Principles of cancer chemotherapy

Question 1

What are the side effects of cytotoxic drugs ?

Answer 1

Extravasation of IV drugs
Thromboembolism
Hyperuricaemia
Alopecia
Nausea and vomiting
Bone marrow suppression
Urothelial toxicity
Oral mucositis
Pregnancy and reproductive function 
Tumour lysis syndrome

Question 2

If patients are taking alkylating drugs and procarbazine what advise should you give to men and women regarding contraception ?

Answer 2

alkylating drug or procarbazine carry the risk of causing permanent male sterility (there is no effect on potency). Pretreatment counselling and consideration of sperm storage may be appropriate. Women are less severely affected, though the span of reproductive life may be shortened by the onset of a premature menopause.

Question 3

What are the clinical features of tumour lysis syndrome?

Answer 3

hyperkalaemia, hyperuricaemia (see below), and hyperphosphataemia with hypocalcaemia; renal damage and arrhythmias can follow.

Question 4

What is tumour lysis syndrome?

Answer 4

condition that occurs when a large number of cancer cells die within a short period, releasing their contents in to the blood.

Question 5

Which patients are at risk of tumour lysis syndrome ?

Answer 5

non-Hodgkin’s lymphoma
Burkitt’s lymphoma, acute lymphoblastic leukaemia and acute myeloid leukaemia
occasionally those with solid tumours
Pre-existing hyperuricaemia, dehydration, and renal impairment

Question 6

Which cytotoxic drugs increase the risk of thromboembolism ?

Answer 6

tamoxifen ( also cause endometrial cancer)

thalidomide, linadamide

Question 7

Which cytotoxic drugs cause oral mucositis ?

Answer 7

anthracyclines

antimetabolites (methotrexate, fluoracil, capecitabine)

Question 8

What advise should you provide to patient regarding oral mucositis, how to prevent it and ease the symptoms ?

Answer 8

• rinse mouth frequently
• use a soft toothbrush 2-3 times daily
• Suck on ice cubes
• Saline mouthwashes
• Folinic acid in MXT induced adverse effects

Question 9

Which cytotoxic drug can cause urothelial toxicity (Haemorrhagic cystitis) and which drug can be used to treat it ?

Answer 9

cyclophosphamide cause it

Treat with MESNA

Question 10

All cytotoxic drugs cause bone marrow suppression, except from ?

Answer 10

Bleomycin and vincristine

Question 11

Fever in a neutropenic patient (neutrophil count less than 1.06×109/litre) should be treated with what ?

Answer 11

broad spectrum antibiotic: filgrastrim (treat low neutrophil count )

Question 12

How should symptomatic iron-deficiency anaemia be treated ?

Answer 12

erythpoieten

red blood cell transfusions

Question 13

HYPERURICAEMIA is present in ….?

Answer 13

high-grade lymphoma and leukaemia, can be markedly worsened by chemotherapy and is associated with acute renal failure.

Question 14

What is the treatment of hyperuricaemia ?

Answer 14

• Allopurinol should be started 24 hours before treating such tumours and patients should be adequately hydrated
• Febuxostat may also be used and should be started 2 days before cytotoxic therapy is initiated.
• Rasburicase for hyperuricaemia associated with blood cancer

Question 15

Doxorubicin, what are the side effects ?

Answer 15

red discolouration of urine
dehydration
diarrhoea

Question 16

Vincristine side effects ?

Answer 16

Bronchospasm:Severe bronchospasm following administration is more common when used in combination with mitomycin-C.
Neurotoxicity:Sensory and motor neuropathies are common and are cumulative. Manufacturer advises monitoring patients for symptoms of neuropathy, such as hypoesthesia, hyperesthesia, paresthesia, hyporeflexia, areflexia, neuralgia, jaw pain, decreased vibratory sense, cranial neuropathy, ileus, burning sensation, arthralgia, myalgia, muscle spasm, or weakness, both before and during treatment

Question 17

What are the side effects of bleomycin ?

Answer 17

Progressive pulmonary fibrosis Progressive pulmonary fibrosis is dose-related, and may occur at lower doses in the elderly. Suspicious chest X-ray changes are an indication to stop therapy with this drug.
Pulmonary toxicity Patients who have received bleomycin may be at risk of developing pulmonary toxicity if exposed to high inspired oxygen concentrations, for example peri-operatively, or during lung function testing.

Question 18

How should vinca alkaloids be administered ?Vincristine, viblastine, vindesine

Answer 18

IV only