Chemo

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Leucovorin calcium (folinic acid)

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given within the first 24 to 42 hours of starting methotrexate to block the systemic toxic effect of high-dose MTX.

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methotrexate (MTX) (Rheumatrex, Trexall)

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Administer leucovorin within 2 days of treatment with MTX

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Green tea

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may enhance antitumor effects of doxorubicin (Adriamycin).

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cyclophosphamide (Cytoxan) – intervention

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pt should drink at least 2 to 3 L of fluid before, during, and after administration to prevent hemorrhagic cystitis.

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What intervention is a priority for patient receiving doxorubicin (Adriamycin)

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Administering dexrazoxane (Zinecard) - cytoprotective (chemoprotective) agent that may be given to help prevent cardiac toxicities associated with doxorubicin administration.

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Cyclophosphamide (Cytoxan)

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causes bone marrow suppression, which is evidenced by a decrease in red blood cells, white blood cells, and platelets. A thrombocyte count of 8000/mm3 is significantly lower than normal.

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Mechlorethamine (nitrogen mustard [Mustargen])

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severe vesicant and can cause tissue necrosis

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Vincristine is pharmacologically classified as

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plant alkaloid.

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Vincristine works by

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stopping cancer cell division at the M phase of cellular replication.

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Glucocorticoids

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used in combination with other chemotherapy agents to treat cancers that develop in or from lymphoid type tissue; used in high doses are toxic to lymph tissue, which results in cell death; better tolerate some of the chemotherapy side effects; typically used with other chemotherapy drugs as part of the treatment.

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Vincristine's major side effect

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damage to the nervous system. Neuropathies are common and the most common effects exhibited are constipation, motor weakness, numbness/tingling in extremities, and sensory deficits.

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Ondansetron is pharmacologically classified as

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5-HT3 receptor blocker. Ondansetron acts on these specific receptors within the central nervous system and in the stomach.

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Ondansetron (Zofran) side effects:

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Headache, Diarrhea, Dizziness, Hypotension, Rash

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Traditional chemotherapy

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generalized, systemic, chemical, cytotoxic treatment that directly kills or severely damages cells. Mechanisms of action for different categories of chemotherapy drugs vary, but the overall outcome is the inhibition of cell division and cell death.

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Targeted therapy for cancer treatment

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differs from traditional cancer chemotherapy by taking advantage of biological features, such as cellular receptors, enzymes, pathways, or other molecular proteins of cancer cells.

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Signal transduction is

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method of communication that allows events, conditions, and substances outside of the cell to influence the cell’s decision to divide, not to divide, or to perform its designated function.

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Tyrosine kinases (TKs)

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family of enzymes that activate other substances by adding a phosphate group (PO4) to them, a process known as phosphorylation

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phosphorylation.

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enzymes that activate other substances by adding a phosphate group (PO4) to them

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Transcription factors for cell division

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substances that enter the nucleus and signal the cell that mitosis is needed

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Suppressor gene products inhibit

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cell division

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Cyclins

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part of a family of proteins that, when active, stimulate the cell to move through the cell cycle

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pro-cell division transcription factors

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promote DNA transcription and increased synthesis of specific pro-cell division cyclins and CDKs, regulates movement of the cell from G1 into the S, G2, and M phases of the cell cycle

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allow cell division to occur but not lead to excessive cell division

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Proteins synthesized by suppressor genes

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Dasatinib,

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a TKI, often causes ELECTROLYTE IMBALANCES AND ECG ABNORMALITIES, ESPECIALLY PROLONGED QT INTERVAL. This drug should be used cautiously in persons at risk for long QT. FLUID RETENTION AND HEMATOLOGICAL SIDE EFFECTS are relatively common.

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Sorafenib

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A MULTIKINASE INHIBITOR that specifically targets serine/threonine and receptor tyrosine kinases, which are activated as a result of gene mutations; common side effects: HYPERTENSION, ALOPECIA, PRURITUS, DRY SKIN, EXFOLIATIVE DERMATITIS, ACNE, FLUSHING, PALMAR-PLANTAR ERYTHRODYSESTHESIA; WEIGHT LOSS, NAUSEA/VOMITING, DIARRHEA, ANOREXIA, CONSTIPATION, ABDOMINAL PAIN; MUCOSITIS, DYSPEPSIA, DYSPHAGIA, AND MILD NEUTROPENIA AND THROMBOCYTOPENIA. More severe effects are possible, including PANCREATITIS, ERECTILE DYSFUNCTION, AND MYOCARDIAL ISCHEMIA.

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Sunitinib

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TKI - inhibits more than 80 tyrosine kinases.Side effects and adverse reactions are more widespread as a result of the number of different types of kinases this drug inhibits and include HYPERTENSION, PERIPHERAL EDEMA, LEFT VENTRICULAR DYSFUNCTION, PROLONGED QT INTERVAL, AND VENOUS THROMBOEMBOLISM; NAUSEA/VOMITING, DIARRHEA, STOMATITIS, AND DYSPEPSIA; FATIGUE, ASTHENIA, HEADACHE, DIZZINESS, PERIPHERAL NEUROPATHY, MILD ARTHRALGIA, LIMB PAIN, MYALGIA, AND BACK PAIN; LIVER IMPAIRMENT; DEPIGMENTATION OF THE SKIN, SKIN DISCOLORATION, RASH, DRY SKIN, AND PALMAR-PLANTAR ERYTHRODYSESTHESIA; HYPOTHYROIDISM AND ADRENAL INSUFFICIENCY; MYELOSUPPRESSION, AND MILD DYSPNEA AND COUGH.

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Gefitinib

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synthetic anilinoquinazoline that selectively inhibits the epidermal growth factor receptor-tyrosine kinase (EGFR-TK). Can cause CONJUNCTIVITIS AND ABNORMAL EYELASH GROWTH, RASH, NAUSEA/VOMITING, DIARRHEA, ACNE, PRURITIS, ANOREXIA, AND AN INCREASE IN HEPATIC TRANSAMINASES.

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Panitumumab

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is a fully humanized monoclonal antibody. Carries a BOXED WARNING FOR DERMATOLOGIC PROBLEMS AND TOXICITY. ELECTROLYTE IMBALANCES may occur and require replacement. Patients should be monitored closely for ANGIOEDEMA AND ANAPHYLAXIS.

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Cetuximab

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is a partially humanized monoclonal antibody. Infusion reactions have been reported with cetuximab. Manifestations include RAPID ONSET OF AIRWAY OBSTRUCTION, INCLUDING BRONCHOSPASM, STRIDOR, HOARSENESS, URTICARIA, AND HYPOTENSION. IT IS ALSO ASSOCIATED WITH DERMATOLOGIC CHANGES THAT TYPICALLY INVOLVE THE FACE, UPPER CHEST, AND BACK.

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Trastuzumab

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is a monoclonal antibody that binds to the HER2 protein on the surface of cancer cells that overexpress this receptor. Trastuzumab carries the risk of CARDIOMYOPATHY; HYPERSENSITIVITY REACTIONS, INCLUDING ANAPHYLAXIS; AND HEADACHE, DIZZINESS, HYPOTENSION, FEVER, CHILLS, AND NAUSEA DURING THE INITIAL INFUSION. Other common side effects include LOSS OF APPETITE, HEADACHE, AND MUSCLE ACHES.

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Bevacizumab

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is a humanized monoclonal antibody…causes reduction of microvascular growth and inhibition of metastatic disease progression. Bevacizumab SHOULD NOT BE GIVEN WITHIN 28 DAYS AFTER MAJOR SURGERY DUE TO THE RISK OF GI PERFORATIONS, WOUND DEHISCENCE, IMPAIRED WOUND HEALING, HEMORRHAGE, AND FISTULA FORMATION. Other side effects include hypertension, hematopoietic suppression, proteinuria, thromboembolism, and deep vein thrombosis.

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Bortezomib

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Proteasome inhibitor - suppression of cancer cell division and enhancement of cancer cell apoptosis.The most common side effects of bortezomib are NAUSEA, VOMITING, ANOREXIA, ABDOMINAL PAIN, BOWEL CHANGES, AND DECREASED TASTE SENSATION. Other general side effects include PERIPHERAL NEUROPATHY, headache, insomnia, rash, pruritus, back pain, arthralgia, bone pain, and muscle cramps. Weakness, low-grade fever, thrombocytopenia, anemia, and neutropenia can occur.

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Temsirolimus

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angiogenesis inhibitor. Hypersensitivity reactions to temsirolimus are common, and PRETREATMENT IS RECOMMENDED. Hyperglycemia is very common; other side effects include headache, insomnia, nausea and vomiting, back pain, arthralgia, myalgia, mucositis, and diarrhea. Integumentary problems such as rash, pruritus, nail disorder, dry skin, acne, and abnormal wound healing may occur. ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITORS OR ANGIOTENSIN II RECEPTOR ANTAGONISTS DURING TEMSIROLIMUS THERAPY ARE AT INCREASED RISK FOR ANGIOEDEMA OF THE FACE AND UPPER AIRWAYS. Avoid any LIVE VACCINES

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Proteasome

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is a large complex of proteins in cytoplasm and cell nucleus that regulates protein expression and the degradation of damaged or old proteins within the cell. Proteasome inhibition results in SUPPRESSION OF CANCER CELL DIVISION AND ENHANCEMENT OF CANCER CELL APOPTOSIS.

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-MAB

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Monoclonal antibodies - largely exert their effects on specific cell membrane surface proteins; MAB Tx is aimed specifically at tumor cells expressing the target antigen. The SIDE EFFECTS OF MONOCLONAL ANTIBODIES ARE RELATED TO ACTIVATION OF THE IMMUNE SYSTEM, LOCATION OF THE TARGET ANTIGEN, AND TYPE OF MONOCLONAL ANTIBODY. !!PROFOUND BONE MARROW SUPPRESSION!!

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Alemtuzumab

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is an unconjugated, humanized MAB; Tx induces FATIGUE NOT RELATED TO INFUSION REACTIONS OR PANCYTOPENIA. The drug causes PROFOUND BONE MARROW SUPPRESSION. Infusion reactions with fever, nausea, chills, blood pressure changes, hyperglycemia, and hypoxia are common and OFTEN REQUIRE PREMEDICATION WITH ANTIHISTAMINES AND ACETAMINOPHEN

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Ibritumomab tiuxetan

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conjugated murine MAB. It binds specifically to the human B-lymphocytes that express the CD20 cell surface antigens. Causes INFUSION REACTIONS WITH FEVER, NAUSEA, CHILLS, AND BLOOD PRESSURE CHANGES. Severe infusion reactions warrant discontinuing the drug. Less severe infusion reactions may be managed using PREMEDICATION WITH ANTIHISTAMINES AND ACETAMINOPHEN. The drug also causes seVERE CYTOPENIA AND SEVERE CUTANEOUS AND MUCOCUTANEOUS REACTIONs, fetal damage if given during pregnancy, and possible second malignancies. Just as with all monoclonal antibodies, this drug causes PROFOUND BONE MARROW SUPPRESSION.

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Tositumomab

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murine MAB conjugated with the radioactive isotope iodine-131. The antibody portion of this drug binds specifically to the human B-lymphocytes that express the CD20 cell surface antigens.SEVERE HYPERSENSITIVITY REACTIONS, SEVERE BONE MARROW SUPPRESSION, AND FETAL DAMAGE when used during pregnancy. Specific tositumomab side effects and adverse effects include asthenia, headache, hypotension, nausea, vomiting, abdominal pain, diarrhea, hypothyroidism, cough, dyspnea, pleural effusion, and pneumonia. TOXICITIES ASSOCIATED WITH RADIOIMMUNOTHERAPY CAN BE ACUTE, DELAYED, OR LONG-TERM. Infusion reactions with fever, nausea, chills, blood pressure changes, hyperglycemia, and hypoxia are common and often require premedication with antihistamines and acetaminophen.