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

• 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– 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