1

. .

o anthracyclines
o Cyclophosphamide
o Trastuzumab

o Cisplatin
o nitrosoureas
o Ifosfamide
o Methotrexate


hypersensitivity reaction
o L-asparaginase
o Paclitaxel
o Docetaxel
o Etoposide teniposide
o antibody
o HSR
o HSR

(chemotherapeutic agents)

(inhibition of protein
synthesis) (inhibition of cell-cycle)

(immunotherapy)
(cure),
(control) (palliation)






1. adjuvant


2. consolidation
(complete remission)

3. induction
(complete response)
(hematological malignancies)
4. intensification
induction

5. maintenance

6. neoadjuvant

7. palliative

8. salvage




1.

2.
3.


4.

5. Luer-lock syringe
6.

1. (acute) (delayed)
1-6 24
5 (delayed)
2. 6
24
3.
4. 2-3
5.

nadir nadir 8-14

3-4



1)
2) (afebrile and non-toxic)
3) standard protocol
4)


5) Luer-lock syringe
zip-lock

6)



()
( body surface area)

(route of administration)



7)

8)

Superia Venacava Occlusion (SVCO)

(route )

9)
10)
11)
(Extravasation)
12) Port-A-Cart

13) 15-30

14)
15)
16)

(vesicant)
vesicant

17) vesicant

(Extravasation)

18)
(Incompatibility)
19)

20)

21)

22) Extravasation
23)

3 cardiomyopathy, arrhythmias
ischemia ( 1)
anthracyclines, cyclophosphamide trastuzumab
1. anthracyclines
anthracyclines
70
anthracyclines myocardial infarction
(MI) congestive heart failure (CHF)
cyclophosphamide, mitomycin C,
etoposide, melphalan, vincristine, bleomycin

anthracyclines
1. continuous infusion bolus
infusion 24-hr infusion fractionated dosing schedules
(weekly administration)

2. bolus administration
doxorubicin 400 /
3. liposomal doxorubicin liposomal daunorubicin

(secondary prevention)
dexrazoxane doxorubicin 300 /


1.
2. ACE inhibitors (after loadreducers), beta-blocker, digoxin, antiplatelet anticoagulant severe cardiac
dysfunction
(myocytes)

2. Cyclophosphamide

cyclophosphamide
120 / bone marrow transplantation
EKG CHF

2-3 doses 2-3

ACE
inhibitors (after load-reducers), beta-blocker, digoxin, antiplatelet anticoagulant
anthracyclines

3. Trastuzumab
trastuzumab 5

anthracyclines
anthracyclines
anthracyclines
anthracyclines
1
Cardiomyopathy
arrhythmias
ischemia
anthracyclines (chronic) anthracyclines (acute)
antimetabolites
Doxorubicin
Doxorubicin
5-Fluorouracil
Daunorubicin
Daunorubicin
plant alkaloids
Epirubicin
Epirubicin
Vinblastine
Idarubicin
Idarubicin
Vincristine
anthracenediones
anthracenediones
Vinorelbine
Mitoxanthrone
Mitoxanthrone
biologics
alkylating gents
alkylating agents
Interleukin-2
Cyclophosphamide
Cyclophosphamide

(high dose)
(high dose)
Bleomycin
Ifosfamide
taxanes
Cisplatin
biologics
Paclitaxel
Mitomycin-C
Interferon-alfa
biologics
Dactinomycin

Interleukin-2
Trastuzumab

Interleukin-2

Arsenic trioxide
Dimethyl sulfoxide

CHF
fractionated schedules dosing
2-5 peak plasma level
amifostine
740 910 / 15
NS 1 NS 2
amifostine
2. nitrosourea (BCNU, MeCCNU, CCNU, Streptozotocin)

(total cumulative dose) Lomustine 100
/ 6
4 6

3. Ifosfamide
ifosfamide 60 /
5 cisplatin carboplatin
(nephrectomy)
ifosfamide

- fractionated schedules dosing

- renal tubular acidosis (RTA)

ifosfamide chloracetaldehyde

10

- NS 1-2
hemorrhagic cystitis hemotoxicity
ifosfamide

4. Methotrexate
50 /
urine pH 7 methorexate
CrCL < 50 / methotrexate

methotrexate
- NS NaHCO3 50
mEq urine PH > 7 methotrexate > 50 100 /

- 100
methotrexate methotrexate 1 < M
- NSAIDs methotrexate

methotrexate henodialysis charcoal hemoperfusion
columns methotrexate thrombocytopenia
hemoperfusion leucovorin methotrexate
mucositis myelosuppression cholestyramine
enterohepatic circulation
carboxypeptidase enzyme methotrexate

cyclophosphamide, ifosfamide
intravesicular mitomycin C, doxorubicin BCG
1-2 NS
mesna ifosfamide cyclophosphamide mesna
60 ifosfamide 20 0, 4, 8,

11

1. (bladder irrigation) 3% saline NS

cystoscopy with fulguration
2. bladder instillation amino caproic acid, tranxenamic
acid, prostaglandin E 2 F2 vitamin E
3. hydrocortisone bladder Instillation 300
4. silver nitrate

3 chronic pulmonary fibrosis, capillary
leak syndrome hypersensitivity reaction ( 2)

bleomycin, busulfan,
carmustine interleukin-2 bleomycin
bleomycin, busulfan,
mitomycin C, cyclophosphamide, doxorubicin actinomycin D
bleomycin, cyclophosphamide
mitomycin C bleomycin, BCNU,
mitomycin C, cyclophosphamide methotrexate COPD
bleomycin, carmustine interlenkin-2 lymphoma
bleomycin sarcoidosis / leukemia

Inhaled oxygen bleomycin

bleomycin

corticosteroids inhaled oxygen

mitomycin C

corticosteroids
hypersensitivity reaction corticosteroids
mitomycin-C carmustine corticosteroids
pulmonary fibrosis

12

2
Chronic Pulmonary Fibrosis
Capillary leak syndrome
antitumor antibiotics
antimetabolites
Bleomycin
Cytarabine
Dactinomycin
Gemcitabine
Mitomycin
Methotrexate
alkyl ting agents
alkylating agents
Carmustine
Cyclophosphamide
Lomustine
Plant Alkaloids
Cyclophosphamide
Docetaxel
Melphalan
Teniposide
Busulfan
antitumor antibiotics
Chlorambucil
Mitomycin
Ifosfamide
Bleomycin oxygen
antimetabolites
Biologics
Methotrexate
G-CSF
Azathioprine
Interleukin-2
Fludarabine
6 Mercaptopurine

Hypersensitivity Reaction
antitumor antibiotics
Bleomycin
antimetabolites
Methotrexate
Fludarabine
Azathioprine
Plant Alkaloids
Docetaxel
Paclitaxel
Teniposide

hypersensitivity reaction
hypersensitivity reaction (HSR)
(excipients) ( 3) HSR
L-asparaginase, paclitaxel, docetaxel
1. L-asparaginase
HSR 41
Escherichia coli E. coli-derived asparaginase
pegaspargase asparaginase ( )

corticosteroids HSR
L-asparaginase

13

3 hypersensitivity reaction

Excipients
plant alkaloids
Benzyl Alcohol
Paclitaxel
Cremophore EL
Docetaxel
Dimethyl acetamide
Teniposide
Mannitol
Etoposide
Parabens
L-asparaginase
Polysorbate 80 (tween 80)
antibody
HSR L-asparaginase
HSR
peak plasma level 10-24 systemic
exposure
HSR intradermal skin testing Lasparaginase HSR asparaginase Erwinia
chrysanthemi derivative Pegaspargase immogenicity
2. Paclitaxel
paclitaxel HSR 2 HSR
40 HSR Cremophor EL
(excipients) HSR
paclitaxel 3
3 HSR
- Dexamethasone 20 12 6 paclitaxel
Dexamethasone 20 30 paclitaxel
- Diphenhydramine 50
- H2 Blockers ranitidine famotidine
(small weekly dose) HSR
HSR
3. Docetaxel
HSR paclitaxel dexamethasone 8
2 3 dexamethasone 1

14

docetaxel HSR
/
4. Etoposide teniposide
HSR etoposide
HSR etopooside phosphate HSR
5. antibody
HSR
paracetamol, diphenhydramine / meperidine
rituximab HSR
50 /
trastuzumab 1-2

HSR
HSR corticosteroids
diphenhydramine HSR

- epinephrine
- wheezing albuterol
epinephrine
corticosteroids HSR
HSR
(rechallenge)
desensitization HSR HSR
anaphylaxis
antibody reactions fevers / chills / rigor paracetamol,
diphenhydramine / meperidine
HSR
HSR
1. epinephrine
diphenhydramhe HSR

15

2. beta-blocker betablocker

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The chemotherapy source book, 3rd ed. Philadelphia:Lippincott Williams &
Wilkin, 2001:458-68.
2) Hinson JM, McKibben AW. Chemotherapy-associated lung injury. In : Perry MC (ed).
The chemotherapy source book, 3rd ed. Philadelphia:Lippincott Williams &
Wilkin, 2001:468 77.
3) Donat SM, Levy DA. Bleomycin associated pulmonary toxicity : is perioperative
oxygen restriction necessary ? J Urol 1998; 160:1347-52.
4) Weiss RB. Hypersensitivity reactions. In : Perry MC (ed). The chemotherapy source
book, 3rd ed. Philadelphia:Lippincott Williams & Wilkin, 2001:436-52.
5) Kintzel PE, Dorr RT. Anticancer drug renal toxicity and elimination : dosing
guidelines for altered renal function. Cancer Treat Rev 1995;21:33-64.
6) Skinner R. Strategies to prevent nephrotoxicity of anticancer drugs. Curr Opin Oncol
1995;7:310 -5.
7) Drake MK, Nixon PM, Crew JP. Drug-induced bladder and urinary disorders. Incidence,
prevention and Management. Drug Safety 1998;19:45-55.
8) West NJ. Prevention and treatment of hemorrhagic cystitis. Pharmacotherapy 1997:
17:696-706.
9) Hensley ML, Sohochter LM, Lindley C, et al. American Society of Clinical Oncology
clinical practice guideline for the use of chemotherapy and radiotherapy protectants. J
Clin Oncol 1999;17:3333-55.