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College of Pharmacy

HelixTalk Episode #59 - The five oncology drugs every pharmacist should know about

Date posted: April 11, 2017, 6:00 am

In this episode, we discuss with Dr. Megan Hartranft the five oncology drugs that every pharmacist should know about, which is a great review for P4 students who are currently preparing for the NAPLEX.  We cover cyclophosphamide, cisplatin, methotrexate, doxorubicin, and vincristine.

Key Concepts

  1. Cyclophosphamide (Cytoxan) and other nitrogen mustards can cause hemorrhagic cystitis -- pain, inflammation, and bleeding of the bladder.  Depending on the chemotherapy regimen, IV mesna may be given to prevent this adverse effect.
  2. Cisplatin (Platinol) and other platinum can cause renal damage.  IV fluids before and after chemotherapy and adequate hydration at home are extremely important with this chemotherapy class.
  3. High-dose methotrexate usually requires “rescue” therapy with leucovorin.  Leucovorin stops the methotrexate toxicity in healthy cells, but is not taken into cancerous cells.
  4. Doxorubicin (Adriamycin) and other anthracyclines can cause cardiotoxicity in the form of heart failure and arrhythmias.  Patients should have echocardiograms and EKG to monitor for toxicity.  To mitigate this risk, a maximum lifetime dose (550 mg/m2 or 450 mg/m2 depending if chest radiation was done) is implemented and in high-risk patients, IV dexrazoxane is sometimes considered.
  5. Vincristine (Oncovin) and other vinca alkaloids should never ever, ever be given via the intrathecal route -- it can be a fatal error if given via the IT route.