NAPLEX _ Oncology I - Overview & SE Management

• " CAUTION "
• C hange in bowel or bladder habits
• A sore that doesn't heal
• U nusual bleeding or discharge
• T hickening or lump in breast or elsewhere
• I ndigestion or difficulty swallowing
• O bvious change in wart or mole
• N agging cough or hoarseness

• " ABCDE "
• Asymmetry -- one half of mole does not match the other
• Border -- edges are irregular, notched
• Color -- not the same all over
• Diameter -- larger than 6 mm, or the size of the tip of a pencil eraser
• Evolving -- mole is changing in size, color, shape or symptoms (itching, bleeding, tenderness)

• Bleomycin: lifetime cumulative dose 400 units
• -- Pulmonary toxicity
• Doxorubicin: lifetime cumulative dose 450-550 units/m2
• -- Cardiotoxicity
• Cisplatin: dose per cycle not to exceed 100 units/m2
• -- Nephrotoxicity
• Vincristine: single dose "capped" at 2 mg 
• -- Neurotoxicity

• almost ALL, except:
• - asparaginase
• - bleomycin
• - vincristine
• - most monoclonal antibodies
• - many tyrosine kinase inhibitors (TKIs)

• Cisplastin !!!
• doxorubicin
• epirubicin
• cyclophosphamide
• ifosfamide
• ** all are HIGHLY ematogenic

• Fluorouracil (5-FU)
• Capecitabine (PO of 5-FU)
• Irinotecan
• Methotrexate
• Many TKIs (afatinib, ponatinib, sorafenib, sunitinib)

• Fluorouracil (5-FU)
• Capcitabine (PO of 5-FU)
• Irinotecan
• Many TKIs

• Vincristine (most)
• Pomalidomide
• Thalidomide

• QT prolongation (ECG || QT >500)
• -- many TKIs ("-nibs")

** Doxorubicin Lifetime Cumulative Dose (450-550 mg/m2) || Dexrazoxane - administered prophylactically in pts recieving doxorubicin

• Cisplatin
• -- Amofostine (Ethyol) given prophylactically to reduce risk of nephrotoxicity
• -- NTE maximum dose of 100 mg/m2 
• Methotrexate

• Ifosfamide (all doses)
• -- Mesna given prophylactically
• Cyclophosphamide (higher doses)

** ensure adequate hydration

• Vinca alkaloids (vincristine, vinblastine, vinorelbine)
• -- limit dose of vincristine to 2 mg per week
• Platinums (cisplatin, oxaliplatin)
• Taxanes (paclitaxel, docetaxel, cabazitaxel)

• Amofostine (Ethyol)
• -- prophylaxis to prevent nephrotoxicity

• Dexrazoxane (Zinecard)
• -- prophylaxis to prevent cardiotoxicity

• Dexrazoxane (Totect)
• -- treatment for extravasation

• Leucovorin or Levoleucovorin (Fusilev)
• -- given with 5-FU to enhance efficacy

• Uridine Triacetate (Vistogard)
• -- use within 96 hours for any overdose or to treat severe, life-threatening or early onset toxicity

• Mesna (Mesnex)
• -- prophylaxis to prevent hemorrhagic cystitis

• Atropine
• -- prophylaxis to prevent acute diarrhea

• Leucovorin or Levoleucovorin (Fusilev)
• -- given after methotrexate (MTX) to reduce myelosuppression and mucositis

• Glucarpidase (Voraxaze)
• -- given in acute renal failure/high concentration of MTX