Managing symptoms of chemotherapy treatment

Question 1

What are the two types of chemotherapy?

Answer 1

1. Conventional - toxic, taken up by cells that divide rapidly (cancer cells, hair cells, mucosa in the mouth) which leads to toxicity and adverse effects e.g. hair loss, neutropenia
2. Targeted - selectively targets pathways so less likely to see broad side effects

Question 2

What are the 3 main types of CINV?

Answer 2

1. Acute - within 24 hours of receiving treatment
2. Delayed - after 24 hours (2-5 days)
3. Anticipatory - conditioned response (vomiting on 1st cycle of chemo leads to body associating feeling sick when in hospital)

Question 3

What is the classification of CINV?

Answer 3

Emetogenic potential (% of pts with emesis) 
Level 1 - minimal (0-<10%)
Level 2 - Low (10-<30%)
Level 3 - Moderate (>30%- <90%)
Level 4 - High (>90%)

Question 4

Give examples of drugs and there emetogenic potential

Answer 4

L1 = Olotanib
L2 = 5FU 
L3 = Capecitabine 
L4 = Cisplatin

Question 5

What does the emotegenic potential of a drug depend on

Answer 5

1. type of drug

2. dose

Question 6

Name a drug that’s emetogenic potential is based on dose

Answer 6

Cylophosphamide less than 1500mg/m2 = moderate risk

>1500 = high risk

Question 7

Which drugs are used to treat CINV?

Answer 7

• Ondansetron/Palonosetron (selective 5HT3 receptor antagonist)
• Apprepitant (NK1 receptor antagonist)
• Dexamethasone (Corticosteroid)
• Metoclopramide (D2 receptor antagonist)
• Cyclizine (H1 receptor antagonist)

Question 8

What is the antiemetic treatment ladder

Answer 8

1. No antiemetic pre chemo, Metoclopramide as take home
2. IV dexamethasone pre chemo, Metoclopramide take home
3. IV dexamethasone and IV Ondansetron pre chemo, Ondansetron + Dexamethasone + Metoclopramide take home
4. Previous step with apprepitant/Palonosetron instead of Ondansetron (IV and Oral)
5. Previous step with apprepitant AND Palonosetron instead of Ondansetron (IV and Oral)

Question 9

What are the 8 common side effects of chemotherapy

Answer 9

1. CINV
2. Mucositis/Stomatitis
3. Palmar Plantar Erthrodeysthesia (PPE/Hand and foot syndrome)
4. CIDiarrrhoea
5. Myelosuppression
6. Neutropenic sepsis
7. Skin problems with kinase inhibitors
8. Hair problems

Question 10

What is the treatment for mucositis/stomatitis?

Answer 10

prevention is better than cure - oral hygiene tips e.g., brush 2x daily, floss, mouthwash, avoid spicy foods
management - Chlorhexidine gluconate, benzdamine hydrochloride mouthwash
Sucralfate suspension
Aciclovir 400mg 5x day
Fluconazole 50mg a day

Question 11

Which chemotherapy drug class is more likely to causes mucositis/stomatitis

Answer 11

Antimetabolite drug class
e.g., MTX, 5-FU, gemcitabine

Question 12

What is Palmar Plantar Erthrodeysthesia (PPE/Hand and foot syndrome)?

Answer 12

Skin on hands and feet peel away/crack/ulcerate, loss of fingerprint

Question 13

What is the treatment for PPE?

Answer 13

Reduce dose/delay treatment of chemo (more common with Capecitabine
Management - moisturise with cream high in urea

Question 14

How does Capecitabine cause PPE? (the chemistry)

Answer 14

carbonate group cleaved in liver into an amino group
this is deaminated into a carbonyl group
sugar is removed to produce 5-FU by uridine/thymidine phosphorylase which is found in high conc in hands and feet so more 5-FU produced = more toxicity