Expansion
Alkylating agents, antimetabolites, antitumour antibiotics and mitotic inhibitors
Expansion
| Class | Examples | Signature toxicity |
|---|---|---|
| Alkylating agents | Cyclophosphamide, ifosfamide | Haemorrhagic cystitis (prevented by mesna), secondary malignancy, infertility |
| Platinums | Cisplatin, carboplatin | Nephrotoxicity, ototoxicity, peripheral neuropathy, severe emesis |
| Antimetabolites | Methotrexate, 5-fluorouracil, cytarabine | Mucositis, myelosuppression |
| Antitumour antibiotics | Doxorubicin | Cardiomyopathy, cumulative dose related |
| Bleomycin | Pulmonary fibrosis; minimal myelosuppression | |
| Vinca alkaloids | Vincristine | Peripheral neuropathy; fatal if given intrathecally |
| Taxanes | Paclitaxel | Neuropathy, hypersensitivity |
| Topoisomerase inhibitors | Etoposide, irinotecan | Myelosuppression, diarrhoea |
Shared toxicity across most: myelosuppression with a nadir at 7 to 14 days, mucositis, alopecia, nausea, infertility and secondary malignancy.
Neutropenic sepsis is the key emergency: a temperature above 38 with a neutrophil count below 0.5 requires antibiotics within one hour, before waiting for results.
Tumour lysis syndrome occurs after treating bulky, rapidly dividing tumours, causing hyperkalaemia, hyperphosphataemia, hyperuricaemia and hypocalcaemia with acute kidney injury; prevented by hydration and allopurinol or rasburicase.