Drug/Class | Main side effects |
Fluorouracil
Pyrimidine analog | Diarrhea, Hand-Foot syndrome |
Capecitabine (Xeloda)
Pyrimidine analog | Hand-Foot syndrome (dose-limiting toxicity)
USE: Colon, breast cancers |
Cytarabine (Ara-C)
Pyrimidine analog | Neurotoxicity (cerebellar syndrome,), conjuctivitis (use prophylactic steroid eye drops) |
Gemcitabine (Gemzar)
Pyrimidine analog | Myelosuppression (affects all 3 lineages, neutropenia prominent); transient rashes (topical/systemic corticosteroids or antihistamines) |
Azacytidine (Vidaza)
Pyrimidine analog | Myelosuppression |
Fludarabine (FAMP, Fludara)
Purine analog | Myelosuppression (also T-cell depleting, increased risk for opportunistic infection, consider adding prophylactic antibiotics) |
Cladribine (Leustatin)
Purine analog | Immunosuppressive (at risk for opportunistic infections) |
6-Mercaptopurine (Purinethol) | Dry rash, hepatotoxicity (may be dose-limiting) |
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! |
Alimta (Pemetrexed)
Folate antagonist | Myelosuppression (decreased by folic acid and B12 supplements) |
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 |
Paclitaxel (Taxol)
Docetaxel (Taxotere)
Taxanes | Hypersensitivity reactions (premedicate with steroid, H1 and H2 antagonists, reaction caused by excipients), alopecia, fluid retention |
Cabazitaxel (Jevtana)
Taxane | High cross-reactivity with other taxanes, myelosuppression (requires growth factor support), hypersensitivity (must premedicate) |
Etoposide (VePesid)
Topoisomerase II inhibitor | Hypotension (infuse slowly--over 1 hour) |
Ixabepilone (Ixempra)
Epothilone | Hypersensitivity (premedicate), caution if patient has cardiac disease (esp. if using with capecitabine)
USE: metastatic breast cancer (with capecitabine) |
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) |
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 |
Epirubicin (Ellence)
Anthracycline | Cardiotoxic (max lifetime dose: 900 mg/m2), less toxic than doxorubicin because of decreased free radical formation |
Mitoxantrone (Novatrone)
Anthracenedione | Similar to anthracyclines, less extravasation, nausea/vomiting, alopecia, cardiotoxicity compared to anthracyclines |
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 |
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 |
Bleomycin (Blenoxane)
Antitumor antibiotic | "Blow-mycin", "anti-Lance Armstrong drug", because causes pulmonary toxicity |
Asparaginase
Pegaspargase
Erwinia asparaginase
Antitumor enzyme | Lower risk of hypersensitivity with pegylated, pancreatitis, monitor clotting function |
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) |
Alemtuzumab (Campath)
MAB | USE: B-cell CLL
Inusion-related reactions (premedicate), prolonged myelosuppression (need prophylaxis up to 6 months afterwards) |
Cetuximab (Erbitux)
MAB | USE: Colorectal, head and neck cancer
Acne-form rash (signature!) on face and torso, reversible |
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) |
Panitumumab (Vectibix)
MAB | USE: Colorectal cancer
Rash (sunscreen and moisturizers), infusion reactions not as common, electrolyte abnormalities (monitor) |
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 |
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 |