Traditional Cytotoxic Chemotherapy: MISC AGENTS

retinoic acid derivative; moa

decreases proliferation and increases differenctiona of acute promyelocytic leukemia (APL) cells

retinoic acid derivative

tretinoin

tretinoin other names

all-trans retinoic acid, ATRA

tretinoin safety concerns

differentiation syndrome (Retinoic acid-acute promyeolotic leukemia syndrome, or RA-APL)

tretinoin monitoring

s/s differentiation syndrome (fever, dyspnea, wt gain, edema, pulmonary infiltrate, pericardial or pleural effusions)

tretinoin; prevention/treatment of differentiation syndrome

systemic steroids (dexamethasone), in severe cases may need to interupt therapy

arsenic trioxide generic

trisenox

arsenic tiroxide moa

increases apotosis of APL cells and damages the fusion protein promyelocytic luekemia reitnoic acid receptor alpha (PML-RARA)

aresenic trixodie safety concerns

QT prolongation, differentiation syndrome

arsenic trioxide; monitroing

ECG to assess QTc, electrolyes K, Mg, s/s differenetiation syndrome

arsenic trioxide management of toxicity

maintain K >4, and Mg > 1.8, avoid concurrent QT prolonging drugs.

Use systemic steroids, may need to interupt therapy

antitumor antibiotic moa

inhibtis dna synthesis via dna strand breaks

antitumor antibiotic

bleomycin

bleomycin safety concerns

pulmonary toxicity (pulmonary fibrosis) and hypersensitivity

bleomycin monitroing

s/s pulm tox, PFT

bleomycin management of tox

limit lifetime cumulative dose to 400 units

conside test dose for first 2 doses and or premedicate to avoid hypersensitivity

proteasome inhibitors moa

inhibt proteasomes, which ehlp regulate intracellular protein homeostasis by inhibitin cell cycle progression adn inducing apoptosis

proteasome inhibitors

brotexomib, carfilzomib

bortezomib generic

velcade

carfilzomib generic

kyprolis

proteaseome inhibitors safety concens

herpes reactivation (zoster and simplex), peripheral neuropathy)

proteasome management of tox

herpes; get tests done prior, consider antiviral agensts like aycclovir or valacyclovir

peripheral neuropahty; administer bortezomib SQ (less neuropathy than IV) and symptomatic management

immunomodulators moa

block angiogensis (formation of new blood cells) and kill abnormal cells in the bone marrow while stimulatin the bone marrow to produce normal healthy cells

immunomodulators

lenalidomide, pomalidomide, thalidomide

lenalidomide generic

revlimid

polalidomide

pomalyst

thalidomide generic

thalomid

immonodulator safety concerns

severe birth defects and thombosis

immunomodulator monitoring

2 negative pregancy tests before initiation; s/s thromboembolism

immunomodulator managment of safety concerns

REMS program; two forms of contraception/abstinence

prophylatic anticoagulation

asapraginase product moa

inhibits protein syntehssis by depleting asparagine in leukemic cells during G1 phase

asapraginase product

pegaspargase; modified form of L-asparaginase from E coli. Conjugated with polyethylene gylcol

pegasapargase generic

oncaspar

pegaspargase safety concern

hypersensitivity; pegylated form allows for less freqnt dosing and less allergic reactions

pegaspargase prevention of hypersensitivity

premidcation with acetaminophen, diphenhydramine, and H2RA (famotidine)