Oncology Supportive Care Sec.2 PDF

Oncology Supportive Care Sec.2 Table of contents 01 Anemia Part. II 04 Diarrhea 02 Miscellaneous 05 Dose Adjustment Antineoplastics for Organ Dysfunction 03 Methotrexate Toxicity  01 Anemia Part. II Managemen...

Oncology Supportive Care Sec.2 Table of contents 01 Anemia Part. II 04 Diarrhea 02 Miscellaneous 05 Dose Adjustment Antineoplastics for Organ Dysfunction 03 Methotrexate Toxicity  01 Anemia Part. II Management of anemia and fatigue:- 1) Erythropoiesis-stimulating agents “ESAs”:- Erythropoiesis Stimulating Agents (ESAs) are medications that stimulate the production of red blood cells, primarily used to treat anemia, especially in patients with chronic kidney disease or those undergoing chemotherapy. These agents work by mimicking erythropoietin, a hormone produced by the kidneys that promotes red blood cell formation. While effective in increasing hemoglobin levels. According to the most recent guidelines, ESAs are initiated once a patient’s Hgb drops below 10 g/dL. Management of anemia and fatigue:- 1) Erythropoiesis-stimulating agents “ESAs”:- Examples:- Epoetin (Epogen®)& Darbepoetin alfa (Aranesp ®). The goal:- to decrease the need for transfusion. It is important to distinguish between the use of these agents for chemotherapy-associated anemia and cancer-associated anemia. The latter is not an approved use. Its use is associated with increased deaths and reduced chemotherapy outcome; so, its use is restricted to non-curative settings. Erythropoiesis-stimulating agents “ESAs”:- :- Side effects:- The use of Erythropoiesis-Stimulating Agents (ESAs) carries several risks, particularly in cancer patients:- 1) Increased Mortality: a potential increase in overall mortality associated with ESA use, particularly in patients with certain cancers. 2) Thromboembolic Events: There is a heightened risk of venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, among patients receiving ESAs. 3) Cardiovascular Risks: ESAs can elevate the risk of serious cardiovascular events such as stroke, heart attack, and heart failure, especially when targeting higher hemoglobin levels (>11 g/dL). 4) Tumor Progression: Concerns have been raised that ESAs may stimulate tumor growth in cancer patients, leading to recommendations against their use in those not receiving active treatment or with curable malignancies. Healthcare providers must carefully weigh these risks against the benefits when considering ESA therapy for anemia management. Management of anemia and fatigue:- 2) Transfusion :- Transfusions are an option if patients are symptomatic. Transfusion goal is to maintain Hgb at 8–10 g/dL.  02 Miscellaneous antineoplastics Miscellaneous Antineoplastic Therapy:- Methotrexate toxicity. Diarrhea. Dose Adjustment for Organ Dysfunction.  03 Methotrexate toxicity Methotrexate (MTX) Methotrexate remains a cornerstone in the treatment of various cancers and autoimmune diseases due to its efficacy in controlling cell proliferation and modulating immune responses. Awareness of the types of toxicity and their risk factors is essential for optimizing treatment outcomes while minimizing adverse effects. Regular follow-up with healthcare providers and supportive care are critical components in managing patients receiving methotrexate therapy to ensure its safe and effective outcomes. Mechanism of action Inhibits nucleotide synthesis, affecting rapidly dividing cells. Methotrexate toxicity Hematologic Toxicity: Methotrexate can cause bone marrow suppression, leading to conditions such as leukopenia (low white blood cell count), thrombocytopenia (low platelet count), and anemia. This toxicity typically appears within 1 to 3 weeks of treatment and may resolve within a similar timeframe. Hepatotoxicity: Liver damage is one of the most serious side effects, with potential outcomes including elevated liver enzymes, fibrosis, and cirrhosis. Long-term use increases the risk, especially in patients with pre-existing liver conditions or those consuming alcohol Methotrexate toxicity Renal Toxicity: Acute kidney injury (AKI) occurs in approximately 2% to 12% of patients receiving high-dose methotrexate. This is often due to crystallization of the drug in renal tubules, which can lead to tubular necrosis. Gastrointestinal Toxicity: Severe mucositis and gastrointestinal bleeding may occur, particularly with high doses. Risk Factors for Toxicity Several factors can increase the risk of methotrexate toxicity: Concomitant Medications: Drugs such as NSAIDs and proton pump inhibitors can enhance methotrexate toxicity by affecting its metabolism or clearance. Pre-existing Conditions: Liver disease, renal impairment, and infections significantly heighten the risk of adverse effects. Dose and Duration: Higher doses (particularly high-dose methotrexate) and prolonged treatment duration correlate with increased toxicity risks  Third Space Accumulation: Methotrexate (MTX) is known to accumulate in "third spaces," such as pleural effusions and ascitic fluid, which can significantly impact its pharmacokinetics and lead to severe toxicity. Management Management strategies for methotrexate toxicity include: Leucovorin Rescue: Administering leucovorin (folinic acid) can mitigate some toxic effects, particularly in cases of high-dose methotrexate administration. Hydration and Urine Alkalinization: These measures help prevent renal toxicity by enhancing the solubility of methotrexate in urine4 Monitoring: Regular blood tests to monitor liver function, kidney function, and blood cell counts are essential for early detection of toxicity  Fluid Drainage: It is recommended to drain any significant third space fluids prior to administering high-dose methotrexate. This intervention helps prevent the prolonged half-life of methotrexate and mitigates the risk of toxicity. Monitoring Methotrexate Levels: Regular monitoring of serum methotrexate levels is essential, especially in patients with known third space accumulation. Adjustments in dosing or administration of leucovorin rescue therapy may be necessary based on these levels.  04 Diarrhea Management of Diarrhea Intensive loperamide therapy using doses higher than the recommended dose was initially described for irinotecan induced diarrhea.  05 Dose adjustment for organ dysfunction Dose Adjustment for Organ Dysfunction Conflicting recommendation for dose adjustment have been reported. Many drugs have not been studied in patients with organ dysfunction. Dose adjustment for renal dysfunction may be considered for methotrexate, carboplatin, cisplatin, etoposide, bleomycin, tobotecan and lenalidomide. Dose adjustment for hepatic dysfunction may be considered for doxorubicin, vincristine, vinblastine, docetaxel, paclitaxel, sorafenib and pazopanib. Thank YOU! Any question????