Antineoplastic Drugs & Biologic Response Modifiers

Antimetabolite prototypes

• methotrexate

• fluorouracil

Methotrexate action

stops cell reproduction needed for synthesis of DNA by inhibiting folic acid conversion

Methotrexate use

• choriocarcinoma, solid tumors, head/neck sarcomas, osteogenic sarcoma, acute lympocytic leukemia, non-Hodgkin’s lymphoma, T-cell

• RA, psoriasis, Crohn’s disease

Methotrexate complications

• mucositis

• RENAL DAMAGE

• bone marrow suppression

• N/V

• gastric ulcers

• perforation

Methotrexate administration

• PO, IV, IM, intrathecal

• 2-3L of daily fluid intake

• admin leucovorin to decrease toxicity to healthy cells

Methotrexate contraindications/cautions

• CATEGOREY X TERATOGENIC

• C/I = renal/liver failure, blood dycrasias

• caution = liver/kidney dysfunction, suppressed bone marrow, leukopenia, thrombocytopenia, anemia, gastric ulcers

Methotrexate interactions

• inhibits folic acid; do NOT take supplement

• salicylates, NSAIDs, sulfonamides, penicillin, tetracyclines can cause toxicity

Methotrexate interventions

• monitor I&Os, BUN/creatinine

• monitor changes in urination

• monitor WBC, neutrophils, platelet count, Hgb and Hct

• assess for bruising/bleeding gums

• monitor for GI bleed

• monitor for s/s of jaundice and infection

• give antiemetics BEFORE treatment

Methotrexate education

• report changes in urination

• stay hydrated

• avoid large crowds/sick individuals

• practice good hand hygiene

• use soft toothbrushes and avoid alcohol mouthwash

• use additional contraceptive measures

• avoid alcohol

• protect skin from sunlight

Fluorouracil action

destroys cells mainly in S-phase

Fluorouracil uses

colon, rectal, breast, stomach, and pancreatic cancer

Fluorouracil administartion

IV

Antitumor antibiotic prototype

doxorubicin

Doxorubicin action

• binds to DNA, altering structure

• inhibits synthesis of DNA and RNA

Doxorubicin use

Tx of breast, lung, GI, ovarian cancer; broad

Doxorubicin complications

• cardiac changes, acute toxicity

• CARDIOTOXIC

• red coloration of urine + sweat

• bone marrow suppression

• N/V, stomatitis

• severe tissue damage

• alopecia

• pulmonary fibrosis + pneumonitis

Doxorubicin administration

• max daily dose of 500 mg

• admin in central line, port, central catheter

• STOP IMMEDIATELY if extravasation occurs

Doxorubicin contraindications/cautions

• C/I = cardiac Hx, pregnant/lactating

• caution = liver impairment

Doxorubicin interactions

• CCBs can increase toxicity

• can increase levels of phenytoin

• NO LIVE VIRUS VACCINES

Doxorubicin interventions

• monitor skin integrity/IV at insertion site

• if pt complains of burning/itching, STOP IMMEDIATELY

• CONSTANT telemonitoring/EKG monitoring

• monitor WBC, neutrophils, platelets, Hgb, Hct

• assess for bruising/bleeding

• pulmonary function tests

• give antiemetics BEFORE treatment

Doxorubicin education

• urine and sweat will change to a ruby-red, but this is non-harmful

• hair loss will occur

Antimitotic prototypes

• vincristine

• paclitaxel

Vincristine action

prevents mitosis, M-phase specific

Vincristine use

• NOT bone marrow toxic

• use in combo

• acute lymphocytic leukemia, Wilm’s tumor, rhabdomyosarcoma, solid tumors, Hodgkin’s and non-Hodgkin’s lymphoma, Kaposi’s sarcoma

Vincristine complications

• peripheral neuropathy

• neurotoxic effects

• sever tissue damage/extravasation

• alopecia

• eye issues

Vincristine administration

• make sure IV is intact before administering

• use central line

Vincristine contraindications/cautions

• C/I = pregnancy/lactation

• caution = liver disease, neuromuscular disease

Vincristine interventions

• monitor/report neurotoxic effects

• monitor IV site CONSTANTLY

• STOP IMMEDIATELY IF EXTRAVASATION OCCURS

• assess for bronchospasm

• monitor for bleeding and infection

• monitor CBC and liver enzymes

Vincristine interactions

• decreases effects of digoxin

• phenytoin can decrease effect

• NO LIVE VIRUS VACCINES

Vincristine education

• hair loss will occur

• report neuro s/s

• practice good oral hygiene

• take additional contraceptive measures

Paclitaxel action

• stop cell division during mitosis

• inhibits cell division and produces apoptosis

Paclitaxel use

ovarian, non-small cell lung tumors, Kaposi’s sarcoma, leukemias

Paclitaxel complications

• bradycardia

• heart block, MI

• peripheral neuropathy

• bone marrow suppression

• alopecia

Paclitaxel interventions

• monitor WBC, neutrophils, platelets, Hgb and Hct

• assess for bruising/bleeding gums

• monitor for cardiac effects

• monitor EKG continuously during administartion

Paclitaxel educations

• avoid large crowds/sick people

• report chest pain/SOB

• hair loss will occur

• take additional contraceptive measures

Paclitaxel contraindications/cautions

• C/I = pregnancy, neutrophil count <1,500/mm³

• caution = myelosuppression, liver impairment

Paclitaxel interactions

• cisplatin or doxorubicin can increase myelosuppression

• cardiac meds that decrease HR can increase bradycardia

• medications that increase bleeding risk can increase bleeding risk

• NO LIVE VIRUS VACCINES

Alkylating agent prototypes

• cyclophosphamide

• cisplatin

Cyclophosphamide action

alkylation of DNA and RNA synthesis to kill rapidly dividing cells

Cyclophosphamide use

broad-spectrum neoplastic Tx

Cyclophosphamide complications

• acute hemorrhagic cystitis

• development of resistance

• bone marrow suppression

• N/V

• alopecia

Cyclophosphamide administration

• obtain provider over for 3L IV fluids

• use mensa to protect bladder

Cyclophosphamide contraindication/cautions

• C/I = pregnant/lactating, severe myelosuppression, sever infections

• caution = kidney disorder, prostatic hypertrophy, liver disorder, leukopenia, thrombocytopenia

Cyclophosphamide interventions

• monitor WBC, neutrophils, platelets, Hgb and Hct

• assess for bruising and bleeding gums, infection

• monitor for blood in the urine

• monitor CBC, uric acid level, and liver enzymes

• STOP IMMEDIATELY IF EXTRAVASATION OCCURS

• give antiemetics BEFORE treatment

Cyclophosphamide education

• avoid large crowds/sick people

• hair loss will occur

• practice good oral hygiene

• take additional contraceptive measures

Cisplatin action

kills rapidly growing cells by interruption DNA and RNA synthesis

Cisplatin uses

bladder, testicular, ovarian cancers

Cisplatin complications

• development of resistance

• bone marrow suppression

• severe N/V

• RENAL TOXICITY

• hearing loss

Cisplatin contraindications/cautions

C/I = pregnant/lactating, severe myelosuppression, kidney disorders, hearing loss

Cisplatin interactions

• concurrent use of ahminoglycosides can increase risk for renal toxicity

• concurrent use of furosemide can increase hearing loss

Cisplatin interventions

• assess hearing prior to and during treatment

• monitor BUN/creatinine

• monitor WBC, neutrophils, platelets, Hgb and Hct

• assess for bruising/bleeding gums

• give antiemetics BEFORE treatment

Topoisomerase inhibitor prototype

topotecan

Topotecan action

interrupts DNA synthesis by making a cut in the DNA strand; phase S-specific

Topotecan use

Tx of cervical, ovarian, colorectal, and small-cell lung cancer

Topotecan complications

• bone marrow suppression

• N/V/D, abd pain

• alopecia

Topotecan interventions

• monitor WBC, neutrophils, platelets, Hgb and Hct

• assess for bruising and bleeding gums

• monitor CBC

• give antiemetics BEFORE treatment

Topotecan education

• avoid large crowds/sick people

• hair loss will occur

• perform good oral hygeine, avoid mouthwash with alcohol

• take additional contraceptive measures

• monitor for drowsiness during the first several days of Tx

Topotecan contraindications/cautions

• C/I = pregnant/lactating, severe myelosuppression, neutrophils <1,500mm³ or hypersensitivity

• caution = impaired renal function

Topotecan interactions

• cisplatin can increase myelosuppression

• NO LIVE VIRUS VACCINES

Hormonal agents

• hormone agonists

• hormone antagonists

Hormone agonists

• cause an increase in a hormone that suppresses another hormone required for a tumor to grow

• negative feedback

Hormone agonist example

use estrogen to suppress testosterone-dependent cancer (prostate)

Hormone antagonist

• block certain hormones and can be effective against tumors that require a particular hormone for support

• directly prevents hormones from binding to cancer cell receptors

Hormone antagonist example

use anti-estrogen hormones to treat an estrogen-dependent cancer (breast)

Hormonal agent uses

prostate and breast cancer

Biologic response modifier prototype

interferon alfa-2b

Interferon alfa-2b action

increase immune response and decrease production of cancer cells

Interferon alfa-2b uses

treat of prevent hairy cell leukemia, chronic myelogenous leukemia, malignant melanoma, follicular lymphoma, AIDS-related Kaposi’s sarcoma

Interferon alfa-2b complications

• flu-like manifestations

  • fever, fatigue, HA, chills, myalgia

• bone marrow suppression

• alopecia

• cardiotoxicity

• thyroid dysfunction

• neurotoxicity

• depression

• anxiety

• altered mental status

• insomnia

Interferon alfa-2b administration

• SQ, IV, IM

• obtain order for tylenol and premedicate

• store in fridge, administer at room temp

• do NOT shake vial

Interferon alfa-2b interventions

• monitor CBC, fatigue, indications of cardio/neurotoxicity

• monitor for s/s of infection

• monitor for bruising, bleeding and blood in stools/urine/sputum/emesis

• monitor mood and mental status

• assess for suicidal thoughts

Interferon alfa-2b contraindications/cautions

• C/I = hypersensitivity, suicidal thoughts, colitis, pancreatitis

• caution = pregnant, severe liver/kidney/heart/pulmonary disease, DM, Hx of depression

Interferon alfa-2b interactions

• concurrent use with meds that are cardio/neurotoxic can increase cardio/neurotoxicity

• NO LIVE VIRUS VACCINES

Interferon alfa-2b education

• report SE to provider

• premedicate w/ tylenol

• avoid large crowds/sick people

• practice good oral hygiene

Targeted antineoplastic medication prototype

• monoclonal antibodies (-mab)

• tyrosine kinase inhibitors

Monoclonal antibody action

stops cancer cell growth and increases apoptosis

Monoclonal antibody use

• newer Tx

• advantages = more selective, often fewer systemic toxicities

• colorectal and solid tumors of head/neck

Monoclonal antibody complications

• infusion site reaction (rash, hypotension, wheezing)

• pulmonary emboli

• skin toxicity/rash

Monoclonal antibody interventions

• monitor for indications of a reaction

• premedicate/stop Tx if needed

• monitor breath sounds and SpO₂

• monitor rash and treat with topical antibiotics PRN

• monitor for infection

• monitor CBC, platelets, electrolytes

• monitor fluid states

• assess for edema

Monoclonal antibody contraindications/cautions

C/I = pregnant/lactating, hypersensitivity

Monoclonal antibody interactions

sun exposure may increase skin toxicity

Monoclonal antibody education

• limit sun exposure/use sunscreen/wear protective clothing

• notify provider of SOB

• practice good oral hygiene

• report adverse reactions (abd pain, skin lesions, HA, bleeding episodes)

Tyrosine kinase inhibitor action

stops cancer growth by inhibiting intracellular enzymes

Tyrosine kinase inhibitor uses

treat chronic myeloid leukemia

Tyrosine kinase inhibitor complications

• N/V

• flu-like s/s

  • fever, fatigue, HA, chills, myalgia

• edema

• hypokalemia

• neutropenia, anemia, thrombocytopenia

Tyrosine kinase inhibitor actions

• take antiemetic BEFORE administering

• take with food

• administer/premedicate w/ tylenol PRN

• monitor for edema

• monitor potassium level

• monitor CBC

• assess for bruising and bleeding gums

Tyrosine kinase inhibitor contraindications/cautions

• C/I = pregnant/lactating, hypersensitivity

• caution = liver disease

Tyrosine kinase inhibitor interactions

acetaminophen can increase chance of liver failure