Post on 14-Apr-2018
transcript
7/27/2019 CHEMO PROTOCOL newwww.pptx
1/71
7/27/2019 CHEMO PROTOCOL newwww.pptx
2/71
BY R ph. HUMAIRA SHAFIQIV Pharmacist at NIBD
7/27/2019 CHEMO PROTOCOL newwww.pptx
3/71
CONTENTS:
History Hematological Malignancy Chemo Regimens Miscellaneous regimens Case history
7/27/2019 CHEMO PROTOCOL newwww.pptx
4/71
7/27/2019 CHEMO PROTOCOL newwww.pptx
5/71
HISTROY:
Early 1900s, the famous German chemist
Paul Ehrlich. (20th century).
He was the one who coined the term
chemotherapy.
In 1908, his use of the rabbit model for
syphilis led to the development of arsenicals
to treat this disease.
7/27/2019 CHEMO PROTOCOL newwww.pptx
6/71
Hematological Malignancies
TYPES
LEUKAEMIAS
ALL AML CLL CML
LYMPHOMAS
HODGKINLYMPHOMAS
NON-HODGKINLYMPHOMAS
MYELOMAS
7/27/2019 CHEMO PROTOCOL newwww.pptx
7/71
7/27/2019 CHEMO PROTOCOL newwww.pptx
8/71
ACUTE LYMPHOBLASTIC
LEUKEMIA: (ALL) Cancer Of The White Blood Cells
Characterized By Excess Lymphoblasts.
25 Years Of Age & Peak Old Age.
Variant Features Of Alla) ALL With Cytoplasmic Granules
b) Aplastic Presentation OfALL
c) ALL With Eosinophilia
d) Relapse OfALL
e) SecondaryALL
http://en.wikipedia.org/wiki/Hematological_malignancyhttp://en.wikipedia.org/wiki/Lymphoblasthttp://en.wikipedia.org/wiki/Lymphoblasthttp://en.wikipedia.org/wiki/Hematological_malignancy7/27/2019 CHEMO PROTOCOL newwww.pptx
9/71
CHRONIC LYMPHOBLASTIC
LEUKEMIA
Rapid Growth Of Immature Cells
Such Cells Are Found In The Bone Marrow,
Blood, And Other Body Tissues.
Middle-aged Adults And In Children.
Philadelphia Chromosome.
7/27/2019 CHEMO PROTOCOL newwww.pptx
10/71
DIFFERENCE BETWEEN ALL &
CLL
ACUTE LYMPHOBLASTICLEUKEMIA
CHRONIC LYMPHOBLASTIC
LEUKEMIA
Develop from early cells,
called "blasts".
Blasts are young cells, that
divide frequently. In acute
leukemia cells,
they don't stop dividing.
The leukemia cells come
from mature, abnormal
cells.
The cells thrive for too long
and accumulate.
The cells grow slowly.
7/27/2019 CHEMO PROTOCOL newwww.pptx
11/71
ACUTE MYELOID LEUKEMIA
(AML)
CancerOf The Myeloid Line Of Blood
Cells,
Rapid Growth Of Abnormal White Blood
Cells
Accumulate In The Bone Marrow
Interfere With The Production Of Normal
Blood Cells
http://en.wikipedia.org/wiki/Cancerhttp://en.wikipedia.org/wiki/Myeloidhttp://en.wikipedia.org/wiki/White_blood_cellhttp://en.wikipedia.org/wiki/White_blood_cellhttp://en.wikipedia.org/wiki/Bone_marrowhttp://en.wikipedia.org/wiki/Haematopoiesishttp://en.wikipedia.org/wiki/Haematopoiesishttp://en.wikipedia.org/wiki/Haematopoiesishttp://en.wikipedia.org/wiki/Haematopoiesishttp://en.wikipedia.org/wiki/Bone_marrowhttp://en.wikipedia.org/wiki/White_blood_cellhttp://en.wikipedia.org/wiki/White_blood_cellhttp://en.wikipedia.org/wiki/Myeloidhttp://en.wikipedia.org/wiki/Cancer7/27/2019 CHEMO PROTOCOL newwww.pptx
12/71
CHRONIC MYELOID
LEUKEMIA
Leukemia cells tend to build up in thebody over time
Too many of a specific type of white
blood cell called a granulocyte.Asymptomatic.
occur in adults
start in organs such as the lungs, colon,or breast and then spread to the bonemarrow
7/27/2019 CHEMO PROTOCOL newwww.pptx
13/71
DIFFERENCE BETWEEN
AML/CML:
ACUTE MYELOID
LEUKEMIA
CHRONIC MYELOID
LEUKEMIA
Granulocytic, myelocytic,myeloblastic, or myeloid.
20% childhood leukemias
Over a short period of daysto weeks
Children with certaingenetic syndromes
Fanconi anemia, Bloomsyndrome, Kostmann
syndrome, and Downsyndrome.
Uncommon in children
Over a period of months
or years
Part of chromosome #9
breaks off and attaches
itself to chromosome
#22, so that there is an
exchange of genetic
material between thesetwo chromosomes.
7/27/2019 CHEMO PROTOCOL newwww.pptx
14/71
LYMPHOMAS:
Lymphoma Is A Disease Where The Body's
Lymphoid Tissues Develop Malignant Cells.
Type Of Cancer Involving Cells Of The
Immune System, Called Lymphocytes.
5 Subtypes OfHodgkin's Disease
30 Subtypes OfNon-hodgkin's Lymphoma.
http://www.emedicinehealth.com/script/main/art.asp?articlekey=3907http://www.emedicinehealth.com/script/main/art.asp?articlekey=39077/27/2019 CHEMO PROTOCOL newwww.pptx
15/71
TYPES OF HD
Nodular sclerosis HD.
Mixed cellularity HD.
Lymphocyte-rich HD.
Lymphocyte-depleted HD.
Nodular lymphocyte predominant HD.
7/27/2019 CHEMO PROTOCOL newwww.pptx
16/71
TYPES OF NHL
Aggressive (Fast-growing)
Indolent (Slow-growing)
B-cell Non-hodgkinLymphomas
a) Burkitt Lymphoma
b) CLL/SLL
c) Diffuse Large B-cellLymphoma
d) Follicular Lymphoma
e) Immunoblastic Large CellLymphoma
f) Precursor B-lymphoblasticLymphoma
g) Mantle Cell Lymphoma.
T-cell Non-hodgkinLymphomas
a) Mycosis Fungoides
b) Anaplastic Large CellLymphoma
c) Precursor T-lymphoblasticLymphoma
7/27/2019 CHEMO PROTOCOL newwww.pptx
17/71
DIFFERENCE B/W HN & NHN
HODGKIN DISEASE NON-HODGKIN
LYMPHOMA
Epstein-barr Virus And
Contain Reed-sternberg
Cells.
Localized In One Lymph
Node.
Surrounding Chain In The
Neck, Shoulder, And Chest.
Age Between 15 And 35
And Over 50.
Develop In Peripheral
Lymph Nodes.
Spread Throughout The B
Age 60 And Over.
7/27/2019 CHEMO PROTOCOL newwww.pptx
18/71
SYMP. OF HN & NHL
7/27/2019 CHEMO PROTOCOL newwww.pptx
19/71
MYELOMA
Also Known As Multiple Myeloma Or
Myelomatosis - Is A Cancer Of Plasma Cells.
Single Type Of Abnormal Antibody.
Para protein Or M Protein.
It Cant Fight Infection Effectively.
7/27/2019 CHEMO PROTOCOL newwww.pptx
20/71
TYPES OF MYELOMA:
Asymptomatic Smoldering Or Indolent
Myeloma
Increased Level Of Plasma
Cells
Elevated M-protein
NoAnemia
Monoclonal Gammopathy
Of UndeterminedSignificance (MGUS)
Symptomatic
Elevation Of Plasma Cells
M- Protein Detected In
The Blood Or Urine
Plasmacytoma.
Waldenstrom's
Macroglobulinemia.
Other Myeloma
Light Chain Myelomas
Heavy Chain Disease
Non- Secretory Myeloma.
http://lymphoma.about.com/od/glossary/g/M-Protein.htmhttp://lymphoma.about.com/od/glossary/g/anemia.htmhttp://lymphoma.about.com/od/glossary/g/Mgus-Monoclonal-Gammopathy-Of-Undetermined-Significance.htmhttp://lymphoma.about.com/od/glossary/g/Mgus-Monoclonal-Gammopathy-Of-Undetermined-Significance.htmhttp://lymphoma.about.com/od/glossary/g/Mgus-Monoclonal-Gammopathy-Of-Undetermined-Significance.htmhttp://lymphoma.about.com/od/glossary/g/Mgus-Monoclonal-Gammopathy-Of-Undetermined-Significance.htmhttp://lymphoma.about.com/od/glossary/g/Plasmacytoma.htmhttp://adam.about.net/encyclopedia/infectiousdiseases/Macroglobulinemia-of-Waldenstrom.htmhttp://adam.about.net/encyclopedia/infectiousdiseases/Macroglobulinemia-of-Waldenstrom.htmhttp://adam.about.net/encyclopedia/infectiousdiseases/Macroglobulinemia-of-Waldenstrom.htmhttp://adam.about.net/encyclopedia/infectiousdiseases/Macroglobulinemia-of-Waldenstrom.htmhttp://adam.about.net/encyclopedia/infectiousdiseases/Macroglobulinemia-of-Waldenstrom.htmhttp://lymphoma.about.com/od/glossary/g/Plasmacytoma.htmhttp://lymphoma.about.com/od/glossary/g/Mgus-Monoclonal-Gammopathy-Of-Undetermined-Significance.htmhttp://lymphoma.about.com/od/glossary/g/Mgus-Monoclonal-Gammopathy-Of-Undetermined-Significance.htmhttp://lymphoma.about.com/od/glossary/g/Mgus-Monoclonal-Gammopathy-Of-Undetermined-Significance.htmhttp://lymphoma.about.com/od/glossary/g/Mgus-Monoclonal-Gammopathy-Of-Undetermined-Significance.htmhttp://lymphoma.about.com/od/glossary/g/Mgus-Monoclonal-Gammopathy-Of-Undetermined-Significance.htmhttp://lymphoma.about.com/od/glossary/g/Mgus-Monoclonal-Gammopathy-Of-Undetermined-Significance.htmhttp://lymphoma.about.com/od/glossary/g/anemia.htmhttp://lymphoma.about.com/od/glossary/g/M-Protein.htmhttp://lymphoma.about.com/od/glossary/g/M-Protein.htmhttp://lymphoma.about.com/od/glossary/g/M-Protein.htm7/27/2019 CHEMO PROTOCOL newwww.pptx
21/71
SYMPTOMS:
7/27/2019 CHEMO PROTOCOL newwww.pptx
22/71
7/27/2019 CHEMO PROTOCOL newwww.pptx
23/71
AML ADE/DA
Indication:Induction chemotherapy as part of the treatment of
acute myeloid leukemia (AML) in patients who
are do not enter the MRC AML 15 Trial. Pre-treatment Evaluation:
FBC.
LFT, U&E, Creatinine
Consider ECG +/- echocardiogram if clinical
suspicion of cardiac dysfunction
7/27/2019 CHEMO PROTOCOL newwww.pptx
24/71
DRUG REGIMEN:
DAY(S) DRUGS DOSE ROUTE COMMENTS
1 - 10 Cytarabine 100mg/m2
BD
IV IV Bolus
1 , 3 + 5 Daunorubicin 50mg/m2
OD
IV IV Infusion in100ml
0.9% NaCl over 1hr
1 - 5 Etoposide 100mg/m2
OD
IV IV Infusion in
500mls 1L
0.9% NaCl over 1hr
7/27/2019 CHEMO PROTOCOL newwww.pptx
25/71
Conti..
Cycle Frequency:
Two cycles of induction chemotherapy are usually
given the first for 10 days the second for 8 days.
Dose Modifications (Hepatic)
Bilirubin 20 - 50mol/l reduce daunorubicin dose by
25% and reduce etoposide dose by 50%.
Bilirubin > 50mol/l reduce daunorubicin dose by 50%
and clinical decision whether to give etoposide.
Bilirubin > 34mol/l reduce cytarabine dose by 50%.
7/27/2019 CHEMO PROTOCOL newwww.pptx
26/71
Dose Modifications: (Renal)
Serum creatinine 105265mol/l reduce
daunorubicin dose by 25%.
Serum creatinine > 265mol/l reducedaunorubicin dose by 50%.
CrCl 45-60 ml/min give 85% dose ofetoposide.
CrCl 30-45 ml/min give 80% dose of etoposide
CrCl 15-30 ml/min give 75% dose of etoposide CrCl < 15 ml/min give 50% dose of etoposide
7/27/2019 CHEMO PROTOCOL newwww.pptx
27/71
Haematological:
The second course of ADE should only
be commenced when neutrophils have
recovered to1.0 x 109/l and platelets to
100 x 109/l.Additional Modifications:
Daunorubicin maximum cumulative dose
= 600mg/m2
7/27/2019 CHEMO PROTOCOL newwww.pptx
28/71
Concurrent Medication:
Consider Allopurinol 300mg od PO
(100mg if creatinine clearance
7/27/2019 CHEMO PROTOCOL newwww.pptx
29/71
AML High Dose Cytarabine
Indication: Consolidation chemotherapy as part of the
treatment of acute myeloid leukaemia (AML)
DAY(S) DRUGS DOSE ROUTE COMMENTS1, 3 + 5 Cytarabine 1.5g/m2 BD/
3g/m2 BD
IV IV Infusion in
250mls 0.9%
NaCl over 4hrs
Cycle Frequency Two courses of chemotherapy.
7/27/2019 CHEMO PROTOCOL newwww.pptx
30/71
Dose Modifications:
Hepatic;
Bilirubin > 34mol/l reduce cytarabine
dose by 50%.
HAEMATOLOGICAL:
A course of Cytarabine should only be
commenced when neutrophils have
recovered to 1.0 x 109/l and platelets to100 x 109/l.
7/27/2019 CHEMO PROTOCOL newwww.pptx
31/71
Concurrent Medication:
Consider Allopurinol 300mg od PO (100mg if
creatinine clearance
7/27/2019 CHEMO PROTOCOL newwww.pptx
32/71
CML CVP
Indication: Follicular and other indolent lymphomas
Waldenstroms macroglobulinaemia
Chronic Lymphocytic Leukaemia Aggressive lymphoma where more intensive
chemotherapy is not indicated
Pre-treatment Evaluation:
FBC. LFT, U&E, Creatinine
7/27/2019 CHEMO PROTOCOL newwww.pptx
33/71
Drug Regimen:
DAY(S) DRUGS DOSE ROUTE COMMENTS
1 Cyclophosphamide 750mg/m IV Bolus via fast running
drip of 0.9% saline.
1 Vincristine 1.4mg/m
(max 2mg)
IV In 20mls 0.9% saline
bolus injection as per
national protocol
1 - 5 Prednisolone 40mg/m PO Take in the mornings;
swallow whole with
food
7/27/2019 CHEMO PROTOCOL newwww.pptx
34/71
Additional Information:
Consider Vincristine 1mg for elderly
patients (>70 years)
Alternatively Cyclophosphamide may be
given as 600 mg/m PO for 5 days.
Cycle Frequency:
Repeat every 21-28 days to a maximum
clinical response.
Usually 6-8 cycles.
7/27/2019 CHEMO PROTOCOL newwww.pptx
35/71
Dose Modifications:Renal:
Creatinine clearance Modification
>50 100%
10-50 75% dose ofCyclophosphamide
7/27/2019 CHEMO PROTOCOL newwww.pptx
36/71
CONTI..
Additional Modifications:
Vincristine: If patient complains of significant constipation orsensory loss in fingers and/or toes, discuss possible dosereduction with Consultant before administration.
Previous neutropenic sepsis, discuss the use of prophylacticantibiotics and/or G-CSF support with Consultant.
Concurrent Medication:
Consider Allopurinol 300mg OD PO (100mg if creatinineclearance
7/27/2019 CHEMO PROTOCOL newwww.pptx
37/71
CLL CVP-R
Indication:
Follicular and other indolent lymphomas. Waldenstroms macroglobulinaemia.
Chronic Lymphocytic Leukaemia. Aggressive lymphoma where more intensivechemotherapy is not indicated.
Cycle Frequency:
Repeat every 21-28 days to a maximum clinical
response
Usually 6-8 cycles
7/27/2019 CHEMO PROTOCOL newwww.pptx
38/71
DRUG REGIMEN:
DAY(S) DRUGS DOSE ROUTE COMMENTS
1 Rituximab 375mg/m IV
1 Cyclophosphamide 750mg/m IV Bolus via fast running
drip of 0.9% saline.
1 Vincristine 1.4mg/m
(max 2mg)
IV In 20mls 0.9% saline
bolus injection
1 - 5 Prednisolone 40mg/m PO Take in the mornings;
swallow whole with
food.
7/27/2019 CHEMO PROTOCOL newwww.pptx
39/71
Additional Information:
Rituximab infusion speed: First infusion: Initiate at 50mg/h; if tolerated
increase rate at 50mg/h increments every 30
minutes to a maximum of 400mg/h.
Subsequent infusions: Initiate at 100 mg/h; iftolerated increase rate at 100mg/h increments
every 30 minutes to a maximum of 400 mg/h.
Consider Vincristine 1mg for elderly patients
(>70years) Alternatively Cyclophosphamide may be given
as750mg/m PO for 5 days.
7/27/2019 CHEMO PROTOCOL newwww.pptx
40/71
Additional Modifications:
Vincristine: If patient complains of significantconstipation or sensory loss in fingers and/or toes,
discuss possible dose reduction with Consultant
before administration.
Previous neutropenic sepsis, discuss the use of
prophylactic antibiotics and/or G-CSF support with
Consultant.
Rituximab
- Circulating tumour cells > 50 x 109/l consider
delay of Rituximab.- Tumour bulk; single lesion >10cm consider delay ofRituximab.
7/27/2019 CHEMO PROTOCOL newwww.pptx
41/71
Concurrent Medication:
ConsiderAllopurinol 300mg od PO (100mgif creatinine clearance
7/27/2019 CHEMO PROTOCOL newwww.pptx
42/71
NHL: FC-R
INDICATION:
Mantle Cell Lymphoma
Pre/post-treatment Evaluation :
FBC, LFT, U&E, Creatinine
7/27/2019 CHEMO PROTOCOL newwww.pptx
43/71
Drug Regimen:
DAY(S) DRUG DOSE ROUTE COMMENTS
1 Rituximab 375mg/m2 IV
1 - 3 Cyclophosphamide 250mg/m2 IV Bolus injection via
fast
running drip of0.9% NaCl
1 - 3 Fludarabine 25mg/m2 IV IV infusion in
100ml 0.9%
NaCl over 30min
Al i l ORA
7/27/2019 CHEMO PROTOCOL newwww.pptx
44/71
Alternatively an ORAL
schedule:DAY(S) DRUG DOSE ROUTE COMMENTS
1 - 5 Cyclophosphamide 150mg/m2 PO With breakfast
1 - 5 Fludarabine 24mg/m2 PO With lunch
Cycle Frequency Repeat every 28 days
Maximum of 6 cycles
Concurrent Medication
Allopurinol 300mg od PO (100mg if creatinine
clearance
7/27/2019 CHEMO PROTOCOL newwww.pptx
45/71
Dose Modifications:
Renal:
Reduce to 50% dose if renal impairment
(CrCl between 30-60ml/min)
Do not give if creatinine clearance 50 100%
10-50 75% dose of
Cyclophosphamide
7/27/2019 CHEMO PROTOCOL newwww.pptx
53/71
Haematology:Neutrophils x 109/l Dose Given
> 0.1 100%
< 0.1 Delay all drugs for 1 week
Platelets x 109/l Dose Given
> 75 100%
50-74 75% doses of Cyclophosphamide and
Doxorubicin.
100% doses of Vincristine and
Prednisolone
7/27/2019 CHEMO PROTOCOL newwww.pptx
54/71
Additional Modifications
Vincristine: If patient complains ofsignificant constipation or sensory loss infingers and/or toes, discuss possible dosereduction with Consultant before
administration. Doxorubicin: Maximum cumulative dose =
450mg/m2.
Previous neutropenic sepsis, discuss theuse of prophylactic antibiotics and/or G-CSF support with Consultant.
7/27/2019 CHEMO PROTOCOL newwww.pptx
55/71
NHL CHOP - RIndication: Intermediate and high grade, B-cell NHL expressing
CD20.
2
nd
or 3
rd
line therapy for low grade, B cell lymphoma. Non-Hodgkins lymphoma expressing CD20.
Pre/post - treatment Evaluation:
FBC.
LFT, U&E, Creatinine. Consider ECG +/- echocardiogram if clinical
suspicion of cardiac dysfunction.
7/27/2019 CHEMO PROTOCOL newwww.pptx
56/71
DRUG REGIMEN:DAY(S) DRUGS DOSE ROUTE COMMENTS
1 Rituximab 375mg/m IV
1 Cyclophosphamide 750mg/m IV Bolus via fast
running drip
of 0.9% saline
1 Doxorubicin 50mg/m IV Bolus via fast
running drip
of 0.9% saline
1 Vincristine 1.4mg/m
(max 2mg)
IV In 20mls 0.9% saline
bolus injection as per
national protocol
1 - 5 Prednisolone 100mg PO Take in the mornings;
swallow whole with
food
7/27/2019 CHEMO PROTOCOL newwww.pptx
57/71
CONTI
Cycle Frequency: Every 21 days.
Treat to CR or maximum response plus further two
cycles (maximum 8 cycles).
Additional Modifications: Vincristine:
If patient complains of significant constipation or sensory loss in
fingers and/or toes, discuss possible dose reduction with Consultant
before administration. Doxorubicin:Maximum cumulative dose = 450mg/m2
7/27/2019 CHEMO PROTOCOL newwww.pptx
58/71
CONTI
Previous neutropenic sepsis, discuss the use of
prophylactic antibiotics and/or G-CSF support with
Consultant
Rituximab
Circulating tumour cells > 50 x 109/l consider
delay of Rituximab.
Tumour bulk; single lesion >10cm consider delay of
Rituximab
NHL Single Agent
7/27/2019 CHEMO PROTOCOL newwww.pptx
59/71
NHL Single Agent
Rituximab
Indication: Chemotherapy-resistant follicular lymphoma in
last line therapy
Second or third line therapy for other indolent B
cell non-Hodgkins lymphoma expressing CD20
Palliative therapy of aggressive B cell non-
Hodgkins lymphoma expressing CD20
7/27/2019 CHEMO PROTOCOL newwww.pptx
60/71
DRUG REGIMEN:
DAY(S) DRUGS DOSE ROUTE COMMENTS
1, 8 , 15
& 22
Rituximab 375mg/m2 IV Initiate at 100mg/h; if
tolerated increase rate by
100mg/h increments
every 30 minutes to a
maximum of 400mg/hr
Cycle Frequency Once weekly intravenous infusion for
4 weeks
7/27/2019 CHEMO PROTOCOL newwww.pptx
61/71
7/27/2019 CHEMO PROTOCOL newwww.pptx
62/71
M.MYELOMA CVAD/VAD
Indication:Newly diagnosed multiple myeloma.
Cycle Frequency:
3 weeklyMinimum of 4 cycles, maximum 6 cycles
depending on response and timing of harvest. At
this time the continuous Thalidomide is stopped.
7/27/2019 CHEMO PROTOCOL newwww.pptx
63/71
DRUG REGIMEN:DAY(S) DRUGS DOSE ROUTE COMMENTS
1 - 4 Doxorubicin 9mg/m2/day
(i.e. total
36mg/m2)
IV Continuous IV
infusion over 4
days in 0.9%
NaCl (mixed with
Vincristine)
1 - 4 Vincristine 0.4mg/day
(i.e. total
1.6mg)
IV Continuous IV
infusion over 4
days in 0.9%
NaCl (mixed with
Doxorubicin)1, 8 + 15 Cyclophosphamide 500mg PO
1-4 + 12-15 Dexamethasone 40mg PO Take in morning;
with food
Miscellaneous regimens:
7/27/2019 CHEMO PROTOCOL newwww.pptx
64/71
Miscellaneous regimens:DISEASE REGIMEN ABBREVIATION
ALL (newly Dx) EARLY INTER Vincritine
Daunorubicin
Cytarabin
Etoposide
ALL HYPER CVAD (cycle I A) Cyclophosphamide
Vincristine
Doxorubicine
Dexamathasone
(cycle B) Methotrexate
Cytarabin
HD ABVD (STAT) Doxorubicin
Bleomycin
Vinblastine
Dacarbazine
CLL / SLL R + B Rituximab
Bendamustine
7/27/2019 CHEMO PROTOCOL newwww.pptx
65/71
Case study:
A 41year old man presents to your clinic for initiatechemotherapy to treat hisALL You explain to the
man and his mother that you will be using several
different chemotherapy agents to treat his disease.
One of the agentsyou will be recom. Acts byblocking DNA n RNA synthesis, however this drug
also causes the production of oxygen radicals,
which can damage cardiac tissue when given at
high doses. In order to avoid this rather serious
side effect, you will carefully monitor levels of the
drug so as to avoid cardiac toxicity if possible.
7/27/2019 CHEMO PROTOCOL newwww.pptx
66/71
AnthracyclinesSimilar drugs Doxorubicin, Daunorubicin, and Idarubicin
MOA Disrupt cellular function by: 1) Block DNA/RNA synthesis.
2) Caue production of O2 radicals, lead to memebrane
damage. 3) Disrupt fluid and ion transport.
Clinical uses Doxo: Solid tumors (breast, ovary, bladder, endometrium,
stomach, lung)
Dauno:Acute leukemia ( AML, ALL, CLL) and neuroblastoma.
Idarubicin:Acute myeloid leukemia.
Side effects Bone marrow suppression, alopecia, cardiac toxicity (we use
dexrazoxane, a compound that acts to decrease free radical
formation)
7/27/2019 CHEMO PROTOCOL newwww.pptx
67/71
7/27/2019 CHEMO PROTOCOL newwww.pptx
68/71
7/27/2019 CHEMO PROTOCOL newwww.pptx
69/71
7/27/2019 CHEMO PROTOCOL newwww.pptx
70/71
7/27/2019 CHEMO PROTOCOL newwww.pptx
71/71