Adverse Effects of cancer chemotherapy

• Common adverse events of chemotherapy include myelosuppression, alopecia, mucositis, N&V, cutaneous reactions, infertility and secondary maglinacies, extravasation
• Myelosuppression is a delayed adverse reaction
• Why granulocytes are most significantly affected by chemotherapy?

  Because WBCs can rapidly proliferate and have a shorter life span
• When neutropenia occurs and take how long to recover?

  WBC nadir: 7-14 days after chemotherapy administration

  Recover by: 3-4 weeks
• Why neutropenic patient is at risk of infection?

  • immunocompromised
  • disrupted integrity of physical defense barriers
• What is the management of neutropenia?

  Granulocyte-colony Stimulating Factor (G-CSF)
• What is the criteria for febrile neutropenia?

  Fever:

  1. >38.3
  2. >38.0 for 1 hour

  And

  Neutropenia:

  1. <0.5x10^9/L
  2. <1.0x10^9?L and expected to fall below <0.5 over 48 hours
• What is the use of Multinational Association Supportive care in cancer (MASCC) risk index?

  to evaluate the patient risk and suitability for outpatient treatment or hospitalization

  • >21 = low risk
  • <21 = high risk
• What is the treatment of febrile neutropenia?

  Empirical antibiotic therapy. Should be initiated within the first hour of triage.

  High risk:

  1.FIRST LINE

  • IV piperacillin/tazobactam (or)
  • IV cefepime

  (+) metronidazole if pt has severe mucositis, intro-abdominal infection or other suspected anaerobic infection

  2.SEOCOND LINE

  • IV carbapenem (except ertapenem)

  Low risk:

  • oral ciprofloxacin + amoxicillin/clavulanate
• What is the criteria for Cancer-related Anemia?

  -Hb <11g/dL

  -decrement of >2g/dL from the baseline
• What is the mainstay treatment of cancer-related anemia?

  blood transfusion
• What are the other treatment of cancer-related anemia? (besides blood transfusion)

  erythropoietin
• What are the advantages and disadvantages of erythropoietin?

  Erythropoietin takes weeks to elicit full respond.

  Advantages:

  1. effectively maintain the target Hb level
  2. reduce transfusion requirement

  Disadvantages:

  1. thromboembolism (black-box warning)
  2. hypertension
  3. stroke
  4. increase mortality
  5. promote tumor progression
• When not to use erythropoietin?

  -not receiving any chemotherapy treatment

  -cancer is curative

  -chemotherapy is non-myelosuppressive
• What is the mainstay treatment of thrombocytopenia?

  platelet transfusions

  • reserved for patient with a platelet count of <10,000 cells/mm3
• Besides platelet transfusion, what are the other treatment of thrombocytopenia?

  recombinant IL-11 (oprelvekin)

  • rarely justified due to its significant AE

  - hypersensitivity reaction

  - fluid retention

  - cardiac toxicity