By: Ghada M. Zaher
Resident of Nuclear Medicine and Clinical
Oncology, Nuclear Medicine Department, Mansoura
University Hospitals
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General idea about chemotherapy
Chemotherputic agents
General Rules in preparing
Chemotherapeutic Agents.
General examples about chemotherapy
prepartion
Take home massage
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Treatment with cytotoxic medication
Prevents cancer cells from dividing and
growing
Kills the cancer cells but also the good cells
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Generally given by intravenous injection or
orally
Most chemotherapy drugs act by damaging
DNA or inhibiting DNA synthesis
Important exceptions are drugs that target
microtubules
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1940’s – first use of successful use alkylating
agent nitrogen mustard to treat human
cancer.
1950-1960’s – major alkylating agents and
anti-metabolites currently in use synthesized.
Effective against wide range of cancer types,
particularly rapidly growing leukemias and
lymphomas.
Scientific principles of cancer chemotherapy
developed.
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1-Cure cancer
2- Control cancer
3-Ease cancer symptoms (also called
palliative care)
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1- Make a tumor smaller before surgery or
radiation therapy. This is called neo-adjuvant
chemotherapy.
 2- Destroy cancer cells that may remain after
surgery or radiation therapy. This is called
adjuvant chemotherapy.
 3- Help radiation therapy and biological
therapy work better.
 4- Destroy cancer cells that have come back
(recurrent cancer) or spread to other parts of
your body (metastatic cancer).
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a regimen for chemotherapy defining the
drugs to be used, their dosage, the frequency
and duration of treatments and other
considerations. In modern oncology, many
regimens combine several chemotherapy
drugs in combination chemotherapy. The
majority of drugs used in cancer
chemotherapy are cytostatic.
The first successful combination
chemotherapy was MOPP introduced in 1963
for lymphomas.
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Alkylating agent :Interact with DNA causing
substitution reactions as cispaltin .
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Antimetabolites:Cytotoxic effects as
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Antitumor antibiotics:Affect structure and function
methotrexate ,gemzar ,5-fu
of nucleic acids by:
 Intercalation between base pairs (doxorubicin),
 DNA strand fragmentation (bleomycin),
 Cross-linking DNA (mitomycin).
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Alkloids:Arrest of cells in metaphase as vincrestine
and vinblastine
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Stabilization of cytoplasmic microtubules
Formation of abnormal bundles of
microtubules
Examples: paclitaxel and docetaxel
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Intravenous and oral cancer treatments are
the main methods of treating cancer. But the
same chemotherapy that treats the cancer
won’t help if it is not made properly.
Improperly made chemotherapy can even be
harmful as we mentioned.
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The Whole process has to be:
Sterile, Accurate, and Timely !
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The chemotherapy must be sterile, so the patient
does not get infected by the chemotherapy as it
is administered into his/her body.
A technician or pharmacist stands in front a
Biological Safety Cabinet (BSC) to make the
chemotherapy.
The chemotherapy is made inside this cabinet for
two reasons. The first reason is to keep the
chemotherapy preparation sterile.
The second reason is to limit the contact between
the chemotherapy particles and the preparation
staff.
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The chemotherapy must be made accurate, which
means that it is made exactly as needed by the
patient.
With chemotherapy, there is no room for error.
The pharmacist must be 100% correct, and
accuracy takes time.
Every chemotherapy order is reviewed by the
clinical team to ensure safe medication use.
In addition, every medication prepared must be
the right drug and the right dose. The fluid that
contains the drug must be right.
Also, the chemotherapy must be labeled
accurately to include the necessary information.
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It takes time to prepare chemotherapy…
The chemotherapy must be made in a timely
manner that also guarantees sterility and
accuracy.
Timely does not mean “as fast as possible.”
Timely means the least amount of time that
still produces an accurate and sterile product.
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The doctor: Orders a chemotherapy.
The pharmacist: Reviews the order for
accuracy and completeness.
Infusion Nurse: Notifies the pharmacy when
all assessments and parameters are cleared.
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Hand washing and disinfecting
Changing procedures
Wash hands again if necessary
Use glove
Preparing for administration:
At the beginning of each day disinfect the safety
workbench with a disinfectant. The vial should be
disinfected before puncturing
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Generic Name: Paclitaxel
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What Taxol Is Used For:
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Taxol is an anti-cancer ("antineoplastic"
or "cytotoxic") chemotherapy drug. Taxol
is classified as a "plant alkaloid," a
"taxane" and an "antimicrotubule agent."
Taxol is used for the treatment of breast,
ovarian, lung, bladder, prostate,
melanoma, esophageal, as well as other
types of solid tumor cancers. It has also
been used in Kaposi's sarcoma.
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Taxol is given as an injection or infusion into the vein
(intravenous, IV)
Taxol is an irritant. An irritant is a chemical that can cause
inflammation of the vein through which it is given. If the
medication escapes from the vein it can cause tissue
damage. The nurse or doctor who gives Taxol must be
carefully trained. If you experience pain or notice redness
or swelling at the IV site while you are receiving Taxol,
alert your health care professional immediately.
Because severe allergic reactions have occurred in some
people taking Taxol, you will be asked to take medications
to help prevent a reaction. Your doctor will prescribe the
exact regimen.
Taxol is given over various amounts of times and in
various schedules.
Protected from light
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Generic Name: Docetaxel
Drug Type:
Taxotere is an anti-cancer
("antineoplastic" or "cytotoxic")
chemotherapy drug. Taxotere is
classified as a "plant alkaloid," a
"taxane" and an "antimicrotubule
agent."
What Taxotere Is Used For:
Approved in treatment of breast
cancer, non-small cell lung cancer,
advanced stomach cancer, head and
neck cancer and metastatic prostate
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Taxotere is given through a vein
(intravenously, IV)
Protect from light
Premedication with a corticosteroid pill
starting a day prior to Taxotere infusion for 3
days is given to reduce the severity of fluid
retention and allergic reactions. Your doctor
will prescribe the exact regimen.
Don’t be shaked
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Trade Names: Platinol
Drug Type:
Cisplatin is an anti-cancer
("antineoplastic" or "cytotoxic")
chemotherapy drug. Cisplatin is
classified as an "alkylating agent."
What Cisplatin Is Used For:
Used to treat testicular, ovarian,
bladder, head and neck, esophageal,
small and non-small cell lung, breast,
cervical, stomach and prostate
cancers. Also to treat Hodgkin's and
non-Hodgkin's lymphomas,
neuroblastoma, sarcomas, multiple
myeloma, melanoma, and
mesothelioma.
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Cisplatin is administered through a vein
Cisplatin is an irritant. An irritant is a chemical that
can cause inflammation of the vein through which it
is given.
If Cisplatin escapes from the vein it can cause tissue
damage. The nurse or doctor who gives Cisplatin
must be carefully trained.
Before and/or after the Cisplatin infusion, extra IV
fluids are given, care is taken to ensure adequate
hydration before, during and after Cisplatin, to
protect your kidney function.
Should be preprated with plenty of fluids contain
potassium and magnsium
Diluted in NaCL solution
Trade name: Paraplatin
 Drug type:
Carboplatin is classified as an "alkylating
agent.“
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What Carboplatin Is Used For:
Carboplatin is used to treat ovarian cancer.
Carboplatin is also used for other types of
cancer, including lung, head and neck,
endometrial, esophageal, bladder, breast,
and cervical; central nervous system or germ
cell tumors; osteogenic sarcoma.
 How Carboplatin Is Given:
Carboplatin is usually given by infusion into a
vein.
Protect from light .
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Trade Name: Eloxatin
Drug Type:
Oxaliplatin is classified as an "alkylating
agent."
What Oxaliplatin Is Used For:
Oxaliplatin is used to treat colon or rectal
cancer that has spread (metastasized), it is
often given in combination with other
anticancer drugs (fluorouracil and
leucovorin).
How Oxaliplatin Is Given:
It is given by infusion into the vein
(intravenous, IV).
Do NOT use NS or other chloride containing
solutions (degrades)
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A….Adryamycin
B…paclitaxel
C…carboplatin,,campto
D…Dacrbazine,Dactinomycin,docetaxel
E…Epirubcin
F…fluracil
V…vincristin ,vinblastin
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BLEOMYCIN
CISPLATIN
GEMZAR
MITOMYCIN
TRASTZUMAB
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CARBOPLATIN
OXALIPLATIN
CAMPTO
SO ALL THE CHEMOTHERAPY
DILUTED IN SALINE EXCEPT COX
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€Capecitabine (Xeloda)
1-Food delays time to peak plasma level 90
minutes and reduced peak concentration 60%
2-Manufacturer recommends with food as
that was the study design
3-Recommendations :
Eat first, then take pills on a full stomach
Hydration VERY important €
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€Abiraterone (Zytiga)
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Low-fat meal (7% fat, 300 cal) increased
Cmax 7-fold & AUC 5-fold
High-fat meal (57% fat, 825 cal) increased
Cmax 17-fold and AUC 10-fold
Since absorption highly variable based on
composition of meals, med should be taken
on a empty stomach
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€Sorafenib (Nexavar)
 High fat meal (50% fat, 900 cal) absorption
reduced 29% vs. fasting
 Moderate fat meal (30% fat, 700 cal)
absorption similar to fasting
 Manufacturer recommends taking on an
empty stomach
 Common side-effect: Abdominal pain
 Anecdotal evidence: can take with a small
low-fat snack to reduce GI symptoms
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€The Grapefruit Developed in the
1700s as a cross between an
orange and a shaddock (Pomelo) €
Active component
It cause Elevation in exposure to
anti-cancer drugs leading to
increased toxicity y Nilotinib &
etoposide have best data y Most
other drugs are extrapolated
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Imatinib (Gleevec)
Bexarotene (Targetin)
Ibrutinib (Imbruvica)
Cabozantinib (Cometriq)
Etoposide (VePesid)
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Put the patient in a comfortable position with the
upper part of the body slightly raised. Prepare an
area of the anterior abdominal wall below the
navel line with an alcohol swab
 Grasp the blue plastic safety tab and pull away
from the syringe, and discard. Remove needle
cover.
 Holding the syringe, pinch the skin of the
patient’s anterior abdominal wall below the navel
line. With the bevel of the needle facing up, insert
the needle at a 30 to 45 degree angle to the
skin in one continuous deliberate motion until
the protective sleeve touches the patient’s skin.
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1.
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Chemotherapy can be harmful to the patient
if not prepared accurately.
Chemotherapy can be harmful to the staff if
not prepared according to the mentioned
guiding protocols.
It is of utmost importance to give great care
to the preparation and storage conditions of
the chemotherapeutic agents.
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Thank You for Your
Attention and
Attendance
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