Handbook of Cancer Treatment-Related Symptoms and Toxicities

Early recognition and management of adverse effects of cancer treatments are essential for optimal care of patients with cancer, and drastically different approaches are required for different physiologic reactions. Handbook of Cancer Treatment-Related Symptoms and Toxicities is a focused, one-stop resource that enables clinicians to quickly find up-to-date, reliable information needed at the point of care. The high-yield approach prioritizes the most common toxicities associated with cancer treatment, and concise, templated chapters offer fast access to information needed in day-to-day practice. Presents a user-friendly overview of cancer treatment-related symptoms and toxicities management in a practical, easy-to-use format, allowing you to quickly find information in one convenient, concise resource. Covers systemic and radiation therapies, including chemotherapy, immunotherapy, targeted therapies, and radiation therapy, detailing symptoms of each toxicity to confirm your diagnosis. Overviews pharmacologic and non-pharmacologic approaches to symptom management. Offers recommendations for mitigating toxicities in high-risk patients. Discusses key topics such as management of infusion reactions, when the need for biopsy is warranted, and the unique challenges posed by novel immunotherapies. Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices. Front Cover Front Matter Copyright Dedication Contributors Preface Acknowledgments CONTENTS Chapter 1 - Mechanisms of Cancer-Directed Therapies Mechanisms of Cancer-Directed Therapies CATEGORIES OF CANCER-DIRECTED THERAPY References Chapter 2 - Neutropenic Complications of Chemotherapy Introduction Etiology of Neutropenia Risk Assessment of Adults With Chemotherapy-Induced Neutropenia Workup of Neutropenic Fever Pharmacological Approaches for Management and Treatment Nonpharmacological Approaches for Management and Treatment References Chapter 3 - Chemotherapy-Induced Anemia Introduction Grading of Anemia Agents Causative of Anemia Supportive Care Pharmacologic Approaches to Anemia References Chapter 4 - Cancer Treatment-Related Thrombocytopenia Introduction Mechanisms of Thrombocytopenia Diagnostic Workup of Thrombocytopenia Treatment of Thrombocytopenia References Chapter 5 - Oral Mucositis Introduction Incidence of Oral Mucositis Differential Diagnoses Etiology and Mechanism of Action of Mucositis Grading of Mucositis Mucositis Management References Chapter 6 - Gastrointestinal Complications of Chemotherapy Introduction Esophageal Complications of Chemotherapy Chemotherapy-Induced Nausea and Vomiting Classification of Chemotherapy-Induced Nausea and Vomiting Risk Factors for the Development of Chemotherapy-Induced Nausea and Vomiting Pathophysiology of Chemotherapy-Induced Nausea and Vomiting Management and Prevention of Chemotherapy-Induced Nausea and Vomiting PHARMACOLOGICAL THERAPY FOR CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING Antiemetic Regimens Based on Emetogenicity of Chemotherapy Management of Anticipatory Emesis Management of Breakthrough and Refractory Emesis Nonpharmacological Approaches for Management of CINV Enterocolitis Constipation Chemotherapy-Induced Diarrhea (CID) Evaluation and Management of Chemotherapy-Induced Diarrhea Hepatotoxicity Conclusion References Chapter 7 - Neurological Complications of Chemotherapy Introduction Chemotherapy-Related Neurotoxicity Chemotherapy-Induced Neurocognitive Deficit (Chemo-Brain) References Chapter 8 - Pulmonary Toxicities of Chemotherapy Introduction Subtypes of Chemotherapy-Associated Pulmonary Toxicity Diagnostic Workup of Suspected Chemotherapy-Associated Pulmonary Toxicity Cytotoxic Chemotherapy Agents and Mechanisms of Action ANTINEOPLASTIC ANTIBIOTICS ALKYLATING AGENTS ANTIMETABOLITES NITROSUREAS PODOPHYLLOTOXINS Taxanes Differentiation Therapy: All-Trans Retinoic Acid (ATRA) and Arsenic Trioxide (ATO) Proteosome Inhibitors Approach to Management Monitoring and Preventative Strategies References Chapter 9 - Dermatological Toxicities of Chemotherapy Introduction Chemotherapy-Induced Alopecia Hypersensitivity Reactions Acral Erythema Extravasation Hyperpigmentation Photosensitivity Radiation Recall Nail Changes Conclusion References Chapter 10 - Cardiovascular Toxicities of Chemotherapy Introduction Antineoplastic Antibiotics ANTHRACYCLINES ANTHRAQUINONES MITOMYCIN C BLEOMYCIN Alkylating Agents Microtubule-Directed Agents Antimetabolites Conclusion References Chapter 11 - Cancer Treatment Infusion Reactions Introduction Recognition of Infusion Reactions Prevention and Treatment of Infusion Reactions Skin Testing Infusion Reactions Caused by Monoclonal Antibodies Infusion Reactions Caused by Chemotherapy Drugs Desensitization Conclusion References Chapter 12 - Mechanisms of Toxicities Associated With Targeted Therapy Introduction Receptor Tyrosine Kinases (RTKs) RAS/RAF/MEK/ERK Pathway Conclusion References Chapter 13 - Gastrointestinal Toxicities of Targeted Therapy Introduction Diarrhea c-KIT–Targeting Agents VEGF–Targeting Agents CDK4/6 Inhibitors Mitogen-Activated Protein Kinase Inhibitors Management of Diarrhea Pharmacological Management of Diarrhea Nonpharmacological Management of Diarrhea Targeted Therapy-Related Nausea and Vomiting ALK Targeted–Therapy and Nausea and Vomiting c-MET Targeted–Therapy and Gastrointestinal Side Effects Pharmacological Management94–104 Nonpharmacological Treatment94–104 Hepatotoxicity Assessment of Liver Toxicity Management Gastrointestinal Perforation References Chapter 14 - Pulmonary Toxicities of Targeted Therapy Introduction Agents and Mechanism of Action EPIDERMAL GROWTH FACTOR RECEPTOR (EGFR)TYROSINE KINASE INHIBITORS Specific EGFR–Targeting Agents Anaplastic Lymphoma Kinase (ALK) Inhibitors BCR-ABL1 Tyrosine Kinase Inhibitors Vascular Endothelial Growth Factor (VEGF) Inhibitors Human Epidermal Growth Factor Receptor 2(HER2)-Targeting Antibodies CD20-Targeting Agents EGFR-Targeting Antibodies Mitogen-Activated Protein Kinase (MEK) Inhibitors Polyadenosine Diphosphate-Ribose Polymerase (PARP) Inhibitors Cyclin-Dependent Kinase (CDK) 4/6 Inhibitors Phosphatidylinositol-3-Kinase (PI3K) Inhibitors mTOR Inhibitors Pharmacological Approaches for the Management of Pulmonary Toxicities Rechallenge Nonpharmacological Approaches for Management of Pulmonary Toxicities References Chapter 15 - Dermatological Toxicities of Targeted Therapy Introduction Acneiform Rash Mechanism of Rash and the EGFR Pathway Approved EGFR–Targeting Therapies Hand-Foot Skin Reaction Stomatitis Alopecia Cutaneous Squamous Cell Carcinoma References Chapter 16 - Cardiovascular Toxicities of Targeted Therapy Introduction Targeted Therapies Associated With Cardiotoxicity Mechanism of action Mechanism of cardiotoxicity Mechanism of action TKIs have antitumor activity in a variety of malignancies Mechanism of cardiotoxicity Types of cardiotoxicity Imatinib Dasatinib Nilotinib Bosutinib Ponatinib Crizotinib and Alectinib Ceritinib Brigatinib BRAF inhibitors (vemurafenib, dabrafenib) Vemurafenib Dabrafenib/Trametinib Common Cardiotoxicities Caused by Targeted Therapie Hypertension Congestive Heart Failure CHF Associated with VEGF Inhibitors Thromboembolic Events Venous Thromboembolic Events (VTEs) Arrhythmias Pleural Effusions References Chapter 17 - Mechanisms of Immune-Related Adverse Events Introduction Physiological Pathways Involved in the Regulation of Immune Homeostasis Pathophysiology of Immune-Related Adverse Events (irAEs) Shared Antigens, Cross Presentation of Neoantigens and T Cell Epitope Spreading Dysregulation of Other Immune Cells Autoantibodies Cytokines Genetic Polymorphisms Environmental Modulation of Immune Responses Specific Immunotherapeutic Agents and their Associated Toxicities Conclusion References Chapter 18 - Endocrine Toxicities of Immunotherapy Introduction Agents and Mechanism of Action INTERLEUKIN 2 (IL-2) Mechanism of Action Mechanism of Endocrine Toxicity Reported Toxicities INTERFERON-α (INF-α) Mechanism of Action Mechanism of Endocrine Toxicities Reported Toxicities IMMUNE CHECKPOINT INHIBITORS (ICIS) Mechanism of Action of ICIs Mechanism of Endocrine Toxicity Hypophysitis: Thyroid dysfunction: Other endocrinopathies: Reported Toxicities Hypophysitis Thyroid disorders Other endocrine disorders ONCOLYTIC VIRUSES Mechanism of Action Reported Endocrine Toxicities CHIMERIC ANTIGEN RECEPTOR CAR T-CELL THERAPY Mechanism of Action Reported Endocrine Toxicities BISPECIFIC T CELL ENGAGER (BiTE) Mechanism of Action Reported Endocrine Toxicities Pharmacological Management of Toxicities INTERLEUKIN-2 INTERFERON (INF)-α IMMUNE CHECKPOINT INHIBITOR Thyroid Dysfunction Hypothyroidism Hyperthyroidism Hypophysitis Primary Adrenal Insufficiency (PAI) Diabetes Mellitus (DM) CAR T-CELL THERAPY AND BiTE THERAPY Non-Pharmacological Management References Chapter 19 - Gastrointestinal Toxicities of Immunotherapy Introduction Description IMMUNE CHECKPOINT INHIBITORS BISPECIFIC ENGAGER OF T-CELL ACTIVITY CHIMERIC ANTIGEN RECEPTOR T CELLS INTERLEUKIN-2 INTERFERON-α Agents and Mechanism of Action IMMUNE CHECKPOINT INHIBITORS GI Manifestations With Immune Checkpoint Inhibitors Anti-CTLA-4. Anti-PD-1. Combination Anti-CTLA-4 and Anti-PD-1 Therapy. Hepatitis Associated With Immune Checkpoint Inhibitors Pancreatitis Associated With Immune Checkpoint Inhibitors Celiac Disease Associated With Immune Checkpoint Inhibitors Mechanism of Immune Checkpoint Inhibitor–Mediated GI and Hepatic Manifestations Biomarkers Predictive of GI irAE. Role of the Gut Microbiome. Histological Presentation Diarrhea and Colitis Nausea/Vomiting/Epigastric Pain. Hepatitis. BISPECIFIC ENGAGER OF T CELL ACTIVITY/BLINATUMOMAB GI, Hepatic, and Pancreatic Manifestations of Blinatumomab Mechanism of Blinatumomab-Mediated GI and Hepatic Toxicities ADOPTIVE CELLULAR THERAPY (CAR T CELL AND T CELL RECEPTOR GENE THERAPIES) GI and Hepatic Manifestations With CAR T-Cell Therapy Mechanism of CAR T Cell–Mediated GI and Hepatic Toxicities INTERLEUKIN-2 GI and Hepatic Manifestations of High-Dose IL-2 Mechanism of IL-2 Mediated GI and Hepatic Toxicities INTERFERON-α GI and Hepatic Manifestations With IFN-α Mechanism of IFN-α Mediated GI and Hepatic Toxicities Nausea and Vomiting. Anorexia. Acute Pancreatitis. Hepatotoxicity. Pharmacologic Approaches for Management and Treatment IMMUNE CHECKPOINT INHIBITORS Approach to a Patient With Diarrhea and/or Colitis Diagnostic Evaluation. Differential Diagnosis of Colitis. Diagnostic Workup for Grades 2, 3, and 4 Colitis.1 Restarting Checkpoint Inhibitors Approach to a Patient With Nausea/Vomiting/Epigastric Pain Expert Consultation Preventive Treatment Concomitant Clostridium difficile Colitis Patient Education ICI Use in Patients With Autoimmune Disease Approach to a Patient With Hepatitis Baseline Workup. Monitoring on Immune Checkpoint Inhibitors. Imaging. Liver Biopsy. Pharmacological Management of ICI-Associated Hepatitis. Inpatient Admission. Restarting Checkpoint Inhibitors. Approach to a Patient With Colitis and Hepatitis Approach to a Patient With Pancreatitis BISPECIFIC ANTIBODIES AND CAR T-CELL THERAPY Prophylaxis Prior to Blinatumomab Infusion CRS Management CRS Due to CAR T-Cell Therapy. CRS Due to Bispecific Antibodies78 Management of HLH/MAS. INTERLEUKIN-2 Nausea and Vomiting Mucositis Diarrhea INTERFERON-α Nausea and Vomiting Anorexia Nonpharmacological Approaches for Management and Treatment IMMUNE CHECKPOINT INHIBITORS Diarrhea Hepatitis BISPECIFIC ANTIBODIES AND CAR T-CELL THERAPY INTERLEUKIN-2 Anorexia Hepatotoxicity INTERFERON-α Hepatotoxicity Pancreatitis References Chapter 20 - Neurological Toxicities of Immunotherapy Introduction Agents INTERLEUKIN Mechanism of Action Mechanism of Neurotoxicity Reported Neurotoxicity INTERFERON Mechanism of Action Mechanism of Neurotoxicity Reported Neurotoxicities IMMUNE CHECKPOINT INHIBITORS Mechanism of Action Mechanism of Neurotoxicity Reported Neurotoxicities CHIMERIC ANTIGEN RECEPTOR T-CELL THERAPY Mechanism of Action Mechanism of Neurotoxicity Reported Neurotoxicity ONCOLYTIC VIRUSES Mechanism of Action Mechanism of Neurotoxicity Reported Neurotoxicities BISPECIFIC T CELL ENGAGERS Mechanism of Action Mechanism of Neurotoxicity Reported Neurotoxicities OTHER MONOCLONAL ANTIBODYS Antibody-Drug Conjugates Mechanism of Action. Mechanism of Neurotoxicity. Reported Neurotoxicity. CD20–Directed Antibodies Reported Toxicities. CD52–Directed Antibodies Reported Toxicity. CD38–Directed Antibodies and Signal LymphocyticActivation Molecule-7–Directed Antibodies Reported Toxicities. Epidermal Growth Factor Receptor–Directed Antibodies Reported Neurological Toxicity. Human Epidermal Growth Factor 2–Directed Antibodies Reported Neurological Toxicity. Clinical Approach and Pharmacological Management of Toxicity INTERLEUKIN-2 INTERFERON-α IMMUNE CHECKPOINT INHIBITORS CNS Involvement Meningitis/Encephalitis. Transverse Myelitis. PNS Involvement Myasthenia Gravis. Guillain-Barre Syndrome. Other Toxicities. CHIMERIC ANTIGEN RECEPTOR T-CELL THERAPY BISPECIFIC T-CELL ENGAGERS OTHER MONOCLONAL ANTIBODIES Progressive Multifocal Leukoencephalopathy Aseptic Meningitis Nonpharmacological Management of Toxicities DELIRIUM NEUROPSYCHIATRIC SYMPTOMS ASSOCIATED WITH INTERFERON-α RESPIRATORY DEPRESSION References Chapter 21 - Pulmonary Toxicities of Immunotherapy Introduction Immunotherapy-related Pneumonitis Agents IMMUNE CHECKPOINT INHIBITORS Pharmacological Approaches for Management and Treatment Nonpharmacological Approaches for Management and Treatment References Chapter 22 - Dermatologic Toxicities of Immunotherapy Introduction Description Diagnostic Workup Agents and Mechanisms of Action ■ Immunosuppression: Nonpharmacological Approaches for Management and Treatment References Chapter 23 - Cardivascular Toxicities of Immunotherapy Introduction Description IMMUNE CHECKPOINT INHIBITORS BLINATUMOMAB ADOPTIVE CELL TRANSFER INTERLEUKIN-2 INTERFERON-α Agents and Mechanism of Action IMMUNE CHECKPOINT INHIBITORS Cardiac Manifestations With Anti–CTLA-4 Treatment Cardiac Manifestations With Anti–PD-1 Treatment Cardiac Manifestations With Combination Immune Checkpoint Inhibitors Mechanism of Immune Checkpoint Inhibitor–Mediated Cardiotoxicity Clinical Presentation of Immune Checkpoint Inhibitor-Mediated Cardiotoxicity Referral and Consultation. BLINATUMOMAB Cardiac Manifestations With Blinatumomab Mechanism of Blinatumomab-Mediated Cardiotoxicity ADOPTIVE CELL TRANSFER Cardiac Manifestations of Adoptive Cell Transfer Mechanism of Adoptive Cell Transfer–Mediated Cardiotoxicity INTERLEUKIN-2 Cardiac Manifestations With Interleukin-2 Mechanism of Interleukin-2–Mediated Cardiotoxicity INTERFERON-α Cardiac Manifestations With Interferon-α Mechanism of Interferon-α–Mediated Cardiotoxicity Pharmacological Approaches for Management and Treatment IMMUNE CHECKPOINT INHIBITORS BLINATUMOMAB Prophylaxis Prior to Blinatumomab Infusion Treatment of Grades 2 to 4 Cytokine Release Syndrome ADOPTIVE CELL TRANSFER Indications for Tocilizumab33 Role of Steroids Approach to the Management of Toxicity From ACT by Grade Grade 2 CRS. Grade 3 CRS. INTERLEUKIN-251 Hypotension Myocarditis/Myocardial Ischemia Cardiac Dysrhythmias Peripheral Edema INTERFERON-α Nonpharmacological Approaches for Management and Treatment IMMUNE CHECKPOINT INHIBITORS ADOPTIVE CELL TRANSFER INTERLEUKIN-2 References Chapter 24 - Rheumatological Toxicities of Immunotherapy Introduction Mechanism of Action The Agents Prevalence Specific Rheumatic Immune-Related Adverse Events INFLAMMATORY ARTHRITIS SICCA SYNDROME POLYMYALGIA RHEUMATICA MYOSITIS OTHERS Diagnosis and Management Strategies Use of Immune Checkpoint Inhibitors in Patients With Preexisting Autoimmune Diseases Conclusion References Chapter 25 - Mechanisms of Radiation-Related Toxicities Introduction Types of Radiation-Related Toxicities Genetic Determinants of Radiation Toxicity Technical Advances in Precision Radiotherapy Can Reduce Toxicity Medical Therapies Alter Radiation Response Conclusions References Chapter 26 - Mucosal and Esophageal Toxicites of Radiation Therapy Introduction Description Risk Factors Mechanism of Action Pharmacological Approaches for Management and Treatment Nonpharmacological Approaches for Management and Treatment References Chapter 27 - Dermatologic Toxicities of Radiation Therapy Introduction Description TIMING Clinical Presentation GRADING AND SEVERITY DIAGNOSTIC EVALUATION Pathogenesis Factors Influencing the Onset, Duration, and Intensity of the Radiation Dermatitis Pharmacological Approaches for Management and Treatment Nonpharmacological Approaches for Management and Treatment References Chapter 28 - Pulmonary Toxicities of Radiation Therapy Introduction Risk of Pneumonitis With Various Treatment Modalities Pharmacological Approaches for Management and Treatment References Chapter 29 - Cardiovascular Toxicities of Radiation Therapy Introduction Description Symptoms Screening and Diagnostic Workup Imaging Grading Mechanisms of Action Pharmacological Approaches for Management and Treatment Nonpharmacological Approaches for Management and Treatment References Index