XVIII. Common Oncologic Pharmaceuticals for Patients with Urologic Malignancy

Name of Chemotherapeutic Agent	Mechanism of Action	Half-life	Primary Clinical Toxicities	Primary Lab Effect	Monitoring
Bladder
Vinblastine	Inhibits assembly of microtubules and arrests cells in metaphase	24 hours	Alopecia, paresthesia, HTN, Myelosuppression	Neutropenia	CBC, BMP, LFTs, serum uric acid
Methotrexate	Inhibits metabolism of folic acid	10 hours	Ulcerative stomatitis, highly teratogenic, CNS toxicity	Neutropenia	CBC, BMP, LFTs, CXR (baseline), urine pH
Adriamycin (Doxorubicin)	Intercalates DNA	3.5 hours	Nausea, vomiting, heart arrhythmias	Neutropenia	CBC, BMP, LFTs, cardiac exam (baseline)
Cisplatin	DNA Alkylating Agent	1 hour	Nephrotoxicity, neurotoxicity, nausea, vomiting, ototoxicity	Creatinine clearance (also hypomagnesemia, hypokalemia, hypocalcemia)	CBC, BMP, LFTs, U/A, audiography
Carboplatin	DNA Alkylating Agent	6 hours	Myelosuppression, nausea, vomiting, nephrotoxicity (more rare)	Neutropenia, anemia, Cr (at high doses)	CBC, BMP, LFTs
Gemcitabine	DNA analogue replaces cytidine in DNA replication and arrests cell cycle	10 hours	Muscle pain, fever, headache, chills, fatigue, skin rash	LFT elevation, proteinuria	CBC, BMP, LFTs
BCG	Live attenuated mycobacteria, induces local inflammatory and granulomatous reaction	Unknown	Dysuria, urgency, fever		Flu like symptoms, fever >3 days, CBC, BMP, LFTs
Mitomycin C	Antitumor antibiotic activity	1 hour	Bone marrow suppression long term, lung fibrosis, renal damage	Anemia	CBC, BMP, PT, PFTs
Interferon	Proteins that act oncogenes to induce cell death	5 hours	Myelosuppression, flu like syndrome, cardiovascular effects	LFT elevation	CBC, BMP, LFTs
Testis
Bleomycin	Inhibits synthesis of DNA by binding DNA and inducing strand breaks	9 hours	Pulmonary fibrosis, alopecia, Hepatotoxicity, chills, fever	Neutropenia, LFT elevation	C BC, BMP, LFTs, PFTs, CXR
Ifosfamide	Cross links DNA causing synthesis inhibition	15 hrs	Myelosuppression, CNS toxicity, hemorrhagic cystitis, alopecia, nausea	Metabolic acidosis, hyperbilirubinemia, AKI	CBC, BMP, LFTs
Etoposide	Delays transit of cells through S phase; topoisomerase II inhibitor causing DNA strand breaks	8 hours	Myelosuppression, hypersensitivity reactions, hypotension, secondary malignancies	Neutropenia, LFT elevation	CBC, BMP, LFTs
Kidney
Sunitinib	VEGF inhibitor	2 days	HTN, Fatigue, diarrhea, nausea, hand-foot syndrome	LFT elevation, AKI, CK elevation	CBC, BMP, LFTs, TFTs, U/A, LVEF w/ Echo.
Pazopanib	VEGF inhibitor	31 hrs	HTN, hair color change, diarrhea, fatigue	LFT elevation	LFTs, U/A, TFTs, blood pressure
Sorafenib	Multikinase inhibitor – inhibits RAF kinase, VEGFR, cKit, and RET	1-2 days	Hand-foot syndrome, HTN, complicates wound healing, diarrhea	Leukopenia, elevates INR, hypoalbuminemia	CBC, BMP, amylase, lipase, TFTs
Bevacizumab	VEGF inhibitor	20 days	Complicates wound healing, hemorrhage, HTN, GI perforation, hypersensitivity	Proteinuria	CBC, blood pressure, urine dipstick for proteinuria,
Temsirolimus	mTOR inhibitor – reduces HIF proteins and VEGF	17hrs	Rash, mucositis, nausea, dyspnea	Hyperlipidemia, hyperglycemia, AKI	CBC, BMP, LFTs, lipid panel
Erlotinib	Epidermal growth factor inhibitor (EGFR)	1-2 days	Fatigue, rash, diarrhea	LFT elevation, renal failure	LFTs, BMP
Everolimus	mTOR inhibitor	30 hrs	Stomatitis, URI, rash, fatigue	Anemia, hypercholesterolemia, LFT elevation	CBC, BMP, LFTs, lipid panel
Interleukin-2	Proliferation of immune cells causing interaction with malignant cells and subsequent cell death	2 hrs	Hypotension (capillary leak syndrome), chills, diarrhea, oliguria, dysnpea	AKI, LFT elevation, thrombocytopenia	CBC, BMP, LFTs, CXR, PFTs, ABG, Thallium stress test
Prostate
Bicalutamide	Antiandrogen, competitive inhibitor for binding of DHT and T	6 days	Hot flashes, pain, constipation	LFT increase	CBC, LFTs, EKG, testosterone, PSA
Flutamide	Antiandrogen, inhibits androgen uptake or binding of androgen in target tissue	6 hours	Gynecomastia, nausea, vomiting, galactorrhea	LFT increase, anemia	LFTs, testosterone/estrogen, phosphatase
Nilutamide	Antiandrogen, blocks testosterone effects at androgen level	3 days	Hot flashes, nausea	LFT increase	LFTs, CXR
Cyproterone	Antiandrogen, blocks DHT to prostate cancer cells and release of LH from pituitary	4 days	Edema, dry skin, chills	LFT increase, adrenal suppression, anemia	CBC, BMP, LFTs, adrenal function
Ketoconazole	Inhibits androgen synthesis	8 hrs	Nausea, vomiting	LFT increase	LFTs
Abiraterone	Selectively and irreversibly inhibits CYP17 (lyase), enzyme required for androgen synthesis	12 hrs	Edema, diarrhea, joint swelling	Triglyceride increase, hypokalemia, LFT increase	LFTs
Docetaxel	Promotes assembly of microtubules resulting in inhibition of DNA, RNA, and protein synthesis	11 hrs	Fluid retention, alopecia, stomatitis, weakness	Neutropenia, LFT increase	CBC, BMP, LFTs
Leuprolide	LHRH agonist	3 hrs	Hot flashes, headache, nausea/vomiting	Increased creatinine	LH and FSH levels, testosterone, PSA
Goserelin	LHRH agonist	4 hrs	Hot flashes, sexual dysfunction	Increased lipids	Bone mineral density, calcium, lipid panel
Buserelin	LHRH agonist	1 hr	Hot flashes, sexual dysfunction	Increased lipids	Serum testosterone, PSA, bone scan
Degarelix	GnRH antagonist	53 days	Hot flashes	Increased lipids, LFT increase	BMP, LFTs, testosterone, PSA
Mitoxantrone	Intercalates DNA resulting in cross-linking and strand breaks	3 days	Fever, alopecia, nausea, weakness	Neutropenia, LFT increase	CBC, LFTs
Sipuleucel-T	Immunotherapy that induces immune cell response against prostate cancer cells	Unk.	Chills, nausea, back pain, infusion reaction	Anemia	CBC, BMP
Cabazitaxel	Taxane that promotes microtubule assembly preventing cell division	4 days	Fatigue, diarrhea, weakness	Anemia, LFT increase	CBC

File:

Common Oncology Drugs for the GU patient_0.ppt