Chapter 12: Drug Therapy for the Treatment of Cancer

QSEN Safety Alert #6

Wear gloves when handling patient's clothing, bed linens, or excreta. Blood and body fluids are contaminated with drugs or metabolites for about 3-5 days after a dose

QSEN Safety Alert #2

When cytotoxic drugs are combined, it is essential to monitor the complete blood cell count (CBC) before and after each treatment to allow time for bone marrow recovery before the next treatment.

Major problem of chemotherapy

drug resistance

Chemotherapy is administered ___________________

in cycles (medication followed by recovery) Overseen by medical oncologists/specialty trained nurses

Why does Tumor Lysis Syndrome develop?

when large numbers of cancer cells are killed or damaged simultaneously and release their intracellular contents into the bloodstream

Safety Precautions With Cytotoxic Antineoplastic Medications

**Most are carcinogenic, mutagenic, and teratogenic. >Avoid exposure while pregnant. Parenteral solutions are irritating to skin, mucous membranes—>avoid direct contact with skin or respiratory tract; wash hands thoroughly after administration.

Common Adverse Effects of Traditional Cytotoxic Antineoplastic Drugs

-Alopecia, anemia, bleeding -Fatigue, mucositis -N/V -neutropenia -thrombocytopenia -Possible damage to heart, liver/kidneys, and nerves

Management of Hand Foot Syndrome

-Avoid increased pressure -Apply ice packs for 15-20 minutes at a time -Acetaminophen may be used for discomfort

Solid neoplasms

-Carcinomas (epithelial tissue) -Sarcomas (connective tissue)

Indications for Use of Traditional Cytotoxic Antineoplastic Drugs

-Cure neoplastic disease -Relieve neoplastic disease symptoms -Induce/maintain remissions -Treatment of nonmalignant conditions >>Rheumatoid arthritis >>Psoriasis

Hematologic malignancies

-Invade bone marrow and lymphoid tissue -Leukemias, lymphomas, multiple myeloma

General Characteristics of Traditional Cytotoxic Antineoplastic Drugs

-Most kill malignant cells by interfering with cell replication in some manner. -Act during the cell's reproductive cycle -Most active against rapidly dividing cells, both normal and malignant -Each dose kills a specific % of cells. -May induce drug-resistant malignant cells -Differing routes of administration

Antineoplastic Drug Selection/Dosage Depends on

-Type, stage of cancer -Drug efficacy in specific cancer -Patient's age, health status->Including liver, kidney function

Signs/Symptoms/Effects of Tumor Lysis Syndrome

-hyperkalemia -hyperphosphatemia -hyperuricemia -hypomagnesemia -hypocalcemia -acidosis

Cytotic Antineoplastic Drugs & Prototypes

1. Alkylating Drugs - Cyclophosphamide (Cytoxan) 2. Antimetabolites - Methotrexate (Trexall) 3. Antitumor Antibiotics - Bleomycin (Blenoxane) 4. Plant Alkaloids - Vincristine (Oncovin)

Adjuvant Medication Used to Treat Cancer

1. Biologic Antineoplastic Drugs -Monoclonal Antibodies -Growth Factor & Tyrosine Kinase Inhibitors -Proteasome Inhibitors 2. Antineoplastic Hormone Inhibitor Drugs -Antiestrogens For breast cancer or prevention in high risk patients -Aromatase Inhibitors -Antiandrogens -Luteinizing Hormone-Releasing Hormone Analogs

Cytoprotectant Drugs

1. Erythropoietin (Epogen, Procrit) - anemia 2. Filgrastin (Neupogen) - neutropenia 3. Oprelvekin (Neumega) - thrombocytopenia

Malignant Neoplasms Classifications

1. Hematologic malignancies -Invade bone marrow and lymphoid tissue -Leukemias, lymphomas, multiple myeloma 2. Solid neoplasms -Carcinomas (epithelial tissue) -Sarcomas (connective tissue)

Oncologic Medication Groups

1. Traditional cytotoxic agents 2. Biologic targeted therapies (cytotoxic) 3. Hormone inhibitors (noncytotoxic) 4. Medications that reduce adverse effects of cytotoxic medications

Hand Foot Syndrome

Aka Palmar-Plantar Erythema A sunburn type of skin reaction with redness, tenderness, & possibly peeling, numbness & tingling of palms & soles. Associated with some traditional cytotoxic dugs

Aromatase Inhibitors

Anastrozole (Armidenx) Indication=breast cancer

QSEN Safety Alert #8

Antineoplastic Hormone Inhibitor Drugs= use effective nonhormonal barrier contraception during therapy and for 2 months after the drug is discontinued.

Purpose of grading/staging classifications

Assist in determining treatment modalities.

QSEN Safety Alert #5

Avoid direct contact with solutions for injection by wearing gloves, face shields, an protective clothing

Antiandrogens

Bicalutamide (Casodex) - Indication=prostatic cancer

Antitumor Antibiotic Prototype

Bleomycin (Blenoxane)

Antineoplastic Drug Guidelines

Consider the patient's age, functional status, nutritional status, blood count, kidney and liver function High doses are usually most effective. Doses are usually calculated according to the body surface area. Doses may be reduced for impairments that reduce the ability to eliminate medications.

Alkylating Drug Prototype

Cyclophosphamide (Cytoxan)

QSEN Safety Alert #3

Cytotoxic drugs are potentially embryotoxic, teratogenic & carcinogenic

Cancer

Disease process characterized by uncontrolled cell growth, invasiveness and metastasis with numerous etiologies, clinical manifestations, and treatments

Luteinizing Hormone-Releasing Hormone Analogs

Goserelin (Zoladex) Indication=advanced prostatic or breast cancer

Grading/Staging Malignant Neoplasms

Grades 1 and 2=-Similar to normal tissue of origin; show cellular differentiation Grades 3 and 4=Unlike normal tissue of origin; less differentiated, more malignant Staging=Localized or metastasized; organ involvement

Purpose of Oncologic Medications

Kill, damage, or slow growth of cancer cells and prevent/treat adverse effects

Antimetabolite Prototype

Methotrexate (Trexall)

Normal Versus Malignant Cells

Normal Cells: -Reproduce in response to the need for tissue growth/repair -Stop reproduction when the need is met -Well differentiated in appearance and function -Have characteristic lifespan Malignant Cells: -Occupy space; serve no useful purpose -Steal blood and nutrients from normal tissue -Grow in uncontrolled fashion -Undifferentiated; loosely connected >>Break off and invade adjacent tissues or circulate throughout the body in bloodstream

QSEN Safety Alert #1

Nurses who administer IV cyotoxic chemotherapy receive special training and are certified in handling and administering the chemotherapy drugs safely & accurately

QSEN Safety Alert #7

Oral Tyrosine Kinase Inhibitors=No crushing or cutting tablets should occur and if necessary dissolve the tablet in water in accordance with the manufacturer's instructions and ingest it immediately

Purpose for Erythropoietin (Epogen, Procrit)

Protection against anemia

Purpose for Filgrastin (Neupogen)

Protection against neutropenia

Purpose for Oprelvekin (Neumega)

Protection against thrombocytopenia

Medical management of metastatic disease

Requires systemic chemotherapy alone

Tumor Lysis Syndrome

Serious life-threatening adverse effect from treatment of leukemias & lymphomas

Medical management of localized tumors

Surgery, radiation, or concurrent chemotherapy and radiation

Antiestrogens

Tamoxifen (Nolvadex) Indication=breast cancer or prevention in high risk patients

QSEN Safety Alert #4

Use of cytotoxic agents that cause bone marrow suppression is not appropriate in people with a white blood cell count less than 2000 cell/mm3, a neutrophil count less than 1500 cells/mm3, and/or platelet count less than 50,000/mm3

Chemotherapy

Use of medications to treat cancer (rather than surgery, radiation) Goal=Damage or kill cancer cells Most regimens involve combination of drugs with differing cellular action

Plant Alkaloid Prototype

Vincristine (Oncovin)