Alkylating Agent (nitrogen mustard)

Low emetogenic potential

Use:  CML

SE:  hepatic veno-occlusive disease, pulmonary fibrosis

alkylating agents (nitrogen mustards)

SE:  pulmonary toxicity, thrombocytopenia

oral

Alkylating Agent - nitrogen mustard

Use:  breast, ovarian, prostate, and lunch

Non-oncology uses:  RA, glomerulonephritis

SE:  metabolite is acrolein which causes hemorrhagic cystitis, SIADH

Prevent SE with lots of hydration and optional infusion of Mesna

alkylating agent - nitrogen mustard

Use:  lung, testicular, lymphomas and sarcomas

ALWAYS GIVE WITH MESNA (not optional like with cyclophosphamide)

alkylating agent - nitrogen mustard

one of the original

Use:  multiple including polycythemia vera, CLL, CML, hodgkins disease

Part of MOPP regimen

alkylating agent - nitrogen mustard

Use:  lymphomas, breast, ovarian

SE:  BMS especially thrombocytopenia

DO NOT CRUSH TABLETS

alkylating agent - nitrogen mustard

Use:  bladder

SE:  BMS

carmustine (BiCNU)

lomustine (CeeNU)

streptozocin (Zanosar)

Nitrosoureas

All used in brain malignancies (good brain penetration)

High emetogenic potential

SE:  leukopenia about 3-5 weeks after therapy

prolonged carmustine associated with pulmonary toxicity

Platinum analogues

cisplatin analogue with less nepthrotoxicity but more BMS

dose based on AUC (most CA drugs weight based mg/m2)

Platinum analogues

Use:  testicular, ovarian, lung, head and neck

SE:  high emotogenic potential**, nephrotoxicity, ototoxicity, peripheral neuropathy, hypoMg

Platinum analogues

Use:  melanomas, hodgkins disease, sarcomas

SE:  severe N/V

Platinum analogues

Use:  hodgkins and other lymphomas

Drug interactions with MAOIs and TCAs and tyromine containing foods.  disulfiram reaction

SE:  CNS (depression)

Anthracyclines

-cardiotoxicity!!

Patients get pre-treatment either ECHO or MUGA

SE:  cardiotoxicity, alopecia, stomatitis

Dose limit of 550mg/m2

liposomal formulation

Anthracyclines

SE:  urine discoloration (red)

Dose limit of 550mg/m2

liposomal formulation

Anthracyclines

lifetime dose is 137.5mg/m2

Anthracyclines

lifetime dose is 150mg/m2

Urine blue-green color

Used in MS patients

Iron chelator used to prevent oxygen free radicals and cardiotoxicity

Dose:  500mg/m2 of zinecards for every 50mg/m2 of doxorubicin

Other antibiotics

Uses:  hodgkins lympohma, testicular

SE:  pulmonary toxicity especially w/ doses >200U/m2 (cumulative dose), mucositis, BMS

Other antibiotics

SE:  mucositis, BMS

Other antibiotics

SE:  stomatitis

MTX

Antimetabolites - folic acid antagonist

Uses:  RA, psoriasis, ectopic pregnancy, variety

SE:  BMS

leucovorin rescue:  10-100mg/m2 q6h until MTX levels fall, used with high dose MTX (1g/m2)

used to lower methotrexate levels to prevent BMS

especially used when giving high doses of methotrexate (1g/m2)

cytarabine (Cytosar)

ARA-C

Antimetabolites

Use:  Induction phase of AML

SE:  myelosuppression common with HIDAC, conjunctivitis (give corticosteroid eye drops)

Antimetabolite - purine antagonist

Use:  CLL

SE:  BMS, neurotoxicity, pulmonary toxicity

BMS can be severe so sometimes will prophylax with bactrim

Anti-metabolite - purine antagonist

Use:  ALL and chronic leukemia

allopurinol inhibits its metabolism so must dose reduce (75%)

SE:  cholestatic liver dysfunction

Antimetabolite - purine antagonist

Use:  Hairy cell leukemia

SE:  neutropenia and drug fever

Antimetabolite - purine antagonist

SE:  nephrotoxic (hydrate well), drug fever

Use:  Hairy cell leukemia

antimetabolite - pyrimidine antagonist

Use:  pancreatic

SE:  neutropenia, increased liver enzymes

antimetabolite - pyrimidine antagonist

Use:  breast, colon, head/neck

May add leucovorin for increased colon Ca response

SE:  BMS and mucositis, low N

antimetabolite - pyrimidine antagonist

Use:  colorectal, metastatic breast

oral 5-FU basically

SE:  lots of pts stops due to GI

Treat in 2 week oral cycles

antimetabolite - pyrimidine antagonist

can cause some drying or darkening of nails and hair (sunlight makes worse)

vincristine (Oncovin)

vinorelbine (Navelbine)

vinblastine (Velban)

Vinca Alkaloids

SE:  vincristine and vinblastine are vesicants so they can cause major damage to surrounding tissues on administration

neurotixic medications

dose max of vincristine is 2mg**

do not give vincristine intrathecally

Epipodophyllotoxin

Oral and IV

Refridgerate

SE:  well tolerated; some alopecia and mucositis

Epipodophyllotoxin

SE:  hypotension and hypersensitivity

Taxanes

Used:  lung, ovarian, breast

SE:  neutopenia (greater with 24 hr infusion), bradycardia, neurotoxicity with parasthesia

Premed with H-2 antagonists, steroids, H-1 antagonists to help with hypersensitivity reaction

Taxanes

SE:  neutropenia, fluid retention w/ high cumulative doses (>500mg/m2)

pretreat with dexamethasone for 3-5 days prior to administration

topotecan (Hycamtin)

irinotecan (Camptosar)

camptothecins

SE:  severe diarrhea (give some loperamide incase)

Biologics

works on HER2 protein, if HER2 + = good candidate

Use:  breast

SE:  cardiotoxicity (baseline ECHO or MUGA), infusion reactions (premed with APAP)

Monoclonal antibody that binds to CD20 antigen expressed in many B-cell NHL lymphomas

if CD20 + = good candidate for rituximab

Use:  B-cell lymphoma as well as follicular lymphoma

SE:  infusion related reactions that have resulted in death!  Especially the initial infusion, hypoxia, pulmonary infiltrates, MI, Vfib, start low go slow

Requires a test dose for administration

Used:  ALL

SE:  hyperglycemia, CNS disturbances, pancreatitis

antiestrogen compound  (oral)

Used:  breast

SE:  flushing, weight gain (premenopausal patients)

anastrazole (Arimidex)

letrozole (Femara)

Aromatase inhibitors

Used:  breast

Used in postmenopausla patients

SE:  HTN, flushing, mood disturbances

Used to prevent cisplatin induced nephron and neurotoxicity

Dose:  910mg/m2 over 15 min

SE:  transient hypotension

palonesetron (Aloxi)

5-HT3

40 hr 1/2 life, give one dose

antiemetic

used with refractory N/V or in cisplatin containing regimens

Dose:  125mg 1 hr before chemo (day 1) and then 80mg once daily on Day 2 and 3

G-CSF (Neupogen or Neulasta)

GM-CSF (Sargramostim or Leukine)

Colony stimulating factors

Used:  Treats neutropenia by stimulating bone marrow

Neulasta is pegfilgrastim (SQ injection one time 24 hours after cycle)

SE:  bone pain

refridgerate

Oral Epidermal Growth Factor Class

Used:  non-small cell lung CA

Dose:  150mg 1hr before or 2hr after food

monoclonal antibody

SE:  infusion related reactions for all monoclonal antibodies, HTN, Headache

Epoetin alfa (Epogen/Procrit)

darbepoeitin (Aranesp)

Used for chemotherapy induced anemia or CKD induced anemia

SE:  hypersensitivity to the albumin, increase risk of cardiovascular events (MI, stroke), may increase risk of certain CA (breast, cervical, head and neck)

darbopoeitin - longer 1/2 life