Nausea
Moderately emetogenic. 5HT3 antagonist and dex front line, can add NK1 antagonist. Lorazepam for anticipatory nausea, olanzapine bedtime day 1-4
Hematological AE
1. Thrombocytopenia: if grade 3 or 4( less than 25K) wait until plt now 75 K or higher ( grade 1). If grade 4, reduce dose 1 level
2. Neutropenia: case by case use of growth factor. If grade 4 ( ANC < 500), dose reduce by 1 level. If grade 3, interrupt. Wait until ANC > 1000 ( grade 2)
Interstitial lung disease: ask at every visit for new or worsening resp symptoms. Can check PFT baseline and q 3 months or so, but unproven to detect grade 1. Walk test also useful but not perhaps for grade 1. Grade 1 is the only grade where you can interrupt and restart. Grade 2 : permanently discontinue, start steroids and antibiotics. Consider pulm consultation.
Cardiac dysfunction: not common, but assess baseline echo EF with strain. Repeat every 3-6 months depending on patients symptoms. If EF drops below 40% or > 20% from baseline, discontinue permanently.
No comments:
Post a Comment