ABSTRACT
Anagrelide -inhibitor of platelet aggregation which causes thrombocy topenia
-cardiovascular effects (CHF, edema, palpitations) -anemia -nausea and vomiting -headache
Anastrazole -nonsteroidal aromatase inhibitor -nausea and vomiting -bowel changes (diarrhea or constipation) -headache -peripheral edema -hot flashes
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-LFT elevations -renal insufficiency -fatigue -hyperglycemia -skin rash -hypokalemia -peripheral neuropathy -high frequency hearing loss
Asparaginase -enzyme that inhibits protein synthesis -anaphylaxis —hepatotoxicity -CNS effects (lethargy, confusion, somnolence, depression) -coagulopathy -pancreatitis
Bicalutamide -nonsteroidal antiandrogen -endocrine effects
-hot flashes -decreased libido -depression -weight gain
-constipation Bleomycin -antitumor antibiotic that causes DNA strand breakage
-dose-related pneumonitis -mucocutaneous effects (stomatitis, mucositis) -acute pulmonary edema -fever in 50% -hyperpigmentation (can rarely be DLT)
Busulfan -alkylating agent -bone marrow suppression-can have prolonged nadir -ovarian suppression -seizures -hepatic veno-occlusive disease (VOD), particularly at BMT
doses -interstitial pulmonary fibrosis -hyperpigmentation (particularly skin creases and nail beds)
Capecitabine -converted to 5-FU preferentially by tumor cells; pyrimidine analogue; antimetabolite; inhibits thymidylate synthase
-mucocutaneous effects (stomatitis, mucositis) -diarrhea -bone marrow suppression -nausea and vomiting -palmar-plantar e ryth rodysethesias (hand-foot syndrome) -fatigue
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during replication
-bone marrow suppression-particularly thrombocytopenia -nausea and vomiting -liver function test abnormalities -uncommon neurotoxicity, ototoxicity
Carmustine (BCNU)
-alkylating agent (cell cycle-independent mechanism) -bone marrow suppression-delayed with a nadir of 3-5
weeks -nausea and vomiting-can be severe and prolonged -facial flushing -interstitial lung disease (dose independent)
Chlorambucil -alkylating agent (cell cycle-independent) -bone marrow suppression -nausea and vomiting -CNS stimulation (uncommon)
Cisplatin -atypical alkylating agent leading to DNA strand breakage during replication
-nephrotoxicity-DLT for single dose -peripheral neuropathy-DLT for multiple doses -bone marrow suppression -nausea and vomiting-can be severe and prolonged -ototoxicity -hypomagnesemia
Cladribine (2-CdA)
-purine analogue; antimetabolite -bone marrow suppression -fever in 50% (probably due to tumor lysis) -rash in 50% -immunosuppression (with profound T-cell lymphopenia)
Cyclophos phamide
-alkylating agent (cell cycle independent) -bone marrow suppression -anorexia, nausea and vomiting -alopecia -hemorrhagic cystitis
Cyclosporine -immunosuppressant -nephrotoxicity -hirsutism —hepatotoxicity -tremor -anxiety -hypertension
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(Ara-C)
replication -bone marrow suppression -nausea and vomiting -cerebellar toxicity (particularly at high doses) -conjunctivitis (at high doses) -hepatotoxicity -mucocutaneous effects (stomatitis, mucositis, diarrhea)
Dacarbazine -atypical alkylating agent, noncell cycle dependent (DTIC) -bone marrow suppression
-nausea and vomiting -vesicant if extravasated -flu-like syndrome -fever
Dactinomycin - antitumor antibiotic; inhibits transcription by complexing with DNA
-bone marrow suppression -nausea and vomiting -erythema -hyperpigmentation -mucocutaneous effects (mucositis, stomatitis, diarrhea) -vesicant if extravasated -immunosuppression
Daunorubicin -anthracycline antitumor antibiotic; DNA intercalating agent -bone marrow suppression -nausea and vomiting-mild to moderate -mucocutaneous effects (mucositis, stomatitis, diarrhea) -vesicant if extravasated —cardiotoxicity (550 mg/M2) -Liposomal daunorubicin: there is significantly less bone
marrow suppression, nausea and vomiting, stomatitis, and cardiotoxicity
Dexamethasone -corticosteroid -leukocytosis -nausea and vomiting -anorexia or increased appetite -CNS effects (psychosis, confusion) -fluid retention -hyperglycemia -osteoporosis
Dexrazoxane -iron chelating agent (cardioprotectant) -leukopenia and thrombocytopenia -nausea and vomiting -elevated liver function tests -hypotension
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besterol (DES)
-nausea and vomiting -cramps -elevated liver function tests -headache -thromboembolic events -weight gain -rash
Docetaxel -semisynthetic taxane; stabilizes tubulin polymers leading to death of mitotic cells
-bone marrow suppression -nausea and vomiting -mucocutaneous effects (mucositis, stomatitis, diarrhea) -hypersensitivity reactions -fluid retention syndrome -fatigue -myalgias -alopecia (universal)
Doxorubicin - anthracycline antitumor antibiotic - DNA intercalating agent -bone marrow suppression -nausea and vomiting -mucocutaneous effects (mucositis, stomatitis) -cardiotoxicity (550 mg/M2) -vesicant if extravasated -rash and hyperpigmentation -alopecia (universal)
Liposomal doxorubicin-bone marrow suppression; significantly less stomati tis, exstravasation necrosis, and cardiotoxicity
Epirubicin -anthracycline antitumor antibiotic-DNA intercalating agent -bone marrow suppression -nausea and vomiting -mucocutaneous effects (mucositis, stomatitis) -cardiotoxicity (1000 mg/M2) -vesicant if extravasated -rash and hyperpigmentation -alopecia
Erythropoietin -hormonal stimulant of red blood cell production -erythrocytosis (with excessive dosage) -flushing
Estramustine -inhibitor of microtubules -nausea and vomiting -headache -edema -impotence -gynecomastia -increases thromboembolic risk
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(VP-16)
-bone marrow suppression -nausea and vomiting -mucocutaneous effects (mucositis, stomatitis)— increased at
higher doses -chemical phlebitis common -hypotension with rapid administration -hypersensitivity reactions -secondary leukemia
Exemestane -aromatase inhibitor -nausea and vomiting -headache -peripheral edema -hot flashes
Filgrastim -hematopoietic growth factor (G-CSF) -bone pain
-low-grade fever -myalgias, arthralgias -leukocytosis (with excessive dosing) -capillary leak syndrome
Fludarabine -purine analogue; antimetabolite; partially cell cycle specific -bone marrow suppression -nausea and vomiting -mucocutaneous effects (mucositis, stomatitis)— increased at
higher doses -CNS toxicity-cortical blindness, confusion, coma,
somnolence -interstitial pneumonitis -immunosuppression
5-Fluorouracil -pyrimidine analogue; antimetabolite; inhibits thymidylate (5-FU) synthase
-mucocutaneous effects (diarrhea, mucositis, stomatitis) -bone marrow suppression -nausea and vomiting -palmar-plantar erythrodysethesias (hand-foot syndrome) -cardiotoxicity (ischemia, arrhythmias) -acute cerebellar syndrome
Fluoxy--synthetic steroidal androgen mesterone -androgenic effects predominate
-hirsuitism -amenorrhea -hoarseness -acne -increased libido -gynecomastia
-cholestatic jaundice -polycythemia
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-endocrine effects
-hot flashes -decreased libido -gynecomastia -impotence -galactorrhea
-diarrhea -nausea and vomiting -myalgias -elevated liver function tests
Gemcitabine - nucleoside analogue; antimetabolite; S-phase specific cytotoxicity
-bone marrow suppression-most commonly thrombocy topenia
-nausea and vomiting -fever during administration -elevated transaminases -rash
Gemtuzumab zoqamicin -monoclonal antibody against CD33 with calicheamicin
(antitumor antibiotic) -fevers and chills -hypotension -grade IV neutropenia and thrombocytopenia -LFT elevations
Goserelin -LHRH agonist -endocrine effects
-hot flashes -decreased libido -gynecomastia -impotence
-nausea and vomiting (uncommon) -transient increase in bone pain
Hydroxyurea -antimetabolite; inhibits ribonucleotide reductase; cell cycle specific
-bone marrow suppression -nausea and vomiting (uncommon at standard doses) -maculopapular rash -skin ulceration -megaloblastosis (elevated MCV)
Idarubicin -anthracycline antitumor antibiotic; DNA intercalating agent -bone marrow suppression -nausea and vomiting-mild to moderate -mucocutaneous effects (mucositis, stomatitis, diarrhea) -vesicant if extravasated -cardiotoxicity (150 mg/M2) -elevated liver function tests
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-bone marrow suppression -hemorrhagic cystitis (need Mesna uroprotection) -nausea and vomiting-mild to moderate -mucocutaneous effects (mucositis, stomatitis, diarrhea) -CNS toxicity-lethargy, stupor, coma, seizures
Interferon -biologic agent -flu-like symptoms-malaise, myalgias, fatigue, fever -nausea and vomiting-mild -anorexia -bone marrow suppression -mucocutaneous effects (stomatitis, mucositis) -cardiovascular effects (arrhythmias, hypotension) -mental status changes (confusion, lethargy, psychosis) -renal impairment (proteinuria) -elevation in transaminase levels
Irinotecan -semisynthetic camptothecin; topoisomerase I inhibitor -bone marrow suppression -diarrhea -nausea and vomiting -flushing -rash -alopecia
Leucovorin - enzyme cofactor for thymidylate synthase; rescues from (folinic acid) methotrexate toxicity; potentiates cytotoxicity of fluoro-
pyrimidines -occasional nausea -skin rash -headache -rare allergic reactions
Leuprolide -LHRH agonist -endocrine effects
-hot flashes -decreased libido -gynecomastia (3%) -breast tenderness -impotence (2%)
-nausea and vomiting (uncommon) -transient increase in bone pain -peripheral edema -dizziness, headache
Levamisole -immune potentiating effects -nausea and vomiting -diarrhea -anorexia -rash (23%) -alopecia (22%) -rare agranulocytosis (more often in women)
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(CCNU) -bone marrow suppression (delayed, prolonged, and
cumulative) -nausea and vomiting -pulmonary fibrosis -neurologic toxicity - confusion, lethargy, ataxia
Mechlorethamine (nitrogen mustard)
-alkylating agent; cell cycle independent -bone marrow suppression -vesicant if extravasated -severe nausea and vomiting -impaired spermatogenesis and amenorrhea -maculopapular skin rash -secondary leukemias
Megestrol acetate
-steroidal progestational agent -nausea and vomiting -headache -peripheral edema -hot flashes -thrombophlebitis -increased appetite with weight gain -hypercalcemia
Melphalan -alkylating agent; cell cycle independent -bone marrow suppression -nausea and vomiting (more frequent with large, single oral
doses) -pulmonary fibrosis -vasculitis -secondary leukemia
6-Mercaptopurine (6-MP)
- purine analogue antimetabolite; predominantly S-phase specific -bone marrow suppression -nausea and vomiting-mild to moderate -mucocutaneous effects (mucositis, stomatitis, diarrhea) —hepatotoxicity -dry scaling rash -fever —eosinophilia
Mesna -thiol uroprotectant (binds and inactivates toxic metabolite acrolein)
-nausea and vomiting -rash -headache -fatigue and lethargy
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-bone marrow suppression -nausea and vomiting-mild to moderate -mucocutaneous effects (mucositis, stomatitis, diarrhea) -hepatotoxicity-more common in high-dose therapy -CNS toxicity-dizziness, malaise, blurred vision,
encephalopathy -nephrotoxicity-including acute renal failure, particularly at
high doses Mitomycin C -antitumor antibiotic; inhibits RNA and DNA synthesis
-bone marrow suppression -nausea and vomiting-mild to moderate -mucocutaneous effects (mucositis, stomatitis, diarrhea) -vesicant if extravasated -nephrotoxicity -veno-occlusive disease (VOD) of the liver -hemolytic-uremic syndrome
Mitotane (o,p-DDD)
-adrenocortical cytotoxin -nausea and vomiting -CNS toxicity-lethargy, vertigo, sedation, dizziness -adrenal insufficiency-must use replacement doses of
mineralocorticoids and glucocorticoids -diarrhea -fever -wheezing -flushing
Mitoxantrone -anthracycline antitumor antibiotic; DNA intercalating agent -bone marrow suppression -nausea and vomiting-mild to moderate -mucocutaneous effects (mucositis, stomatitis, diarrhea) -cardiotoxicity (160 mg/M2) -elevated liver function tests
Octreotide -synthetic peptide analogue of somatostatin -abdominal pain, nausea, vomiting, diarrhea -local injection site reactions -cholelithiasis -sweating, flushing -hyperglycemia (many patients will require insulin therapy)
Oprelvekin (IL-11, Neumega)
-stimulation of megakaryoctye proliferation -fluid retention -constitutional symptoms-headache, fever, malaise -dyspnea -rash -diarrhea -pleural effusions -anemia
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-peripheral neuropathy (cumulative)— often reversible with
cessation of therapy -mild bone marrow suppression -nausea and vomiting (which may be severe)
Paclitaxel -natural taxane; inhibits depolymerization of tubulin in mitotic spindle apparatus
-bone marrow suppression -nausea and vomiting-mild -mucocutaneous effects (mucositis, stomatitis, diarrhea) -hypersensitivity reactions -peripheral neuropathy -myalgias, arthralgias -mild vesicant
Pamidronate -organic bisphosphonate; inhibits bone resorption by osteoclasts
-hypotension -syncope -tachycardia -hypocalcemia, hypokalemia, hypomagnesemia -nausea and vomiting rarely
Pentostatin -purine analogue; antimetabolite; inhibits adenosine deaminase
-nephrotoxicity (including acute renal failure) -bone marrow suppression -neurotoxicity-lethargy, fatigue, seizures, coma -immunosuppression (lymphopenia) -nausea and vomiting -fever -anorexia —hepatotoxicity
Prednisone -corticosteroid -leukocytosis -nausea and vomiting; indigestion -anorexia or increased appetite -CNS effects (depression, anxiety, euphoria, insomnia,
psychosis, confusion) -fluid retention -hyperglycemia -osteoporosis -acne -adrenal insufficiency with prolonged use
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-bone marrow suppression-prolonged -nausea and vomiting-severe; tolerance often develops with
repeated dosing -mucocutaneous effects (mucositis, stomatitis, diarrhea) -rash, hives, photosensitivity -interstitial pneumonitis -CNS toxicity-seizures, lethargy, headache, ataxia -flu-like syndrome -azoospermia and amenorrhea almost universal
Rituximab -monoclonal antibody to CD20 (B-cell surface antigen) -fever, chills, malaise -nausea, vomiting -flushing -bronchospasm, angioedema, urticaria -rhinitis -pain at disease sites -tumor lysis syndrome may occur in patients with high
peripheral lymphocyte count Sargramostim (GM-CSF)
-hematopoietic growth factor -nausea and vomiting -flushing -capillary leak syndrome -fevers and chills -headache -bone pain -myalgias, arthralgias -leukocytosis
Streptozocin -alkylating agent; cell cycle independent -nephrotoxicity-can be dose-limiting -nausea and vomiting-may get progressively worse with
continued administration -mucocutaneous effects (mucositis, stomatitis, diarrhea) -bone marrow suppression -irritant if extravasated (not vesicant) -delirium or depression -risk of secondary leukemias
Tamoxifen -nonsteroidal antiestrogen -nausea and vomiting -bowel changes (diarrhea or constipation) -headache -peripheral edema -hot flashes -endometrial carcinoma -vaginal bleeding -venous thrombosis
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-bone marrow suppression-delayed -nausea and vomiting-mild to moderate -constipation -rash -headache -elevated transaminases
Teniposide (VM-26)
-topoisomerase II inhibitor -bone marrow suppression -nausea and vomiting -mucocutaneous effects (mucositis, stomatitis) -chemical phlebitis common -hypotension with rapid administration -hypersensitivity reactions -secondary leukemia
6-Thioguanine (6-TG)
-purine analogue antimetabolite; cell cycle dependent -bone marrow suppression -nausea and vomiting -mucocutaneous effects (mucositis, stomatitis) -rash -hepatotoxicity -hyperuricemia
Thiotepa -alkylating agent; cell cycle independent -bone marrow suppression -nausea and vomiting-uncommon -mucocutaneous effects (mucositis, stomatitis)— uncommon -fever -angioedema -urticaria -secondary leukemia
Topotecan -semisynthetic camptothecin; topoisomerase I inhibitor -bone marrow suppression -nausea and vomiting -mucocutaneous effects (mucositis, stomatitis) -constitutional symptoms-fatigue, anorexia, malaise -hematuria -renal insufficiency -hypertension -hepatotoxicity
Toremifene - nonsteroidal antiestrogen -nausea and vomiting -bowel changes (diarrhea or constipation) -headache -peripheral edema -hot flashes -vaginal bleeding or discharge -venous thrombosis
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(Herceptin)
HER-2/neu receptor
-fevers, chills, nausea, vomiting, headache during administration
-cardiotoxicity (the FDA has not approved concurrent use with doxorubicin)
Tretinoin -naturally occurring retinoid -retinoic acid syndrome
-fever -chest pain -hypoxia -pulmonary infiltrates -pleural/pericardial effusions
-nausea and vomiting -mucocutaneous effects -arthralgias -headaches -increased triglycerides -xerostomia, exfoliation, chelitis
Trimetrexate -antifolate antimetabolite -bone marrow suppression -mucocutaneous effects (mucositis, stomatitis) -nausea and vomiting -fever -maculopapular rash-usually self-limited -anorexia, malaise -above toxicities increased in patient with hypoalbuminemia
(<3.5) Vinblastine -vinca alkaloid; inhibits tubulin polymerization; G2 phase
specific -bone marrow suppression -vesicant if extravasated -nausea and vomiting -constipation (often secondary to neuropathy induced ileus) -neuropathy (jaw pain, peripheral neuropathy, autonomic
neuropathy) -SIADH -tumor pain
Vincristine -vinca alkaloid; inhibits tubulin polymerization; G2 phase specific
-neurotoxicity-peripheral neuropathy -vesicant if extravasated -nausea and vomiting -bone marrow suppression-mild -transient transaminase elevation -constipation (often secondary to neuropathy induced ileus) * ‘ -intrathecal injection is ALWAYS FATAL
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specific
-bone marrow suppression -vesicant if extravasated -neurotoxicity -nausea and vomiting -acute reaction during administration-wheezing, chest pain,
dyspnea -can be prevented on future administration with
corticosteroids
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