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Chemotherapy Toxicities

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Oncologic Emergency Medicine

Abstract

Patients frequently present to the emergency department (ED) secondary to chemotherapy-induced toxicity. This chapter will discuss the most frequently encountered issues in the ED, including central nervous system toxicity, peripheral neuropathy, hypertensive crisis, nausea and vomiting, nephrotoxicity, electrolyte disorders, anaphylaxis, and extravasation. Each toxicity will include a discussion on epidemiology, pathophysiology, chemotherapy agents implicated, diagnosis, prevention (if available), and management.

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References

  1. Stone JB, DeAngelis LM. Cancer-treatment-induced neurotoxicity–focus on newer treatments. Nat Rev Clin Oncol. 2016;13(2):92–105.

    CAS  PubMed  Google Scholar 

  2. Verstappen CC, Heimans JJ, Hoekman K, Postma TJ. Neurotoxic complications of chemotherapy in patients with cancer: clinical signs and optimal management. Drugs. 2003;63(15):1549–63.

    CAS  PubMed  Google Scholar 

  3. Chamberlain MC. Neurotoxicity of cancer treatment. Curr Oncol Rep. 2010;12(1):60–7.

    PubMed  Google Scholar 

  4. Howard SC, McCormick J, Pui CH, Buddington RK, Harvey RD. Preventing and managing toxicities of high-dose methotrexate. Oncologist. 2016;21(12):1471–82.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Bhojwani D, Sabin ND, Pei D, Yang JJ, Khan RB, Panetta JC, et al. Methotrexate-induced neurotoxicity and leukoencephalopathy in childhood acute lymphoblastic leukemia. J Clin Oncol. 2014;32(9):949–59.

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Quinn CT, Griener JC, Bottiglieri T, Hyland K, Farrow A, Kamen BA. Elevation of homocysteine and excitatory amino acid neurotransmitters in the CSF of children who receive methotrexate for the treatment of cancer. J Clin Oncol. 1997;15(8):2800–6.

    CAS  PubMed  Google Scholar 

  7. Rinne ML, Lee EQ, Wen PY. Central nervous system complications of cancer therapy. J Support Oncol. 2012;10(4):133–41.

    CAS  PubMed  Google Scholar 

  8. Magge RS, DeAngelis LM. The double-edged sword: neurotoxicity of chemotherapy. Blood Rev. 2015;29(2):93–100.

    CAS  PubMed  Google Scholar 

  9. Omuro AMP, Ben-Porat LS, Panageas KS, Kim AK, Correa DD, Yahalom J, et al. Delayed neurotoxicity in primary central nervous system lymphoma. Arch Neurol. 2005;62(10):1595–600.

    PubMed  Google Scholar 

  10. Hasle H. Cerebellar toxicity during cytarabine therapy associated with renal insufficiency. Cancer Chemother Pharmacol. 1990;27(1):76–8.

    CAS  PubMed  Google Scholar 

  11. Tran PN, Kong XT. Cytarabine induced acute cerebellar syndrome during hyper-cvad treatment for Bb-cell acute lymphoblastic leukemia. Case Rep Neurol. 2017;9(1):114–20.

    PubMed  PubMed Central  Google Scholar 

  12. Ajithkumar T, Parkinson C, Shamshad F, Murray P. Ifosfamide encephalopathy. Clin Oncol (R Coll Radiol). 2007;19(2):108–14.

    CAS  Google Scholar 

  13. Pelgrims J, De Vos F, Van den Brande J, Schrijvers D, Prové A, Vermorken JB. Methylene blue in the treatment and prevention of ifosfamide-induced encephalopathy: report of 12 cases and a review of the literature. Br J Cancer. 2000;82(2):291–4.

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Sood C, O’Brien PJ. 2-Chloroacetaldehyde-induced cerebral glutathione depletion and neurotoxicity. Br J Cancer Suppl. 1996;27:S287–93.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Patel PN. Methylene blue for management of Ifosfamide-induced encephalopathy. Ann Pharmacother. 2006;40(2):299–303.

    CAS  PubMed  Google Scholar 

  16. Eberly AL, Anderson GD, Bubalo JS, McCune JS. Optimal prevention of seizures induced by high-dose busulfan. Pharmacotherapy. 2008;28(12):1502–10.

    CAS  PubMed  Google Scholar 

  17. Vassal G, Deroussent A, Hartmann O, Challine D, Benhamou E, Valteau-Couanet D, et al. Dose-dependent neurotoxicity of high-dose busulfan in children: a clinical and pharmacological study. Cancer Res. 1990;50(19):6203–7.

    CAS  PubMed  Google Scholar 

  18. Ciurea SO, Andersson BS. Busulfan in hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2009;15(5):523–36.

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Brydøy M, Oldenburg J, Klepp O, Bremnes RM, Wist EA, Wentzel-Larsen T, et al. Observational study of prevalence of long-term Raynaud-like phenomena and neurological side effects in testicular cancer survivors. J Natl Cancer Inst. 2009;101(24):1682–95.

    PubMed  PubMed Central  Google Scholar 

  20. Avan A, Postma TJ, Ceresa C, Avan A, Cavaletti G, Giovannetti E, et al. Platinum-induced neurotoxicity and preventive strategies: past, present, and future. Oncologist. 2015;20(4):411–32.

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Rademaker-Lakhai JM, Crul M, Zuur L, Baas P, Beijnen JH, Simis YJ, et al. Relationship between cisplatin administration and the development of ototoxicity. J Clin Oncol. 2006;24(6):918–24.

    CAS  PubMed  Google Scholar 

  22. Fung C, Dinh P Jr, Ardeshir-Rouhani-Fard S, Schaffer K, Fossa SD, Travis LB. Toxicities associated with cisplatin-based chemotherapy and radiotherapy in long-term testicular cancer survivors. Adv Urol. 2018;2018:8671832.

    PubMed  PubMed Central  Google Scholar 

  23. Li SH, Chen WH, Tang Y, Rau KM, Chen YY, Huang TL, et al. Incidence of ischemic stroke post-chemotherapy: a retrospective review of 10,963 patients. Clin Neurol Neurosurg. 2006;108(2):150–6.

    PubMed  Google Scholar 

  24. Singh G, Rees JH, Sander JW. Seizures and epilepsy in oncological practice: causes, course, mechanisms and treatment. J Neurol Neurosurg Psychiatry. 2007;78(4):342–9.

    PubMed  PubMed Central  Google Scholar 

  25. Brewer JR, Morrison G, Dolan ME, Fleming GF. Chemotherapy-induced peripheral neuropathy: current status and progress. Gynecol Oncol. 2016;140(1):176–83.

    CAS  PubMed  Google Scholar 

  26. Pike CT, Birnbaum HG, Muehlenbein CE, Pohl GM, Natale RB. Healthcare costs and workloss burden of patients with chemotherapy-associated peripheral neuropathy in breast, ovarian, head and neck, and nonsmall cell lung cancer. Chemother Res Pract. 2012;2012:913848.

    PubMed  PubMed Central  Google Scholar 

  27. Zajączkowska R, Kocot-Kępska M, Leppert W, Wrzosek A, Mika J, Wordliczek J. Mechanisms of chemotherapy-induced peripheral neuropathy. Int J Mol Sci. 2019;20(6):1451.

    PubMed Central  Google Scholar 

  28. Seretny M, Currie GL, Sena ES, Ramnarine S, Grant R, MacLeod MR, et al. Incidence, prevalence, and predictors of chemotherapy-induced peripheral neuropathy: a systematic review and meta-analysis. Pain. 2014;155(12):2461–70.

    PubMed  Google Scholar 

  29. Molassiotis A, Cheng HL, Lopez V, Au JSK, Chan A, Bandla A, et al. Are we mis-estimating chemotherapy-induced peripheral neuropathy? Analysis of assessment methodologies from a prospective, multinational, longitudinal cohort study of patients receiving neurotoxic chemotherapy. BMC Cancer. 2019;19(1):132.

    PubMed  PubMed Central  Google Scholar 

  30. Staff NP, Grisold A, Grisold W, Windebank AJ. Chemotherapy-induced peripheral neuropathy: a current review. Ann Neurol. 2017;81(6):772–81.

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Durand JP, Deplanque G, Montheil V, Gornet JM, Scotte F, Mir O, et al. Efficacy of venlafaxine for the prevention and relief of oxaliplatin-induced acute neurotoxicity: results of EFFOX, a randomized, double-blind, placebo-controlled phase III trial. Ann Oncol. 2012;23(1):200–5.

    CAS  PubMed  Google Scholar 

  32. Clinical pharmacology [database online]. Tampa: Elsevier; 2020; http://www.clinicalpharmacology.com. (Accessed 12 Jul 2020). Subscription required to view.

  33. Gewandter JS, Brell J, Cavaletti G, Dougherty PM, Evans S, Howie L, et al. Trial designs for chemotherapy-induced peripheral neuropathy prevention: ACTTION recommendations. Neurology. 2018;91(9):403–13.

    PubMed  PubMed Central  Google Scholar 

  34. Yang YH, Lin JK, Chen WS, Lin TC, Yang SH, Jiang JK, et al. Duloxetine improves oxaliplatin-induced neuropathy in patients with colorectal cancer: an open-label pilot study. Support Care Cancer. 2012;20(7):1491–7.

    PubMed  Google Scholar 

  35. Matsuoka H, Makimura C, Koyama A, Otsuka M, Okamoto W, Fujisaka Y, et al. Pilot study of duloxetine for cancer patients with neuropathic pain non-responsive to pregabalin. Anticancer Res. 2012;32(5):1805–9.

    CAS  PubMed  Google Scholar 

  36. Smith EM, Pang H, Cirrincione C, Fleishman S, Paskett ED, Ahles T, et al. Effect of duloxetine on pain, function, and quality of life among patients with chemotherapy-induced painful peripheral neuropathy: a randomized clinical trial. JAMA. 2013;309(13):1359–67.

    PubMed  PubMed Central  Google Scholar 

  37. Battaglini E, Park SB, Barnes EH, Goldstein D. A double blind, placebo controlled, phase II randomised cross-over trial investigating the use of duloxetine for the treatment of chemotherapy-induced peripheral neuropathy. Contemp Clin Trials. 2018;70:135–8.

    PubMed  Google Scholar 

  38. Barton DL, Wos EJ, Qin R, Mattar BI, Green NB, Lanier KS, et al. A double-blind, placebo-controlled trial of a topical treatment for chemotherapy-induced peripheral neuropathy: NCCTG trial N06CA. Support Care Cancer. 2011;19(6):833–41.

    PubMed  Google Scholar 

  39. Rao RD, Michalak JC, Sloan JA, Loprinzi CL, Soori GS, Nikcevich DA, et al. Efficacy of gabapentin in the management of chemotherapy-induced peripheral neuropathy: a phase 3 randomized, double-blind, placebo-controlled, crossover trial (N00C3). Cancer. 2007;110(9):2110–8.

    CAS  PubMed  Google Scholar 

  40. Saif MW, Syrigos K, Kaley K, Isufi I. Role of pregabalin in treatment of oxaliplatin-induced sensory neuropathy. Anticancer Res. 2010;30(7):2927–33.

    CAS  PubMed  Google Scholar 

  41. Gradishar W, Vokes E, Schilsky R, Weichselbaum R, Panje W. Vascular events in patients receiving high-dose infusional 5-fluorouracil-based chemotherapy: the University of Chicago experience. Med Pediatr Oncol. 1991;19(1):8–15.

    CAS  PubMed  Google Scholar 

  42. Li K, Giustini D, Seely D. A systematic review of acupuncture for chemotherapy-induced peripheral neuropathy. Curr Oncol. 2019;26(2):e147–e54.

    CAS  PubMed  PubMed Central  Google Scholar 

  43. McCrary JM, Goldstein D, Sandler CX, Barry BK, Marthick M, Timmins HC, et al. Exercise-based rehabilitation for cancer survivors with chemotherapy-induced peripheral neuropathy. Support Care Cancer. 2019;27(10):3849–57.

    PubMed  Google Scholar 

  44. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–20.

    CAS  PubMed  Google Scholar 

  45. Mouhayar E, Salahudeen A. Hypertension in cancer patients. Tex Heart Inst J. 2011;38(3):263–5.

    PubMed  PubMed Central  Google Scholar 

  46. Małyszko J, Małyszko M, Kozlowski L, Kozlowska K, Małyszko J. Hypertension in malignancy-an underappreciated problem. Oncotarget. 2018;9(29):20855–71.

    PubMed  PubMed Central  Google Scholar 

  47. Fraeman KH, Nordstrom BL, Luo W, Landis SH, Shantakumar S. Incidence of new-onset hypertension in cancer patients: a retrospective cohort study. Int J Hypertens. 2013;2013:379252.

    PubMed  PubMed Central  Google Scholar 

  48. Peixoto AJ. Acute severe hypertension. N Engl J Med. 2019;381(19):1843–52.

    PubMed  Google Scholar 

  49. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):e13–e115.

    CAS  PubMed  Google Scholar 

  50. Arakawa-Todo M, Yoshizawa T, Zennami K, Nishikawa G, Kato Y, Kobayashi I, et al. Management of adverse events in patients with metastatic renal cell carcinoma treated with sunitinib and clinical outcomes. Anticancer Res. 2013;33(11):5043–50.

    CAS  PubMed  Google Scholar 

  51. Tocci G, Presta V, Volpe M. Hypertensive crisis management in the emergency room: time to change? J Hypertens. 2020;38(1):33–4.

    CAS  PubMed  Google Scholar 

  52. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019;50(12):e344–418.

    PubMed  Google Scholar 

  53. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42(6):1206–52.

    CAS  PubMed  Google Scholar 

  54. Chaikof EL, Dalman RL, Eskandari MK, Jackson BM, Lee WA, Mansour MA, et al. The society for vascular surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018;67(1):2–77, e2.

    PubMed  Google Scholar 

  55. Hemphill JC 3rd, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46(7):2032–60.

    PubMed  Google Scholar 

  56. Braverman AC. Acute aortic dissection: clinician update. Circulation. 2010;122(2):184–8.

    PubMed  Google Scholar 

  57. Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology,American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons,and Society for Vascular Medicine. J Am Coll Cardiol. 2010;55(14):e27–e129.

    PubMed  Google Scholar 

  58. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147–239.

    PubMed  Google Scholar 

  59. Rhoney D, Peacock WF. Intravenous therapy for hypertensive emergencies, part 2. Am J Health Syst Pharm. 2009;66(16):1448–57.

    CAS  PubMed  Google Scholar 

  60. Vaughan CJ, Delanty N. Hypertensive emergencies. Lancet. 2000;356(9227):411–7.

    CAS  PubMed  Google Scholar 

  61. Peacock WF, Hilleman DE, Levy PD, Rhoney DH, Varon J. A systematic review of nicardipine vs labetalol for the management of hypertensive crises. Am J Emerg Med. 2012;30(6):981–93.

    PubMed  Google Scholar 

  62. Hecht JP, Richards PG. Continuous-infusion labetalol vs nicardipine for hypertension management in stroke patients. J Stroke Cerebrovasc Dis. 2018;27(2):460–5.

    PubMed  Google Scholar 

  63. Davis SM, Broderick J, Hennerici M, Brun NC, Diringer MN, Mayer SA, et al. Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage. Neurology. 2006;66(8):1175–81.

    CAS  PubMed  Google Scholar 

  64. Anderson CS, Huang Y, Wang JG, Arima H, Neal B, Peng B, et al. Intensive blood pressure reduction in acute cerebral haemorrhage trial (INTERACT): a randomised pilot trial. Lancet Neurol. 2008;7(5):391–9.

    PubMed  Google Scholar 

  65. Qureshi AI. Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH): rationale and design. Neurocrit Care. 2007;6(1):56–66.

    CAS  PubMed  Google Scholar 

  66. Rosenfeldt Z, Conklen K, Jones B, Ferrill D, Deshpande M, Siddiqui FM. Comparison of nicardipine with clevidipine in the management of hypertension in acute cerebrovascular diseases. J Stroke Cerebrovasc Dis. 2018;27(8):2067–73.

    PubMed  Google Scholar 

  67. Varelas PN, Abdelhak T, Corry JJ, James E, Rehman MF, Schultz L, et al. Clevidipine for acute hypertension in patients with subarachnoid hemorrhage: a pilot study. Int J Neurosci. 2014;124(3):192–8.

    CAS  PubMed  Google Scholar 

  68. Graffagnino C, Bergese S, Love J, Schneider D, Lazaridis C, LaPointe M, et al. Clevidipine rapidly and safely reduces blood pressure in acute intracerebral hemorrhage: the ACCELERATE trial. Cerebrovasc Dis. 2013;36(3):173–80.

    CAS  PubMed  Google Scholar 

  69. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119–77.

    PubMed  Google Scholar 

  70. Sommariva S, Pongiglione B, Tarricone R. Impact of chemotherapy-induced nausea and vomiting on health-related quality of life and resource utilization: a systematic review. Crit Rev Oncol Hematol. 2016;99:13–36.

    PubMed  Google Scholar 

  71. Aapro M. CINV: still troubling patients after all these years. Support Care Cancer. 2018;26(Suppl 1):5–9.

    PubMed  PubMed Central  Google Scholar 

  72. Lohr L. Chemotherapy-induced nausea and vomiting. Cancer J. 2008;14(2):85–93.

    CAS  PubMed  Google Scholar 

  73. Hesketh PJ. Chemotherapy-induced nausea and vomiting. N Engl J Med. 2008;358(23):2482–94.

    CAS  PubMed  Google Scholar 

  74. Janelsins MC, Tejani MA, Kamen C, Peoples AR, Mustian KM, Morrow GR. Current pharmacotherapy for chemotherapy-induced nausea and vomiting in cancer patients. Expert Opin Pharmacother. 2013;14(6):757–66.

    CAS  PubMed  PubMed Central  Google Scholar 

  75. Vig S, Seibert L, Green MR. Olanzapine is effective for refractory chemotherapy-induced nausea and vomiting irrespective of chemotherapy emetogenicity. J Cancer Res Clin Oncol. 2014;140(1):77–82.

    CAS  PubMed  Google Scholar 

  76. Ettinger DS, Berger MJ, Barbour S, Bergsbaken J, Brandt D, Brown GE, et al. NCCN Guidelines: antiemesis, version 2.2020 2020. Available from: https://www.nccn.org/professionals/physician_gls/pdf/antiemesis.pdf

  77. Grunberg SM, Warr D, Gralla RJ, Rapoport BL, Hesketh PJ, Jordan K, et al. Evaluation of new antiemetic agents and definition of antineoplastic agent emetogenicity--state of the art. Support Care Cancer. 2011;19(Suppl 1):S43–7.

    PubMed  Google Scholar 

  78. Hesketh PJ, Kris MG, Basch E, Bohlke K, Barbour SY, Clark-Snow RA, et al. Antiemetics: American society of clinical oncology clinical practice guideline update. J Clin Oncol. 2017;35(28):3240–61.

    CAS  PubMed  Google Scholar 

  79. Roila F, Molassiotis A, Herrstedt J, Aapro M, Gralla RJ, Bruera E, et al. 2016 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting and of nausea and vomiting in advanced cancer patients. Ann Oncol. 2016;27(Suppl 5):v119–v33.

    CAS  PubMed  Google Scholar 

  80. Jordan K, Schmoll HJ, Aapro MS. Comparative activity of antiemetic drugs. Crit Rev Oncol Hematol. 2007;61(2):162–75.

    PubMed  Google Scholar 

  81. Sharma R, Tobin P, Clarke SJ. Management of chemotherapy-induced nausea, vomiting, oral mucositis, and diarrhoea. Lancet Oncol. 2005;6(2):93–102.

    CAS  PubMed  Google Scholar 

  82. Srivastava M, Brito-Dellan N, Davis MP, Leach M, Lagman R. Olanzapine as an antiemetic in refractory nausea and vomiting in advanced cancer. J Pain Symptom Manag. 2003;25(6):578–82.

    Google Scholar 

  83. Inoue T, Kimura M, Uchida J, Nishino K, Kumagai T, Taniguchi J, et al. Aprepitant for the treatment of breakthrough chemotherapy-induced nausea and vomiting in patients receiving moderately emetogenic chemotherapy. Int J Clin Oncol. 2017;22(3):600–4.

    CAS  PubMed  Google Scholar 

  84. Jones JM, Qin R, Bardia A, Linquist B, Wolf S, Loprinzi CL. Antiemetics for chemotherapy-induced nausea and vomiting occurring despite prophylactic antiemetic therapy. J Palliat Med. 2011;14(7):810–4.

    PubMed  PubMed Central  Google Scholar 

  85. Navari RM, Nagy CK, Gray SE. The use of olanzapine versus metoclopramide for the treatment of breakthrough chemotherapy-induced nausea and vomiting in patients receiving highly emetogenic chemotherapy. Support Care Cancer. 2013;21(6):1655–63.

    PubMed  Google Scholar 

  86. Chiu L, Chiu N, Chow R, Zhang L, Pasetka M, Stinson J, et al. Olanzapine for the prophylaxis and rescue of chemotherapy-induced nausea and vomiting (CINV): a retrospective study. Ann Palliat Med. 2016;5(3):172–8.

    PubMed  Google Scholar 

  87. Nakagaki M, Barras M, Curley C, Butler JP, Kennedy GA. A randomized trial of olanzapine versus palonosetron versus infused ondansetron for the treatment of breakthrough chemotherapy-induced nausea and vomiting in patients undergoing hematopoietic stem cell transplantation. Support Care Cancer. 2017;25(2):607–13.

    PubMed  Google Scholar 

  88. Mehta RL, Awdishu L, Davenport A, Murray PT, Macedo E, Cerda J, et al. Phenotype standardization for drug-induced kidney disease. Kidney Int. 2015;88(2):226–34.

    PubMed  PubMed Central  Google Scholar 

  89. Malyszko J, Kozlowska K, Kozlowski L, Malyszko J. Nephrotoxicity of anticancer treatment. Nephrol Dial Transplant. 2017;32(6):924–36.

    CAS  PubMed  Google Scholar 

  90. Kintzel PE. Anticancer drug-induced kidney disorders. Drug Saf. 2001;24(1):19–38.

    CAS  PubMed  Google Scholar 

  91. Schuchter LM, Hensley ML, Meropol NJ, Winer EP. 2002 update of recommendations for the use of chemotherapy and radiotherapy protectants: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol. 2002;20(12):2895–903.

    PubMed  Google Scholar 

  92. Santos MLC, de Brito BB, da Silva FAF, Botelho A, de Melo FF. Nephrotoxicity in cancer treatment: an overview. World J Clin Oncol. 2020;11(4):190–204.

    PubMed  PubMed Central  Google Scholar 

  93. Izzedine H, Perazella MA. Anticancer drug-induced acute kidney injury. Kidney Int Rep. 2017;2(4):504–14.

    PubMed  PubMed Central  Google Scholar 

  94. Uzawa K, Kasamatsu A, Saito T, Kita A, Sawai Y, Toeda Y, et al. Growth suppression of human oral cancer cells by candidate agents for cetuximab-side effects. Exp Cell Res. 2019;376(2):210–20.

    CAS  PubMed  Google Scholar 

  95. Liu W, Qdaisat A, Soliman PT, Ramondetta L, Lopez G, Narayanan S, et al. Hypomagnesemia and survival in patients with ovarian cancer who received chemotherapy with carboplatin. Oncologist. 2019;24(6):e312–e7.

    CAS  PubMed  PubMed Central  Google Scholar 

  96. Rosner MH, Capasso G, Perazella MA. Acute kidney injury and electrolyte disorders in the critically ill patient with cancer. Curr Opin Crit Care. 2017;23(6):475–83.

    PubMed  Google Scholar 

  97. Berghmans T. Hyponatremia related to medical anticancer treatment. Support Care Cancer. 1996;4(5):341–50.

    CAS  PubMed  Google Scholar 

  98. Liamis G, Filippatos TD, Elisaf MS. Electrolyte disorders associated with the use of anticancer drugs. Eur J Pharmacol. 2016;777:78–87.

    CAS  PubMed  Google Scholar 

  99. Kraft MD, Btaiche IF, Sacks GS, Kudsk KA. Treatment of electrolyte disorders in adult patients in the intensive care unit. Am J Health Syst Pharm. 2005;62(16):1663–82.

    CAS  PubMed  Google Scholar 

  100. Schrag D, Chung KY, Flombaum C, Saltz L. Cetuximab therapy and symptomatic hypomagnesemia. J Natl Cancer Inst. 2005;97(16):1221–4.

    CAS  PubMed  Google Scholar 

  101. Buckley JE, Clark VL, Meyer TJ, Pearlman NW. Hypomagnesemia after cisplatin combination chemotherapy. Arch Intern Med. 1984;144(12):2347–8.

    CAS  PubMed  Google Scholar 

  102. Lajer H, Daugaard G. Cisplatin and hypomagnesemia. Cancer Treat Rev. 1999;25(1):47–58.

    CAS  PubMed  Google Scholar 

  103. Schilsky RL, Anderson T. Hypomagnesemia and renal magnesium wasting in patients receiving cisplatin. Ann Intern Med. 1979;90(6):929–31.

    CAS  PubMed  Google Scholar 

  104. Blachley JD, Hill JB. Renal and electrolyte disturbances associated with cisplatin. Ann Intern Med. 1981;95(5):628–32.

    CAS  PubMed  Google Scholar 

  105. Shahab I, Patterson W. Renal and electrolyte abnormalities due to chemotherapy. In: Perry M, editor. The chemotherapy source book. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 223–44.

    Google Scholar 

  106. Lyman NW, Hemalatha C, Viscuso RL, Jacobs MG. Cisplatin-induced hypocalcemia and hypomagnesemia. Arch Intern Med. 1980;140(11):1513–4.

    CAS  PubMed  Google Scholar 

  107. Ma Y, Hou L, Yu F, Lu G, Qin S, Xie R, et al. Incidence and physiological mechanism of carboplatin-induced electrolyte abnormality among patients with non-small cell lung cancer. Oncotarget. 2017;8(11):18417–23.

    PubMed  Google Scholar 

  108. Hamdi T, Latta S, Jallad B, Kheir F, Alhosaini MN, Patel A. Cisplatin-induced renal salt wasting syndrome. South Med J. 2010;103(8):793–9.

    PubMed  Google Scholar 

  109. Gilbar PJ, Richmond J, Wood J, Sullivan A. Syndrome of inappropriate antidiuretic hormone secretion induced by a single dose of oral cyclophosphamide. Ann Pharmacother. 2012;46(9):e23. https://doi.org/10.1345/aph.1R2961.

    Article  PubMed  Google Scholar 

  110. Bruining DM, van Roon EN, de Graaf H, Hoogendoorn M. Cyclophosphamide-induced symptomatic hyponatraemia. Neth J Med. 2011;69(4):192–5.

    CAS  PubMed  Google Scholar 

  111. Hammond IW, Ferguson JA, Kwong K, Muniz E, Delisle F. Hyponatremia and syndrome of inappropriate anti-diuretic hormone reported with the use of Vincristine: an over-representation of Asians? Pharmacoepidemiol Drug Saf. 2002;11(3):229–34.

    CAS  PubMed  Google Scholar 

  112. Stohr W, Paulides M, Bielack S, Jurgens H, Treuner J, Rossi R, et al. Ifosfamide-induced nephrotoxicity in 593 sarcoma patients: a report from the Late Effects Surveillance System. Pediatr Blood Cancer. 2007;48(4):447–52.

    CAS  PubMed  Google Scholar 

  113. Stintzing S, Fischhaber D, Mook C, Modest DP, Giessen C, Schulz C, et al. Clinical relevance and utility of cetuximab-related changes in magnesium and calcium serum levels. Anti-Cancer Drugs. 2013;24(9):969–74.

    CAS  PubMed  Google Scholar 

  114. Vincenzi B, Santini D, Galluzzo S, Russo A, Fulfaro F, Silletta M, et al. Early magnesium reduction in advanced colorectal cancer patients treated with cetuximab plus irinotecan as predictive factor of efficacy and outcome. Clin Cancer Res. 2008;14(13):4219–24.

    CAS  PubMed  Google Scholar 

  115. Chen P, Wang L, Li H, Liu B, Zou Z. Incidence and risk of hypomagnesemia in advanced cancer patients treated with cetuximab: a meta-analysis. Oncol Lett. 2013;5(6):1915–20.

    CAS  PubMed  PubMed Central  Google Scholar 

  116. Milionis HJ, Liamis GL, Elisaf MS. The hyponatremic patient: a systematic approach to laboratory diagnosis. CMAJ. 2002;166(8):1056–62.

    PubMed  PubMed Central  Google Scholar 

  117. Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, Bichet D, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Intens Care Med. 2014;40(3):320–31.

    Google Scholar 

  118. Lenz HJ. Management and preparedness for infusion and hypersensitivity reactions. Oncologist. 2007;12(5):601–9.

    CAS  PubMed  Google Scholar 

  119. Kanji S, Chant C. Allergic and hypersensitivity reactions in the intensive care unit. Crit Care Med. 2010;38(6 Suppl):S162–8.

    PubMed  Google Scholar 

  120. Syrigou E, Makrilia N, Koti I, Saif MW, Syrigos KN. Hypersensitivity reactions to antineoplastic agents: an overview. Anti-Cancer Drugs. 2009;20(1):1–6.

    CAS  PubMed  Google Scholar 

  121. Lieberman P. Biphasic anaphylactic reactions. Ann Allergy Asthma Immunol. 2005;95(3):217–26; quiz 26, 58.

    PubMed  Google Scholar 

  122. Shaker MS, Wallace DV, Golden DBK, Oppenheimer J, Bernstein JA, Campbell RL, et al. Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. J Allergy Clin Immunol. 2020;145(4):1082–123.

    CAS  PubMed  Google Scholar 

  123. Castells Guitart MC. Rapid drug desensitization for hypersensitivity reactions to chemotherapy and monoclonal antibodies in the 21st century. J Investig Allergol Clin Immunol. 2014;24(2):72–9.

    CAS  PubMed  Google Scholar 

  124. Worth A, Soar J, Sheikh A. Management of anaphylaxis in the emergency setting. Expert Rev Clin Immunol. 2010;6(1):89–100.

    PubMed  Google Scholar 

  125. Simons FE. Pharmacologic treatment of anaphylaxis: can the evidence base be strengthened? Curr Opin Allergy Clin Immunol. 2010;10(4):384–93.

    CAS  PubMed  Google Scholar 

  126. Simons FE, Gu X, Simons KJ. Epinephrine absorption in adults: intramuscular versus subcutaneous injection. J Allergy Clin Immunol. 2001;108(5):871–3.

    CAS  PubMed  Google Scholar 

  127. Simons KJ, Simons FE. Epinephrine and its use in anaphylaxis: current issues. Curr Opin Allergy Clin Immunol. 2010;10(4):354–61.

    CAS  PubMed  Google Scholar 

  128. Campbell RL, Bellolio MF, Knutson BD, Bellamkonda VR, Fedko MG, Nestler DM, et al. Epinephrine in anaphylaxis: higher risk of cardiovascular complications and overdose after administration of intravenous bolus epinephrine compared with intramuscular epinephrine. J Allergy Clin Immunol Pract. 2015;3(1):76–80.

    PubMed  Google Scholar 

  129. Lieberman P, Nicklas RA, Oppenheimer J, Kemp SF, Lang DM, Bernstein DI, et al. The diagnosis and management of anaphylaxis practice parameter: 2010 update. J Allergy Clin Immunol. 2010;126(3):477–80, e1–42.

    PubMed  Google Scholar 

  130. Goolsby TV, Lombardo FA. Extravasation of chemotherapeutic agents: prevention and treatment. Semin Oncol. 2006;33(1):139–43.

    CAS  PubMed  Google Scholar 

  131. Ener RA, Meglathery SB, Styler M. Extravasation of systemic hemato-oncological therapies. Ann Oncol. 2004;15(6):858–62.

    CAS  PubMed  Google Scholar 

  132. Kreidieh FY, Moukadem HA, El Saghir NS. Overview, prevention and management of chemotherapy extravasation. World J Clin Oncol. 2016;7(1):87–97.

    PubMed  PubMed Central  Google Scholar 

  133. Jackson-Rose J, Del Monte J, Groman A, Dial LS, Atwell L, Graham J, et al. Chemotherapy extravasation: establishing a national benchmark for incidence among cancer centers. Clin J Oncol Nurs. 2017;21(4):438–45.

    PubMed  Google Scholar 

  134. Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. Management of chemotherapy extravasation: ESMO-EONS clinical practice guidelines. Ann Oncol. 2012;23(Suppl 7):vii167–73.

    PubMed  Google Scholar 

  135. Wickham R, Engelking C, Sauerland C, Corbi D. Vesicant extravasation part II: evidence-based management and continuing controversies. Oncol Nurs Forum. 2006;33(6):1143–50.

    PubMed  Google Scholar 

  136. Vidall C, Roe H, Dougherty L, Harrold K. Dexrazoxane: a management option for anthracycline extravasations. Br J Nurs. 2013;22(17):S6–12.

    PubMed  Google Scholar 

  137. Schulmeister L. Extravasation management. Semin Oncol Nurs. 2007;23(3):184–90.

    PubMed  Google Scholar 

  138. Patel JS, Krusa M. Distant and delayed mitomycin C extravasation. Pharmacotherapy. 1999;19(8):1002–5.

    CAS  PubMed  Google Scholar 

  139. Al-Benna S, O’Boyle C, Holley J. Extravasation injuries in adults. ISRN Dermatol. 2013;2013:856541.

    CAS  PubMed  PubMed Central  Google Scholar 

  140. Mouridsen HT, Langer SW, Buter J, Eidtmann H, Rosti G, de Wit M, et al. Treatment of anthracycline extravasation with Savene (dexrazoxane): results from two prospective clinical multicentre studies. Ann Oncol. 2007;18(3):546–50.

    CAS  PubMed  Google Scholar 

  141. Fontaine C, Noens L, Pierre P, De Grève J. Savene® (dexrazoxane) use in clinical practice. Support Care Cancer. 2012;20(5):1109–12.

    PubMed  Google Scholar 

  142. Olver IN, Aisner J, Hament A, Buchanan L, Bishop JF, Kaplan RS. A prospective study of topical dimethyl sulfoxide for treating anthracycline extravasation. J Clin Oncol. 1988;6(11):1732–5.

    CAS  PubMed  Google Scholar 

  143. Schrijvers DL. Extravasation: a dreaded complication of chemotherapy. Ann Oncol. 2003;14(Suppl 3):iii26–30.

    PubMed  Google Scholar 

  144. Bertelli G, Dini D, Forno GB, Gozza A, Silvestro S, Venturini M, et al. Hyaluronidase as an antidote to extravasation of Vinca alkaloids: clinical results. J Cancer Res Clin Oncol. 1994;120(8):505–6.

    CAS  PubMed  Google Scholar 

  145. Sauerland C, Engelking C, Wickham R, Corbi D. Vesicant extravasation part I: mechanisms, pathogenesis, and nursing care to reduce risk. Oncol Nurs Forum. 2006;33(6):1134–41.

    PubMed  Google Scholar 

  146. Stanford BL, Hardwicke F. A review of clinical experience with paclitaxel extravasations. Support Care Cancer. 2003;11(5):270–7.

    PubMed  Google Scholar 

  147. Sibaud V, Lebœuf NR, Roche H, Belum VR, Gladieff L, Deslandres M, et al. Dermatological adverse events with taxane chemotherapy. Eur J Dermatol. 2016;26(5):427–43.

    PubMed  PubMed Central  Google Scholar 

  148. Jordan K, Behlendorf T, Mueller F, Schmoll HJ. Anthracycline extravasation injuries: management with dexrazoxane. Ther Clin Risk Manage. 2009;5(2):361–6.

    CAS  Google Scholar 

  149. Maly C, Fan KL, Rogers GF, Mitchell B, Amling J, Johnson K, et al. A primer on the acute management of intravenous extravasation injuries for the plastic surgeon. Plast Reconstr Surg Glob Open. 2018;6(4):e1743.

    PubMed  PubMed Central  Google Scholar 

  150. Dorr RT. Antidotes to vesicant chemotherapy extravasations. Blood Rev. 1990;4(1):41–60.

    CAS  PubMed  Google Scholar 

  151. Boschi R, Rostagno E. Extravasation of antineoplastic agents: prevention and treatments. Pediatr Rep. 2012;4(3):e28.

    PubMed  PubMed Central  Google Scholar 

  152. Laurie SW, Wilson KL, Kernahan DA, Bauer BS, Vistnes LM. Intravenous extravasation injuries: the effectiveness of hyaluronidase in their treatment. Ann Plast Surg. 1984;13(3):191–4.

    CAS  PubMed  Google Scholar 

  153. Bozkurt AK, Uzel B, Akman C, Ozgüroğlu M, Molinas MN. Intrathoracic extravasation of antineoplastic agents: case report and systematic review. Am J Clin Oncol. 2003;26(2):121–3.

    PubMed  Google Scholar 

  154. Mas V, Simon AL, Presedo A, Mallet C, Ilharreborde B, Jehanno P. Upper limb extravasation of cytotoxic drugs: results of the saline washout technique in children. J Child Orthop. 2020;14(3):230–5.

    PubMed  PubMed Central  Google Scholar 

  155. Goutos I, Cogswell LK, Giele H. Extravasation injuries: a review. J Hand Surg Eur Vol. 2014;39(8):808–18.

    CAS  PubMed  Google Scholar 

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Toale, K.M., Johnson, T.N., Ma, M.Q., Vu, N.H. (2021). Chemotherapy Toxicities. In: Todd, K.H., Thomas, Jr., C.R., Alagappan, K. (eds) Oncologic Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-67123-5_48

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