# risk factors for CINV - women __ men - younger __ older - prior history of ___ and ___ sickness - previous CINV tend to do worse - anxiety/high pretreatment ___ of nausea - chronic ethanol can be ___

- > - > - motion, morning - anticipation - protective

Supportive Care: I Flashcards by Reagan Smith

complications of N/V

most feared complication of chemo despite ___ nature
can result in the inability to deliver intended dose of chemo

limited
- dehydration
- electrolyte
- abnormalities
- fatigue
- depression

before 5-HT3 anti-emetics, it was expected to vomit 5-12 times per day

How well did you know this?

Not at all

Perfectly

Types of N/V

anticipatory
- ___ response conditioned by severity and duration of previous emetic reactions from prior cycles of chemo
- non-PCOL like hypnosis helpful
- can be provoked by sight, sound, or smell

learned

cancer patients have hightened senses

How well did you know this?

Not at all

Perfectly

Types of N/V

Acute
- emetic response correlating with the administration of chemo
- within __ hours of receiving chem

Delayed
- Related to chemotherapy occurring > ___ hours following completion of chemotherapy
– Mechanism is not fully understood, but there is ↑
evidence that substance P binding to ___ receptor may play a role

24
24
neurokinin 1

How well did you know this?

Not at all

Perfectly

Types of N/V

Breakthrough
- occurs even if on scheduled anti-emetics ___ to chemotherapy

Refractory
- persists despite ___ anti-emetics
- Failed other therapies

prior
appropriate

How well did you know this?

Not at all

Perfectly

Patho of CINV

Chemo is toxic to GI tract inducing damage to the epithelial cells
Enterochromaffin cells lining the GI tract contain large stores of ___ that are released in massive quantities after exposure to chemo
chemoreceptor trigger zone (CTZ)
stimulates the vomiting center
Located in the nucleus tractus solitarii in the ___ which stimulates the emetic response
Input to the vomiting center from the higher cortical centers, pharynx, and GI
tract can induce emesis

serotonin
medulla

How well did you know this?

Not at all

Perfectly

Neurotransmitters implicated in CINV (5)

dopamine
histamine
acetylcholine
serotonin
substance P

How well did you know this?

Not at all

Perfectly

highly emetogenic chemo (level 5)

single agent

Carboplatin
Carmustine
Cisplatin
Cyclophosphamide
Dacarbazine
Doxorubicin
Epirubicin
Fam-trastuzumab-deruxtecan
Ifosfamide
Mechlorethamine
Melphalan
Sacituzumab govitecan-hziy
Streptozocin

How well did you know this?

Not at all

Perfectly

Combo Chemo

when considering combo chemo, need to consider emetogenicity
- level 1 or 2 agents do not contribute to the emetogenicity of the regimen
- adding level 3 or 4 ___ the emetogenicity of the combo by 1 level per agent
- add the different levels together to decide on which antiemetics to use

increasing

How well did you know this?

Not at all

Perfectly

Oral Anticancer Agents

Moderate to high emetic risk:
(≥ 30% risk) Prophylaxis required on days of oral anticancer agent administration

Azacitidine
Busulfan
Ceritinib
Cyclophosphamide
Fedratinib
Lomustine
Midostaurin
Mitotane
Selinexor
Temozolomide

How well did you know this?

Not at all

Perfectly

Oral Anticancer Agents

Moderate to high emetic risk:
(≥ 30% risk) As needed dosing is initially appropriate on days of oral anticancer agent administration

Adagrasib
Elacestrant
Avapritinib
Binimetinib
Bosutinib
Cabozantinib
Crizotinib
Dabrafenib
Enasidenib
Encorafenib
Estramustine
Etoposide
Imatinib
Lenvatinib
Niraparib
Olaparib
Procarbazine
Rucaparib

How well did you know this?

Not at all

Perfectly

risk factors for CINV

women __ men
younger __ older
prior history of ___ and ___ sickness
previous CINV tend to do worse
anxiety/high pretreatment ___ of nausea
chronic ethanol can be ___

>
>
motion, morning
anticipation
protective

How well did you know this?

Not at all

Perfectly

treatment guidelines

___ for acute N/V is based on the emetogenic potential of chemo
- ___ receptor antagonists may be substituted for each other
- oral efficacy = IV efficacy

prophylaxis
- 5HT3

How well did you know this?

Not at all

Perfectly

highly emetogenic regimens

A) 4 drug
B) 3 drug
C) 3 drug

A) NK-1 antagonist, steroid, 5-HT3 antagonist, atypical anti-psychotic
B) atypical antipsychotic, 5HT-3 antagonist, steroid
C) NK-1 antagonist, steroid, 5-HT3 antagonist

How well did you know this?

Not at all

Perfectly

These 3 agents can be added with any regimen and any emetogenicity if patients are experiencing these toxicities

+/- Lorazepam 0.5 mg to 2 mg PO or IV or sublingual either every 4 or 6 hours as needed
+/- H2 blocker or proton pump inhibitor

How well did you know this?

Not at all

Perfectly

moderately emetogenic

A) 2 drug
B) 3 drug
C) 3 drugs

steroid, 5-HT3
anti-psychotic, steroid, 5-HT3
NK-1, steroid, 5-HT3 antagonist

How well did you know this?

Not at all

Perfectly

low emetogenic regimens

only 1 needed
- steroid ( ___ )
- metoclopramide
- prochlorperazine
- 5-HT3 (3)

dexamethasone
dolasetron, granisetron, ondansetron

How well did you know this?

Not at all

Perfectly

Breakthrough Nausea and Vomiting

give an additional agent from a different drug class as needed

haloperidol or metoclopramide
prochlorperazine or promethazine
olanzapine
lorazepam
dronabinol or nabilone
dolasetron, granisetron, or ondansetron
dexamethazone
scopolamine

Depending on the severity of the N/V, you can schedule these agents

How well did you know this?

Not at all

Perfectly

Delayed Nausea and Vomiting

typically involves use of one of the following (3)

dexamethasone
NK-1 antagonist
olanzapine

How well did you know this?

Not at all

Perfectly

Anticipatory N/V

___ - Use optimal antiemetic therapy during
every cycle of treatment
___ - 0.5 to 1 mg orally beginning the night before treatment and then again 1 to 2 hours prior to beginning of
chemotherapy

prevention
lorazepam

How well did you know this?

Not at all

Perfectly

other prevention guidelines

Oral chemotherapy - High to moderate emetogenic risk
- Start ___ chemotherapy and continue daily
- ___ antagonists

Low to minimal emetogenic risk
- Start ___ chemotherapy and maybe given daily or prn
– ___
– ___
– ___ antagonists

before
5-HT3
before
Metoclopramide
Prochlorperazine
5-HT3

How well did you know this?

Not at all

Perfectly

Other Prevention Guidelines

Radiation Induced Emesis
- Start pretreatment for each day of radiation
therapy
- ___ PO +/- dexamethasone
- ___ PO +/- dexamethasone

Granisetron
Ondansetron

How well did you know this?

Not at all

Perfectly

Radiopharmaceuticals

Nausea is associated with the ___ infusion accompanying treatment
Antiemetics should be given ___ minutes prior to start of infusion

Recommendations for antiemetics include:
- ___ or ___ antagonists
- NOT ___ due to down regulation of somatostatin receptors

amino acid
30
5-HT3, NK-1
steroids

How well did you know this?

Not at all

Perfectly

Common Toxicities Across Classes

Serotonin (5-HT3) antagonists
- Ondansetron
- Granisetron
- Dolasetron
- Palonosetron single agent or combination products (+/- netupitant
or fosnetupitant)

Headache
asymptomatic and transient EKG changes (max doses)
constipation
increased transaminases

How well did you know this?

Not at all

Perfectly

Common Toxicities Across Classes

Corticosteroids
- Dexamethasone

(Short term use):
- Anxiety
- euphoria
- insomnia
- hyperglycemia
- ↑’d appetite

How well did you know this?

Not at all

Perfectly

# Common Toxicities Across Classes Substance P antagonists - Aprepitant - Aprepitant injectable emulsion - Fosaprepitant - Rolapitant - Netupitant - Fosnetupitan

- Hiccups - worry about drug interactions

# Common Toxicities Across Classes Dopamine antagonists - Chlorpromazine - Haloperidol - Metoclopramide

- Extrapyramidal side effects - diarrhea - sedation

# Common Toxicities Across Classes Atypical antipsychotic - Olanzapine

- dystonic reactions - sedation

# Common Toxicities Across Classes Phenothiazines - Prochlorperazine - Promethazine

- Sedation - akathesia - dystonia - IV promethazine = tissue damage

# Common Toxicities Across Classes Cannibanoids - Dronabinol

- Drowsiness - dizziness - euphoria - mood changes - hallucinations - ↑’d appetite

# Common Toxicities Across Classes Benzodiazepines - Lorazepam

- sedation - hypotension - urinary - incontinence - hallucinations

# Common Toxicities Across Classes Anticholinergic - Scopolamine Patch

- Anti-cholinergic side effects

# Important Principles for Prevention and Management - Review medical history, diagnosis, and concurrent medications – Consider any contributing causes to nausea/vomiting, and treat appropriately – ___ is a risk with phenothiazines and metoclopramide - Evaluate the emetogenic potential and pattern of the chemotherapeutic regimen to be given

EPS

# Important Principles for Prevention and Management - Emetogenicity is ___ - Emetogenic potential may be different on different days of treatment (stronger day 1 than 2 and 3) - acute/delayed N/V - most guidelines are tailored to chemo on day 1

additive

# Important Principles for Prevention and Management T or F: Anti-emetics are most effective when given as prophylaxis

T - Begin therapy at least 5 to 30 minutes prior to chemo - Administer around-the-clock until chemo is complete and provide PRN agents for breakthrough N/V - Always provide patients with additional PRN anti-emetics to take home

# Mucositis GI mucosa is comprised of epithelial cells and has a rapid turnover rate - Initiation -> Up-regulation with generation of messengers -> Signaling and amplification -> Ulceration -> Healing - range from mild inflammation to bleeding ulcerations - It can affect the entire length of the GI tract from top to bottom - Course parallels the neutrophil nadir and begins on day 5 to 7 after chemotherapy and improves as the neutrophil count ___

increases

# chemo induced mucositis Continuous infusions ___ short IV infusions

# risk factors to mucositis - Pre-existing oral lesions - Poor dental hygiene or ill-fitting dentures - Combined modality treatment ( ___ + ___ )

- chem + radiation

# Prevention and Treatment Diet recommendations: – Avoid rough food, spices, salt and acidic fruit – Mainly eat soft or liquid foods nonacidic fruits, soft cheeses, and eggs – Avoid ___ and alcohol Pre-treatment dental screening, especially in patients receiving ___ therapy to the oral mucosa or those receiving high-dose chemo with a ___ transplant – Baking soda rinses, soft-bristled toothbrush to minimize gingival irritation, saliva substitute for radiation-induced xerostomia

- smoking - radiation - bone marrow

# Pain Management - mucositis Topical anesthetics – Often provide adequate relief, but the effect tends to be short-lived – Various combinations of lidocaine, diphenhydramine, and antacids have been used with success ( ___ ___ ) - Patients should be instructed to swish and spit or swallow depending on the location of the mucositis) every few hours as needed Ice Chips - vaso ___ decreased chemo delivery to mouth - 30 min prior to ___ doses decreases incidence/severity Sucralfate - nauseating

magic mouthwash vasoconstriction 5-FU

# Pain Management - mucositis Oral and parenteral opioid analgesics - Often required in moderate to severe mucositis - Many oral solutions contain a high percentage of alcohol, which may burn (dont get OTC) - Opioids are best administered ___ for patients with moderate to severe mucositis - Use of ___ is common

- around the clock - PCA

# neutropenia White blood cells (WBC): - Normal range of 4.8-10.8 x10 3 /μL - Decreased WBC = Neutropenia (< 0.5 x 103 /μL), leukopenia, or granulocytopenia - Risk of life-threatening ___ Megakaryocytes (platelets) - Normal range of 140 - 440 x 10 3 /μL - ___ platelets = Thrombocytopenia (< 100 x 103 /μL) - Risk of ___ Red blood cells (RBC) - Normal range of 4.6 to 6.2 x1012 /L - Decreased RBC = ___ - Risks of hypoxia and __

- infection - decreased - bleeding - anemia - fatigue

# Neutropenia ___ suppression is the most common dose-limiting toxicity of chemo The ___ (usually described by the absolute neutrophil count or ANC) is the lowest value the blood counts fall to during a cycle of chemo - Generally, occurs ___to ___ days after chemo administration and counts usually recover by 3 to 4 weeks after - Some exceptions include mitomycin C and nitrosoureas which nadirs 4 - 6 weeks after treatment

- bone marrow - nadir - 10, 14

# Neutropenia ANC = WBC x % granulocytes (Segs + Bands) - To administer chemotherapy safely the patient’s counts should be as assessed prior to administration. These are typical guidelines: – WBC > __ x103 /μL OR – Absolute neutrophil count (ANC) of > ___ x103 /μL AND platelet count > ___ x103 /μL

- 3 - 1.5, 100

# neutropenia Severe neutropenia is defined as ANC < ___ x 103 /μL * Neutropenic patients are at an ↑’d risk of developing serious infections * ___ neutropenia (FN) is defined as: – ANC < 0.5 x 103 /μL and a single oral temperature > 101°F (> 38.3°C) or > 100.4°F (> 38.0°C) for at least an hour

- 0.5 - febrile

# neutropenia Other factors affecting myelosuppression:

- previous chemotherapy - previous radiation therapy - direct bone marrow involvement

# neutropenia T or F: The usual s/s of infection (abscess, pus, infiltrates on chest x-ray) are absent with fever being the only reliable indicator

T WBC low = no pus

# Colony Stimulating Factors (CSFs) Prophylactic use following chemo has demonstrated decreased: - Incidence of ___ neutropenia - Length of hospitalization - Confirmed ___ - Duration of ___

- febrile - infections - antibiotics

# CSF guidelines (ASCO NCCN) Primary prophylaxis If the patient is to receive a chemo regimen that is expected to cause > 20% incidence of ___ neutropenia High risk patients defined as: - Preexisting neutropenia due to disease - Extensive prior chemo - Previous irradiation to the pelvis or other areas containing large amounts of ___

- febrile - bone marrow

# CSF guidelines (ASCO) Secondary prophylaxis - The patient experienced a neutropenic complication from a previous cycle of chemo and now you want to prevent that again – Use a CSF ___ with next cycle of chemo

preventively

# Other uses for CSF’s: - Used to support patients through dose ___ chemo - Can be used alone, after chemo, or in combination with ___ to mobilize peripheral blood progenitor cells - After a __ transplant to reduce the duration of severe neutropenia - Guidelines for pediatric use are available and should be followed

- dense - plerixafor - stem cell

CSF agents (3)

- filgrastim - pegfilgrastim - sargramostim

# CSF - filgrastim - Regulates the production, maturation, and function of neutrophil cell line - Dose dependent elevation in neutrophil count, rapid drop in WBC and neutrophil count following ___ (approximately 50% decrease within 24 hours)

discontinuation

# CSF - pegfilgrastim - Differs from filgrastim due to a 20-kD pegylated molecule that is attached to the N-terminus of filgrastim - Stimulates production & maturation of neutrophil precursors like filgrastim - ___ pharmacokinetics & clearance ___ with increasing neutrophil count

- Non-linear - increases

# CSF - Sargramostim - Effects on phagocytic accessory cells which mediates its action on the neutrophil lineage - Drop in WBC & neutrophil count following ___ (approximately 50% decrease within 24 hours)

- discontinuation

# CSF - Biosimilars: Similar or Not? 1. Tbo-Filgrastim (Granix) 2. Filgrastim-sndz (Zarxio) 3. Filgrastim-aafi (Nivestym) 4. Filgrastim-ayow (Releuko)

Tbo-filgrastim is not considered a biosimilar and received an original biologic license through the FDA - Filgrastim-sndz was the first biosimilar approved in the US in March 2015 - Did NOT receive interchangeable status **Patient should remain on whichever agent it is started on and not switch between manufactured products**

# Dosing and Adverse Effects Filgrastim: 5 mcg/kg/day – Start up to 3 - 4 days ___ completion of chemotherapy and continue until post-nadir ANC recovery to ___ ish levels

- after - normal

# Dosing and Adverse Effects Pegfilgrastim: 6 mg SQ x 1 dose - Start at least 24 hours ___ chemo and can be given up to 3 – 4 days after chemo - At least __ days should elapse between dose and the next cycle of chemo - Same day therapy is generally not recommended - OnPro® body injector can be applied same day

after 14

CSF Adverse Effects

- Flu-like symptoms - bone and joint pain - DVT

# CSF Adverse Effects Bone or musculoskeletal pain occurs in 20-30% of patients receiving CSF’s - Attributed to rapid proliferation of the bone marrow myeloid cells - Can use acetaminophen/non-opioid analgesics - Data with use of ___ . Why? Thought is that pain is due to histamine release. Rare Adverse Effects - ___ enlargement with long term CSF use

- loratidine - splenic

# Thrombocytopenia Usually defined as a platelet count < ___ x 10 3 /μL, however increased risk of bleeding occurs when platelet count is < 20 x 10 3 /μL and therefore may require transfusion - Most institutions do not transfuse until patient becomes ___ - ASCO guideline recommends a threshold for platelet transfusion of ___ x 10 3 /μL

- 100 - symptomatic - 10

# General Causes of Anemia Decreased red blood cell production - Cancer therapy: Radiation or chemo - Tumor infiltration into the ___ Decreased erythropoietin production - ___ dysfunction - Decreased body stores of vitamin B12, iron, or folic acid - Blood loss

- bone marrow - renal

# Significance of Anemia in Cancer Fatigue has been reported in several surveys as more troubling to cancer patients than nausea, vomiting, or pain - Low ___ levels have been correlated with poor performance status which has been correlated with decreased survival and quality of life

hemoglobin

# Chemotherapy Induced Anemia Patients with a Hgb ≤ __ g/dL or ≥ __ g/dL drop from baseline should undergo a work-up:

11, 2

# Chemotherapy Induced Anemia If patient is symptomatic: - ___ as indicated - Consider use of ___ - Perform ___ studies:

- transfuse - ESA - iron | patients need to be counseled on the risks and benefits of therapy

ESA warnings

WARNING: ESAs INCREASE THE RISK OF DEATH, MYOCARDIAL INFARCTION, STROKE, VENOUS THROMBOEMBOLISM, THROMBOSIS OF VASCULAR ACCESS AND TUMOR PROGRESSION OR RECURRENCE | boxed warnings

# Considerations for Use of ESA’s ESAs are NOT recommended: – In patients receiving myelosuppressive chemotherapy with ___ intent – In patients with cancer NOT receiving chemo – In patients receiving non- ___ chemo

- curative - myelosuppressive

# Considerations for Use of ESA’s Consider using: – Cancer and ___ – Patient’s undergoing ___ chemotherapy – Patients without other identifiable causes

- CKD - palliative

# Risks and Benefits of Therapy Survival studies: - 3 meta-analyses demonstrated ___ survival when taking ESAs to correct Hgb > 12 g/dL - 2 meta-analysis did not show differences in survival when ESAs utilized - Additional ongoing trials are underway to guide optimal use

- decreased

# Risk and Benefits of Therapy Risks 1. Increased ___ events 2. Possible ___ survival 3. Time to tumor progression ___ Benefits 1. ___ avoidance 2. Gradual improvement in ___ related symptoms

- thrombotic - decreased - shortened - transfusion - anemia

# Risk and Benefits of Therapy Risks 1. Transfusion ___ 2. Transfusion related circulatory overload 3. Virus transmission (hepatitis, HIV, etc.) 4. Bacterial contamination 5. Iron overload 6. Increased ___ events 7. Possible decreased survival Benefits 1. Rapid increase of ___ and hematocrit levels 2. Rapid improvement in anemia related symptoms like ___

- reactions - thrombotic - hemoglobin - fatigue

# Epoetin alfa (Erythropoietin, Epoetin) Pharmacology - Glycoprotein which stimulates ___ production - Stimulates ___ and ___ of committed erythroid progenitors in the bone marrow - Produced in the ___ - Endogenous production regulated by level of tissue oxygenation

- RBC - division, differentiation - kidney

# Epoetin alfa (Erythropoietin, Epoetin) For chemotherapy-associated anemia - Dose should be adjusted to maintain the ___ Hgb level - If the Hgb increases > __ g/dL in a 2-week period, the dose should be decreased by __ % for epoetin alfa and __ % for darbepoetin

- lowest - 1 - 25, 40

# Darbepoetin (Aranesp) Stimulates erythropoiesis by binding to the ___ receptor like erythropoietin - Biochemically distinct from epoetin alfa by the addition of a sialic acid - half life 2 - 3 x ___ than epoetin Indications - Anemia in patients with non- ___ malignancies where anemia is caused by chemo Dosing - Titrate to response same as with epoetin alfa

- epoetin - longer - myeloid

# Iron in Anemic Cancer Patients T or F: All oncology patients who are prescribed ESA therapy should have baseline iron studies performed

# Iron in Anemic Cancer Patients Serum ferritin, iron, iron saturation - If a patient is iron deficient, a workup should be done - If no other causes for anemia is identified, **oral iron supplementation is ___** - Iron absorption will be ___ (by as much as half) if food is eaten 2 hours before or 1 hour after ingestion

- recommended - decreased

# Iron Dosing - Low Molecular Weight Iron Dextran (Dexferrum) - IV ___ - Iron Sucrose (Venofer) - IV ___ , ___ - Ferric Gluconate (Ferrlecit) - IV ___ , ___ Patients with an active ___ should not receive iron therapy

- infusion - infusion, injection - infusion, injection - infection

# Classic Chemotherapy Toxicities Toxicity: Myalgias/Arthralgias Chemo (5) Treatment (2)

- Paclitaxel, Docetaxel Anastrozole, Letrozole, Exemestane - NSAIDs, opioids

# Classic Chemotherapy Toxicities Toxicity: Hemorrhagic cystitis Chemo (2) Treatment (2)

- High dose cyclophosphamide, Ifosfamide - Hydration (prevention), Mesna (prevention)

# Classic Chemotherapy Toxicities Toxicity: Heart Failure Chemo (3) Treatment (3)

- Anthracyclines, High dose cyclophosphamide, Trastuzumab (other HER2 targeted therapies) - Monitor cumulative dose, assess for risk factors, Dexrazoxane (chemoprotectant)

# Classic Chemotherapy Toxicities Toxicity: Peripheral Neuropathy Chemo (3) Treatment (2)

- Taxanes, Vinca Alkaloids, Platinums - Change infusion rates (i.e., Paclitaxel), Adjunctive pain medications (ex. Gabapentin, amitriptyline)

# Classic Chemotherapy Toxicities Toxicity: Pulmonary Chemo: (1) Treatments (1)

- bleomycin - Corticosteroids (no good treatment once it happens)

# Mesna Mesna should be used with standard ifosfamide ( ___ ) doses of < 2.5 g/m2 /day to decrease risk of hemorrhagic cystitis - toxic metabolite: ___

- cyclophosphamide - acrolein

# Cardiac Toxicity Mechanism - Formation of iron-dependent oxygen free ___ due to stable anthracycline-iron complexes, which cause catalysis of electron transfer - Myocardium is more susceptible due to lower levels of ___ capable of detoxifying oxygen free radicals compared with other tissues

- radicals - enzymes

# Type I Chemotherapy Related: Cardiac Dysfunction Acute - Occurs immediately after a single dose or course of therapy with an ___ - Uncommon and transient - May involve abnormal ECG findings, including QT-interval prolongation, ST-T wave changes, and arrhythmias - Rarely, CHF and/or pericarditis are observed - Not related to cumulative dose and is uncommon

anthracycline

# Type I Chemotherapy Related: Cardiac Dysfunction Chronic - Onset usually within a ___ of receiving ___ therapy - Rapid onset and progression - Common and life threatening - Related to ___ dose patient received - Symptoms include tachycardia, tachypnea, exercise intolerance, pulmonary and venous congestion, ventricular dilatation, poor perfusion, and pleural effusion

- year - anthracycline - cumulative

# Type I Chemotherapy Related Cardiac Dysfunction Late-onset - Develops several years or even ___ after therapy - Manifests as ventricular dysfunction, CHF, conduction disturbances, and arrhythmias - Occurs more often in childhood / adolescence cancer survivors who received ___

- decades - anthracyclines

# Type II Chemotherapy Related Cardiac Dysfunction Trastuzumab - Does not appear to be dose related or occur in all patients - Ranges widely in severity - Has not been associated with cardiac ___ - Mechanism involves ___ pathway which normally blunts the effects of stress signaling pathways (a stunning effect) that are required to maintain cardiac function, structure, and contractility

- damage - EGFR

# Type II Chemotherapy Related Cardiac Dysfunction Trastuzumab - Appears to be largely ___ and short lived - Incidence is ~ 3% in non-anthracycline treated patients and increases to 5% in those who have received previous anthracyclines - If trastuzumab is given ___ with anthracycline, the incidence can increase up to ___ % cardiac toxicity (NYHA class III/IV)

- reversible - concurrently - 27%

Supportive Care: I Flashcards

(89 cards)