NAPLEX Question of the Week: Chemotherapy and Toxicity

Knowledge of chemotherapeutic agents with common toxicities are important for all pharmacists who help care for oncology patients.

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Which of the following correctly matches the chemotherapy agent with one of its known toxicities? Select all that apply.


A. Capecitabine – hand and foot syndrome

B. Docetaxel – hemorrhagic cystitis

C. Doxorubicin – cardiotoxicity 

D. Cisplatin – nephrotoxicity 

E. Irinotecan – constipation  



Answer with rationale:

The correct answers are A, C, and D. 

Although oncology is a very specialized area, pharmacists may often see patients who are being treated for different types of cancer. It is important to be aware of the medications these patients are receiving to help minimize any potential drug interactions or mitigate and/or treat adverse drug reactions. 

Capecitabine has a known toxicity of hand and foot syndrome, making answer A correct. Other toxicities include diarrhea, hyperbilirubinemia, and eye irritation.

Answer B is incorrect because hemorrhagic cystitis is associated with cyclophosphamide and ifosfamide. Mesna, a chemoprotective agent is usually given with cyclophosphamide and ifosfamide to prevent binding to acrolein, the metabolite associated with hemorrhagic cystitis. Docetaxel is more commonly associated with peripheral neuropathy, alopecia, fluid retention, and hypersensitivity reactions.

Answer C is correct. Doxorubicin and other anthracyclines have a dose-limiting toxicity of cardiotoxicity. Doxorubicin is limited to cumulative lifetime doses of 450-550 mg/m2 due to its cardiotoxicity risk. Dexrazoxane (Zinecard) can be used to decrease risk of cardiomyopathy, often in patients who will continue to receive doxorubicin therapy and have already received > or = 300mg/m2.  Other side effects of doxorubicin include urine discoloration (red), alopecia, and myelosuppression. Additionally, doxorubicin is a vesicant and can cause extravasation and therefore is preferred to be administered via central line. Management of extravasation from anthracyclines can include dexrazoxane (Totect) or DMSO (topically).

Cisplatin has a dose-limiting toxicity of nephrotoxicity, making answer D correct. Amifostine can be given to prevent cisplatin-induced nephrotoxicity. Peripheral neuropathy and ototoxicity are other adverse effects of cisplatin. While nausea and vomiting are classwide side effects of many chemotherapeutic agents, platinum analogues such as cisplatin are associated with severe, high grade nausea and vomiting, often requiring aggressive premedication with multiple classes (i.e. serotonin antagonists, corticosteroids, +/-  substance P/neurokinin-1 receptor antagonists).

Answer E is incorrect because a very common side effect of irinotecan is diarrhea, not constipation. Other toxicities include mucositis, fever, and alopecia.

Have a great week!

Dr. B

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.