Types of Cytotoxic chemos
Anthracyclines damage the DNA in cancer cells. Name the most common anthracycline used in outpatient clinics.
For bonus points, name others as well.
Adriamycin is the most common.
Others include Daunorubicin, Epirubicin, Mitoxantrone.
Pearls: This type of chemo generally has dye in it to warn nurse about Vesicant potential.
Immunotherapy treatments can cause a separate set of side effects when compared to chemotherapy.
What type of side effects are most common?
Inflammatory related adverse effects are common.
-Rash, pneumonitis, myalgias, colitis, any "itis" side effects.
Pearl: High dose steroids are the gold standard for treatment of these AE's.
Adriamycin
Cardiomyopathy, Severe Myelosuppression, Extravasation and Tissue Necrosis, Secondary Malignancies
ANC Levels & Risk:
How do you calculate the ANC?
(Segs+Bands) x WBC / 100
Segs=Grans and Polys
Antifolates disrupt cellular proliferation by blocking folate-dependent reactions. Name the most common antifolate we use in our clinic.
Bonus for others named.
Pemetrexed is most common.
Methotrexate is another.
Pearls: Pt needs to take folate and B12 to prevent life threatening side effects.
What type of immunotherapy involves genetically engineering a patient's own T-cells to fight cancer?
CAR T-cell therapy (Chimeric Antigen Receptor T-cell therapy
Carboplatin
Can cause significant bone marrow suppression, increasing with dosage.
Platelets levels & risk:
Treatment specific.
100 is standard. Review general orders for each chemo to make sure platelets are over limit for specific chemo.
What is the Nadir?
Nadir is the point in time after receiving chemo that your WBC count is at the lowest point before starting to climb back up.
Average 7-12 days post treatment.
Alkylating agents work by cross-linking of DNA strands which inhibits replication of DNA and transcription of RNA.
Name at least 3 common alkylating agents we use in clinic. HINT: Some of them are also Platinum derivatives.
Carboplatin, Bendamustine, Cisplatin, Cyclophosphamide, Dacarbazine, Oxaliplatin.
Pearl: Risk of leukemia after getting these drugs is highest about 5-10 years after treatment.
What is a common biomarker used to predict response to immunotherapy in lung cancer?
The expression level of PD-L1 on the tumor.
Cisplatin
High emetogenic potential, nephrotoxic, myelosuppression, peripheral neuropathy.
Describe necessary precautions when drawing a Uric Acid level on a patient who received Rasburicase.
If Rasburicase was given within the last 96 hours, specimen must be on ice.
What is CRAB in Multiple Myeloma?
C-Calcium is elevated from bone destruction.
R-Renal dysfunction
A-Anemia
B-Bone disease (lesions)
Topoisomerase inhibitors prevent unwinding of DNA strands leading to cell death.
Name 2 drugs we use in clinic.
Topotecan, Irinotecan.
Name a drug which uses humanised monoclonal antibodies that target CD20 cancer cells.
Rituxan
Dacarbazine
Bone marrow depression, Hepatic necrosis, high emetogenic potential.
Match tumor marker with cancer.
PSA, CEA, Ca-125, Ca 19-9, Ca-153
PSA:Prostate, CEA:Colorectal and Breast,
Ca-125:Ovarian, Ca 19-9:Pancreatic, Ca-153:Breast
What is the MOST complained about side effect of chemo/immunotherapy?
Profound fatigue
Vinca alkaloids stop mitosis which leads to cell growth being blocked.
Name 2 Vinca alkaloids we use in clinic.
Vincristine, Vinblastine.
Less common is Vinorelbine.
Pearl: for Vinca alkaloid extravasation, always use WARM compresses.
Name as many immunotherapy treatments as possible.
Pembrolizumab, ipilimumab, nivolumab, rituximab, trastuzumab, atezolizumab, bevacizumab, cetuximab, daratumumab, durvalumab, elotuzumab, obinutuzumab, pertuzumab, ramucirumab, tafasitamab, tarlatamab, sacituzumab. etc
Sacituzumab
Neutropenia, Diarrhea.
What labs are used to monitor Multiple Myeloma?
CBC, CMP, S-Pep and/or U-Pep, Serum free light chains, Beta-2 microglobulin, QIGs.
What chemo can cause permanent alopecia?
Taxotere