2 Explain the use of antineoplastic drugs in immunosuppressive therapy.
3 Understand the use of hormones in the treatment of certain tumors.
4 Understand and anticipate the toxic effects of antineoplastic agents.
5 Discuss nursing measures that provide supportive therapy for cancer patients.
Drugs used to treat cancer— have a very important role in the treatment of certain tumors. Systemic drug treatment is important when cancer is widespread or when the organ or tissue cannot be removed.
Antineoplastic drugs are also used after surgical removal of a cancer to treat microscopic disease that may be left behind.
The more rapidly dividing healthy tissues (e.g., gastrointestinal [GI] epithelium, oral mucosa, bone marrow, lymphoid tissue, and gonads) are the first to be affected by antineoplastic drugs, and too much tissue destruction in these areas can require withdrawal of the antineoplastic drug before the disease is brought under control.
2. Antimetabolites interfere with some phase of normal cellular metabolism. Antimetabolites are substances that compete with, replace, or antagonize a metabolic or bodily function.
3. Hormones may antagonize certain tumors of the reproductive tract and accessory sex organs by altering normal hormonal balance.
4. Antitumor antibiotics act usually by interfering with DNA or RNA synthesis.
5. Enzyme inhibitors interfere with tumor enzymes.
6. Immunomodulating agents enhance the body’s own defense mechanisms to attack the cancer cells.
7. Molecular medicine and targeted therapy treat cancer at the cellular level with agents that are specifically developed to arrest cancer at the cellular level.
8. Platinum-containing agents disrupt the function of DNA and proteins because the platinum component of the drugs binds to the DNA and proteins.
9. Vaccines stimulate the individual’s own immune system to destroy the cancer cells.
10. Miscellaneous drugs are a heterogeneous group of drugs having various mechanisms of action.
Capecitabine is contraindicated in patients allergic to 5-FU.
selective estrogen receptor modulators
Because of their estrogen receptor-activating properties, SERMs can be used to prevent or treat diseases caused by estrogen deficiency, such as osteoporosis. Because of their estrogen receptor- blocking properties, they can also be used to prevent or treat diseases such as breast cancer.
2. There is an increased risk of blood clots, stroke, and endometrial carcinoma after administration. The patient should be monitored for cataracts.
Adults only: (Oral) 1 mg daily.
Adults only: (Oral) 25 mg once daily.
Adults only: (Oral) 2.5 mg daily.
goserelin acetate (Zoladex).
bleomycin sulfate, USP-NF, BP (Blenoxane).
asparaginase, L-asparaginase (Elspar).
Dosage: Children and young adults 9 to 26 years: (IM) 0.5 mL in a series of three injections. The second and third injections are administered 2 months and 6 months after the first.
Dosage: Adults: (IV) Up to 50 million total cells administered back to the patient at 2-week intervals for three doses.
Dosage: Adults only: (IV) 60 to 100 mg/m2 every 3 weeks.
Dosage: Adults: (Oral) 20 to 30 mg/kg daily. Children: Dosage has not been established.
Dosage: Adults only: (Oral) 2 to 10 gm daily in three or four divided doses.
Dosage: Adults: (IV) 4 to 20 mg/m2 weekly. Children: (IV) 2.5 mg/m2 every 1 to 2 weeks.
Dosage: Adults: (IV) 0.5 to 1.4 mg/m2 weekly. Children: (IV) 1.5 to 2 mg/m2 weekly.
Dosage: Adults only: (IV) 30 mg/m2 weekly.
by antagonizing serotonin receptors. All doses are for adults. Some agents may be adapted for pediatric use.
Asperheim, Mary Kaye; Justin Favaro. Introduction to Pharmacology (Page 209). Elsevier Health Sciences. Kindle Edition.
2. The health care provider should instruct the patient about the importance of good nutrition and his or her nutritional requirements. A diet high in protein but low in saturated fat is optimal (e.g., fish, lean poultry, eggs, nonfat dairy products, nuts, seeds, and legumes). Healthy choices include whole legumes, fruits, and vegetables. Dietary supplements may be beneficial but cannot replace a nutrient-rich diet.
3. Assess the patient’s understanding of his or her illness and the possible side effects of medication.
4. Hair loss can be an emotional issue. Patients should be advised that hair grows back in time, even if total alopecia results from the treatments. A wig purchased in advance is a good idea.
5. Oral lesions and bleeding from the gums may result from treatment with antineoplastic agents. Good oral hygiene should be promoted, such as the use of lemon-glycerin swabs and the avoidance of irritating foods or acidic juices. Ice chips held in the mouth during chemotherapy administration can dilute these drugs in the oropharynx and decrease mucositis and the metallic aftertaste.
6. Common side effects of antineoplastic agents are fever, sore throat, blood dyscrasias, and infections. Patients should be monitored for these effects. Any fever should be reported to the physician immediately.
7. Patients receiving antineoplastic medications are susceptible to untoward effects from minor illnesses. Patients and families should be counseled about avoiding contact with possibly infected persons.
8. Sedation or antiemetic medication before the administration of intravenous agents may minimize the nausea and vomiting produced as side effects. Administration in the evening may allow remission of the nausea before the next morning. Patients should be encouraged to eat small, frequent meals.
9. The site of injection should be observed carefully for signs of extravasation because these agents may produce sloughing of tissues.
10. Observe patients for therapeutic effects, such as reduction in tumor size and weight gain.
11. A patient may be depressed as a result of having cancer. Observation for depression and recommendation for treatment, if indicated, help in the overall management of the patient.
Interfere with some phase of normal cellular metabolism. Antimetabolites are substances that compete with, replace, or antagonize a metabolic or bodily function.
Have been used in the treatment of hairy cell leukemia; Kaposi’s sarcoma in patients with AIDS; renal cell carcinoma; bladder, cervical, and ovarian cancer; melanoma; and multiple myeloma. Interferon alfa is used after surgical resection of melanoma. Side effects include a flulike syndrome, myalgia, arthralgia, anorexia, mental disturbances, elevated liver enzymes, and skin rashes.
This enzyme, derived from Escherichia coli, is mainly used in combination chemotherapy for childhood acute lymphocytic leukemia, but it is used in adults as well.
In pharmacology, an antagonist agent blocks or interferes with some activity. Methotrexate is called a folic acid antagonist agent because it interferes with the formation of the active form of folic acid.
Because the reproductive system is greatly affected by hormones, they may be useful in antagonizing tumors of that system.
Many types of chemotherapy reduce the production of white blood cells (WBCs). Because filgrastim stimulates the formation of WBC precursors in the bone marrow, it is given to reduce the risk of neutropenia in patients on chemotherapy.
Hemorrhagic cystitis is an adverse effect of cyclophosphamide; therefore the patient should be monitored for bloody urine.
The activity of pharmacologic interferon is like that of substances produced by WBCs. It has antineoplastic, antiviral, and immunomodulary properties.
Intrathecal means within the spinal cord, specifically into the subarachnoid space.
Mucositis (inflammation of the oral tissues) is a common adverse effect of many antineoplastic agents. Cooling the mouth with ice chips may constrict blood vessels in the mouth, thereby decreasing the exposure of the oral tissues to the drug.
Anemia may occur because of the drug effects on the bone marrow. Mouth ulcers and gastric ulcers can develop because of the effects of antineoplastic drugs on the gastrointestinal lining. Slurred speech is not a common side effect.
Avoid people with infections because your resistance is low.
A high-protein, low-saturated fat diet is recommended.
Side effects include a flulike syndrome, myalgia, arthralgia, anorexia, mental disturbances, elevated liver enzymes, and skin rashes.