Drugs, class, side effect
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| Fluorouracil Pyrimidine analog | Diarrhea, Hand-Foot syndrome
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| Capecitabine (Xeloda) Pyrimidine analog | Hand-Foot syndrome (dose-limiting toxicity)
USE: Colon, breast cancers
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| Cytarabine (Ara-C) Pyrimidine analog | Neurotoxicity (cerebellar syndrome,), conjuctivitis (use prophylactic steroid eye drops)
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| Gemcitabine (Gemzar) Pyrimidine analog | Myelosuppression (affects all 3 lineages, neutropenia prominent); transient rashes (topical/systemic corticosteroids or antihistamines)
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| Azacytidine (Vidaza) Pyrimidine analog | Myelosuppression
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| Fludarabine (FAMP, Fludara) Purine analog | Myelosuppression (also T-cell depleting, increased risk for opportunistic infection, consider adding prophylactic antibiotics)
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| Cladribine (Leustatin) Purine analog | Immunosuppressive (at risk for opportunistic infections)
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| 6-Mercaptopurine (Purinethol) | Dry rash, hepatotoxicity (may be dose-limiting)
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| Methotrexate (Folex) Folate antagonist | Myelosuppression (also T-cell depleting, increased risk for opportunistic infection, consider adding prophylactic antibiotics), CNS toxicity possible, dose-related hearing loss, mucositis!
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| Alimta (Pemetrexed) Folate antagonist | Myelosuppression (decreased by folic acid and B12 supplements)
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| Vincristine (Oncovin) Vinblastine (Velban) Vinorelbine (Navelbine) Vinca alkaloids | Extravastation, myelosuppression, neurotoxic(esp. Vincristine, dose-limiting), alopecia, FATAL if given intrathecally
DOSE: Vincristine max is 2 mg
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| Paclitaxel (Taxol) Docetaxel (Taxotere) Taxanes | Hypersensitivity reactions (premedicate with steroid, H1 and H2 antagonists, reaction caused by excipients), alopecia, fluid retention
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| Cabazitaxel (Jevtana) Taxane | High cross-reactivity with other taxanes, myelosuppression (requires growth factor support), hypersensitivity (must premedicate)
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| Etoposide (VePesid) Topoisomerase II inhibitor | Hypotension (infuse slowly--over 1 hour)
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| Ixabepilone (Ixempra) Epothilone | Hypersensitivity (premedicate), caution if patient has cardiac disease (esp. if using with capecitabine)
USE: metastatic breast cancer (with capecitabine)
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| Topotecan (Hycamtin) Irinotecan (Camptosar) Topoisomerase I inhibitors | Diarrhea (esp. irinotecan--"I run to the can"), use loperamide (4 mg at first sign, 2 mg Q2 hours until diarrhea-free for 12 hours)
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| Doxorubicin (Adriamycin) Daunorubicin (Cerubidine) Idarubicin (Idamycin) Anthracyclines | Major nausea and vomiting, myelosuppression, and alopecia!
Cardiotoxic! Max lifetime doses: Doxorubicin: 550 mg/m2; Daunorubicin: 900-1000 mg/m2
Extravasation (use DMSO to treat)
Dexrazoxane (Zinecard)--cardioprotectant
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| Epirubicin (Ellence) Anthracycline | Cardiotoxic (max lifetime dose: 900 mg/m2), less toxic than doxorubicin because of decreased free radical formation
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| Mitoxantrone (Novatrone) Anthracenedione | Similar to anthracyclines, less extravasation, nausea/vomiting, alopecia, cardiotoxicity compared to anthracyclines
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| Cyclophosphamide (Cytoxan) Ifosfamide (Ifex) Alkylating agents | Myelosuppression, ifosfamide dose-limiting side effect is hemorrhagic cystitis (less in cyclophosphamide), nephrotoxicity
Mesna--prevents hemorrhagic cystitis by increasing acrolein excretion
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| Cisplatin (Platinol) Carboplatin (Paraplatin) Oxaliplatin (Eloxatin) Platinums | Cisplatin--worst for nephrotoxicity (1-2L NS pre- and post-dose), nausea/vomiting (esp. dose > 60mg/m2), neuropathy (also bad with oxaliplatin, may be exacerbated by cold), ototoxicity, potassium and magnesium wasting; carboplatin suppresses platelets
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| Bleomycin (Blenoxane) Antitumor antibiotic | "Blow-mycin", "anti-Lance Armstrong drug", because causes pulmonary toxicity
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| Asparaginase Pegaspargase Erwinia asparaginase Antitumor enzyme | Lower risk of hypersensitivity with pegylated, pancreatitis, monitor clotting function
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| Trastuzumab (Herceptin) MAB | USE: Breast cancer
Cardiomyopathy (must evaluate left ventricular function pre- and during treatment), infusion-related reactions (pre-treat with APAP and Benadryl)
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| Alemtuzumab (Campath) MAB | USE: B-cell CLL
Inusion-related reactions (premedicate), prolonged myelosuppression (need prophylaxis up to 6 months afterwards)
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| Cetuximab (Erbitux) MAB | USE: Colorectal, head and neck cancer
Acne-form rash (signature!) on face and torso, reversible
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| Bevacizumab (Avastin) MAB | USE: Colorectal, lung cancer
Most serious side effect is GI perforation/bleeding (only ~2%), severe hypertension (caution in patients with PMH, treat with antihypertensives)
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| Panitumumab (Vectibix) MAB | USE: Colorectal cancer
Rash (sunscreen and moisturizers), infusion reactions not as common, electrolyte abnormalities (monitor)
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| Gemtuzumab (Mylotarg) MAB | USE: CD33 and AML
Severe mylosuppression (all 3 cell lines), hypersensitivity and infusion-related reactions (pretreat with APAP/Benadryl), hepatotoxic, pulmonary toxicity
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| Rituximab (Rituxan) MAB | USE: lymphoma, rheumatoid arthritis, leukemia
Hypersensitivity reactions (do not re-try agent if these occur, stop infusion and give epinephrine, antihistamines, corticosteroids), infuse slowly, tumor lysis syndrome
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