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
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
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
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
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