PNN Oncology, Biostats

Chemo guidelines

NCCN

national comprehensive cancer network

M phase meds

vinca alkaloids

taxanes

"MTV"

Vinca alkaloids

M phase

IV, NO intrathecal, WARM compress for extravasation

constipation

vincristine max 2mg/dose

vinblastine

vinorelbine

Taxanes

M phase

paclitaxel

docetaxel

docetaxel

HSR - premed with steroid

fluid retention

ocular

peripheral neuropathy

Taxol

paclitaxel

non-PVC, use 0.22 filter

premedicate with steroid, H2 blocker, diphenhydramine

peripheral neuropathy

ethanol

caster oil

IV only

G1 phase

no meds work directly on G1

S phase meds

DNA replication

MTX, fluorouracil, capecitabine, 6-MP

Methotrexate

antimetabolite - S phase

RA: weekly 20 mg

cancer: 12,000mg/m2 IV q2-3 weeks then leucovorin (folinic acid)

PO, IM, SC, IV, intrathecal (PF)

SE: renal (sodium bicarb, glucarpidase (Vorazase)) AND hepatic, pulmonary fibrosis, photosensitivity, mucositosis, NO preg

Vorazase

glucarpidase

breaks down MTX before it gets to the kidneys, use in renal impairment

5FU

fluorouracil

antimetabolite

+ leucovorin (synergistic)

Inc INR, hand-foot syndrome

Efudex

fluorouracil topical

actinic or solar keratosis, superficial basal cell carcinoma

Xeloda

capecitabine

antimetabolite, PO, after meals

prodrug of 5FU

2 weeks on, one week off

Increase INR

Purinethol, Purixan

mercaptopurine (6MP)

antimetablite

drug interaction with allopurinol and febuxostat (Uloric) (need to decrease 6MP dose)

G2 phase meds

RNA and protein

etoposide, teniposide

Toposar

Etoposide (G2)

PO: VP-16 refrigerated

IV

Irinotecan

early D: atropine

late D: loperamide

cell cycle non-specific meds

works on many phases

alkylating agents, antitumor antibiotics

Alkylating agents

non-specific

cispatin, carboplatin, oxaliplatin

- peripheral neuropathy

busulfan - pulm

cyclophosphamide, ifosphamide (anaolog of cyclo)

carmustine, lomustine

steprozocin (Zanosar) - pancreatic cancer

melphalan

bendamustine

mechlorethamine, altretamine

procarbazine (MAOI)

Platinol

cisplatin (alkylating)

ototox

nephrotox: hydrate, mannitol (5micron filter), amifostine

peripheral neuropathy

Efloxatin

oxaliplatin (alkylating)

for colorectal cancer with 5FU + leucovorin

(FOLFOX)

Busulfan

(alkylating)

pulmonary fibrosis - CXR

inc seizures (premed phenytoin, VA, etc)

Cytoxan

cyclophosphamide (alkylating)

hemorrhagic cystitis - hydrate, mesna (binds to acrolein)

Ifex

Ifosfamide (alkylating agent)

analog of cyclophosphamide

- fluid, mesna

BiCNU

carmustine (alkylating)

LIPID soluble - used for CNS malignancies

CeeNU

Lomustine (alkylating)

LIPID soluble - used for CNS malignancies

Zanosar

Streptozocin (alkylating agent)

pancreatic cancers

monitor T1DM

Melphalan

alkylating agent

PO, IV - use within 60 min

Valchlor

alkylating agent

mechlorethamine topical gel - in fridge

Hexalen

Altretamine (alkylating agent)

- fertility impairment

- ovarian cancer

procarbazine

alkylating, PO

MAOI, avoid alcohol (disulfram)

Treanda

Bendamustine (alkylating agent)

infusion reaction

antitumor antibiotcs

non-specific

dactinomyin, daunorubicin, doxorubicin, valrubicin, mitomycin, mitoxantrone

Bleomycin

antibiotic

pulmonary fibrosis

max 400 units total lifetime dose

doxorubicin, daunorubicin

antibiotic

max 500mg/m2

dexrazaxane

- Zinecar - protects against cardiotox

- totect - extravasation (COLD)

zinecard vs totect

dexrazoxane

Z: protects against cardiotoc

T: for extravasation (COLD)

Novantrone

Mitoxantrone (antibiotic)

BLUE

cardiotox: for MS, max is 140mg/m2 lifetime

Tyrosine kinase inhibitors

3A4 substrates, all PO, SEdiarrhea

Gleevec

Imatinib

TKI

Tarcera

Erlotinib

Tykerb

Lapatinib

Tasigna

Nilotinib

EGFR inhibitors

Cetuximab (Erbitux), Panitumumab

VEGF

Bevacizumab (Avastin)

bleeding - hemotysis (hemotysis, epitaxis)

Avastin

bevacizumab

most likely to casue CINV

cisplatin

CINV order

5-HT3i, dexamethazome, NK-1 receptor antagonist

CINV add ons

cannabinoids, dopimergic antagonists, antihistamines, BZD, lorazapam, olanzapin = off label

5HT3 inhibitors

dolasetron (Anzemet)

granisetron (Kyrril, Granisol, Sancuso patch)

ondansetron (Zofran, ODT)

palonetron (Aloxi) IV

PO: 1hour before, IV: 30 min before, patch 24-48hr before

Corticosteroids

dexamthasone

NK-1 receptor blockers

"-pitant"

Aprepitant (Emend)

Fosaprepitant (Emend IV)

Rolapitant (Varubi) - 2D6 inhibitors

Cannobinoids

THC

dronabinol (Marinol) C-III (Sydros - solution C-II)

(NOT CBD Epidolex for seizures - NOT controlled)

Dopamine Antagonists

NEVER to parkinsons

block dopamine = increase motility

metoclopramide (Reglan)

prochloroparazine (Compazine)

SE: dystonia (benstropin) and other EPSE, diarrhea, spasma, seizures)

Antihistamines

not strong enough for CINV

BZD

lorazepam

antidote: flumazinil over 30 sec

chemo-induced anemia

only use if there is no cure, ESRD, zidovudine-induced anemia

Erythropoietin (Epogen, Procrit, Retacrit) 3x/week or weekly SC unless HD, then use IV; multidose vials discard after 21 days

Darbepoetin (Aranesp) SC q3w

CI: uncontrolled HTN

monitor Hgb - once hits 11, d/c

monitor: BP, CBC, Hbg, Ferritin (start iron if <100mcg/mL), folic acid,

fridge temp

2-8 C, 36-46 F

chemo-induced leukocytosis

filgrastim (Granix, Neupogen, Zarxio)

pegfilgrastim (Neulasta)

SC usually

SE: bone pain

used to prevent FN (start 24 hours after chemo)

Tumor lysis syndrome results in:

hyperkalemia

hyperuricemia

hyperphosphatemia

secondary hypocalcemia

hyperkalemia

calcium (protects the heart)

- chloride - central line only (1g = 270mg)

- gluconate - (1g = 90mg)

shifts intracellularly

- insulin regular + dextrose

- albuterol

- sodium bicarb

removes potassium

- Lokelma (SZC)

- Veltassa (patiromer)

- Kayexalate (SPS)

- loop

- HD

Hyperphosphatemia

secondary hypocalcemia

- calcium acetate (Phoslo) - with food

- Sevelamer (Renagel)

- Lanthanum (Fosrenol)

Hyperuricemia

- can start allopurinol (5801)

chemo induced peripheral neuropathy meds

vincas, taxanes, platinums (especially oxaliplatin - COLD induced)

max lifetime dose for doxorubicin, daurnorubicin

550 mg/m2

if 60mg/m2 doxorubicin, BSA = 2m2, how many cycles can you give?

9 cycles

what age to check for breast cancer

40

breast cancer three treatment options

chemo, hormone, target

hormone therapy for breast cancer

target therapy for ER+ breast cancer

Ibrance

Kisaali

Afinitor

target therapy for HER2+ breast cancer

Herceptin

trastuzumab

Breast cancer HER2+

CARDIOTOX

pulmonary tox

anaphylaxis

Perjeta

Tykerb

Lapatinib (HER2)

Neratinib

hormone therapy for premenopausal breast cancer

GNRH, SERMs

Tamoxifen

SERM

pre menopausal breast cancer

CLOTS, DDI (2D6 inhibitors will DECREASE it - DO NOT GIVE paroxetine fluoxetine, duloxetine, bupropion; can give venlafaxine)

antidepressant 2D6 inhibitors

paroxetine fluoxetine, duloxetine, bupropion;

venlafaxine okay to use

post menopausal breast cancer hormone therapy

Aromatase inhibitors

Fulvestratnt (Faslodex)

secondary prevention of breast cancer

premen: tamoxifen

postmen: raloxifen (Evista) PO QD

x5-10 years

counseling: walk around

PSA for prostate cancer; goal for prostate cancer

normal 0-4; >10 = suspicious

decrease testosterone

prostate cancer tx

LHRH/GNRH agonists (also used for premen breast cancer, endometriosis)

+

antiandrogen for 2-4 weeks to prevent tumor flair

will increase testosterone at first

LHRH/GNRH agonists

Goserelin (Zoladex)

Leuprolide (Lupron Depot, Eligard)

Triptorelin (Trelstar, Triptodur)

Histreline (Vantas)

not oral

antiandrogens

added to LHRH agonists to prevent tumor flair

start before, continue for 2-4 weeks

"tamide"

flutamide, biclutamid, nilutamide

PO

Firmagon

degarelix

GnRH ANTAGONIST:

prostate cancer

cancer testing

cervical: 21-29 q3y

breast: 40

colon: 45

lung (low dose CT): 50-80: 20 pack year smoking history OR quit within the last 15 years

- pack year = #pack/day x #years

antidote for serotonin syndrome

Cyproheptadine

antidote for neuroleptic malignant syndrome

Dantrolene, Bromocriptine, cool them down

antidote for ethylene glycol and methanol

Fomepizole (Antizol)

warfain antidote

vitamin K-1 (phytonadione, Mephyton)

drug reference for foreign brand names

Martindale

drug reference for peds

Harriet Lane

HIV/AIDs reference

clinicalinfo.hiv.gov

red book

drug prices

orange book

Therapeutic equivalence

purple book

biologic similars

yellow book

travel

pink book

Epidemiology and vaccine-preventable diseases