English
General overview
Rationale r2
Outcomes
Drug therapy
Medication | Common regimens | Life-threatening or dose-limiting adverse reactions | Notable or nonemergent adverse reactions | Special considerations |
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Alkylating agent - nitrogen mustard | ||||
Cyclophosphamide | • Cyclophosphamide (oral) + bevacizumab | • Bone marrow suppression • Cardiotoxicity • Hyponatremia • Impaired wound healing • Nephrotoxicity • Pulmonary toxicity • Secondary malignancy • Urotoxicity • Veno-occlusive liver disease | • Alopecia • Diarrhea • Febrile neutropenia • Fever • Nausea/vomiting | • Effective contraception required during and for up to 1 year after therapy for females of reproductive potential |
Alkylating agent - platinum | ||||
Carboplatin | • Carboplatin + gemcitabine ± bevacizumab • Carboplatin + liposomal doxorubicin ± bevacizumab • Docetaxel + carboplatin • Docetaxel + carboplatin + bevacizumab + maintenance bevacizumab • Paclitaxel + carboplatin • Paclitaxel + carboplatin+ bevacizumab + maintenance bevacizumab | • Anaphylaxis • Bone marrow suppression • Nausea/vomiting • Nephrotoxicity | • Electrolyte loss • Ototoxicity • Peripheral neuropathy • Secondary malignancy | • Avoid coadministering nephrotoxic or ototoxic agents • Ensure adequate hydration |
Cisplatin | • Cisplatin + gemcitabine • Paclitaxel IV + cisplatin IP + paclitaxel IP | • Anaphylaxis • Bone marrow suppression • Nausea/vomiting • Nephrotoxicity • Ocular toxicity | • Electrolyte loss • Ototoxicity • Peripheral neuropathy • Secondary malignancy | • Avoid coadministering nephrotoxic or ototoxic agents • Ensure adequate hydration • Cisplatin has been associated with optic neuritis, papilledema, vision loss • Effective contraception required during and after therapy for 14 months for females of reproductive potential |
Oxaliplatin | • Capecitabine + oxaliplatin ± bevacizumab • Fluorouracil + leucovorin + oxaliplatin ± bevacizumab | • Anaphylaxis • Bleeding • Bone marrow suppression • Nausea/vomiting • Posterior reversible encephalopathy syndrome (PRES) • Pulmonary fibrosis • QT prolongation and ventricular arrhythmias • Rhabdomyolysis | • Diarrhea • Fatigue • Increased hepatic enzymes • Peripheral sensory neuropathy • Stomatitis | • Effective contraception required during and after therapy for 9 months for females of reproductive potential |
Capecitabine | • Capecitabine + oxaliplatin ± bevacizumab | • Bone marrow suppression • Cardiotoxicity • Dehydration • Dermatologic toxicity • Hyperbilirubinemia • Renal failure | • Abdominal pain • Diarrhea • Fatigue/weakness • Nausea • Vomiting | • Increased risk of serious or fatal adverse reactions in patients with low or absent dihydropyrimidine dehydrogenase activity • Effective contraception required during and after therapy for 6 months for females of reproductive potential |
Antimetabolite - nucleoside metabolic inhibitor | ||||
Fluorouracil | • Fluorouracil + leucovorin + oxaliplatin ± bevacizumab | • Bone marrow suppression • Cardiotoxicity • Diarrhea • Hyperammonemic encephalopathy • Mucositis • Neurotoxicity • Palmar-plantar erythrodysesthesia (hand-foot syndrome) | • Increased risk of serious or fatal adverse reactions in patients with low or absent dihydropyrimidine dehydrogenase activity • Effective contraception required during and after therapy for 3 months for females of reproductive potential | |
Gemcitabine | • Carboplatin + gemcitabine ± bevacizumab • Cisplatin + gemcitabine • Gemcitabine monotherapy | • Bone marrow suppression • Capillary leak syndrome • Hemolytic uremic syndrome (HUS) • Hepatotoxicity • Posterior reversible encephalopathy syndrome (PRES) • Pulmonary toxicity | • Dyspnea • Edema • Fever • Hematuria • Increased hepatic enzymes • Nausea/vomiting • Proteinuria • Radiation sensitization • Rash | • Effective contraception required during and after therapy for at least 6 months for females of reproductive potential |
Aromatase inhibitor | ||||
Anastrozole | • Anastrozole monotherapy | • Bone loss/fractures • Ischemic cardiovascular events | • Arthralgia • Arthritis • Asthenia • Back pain • Bone pain • Cough • Depression • Dyspnea • Headache • Hot flashes • Hypercholesterolemia • Hypertension • Insomnia • Lymphedema • Nausea/vomiting • Pain • Peripheral edema • Pharyngitis • Rash | • Effective contraception required during and after therapy for at least 3 weeks for females of reproductive potential |
Exemestane | • Exemestane monotherapy | • Bone loss/fractures • Ischemic cardiovascular events | • Arthralgia • Fatigue • Headache • Hot flashes • Increased appetite • Insomnia • Nausea • Sweating | • Drug interactions: may need to avoid or adjust dosage of certain drugs • Effective contraception required during and after therapy for 1 month for females of reproductive potential |
Letrozole | • Letrozole monotherapy | • Bone loss/fractures | • Arthralgia • Asthenia • Bone pain • Dizziness • Edema • Flushing • Headache • Hot flashes • Hypercholesterolemia • Musculoskeletal pain • Sweating | • Effective contraception required during and after therapy for at least 3 weeks for females of reproductive potential |
Estrogen agonist/antagonist | ||||
Tamoxifen | • Tamoxifen monotherapy | • Bone marrow suppression • Hepatotoxicity • Hypercalcemia • Ocular toxicity • Stroke • Uterine malignancy • Venous thromboembolic events (VTE) | • Edema • Hot flashes • Mood disturbances • Nausea • Vaginal discharge • Vaginal bleeding | • Effective nonhormonal contraception required during and after therapy for 2 months for females of reproductive potential |
Estrogen receptor antagonist | ||||
Fulvestrant | • Fulvestrant monotherapy | • Generally not applicable | • Anorexia • Arthralgia • Asthenia • Back pain • Bone pain • Constipation • Cough • Dyspnea • Extremity pain • Fatigue • Headache • Hot flashes • Increased hepatic enzymes • Injection site reactions • Musculoskeletal pain • Nausea/vomiting | • Fulvestrant can interfere with estradiol measurement by immunoassay, resulting in falsely elevated estradiol concentrations, due to structural similarity • Effective contraception required during and after therapy for 1 year for females of reproductive potential |
Folate receptor alpha (FRα)-directed antibody and microtubule inhibitor conjugate | ||||
Mirvetuximab soravtansine | • Mirvetuximab soravtansine monotherapy • Mirvetuximab soravtansine + bevacizumab | • Infusion-related reactions • Ocular toxicities • Peripheral neuropathy • Pneumonitis | • Abdominal pain • Anemia • Constipation • Diarrhea • Fatigue • Hypoalbuminemia • Hypomagnesemia • Increased hepatic enzymes • Leukopenia • Lymphopenia • Nausea • Neutropenia | • Effective contraception required during and after therapy for 7 months for females of reproductive potential |
Gonadotropin-releasing hormone (GnRH) agonist | ||||
Leuprolide | • Leuprolide monotherapy | • Cerebrovascular and ischemic cardiovascular events • QT prolongation • Seizures • Spinal cord compression • Urinary tract obstruction | • Fatigue • Hot flashes • Hyperglycemia • Malaise • Sweating | |
Kinase inhibitor | ||||
Binimetinib | • Binimetinib monotherapy | • Bleeding • Cardiomyopathy • Dermatologic toxicity • Hepatotoxicity • Interstitial lung disease (ILD) • Retinal vein occlusion (RVO) • Rhabdomyolysis • Serous retinopathy • Uveitis • Venous thromboembolism (VTE) | • Abdominal pain • Diarrhea • Fatigue • Nausea/vomiting | • Effective contraception required during and after therapy for at least 30 days for females of reproductive potential |
Dabrafenib | • Dabrafenib + trametinib | • Bleeding • Cardiomyopathy • Dermatologic toxicity • Fever • New primary malignancy • Uveitis | • Alopecia • Arthralgia • Headache • Hyperglycemia • Hyperkeratosis • Papilloma | • Potential risk of hemolytic anemia in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency • Effective nonhormonal contraception required during and after therapy for at least 2 weeks for females of reproductive potential |
Entrectinib | • Entrectinib monotherapy | • Bone marrow suppression • Heart failure • Hepatotoxicity • Hyperuricemia • Neurotoxicity • QT prolongation • Skeletal fractures • Vision disorders | • Arthralgia • Cognitive impairment • Constipation • Cough • Diarrhea • Dizziness • Dysesthesia • Dysgeusia • Dyspnea • Edema • Fatigue • Fever • Increased hepatic enzymes • Myalgia • Nausea/vomiting • Weight gain | • Effective contraception required during and after therapy for at least 5 weeks for females of reproductive potential • Drug interactions: may need to avoid or adjust dosage of certain drugs |
Larotrectinib | • Larotrectinib monotherapy | • Hepatotoxicity • Neurotoxicity | • Constipation • Cough • Diarrhea • Dizziness • Fatigue • Increased hepatic enzymes • Nausea/vomiting | • Effective contraception required during and after therapy for at least 1 week for females of reproductive potential • Drug interactions: may need to avoid or adjust dosage of certain drugs |
Pazopanib | • Pazopanib monotherapy | • Bleeding • Cardiotoxicity • Gastrointestinal perforation or fistula • Hepatotoxicity • Hypertension • Hypothyroidism • Impaired wound healing • Infection • Interstitial lung disease (ILD)/pneumonitis • Posterior reversible encephalopathy syndrome (PRES) • Proteinuria • QT prolongation • Thromboembolic events • Thrombotic microangiopathy (TMA) • Tumor lysis syndrome | • Anorexia • Diarrhea • Dysgeusia • Dyspnea • Fatigue • Hair depigmentation • Headache • Hypertension • Musculoskeletal pain • Nausea/vomiting • Skin hypopigmentation • Tumor pain • Weight loss | • Drug interactions: may need to avoid or adjust dosage of certain drugs • Withhold therapy for at least 1 week prior to elective surgery and at least 2 weeks after major surgery and until adequate wound healing • Effective contraception required during and after therapy for at least 2 weeks for females of reproductive potential |
Selpercatinib | • Selpercatinib monotherapy | • Bleeding • Hepatotoxicity • Hypersensitivity reactions • Hypertension • Hypothyroidism • Impaired wound healing • Interstitial lung disease (ILD)/pneumonitis • QT prolongation • Tumor lysis syndrome | • Abdominal pain • Constipation • Diarrhea • Dry mouth • Edema • Fatigue • Headache • Hypertension • Hypocalcemia • Hyponatremia • Increased hepatic enzymes • Lymphopenia • Nausea • Rash | • Drug interactions: may need to avoid or adjust dosage of certain drugs • Withhold therapy for at least 1 week prior to elective surgery and at least 2 weeks after major surgery and until adequate wound healing • Effective contraception required during and after therapy for 1 week for females of reproductive potential |
Trametinib | • Dabrafenib + trametinib • Trametinib monotherapy | • Bleeding • Cardiomyopathy • Colitis and gastrointestinal perforation • Dermatologic toxicity • Fever • Interstitial lung disease (ILD)/pneumonitis • New primary malignancy • Retinal pigment epithelial detachment (RPED) • Retinal vein occlusion (RVO) • Venous thromboembolism (VTE) | • Diarrhea • Hyperglycemia • Lymphedema • Rash | • Effective contraception required during and after therapy for 4 months for females of reproductive potential |
Microtubule inhibitor | ||||
Docetaxel | • Docetaxel monotherapy • Docetaxel + carboplatin • Docetaxel + carboplatin + bevacizumab + maintenance bevacizumab | • Asthenia • Bone marrow suppression • Cystoid macular edema • Dermatologic toxicity • Diarrhea • Edema • Enterocolitis and neutropenic colitis • Febrile neutropenia • Hepatotoxicity • Hypersensitivity reactions • Infections • Neurotoxicity • Stomatitis/mucositis • Toxic deaths | • Alopecia • Anorexia • Constipation • Dysgeusia • Dyspnea • Myalgia • Nail disorders • Nausea/vomiting • Pain • Secondary malignancy | • Drug interactions: may need to avoid or adjust dosage of certain drugs • Some docetaxel injection formulations contain alcohol and may impact the central nervous system and ability to drive or operate machinery • Effective contraception required during and after therapy for 6 months for females of reproductive potential |
Paclitaxel | • Paclitaxel + carboplatin • Paclitaxel + carboplatin + bevacizumab + maintenance bevacizumab • Paclitaxel IV + cisplatin IP + paclitaxel IP | • Anaphylaxis • Bone marrow suppression • Cardiotoxicity • Neurotoxicity | • Alopecia • Arthralgia • Diarrhea • Increased hepatic enzymes • Injection site reactions • Mucositis • Myalgia • Nausea/vomiting | • Some paclitaxel formulations contain alcohol and may impact the central nervous system and ability to drive or operate machinery |
Poly-(ADP-ribose) polymerase (PARP) inhibitor | ||||
Niraparib | •Niraparib monotherapy | • Bone marrow suppression • Hypertension • Myelodysplastic syndrome/acute myeloid leukemia • Posterior reversible encephalopathy syndrome (PRES) | • Abdominal pain • Anorexia • Constipation • Cough • Diarrhea • Dizziness • Dyspnea • Fatigue • Headache • Hypomagnesemia • Insomnia • Musculoskeletal pain • Nausea/vomiting • Nephrotoxicity • Rash • Urinary tract infection | • Effective contraception required during and after therapy for 6 months for females of reproductive potential |
Olaparib | • Olaparib monotherapy | • Bone marrow suppression • Myelodysplastic syndrome/acute myeloid leukemia • Pneumonitis • Venous thromboembolism (VTE) | • Anorexia • Asthenia/fatigue • Cough • Diarrhea • Dizziness • Dysgeusia • Dyspepsia • Dyspnea • Headache • Nausea/vomiting | • Drug interactions: may need to avoid or adjust dosage of certain drugs • Effective contraception required during and after therapy for 6 months for females of reproductive potential |
Rucaparib | • Rucaparib monotherapy | • Bone marrow suppression • Myelodysplastic syndrome/acute myeloid leukemia | • Asthenia/fatigue • Abdominal pain/distention • Anorexia • Constipation • Diarrhea • Dysgeusia • Dyspnea • Increased hepatic enzymes • Nasopharyngitis/upper respiratory infection • Nausea/vomiting • Rash • Stomatitis | • Effective contraception required during and after therapy for 6 months for females of reproductive potential |
Programmed death receptor-1 (PD-1) blocking antibody | ||||
Dostarlimab | • Dostarlimab monotherapy | • Adrenal insufficiency • Colitis • Diabetic ketoacidosis • Exfoliative dermatitis • Hepatitis • Hyperthyroidism • Hypophysitis • Hypothyroidism • Infusion-related reactions • Myocarditis • Nephritis • Pneumonitis • Thyroiditis | • Anemia • Asthenia • Diarrhea • Fatigue • Nausea | • Effective contraception required during and after therapy for 4 months for females of reproductive potential |
Pembrolizumab | • Pembrolizumab monotherapy | • Adrenal insufficiency • Anaphylaxis • Colitis • Diabetic ketoacidosis • Exfoliative dermatitis • Hepatitis • Hyperthyroidism • Hypophysitis • Hypothyroidism • Myocarditis • Nephritis • Pneumonitis • Thyroiditis | • Abdominal pain • Anorexia • Constipation • Cough • Diarrhea • Dyspnea • Fatigue • Fever • Myalgia • Nausea • Pruritus • Rash | • Effective contraception required during and after therapy for at least 4 months for females of reproductive potential |
Synthetic progestin | ||||
Megestrol | • Megestrol monotherapy | • Adrenal insufficiency • Cushing syndrome • Diabetes mellitus onset/exacerbation • Heart failure • Venous thromboembolic events (VTE) | • Alopecia • Asthenia • Carpal tunnel syndrome • Dyspnea • Edema • Hot flashes • Hypertension • Lethargy • Malaise • Metrorrhagia • Mood changes • Nausea/vomiting • Rash • Sweating • Tumor flare • Weight gain | |
Topoisomerase I inhibitor | ||||
Topotecan | • Topotecan monotherapy • Topotecan + bevacizumab | • Bone marrow suppression • Febrile neutropenia • Interstitial lung disease | • Asthenia • Abdominal pain • Diarrhea • Dyspnea • Fatigue • Nausea/vomiting • Pain • Pneumonia | • Effective contraception required during and after therapy for 6 months for females of reproductive potential |
Topoisomerase II inhibitor - anthracycline | ||||
Liposomal doxorubicin | • Carboplatin + liposomal doxorubicin ± bevacizumab • Liposomal doxorubicin monotherapy | • Bone marrow suppression • Cardiomyopathy • Infusion-related reactions • Palmar-plantar erythrodysesthesia (hand-foot syndrome) • Secondary oral neoplasms • Stomatitis | • Anorexia • Asthenia • Constipation • Diarrhea • Fatigue • Fever • Nausea/vomiting • Rash | • Can cause reddish-orange discoloration of urine and other bodily fluids after administration • Effective contraception required during and after therapy for 6 months for females of reproductive potential |
Topoisomerase II inhibitor - epipodophyllotoxin | ||||
Etoposide | • Etoposide (oral) monotherapy | • Anaphylaxis • Bone marrow suppression | • Alopecia • Nausea/vomiting • Secondary malignancy | • Effective contraception required during and after therapy for at least 6 months for females of reproductive potential |
Vascular endothelial growth factor (VEGF) inhibitor | ||||
Bevacizumab | • Bevacizumab monotherapy • Capecitabine + oxaliplatin ± bevacizumab • Carboplatin + gemcitabine ± bevacizumab • Carboplatin + liposomal doxorubicin ± bevacizumab • Cyclophosphamide (oral) + bevacizumab • Docetaxel + carboplatin + bevacizumab + maintenance bevacizumab • Fluorouracil + leucovorin + oxaliplatin ± bevacizumab • Liposomal doxorubicin + bevacizumab • Paclitaxel + carboplatin + bevacizumab + maintenance bevacizumab • Mirvetuximab soravtansine + bevacizumab • Niraparib + bevacizumab • Paclitaxel + bevacizumab | • Bleeding • Gastrointestinal perforation or fistula • Heart failure • Hypertension • Impaired wound healing • Infusion-related reactions • Nephrotoxicity and proteinuria • Ovarian failure • Posterior reversible encephalopathy syndrome (PRES) • Thromboembolic events | • Abdominal pain • Anorexia • Constipation • Cough • Diarrhea • Dizziness • Dyspnea • Fatigue • Headache • Hypomagnesemia • Insomnia • Musculoskeletal pain • Nausea/vomiting • Nephrotoxicity • Rash • Urinary tract infection | • Withhold therapy for at least 28 days prior to elective surgery and for 28 days after major surgery and until adequate wound healing • Effective contraception required during and after therapy for 6 months for females of reproductive potential |
Tailor supportive care measures to meet each patient's needs, according to age, performance status, disease status, and specific chemotherapeutic agents used; treatment may include: r2
Palliative measures may include: r2