Onco Supportive Care

• High Risk Level

  • AC combination
  • Cisplatin
  • Cyclophosphamide - greater than 1500 mg/m2
  • Doxorubicin - greater than 50 mg/m2
• Moderate Risk Level

  • Cyclophosphamide - less than 1500 mg/m2
  • Cytarabine - greater than 200 mg/m2
  • Dactinomycin
  • Doxorubicin - less than 50 mg/m2
  • Methotrexate - greater than or equal to 250 mg/m2
• Low Risk Level

  • Cytarabine - 100 to 200 mg/m2
  • Doxorubicin - liposomal
  • 5-Fluorouracil
  • Methotrexate - lesser than 250 but greater than 50 mg/m2
  • Paclitaxel
• Minimal Risk Level

  • Bleomycin
  • Cetuximab
  • Cytarabine - less than 100 mg/m2
  • Methotrexate - less than or equal to 50 mg/m2
  • Siltuximab
  • Vinblastine
  • Vincristine
  • Vincristine - liposomal
  • Vinorelbine
• Serotonin 5HT3 Receptor Antagonists

  • Blocks serotonin receptors peripherally in the gastrointestinal tract and centrally in the medulla
  • Dolasetron, Granisetron, Ondansetron
• Corticosteroids

  • MOA is unknown but is believed to act by inhibiting prostaglandin synthesis in the cortex
  • Dexamethasone, Methylprednisone
• Neurokinin-1 Receptor Antagonist

  • Used in combination with other antiemetic drugs for preventing acute and delayed nausea
  • Aprepitant, Fosaprepitant
• Benzamide Analogs

  • Blocks dopamine receptors in the CTZ or chemotherapeutic trigger zone in the brain
  • Stimulation of cholinergic activity in the gut
  • Increases gut motility
  • Antagonizes peripheral serotonin receptor in the intestine
  • Prochlorperazine, Chlorpromazine, Promethazine
• Butyrophenone

  • Similar with Phenothiazine
• Benzodiazepine

  • Minimal antiemetic activity
  • Used in combination with other anti-emetics
  • Anterograde amnesia to prevent anticipatory nausea and vomiting
  • Relief of anxiety
  • Lorazepam
• Cannabinoid

  • Mediate at least some of the antiemetic activity
  • Inhibition of prostaglandin and blockade of adrenergic
• HEC: Single day

  • Olanzapine
  • 5HT3 antagonists
  • Steroids
  • NK-1 antagonists
• HEC or MEC: Single day

  • Olanzapine
  • 5HT3 antagonists
  • Steroids
• HEC or MEC: Single or Multi-day

  • 5HT3 antagonists
  • Steroids
  • NK-1 antagonists
• MEC: Single or Multi-day

  • 5HT3 antagonists
  • Steroids
• Olanzapine 5-10 mg PO
• Granisetron 1 mg IV
• Ondansetron 8 to 16 mg IV
• Palonosetron 0.25 mg IV
• Dexamethasone 12 mg IV then 8 mg PO
• Aprepitant 125 mg PO (Day 1) then 80 mg PO (Day 2-3)
• Fosaprepitant 150 mg IV
• Prochlorperazine 5 to 10 mg PO every 6 hrs
• Ondansetron 8 mg PO every 12 hrs
• Granisetron 3.1 mcg / 24 hour patch
• Mild: Pain Level 1 to 3

  • Paracetamol or NSAIDs
• Mild to Moderate: Pain Level 4 to 6

  • Weak opioid + Paracetamol or NSAIDs
  • First line - weak opioid
  • Adjunct - Paracetamol or NSAID
• Moderate to Severe: Pain Level 7 to 10

  • Strong opioid + Paracetamol or NSAIDs
• Non-opioid analgesics act peripherally to inhibit the activity of prostaglandin in the pathway
• Opioid analgesics act centrally in the brain and at the level of the spinal cord at specific opioid receptors
• Antidepressants and Anticonvulsants are used for neuropathic pain
• Transdermal Lidocaine is used for localized neuropathic pain
• Corticosteroids are used for inflammation, bone pain, or to increase intracranial pressure
• Benzodiazepines, Diazepam, Lorazepam are used for muscle pain and muscle relaxation
• Normal WBC Count - 4.8 to 10.83 cells/mm3
• Neutropenia - less than 500/mm3
• Febrile Neutropenia - single oral temperature of 101 F or more or temperature of 100.4 F or more for at least 1 hour