Oncology handbook

1 x 10 ^–7 molar = 0.1 molar; 5 x 10^–8 = 0.05 molar.
C) Ifosfamide

Alkylating agent similar to Cytoxan; converted to active metabolite in liver. Hemorrhagic cystitis caused by Ifosfamide is much more severe than that of Cytoxan. Co-administration of Mesna along with good hydration following Ifosfamide administration is always necessary. Has been associated with CNS symptoms of altered mental status, cerebellar and cranial nerve dysfunction, and seizures (may be exacerbated by sedative effect of anti-emetics). Can cause renal tubular damage with HCO_3, PO₄ and K wasting and renal rickets. Other side effects include nausea, vomiting, alopecia and myelosuppression.

D) Cyclophosphamide (Cytoxan: CTX).

Alkylating agent; inert until converted to active metabolite in liver. Myelosuppression is dose-limiting toxicity. Hemorrhagic cystitis is the main non-hematologic toxicity and requires good hydration (to dilute bladder concentration of toxic metabolites) before and after Cytoxan administration to prevent this. Some protocols require co-administration of the sulfhydryl uroprotector, Mesna, for which patients usually need hospitalization. Other side effects include nausea, vomiting, SIADH (transient), alopecia, exacerbation of Adriamycin cardiotoxicity, pulmonary fibrosis (long-term).

E) Cisplatin

Alkylating agent; cross links DNA. Nephrotoxicity is dose-limiting toxicity. Glomerular injury causes reduced GFR; renal tubular injury causes wasting of magnesium, calcium, potassium. Calculated creatinine clearance should be greater than about 60 before giving cisplatin. Prolonged hydration with forced Mannitol diuresis is necessary to enhance renal excretion following Cisplatin administration. Magnesium, calcium, and potassium IV supplementation is often necessary. Chronic oral supplementation with magnesium and potassium is often necessary as well. Cisplatin causes irreversible ototoxicity (high-frequency hearing loss) which should be monitored with serial audiograms. Other side effects include severe nausea and vomiting, peripheral neuropathies and myelosuppression.