- 1. Outline Introduction Chemotherapy induced nausea andvomiting
Chemotherapy induced mucositis Chemotherapy induced bone
marrowsuppressioni Chemotherapy induced renal toxicitypyy
Chemotherapy induced neuropathy Other adverse effect September 23 ,
2012 1.:, 2.: 3.: 4.: 5.
2. ()( ) BSA() = BSA x ( mg/m2 ) (regimen) 10% , LBW LBW ( lean
body weight ) = IBW + 0.3 x (BW-IBW) (Epirubicin, Doxorubicin,
(Epirubicin Doxorubicin- Bleomcyin..)CBC,CBC hepatitis marker,
Biochemistry, marker Biochemistryliver & lung function - (CXR12
lead EKG)12 (, , ,, , ( (CVCPortPICC) ) 3. The CTCAE: Common
Terminology Criteria for Adverse Events (v4.03 June 14, 2010) Grade
1 Mild; asymptomatic or mild symptoms; clinical or diagnostic
observations only; intervention not indicated. Grade 2 Moderate;
minimal, local or noninvasive intervention indicated Grade 3 Severe
or medically significant but not immediately life-threatening;
hospitalization or prolongation of hospitalization indicated Grade
4 Life-threatening consequences; urgent intervention. intervention
Grade 5 Death related to AE. InvestigationgInvestigationIti ti 4.
24 72 h 24-72 hrs:, () (), (Acute emesis)(Delayed emesis) 3-7: 3 7:
7 14 ( 7-14:( (Anticipatory emesis) ) (cisplatin : ), ()( )
(ASCO2006) >90%Ci l i C l h h id 1 00 /
2CisplatinCyclophosphamide 1500mg/mBCNU(carmustine) DTIC
(dacarbazine) 30
90%30-90%Oxaliplatineirinotecancytarabine1g/m2CarboplatinIfosfamideDoxorubicinEpirubicinDaunorubicinIdarubicin
10-30%10 30% PaclitaxelDocetaxelMitoxantroneTopotecan
TopotecanEtoposideGemcitabinemitomycin ppy
FluorouracilCetuximabTrastuzumab 30 Gy. ComfflamBenzydamine
Comfflam Benzydamine Xylocaine hydrochloridine pumpComfflam 1~4
XylocaineViscous solution 4 X l i Xylocainepump XylocaineViscous 6.
() (Hb)::14 18 g/dl :12 16/dl (Hb)::14-18 :12-16/dl Grade 1: 7.0 45
50fluidUrine sulfonate ) 3, 3. LeucovorinMTX24hrs MTX 48hrserum
level (vincritine, vinblastin, vinorelbine) (taxane) 9. Ototoxicity
Prevention of neuropathies Oxaliplatin, p, Cisplatin >
Oxaliplatin . Cisplatin Glutathine () (), Blood-brain Barrier
Cisplatin ,,. Glutamine,highdose paclitaxel Glutamine ,. Pulmonary
toxicity (acute lungHair loss (alopecia)( p)injury, interstitial
fibrosis) hair loss due to chemotherapy is one of the most
distressing side effectspygBusulfan (myeleran), of chemo
treatments. Hair loss may occur as early as the second or third
week after the firstCarmustine (BCNU)cycle of
chemotherapy,chemotherapy Hair loss can be sudden or slow
(including eyelashes, eyebrows, andBleomycineven pubic
hair)Tyrosine kinase inhibitor (Iressa 39/5993, In almost all
cases, IT may take from 3 to 6 months after therapy is completed .
The "new" hair to possibly have a slightly different color,Tarceva
0.7%)) texture, curl texture or curl. (1)(1) (2) Lipodoxol 10.
Hand-foot syndrome Hand- Hand-foot syndrome (Hand-foot syndrome;
palmar plantarerythema) (1) (2)B6Toxicity of Taxane Dilated
cardiomyopathy (hypersensitivity reaction) (dil t d cardiomyopathy)
(dilated dith ) Paclitaxel Anthracyclines tsteroids antihistamines
R itidi idtihi t i Ranitidine Echocardiography ejection
fractionZantec fluid retention doxorubicin450 mg/m2 Docetaxel 126
700 mg/m2 dexamethasonecardiomyopathy30%dih 30% 11. Hemolytic
uremic syndroem Tumor lysis syndromey y () Mitomycin C
chemo-sensitive tumors: acute leukemia, Burkittslymphoma, diffuse
aggressive lymphoma Gemcitabine : , Management Hydration sodium
bicarbonate in N/S Correct electrolyte imbalance Give allopurinol
300~800mg/day diuresis: mannitol or lasix hemodialysis Adverse
Events of Clinical Interest (any Grade) ( y )Pleural effusion AE
Grade 1: Asymptomatic Grade 2: Symptomatic, intervention such as
diuretics or y pup to 2 therapeutic thoracenteses indicated Grade
3: Symptomatic and supplemental oxygen, >22therapeutic
thoracenteses, tube drainage, orpleurodesis indicated Grade 4:
Life-threatening (e.g. causing hemodynamicinstability or
ventilatory support indicated) Grade 5: Death Overall, most AEs
occurred within the first year with minimal increases between 1-2
years and 2- ,y y3 years One patient in each arm experienced a QTc
interval prolongation 1 month from the start of treatment; no
patients developed a QTc prolongation between 3 months and 3 years
12. 2011/02/06 pleural 2011/02/13 2011/02/242011/05/12 2011/05/26
effusion pImprovedg Re-cahllenge Steroid 15Dasatinib Hold
Dasatinib, Dasatinib mg/d add steroid THANK YOU FORYOUR
ATTENTION
