Chemotherapy Administration: Part 3

1
Chemotherapy Administration Part 3

• Kaiser Permanente Ohio Nursing Educational Module

2
Learning Objectives

• After completing this competency presentation,
  the nurse should be able to
• Identify the top 12 IV chemotherapy agents
  administered in KP MAS
• Understand the chemotherapy agents mechanisms of
  action, what cancers the medications are used to
  treat, any black box warnings.
• Understand common side effects that will require
  nursing assessment and interventions.

3
  Top 12 drugs dispensed Oncology Infusion
Medications

• Fluorouracil
• Gemzar
• Herceptin
• Carboplatin
• Paclitaxel
• Cytoxan
• Taxotere
• Doxorubicin
• Avastin
• Eloxatin
• Etoposide
• Bevacizumab

4
Fluorouracil

• Class Antineoplastic agent
•  
• MOA Antimetabolite (Pyrimidine analog).
  Considered to be cell-cycle specific to the S
  phase of cell division. Inhibits DNA and RNA
  synthesis.
• Tumor types Breast, colon, rectum, pancreas and
  stomach
•  
• Black Box Warnings It is recommended that the
  patient be hospitalized during the initial course
  of treatment due to the possibility of severe
  toxic reaction.
• Adverse Effects Nausea, vomiting, diarrhea,
  headache, alopecia, photosensitivity, hand-foot
  syndrome, gastric ulcer, intractable vomiting,
  diarrhea, precipitous fall in white blood and/or
  platelet count, myocardial ischemia, hemorrhage,
  gastrointestinal ulcer, stomatitis,
  esophagopharyngitis

5
Gemzar

• Class Antineoplastic agent
•  
• MOA Antimetabolite nucleoside analogue that
  exhibits antitumor activity that is specific to
  cell cycle for S phase and the G1/S phase of cell
  division
•  
• Tumor types pancreas, breast, breast and
  non-small cell lung cancer
•  
• Black Box Warnings
•  
• Adverse Effects Alopecia, peripheral edema,
  rash, hyperglycemia, constipation, diarrhea,
  nausea, vomiting, stomatitis, anemia, leukopenia,
  neutropenia, thrombocytopenia, raised alkaline
  phosphatase, peripheral motor neuropathy, hearing
  disorder, hematuria, increase serum creatinine,
  dyspnea, fever, fatigue, pain, cardiac
  dysrhythmias, congestive heart failure, liver
  failure, renal failure, acute respiratory
  distress.
•  
•  
•  

6
Herceptin

• Class Monoclonal antibody
• MOA Binds to the extracellular domain of the
  HER2 protein, which is over expressed in 25 to
  30 of primary breast cancers. By binding to the
  HER2 protein, herceptin inhibits the growth of
  tumor cells and mediates antibody-dependent
  cellular cytotoxicity (ADCC) in cancer cells that
  overexpress the HER2 protein.
•  
• Tumor types Breast and gastric with HER2
  oversuppression
•  
• Black Box Warnings Herceptin can result in
  subclinical and clinical cardiac failure, with
  greatest risk when administered concurrently with
  anthracyclines. Evaluate cardiac function prior
  to and during treatment. Discontinue herceptin
  for cardiomyopathy. Serious and fatal infusion
  reactions and pulmonary toxicity may occur.
  Discontinue herceptin for anaphylaxis,
  angioedema, interstitial pneumonitis, or acute
  respiratory distress syndrome. Exposure during
  pregnancy can result in oligohydramnios, in some
  cases complicated by pulmonary hypoplasia and
  neonatal death
•  

7
Herceptin - continued

• Adverse Effects edema, tachycardia, weight loss,
  rash, abdominal pain, nausea, vomiting,
  stomatitis, anemia, neutropenia,
  thrombocytopenia, backache, myalgia, insomnia,
  renal impairment, cough, dyspnea, pharyngitis,
  fatigue, cardiomyopathy, hepatotoxicity, renal
  failure, pulmonary toxicity

8
Carboplatin

• Class Antineoplastic agent
•  
• MOA Resembles an alkylating agent. Although the
  exact mechanism of action is unknown, action is
  thought to be similar to that of the bifunctional
  alkylating agents, that possibly causes
  cross-linking and interference with the function
  of DNA. It is cell cyclephase nonspecific.
•  
• Tumor types Ovarian cancer
•  
• Black Box Warnings Bone marrow suppression with
  carboplatin is dose-related and may be severe,
  resulting in infection and/or bleeding. Anemia
  may be cumulative and may require transfusion
  support. Vomiting is another frequent
  drug-related side effect. Anaphylactic- like
  reactions to carboplatin have been reported and
  may occur within minutes of carboplatin
  administration
•  
• Adverse Effects Alopecia, hypocalcemia,
  hypomagnesemia, hyponatremia, abdominal pain,
  nausea, vomiting, diarrhea, anemia, leukopenia,
  neutropenia, thrombocytopenia, raised alkaline
  phosphatase, abdominal blood urea, elevated serum
  creatinine, pain, immune hypersensitivity
  reaction, unexplained visual loss
•  
•  

9
Paclitaxel

• Class Antineoplastic agent, mitotic inhibitor
•  
• MOA Promotes the assembly of microtubules and
  inhibits normal dynamic reorganization of the
  microtubule network that is essential for vital
  interphase and mitotic cellular functions. In
  addition, paclitaxel induces abnormal arrays or
  'bundles' of microtubules throughout the cell
  cycle and multiple asters of microtubules during
  mitosis.
•  
• Tumor types Breast, non-small cell lung,
  ovarian, AIDS related Kaposis sarcoma
•  
• Black Box Warnings Anaphylaxis and severe
  hypersensitivity reactions characterized by
  dyspnea and hypotension requiring treatment,
  angioedema, and generalized urticaria have
  occurred in clinical trials. Fatal reactions have
  occurred in patients despite premedication and
  all patients should be pretreated with
  corticosteroids, diphenhydramine, and H(2)
  antagonists. Patients who experience severe
  hypersensitivity
• reactions to paclitaxel should not be
  rechallenged with the drug. Paclitaxel therapy
  should not be given to patients with solid tumors
  who have baseline neutrophil counts of less
• than 1500 cells/mm and should not be given to
  patients with AIDS-related Kaposi's
• sarcoma if the baseline neutrophil count is less
  than 1000 cells/mm. Monitor peripheral blood cell
  counts frequently.
•  

10
Paclitaxel - continued

• Adverse Effects Alopecia, diarrhea, inflammation
  of mucous membranes, nausea, vomiting, anemia,
  leukopenia, neutropenia, thrombocytopenia,
  arthralgia, peripheral neuropathy, cardiac
  dysrhythmia, cardiotoxicity, congestive heart
  failure, myocardial infarction, gastrointestinal
  perforation, anaphylaxis, grand mal seizure,
  peripheral neuropathy, pulmonary embolism,
  respiratory failure
•  

11
Cytoxan

• Class Alkylating agent, antineoplastic agent,
  nitrogen mustard
•  
• MOA Binds with many intracellular molecular
  structures, including nucleic acids. Its
  cytotoxic action is primarily due to
  cross-linking of strands of DNA and RNA, as well
  as to inhibition of protein synthesis. Cytoxan is
  a potent immunosuppressant. It also causes marked
  and persistent inhibition of cholinesterase
  activity
•  
• Tumor types Hodgkins lymphoma, non-Hodgkins
  lymphoma, chronic lymphocytic leukemia, chronic
  myelocytic leukemia, acute myelocytic leukemia,
  acute lymphocytic leukemia, mycosis fungoides,
  multiple myeloma, neuroblastoma, retinoblastoma,
  breast cancer, ovarian adenocarcinoma
•  
• Black Box Warnings Cardiotoxicity, fertility
  effects, hemorrhagic cystitis, secondary
  malignancies, and immunosuppression may occur.
  Use with caution in patients with hepatic or
  renal impairment.
•  
• Adverse Effects Alopecia, nausea, vomiting,
  leukopenia, amenorrhea, cardiotoxicity,
  congestive heart failure, pericardial effusion,
  pericarditis, fibrosis of bladder, azospermia,
  oligozoospermia, pulmonary fibrosis
•  
•  
•  
•  
•  
•  

12
Toxotere

• Class Antineoplastic agent, mitotic inhibitor
•  
• MOA Binds to free tubulin,then promotes the
  polymerization of tubulin into stable
  microtubules and inhibits microtubule
  disassembly, resulting in blockade of cellular
  mitotic and interphase functions and,
  consequently, in inhibition of cell division.
•  
• Tumor types Breast cancer, non-small cell lung
  cancer, metastatic prostate cancer, advanced
  gastric adenocarcinoma,squamous cell head and
  neck cancer
•  
• Black Box Warnings Treatment-related mortality
  increases with abnormal liver function, at higher
  doses, and in patients with non-small cell lung
  carcinoma and a history of prior treatment with
  platinum-based therapy receiving docetaxel at 100
  mg/m. Toxotere should generally not be given to
  patients with bilirubin greater than the ULN, or
  to patients with SGOT and/or SGPT greater than
  1.5 x ULN concomitant with alkaline phosphatase
  greater than 2.5 x ULN. These patients are at
  increased risk for developing severe or life-
  threatening toxicities. Monitor LFTs prior to
  each treatment cycle. Toxotere therapy should not
  be given to patients with neutrophil counts of
  less than 1500 cells/mm obtain frequent blood
  counts to monitor for neutropenia. Severe
  hypersensitivity reactions, including fatal
  anaphylaxis, has been reported in patients who
  received dexamethasone premedication. Use is
  contraindicated in patients with a severe
  hypersensitivity to docetaxel or polysorbate 80.
  Severe fluid retention may occur.
•  
•  
•  

13
Toxotere - continued

• Adverse Effects Edema, vasodilatation, alopecia,
  rash, nail changes, diarrhea, nausea, vomiting,
  stomatitis, anemia, leukopenia, neutropenia,
  neuropathy, amenorrhea, colitis, hepatotoxicity,
  renal failure, pulmonary embolism, anaphylaxis

14
Doxorubicin

• Class Antineoplastic agent, anthracycline
  antibiotic
•  
• MOA Thought to act on malignant cells by
  blocking replication of nucleotide and action of
• DNA and RNA polymerases.
•  
• Tumor types Acute lymphocytic leukemia, acute
  myeloid leukemia, Hodgkins disease, malignant
  lymphoma, soft tissue and bone sarcoma, thyroid
  cancer, small cell lung cancer, breast cancer,
  gastric cancer, ovarian cancer, bladder cancer,
  neuroblastoma, Wilms tumor
•  
• Black Box Warnings Severe local tissue necrosis
  will occur if there is extravasation during
  administration do not administer by the
  intramuscular or subcutaneous route. Myocardial
  toxicity manifested in its most severe form by
  potentially fatal congestive heart failure (CHF)
  may occur either during therapy or months to
  years after termination of therapy. The risk of
  developing CHF increases rapidly with increasing
  total cumulative doses of doxorubicin in excess
  of 400 mg/m(2). Secondary acute myelogenous
  leukemia (AML) and myelodysplastic syndrome (MDS)
  have been reported in patients treated with
  anthracyclines. Pediatric patients are also at
  risk for developing secondary AML. Reduce dosage
  in patients with impaired hepatic function.
  Severe myelosuppression may occur with therapy.
•  
• Adverse Effects Alopecia, nausea, vomiting,
  cardiomyopathy, congestive heart failure,
  myocardial infarction, myocarditis, pericarditis,
  pancreatitis, colon ulceration, hepatitis,
  anaphylaxis, septic shock, other leukemias.

15
Avastin

• Class Monoclonal antibody
•  
• MOA Binds to vascular endothelial growth factor
  (VEGF) and inhibits the interaction of VEGF to
  Flt1 and KDR receptors on the surface of
  endothelial cells. In the process, it prevents
  the proliferation of endothelial cells and
  formation of new blood vessels.
•  
• Tumor types metastatic colorectal cancer
  advanced, nonsquamous,non-small cell lung cancer
  metastatic HER2 negative breast cancer
  progressive glioblastoma metastatic renal cell
  cancer.
•  
• Black Box Warnings Gastrointestinal perforation,
  hemorrhage, wound dehiscence
•  
• Adverse Effects hypertension, alopecia,
  hand-foot syndrome, abdominal pain, constipation,
  diarrhea, loss of appetite, stomatitis, altered
  taste, hemorrhage, asthenia, dizziness, headache,
  proteinuria, dyspnea, epistaxis, arterial
  thromoembolism, congestive heart failure,
  myocardial infarction, impaired wound healing,
  wound dehiscence, gastrointestinal hemorrhage or
  perforation, tracheoesophageal fistula, deep vein
  thromobis, fistula of bile duct. 
•  
•  

16
Eloxatin

• Class Antineoplastic agent
•  
• MOA Forms cross-links that inhibit DNA
  replication and transcription. Cytotoxicity is
  cell-cycle nonspecific.
•  
• Tumor types Stage 3 colon cancer (adjuvant),
  advanced colorectal cancer
•  
• Black Box Warnings Anaphylactic reactions to
  Eloxatin have been reported, and may occur within
  minutes of administration.
•  
• Adverse Effects Abdominal pain, diarrhea,
  constipation, nausea, vomiting, loss of appetite,
  stomatitis, anemia, neutropenia, backache, cough,
  fatigue, fever, edema, colitis, pancreatitis,
  febrile neutropenia, hemolytic anemia,
  leukopenia, thrombocytopenia, thromboembolytic
  disorder, anaphylaxis, immune hypersensitivity
  reaction, neuropathy, dysesthesia, transient
  visual loss, hearing loss, dyspnea, pulmonary
  fibrosis
•  
•  
•  
•  

17
Etoposide

• Class Antineoplastic agent, mitotic inhibitor
•  
• MOA The exact mechanism of etoposide's
  antineoplastic effect is unknown. Etoposide is a
  topoisomerase II inhibitor. It seems to act at
  the premitotic stage of cell division to inhibit
  DNA synthesis it is cell cycledependent and
  phase-specific, with maximum effect on the S and
  G 2 phases of cell division.
•  
• Tumor types Treatment of refractory testicular
  tumors, small cell lung cancer
•  
• Black Box Warnings Severe myelosuppression with
  resulting infection or bleeding
•  
• Adverse Effects Alopecia, shivering, diarrhea,
  inflammatory disease of mucous membranes, loss of
  appetite, nausea, vomiting, asthenia, fever,
  malaise, congestive heart failure, myocardial
  infarction, Stevens-Johnson syndrome, toxic
  epidermal necrolysis, acute leukemia,
  myelosuppression, hepatotoxicity, immune
  hypersensitivity reaction.
•  
•  

18
Bevacizumab

• Class Monoclonal antibody
•  
• MOA Vascular endothelial growth factor inhibitor
  that inhibits angiogenesis (formation of new
  blood vessels) and slows tumor growth
•  
• Tumor types metastatic, nonsquamous, non-small
  cell lung cancer metastatic colorectal cancer
  metastatic HER-2 negative breast cancer
  glioblastoma renal cell cancer
•  
• Black Box Warnings GI perforation, hemorrhage,
  wound dehiscence
•  
• Adverse Effects Hypertension, alopecia,
  hand-foot syndrome, abdominal pain, constipation,
  diarrhea, loss of appetite, stomatitis, altered
  taste, hemorrhage, asthenia, dizziness, headache,
  dyspnea, epistaxis, arterial thromboembolism,
  congestive heart failure, impaired wound healing,
  wound dehiscence, gastrointestinal hemorrhage or
  perforation, tracheoesophageal fistula, deep vein
  thrombosis, febrile neutropenia, fistula of the
  bile duct, cerebral artery occlusion, cerebral
  infarction, subarachnoid hemorrhage, bladder
  perforation or fistula, vaginal fistula,
  bronchopleural fistula, hemoptysis, perforation
  of nasal septum, pulmonary hypertension,
  hypersensitivity, proteinuria
•  
•  
•  

19
Conclusion

• After the completion of Administration of
  Chemotherapy Part 3
• 1.The nurse can identify the top 12 IV
  chemotherapy agents being administered.
• 2.The nurse understands the mechanism of action,
  side effects and nursing assessment required for
  each drug.
• 3.The nurse feels competent to administer
  medications.

20
References

• Kim, K (2008). Top 10 drugs dispensed out of
  Oncology pharmacy. Retrieved on November 18, 2008
  from Kun Kim, PharmD. Chief of Infusion
  Services.
• Lexicomp Online. Accessed 09.15.11.
• Micromedex 2.0 Online. Accessed 09.15.11
•