Chemotherapy Drugs and Adverse Effects

Question 1

What type of adverse/effects toxicities can Doxorubicin have?

Answer 1

Cardiotoxicity (dysrhythmias, DCM), mast cell degranulation, GI colitis, causes tissue necrosis if extravascular.

Question 2

How can you prevent/treat cardiotoxicity from Doxorubicin?

Answer 2

Give over a 20-30 minute period, monitor by echo. Be careful not to give over >180mg/m^2 cumulatively as this increases risk.

Question 3

What type of adverse/effects toxicities can Cyclophosphamide have?

Answer 3

Haemorrhagic cystitis in dogs (rare in cats). It irritates the bladder)

Question 4

How can you prevent/treat haemorrhagic cystitis from Cyclophosphamide?

Answer 4

Prevent - dose in morning, fresh water, divide dose over 2 days. Furosemide (loop diur) on same day.
Treat - analgesia, oxybutinin, DMSO

Question 5

What type of adverse/effects toxicities can Vincristine have?

Answer 5

Peripheral neuropathies, ileus (abdominal pain), constipation (esp. cats), skin sloughs if given perivascularly.

Question 6

What type of adverse/effects toxicities can Lomustine have?

Answer 6

Hepatotoxicity (esp dogs), nephrotoxicity reported.

Question 7

How can you prevent/treat hepatotoxicity and nephrotoxicity from Lomustine?

Answer 7

Hepato - monitor ALT prior to dosing, SAMe to protect liver

Nephro - Monitor USG, dipstick for glucosuria.

Question 8

What type of adverse/effects toxicities can Platinum drugs (e.g. Cisplatin, carboplatin) have?

Answer 8

Cisplatin is particularly nephrotoxic, can cause central nausea.

Question 9

How can you prevent/treat nephrotoxicity and central nausea from Platinum drugs?

Answer 9

Nephro - use Carboplatin instead of cisplatin, monitor USG.

Central nausea - maropitant.

Question 10

What type of adverse/effects toxicities can Corticosteroids have? What are they used for in chemotherapy treatment?

Answer 10

PU/PD, Muscle weakness, immunosuppression, panting. May help MDR gene activate. Used for apoptosis of lymphoid and mast cells.

Question 11

What type of adverse/effects toxicities can L-asparginase have? What are they used for in chemotherapy treatment?

Answer 11

Possible allergic/anaphylactic shock - give antihistamine prior to second dose. Neoplastic cells need L-asparginine and can’t make it themselves.

Question 12

What type of adverse/effects toxicities can NSAID’s have? What are they used for in chemotherapy treatment?

Answer 12

Gastric ulceration, nephrotoxicity. Used to inhibit angiogenesis and promote apoptosis, anti-inflam. Often used in metronomic protocols.

Question 13

What type of adverse/effects toxicities can Receptor tyrosine kinase inhibitors have?

Answer 13

Vomiting, diarrhoea, weightloss, haemorrhage, myelosuppression, proteinurea, hypertension, depigmentation.

Question 14

What are Receptor tyrosine kinase inhibitors used for in chemotherapy treatment? Can you give any examples of these drugs?

Answer 14

Cancer cells may over express RTK’s or have mutated RTK’s e.g. KIT receptor in canine MCT. Drugs: Toceranib, Mastinib.

Question 15

Which chemotherapy drugs should you NEVER give to cats? Why?

Answer 15

• Cisplatin - fatal pulmonary oedema.

- 5-fluorouracil - extreme neurotoxicity.

Question 16

Which chemotherapy drugs should you be careful administering to herding breeds (e.g. collies, sheep dogs, whippets)? How can you check?

Answer 16

They breeds have an increased sensitivity to vinca alkaloids and doxirubicin. Check for MDR1 mutation.