thera oncology

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coal
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252065
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thera oncology
Updated:
2013-12-09 19:31:12
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thera oncology
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thera oncology
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  1. alkylating agents DLT
    myelosuppression (neutropenia)
  2. 6 alkylating agents
    • platinum agents
    • alkyl sulfonates
    • nitrogen mustards
    • nitrosureas
    • ethylenimines
    • triazenes
  3. mesna dosing with ifosfamide
    • 20% of ifosfamide dose immediately before and then 4 and 8 hours after IV boluses of IFOS
    • mesna is 50% bioavailable - oral dose must be 40% of ifos dose
  4. acrolein
    metabolite of ifosfamide that irritates the bladder = hemorrhagic cystitis
  5. nitrogen mustard DLT
    hemorrhagic cystitis
  6. nitrosureas DLT
    DELAYED (possible a month later) myelosuppression
  7. alkyl sulfonates toxicity
    pulmonary
  8. triazene that is IV only
    dacarbazine - DTIC, Dome
  9. triazene that is PO only
    temozolomide - temoday, crosses BBB
  10. triazene toxicity
    severe N/V
  11. cisplatin - platinol uniqueness
    • platinum agent
    • nephron & oto toxic - requires pre & post hydration
  12. oxaliplatin - eloxatin unique
    peripheral neuropathy that is cold activated
  13. enzyme inhibitors
    • anthracyclines
    • epipodpphyllotoxins
    • mitoxantrone
  14. anthracyclines
    rubicin's
  15. anthracycline uniqueness
    • cardiotoxic - lifetime doses
    • radiation recall - area radiated will turn bright red, even if several weeks later
    • may discolor fluids red
  16. epipodophyllotixins unique
    IV infusion - dilute to < 0.4 mg/mL, concentration dependent, infuse over 30-60 minutes to avoid HoTN
  17. mitoxantrone unique
    • does NOT form oxygen free radicals = less damage to the heart
    • urine may turn blue/green 24-48 hours after infusion
  18. vinca alkaloids toxicity
    • constipation
    • vincristine - neuropathy in gut, big constipation compounded by antiemetics
  19. vinca alkaloids uniqueness
    • excreted via biliary route
    • potent vesicants - apply heat & hyaluronidase
    • vincristine max dose = 2 mg
  20. taxane unique
    • alopecia - lose ALL hair
    • give taxane before platinums to decrease interaction
    • abraxane - not substitutable
  21. camptothecins DLT
    • diarrhea
    • over 50% have diarrhea on irinotecan
  22. tx of early diarrhea
    atropine - usually caused by cholinergics
  23. tx of late diarrhea
    • loperamide - 4 mg at first onset, then 2 mg every 2 hours until diarrhea free for 12 hours.
    • overnight - 4 mg q 4 hours
  24. folate antagonitst toxicities
    • leukopenia
    • tubular necrosis - hydration & alkalinization of the urine to prevent
    • stomatitis - erosion down into the stomach and they can't eat
  25. pemetrexed - alimta
    • routine supplementation of folic acid and vitamin B12 = 1 week prior
    • dosage adjustments based on CrCl - cutoff is 45 ml/min
  26. leucovorin rescue dosing
    • mtx 1-5 μM = 50mg/m2 IV q6h
    •        5.01- 10 μM = 100mg/m2 IV q6h
    •        10.1 - 20 μM = 200mg/m2 IV q6h 
    • rescue started app 12 hours after a 3-6 hour MTX infusion until MTX level is <0.1 μM
    • must be initiated w/I 24 hours
  27. pyrimidine analogues toxicities
    • leukopenia
    • flu-like syndrome
    • rash
  28. pyrimidine analogues causing cerebral toxicity (trouble walking) and chemical conjunctivitis
    HD Ara-C - cerebral toxicity, trouble walking & chemical conjunctivitis (dexamethasone)
  29. which pyrimidine analogue that can be a radio sensitizer
    fluorouracil - 5FU
  30. pyrimidine analogue associated with hand foot syndrome
    • capecitabine - Xeloda
    • oral prodrug of 5-FU
  31. mesna dosing
    • prevention is key - forced IV hydration (1-2 L of NS pre & post). oral 2-3 L/day
    • 1st dose has to be IV
    • 20% of ifos dose given IV prior to ifos dose then 40% of ifos dose PO at 2h & 6h
    •       or
    • 20% of ifos dose given IV prior to ifos dose then
    • 20% of ifos dose given IV at 4h & 8h
  32. exudative diarrhea
    disruption of intestinal epithelium, leakage of water, electrolytes, WBC's, RBC's
  33. hypermotile diarrhea
    rapid transit of stool, no time in the lumen for reabsorption
  34. osmotic diarrhea
    diminished absorption or excessive solutes which increase water entering the lumen, fasting will improve symptoms
  35. secretory diarrhea
    stimulation of active secretion above and beyond normal absorptive capacity, unaffected by fasting
  36. biggest offenders of chemo induced diarrhea
    • 5-fu
    • methotrexate
    • cytarabine
    • irinotecan
  37. loperamide dosing
    4mg at first sign of diarrhea, then 2mg q 2h until diarrhea free for 12h
  38. polymorphism putting pts on irinotecan at a higher risk for severe diarrhea
    UGT1A1 7/7
  39. drug responsible for EGFR and papulopustular rash, predominantly on the face
    sorafenib - nexavar
  40. drug responsible for EGFR affects from multiple kinase inhibitor presenting with a rash that predominantly affects the trunk
    lapatinib - tykerb
  41. 2 reactions from multi-kinase inhibitors
    • papulopustular rash
    • hand-foot skin reaction
    • paronychia
  42. grade 1 HFSR and tx
    • skin changes, erythema, edema, no pain
    • tx = urea 20% BID + clobetasol 0.05% cream daily
  43. grade 2 HFSR and Tx
    • peeling, blisters, bleeding, +pain, limits ADL's
    • tx urea 20% + clobetasol 0.05% cream daily + (NSAIDs/GABA agonists/narcotics)
  44. grade 3 HFSR and tx
    • severe changes, peeling, bleeding, +pain, limits self care ADLs
    • tx - stop chemo tx until grade 0-1 toxicity, continue with clobetasol 0.05% cream BID & pain control (NSAIDs/GABA agonist/narcotics)
  45. tx for high emetic risk
    5HT3 antagonist + steroid + NK-1 antagonist
  46. tx for moderate emetic risk
    • day 1 - 5HT3 antagonist + steroid
    • day 2-3 - 5HT3 monotherapy, steroid monotherapy, or NK1 + steroid, lorazepam, H2 blocker or PPI
  47. tx's of low emetic risk
    • dexamethasone
    • metoclopramide
    • prochlorperazine
    • lorazepam
    • H2 blocker or PPI
  48. tx minimal emetic risk
    no routine prophylaxix
  49. tx of high to moderate risk nausea from oral chemo
    • 5HT3 antagonist
    • lorazepam
    • H2 blocker or PPI
  50. tx of low to minimal risk nausea from oral chemotherapy
    PRN
  51. antidote for extravasation of anthracyclines
    • dexrazoxane - totect 1QD for 3d
    • 1st dose ASAP w/I 6 hours after extravasation
    • day 1 & 2 - 100mg/m2 (max 2000mg) IV over 1-2 hr
    • day 3 - 500 mg/m2 (max 1000 mg) IV over 1-2h
    • day 2 & 3 should be given w/I +/- 3 h of the time of 1st dose of subsequent days
    • dose shold be reduced by 50% if CrCl<40ml/min
  52. tx of extravasation of cisplatin & mechlorethamine
    sodium thiosulfate
  53. tx of extravasation of taxanes & vinca alkaloids
    hyaluronidase
  54. hyaluronidase dosing
    • 150 units per mL in the hyaluronidase solution
    • inject 1 mL of solution as (5) 0.2 mL injections into extravasation site
  55. electrolyte disturbances that occur with tumor lyses syndrome
    • hyper
    • kalemia
    • uricemia
    • phosphatemia

    hypocalcemia
  56. criteria for a diagnosis of TLS
    • 1 or more of the following
    • ARF (rise in Scr to 1.5 x ULN)
    • arrhythmias (including sudden cardiac death)
    • seizures
  57. laboratory diagnosis of TLS
    • uric acid - > 8mg/dL
    • potassium - > 6mEq/L
    • phosphorus - > 6.5 mg/dL
    • calcium - < 7 mg/dL
    • or
    • 25% increase from baseline of the above

    2 or more lab changes must be observed w/I 3 days before or 7 days after cytotoxic therapy
  58. prophylaxis tx for TLS
    • allopurinol - 48hr prior to treatment
    • 100 mg/m2 PO 1 8h (max = 800 mg)
  59. 2 points about allopurinol tx
    • does not alter existing uric acid
    • accumulation of xanthines can worsen renal fxn
  60. tx of TLS
    • rasburicase (elitek)
    • converts uric acid into allantoin
    • must be on ice immediately

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