Other immunomodulating drugs 492 surgery or both as either neoadjuvant treatment (initial chemotherapy aimed at shrinking the primary tumour,
8.2.4 Other immunomodulating drugs 492 surgery or both as either neoadjuvant treatment (initial chemotherapy aimed at shrinking the primary tumour,
8.3 Sex hormones and hormone
thereby rendering local therapy less destructive or more
antagonists in malignant dis-
effective) or as adjuvant treatment (which follows defi-
ease
496 nitive treatment of the primary disease, when the risk of
8.3.1 Oestrogens
sub-clinical metastatic disease is known to be high). All chemotherapy drugs cause side-effects and a balance
8.3.2 Progestogens
has to be struck between likely benefit and acceptable
8.3.3 Androgens
toxicity.
8.3.4 Hormone antagonists
Guidelines for handling cytotoxic drugs:
Malignant
8.3.4.1 Breast cancer
1. Trained personnel should reconstitute cyto-
8.3.4.2 Prostate cancer and gonadorelin
toxics;
analogues
2. Reconstitution should be carried out in desig-
8.3.4.3 nated areas; Somatostatin analogues
disease
3. Protective clothing (including gloves, gowns, and masks) should be worn;
4. The eyes should be protected and means of first aid should be specified;
and
5. Pregnant staff should avoid exposure to cyto- toxic drugs (all females of child-bearing age
immunosupp
should be informed of the reproductive hazard);
6. Use local procedures for dealing with spillages and safe disposal of waste material, including syringes, containers, and absorbent material;
7. Staff exposure to cytotoxic drugs should be monitored.
ressio n
8.1 Cytotoxic drugs BNF 57 Intrathecal chemotherapy Once a sore mouth has developed, treatment is much
less effective. Saline mouthwashes should be used but
A Health Service Circular (HSC 2003/010) provides there is no good evidence to support the use of anti- guidance on the introduction of safe practice in NHS
septic or anti-inflammatory mouthwashes. In general, Trusts where intrathecal chemotherapy is adminis-
mucositis is self-limiting but with poor oral hygiene it tered. Support for training programmes is also avail-
can be a focus for blood-borne infection. able.
Tumour lysis syndrome Tumour lysis syndrome can Department of Health
Copies, and further information may be obtained from:
occur as a result of massive cell breakdown following PO Box 777
treatment of cancer sensitive to the chemotherapy. London SE1 6XH
Features include hyperkalaemia, hyperuricaemia (see Fax: 01623 724524
below), and hyperphosphataemia with hypocalcaemia; It is also available from the Department of Health
renal damage and arrhythmias can follow. website ( www.dh.gov.uk )
Hyperuricaemia Hyperuricaemia, which may be pre- sent in high-grade lymphoma and leukaemia, can be
n markedly worsened by chemotherapy and is associated
Combinations of cytotoxic drugs are frequently more
toxic than single drugs but have the advantage in certain with acute renal failure. Allopurinol (section 10.1.4) tumours of enhanced response, reduced development of
should be started 24 hours before treating such tumours essio drug resistance and increased survival. However for and patients should be adequately hydrated. The dose of some tumours, single-agent chemotherapy remains the mercaptopurine or azathioprine should be reduced if
treatment of choice. allopurinol needs to be given concomitantly (see Appen-
osuppr
Most cytotoxic drugs are teratogenic and all may
dix 1).
cause life-threatening toxicity; administration should Rasburicase (section 10.1.4), a recombinant urate oxi-
immun dase, is licensed for hyperuricaemia in patients with
Because of the complexity of dosage regimens in the haematological malignancy, for details, see p. 575. It
be confined to those experienced in their use.
and
treatment of malignant disease, dose statements rapidly reduces plasma uric acid and may be of parti- have been omitted from some of the drug entries
cular value in reducing complications following treat- in this chapter. In all cases detailed specialist literature
ment of leukaemias or bulky lymphomas.
should be consulted disease .
Prescriptions should not be repeated except on the Nausea and vomiting Nausea and vomiting cause instructions of a specialist.
considerable distress to many patients who receive
gnant chemotherapy and, to a lesser extent, abdominal radio-
Cytotoxic drugs fall into a number of classes, each with therapy; it may lead to refusal of further treatment. characteristic antitumour activity, sites of action, and
Mali Symptoms may be acute (occurring within 24 hours of
toxicity. A knowledge of sites of metabolism and excre- treatment), delayed (first occurring more than 24 hours