Naplex Question of the Week: Chemotherapy adverse effects and supportive care

Oncology is an increasingly growing specialty area for pharmacists. All pharmacists even those not specializing in oncology should be familiar with supportive care issues regarding cancer chemotherapy. Today's question focuses on adverse effects and supportive care.

Like Comment

A 42 year old female with no significant past medical history is diagnosed with breast cancer that will require Adriamycin (doxorubicin) and cyclophosphamide. Which of the following adverse effects are significantly associated with this regimen and require monitoring? Select all that apply.

A. Cardiomyopathy

B. Extravasation

C. Hyperthyroidism

D. Hemorrhagic cystitis

E. Myelosuppression

Answer with rationale:

The correct answers are A, B, D, and E. Adverse effects and supportive care are important to every pharmacist, no matter if you are an oncology specialist or not. Therefore a solid knowledge of the common and or life-threatening adverse effects associated with the most common agents is critical. Answer E (myelosuppression) is associated with a number of chemotherapy agents, especially when given in combination as part of an overall regimen. The anthracycline antibiotics, such as doxorubicin, are associated with significant extravasation as well as cardiomyopathy. The maximum lifetime cumulative dose of doxorubicin is 550mg/m2 in order to limit the risk of cardiomyopathy. Cyclophosphamide as well as ifosfamide are associated with hemorrhagic cystitis due to their active metabolite (acrolein). For ifosfamide, administration of mesna is recommended as a protective agent to decrease the risk of cystitis by binding the acrolein. Patients receiving cyclophosphamide may be given IV fluids alone in many circumstances to attenuate the risk. Hyperthyroidism (answer C) is not a known adverse effect of this regimen.

For more information on oncology supportive care, see our chapter in the Naplex 3rd edition review guide:§ionid=201032533#1158313611

Christopher M. Bland

Clinical Professor, University of Georgia College of Pharmacy

Dr. Christopher M. Bland is a Clinical Professor at the University of Georgia College of Pharmacy at the Southeast GA campus in Savannah, GA. Dr. Bland has over 20 years of academic and clinical experience in a number of clinical areas. He is a Fellow of both the Infectious Diseases Society of America as well as the American College of Clinical Pharmacy. He is co-founder of the Southeastern Research Group Endeavor, SERGE-45, with over 80 practitioners across 14 states involved. Dr. Bland serves as Associate Editor for the NAPLEX Review Guide 4th edition as well as Editor-In-Chief for the Question of the Week. He has provided live, interactive reviews for more than 10 Colleges/Schools of Pharmacy over the course of his career.