Streptozocin alkylating agent cell cycle independent nephrotoxicitycan be doselimiting

-nausea and vomiting—may get progressively worse with continued administration -mucocutaneous effects (mucositis, stomatitis, diarrhea) -bone marrow suppression -irritant if extravasated (not vesicant) -delirium or depression -risk of secondary leukemias

Tamoxifen -nonsteroidal antiestrogen -nausea and vomiting -bowel changes (diarrhea or constipation) -headache -peripheral edema -hot flashes -endometrial carcinoma -vaginal bleeding -venous thrombosis

Temozolomide -alkylating agent;

-bone marrow suppression-delayed

-nausea and vomiting—mild to moderate

-constipation

-rash

-headache

-elevated transaminases

Teniposide -topoisomerase II Inhibitor (VM-26) -bone marrow suppression

-nausea and vomiting

-mucocutaneous effects (mucositis, stomatitis) -chemical phlebitis common -hypotension with rapid administration -hypersensitivity reactions _-secondary leukemia_

6-Thioguanine -purine analogue antimetabolite; cell cycle dependent (6-TG) -bone marrow suppression

-nausea and vomiting

-mucocutaneous effects (mucositis, stomatitis) -rash

-hepatotoxicity

_-hyperuricemia_

Thiotepa -alkylating agent; cell cycle independent

-bone marrow suppression

-nausea and vomiting-uncommon

-mucocutaneous effects (mucositis, stomatitis)—uncommon

-fever

-angioedema -urticaria

_-secondary leukemia_

Topotecan -semisynthetic camptothecin; topoisomerase I inhibitor -bone marrow suppression -nausea and vomiting

-mucocutaneous effects (mucositis, stomatitis)

-constitutional symptoms—fatigue, anorexia, malaise

-hematuria

-renal insufficiency

-hypertension

-hepatotoxicity

Toremifene - nonsteroidal antiestrogen -nausea and vomiting -bowel changes (diarrhea or constipation) -headache -peripheral edema -hot flashes

-vaginal bleeding or discharge -venous thrombosis tu u c re U M C D

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Trastuzumab

-humanized mouse monoclonal antibody directed against

era

(Herceptin)

HER-2/neu receptor

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-fevers, chills, nausea, vomiting, headache during

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-cardiotoxicity (the FDA has not approved concurrent use with

doxorubicin)

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Tretinoin

-naturally occurring retinoid

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-retinoic acid syndrome

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-fever

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-chest pain

-hypoxia

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-pulmonary infiltrates

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-pleural/pericardial effusions

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-nausea and vomiting

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-mucocutaneous effects -arthralgias

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-headaches

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-increased triglycerides

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-xerostomia, exfoliation, chelitis

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Trimetrexate

-antifolate antimetabolite

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-bone marrow suppression -mucocutaneous effects (mucositis, stomatitis)

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-nausea and vomiting

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-fever

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-maculopapular rash—usually self-limited

o era

-above toxicities increased in patient with hypoalbuminemia

Vinblastine

vinca alkaloid; inhibits tubulin polymerization; G2 phase specific bone marrow suppression vesicant if extravasated nausea and vomiting constipation (often secondary to neuropathy induced ileus) neuropathy (jaw pain, peripheral neuropathy, autonomic neuropathy) SIADH

_tumor pain_

Vincristine -vinca alkaloid; inhibits tubulin polymerization; G2 phase specific

-neurotoxicity—peripheral neuropathy

-vesicant if extravasated

-nausea and vomiting

-bone marrow suppression—mild

-transient transaminase elevation

-constipation (often secondary to neuropathy induced ileus)

**-intrathecal injection is ALWAYS FATAL

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