1. Outline Introduction Chemotherapy induced nausea andvomiting Chemotherapy induced mucositis Chemotherapy induced bone marrowsuppressioni Chemotherapy induced renal toxicitypyy Chemotherapy induced neuropathy Other adverse effect September 23 , 2012 1.:, 2.: 3.: 4.: 5.

2. ()( ) BSA() = BSA x ( mg/m2 ) (regimen) 10% , LBW LBW ( lean body weight ) = IBW + 0.3 x (BW-IBW) (Epirubicin, Doxorubicin, (Epirubicin Doxorubicin- Bleomcyin..)CBC,CBC hepatitis marker, Biochemistry, marker Biochemistryliver & lung function - (CXR12 lead EKG)12 (, , ,, , ( (CVCPortPICC) ) 3. The CTCAE: Common Terminology Criteria for Adverse Events (v4.03 June 14, 2010) Grade 1 Mild; asymptomatic or mild symptoms; clinical or diagnostic observations only; intervention not indicated. Grade 2 Moderate; minimal, local or noninvasive intervention indicated Grade 3 Severe or medically significant but not immediately life-threatening; hospitalization or prolongation of hospitalization indicated Grade 4 Life-threatening consequences; urgent intervention. intervention Grade 5 Death related to AE. InvestigationgInvestigationIti ti 4. 24 72 h 24-72 hrs:, () (), (Acute emesis)(Delayed emesis) 3-7: 3 7: 7 14 ( 7-14:( (Anticipatory emesis) ) (cisplatin : ), ()( ) (ASCO2006) >90%Ci l i C l h h id 1 00 / 2CisplatinCyclophosphamide 1500mg/mBCNU(carmustine) DTIC (dacarbazine) 30 90%30-90%Oxaliplatineirinotecancytarabine1g/m2CarboplatinIfosfamideDoxorubicinEpirubicinDaunorubicinIdarubicin 10-30%10 30% PaclitaxelDocetaxelMitoxantroneTopotecan TopotecanEtoposideGemcitabinemitomycin ppy FluorouracilCetuximabTrastuzumab 30 Gy. ComfflamBenzydamine Comfflam Benzydamine Xylocaine hydrochloridine pumpComfflam 1~4 XylocaineViscous solution 4 X l i Xylocainepump XylocaineViscous 6. () (Hb)::14 18 g/dl :12 16/dl (Hb)::14-18 :12-16/dl Grade 1: 7.0 45 50fluidUrine sulfonate ) 3, 3. LeucovorinMTX24hrs MTX 48hrserum level (vincritine, vinblastin, vinorelbine) (taxane) 9. Ototoxicity Prevention of neuropathies Oxaliplatin, p, Cisplatin > Oxaliplatin . Cisplatin Glutathine () (), Blood-brain Barrier Cisplatin ,,. Glutamine,highdose paclitaxel Glutamine ,. Pulmonary toxicity (acute lungHair loss (alopecia)( p)injury, interstitial fibrosis) hair loss due to chemotherapy is one of the most distressing side effectspygBusulfan (myeleran), of chemo treatments. Hair loss may occur as early as the second or third week after the firstCarmustine (BCNU)cycle of chemotherapy,chemotherapy Hair loss can be sudden or slow (including eyelashes, eyebrows, andBleomycineven pubic hair)Tyrosine kinase inhibitor (Iressa 39/5993, In almost all cases, IT may take from 3 to 6 months after therapy is completed . The "new" hair to possibly have a slightly different color,Tarceva 0.7%)) texture, curl texture or curl. (1)(1) (2) Lipodoxol 10. Hand-foot syndrome Hand- Hand-foot syndrome (Hand-foot syndrome; palmar plantarerythema) (1) (2)B6Toxicity of Taxane Dilated cardiomyopathy (hypersensitivity reaction) (dil t d cardiomyopathy) (dilated dith ) Paclitaxel Anthracyclines tsteroids antihistamines R itidi idtihi t i Ranitidine Echocardiography ejection fractionZantec fluid retention doxorubicin450 mg/m2 Docetaxel 126 700 mg/m2 dexamethasonecardiomyopathy30%dih 30% 11. Hemolytic uremic syndroem Tumor lysis syndromey y () Mitomycin C chemo-sensitive tumors: acute leukemia, Burkittslymphoma, diffuse aggressive lymphoma Gemcitabine : , Management Hydration sodium bicarbonate in N/S Correct electrolyte imbalance Give allopurinol 300~800mg/day diuresis: mannitol or lasix hemodialysis Adverse Events of Clinical Interest (any Grade) ( y )Pleural effusion AE Grade 1: Asymptomatic Grade 2: Symptomatic, intervention such as diuretics or y pup to 2 therapeutic thoracenteses indicated Grade 3: Symptomatic and supplemental oxygen, >22therapeutic thoracenteses, tube drainage, orpleurodesis indicated Grade 4: Life-threatening (e.g. causing hemodynamicinstability or ventilatory support indicated) Grade 5: Death Overall, most AEs occurred within the first year with minimal increases between 1-2 years and 2- ,y y3 years One patient in each arm experienced a QTc interval prolongation 1 month from the start of treatment; no patients developed a QTc prolongation between 3 months and 3 years 12. 2011/02/06 pleural 2011/02/13 2011/02/242011/05/12 2011/05/26 effusion pImprovedg Re-cahllenge Steroid 15Dasatinib Hold Dasatinib, Dasatinib mg/d add steroid THANK YOU FORYOUR ATTENTION