Chemotherapy Side Effects
Carboplatin
Neutropenia; thrombocytopenia; nausea; vomiting; hypersensitivity; alopecia; rash
Oxaliplatin
Peripheral neuropathy; myelosuppression; anaphylactic reactions; nausea; vomiting; diarrhea; pulmonary fibrosis; fatigue; fever; increased transaminases; increased alkaline phosphatase
Nivolumab
Fatigue; malaise; peripheral neuropathy; GI toxicities; elevated LFTs; increased creatinine; electrolyte imbalances; weakness; anemia; neutropenia; thrombocytopenia; myalgia; upper respiratory tract infection; cough; febrile reaction; immune-mediated adverse reactions
Pembrolizumab
Fatigue; rash; hyperglycemia; metabolic imbalances; GI toxicities; vomiting; urinary tract infection; anemia; lymphocytopenia; thrombocytopenia; elevated LFTs; increased serum creatinine; fever; immune-mediated adverse reactions
Ferric carboxymaltose
Nausea; vomiting; changes in taste; headache; injection site reactions; brown discoloration of the skin; hot flashes/flushing
Zoledronic Acid
Serum creatinine
BSA (DuBois)
Male, 205 lbs, 74 inches tall
2.2
Sepsis
Risk: Cancer; > 60 years old, prolonged neutropenia (> 7 days), implanted catheter
Symptoms: Fever; mental status changes; confusion; difficulty arousing; severe pain/discomfort; hypotension; tachycardia; tachypnea
Interventions: antimicrobials, hemodynamic support, fluid resuscitation, vasopressors, oxygen
Cyclophosphamide
Hemorrhagic cystitis; myelosuppression; nausea; vomiting; alopecia; maxillary burning; acute cardiomyopathy; SIADH
Fluorouracil
Mucositis; myelosuppression; nausea; anorexia; vomiting; diarrhea; alopecia; ocular toxicities; darkening of the veins; dry skin; neurotoxicity; palmar-plantar erythrodysesthesia
Atezolizumab
Fatigue; hypoalbuminemia; hyponatremia; decreased appetite; nausea; constipation; increased serum alkaline phosphatase; increased serum AST and ALT; antibody development; infection; musculoskeletal pain; fever; immune-mediated adverse reactions
Pertuzumab
Black box: left ventricular dysfunction, embryo-fetal toxicity; weakness; myalgias; neutropenia; anemia; diarrhea; nausea; vomiting; alopecia; rash; fatigue; headache; cardiac dysfunction
Denosumab
Osteonecrosis of the jaw; hypocalcemia; hypophosphatemia; dyspnea; injection-site reactions
Carboplatin
Serum creatinine
BSA (DuBois)
Female, 145 lbs, 63 inches tall
1.69
Immune effector cell-associated neurotoxicity syndrome (ICANS)
Neurotoxicity associated with CAR T-cell; bispecific T cell engager therapies.
Risk: CRS; pre-existing neuro comorbidities; younger age; high disease burden; ALL; pre-treat elevated LDH, decreased platelet, high ferritin day 3 post admin
Assessment: ICE assessment (handwriting, counting backwards, object identification, orientation to time/space etc)
Gemcitabine
Myelosuppression; thrombocytopenia; nausea; vomiting; fever; headache; arthralgias; myalgias; rash; peripheral edema; dyspnea; pulmonary toxicity; hepatoxicity
Rituximab
Black box: infusion-related reactions within 24 hours, TLS; fatigue; chills; neuropathy; nausea; lymphocytopenia; anemia; infection; weakness
Cemiplimab-rwlc
Fatigue; rash; diarrhea; pneumonitis; colitis; hepatitis; endocrinopathies; nephritis; dermatologic toxicities
Darbepoetin alfa
Shortness of breath, cough, abdominal pain, edema, hypertension, rash, urticaria, myalgia, infection, fatigue, diarrhea, thrombotic events
Calcium Levels
BSA (DuBois):
Male, 175 lbs, 68 inches tall
1.93
Cytokine Release Syndrome
Symptoms: myalgias; headache; fever; fatigue; nausea; hypotension; capillary leak
Treatment: Corticosteroids, Tocilizumab; symptom management
Timing: Within 14 days
Etoposide
Myelosuppression; hypersensitivity reaction; nausea; vomiting; alopecia; anorexia; hypotension
Azacitidine
Ado-trastuzumab emtansine
Fatigue; nausea; musculoskeletal pain; arthralgia; peripheral neuropathy; headache; increased transaminases; constipation; thrombocytopenia; bleeding; epistaxis; cardiotoxicity
Fam-trastuzumab deruxtecan
Pneumonitis; cough; dyspnea; fever; worsening respiratory status; nausea; fatigue; vomiting; alopecia; constipation; decreased appetite; anemia; diarrhea; leukopenia; thrombocytopenia; left ventricular dysfunction
Filgrastim
Filgrastim
Neutrophils
ANC calculation:
WBC = 1.2; % Neutrophils = 70; % Lymphocytes = 31; % Monocytes = 9; % Bands = 3
876
Tumor Lysis Syndrome
When large numbers of rapidly dividing cells are killed and release their contents into the bloodstream
Risk: high tumor burden/bulky tumors; leukemias, lymphomas, some solid tumors; poor renal function
Symptoms: elevated uric acid, phosphorus, potassium, BUN, and/or creatinine; decreased calcium; oliguria, anuria, flank pain, dysrhythmias, n/v/d, anorexia, cramps, confusion
Prevention: allopurinol, rasburicase
Bleomycin
Hypersensitivity; pulmonary toxicity; hyperpigmentation; alopecia; photosensitivity; renal toxicity; hepatotoxicity; fever; chills; erythema; rash; mucositis
Paclitaxel protein-bound
Myelosuppression; sensory neuropathy; sepsis; pneumonitis; hypersensitivity reaction; alopecia; anemia; myalgia/arthralgia; nausea; vomiting; diarrhea
Cetuximab
Daratumumab
Fatigue; nausea; lymphocytopenia; neutropenia; anemia; back pain; cough; fever; infusion-related reactions; asthenia; diarrhea; constipation; decreased appetite; vomiting; muscle spasms; arthralgia; fever; chills; dizziness; insomnia; cough; dyspnea; peripheral edema; peripheral neuropathy; bronchitis; pneumonia; upper respiratory tract infection
Pegfilgrastim
Urticaria, rash, facial edema, acute respiratory distress syndrome, nausea, vomiting, bone pain, fever, risk of splenic rupture
Atezolizumab
LFTs
Carboplatin calculation:
Male, 65 years old, 5'10", 200 lbs, serum creatinine 1.0. Target AUC = 6
718 mg
Superior Vena Cava Syndrome
Risks: lung ca or non-Hodgkin lymphoma
Symptoms: facial swelling; head fullness; facial/chest/neck/upper-extremity edema; dyspnea; nonproductive cough; distended chest veins
Assess: respiratory, cardiovascular, neurologic compromise; supportive care (oxygen, bronchodilators, elevate head, anxiety mgmt)
Vinorelbine
Myelosuppression; hepatotoxicity; severe constipation and bowel obstruction; neurotoxicity; peripheral neuropathy; pulmonary toxicity; respiratory failure; nausea; vomiting; alopecia
Arsenic trioxide
Fatigue; prolonged QT interval; leukocytosis; headache; nausea; vomiting; diarrhea; abdominal pain; fever; dermatitis; cough; dyspnea; peripheral neuropathy
Eculizumab
Headache; nasopharyngitis; back pain; nausea; increased risk of meningococcal infections; infusion-related reactions
Brentuximab vedotin
Peripheral neuropathy; fatigue; rash; neutropenia; anemia; upper respiratory tract infection; cough; fever; infusion-related reactions; nausea; constipation; vomiting; alopecia; decreased weight; abdominal pain; stomatitis; thrombocytopenia; lymphopenia; mucositis; renal toxicity; hepatotoxicity
IVIG
Headache, chills, fever, flushing, muscle pain, joint pain, fatigue, nausea, vomiting, rash
Trastuzumab
Echocardiogram
Carboplatin Calculation:
Female, 50 years old, 5'5", 185 lbs, serum creatinine 0.8. Target AUC= 5
685 mg
Disseminated Intravascular Coagulation
What it is: clotting and bleeding occur simultaneously
Risk factors: APL; adenocarcinomas; CAR-T
Symptoms: oozing to uncontrolled hemorrhage; s/s of internal bleeding; ischemia; infarction; organ failure
Assess for s/s of bleeding or thrombosis; monitor labs, vital signs, oxygenation and fluid status