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Common Urologic Agents Used in the GU Cancer Patient

Learn about the common urologic agents used in the treatment of GU cancers, their mechanisms of action, clinical toxicities, and primary lab effects. Monitoring of treatment is also discussed.

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Common Urologic Agents Used in the GU Cancer Patient

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  1. Common Urologic Agents Used in the GU Cancer Patient Jay Simhan, MDMarch 2012

  2. Bladder Cancer

  3. Vinblastine Mechanism of Action: Inhibits assembly of microtubules and arrests cells in metaphase Half-life: 24 hrs Primary clinical toxicity: Alopecia Parethesias HTN Myelosuppression Primary lab effect: Neutropenia Monitoring of Treatment: CBC, BMP, LFTs, Serum Uric Acid

  4. Methotrexate Mechanism of Action: Inhibits metabolism of folic acid Half-life: 10 hrs Primary clinical toxicity: Ulcerative stomatitis CNS toxicity Primary lab effect: Neutropenia Monitoring of Treatment: CBC, BMP, LFTs, Serum Uric Acid

  5. Adriamycin (Doxorubicin) Mechanism of Action: Intercalates DNA Half-life: 3.5 hrs Primary clinical toxicity: Nausea Vomiting Heart Arrhythmias Primary lab effect: Neutropenia Monitoring of Treatment: CBC, BMP, LFTs, cardiac exam (baseline)

  6. Cisplatin Mechanism of Action: DNA alkylating agent Half-life: 1 hrs Primary clinical toxicity: Nephrotoxicity Neurotoxicity Nausea, vomiting Ototoxicity Primary lab effect: Cr clearance, hypomagnesemia, hypocalcemia Monitoring of Treatment: CBC, BMP, LFTs, U/A, Audiography

  7. Carboplatin Mechanism of Action: DNA alkylating agent Half-life: 6 hrs Primary clinical toxicity: Myelosuppression Nausea/Vomiting Nephrotoxicity (at high doses) Primary lab effect: Neutropenia, anemia, Cr (at high dosese) Monitoring of Treatment: CBC, BMP, LFTs

  8. Gemcitabine Mechanism of Action: DNA analogue replaces cytidine in DNA replication, arresting cell cycle Half-life: 10 hrs Primary clinical toxicity: Muscle pain, Fever, chills, fatigue Headache Primary lab effect: LFT elevation, proteinuria Monitoring of Treatment: CBC, BMP, LFTs

  9. BCG Mechanism of Action: Live attenuated mycobacteria, induces local inflammatory and granulomatous reaction Half-life: unknown Primary clinical toxicity: Dysuria Urinary urgency Fever Monitoring of Treatment: Flu like syndrome/fever> 3days, CBC, BMP, LFTs

  10. Mitomycin C Mechanism of Action: Antitumor antibiotic activity Half-life: 1 hour Primary clinical toxicity: Bone marrow suppression (w/ long term use) Lung fibrosis Renal damage Primary lab effect: Anemia Monitoring of Treatment: CBC, BMP, PT, PFTs

  11. Interferon Mechanism of Action: Protein that acts on oncogenes to induce cell death Half-life: 5 hours Primary clinical toxicity: Bone marrow suppression Flu like syndrome Cardiovascular effects Primary lab effect: LFT elevation Monitoring of Treatment: CBC, BMP, LFTs

  12. Testis Cancer

  13. Bleomycin Mechanism of Action: Inhibits synthesis of DNA by binding DNA and inducing strand breaks Half-life: 9 hours Primary clinical toxicity: Pulmonary fibrosis Alopecia Hepatotoxicity Chills/Fever Primary lab effect: LFT elevation Monitoring of Treatment: CBC, BMP, LFTs, PFTs, CXR

  14. Ifosfaminde Mechanism of Action: Cross links DNA causing synthesis inhibition Half-life: 15 hours Primary clinical toxicity: Bone marrow suppression CNS toxicity Hemorrhagic cystitis Primary lab effect: Metabolic acidosis, hyperbilirubinemia, AKI Monitoring of Treatment: CBC, BMP, LFTs

  15. Etoposide Mechanism of Action: Delays transit of cells through S phase; topoisomerase II inhibitor Half-life: 8 hours Primary clinical toxicity: Bone marrow suppression Hypersensitivity reactions Hypotension Primary lab effect: Neutropenia, LFT elevation Monitoring of Treatment: CBC, BMP, LFTs

  16. Kidney Cancer

  17. Sunitinib Mechanism of Action: VEGF inhibitor Half-life: 2 days Primary clinical toxicity: HTN Fatigue Hand-foot syndrome Nausea Primary lab effect: LFT elevation, CK elevation, AKI Monitoring of Treatment: CBC, BMP, LFTs, TFTs, U/A, Echo (assessing LV EF)

  18. Pazopanib Mechanism of Action: VEGF inhibitor Half-life: 31 hrs Primary clinical toxicity: HTN Hair color change Diarrhea, fatigue Primary lab effect: LFT elevation Monitoring of Treatment: CBC, LFTs, TFTs, U/A, blood pressure

  19. Sorafenib Mechanism of Action: Multikinase inhibitor, including VEGF, RAF kinase, cKIT, RET Half-life: 1-2 days Primary clinical toxicity: Hand-foot syndrome HTN Complications from wound healing Primary lab effect: Leukopenia, elevates INR, hypoalbuminemia Monitoring of Treatment: CBC, BMP, amylase, lipase, TFTs

  20. Bevacizumab Mechanism of Action: VEGF inhibitor Half-life: 20 days Primary clinical toxicity: GI organ perforation HTN Complications from wound healing Primary lab effect: Proteinuria Monitoring of Treatment: CBC, blood pressure, urine dipstick for proteinuria

  21. Temsirolimus Mechanism of Action: mTOR inhibitor – reduces HIF proteins and VEGF Half-life: 17 hours Primary clinical toxicity: Rash Mucositis Nausea Dyspnea Primary lab effect: hyperlipidemia, hyperglycemia Monitoring of Treatment: CBC, BMP, LFTs, lipid panel

  22. Erlotinib Mechanism of Action: EGFR inhibitor Half-life: 1-2 days Primary clinical toxicity: Fatigue Rash Diarrhea Dyspnea Primary lab effect: LFT elevation, renal failure Monitoring of Treatment: LFTs, BMP

  23. Everolimus Mechanism of Action: mTOR inhibitor Half-life: 30 hrs Primary clinical toxicity: Stomatitis URI Rash Fatigue Primary lab effect: LFT elevation, anemia, hypercholesterolemia Monitoring of Treatment: CBC, BMP, LFTs, lipid panel

  24. IL-2 Mechanism of Action: Proliferation of immune cells causing interaction w/malignant cells and subsequent cell death Half-life: 2 hrs Primary clinical toxicity: Hypotension (capillary leak syndrome) Chills, diarrhea Oliguria, dyspnea Primary lab effect: AKI, LFT elevation, thrombocytopenia Monitoring of Treatment: CBC, BMP, LFTs, CXR, PFTs, ABG, Thallium stress test

  25. Prostate Cancer

  26. Bicalutamide Mechanism of Action: Antiandrogen, competitive inhibitor for binding of DHT and testosterone Half-life: 6 days Primary clinical toxicity: Hot flashes Pain Constipation Primary lab effect: LFT increase Monitoring of Treatment: CBC, LFTs, EKG, testosterone, PSA

  27. Flutamide Mechanism of Action: Antiandrogen, inhibits androgen uptake or binding of androgen in target tissue Half-life: 6 hours Primary clinical toxicity: Gynecomastia Nausea/vomiting Galactorrhea Primary lab effect: LFT increase, anemia Monitoring of Treatment: LFTs, testosterone/estrogen, phosphatase

  28. Nilutamide Mechanism of Action: Antiandrogen, blocks testosterone effects at the androgen level Half-life: 3 days Primary clinical toxicity: Hot flashes Nausea Primary lab effect: LFT increase Monitoring of Treatment: LFTs, CXR

  29. Ketoconazole Mechanism of Action: Inhibits androgen synthesis Half-life: 8 hours Primary clinical toxicity: Nausea/vomiting Primary lab effect: LFT increase Monitoring of Treatment: LFTs

  30. Cyproterone Mechanism of Action: Antiandrogen, blocks DHT to prostate cancer cells and release of LH from pituitary Half-life: 4 days Primary clinical toxicity: Edema Dry skin Chills Primary lab effect: LFT increase, anemia, adrenal suppression Monitoring of Treatment: CBC, BMP, LFTs, adrenal function

  31. Abiraterone Mechanism of Action: Selectively and irreversibly inhibits CYP17 (lyase), enzyme required for androgen synthesis Half-life: 12 hours Primary clinical toxicity: Edema Diarrhea Joint swelling Primary lab effect: Triglyceride increase, hypokalemia, LFT increase Monitoring of Treatment: LFTs

  32. Docetaxel Mechanism of Action: Promotes assembly of microtubules resulting in inhibition of DNA, RNA, and protein synthesis Half-life: 11 hours Primary clinical toxicity: Fluid retention Alopecia Stomatitis Primary lab effect: Neutropenia, LFT increase Monitoring of Treatment: CBC, BMP, LFTs

  33. Leuprolide Mechanism of Action: LHRH agonist Half-life: 3 hours Primary clinical toxicity: Hot flashes Headache Nausea/vomiting Primary lab effect: Increased creatinine Monitoring of Treatment: LH and FSH levels, testosterone, PSA

  34. Goserelin Mechanism of Action: LHRH agonist Half-life: 4 hours Primary clinical toxicity: Hot flashes Sexual dysfunction Primary lab effect: Increased lipids Monitoring of Treatment: Bone mineral density, calcium, lipid panel

  35. Degarelix Mechanism of Action: GnRH antagonist Half-life: 53 days Primary clinical toxicity: Hot flashes Primary lab effect: Increased lipids, LFT increase Monitoring of Treatment: Testosterone, PSA, BMP, LFTs

  36. Mitoxantrone Mechanism of Action: Intercalates DNA resulting in cross-linking and strand breaks Half-life: 3 days Primary clinical toxicity: Fever Alopecia Nausea Weakness Primary lab effect: Neutropenia, LFT increase Monitoring of Treatment: CBC, LFTs

  37. Sipuleucel-T Mechanism of Action: Immunotherapy that induces immune response against prostate cancer cells Half-life: Unknown Primary clinical toxicity: Chills Nausea Back pain Infusion reaction Primary lab effect: Anemia Monitoring of Treatment: CBC, BMP

  38. Cabazitaxel Mechanism of Action: Taxane that promotes microtubule assembly preventing cell division Half-life: 4 days Primary clinical toxicity: Fatigue Diarrhea Weakness Primary lab effect: Anemia Monitoring of Treatment: CBC

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