Nuclear Medicine · MU Sofia

9. Adverse drug events - manifestations and treatment: Febrile neutropenia. Upper and lower dyspeptic complications. Haematological toxicity. Extravasates. Drug-induced autoimmune diseases. Hypersensitivity reactions.

Covers skin side effects of targeted therapy, including rashes, hyperpigmentation, photosensitivity and hand-foot syndrome, plus other non-haematological toxicities such as neuropathy and cardiotoxicity. Explains myelosuppression, neutropenia management with filgrastim and prophylactic antibiotics, and treatment of anaemia and thrombocytopenia. Also outlines surgery, radiotherapy, chemotherapy regimens and cetuximab for head and neck cancers, with a link to NICE guidance.

Inside: 3 sections · 15 flashcards · 3 min

Topic 42 of 50 in the MU Sofia syllabus for Nuclear Medicine (Medicine, Year 4). The free AceMed note covers it in 3 sections, about 442 words (3 min of reading), with 15 flashcards.

In this note

  1. Implications of control of side effects from targeted therapy - skin and non-hematological toxicity
  2. Prevention and treatment of hematological toxicity from drug therapy in oncology patients
  3. Approaches for treatment of common head and neck cancers

Implications of control of side effects from targeted therapy - skin and non-hematological toxicity

Skin:

  • Side effects include dryness, redness, itching, pain, discomfort, discoloration (hyperpigmentation), light sensitivity, rashes, hand and foot syndrome (includes sore peeling skin)
  • Some medication can trigger allergic or pseudoallergic reactions
  • Side effects depend on specific drug, and can be as a result of Graft vs host disease
  • The best mitigation of these side effects is to reduce chemotherapeutic dose, or increase the time between cycles. Can also give Antibiotics, Antimycotics, steroids and topical creams and ointments to manage side effects

Other non-hematological toxicity

  • Gastrointestinal distress (covered above)
  • Fatigue (can be chronic)
  • Hair loss
  • Infertility
  • Peripheral neuropathy
  • Cognitive impairment
  • Organ damage
  • Cardiotoxicity especially prominent, with hepatotoxicity and nephrotoxicity also present. Ototoxicity common side effect of platinum based drugs

Prevention and treatment of hematological toxicity from drug therapy in oncology patients

Hematological side effects are the most significant and potentially life threatening side effects a patient can have. We will address the main ones below and consider their implications:

  • Immunosuppression and myelosuppression
  • Almost all chemotherapeutic regimes can cause immune system depression by paralysing bone marrow and leading to WBC, RBC and platelet reduction.
  • Neutropenia (with low neutrophil count) makes patients significantly more prone to infection and they should be monitored closely. Treatment with synthetic granulocyte colony stimulating factor (e.g. filgrastim) is recommended
  • Sepsis, herpes simplex and shingles are common conditions patients get
  • Prophylactic quinolones or trimethoprim/sulfamethoxazole are indicated
  • In severe myelosuppression, all the bone marrow stem cells are destroyed. Bone marrow transplants are required in these cases.
  • Anemia caused ty myelosuppression - treat with erythropoietin, iron and blood transfusions. Low platelet counts can be treated with platelet transfusions

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