-block cell signals --> apoptosis (programmed cell death)

-may be used as single agent or combined w/ other chemotherapies

-expensive

Example: VEGF - vascular endothelial growth factor

-topoisomerase II inhibitor

-treat testicular cancer & small cell lung cancer

-IV

-SE: n/v/d, anorexia, stomatitis, rash, chills

-Adverse: bronchospasm, bone marrow suppression, anaphylaxis

-topoisomerase I inhibitor

-treat advanced colon cancer

-IV

-tyrosine kinase inhibitor

-treat refractory non-small cell lung cancer

-po

-SE: HTN, pruritis, pustular rash, conjunctivitis, corneal erosions, hemoptysis, gi hemorrhage

drug-drug: warfarin, azoles, erythromycin, St. John's wort (inactivates drug), anticonvulsants

-watch CYP 34A enzyme (can inhibit or stimulate)

-tyrosine kinase inhibitor

-treat chronic myeloid leukemia, GIST (GI stromal tumors)

-proteasome inhibitor

-treat refractory multiple myeloma, under investigation for other therapies

-IVP for 3-5 seconds

-SE: fatigue, dizziness, hypotension, n/v/d, peripheral neuropathies, pyrexia, neutropenia, thrombocytopenia

-inhibit formation of blood vessels needed for tumor growth & metastasis

-treat metastatic carcinoma of colon & rectum

-Example: Bevacizumab (Avastin)

-angiogenesis inhibitor

-targets VEGF (vascular endothelial growth factor)

-IV

SE: dizziness, diarrhea, epistaxis

-block growth of tumor cells or alert immune system to attack cancer cells

Examples: cetuximab (Erbitux), trastuzumab (Herceptin), panitumumab (Vectibix), rituximab (Rituxan)

-monoclonal antibody drug

-treat B-cell non-Hodgkin's; single agent or in combination

-IV

-SE: n/v, vertigo, h/a, fever, chills, fatigue

-Adverse: mucotaneous, dysrhythmias, renal failure, bone marrow suppression

-monitor CBC

-monitor CBC, LFT. renal, electrolytes

-assess stomatitis

-assess neuropathies (stocking/glove syndrome)

-oral care

-monitor weight, I&O, VS, temp

-small, frequent meals

-bland foods (BRAT diet), no caffeine/carbonation

-psychosocial issues - alopecia

-monitor for infection (medical asepsis)

-assess IV site for infiltrate/extravastion/necrosis