms, weight loss
Do not donate blood within 7 months of last dose
Men use condoms and spermicide
Women use contraception
Avoid pregnancy!
DDI: PPI, H2RA
Olaparib
Thrombocytopenia, neutrocytopenia, increased SCr
Call MD for bleeding, muscle/joint pain
Monitor CBC, SCr, pulmonary function
Bacillus Calmettr-Guerin
Patient must have competent immune system
Contraindication: those receiving immunosuppressants (chemo, radiation, steroids)
AE: flu symptoms: chills, fever, myalgia
Interferons
Not absorbed orally
Flu-like syndrome
Dose limiting fatigue
Neurological and psych depression after several weeks (mental slowing, memory loss)
Dexamethasone contraindicated
Interleukin 2
Proteins, not absorbed orally
Toxic, requires vigorous supportive care
Hypotension, fluid retention, renal dysfunction
Capillary leak syndrome , infections (staph)
Monitor renal, cardiac, edema, CBC, BP
AE reduced with corticosteroids but don’t use prophylactically or routinely (may interfere with IL-2 efficacy)
Ziv-afilbercept
VEGF: HTN, bleeding
Proteinuria
Monitor Urine protein
Mab nomenclature
Li - immune Tu - tumor Os - bon Vi - virus Les - inflammation
O - mouse
U - human
Xi - chimera
Zu - humanized
Alemtuzumab
HADP prophylaxis
Recognizes CD52 antigen
Use within 8 hours if diluting
Protect from light
Premedicate with 50mg diphenhydramine and 650mg acetaminophen to reduce infusion AE
Pneumocystis and HSV prophylaxis and continue until CD4 = 200 cells/liter
Avoid if active infection, immunodeficiency
Brentuximab
Target CD30
Peripheral neuropathy, anemia, neutropenia, thrombocytopenia
Monitor CBC and for peripheral neuropathy
Contraindicated with bleomycin due to pulmonary toxicity
3A4
Cetuximab
No efficacy in KRAS mutant tumors
Acneform, follicular rash, asthenia
Wear sunscreen and hat
Prophylaxis with antihistamine
Administer undiluted using 0.22 micron filter
Panitimumab
Dermatologic reactions, ocular toxicity, diarrhea
Sunscreen, hat
Rituximab
Targets CD20 antigen
Premedicate with diphenhydramine and acetaminophen for infusion reactions
Tositumomab
TThyroid
Give sski the day prior to protect thyroid
Radiation mechanism
Ibritumomab
A lot of radiation: need to avoid human contact
Prolonged neutrocytopenia, thrombocytopenia
Human anti-mouse antibody reactions
Trastuzumab
Target HER-2
Pulmonary toxicity, cardio toxicity (contraindicated with doxorubicin)
No dextrose
Trastuzumab emtansine (Kadcyla)
Antibody drug conjugate
Cardiopulmonary toxicity, Thrombocytopenia, increase LFTs
No dextrose
Pertuzumab
LV dysfunction
Monitor LV ejection function
No dextrose
Bevacizumab
VEGF: HTN, hemorrhage, DVT
GI perforations, proteinuria
Dilute with Normal saline NOT dextrose
Protect from light
Wait 28 days after surgery before starting
Monitor abdominal pain for GI lesions
Gemtuzumab
Targets CD33
Last ditch effort
Premedicate with diphenhydramine and acetaminophen
Neutropenia, thrombocytopenia
Diarrhea, stomatitis, fever, chills
Protect from light, administer immediately after mixing
Nivolumab
Increase LFTs, rash
AE related to immunity locations: GI, respiratory, skin, first pass
Monitor LFTs, symptoms of pneumonitis and colitis
Ipilimumab
IIIimmuneitis
Immune mediated complications: colitis, hepatitis, dermatitis
Monitor LFTs, bowel changes, abdominal pain
Pembrolizumab
Immune mediated reactions
GI, liver first pass, skin, respiratory
Monitor TSH, LFT
Stipuleucel-T
Plasma dialysis, add antigen, boost immune response to Prostate cancer
Monitor for infusion reactions
Chemo Man
Neurotoxic: nitrosourea (carmustine,lomustine)
Ototoxicity/nephrotoxic: CISplatin, carboplatin
Peripheral neuropathy: vinca alkaloids
Pulmonary fibrosis: bleomycin
Cardio toxic: doxorubicin, daunorubicin
Cystitis (bladder toxicity): cyclophosphamide
Myelosuppression: methotrexate, 5-FU
Non-PVC tubing
TEC
Paclitaxel
Docetaxel
Cabazitaxel
Etoposide
Carmustine
CNS toxicity
FIMP
Cytarabine - write smaller Fludrabine Ifosfamide Methotrexate Procarbazine
Empty stomach
LMN TAPE CAPTinib
Lomustine Melphalan Nilotinib Temozolamide Abiraterone Pomalidomide Erlotinib Ceritinib Afatinib Pazopanib Trametinib
Prolong QT interval
Ceritinib
Arsenic trioxide
Trametinib
Eribulin mesylate
Premedicate diphenhydramine and dex
PIC DD
Paclitaxel
Ixabepilone
Cabazitaxel
Premedicate with diphenhydramine and APAP
Alemtuzumab
Rituxamab
Mix/dilute in saline
CISplatin
BevaCIZumab
No dextrose
PET
Pertuzumab
Eribulin mesylate
Trastuzumab
Antibiotic prophylaxis
Decitabine
Fludarabine
Cladribine
Pentostatin
Antiviral prophylaxis
Azacitidine plus antifungal
Alemtuzumab (herpes)
High risk emetogenic potential
CCDD
Cisplatin
Cyclophosphamide
Dacarbazine
Doxorubicin
Chemo Mucositis
5-FU Capecitabine Doxorubicin Methotrexate Melphalan
Chemo diarrhea
5-FU
Capecitabine
Irinotecan
Premedicate antihistamine only
Cetuximab
KRAS wild type
Can use EGFR targeted therapy
Cetuximab
Panitumumab
Flush in dextrose
Oxaliplatin
Irinotecan
Lacerated ringers solution
Ixabepilone
With food
Capecitabine
Abiraterone
Procarbazine
Imatinib
