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1. Chemotherapy
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2. INDIAN DENTAL ACADEMY
Leader in continuing dental education
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3. Overview
Purpose of chemotherapy
Types of chemotherapy
Toxicity associated with chemotherapy
Side effect management
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4. Chemotherapy
Treatment of:
cancer
autoimmune disorders
Goal: cure, control or palliation of
disease
Cancer cell growth & division
Action is most pronounced in rapidly
growing and dividing cells
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5. Types of chemotherapy
Cell cycle dependent
Cell cycle phase specific
Cell cycle independent
Cell cycle phase non-specific
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6. Classes of antineoplastic
drugs
Alkylating agents
Interact directly with cellular DNA
Antimetabolites
Resemble cellular metabolites (folic acid, purine,
pyrimidine)
Interfere with DNA precursors & cellular metabolism
Antitumor antibiotics
Derived from soil fungus, some antiinfective activity
Interfere with DNA activity
Mitotic Inhibitors
Derived from plant extracts
Interfere with formation of mitotic spindle, arresting
mitosis
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7. Classes of antineoplastic
drugs
Miscellaneous
Hormones and hormone antagonists
Angiogenesis inhibitors
Destroy capillary network to tumor causing
tumor shrinkage
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8. Normal cells most susceptible
to chemotherapy
Bone marrow
GI tract
Hair follicles
Many adverse effects seen in these
systems
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9. Factors influencing response
of cancer to chemotherapy
Size of tumor
Resistance
Intrinsic
no prior exposure
Acquired
after start of therapy
Temporary
Permanent
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10. Chemotherapy cycles
Cycle
a drug protocol, given over a period of time
(usually 3-6 weeks)
chemotherapy prescribed as
a certain number of cycles
evaluation of effectiveness
reevaluation and planning of further treatment
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11. Chemotherapy dosing
Based on body size in m2 using
nomogram
Goal: maximal dose, minimal interval
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12. Chemotherapy regimens
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13. Biologic Response Modifiers
Interferons
Interleukins
Colony Stimulating Factors
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14. Routes of administration
Oral
IV
Site-specific
intrathecal: cerebrospinal fluid
intraventricular: ventricle of brain,
Ommaya reservoir
intraperitoneal
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15. Intravenous access devices
Peripheral IV
Nontunneled central venous catheter
PICC: peripherally inserted central
catheter
Tunneled central venous catheter
Hickman, Groshong
Implantable port
Port-a-cath
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16. Hickman catheter
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17. Portacath
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18. Accessed Portacath
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19. Extravasation of infusions
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20. Handling of chemotherapy
Potential carcinogenic & teratogenic
effects
Chemotherapy precautions
Disposal of waste
Body fluids
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21. Adverse effects of
chemotherapy
Alopecia: hair loss
Myelosuppression: bone marrow suppression
anemia: decreased red blood cells
fatigue, dyspnea
thrombocytopenia: decreased platelets
risk for bleeding
neutropenia: decreased white blood cells
risk for infection
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22. Adverse effects of
chemotherapy
GI effects:
Stomatitis: ulcerated or painful oral mucous
membranes
Anorexia, nausea & vomiting
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23. Toxicities of chemotherapy
Ototoxicity: hearing loss
monitor hearing
Nephrotoxicity: kidney dysfunction
monitor I&O, weight, fluid status, creatinine, BUN,
electrolytes
Hepatotoxicity: liver dysfunction
monitor for jaundice, liver function tests
Neurotoxicity: nerve damage
monitor for CNS problems, neuropathies
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24. Toxicities of chemotherapy
Pulmonary toxicity: lung damage
monitor for dyspnea, pulmonary function tests
Cardiotoxicity: heart damage
monitor for signs of heart failure, arrhythmias,
chest discomfort
Gastrointestinal toxicity:
monitor for stomatitis, diarrhea, fluid status
Gonadal toxicity:
offer reproductive options
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25. Management of chemotherapy
side effects
Anticipate adverse effects
Prophylactic treatment
Monitor for toxic effects
Laboratory tests
Diagnostic screening tests
Importance of patient & family
education
Multidisciplinary team management
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26. Bone marrow suppression
Anemia: decreased red blood cells
Erythropoietin (EPO): stimulates
production of red blood cells in the bone
marrow
administered SC or IV
Side effects: headache, hypertension,
arthralgia (bone or joint pain), diarrhea, nausea,
fatigue
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27. Bone marrow suppression
Neutropenia: decreased white blood
cells
G-CSF (granulocyte-colony-stimulating
factor): stimulates production of white
blood cells in the bone marrow
Administered SC or IV
Common side effect: bone pain
Do not give < 24 hrs before or after
chemotherapy, or within 12 hours of radiation
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28. Bone marrow suppression
Thrombocytopenia: decreased platelets
GM-CSF (granulocyte-magrophage-colonystimulating factor)
Stimulates neutrophils and platelets
Platelet transfusion to keep platelet count
>20,000
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29. Gastrointestinal effects:
Stomatitis & Esophagitis
May be due to chemotherapy or radiation
Pain medications: narcotic analgesics
Viscous Lidocaine: topical anesthetic
Oral ulcer solutions:
I.e. lidocaine + antacid + benadryl elixir
Nystatin swish & swallow: used to treat thrush
Artificial saliva: salivary gland deactivation
Remember: pain with oral medication
administration, may need elixirs or IV
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30. Gastrointestinal effects:
Nausea & Vomiting
Acute: first 24 hours
Delayed: after 24 hours
Anticipatory: stimulated by the
experience of chemotherapy
Nausea control during first 24 hours
prevents delayed response
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31. Gastrointestinal effects:
Nausea & Vomiting
Combinations of chemotherapy drugs
can stimulate different nausea
pathways
Combinations of antiemetics work on
different pathways, increasing
effectiveness
Routine administration: before or during
chemotherapy and for 24-48 hours after
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32. Types of Antiemetics:
Serotonin Antagonists
Ondansetron (Zofran): first drug serotonin
antagonist, 1992
Granisetron (Kytril): longer acting, more
potent
Blocks serotonin receptors of chemoreceptor
trigger zone and vagal nerve endings
Most effective antiemetics, first-line for
chemotherapy
Side effects: headache, weakness, drowsiness,
constipation
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33. Types of antiemetics
Corticosteriods
Inhibit prostaglandin synthesis
Decadron (dexamethasone)
Solumedrol (methylprednisolone)
Side effects: anxiety, euphoria, insomnia,
edema
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34. Types of antiemetics
Anxiolytics
Decrease sensitivity of vomiting center
Benzodiazepines : lorazepam (Ativan),
diazepam (Valium)
Useful in anticipatory nausea & vomiting
Side effects: sedation, confusion, amnesia
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35. Types of antiemetics
Phenothiazines:
Prochlorperazine (Compazine)
Promethazine (Phenergan)
Useful in mild to moderate nausea
treatment (second-line with chemotherapy)
Often used after surgery
Side effects: sedation, orthostatic hypotension,
extrapyramidal symptoms
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36. Antiemetic combinations
Decadron (dexamethasone)
+
Ondansetron
+
Lorazepam (Ativan)
Decadron (dexamethasone)
+
Kytril (granisetron)
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37. www.indiandentalacademy.com
Leader in continuing dental education
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