Chemotherapy Side Effects: What YOU Need to Know

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• Speaker: Ashley Glode, PharmD

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Disclaimer:

The information and services provided by Fight Colorectal Cancer are for general informational purposes only. The information and services are not intended to be substitutes for professional medical advice, diagnoses or treatment.

If you are ill, or suspect that you are ill, see a doctor immediately. In an emergency, call 911 or go to the nearest emergency room.

Fight Colorectal Cancer never recommends or endorses any specific physicians, products or treatments for any condition.

Speaker:Ashley E. Glode, PharmD, Assistant Professor, Department of Clinical Pharmacy, is a Board Certified Oncology Pharmacist practicing at the University of Colorado Cancer Center, Anschutz Outpatient Cancer Pavilion. The services she provides include provision of drug information and education, supportive care management for patients, drug counseling on chemotherapy and investigational agents, toxicity monitoring for patients on phase 1clinical trials and pharmacy-based chemotherapy-induced anemia clinic.

CHEMOTHERAPY SIDE EFFECTSWHAT YOU NEED TO KNOW ASHLEY GLODE, PHARMD, BCOP

WEBINAR ROAD MAP

Commonlyused agents

Side effects and their

management

Toxicity monitoring

Communication with

your team

COMMONLY USED AGENTS

Traditional Cytotoxic Agents

• Fluorouracil• Leucovorin • Capecitabine• Oxaliplatin• Irinotecan

Monoclonal Antibodies

• Bevacizumab• Ziv-aflibercept• Cetuximab• Panitumumab• Nivolumab• Pembrolizumb

Unique Oral Therapies

• Regorafenib• Trifluridine +

tipiracil

TRADITIONAL CYTOTOXIC AGENTS

Fluorouracil (5-FU) Infusion as bolus and/or continuous Used in combination with

leucovorin Leucovorin (LV/folinic acid)

Increases efficacy of 5-FU Capecitabine (CAP)

Given orally Transformed into 5-FU in the body

Oxaliplatin (OX) Infusion over 2 hours Usually given in combination with

other agents Irinotecan (IRI)

Infusion over 90 minutes Rarely given alone

COMMON REGIMENS

FOLFOX: 5-FU, LV and oxaliplatin FOLFIRI: 5-FU, LV and irinotecan FOLFOXIRI: 5-FU, LV, oxaliplatin and irinotecan CAPOX: capecitabine and oxaliplatin

MONOCLONAL ANTIBODIES

Bevacizumab Infused over 30-90 minutes Can be given in combination with

any of the chemotherapy regimens listed previously

Ziv-aflibercept Usually given over 60 minutes Only in combination with FOLFIRI

after oxaliplatin-based therapy

Cetuximab Infused over 1-2 hours Can be given alone or in

combination with chemotherapy Panitumumab

Infused over 1 hour Can be given alone or in

combination with chemotherapy

MONOCLONAL ANTIBODIES

Nivolumab Infused over 60 minutes Administered as a single drug

Pembrolizumab Infused over 30 minutes Administered as a single drug

UNIQUE ORAL THERAPIES

Regorafenib Given orally Administered as a single drug Option for those who have failed

other treatment options

Trifluridine + tipiracil Given orally Administered as a single drug Option for those who have failed

other treatment options

SIDE EFFECTS AND THEIR MANAGEMENT

TRADITIONAL CYTOTOXIC AGENTS: GENERAL SIDE EFFECTS

Decreased blood cell counts Anemia: fatigue, shortness of

breath Transfusions, erythropoiesis-

stimulating agents (ESAs) Neutropenia: infection

Granulocyte colony stimulating factors (GCSFs), infection prophylaxis

Thrombocytopenia: bleeding, bruising Transfusions, avoid platelet inhibitors,

monitor anticoagulation closely

Fatigue Exercise Prioritize tasks Naps Relax Sleep Eat well

TRADITIONAL CYTOTOXIC AGENTS: GENERAL SIDE EFFECTS

Chemo brain Make lists Keep a schedule of tasks Don’t multitask Try mind building activities Rest Ask for help

TRADITIONAL CYTOTOXIC AGENTS: GENERAL SIDE EFFECTS Nausea/vomiting

Serotonin receptor antagonists: ondansetron, granisetron

Corticosteroids: dexamethasone Neurokinin-1 receptor antagonists:

aprepitant, netupitant, rolapitant Phenothiazines: prochlorperazine,

promethazine Benzodiazepines: lorazepam Dopamine antagonists: haloperidol,

metoclopramide Atypical antipsychotics: olanzapine

Ginger Diet Hydration Acupuncture/acupressure Aromatherapy

TRADITIONAL CYTOTOXIC AGENTS: GENERAL SIDE EFFECTS

Diarrhea Irinotecan: I run to the can Loperamide, lomotil, octreotide Diet Hydration

Constipation Opioid medications Sennosides, bisacodyl, docusate Diet Hydration

TRADITIONAL CYTOTOXIC AGENTS: GENERAL SIDE EFFECTS

Sore mouth or mouth ulcers Mouth rinses Diet Avoid alcohol and tobacco

Taste changes Mint or lemon candy Mouth rinses Herbs and spices Plastic or wooden utensils

TRADITIONAL CYTOTOXIC AGENTS

Fluorouracil (5-FU) Skin sensitivity to sunlight Hand foot syndrome (palmo-plantar

erythema) Capecitabine

Hand foot syndrome Drug-drug interactions

Oxaliplatin Numbness of the lips, hands or feet Tingling of hands or feet Sensitivity to cold

Irinotecan Sweating Watery eyes Increased production of saliva Cramping stomach pain Diarrhea starting the day after

treatment

MONOCLONAL ANTIBODIES

Bevacizumab Hypertension Proteinuria Rare: arterial thrombosis, mucosal

bleeding, gastrointestinal perforation, delayed wound healing

Ziv-aflibercept Fatigue Liver problems Hypertension Proteinuria Diarrhea Decreased blood cell counts Bleeding

MONOCLONAL ANTIBODIES

Cetuximab and Panitumumab Acneiform rash Low magnesium Allergic reactions

Nivolumab and Pembrolizumab Rash Diarrhea Adrenal problems Liver problems Fatigue

UNIQUE ORAL THERAPIES

Regorafenib Hand foot syndrome Skin rash Fatigue Liver problems Hypertension Proteinuria Diarrhea Bleeding Drug-drug interactions

Trifluridine + tipiracil Fatigue Decreased blood cell counts Nausea/vomiting Diarrhea

MANAGEMENT OF UNIQUE SIDE EFFECTS

Hand foot syndrome Moisturizing creams and lotions White cotton gloves and socks Avoid friction/ tight shoes Cool water with washing

Acneiform rash Topical hydrocortisone and

clindamycin Oral antibiotics: doxycycline,

minocycline NO acne medications Keep skin well moisturized Avoid topical agents with alcohol,

perfumes and dyes Sunscreen Cool water with washing

MANAGEMENT OF UNIQUE SIDE EFFECTS

Neuropathy Pins and needles, numbness and

tingling Cumulative May improve after treatment Antidepressants, anticonvulsants,

lidocaine patches

Cold-induced neuropathy Avoid cold 7-10 days Have room temperature food and

beverages Wear gloves and scarves to cover

your face

TOXICITY MONITORING

TOXICITY MONITORING

Adverse effects Acute Delayed Cumulative Persistent

Laboratory assessments CBC BMP/CMP: electrolytes, liver

function, renal function

Physical exams Review of systems: head to toe

assessment Mental health/wellbeing Quality of life

COMMUNICATION WITH YOUR TEAM

BEFORE STARTING THERAPY

Current Medication List OTCs, herbals, and supplements Vaccinations

Alcohol/Tobacco intake Current medical history Pregnancy and contraception

TEAMWORK

You are an active team member Speak openly and honestly Make sure you are being understood Ask questions and gather information Make a plan for your treatment and care

MAKE SURE YOU DISCUSS…

Treatment options How side effects and symptoms will be managed Any other issues you find important

PERSONAL INFORMATION TO SHARE WITH YOUR TEAM

Type of work and degree of physical work or mental stress involved Close relatives who have had cancer and their types Idea of how much you know about cancer and its treatment How much you are affected by family problems, money problems,

work-related stress, or other issues Hobbies and other interests Goals for your quality of life during and after treatment Desire for children in the future Any important cultural beliefs

KNOW YOUR RESOURCES

Complementary and alternative therapies Dietary/nutritional support Emotional/social support Financial counseling Physical activities Support groups Palliative care

HELPFUL RESOURCES/WEBSITES Fight Colorectal Cancer

http://fightcolorectalcancer.org/fight-it/managing-side-effects/ American Cancer Society

http://www.cancer.org/ Chemo Care

http://www.chemocare.com/about/default.aspx National Cancer Institute: Resources for Patients

https://www.cancer.gov/resources-for/patients

Your health care team!

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