Chemotherapy
Oncology Dx
Antineoplastics
Cytotoxic (SE: marrow suppression, N+V, Mucositis, Diarrhoea, Alopecia, Infertility, Secondary Malignancy)
Supportive Rx
Late Effects:
Antineoplastics
Cytotoxic (SE: marrow suppression, N+V, Mucositis, Diarrhoea, Alopecia, Infertility, Secondary Malignancy)
- Alkylating agents (Interfere with cellular replication by forming cross-linkages between DNA strands) SE: AML
- Nitrogen mustards
- Cyclophosphamide
- Ifosfamide
- Nitrogen mustards
- Anthracyclins (Inhibit DNA and RNA synthesis by intercalation of DNA base pairs and prevent DNA repair by inhibiting topoisomerase II) SE: Cardiac toxicity, Radiation recall (skin inflammation at previous radiotherapy site post dose)
- Daunorubicin
- Doxorubicin
- Antimetabolites (inhibit DNA and RNA synthesis by interfering with purine or pyrimidine metabolic pathways)
- Folic acid antagonists (impair nucleotide synthesis)
- Methotrexate
- Purine antagonists
- Mercaptopurine (ALL, AML, Lymphoma)
- Thioguanine (ALL, AML)
- Pyrimidine antagonists
- Cytarabine (ALL, AML, Lymphoma)
- Hydroxyurea (block conversion of ribonucleotides to deoxyribonucleotides for DNA synthesis)
- Folic acid antagonists (impair nucleotide synthesis)
- Platinum compounds (DNA replication, transcription and cell division are inhibited, ultimately inducing apoptosis)
- (SE ototoxic, nephrotoxic)
- Cisplatin
- Carboplatin
- Podophyllotoxins (Inhibit topoisomerase II resulting in DNA strand breaks and inhibition of cell division in the late S and G2 phases of the cell cycle) SE: AML
- Etoposide
- Topoisomerase I inhibitors (Inhibit the enzyme topoisomerase I, thereby interfering with coiling and uncoiling of DNA during replication, which inhibits nucleic acid synthesis. Actions are specific for S‑phase.)
- Irinotecan
- Vinca alkaloids (Bind to tubulin (i.e. NOT related to DNA) inhibiting its polymerisation and microtubule formation; results in mitotic arrest in metaphase. Cell cycle specific for M phase) SE Neurotoxicity inc peripheral, autonomic, CN, including jaw pain, Extravasation, IT = death
- Vinblastine
- Vincristine
- Others
- Bleomycin (inhibits DNA synthesis) Pulmonary fibrosis
- Antineoplastic antibodies
- Rituximab: anti-CD20 (B lymphocytes) monoclonal antibody (NHL, CLL)
- mTOR inhibitors (oncology)
- Everolimus: blocks mTOR kinase, inhibiting angiogenesis
Supportive Rx
- G‑CSF (Granulocyte colony stimulating factors) stimulate production and differentiation of neutrophils from blood precursor cells
- (Prevention and treatment of neutropenia AND Stem cell mobilisation post transplant)
- (avoid 24h before - 24h post chemotherapy as rapidly dividing cells are more sensitive to myelosuppression)
- Filgrastim
- Lenograstim
- Mesna (free sulfhydryl (thiol) groups that interact with metabolites in urine to prevent haemorragic cystitis)
- Used with the nitrogen mustards (Cyclophosphamide, Ifosfamide)
- Folinic Acid (Bypasses inhibition of dihydrofolate reductase by folic acid antagonists)
- Used as rescue or in overdose post methotrexate
- Tumour lysis syndromes
- Antiemetics
Late Effects:
- Neurocognitive: Methotrexate, cranial irradiation
- Visual loss: Steroids, radiation
- Hearing loss: Cisplatin, carboplatin, cranial irradiation
- Peripheral Neuropathy: Sensory > Platinums (Cisplatin, carboplatin), Sensory and motor > Vincas (vincristine, vinblastine)
- Renal > Platinums (Cisplatin, carboplatin) or Irradiation
- Pulmonary > Bleomycin or radiation
- Cardiomyopathy > Anthracyclins (Doxy/Daun)
- Gonadal dysfunction, delayed puberty, menopause > alkylating agents (Cyclophosphamide/Ifosfamide) or irradiation
- GH deficiency/Precocious puberty > cranial irradiation
- HP axis deficiencies: cranial irradiation
- GIT > irradiation or surgery
- Secondary malignancy: AML alkylating agents (Cyclophosphamide/Ifosfamide) and Etoposide