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.