Adverse Events

Anthracyclines:

• Myelosuppression (esp neutropenia)

• Nausea, vomiting

• Total alopecia

• Mucositis

• Red-colored urine

• Cardiomyopathy (mostly with Doxorubicin, risk increases with cumulative dose)

• Secondary malignancies (AML, MDS)

Topoisomerase I inhibitors:

Irinotecan:

• Severe diarrhea, nausea, vomiting

• Neutropenia

Topotecan:

• Myelosuppression

• Less GI toxicity

• Interstitial lung disease (rare but serious)

Topoisomerase II inhibitors: 

Doxorubicin:

• Discussed in Anthracyclines section

Etoposide:

• Myelosuppression (esp neutropenia and thrombocytopenia)

• Nausea, vomiting

• Secondary leukemias (with long-term use)

• Hypersensitivity reactions (anaphylaxis, rash, urticaria)

• Embryo-fetal toxicity, Infertility

Alkylating agents:

• Myelosuppression (neutropenia, anemia, thrombocytopenia)

• Nausea and vomiting

• Mucositis

• Alopecia

• Gonadal dysfunction (infertility, premature menopause, ovarian/testicular failure)

• Hemorrhagic cystitis (esp with cyclophosphamide and ifosfamide)

• Secondary malignancies (leukemia and myelodysplasia)

• Organ-specific toxicities (cardiac, renal and hepatic toxicities)

• Pulmonary fibrosis (with Busulfan, Melphalan and Carmustine)

Taxens:

• Peripheral neuropathy (esp Paclitaxel)

• Hypersensitivity reactions (esp Paclitaxel)

• Myelosuppression (severe neutropenia in Docetaxel)

• Fluid retention (esp Docetaxel)

• Organ-specific toxicities

Erythropoiesis Stimulating Agents (ESA):

• Allergic reactions

• Hypertension

• Seizures

• Thrombosis

• Decreased overall survival in cancer patients

• Neutralizing antibodies can lead to pure red cell aplasia

Granulocyte Colony-Stimulating Factor (G-CSF):

• Allergic reactions

• Bone pain (treat with NSAID and/or antihistamines)

• ARDS

• Splenic Rupture

• Sickle Cell Crises

• Sweet syndrome, cutaneous vasculitis

• MDS/AML (0.4% absolute risk)

Granulocyte-macrophage colony-stimulating factor (GM-CSF):

• Allergic reaction

• Edema/ capillary leak syndrome

• Pleural/pericardial effusion

• Supraventricular tachycardia

Thrombomimetics (TPO):

Headache, Arthralgia/myalgia, GI symptoms, thromboembolism (venous and arterial) +

Eltrombopag (Promacta):

• Menorrhagia

• Hepatic toxicity (rare)

Avatrombopag (Doptelet):

• Fever

• Headache

• Peripheral edema

Romiplostim (Nplate):

• Bone marrow reticulin (myelofibrosis)

• Increase in blasts (in patients with MDS)

IN PROGRESS..!