26. Common Chemotherapy Side Effects

  • Anthracycline antibiotics: cardiac toxicity in accumulated dose and more rarely acutely (most patients should have a pretreatment MUGA or echocardiogram). Cardioprotective agents such as beta blockers and dexrazoxane may be considered as adjunctive agents to reduce risk of toxicity.
  • Cyclophosphamide, ifosfamide: hemorrhagic cystitis (treat concurrently with mesna and hydration).
  • Etoposide: fever, hypotension during infusion, metabolic acidosis after infusion.
  • Cytarabine: severe mucositis, pink rash that can desquamate, renal insufficiency.
  • Cisplatin: renal toxicity (recommend pre/post IV isotonic saline), ototoxicity, potassium and magnesium wasting.
  • Vincristine, vinblastine: peripheral neuropathy, constipation.
  • Bleomycin: pulmonary fibrosis, anaphylaxis during infusion.
  • Taxanes (paclitaxel/docetaxel): immediate hypersensitivity reactions, stop infusion treat with hydrocortisone, epinephrine and diphenhydramine. Also cause sensory neuropathy.
  • Biologics:
    • Bevacizumab: hypertension, impaired wound healing, bowel perforation, gastrointestinal bleeding, thromboembolism, reversible posterior leukoencephalopathy syndrome (RPLS).
    • Erlotinib, cetuximab: maculopapular rash, often acneiform, occurring predominantly on face and upper trunk.
    • Rituximab: fevers, chills, rigors, rarely anaphylaxis. All during infusion.
    • Sorafenib: hypertension, hand/foot syndrome.
    • Traztuzumab: increase risk of CHF, especially with anthracycline treatment.