Managing chemotherapy toxicities in gi cancers
This presentation is the property of its rightful owner.
Sponsored Links
1 / 40

Managing Chemotherapy Toxicities in GI Cancers PowerPoint PPT Presentation


  • 112 Views
  • Uploaded on
  • Presentation posted in: General

Managing Chemotherapy Toxicities in GI Cancers. September 30, 2008. Christine Brezden-Masley, MD PhD FRCPC. To understand toxicities from colorectal cancer therapy gastric cancer therapy To manage toxicities from colorectal cancer therapy gastric cancer therapy. Objectives.

Download Presentation

Managing Chemotherapy Toxicities in GI Cancers

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Managing chemotherapy toxicities in gi cancers

Managing Chemotherapy Toxicities in GI Cancers

September 30, 2008

Christine Brezden-Masley, MD PhD FRCPC


Objectives

To understand toxicities from

colorectal cancer therapy

gastric cancer therapy

To manage toxicities from

colorectal cancer therapy

gastric cancer therapy

Objectives


Colorectal cancer

Adjuvant colorectal cancer

FOLFOX

Xeloda

Clinical trial:

CRC2 – Stage 3 CRC: FOLFOX +/- Cetuximab (for RAS wt patients)

CRC3 – Stage 2 CRC: 18q deletion: FOLFOX +/- Avastin

CRC4 – Stage 2-3 Rectal cancer: FOLFOX +/- Avastin

Colorectal Cancer


Folfox

Dose-limiting cold-induced sensory peripheral neuropathy

Ask patients if are able to button shirt and write

If so, but have tingling >14 days (into next cycle) then decrease dose of oxaliplatin 85 mg/m2 to 65 mg/m2

If pain and significant paresthesia, cannot button shirt, cannot write – discontinue oxaliplatin and continue with FUFA

Any prevention studies for neuropathy?

FOLFOX


Calmag infusions

CalMag Infusions


Managing chemotherapy toxicities in gi cancers

2008 ASCO


Managing chemotherapy toxicities in gi cancers

2008 ASCO


Managing chemotherapy toxicities in gi cancers

2008 ASCO


Managing chemotherapy toxicities in gi cancers

2008 ASCO


Managing chemotherapy toxicities in gi cancers

2008 ASCO


Managing chemotherapy toxicities in gi cancers

2008 ASCO


Managing chemotherapy toxicities in gi cancers

2008 ASCO


Managing chemotherapy toxicities in gi cancers

2008 ASCO


Managing chemotherapy toxicities in gi cancers

2008 ASCO


Managing chemotherapy toxicities in gi cancers

2008 ASCO


Managing chemotherapy toxicities in gi cancers

2008 ASCO


Managing chemotherapy toxicities in gi cancers

2008 ASCO


Managing chemotherapy toxicities in gi cancers

2008 ASCO


Managing chemotherapy toxicities in gi cancers

2008 ASCO


Managing chemotherapy toxicities in gi cancers

2008 ASCO


Managing chemotherapy toxicities in gi cancers

2008 ASCO


Managing chemotherapy toxicities in gi cancers

2008 ASCO


Managing chemotherapy toxicities in gi cancers

2008 ASCO


Managing chemotherapy toxicities in gi cancers

2008 ASCO


Neuropathy

CalMag

2-3 tablets per day without food

Stay warm

Do not drink cold fluids

Neuropathy


Nausea and vomiting

FOLFOX

Hesketh 4

FOLFIRI

Hesketh 4

ECF/ECX

Hesketh 5

Xeloda (Capecitabine)

Hesketh 2

Nausea and Vomiting


Nausea and vomiting1

Immediate

Zofran 8mg po BID

Decadron 8 mg po BID

X 3 days with chemotherapy

Delayed

Stemetil

Maxeran

Nausea and Vomiting


Delayed n v

IV hydration at home

CCAC daily IV hydration with NS 600ml/day

Marinol/Nabilone (cannabinoid)

Haldol

Aprepitant

Cost

Zyprexa (olanzapine)

Delayed N/V


Diarrhea

FOLFOX

FOLFIRI

Imodium

Loperamide

NO MAXIMUM for chemotherapy-induced diarrhea

Ensure no C.Difficile (ischemic gut)

Somatostatin (100 mg sc x1)

Diarrhea


Folfiri

Immediate diarrhea (during infusion)

SN38 active metabolite

Cholinergic response

Treatment with Atropine 0.2 mg sc x1

Morphine (cramping)

FOLFIRI


Myelosuppression

No role for primary prevention of GCSF

FOLFIRI>FOLFOX

ECF/ECX

For CURATIVE intent

Can treat with GCSF – funding an issue

If private insurance – can use in advanced care to push doses

Myelosuppression


Myelosuppression1

If febrile neutropenia

Not difficult for Section 8 to fund

FOLFOX and Gemcitabine

Thrombocytopenia

If platelets <85 should dose-reduce

Educate patient about bleeding risk

Anemia

Check for Fe stores – supplement

Role for ESAs?

Myelosuppression


Xeloda

Hand-Foot Syndrome

Keep hands and feet moist with Udder cream

May reduce dose if continues (blistering and desquamation and pain)

Diarrhea

Mucositis

XELODA


Mucositis

Good oral hygeine critical

Baking soda rinses – ½ teaspoon of baking soda in half glass of water daily 2-3x

If severe neutropenia – than mucositis usually occurs

Nystatin (Nilstat) 500,000 Units po q4-6 hours (swish and swallow)

Tantum (ODB)

Butlers/Blacksteins mouth wash

Mucositis


Managing chemotherapy toxicities in gi cancers

Dihydropyrimidine dehydrogenase (DPD)

Catabolic pathway of 5-FU

Responsible for 85% of degradation of 5-FU

5-FU5-FUTP5-FdUMP (ACTIVE form)

DPD deficiency

3-5% population (polymorphisms as high as 8%)

Autosomal recessive

DPD


Dpd deficiency

DPD Deficiency Syndrome

Grade 4 neutropenia

Severe/fatal diarrhea

Mucositis/stomatitis

Rash

Can happen after 1st or 2nd dose of 5-FU

Treatment

Supportive care

DPD Deficiency


Clinical pearls

Shape your practice – you’re the boss

Do not need to examine patient at each chemotherapy session – but need to

MONITOR ALL BLOODWORK

MONITOR SIDE-EFFECTS

ASK PATIENT HOW THEY’RE DOING

FATIGUE/ENERGY

APPETITE

MOOD

Clinical Pearls


Clinical pearls1

NEED TO ASSESS PATIENT

Pain

New symptoms/signs

Dehydration

Neurologic

Major organ involvement

Respiratory (r/o PE)

Cardiac (electrolyte disturbances)

Renal

Hepatic (Ascites)

CLINICAL PEARLS


Thanks

Thanks

Questions?

[email protected]


  • Login