Transcript Minimizing side effects of chemotherapy

Minimizing the Side Effects
Of Chemotherapy
Joseph T. Ruggiero, M.D.
Medical Oncologist
The Jay Monahan Center for Gastrointestinal Health
Associate Professor of Clinical Medicine
Weill Medical College of Cornell University
Nausea and Vomiting
• Certain classes of drugs are worse than
others
--Cis-Platinum
--Doxorubicin (Adriamycin)
• Which anti-emetic agents should be used
is determined by the emetic potential of
the drug
Neurotransmitter Sites
For Nausea
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Muscarinic
Dopaminergic
Histamine
Serotonin (5HT-3)
Neurokinin 1 (NK 1)
Serotonin Receptor
Inhibitors
• Granisetron (Kytril)
• Ondansetron (Zofran)
• Palonosetron (Aloxi) : Benefit of longer
duration of action
• Best used as a “cocktail” with steroid
(dexamethasone) and lorazepam
Serotonin Receptor Inhibitors:
Common Side Effects
• Headache
• Constipation
– Prevent with use of laxatives and stool
softeners
NK 1 Receptor Inhibitor
• Aprepitant (Emend)
– Used for acute and delayed nausea
in combination with a serotonin
receptor-blocking drug
Dopamine Antagonists
• Phenothiazines
– Prochlorperazine (Compazine)
• Metoclopramide (Reglan)
• Trimethobenzamide (Tigan)
– Limited role except for mildly
emetogenic drugs and may be helpful
in delayed nausea
Delayed Nausea
• Dexamethasone
• Lorazepam (Ativan)
• Dopamine antagonists
– Prochlorperazine (Compazine)
– Trimethobenzamide (Tigan)
Mucositis (Mouth Sores)
• More common with certain drugs:
– 5-fluorouracil (5-FU)
– Methotrexate
– Doxorubicin (Adriamycin)
– Cyclophosphamide (Cytoxan)
Mucositis (Mouth Sores)
• Prevention
– Icing of the mouth during
treatment
• Treatment Options
– Gel Clear
– Magic Mouthwash
– Viscous lidocaine
Diarrhea
• Major toxicity of several drugs used to
treat gastrointestinal cancers, for
example, 5-FU and irinotecan
(Camptosar)
• Acute diarrheal reaction to irinotecan
– Atropine at time of treatment
Delayed Diarrhea:
Treatment
• Anti-Motility Drugs
– Loperamide (Imodium)
– Diphenoxylate (Lomotil)
• Octreotide (Sandostatin)
– Somatostatin analogue
– Works to prolong GI transit time
– Subcutaneous administration
Diarrhea: Changes in Diet
• Increased fluid intake
• Increased starch content
Hand-Foot Syndrome
• Pain, redness, swelling, and peeling of the
skin of the palms and soles
• Associated with certain agents
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Capecitabine (Xeloda)
Liposomal doxorubicin (Doxil)
Infusional 5-FU
Weekly taxane therapy
Hand-Foot Syndrome:
Treatment Options
• Dose reduction
• Avoid tight-fitting shoes; repetitive rubbing or
prolonged heat to hands and feet
• Emollients
– Eucerin
– Bag Balm
– Can be used effectively with cotton socks and/or
gloves at bedtime
Fatigue: Multifactorial
• Anemia
– Erythropoietin (Procrit)/darbepoetin (Aranesp)
• Depression
– Selective serotonin reuptake inhibitor (SSRI)
• Sleep Disturbance
-- Sleep aid: zolpidem tartrate (Ambien),
eszopiclone (Lunesta)
• Psychostimulants
-- Methylphenidate (Ritalin)
Neuropathy
• Painful burning sensation
• Progressive numbness
• Motor weakness
Neuropathy
• Acute, cold induced
– Oxaliplatin (Eloxatin)
• Chronic, dose related
– Oxaliplatin
– Taxanes
Neuropathy: Prevention
• Avoidance of cold exposure for 48-72
hours after oxaliplatin therapy
• Amino acid therapy (glutamine)
• Vitamin B6 (pyridoxine)
Neuropathy:
Treatment Options
• Dose reduction
• Gabapentin (Neurontin)
• Amitriptyline (Elavil)
Report Your Side Effects Early
• It is important to report any side effects
to your oncologist
• Side effects can be minimized effectively
with early intervention