Chemotherapies: Uses, Toxicities, Interactions

Methotrexate use (folic acid analog)

Choriocarcinoma, Breast, Lung, H&N sarcomas, osteogenic sarcomas, ALL, NHL, T-cell lymphoma

Pemetrexed use (folic acid analog)

Pleural mesothelioma, NSCLC

Pralatrexate (folic acid analog)

Peripheral T-cell lymphoma, NHL

Cytarabine (pyrimidine analog)

AML, NHL, ALL

Fluorouracil uses (pyrimidine analog)

Colon, rectal, stomach, pancreatic, breast

Floxuridine uses (pyrimidine analog)

GI adenoma metastatic to liver

Capecitabine uses (pyrimidine analog)

Metastatic colorectal & breast

Gemcitabine uses (pyrimidine analog)

Pancreatic, NSCLC, advanced ovarian & breast

Mercaptopurine uses (purine analog)

ALL, CLL, acute nonlymphocytic leukemias

Thioguanine uses (purine analog)

ALL, CLL, acute nonlymphocytic leukemias

Pentostatin uses (purine analog)

Hairy cell leukemia

Fludrabine uses (purine analog)

CLL, low-grade NHL, follicular lymphoma, AML

Methotrexate specific toxicities

Mucositis, gastric ulcers, perforation

Reproductive abilities for 6 mos

Renal damage (hyperuricemia)

Cytarabine specific toxicities

Stomatitis, Conjunctivitis

Hepatic toxicity

Pulmonary edema

Cytarabine syndrome 6-12hrs(fever, myalgia, malaise, conjunctivitis)

Arachnoiditis - nausea, HA, fever

Nystagmus

5-FU & Capecitabine specific toxicities

Hand & foot syndrome

Diarrhea, Mucositis

Mercaptopurine specific toxicities

Hepatic toxicity

Mucositis, gastric ulcers, perforation

Reproductive abilities for 6 mos

Methotrexate interactions

Salicylates, NSAIDS, sulfonamides, penicillin, tetracycline = toxicity

Folic acid = decreased effect

PPIs

Cytarabine interactions

Digoxin = reduced absorption of heart med

Live virus vaccines = decreased abs response, increased adverse event

Anticoagulants

Mercaptopurine interactions

Allopurinol = reduce breakdown of chemo

Warfarin = increase or decreases levels of W

Methotrexate Admin

Leucovorin rescue for healthy cells & Sodium Bicarbonate for renal toxicity

Cytarabine admin

With dex to reduce neurotoxicity

Floxuridine admin

Into hepatic artery

Doxorubicin uses (anthracycline)

Lung, bone, stomach, breast, Hodgkin’Lymphoma, NHL, soft tissue & bone sarcomas, ovarian carcinoma, testicular carcinoma, thyroid

Liposomal doxorubicin uses (anthracycline)

AIDs Kaposi Sarcoma, Met Ovarian & Breast, Multiple Myeloma

Daunorubicin uses (anthracycline)

HIV Kaposi Sarcoma, Leukemia

Epirubicin uses (anthracycline)

Breast cancer

Idarubicin uses (anthracycline)

AML

Valrubicin uses (anthracycline)

Bladder

Mitoxantrone uses (anthracycline)

Prostate, acute nonlymphocytic leukemias

Dactinomycin uses (Antitumor antibx: Nonanthracycline)

Wilma’s tumor, rhabdomyosarcoma, choriocarcinoma, Ewing’s sarcoma, Kaposi’s sarcoma, testicular

Bleomycin uses (Antitumor antibx: Nonanthracycline)

Testicular carcinoma, squamous cell carcinoma, Hodgkin’s Lymphoma

Mitomycin uses (Antitumor antibx: Nonanthracycline)

Disseminated stomach & pancreas adenocarcinoma, carcinomas of colon, rectum, esophagus, cervix, bladder, breast, & lung

Doxorubicin specific toxicities

Dysrhythmias, ECG changes, cardiomyopathy

Red coloration to excretions

Dexrazoxane uses

Treats cardiac changes with doxorubicin; increases myelosuppression and decreases antitumor effects

Meds to treat/prevent cardiotoxicity w/ doxorubicin

Dexrazoxane, ACE Inhibitors

Bleomycin specific toxicities

Pulmonary fibrosis, pneumonitis (pulm fix test)

Doxorubicin Contraindication

Lifetime dose of 550 mg/m2

Doxorubicin interactions

CCB (amlodipine, nifedipine, dilitiazem, verapamil) = increased cardiotoxicity

Phenobarbital = decreased metab of chemo

Paclitaxel = decreased clearance of chemo

Phenytoin = increased levels of anti seizure med

Live virus vaccine (MMR, Polio, Varicella, BCG, yellow fever)

Nonmyelotoxic

Vinca alkaloids

Vincristine uses (vinca alkaloid)

ALL, Wilm’s tumor, rhabdomyosarcoma, bladder, breast, Hodgkin’s Lymphoma, NHL, Kaposi’s Sarcoma

Vinblastine uses (vinca alkaloid)

Kaposi’s Sarcoma, Hodgkin’s Lymphoma, NHL, breast carcinoma, testicular carcinoma

Vinorelbine uses (vinca alkaloid)

NSCLC

Paclitaxel uses (vinca alkaloid)

Ovarian, NSCLC, Kaposi’s Sarcoma, Leukemias

Docetaxel uses (vinca alkaloid)

Metastatic breast, metastatic NSCLC, prostate

Vincristine specific toxicities

Autonomic neurotoxicity = constipation, hesitancy

Peripheral neuropathy

Vesicant

Alopecia

Paclitaxel specific toxicities

Myelosuppression, Alopecia

Bradycardia, heart block, MI, hypotension

Peripheral neuropathy

Severe HSTVY reaction (methylprednisolone, hydrocortisone)

Bronchospasms

Vincristine CI

Radiation therapy

Vincristine interactions

Digoxin = reduced effect of digoxin

Mitomycin = increased risk for bronchospasm

Phenytoin = decreased chemo effect

Paclitaxel interactions

Cisplatin = increased Myelosuppression

Doxorubicin = increased Myelosuppression

Beta blockers, CCB, Digoxin = increased bradycardia

Cross BBB, therefore more effective at treating CNS tumors

Carmustine & Lomustine

Uptake by pancreatic islet cells

Streptozocin

Cyclophosphamide uses (nitrogen mustard)

Acute lymphomas, H&N, ovarian, breast, Hodgkin’s Lymphoma, NHL, MM

Mechlorethamine uses (nitrogen mustard)

Bronchogenic carcinoma, Hodgkin’s Lymphoma, leukemias, mycosis fungoides

Bendamustine uses (nitrogen mustard)

CLL, NHL

Chlorambucil uses (nitrogen mustard)

CLL, Hodgkin’s Lymphoma, NHL, MM

Melphlan uses (nitrogen mustard)

MM, lymphoma, ovarian, breast

Carmustine uses (nitrosureas)

Brain tumors, Hodgkin’s Lymphoma, NHL, MM, stomach adenocarcinoma, colon adenocarcinoma, rectal adenocarcinoma, malignant melanoma, hepatoma

Lomustine uses (nitrosureas)

Brain tumors, Hodgkin’s lymphoma

Streptozocin uses (nitrosureas)

Metastatic islet cell tumors

Cisplatin uses (platinum compounds)

Bladder, testicular, ovarian

Carboplatin uses (platinum compounds)

SCLC, squamous cell carcinoma of H&N, endometrial

Cyclophosphamide specific toxicities

Acute hemorrhagic cystitis = mesna

Sterility

Carmustine specific toxicities

Severe nausea & vomiting

Pulmonary fibrosis

Life & kidney toxicity

Cisplatin specific toxicities

Severe nausea & vomiting

Renal toxicity

Hearing loss

Cyclophosphamide interactions

Succinylcholine = increased neuromuscular blockade

Carmustine interactions

Cimetedine = increased myelosuppression

Cisplatin interactions

Aminoglycosides (gentamicin, neomycin) = renal toxicity

Furosemide = increased hearing loss risk

Topotecan uses (topoisoimerase inh.)

Metastatic ovarian, cervical, colorectal, and SCLC

Topotecan specific toxicities

Myelosuppression

N/V, abdominal pain, diarrhea

Topotecan interactions

Cisplatin = increased Myelosuppression

Aspariginase uses

ALL

Hydroxyurea uses

CML, ovarian, squamous cell, sickle cell anemia

Procarbazine uses

Brain tumors, Hodgkin’s lymphoma, NHL

Aspariginase specific toxicities

HSTVY Reactions

Neurotoxicity = confusion, coma

Liver & pancreatic toxicity

Renal toxicity

Hydroxyurea specific toxicities

Bone marrow suppression

Procarbazine specific toxicities

Myelosuppression

CNS Depression, Peripheral Neuropathy

Secondary Leukemia

Sterility = > in males

Aspariginase interactions

Methotrexate = decreased effect of methotrexate

Prednisone = increased chemo toxicity, hyperglycemia

Vincristine = increased chemo toxicity, hyperglycemia

Hydroxyurea interactions

Cytotoxic meds = increased toxicity

Antivirals = increased toxicity

Procarbazine interactions

CNS depressants like opioids = increased CNS depression

MAOI (phenelzibe, isocarboxazid), TCAs (amitryptaline, clomiprine), sympathomimetic drugs (dobutamine, phenylephrine, amphetamine, cocaine), cough meds, tyramibe containing foods = hypertensive crisis

Alcohol = disulfiram like reaction

Smoking = secondary lung cancer

Digoxin = low levels of digoxin