(Bacilli Calmette-Guêrin) Trastuzumib (Herceptin)

Interferon alfa lnterleukin-2


Octreotide Rituximab

Acute toxicity

Bladder irritation; nausea and vomiting; fever; sepsis

Fever: chills: nausea and vomiting; pain; hypersensitivity and pulmonary reactions

Fever; chills; myalgias; fatigue; headache; arthralgias; hypotension

Fever; fluid retention; hypotension; respiratory distress; rash, anaemia, thrombocytopenia; nausea and vomiting: diarrhoea, capillary leak syndrome, nephrotoxicity: myocardial toxicity, hepatotoxicity; erythema nodosum; neutrophil chemotactic defects

Fatigue; headache: nausea and vomiting; pruritis

Nausea and vomiting; diarrhoea

Fever; chills; rigors; hypotension; bronchospasm

Delayed toxicity

Granulomatous pyelonephritis; hepatitis; urethral obstruction; epididymitis; renal abscess Bone marrow depression; cardiomyopathy; ventricular dysfunction; congestive cardiac failure; diarrhoea

Bone marrow depression; anorexia; neutropenia; anaemia; confusion: depression; renal toxicity: hepatic toxicity; facial and peripheral oedema: cardiac arrhythmias

Neuropsychiatrie disorders:hypothyroidism; nephrotic syndrome: possibly acute leucoencephalopathy; brachial plexopathy; bowel perforation

Teratogenic; cheilitis: xerostomia: rash: conjunctivitis and eye irritation; anorexia; hypertriglyceridaemia: pseudotumour cerebri S tea to rr h oea : ga I Is ton es

Bone marrow depression; angioedema; precipitation of angina or arrhythmia with pre-existing heart disease

Carcinogenicity (second malignancies). Many cytotoxic drugs are carcinogenic, and a patient may be cured of the primary disease only to succumb to a second, treatment-induced cancer 5-20 years later. Whether this is due to a mutagenic effect, to immunosuppression, or both, remains undecided. Alkylating agents are particularly incriminated and also some antimetabolites (mercaptopurine) and cytotoxic antibiotics (doxorubicin). The risk can be as high as 10-20 times that of unexposed people and the cancers include leukaemia, lymphoma and squamous carcinoma.

In Hodgkin's lymphoma life is greatly prolonged by chemotherapy, but in ovarian cancer it is not; these aspects are plainly relevant to acceptance of risk of second tumours.

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