WHO recommends that sufficient resources and specialized supervision be taken into account before using this group of medicines. Specific experience, accuracy in diagnosis, and dose or special equipment are required to be used correctly.
Treatment of cancer with drugs, radiotherapy and surgery is complicated and must be done only by an oncologist. For this reason, the following information is provided as guidance only. Chemotherapy can be healing or used to relieve symptoms or prolong longevity. When the condition becomes unmanageable with cytotoxic therapy, alternative palliative treatment (section 4.8) should be considered.
For some tumors, chemotherapy may suffice with one drug, but for many malignant tumors, a combination of drugs provides the best response. Examples of treatment combination include:
- CHOP (cyclophosphamide, doxorubicin, fincristine, prednisolone) for non Hodgkin disease;
- ABVD (doxorubicin, bleomycin, phenplastine, dacarbazine) for Hodgkin's disease.
- MOPP (Clormithine, Finchristine, Procarbazine, Prednisolone) for Hodgkin's disease
Cytotoxic drugs are often combined with other combinations of drugs in the treatment of malignant diseases. Such drugs include antagonists and antagonists of hormones, corticosteroids and immunosuppressive drugs. But combinations are more toxic than single drugs.
The following information covers drugs with anti-tumor activity. But they are toxic drugs and should be used with great care and monitoring. Dosage, contraindications, precautions and adverse effects of cytotoxic drugs have been excluded from this section because treatment should be performed by specialists using agreed treatment regimens. Health authorities may consider setting up their own systems on the advice of experts.
Precautions and contraindications. Treatment with cytotoxic drugs should begin only after baseline tests of liver and kidney functions and baseline determination of the blood count. It may be necessary to modify or delay processing in some cases. The patient's condition should be monitored regularly during chemotherapy and the cessation of cytotoxic drugs if there is a significant deterioration in the function of bone marrow, liver or kidneys.
Many cytotoxic drugs are toxic and should not be given during pregnancy, especially in the first trimester. Contraceptive procedures are required during treatment and possibly for post-treatment period. Cytotoxic drugs are also banned during breast-feeding.
Cytotoxic drugs should be given with care to avoid unnecessary toxicity of the patient or exposure of the healthcare provider during circulation. Local policies should be strictly adhered to for the handling and re-structuring of cytotoxic drugs; all residues, including fluids and body secretions (and any contaminants) must be treated as hazardous substances.
The leakage of intravenous cytotoxic drugs can lead to severe pain and necrosis in the surrounding tissues. If the leak occurs, first try to sip the medicine, then lift the injured side and put warm pads to accelerate and reduce the infusion, or determined by placing cold pads until the infection disappears; in severe cases can be placed topical hydrocortisone ointment on the site of inflammation. Refer to the manufacturer's brochure for more detailed information.
Adverse effects: cytotoxic drugs have a great ability to destroy normal tissues. There are particularly adverse effects of different drugs, but there are a number of common effects in all cytotoxic drugs such as bone marrow suppression and immunosuppression. In addition, the use of immunosuppressive drugs at the same time enhances exposure to infections. The appearance of a fever with neutrophils or immunosuppression requires immediate antibiotic treatment.
Nausea and vomiting. Nausea and vomiting following the administration of cytotoxic drugs and radiation therapy to the abdomen may reach the point of distress, which may affect the continuation of treatment. Symptoms may be severe (occurring within 24 hours of treatment) or delayed (first occurring after more than 24 hours of treatment) or expected (occurring before the following doses). The delayed and expected symptoms are more difficult to control than acute symptoms and require different treatment measures.
Those associated with moderate risk include a low dose of cyclophosphamide, doxorubicin, and a high dose of methotrexate; the highest risk with cisplatin, a high dose of cyclophosphamide, dacarbazine, and a high dose of methotrexate; .
For patients with low risk of vomiting, previous treatment with oral phenothiazines (such as chloropromazine), lasting 24 hours after chemotherapy, is usually useful. For patients at higher risk, dexamethasone can be added 6-10 mg orally before chemotherapy. For patients at high risk of vomiting or when other treatments are ineffective, large doses of intravenous metoclopramide may be used.
Note. Larger doses of metoclopramide should be administered by continuous intravenous infusion: an initial dose of 2-4 mg / kg given over 15-20 minutes followed by a dose of 3-5 mg / kg over 8-12 hours; Total dose exceeded 10 mg / kg in 24 hours.
Dexamethasone is the drug chosen to prevent late symptoms; it is used alone or with metoclopramide.
Good control of symptoms is the best way to prevent prophylactic symptoms and to add diazepam to anti-curing therapy because of its sedative, anxiolytic and loss-of-memory effects.
Hyperuricemia. Hyperuricemia may double the treatment of cases such as non-Hodgkin's lymphoma and leukemia. Kidney damage may result from the formation of uric acid crystals. Patients must be adequately hydrated and hyperuricemia can be treated with alopurinol, which starts 24 hours before cytotoxic treatment and lasts 7-10 days thereafter.
Alopecia. Tuberculosis is common during treatment with cytotoxic drugs. There is no drug treatment, but the condition is usually automatically reversed once the treatment is stopped.
