Oncology

Question 1

Bleomycin maximum dose and toxicity

Answer 1

LCD: 400 units; Pulmonary toxicity

Question 2

Doxorubicin maximum dose and toxicity

Answer 2

LCD: 450-550 mg/m2; Cardiotoxicity

Question 3

Cisplatin maximum dose and toxicity

Answer 3

Dose per cycle max 100 mg/m2; Nephrotoxicity

Question 4

Vincristine maximum dose and toxicity

Answer 4

Single-dose “capped” at 2 mg; Nephrotoxicity

Question 5

Neutropenia management

Answer 5

colony-stimulating factors (CSFs)

Question 6

Thrombocytopenia management

Answer 6

platelet transfusion

Question 7

Chemo-induced N/V management

Answer 7

NK-1 receptor antagonist, Serotonin-3 receptor antagonist, dexamethasone, metoclopramide, prochlorperazine; and IV/PO fluid hydration

Question 8

Mucositis management

Answer 8

symptomatic management (mucosal coating agents, topical local anesthetics)

Question 9

Diarrhea management

Answer 9

IV/PO fluid hydration, antimotility agent (eg. loperamide), irinotecan (atropine for early onset diarrhea)

Question 10

Constipation management

Answer 10

Stimulant laxatives, Polyethylene glycol

Question 11

Xerostomia management

Answer 11

artificial saliva substitues, pilocarpine

Question 12

Cardiotoxicity management

Answer 12

{Cardiomyopathy: DNE LCD for doxorubicin. Dexrazoxane can be given prophylactically in some patients receiving doxorubicin.} [QT prolongation: Maintain K, Mg, Ca WNL. Hold therapy if QTc > 500msec}

Question 13

Pulmonary toxicity management

Answer 13

Stop therapy. symptom management. Corticosteroid may be used if autoimmune mechanism is suspected

Question 14

Hepatotoxicity management

Answer 14

Symptom management. Consider stopping. Corticosteroids if an autoimmune mechanism for PD-1 immunotherapy.

Question 15

Nephrotoxicity management

Answer 15

Amifostine (Ethyol) for prophylaxis with cisplatin. Adequate hydration. DNE maximum cisplatin dose.

Question 16

Hemorrhagic cystitis management

Answer 16

Mesna (Mesnex) is always given with IFOSFAMIDE (and sometimes with cyclophosphamide) prophylactically. Adequate hydration!

Question 17

Neuropathy management

Answer 17

Symptom management.
{Vincristine: limit dose to 2mg/wk regardless of BSA}

[Bortezomib: SC administration has less risk than IV]

Question 18

Thromboembolic risk management

Answer 18

thromboprophylaxis (anticoagulants) based on risk factors.

Question 19

Causes myelosuppression

Answer 19

almost all except: asparaginase, bleomycin, vincristine*, most monoclonal antibodies, and many TKIs

Question 20

Causes N/V

Answer 20

cisplatin, cyclophosphamide, ifosfamide*, doxorubicin, epirubicin

Question 21

Causes mucositis

Answer 21

Methotrexate, fluorouracil, irinotecan, capecitabine, many TKIs

Question 22

Causes diarrhea

Answer 22

fluorouracil, irinotecan, capecitabine*, many TKIs

Question 23

Causes constipation

Answer 23

vincristine*, pomalidomide, thalidomide

Question 24

Causes cardiotoxicity

Answer 24

{cardiomyopathy: anthracyclines*, HER2 inhibitors, fluorouracil, lapatinib}

Question 25

Causes pulmonary toxicity

Answer 25

{pulmonary fibrosis: Bleomycin, busulfan, carmustine, lomustine}

Question 26

Causes hepatotoxicity

Answer 26

ANTIANDROGENS (bicalutamide, flutamide, nilutamide), FOLATE ANTIMETABOLITES*** (mtx, pemetrexed, pralatrexate), PYRIMIDINE ANALOG ANTIMETABOLITES (cytarabine, gemcitabine), many TKIs, ipilimumab, pembrolizumab, nivolumab, atezolizumab

Question 27

Causes nephrotoxicity

Answer 27

Cisplatin, mtx (high dose), pemetrexed, pralatrexate, carfilzomib, bevacizumab, nivolumab, pembrolizumab, ipilimumab, atezolizumab

Question 28

Causes hemorrhagic cystitis

Answer 28

ifosfamide* (all dose), cyclophosphamide* (higher doses eg. > 1g/m2)

Question 29

Causes neuropathy

Answer 29

{Peripheral Sensory Neuropathy: Vinca alkaloids, platinums, taxanes*, proteasome inhibitors, thalidomide, ado-trastuzumab, cytarabine-high dose, and brentuximab} [Autonomic neuropathy: vinca alkaloids]

Question 30

Causes clotting

Answer 30

aromatase inhibitors, SERMs (eg. tamoxifen), immunomodulators (thalidomide, lenalidomide, pomalidomide)

Question 31

Cisplatin adjunctive agent

Answer 31

Amifostine - prevent nephrotoxicity

Question 32

Doxorubicin adjunctive agent

Answer 32

Dexrazoxane - prevent cardiomyopathy (Zinecard); treatment of extravasation (Totect)

Question 33

Fluorouracil adjunctive agent

Answer 33

Leucovorin or levoleucovorin - enhance efficacy as a cofactor

Question 34

Fluorouracil or capecitabine adjunctive agent

Answer 34

Uridine triacetate - antidote (use w/in 96 hours)

Question 35

Ifosfamide adjunctive agent

Answer 35

Mesna - prevent hemorrhagic cystitis

Question 36

Irinotecan adjunctive agent

Answer 36

Atropine - prevent/treat diarrhea;

Loperamide - treat delayed diarrhea

Question 37

MTX adjunctive agent

Answer 37

Leucovorin or levoleucovorin or Glucarpidase - reduce myelosuprression, mucositis antidote, mtx removal in acute renal failure

Question 38

Colony Stimulating Factors (CSF)

Answer 38

Filgrastim (G-CSF: Neupogen, Zarxio), Pegfilgrastim (Pegylated G-CSF: Neulasta), and Sargaramostim (GM-CSF: Leukine). – GM-CSF is only for stem cell transplant

Question 39

G-CSF (filgrastim and pegfilgrastim) SEs and Notes

Answer 39

SEs are bone pain, fever, glomerulonephritis, rash, injection site pain. Store in the refrigerator. First dose window is 24 to 72 hours after chemo. Look for enlarged spleen Sx (left upper abd pain or RDS). Filgrastim is QD and Pegfilgrastim is once per cycle.

Question 40

GM-CSF (sargramostim) SEs and Notes

Answer 40

SEs are bone pain, fever, arthralgia, myalgia, rash, dyspnea, peripheral edema, HTN, and chest pain. Store in the refrigerator. First dose window is 24 to 72 hours after chemo. Look for enlarged spleen Sx (left upper abd pain or RDS). QD dosing.