Chapter 11
Oncology: Nursing management in cancer care
253
is often required if critical laboratory values or the patient’s
symptoms indicate unacceptable or dangerous toxicities or
if the patient’s weight and therefore body surface area has
changed since commencing chemotherapy treatment. Various
laboratory tests, in addition to daily to weekly weights, are per-
formed prior to, during and after chemotherapy to determine
optimal treatment options, evaluate the patient’s response and
monitor toxicity. Laboratory and physical assessments of the
Dosage
Dosage of antineoplastic agents is based primarily on the
patient’s total body surface area, previous response to chemo
therapy or radiation therapy, and function of major organ
systems. Dosages are determined to maximise cell kill while
minimising impact on healthy tissues and subsequent toxici-
ties. The therapeutic effect may be compromised if inadequate
dosing is required due to toxicities. Modification of dosage
Table 11-7 Antineoplastic Agents
Drug class and examples
Mechanism of action
Cell cycle specificity Common side effects
Alkylating agents
Busulfan, carboplatin, chlorambucil,
Alter DNA structure by misreading
Cell cycle—non-specific Bone marrow suppression, nausea,
cisplatin, cyclophosphamide,
DNA code, initiating breaks in
vomiting, cystitis (cyclophosphamide,
dacarbazine, fotemustine, ifosfamide,
the DNA molecule, cross-linking
ifosfamide), stomatitis, alopecia,
melphalan, temozolomide, thiotepa
DNA strands
gonadal suppression, renal toxicity
(cisplatin)
Nitrosureas
Carmustine (BCNU), lomustine
Similar to the alkylating agents;
Cell cycle—non-specific Delayed and cumulative
(CCNU), semustine (methyl
cross the blood–brain barrier
myelosuppression, especially
CCNU), streptozotocin (Zanosar)
thrombocytopenia; nausea, vomiting
Topoisomerase I inhibitors
Irinotecan, topotecan
Induce breaks in the DNA strand
Cell cycle—specific
Bone marrow suppression, diarrhoea,
by binding to enzyme
nausea, vomiting, hepatotoxicity
topoisomerase I, preventing
cells from dividing
Antimetabolites
5-azacytadine, cytarabine,
Interfere with the biosynthesis of
Cell cycle—specific
Nausea, vomiting, diarrhoea, bone
edatrexate fludarabine,
metabolites or nucleic acids
(S phase)
marrow suppression, proctitis,
5-fluorouracil (5-FU), FUDR,
necessary for RNA and DNA
stomatitis, renal toxicity
gemcitabine, hydroxyurea,
synthesis
(methotrexate), hepatotoxicity
leustatin, 6-mercaptopurine,
methotrexate, pentostatin,
6-thioguanine
Antitumour antibiotics
Bleomycin, dactinomycin,
Interfere with DNA synthesis by
Cell cycle—non-specific Bone marrow suppression, nausea,
daunorubicin, doxorubicin
binding DNA; prevent RNA
vomiting, alopecia, anorexia, cardiac
(Caelyx), epirubucin, idarubicin,
synthesis
toxicity (daunorubicin, doxorubicin)
mitomycin, mitoxantrone,
plicamycin
Mitotic spindle poisons
Plant alkaloids
: etoposide, teniposide,
Arrest metaphase by inhibiting
Cell cycle—specific
Bone marrow suppression (mild with
vinblastine, vincristine (Oncovin),
mitotic tubular formation
(M phase)
VCR), neuropathies (VCR),
vindesine, vinorelbine
(spindle); inhibit DNA and
stomatitis
protein synthesis
Taxanes
: paclitaxel, docetaxel
Hormonal agents
Androgens and antiandrogens,
Arrest metaphase by inhibiting
Cell cycle—specific
Bradycardia, hypersensitivity
oestrogens and antioestrogens,
tubulin depolymerisation
(M phase)
reactions, bone marrow
progestins and antiprogestins,
suppression, alopecia,
aromatase inhibitors, luteinising
neuropathies
hormone–releasing hormone
analogues, steroids
Miscellaneous agents
Asparaginase, procarbazine
Bind to hormone receptor sites
Cell cycle—non-specific Hypercalcaemia, jaundice, increased
that alter cellular growth; block
appetite, masculinisation,
binding of oestrogens to receptor
feminisation, sodium and fluid
sites (antioestrogens); inhibit
retention, nausea, vomiting, hot
RNA synthesis; suppress
flushes, vaginal dryness
aromatase of P450 system, which
decreases oestrogen level
Unknown or too complex
Varies
Anorexia, nausea, vomiting, bone
to categorise
marrow suppression, hepatotoxicity,
anaphylaxis, hypotension, altered
glucose metabolism
