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Chemotherapeutics (Important Cytotoxic Classes (Cytotoxic Abx (Mechanism…
Chemotherapeutics
Important Cytotoxic Classes
Alkylating agents
Cyclophosphamide
SE
Haemorrhagic cystitis: give mesna
BM suppression
Hair loss
chlorambucil
busulfan
cisplatin
Mechanism
DNA x-linking
Base mis-paring
Excision of alkylated DNA → strand breaks
Cytotoxic Abx
Bleomycin
Mechanism
Free radical formation
Intercalate with DNA
Anthracyclines: doxorubicin, daunorubicin
Microtubule Inhibitors
Taxanes: paclitaxel
Vinca alkaloids: vincristine, vinblastine
Antimetabolites
methotrexate, 5-FU
Topoisomerase Inhibitors
Etoposide
Immune Modulators
thalidomide, lenalidomide
MAbs
Trastuzumab (anti-Her2): breast Ca
Bevacizumab (anti-VEGF): RCC, CRC, lung
Cetuximab (anti-EGFR): CRC
Rituximab (anti-CD20): NHL
Tyrosine Kinase Inhibitors
Erlotinib: lung Ca
Imatinib: CML
Sunitinib: RCC
Endocrine Modulators
tamoxifen, anastrazole
Common Regimens
Breast Ca: FEC
5-FU
Epirubicin
Cyclophosphamide
Breast Ca: CMF
Cyclophosphamide
Methotrexate
5-FU
Testicular Teratoma: BEP
Bleomycin
Etoposide
CisPlatin
Ovarian
Carboplatin
Paclitaxel
NHL: R-CHOP
Rituximab
Cyclophosphamide
Hydroxydaunomycin (doxorubicin)
Oncovin
Prednisolone
HL: ABVD
Adriamycin (doxorubicin)
Bleomycin
Vinblastine
Dacarbazine
Mx Chemo-induce Emesis
Low risk of emesis
Domperidone / metoclopramide started pre-Rx
High risk of emesis
Ondansetron / granisetron +
Dexamthasone +
Aprepitant
Common Side Effects
n/v: prophylactic anti-emetics
Alopecia
Neutropenia: 10-14d after chemo
Extravasation of chemo agent
Pain, burring, bruising @ infusion site
Stop infusion, give steroids, apply cold pack
Liaise early with plastics
Hyperuricaemia
Oral mucositis