Misc Chemotherapy Side-Effects

CHEMOTHERAPY

Topoisomerase Inhibitors

Name Class Mechanism Side-effects Other
Irinotecan Camptothecin topoisomerase 1 inhibitor severe diarrhea
immunosuppression
used in colon cancer (ex. FOLFIRI)
Etoposide Epipodophyllotoxins nonintercolating topoiomerase II poison Dose limiting myelosupression Secondary acute myelogenous leukemia

Antracyclines

Name Class Mechanism Side-effects Other
Doxorubicin (Adriamycin) Antibiotic that stabilize Topoisomerase II-alpha complex Myelosuprression Cardiotoxicity at 400 mg/m2 (w/o RT)

CLASS:
NAME: Docetaxel(Taxotere®)
MECHANISM: antimetabolites (nucleoside analog. )
USE:
SIDE EFFECTS:

  • Fluid retention (ie. pleural effusion)
  • Immunosuppression (ie. Infection)
  • Common (alopecia and neurosensory)

CLASS:
NAME: Gemcitabine(Gemzar®)
MECHANISM:
promoting and stabilising microtubule assembly.
USE: NSCLC, pancreatic, ovarian
SIDE EFFECTS:

  • Radiation "recall" dermatitis
  • Alopecia
  • Neuropathy

CLASS:
NAME: Methotrexate
MECHANISM:
reversibly inhibits dihydrofolate reductase (DHFR), an enzyme that is part of the folate synthesis metabolic pathway.
USE:
SIDE EFFECTS:

  • Fluid retention
  • immunosuppression.

CLASS:
NAME: Paclitaxel
MECHANISM:
interferes with the disassembly of microtubule
USE:
SIDE EFFECTS:

  • Fluid retention
  • immunosuppression.

CLASS: Alkylating Agent
NAME: Cyclophosphamide
MECHANISM:

USE:
DOSE LIMITING:

  • hematopoietic

SIDE EFFECTS:

Targeted Therapy

Gefitinib (Iressa)
MECHANISM:

  • epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor

USE:

  • two failed clinical studies of Iressa for NSCLC
  • The response rate in patients taking the drug was approximately 10%.
  • There was no significant survival benefit in the overall study population nor in patients who had high levels of a surface marker called “EGFR”.

DOSE LIMITING:

  • diarrhea

Erlotinib hydrochloride (Tarceva)

Imatinib (Gleevec)
MECHANISM:

  • specific inhibitor of a number of tyrosine kinase enzymes

USE:

  • chronic myelogenous leukemia (CML)
  • gastrointestinal stromal tumors (GISTs)

DOSE LIMITING:

SIDE EFFECT

  • Nausea (most common)

Combination Therapy

MOPP (Mechlorethamine, VBL, Procarbazine, Prednisone)

  • sterility
  • leukemia

ABVD

  • pulmonary toxicity
  • cardiac toxicity

CHOP-R (Cyclophosphamide, Adriamycine (doxorubicin), Vincristin, (oncovin), and prednisone) - Rituximab

  • cardiotoxicity (primary toxicity)
  • pancytopenia
  • infusion-effects

TABLE OF CHEMOTHERAPY

CLASS MECHANISM NAME DOSE LIMITING OTHER USES
Alkylating Cyclophosphamide Hematopoietic Sterility, 5% leukemic risk, Hemorrhagic cystitis (unique to Cyclophosphamide)
Anthracyclines Antibiotic Doxorubicin (Adriamycin) Hematopoietic Cardiotoxicity at 400 mg/m2 (w/o RT)
Antimetabolities Methotrexate Hematopoietic, mucositis
Vinca Alkaloid Disrupt microtubule formation Vincristine (oncovin) Neurotoxicity not much myelosuprresion
Vinblastin (VBL) Neutropenia
Others Bleomycin Pneumonitis Toxicity for those > 70 years of age and > 400 units
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