Oncology Pharmacy

ONCOLOGY PHARMACY BROCHURE
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Tumor
Classification 		Tumor Classification Tumor Type Tumor Type Typical Prognosis First-Line Regimens Second-Line /
Subsequent Regimens 		Key Genetic Mutations /
Biomarkers 		Major Risk Factors Key Clinical / Pharmacy Notes
Solid Breast Cancer Variable Surgery ± RT; ER+ → endocrine (AI/Tam);
HER2+ → trastuzumab + chemo 		CDK4/6 inhibitors, PARP inhibitors, ADCs BRCA1/2, HER2, ER/PR, PIK3CA Hormonal exposure, genetics Subtype-driven therapy
Lung Cancer NSCLC Poor Targeted TKI (if driver+); chemo-IO Alternate TKIs, chemo,
antibody–drug conjugates 		EGFR, ALK, KRAS, BRAF, PD-L1 Smoking, radon Molecular testing mandatory
SCLC Very poor Platinum + etoposide ± IO Topotecan, lurbinectedin TP53, RB1 loss Smoking Rapid relapse common
Colorectal Cancer Good if early Surgery ± FOLFOX/FOLFIRI Anti-EGFR, anti-VEGF,
immunotherapy (MSI-H) 		KRAS, NRAS, BRAF, MSI Diet, Lynch syndrome KRAS mutant ≠ anti-EGFR
Prostate Cancer Favorable ADT ± radiation AR inhibitors, docetaxel, PARP inhibitors AR, BRCA2 Age, race Hormone-driven
Brain Cancer Glioblastoma Poor Surgery + RT + temozolomide Bevacizumab, trials IDH-WT, MGMT methylation Sporadic BBB limits therapy
Low-Grade Glioma Moderate Surgery ± RT PCV, temozolomide IDH1/2, 1p/19q Genetic IDH mutation = better outcome
Head & Neck SCC Variable Surgery or RT ± cisplatin Immunotherapy (PD-1 inhibitors) HPV-16 (p16), TP53 Smoking, HPV HPV+ better prognosis
Gastric Cancer Poor Surgery + peri-op chemo Trastuzumab (HER2+), IO HER2, CDH1, MSI H. pylori HER2 testing essential
Hepatocellular Carcinoma Poor Atezolizumab + bevacizumab TKIs (sorafenib, lenvatinib) TP53, CTNNB1 HBV/HCV, cirrhosis Liver function limits dosing
Pancreatic Cancer Very poor FOLFIRINOX or gemcitabine Nanoliposomal irinotecan KRAS, TP53 Smoking Highly chemoresistant
Renal Cell Carcinoma Variable IO + TKI combinations Alternate TKIs, mTOR inhibitors VHL Smoking Anti-angiogenic focus
Melanoma Poor if metastatic Immunotherapy ± BRAF/MEK Alternate IO, TIL therapy BRAF V600E UV exposure High IO response
Bladder Cancer Variable Cisplatin-based chemo IO, FGFR inhibitors FGFR3, TP53 Smoking BCG for NMIBC
Thyroid Cancer Papillary Excellent Surgery ± radioactive iodine TKIs (advanced) BRAF V600E Radiation TSH suppression
Medullary Variable Surgery RET inhibitors RET MEN2 Calcitonin marker
Sarcoma Soft Tissue Sarcoma Variable Surgery ± doxorubicin TKIs, trabectedin KIT, PDGFRA (GIST) Radiation Histology-specific
Osteosarcoma Moderate MAP chemo + surgery Ifosfamide RB1, TP53 Adolescence High MTX toxicity
Ewing Sarcoma Moderate VDC/IE chemo High-dose chemo EWSR1-FLI1 Pediatric Highly chemosensitive
Gynecological Tumors Endometrial Cancer Favorable Surgery ± RT Progestins, IO (MSI-H) PTEN, MSI Obesity Hormone-sensitive
Cervical Cancer Variable RT + cisplatin Bevacizumab, IO HPV 16/18 HPV Vaccine-preventable
Ovarian Cancer Poor Surgery + platinum-taxane PARP inhibitors BRCA1/2, HRD Genetics Maintenance therapy critical
Testicular Cancer Excellent BEP chemo Salvage chemo i(12p) Cryptorchidism Highly curable
Pediatric Cancer Neuroblastoma Variable Risk-based chemo + surgery Anti-GD2 immunotherapy MYCN Pediatric Age-dependent risk
Wilms Tumor Excellent Surgery + chemo Intensified chemo WT1 Congenital >90% cure
Medulloblastoma Moderate Surgery + RT + chemo Targeted trials SHH, WNT Pediatric Neurotoxicity risk
Rhabdomyosarcoma Variable VAC chemo Intensified regimens PAX3-FOXO1 Pediatric Sarcoma subtype
Lymphoma Hodgkin Lymphoma Excellent ABVD Brentuximab, IO CD30 EBV High cure rate
Hematologic
Tumors 		NHL (DLBCL) Curable R-CHOP CAR-T MYC, BCL2 Immunosuppression Aggressive
Liquid Tumors Leukemia AML Variable Intensive chemo ± targeted HSCT, novel agents FLT3, NPM1, IDH Age, therapy-related Cytogenetic risk
ALL Excellent (children) Multi-agent chemo ± TKI HSCT BCR-ABL1 Pediatric CNS prophylaxis
CML Excellent TKI (imatinib) 2nd-gen TKIs BCR-ABL1 None specific Model targeted cancer
CLL Indolent Watch-and-wait or BTKi Venetoclax TP53, IGHV Age Oral therapy dominant
Multiple Myeloma Chronic VRd CAR-T, bispecifics del17p Age Bone & renal toxicity
MDS Variable HMAs HSCT TP53, SF3B1 Age AML progression risk
WordPress Data Table

 

Complete Oncology Reference — Unified Table

Category Details
Treatment Strategies Curative intent; Neoadjuvant therapy (before surgery); Adjuvant therapy (after surgery); Palliative therapy (symptom relief); Cancer‑free = no detectable disease; Recurrence = cancer returns after remission
7 Warning Signs (CAUTION) C: Change in bowel/bladder habits; A: A sore that does not heal; U: Unusual bleeding/discharge; T: Thickening/lump; I: Indigestion/difficulty swallowing; O: Obvious change in wart/mole; N: Nagging cough/hoarseness
Performance Status Karnofsky: 100 = normal → 0 = dead; ECOG: 0 = fully active → 5 = dead
Cell Cycle & Agents M Phase: Vinca Alkaloids, Taxanes; S Phase: Antimetabolites, Topoisomerase inhibitors; Non–Cell‑Cycle Specific: Alkylating agents, Anthracyclines
Common ADRs Oral mucositis: sprays, emollients; Hand‑Foot Syndrome: PPE; Pregnancy/Breastfeeding: avoid chemo; Myelosuppression: ↓ platelets, ↓ neutrophils; Neutropenia: risk stratification + G‑CSF; Hypercalcemia: hydration + bisphosphonates; Febrile neutropenia: broad‑spectrum antibiotics; Anemia: ESA guidelines + iron
Toxicities by Agent N/V: Cisplatin, Cyclophosphamide; Mucositis: Methotrexate, 5‑FU; Diarrhea: Irinotecan, 5‑FU; Constipation: Vincristine; Xerostomia: radiation; Clotting: Tamoxifen; Cardiotoxicity: Doxorubicin, Trastuzumab; Hepatotoxicity: Methotrexate; Pulmonary toxicity: Bleomycin, Busulfan; Nephrotoxicity: Cisplatin, Methotrexate; Hemorrhagic cystitis: Cyclophosphamide, Ifosfamide
Chemo Man Mnemonic B = Bleomycin (lungs); D = Doxorubicin/Adriamycin (heart); C = Cisplatin (kidneys/ears); V = Vincristine (nerves); M = Methotrexate (liver); T = Taxanes (neuropathy); I = Ifosfamide (bladder)
Dosing Limits Bleomycin: 400U lifetime (pulmonary toxicity); Doxorubicin: 450–550 mg lifetime (cardiotoxicity); Cisplatin: ≤100 mg/cycle (nephrotoxicity); Vincristine: max 2 mg/dose (neuropathy)
Chemo Adjuncts G‑CSF: Filgrastim, Tbo‑filgrastim, Peg‑filgrastim, Sargramostim; Leucovorin: MTX rescue, 5‑FU enhancement; Mesna: prevents hemorrhagic cystitis; Amifostine: cytoprotection; Dexrazoxane: protects heart from anthracyclines; Uridine Triacetate: antidote for 5‑FU toxicity
GENERIC BRAND MOA ADRs BBW CONTRADUCTION NOTES
Cyclophosphamide Cytoxan Alkylating Agents: NON-Specific Agents (DNA disruption) Hemorrhagic Cystitis Myelosuppression ALL have BBW: Myelosuppression Must prevent w/ MESNA (Mesna) & Hydration
Ifosfamide Ifex Alkylating Agents: NON-Specific Agents (DNA disruption) Hemorrhagic Cystitis Myelosuppression ALL have BBW: Myelosuppression Must prevent w/ MESNA (Mesna) & Hydration
Carmustine BCNU Alkylating Agents: NON-Specific Agents (DNA disruption) Pulmonary Toxicity Neurotoxicity   Pulmonary Toxicity
Bendamustine Bendeka, Treanda Alkylating Agents: NON-Specific Agents (DNA disruption)        
Busulfan Myleran, Busulfex Alkylating Agents: NON-Specific Agents (DNA disruption) Pulmonary Toxicity     Pulmonary Toxicity
Melphalan Alkeran, Evomela Alkylating Agents: NON-Specific Agents (DNA disruption)        
Cisplatin   Platinum-Based: Non-Specific Agents (DNA disruption) Peripheral Neuropathy, Ototoxicity, Nephrotoxicity Myelosuppression, Anaphylaxis Highest Nephrotoxicity & CINV Nephrotoxicity, Ototoxicity; Amifostine for prophylaxis
Carboplatin   Platinum-Based: Non-Specific Agents (DNA disruption) Peripheral Neuropathy, Ototoxicity, Nephrotoxicity Myelosuppression Calvert Formula used for dosing  
Oxaliplatin   Platinum-Based: Non-Specific Agents (DNA disruption) Peripheral Neuropathy (Acute Sensory Neuropathy)   Exacerbated by COLD weather  
Doxorubicin   Anthracyclines: NON-Specific Agents RED-Litrite Discoloration, Hand-Foot Syndrome, CINV Myelosuppression, Myocardial Toxicity, Vesicant Cardiotoxicity = related to TOTAL cumulative anthracycline dose received over LIFETIME – MAX Dose = 450-550 mg/m² Prophylaxis = Dexrazoxane (Zinecard)
Mitoxantrone   Anthracyclines: NON-Specific Agents BLUE-Litrite Discoloration Myelosuppression, Myocardial Toxicity, Vesicant Cardiotoxicity = related to TOTAL cumulative anthracycline dose received over LIFETIME – MAX Dose = 140-160 mg/m²  
Vincristine   Vinca Alkaloids: M-Phase Neuropathy (Paresthesia), Constipation IV Only – NO intrathecal NOT Myelosuppressive MAX DOSE = 2 mg/Dose; Dose in small IV bag (Piggy Back); MOST CNS Toxicity; Intrathecal Administration → DEATH + PARALYSIS
Vinblastine   Vinca Alkaloids: M-Phase   Myelosuppressive    
Vinorelbine   Vinca Alkaloids: M-Phase   Myelosuppressive    
Paclitaxel   Taxanes: M-Phase Neuropathy, Myalgia, Arthralgia Myelosuppression, Hypersensitivity Reactions, Fatal Anaphylaxis Infusion Hypersensitivity Reaction = Pre-Medicate w/ Benadryl, Steroid, or H2RA Give Taxanes BEFORE Platinum; Fluid Retention
Docetaxel   Taxanes: M-Phase Neuropathy, Myalgia, Arthralgia, Fluid Retention Myelosuppression, Hypersensitivity Reactions    
Irinotecan   Topoisomerase 1 inhibitor: S-Phase N/V/D, Diarrhea, Abdominal Pain, Alopecia Myelosuppression Cholinergic Sx (Flushing, Sweat, Cramps); Delayed Diarrhea Mono UGT1A1*28 causes neutropenia; Delayed Diarrhea (Early + Late)
Topotecan   Topoisomerase 1 inhibitor: S-Phase   Myelosuppression    
Etoposide IV   Topoisomerase 2 inhibitor: G2-Phase Hypersensitivity, Anaphylaxis Myelosuppression Infusion Rate-Related Hypotension; Use Non-PVC IV bag + Tubing; Refrigerate Capsules  
Etoposide Capsules VePesid Topoisomerase 2 inhibitor: G2-Phase        
Fluorouracil 5-FU Pyrimidine Analogs: S-Phase Hand-Foot Syndrome, Cardiotoxicity, Photosensitivity, Diarrhea, Mucositis ↑ INR CrCl <30 DPD Deficiency = Toxicity
Capecitabine Xeloda Pyrimidine Analogs: S-Phase Hand-Foot Syndrome, Diarrhea, Mucositis     Pro-Drug of 5-FU; DPD Deficiency = Toxicity
Cytarabine ARA-C Pyrimidine Analogs: S-Phase        
Gemcitabine   Pyrimidine Analogs: S-Phase        
Methotrexate   Folate Anti-Metabolites: S-Phase Nephrotoxicity, Hepatotoxicity, Mucositis Myelosuppression, Mucositis, Diarrhea NSAID, Salicylate = DDI Give Folic Acid, Vit-B12 for S/E; Intrathecal should ONLY be given if Preservative-Free formulation; Dose >500 mg rec, Leucovorin; Must Hydrate + IV Sodium Bicarb to ↓ Nephrotoxicity
Pemetrexed   Folate Anti-Metabolites: S-Phase        
Everolimus Zortress mTOR inhibitor; Indication = Transplant Dyslipidemia, Stomatitis, Rash, Interstitial Lung Disease      
Temsirolimus IV Torisel mTOR inhibitor        
GENERIC BRAND MOA ADRs BBW CONTRANDICATION NOTES
Tretinoin Vesanoid Miscellaneous Agents RA-APL Differentiation Syndrome, QT-Prolongation      
Arsenic Trioxide   Miscellaneous Agents RA-APL Differentiation Syndrome, Hypersensitivity, Pancreatitis, Prolonged Prothrombin Time/INR      
Asparaginase   Miscellaneous Agents Pulmonary Fibrosis     No Myelosuppression; MAX LIFE Dose = 400 units
Pegaspargase   Miscellaneous Agents       REMS Drug – Pregnancy
Bleomycin   Miscellaneous Agents Pulmonary Fibrosis, Neutropenia, Thrombocytopenia Fetal Risk Pregnancy, DVT, PE risk Pregnancy  
Mitomycin   Miscellaneous Agents Pulmonary Fibrosis      
Bortezomib   Miscellaneous Agents Peripheral Neuropathy, Neutropenia, Thrombocytopenia     Give Acyclovir, Valacyclovir to prevent Herpes reactivation
Bevacizumab Avastin VEGF Inhibitor HTN Fatal Bleeding, GI Perforation Poor Wound Healing – AVOID 28 days before/after Surgery Affects circulatory system
Trastuzumab Herceptin HER-2 Inhibitor Cardiotoxicity, Fetal Toxicity     MONITOR: LVEF w/ ECG or MUGA Scan @ Baseline & During Tx
Ado-Trastuzumab Emtansine Kadcyla HER-2 Inhibitor       MED GUIDE – REMS Drug
Cetuximab Erbitux EGFR Inhibitor Skin Rash     EGFR + Gene Expression = BETTER Response in NSCLC – Must be KRAS-Wild Type to use
Panitumumab Vectibix EGFR Inhibitor        
Ipilimumab Yervoy CTLA-4 Inhibitor Myelosuppression, Viral Infection, Colitis, Hepatotoxicity, Thyroid Dysfunction, Myocarditis      
Rituximab Rituxan CD20 Inhibitor       Must be CD20 + to use; MED GUIDE Required
Imatinib Gleevec BCR-ABL Inhibitor – Tx CML QT-Prolongation, Fluid Retention     Must be Philadelphia BCR-ABL +
Vemurafenib   BRAF Inhibitor New Malignancies     Must be BRAF V600E or V600K +
Dabrafenib   BRAF Inhibitor        
Afatinib   EGFR Inhibitor       Must be EGFR +
Erlotinib   EGFR Inhibitor        
Gefitinib   EGFR Inhibitor        
Crizotinib   ALK Inhibitor       Must be ALK +
Ceritinib   ALK Inhibitor        
Alectinib   ALK Inhibitor        
Lapatinib   HER-2/EGFR Inhibitor       Must have HER-2 Overexpression

Acute Oncology: Problems and Common Causes

Problem Common Causes
Fever Neutropenic sepsis
Breathlessness Pulmonary embolus, pleural effusion
Neutropenic sepsis
Bronchial obstruction and lobar collapse
Tense ascites
Hypotension Neutropenic sepsis
Pulmonary embolus, pericardial tamponade
Swollen face Superior vena caval obstruction
Leg weakness Spinal cord compression
Mental deterioration Hypercalcaemia
Raised intracranial pressure
Renal failure Obstructive uropathy, sepsis
Drugs: non-steroidal anti-inflammatory drugs, methotrexate, cisplatin
Metabolic: calcium, uric acid, myeloma protein, tumour lysis
Haemorrhage Tumour erosion, thrombocytopenia, disseminated intravascular coagulation
Bone pain Pathological fracture
Acute abdomen Intestinal obstruction and perforation
Jaundice Obstructing mass liver, parenchymal destruction by tumour or drugs

Comprehensive Antineoplastic Classes – With Tumor Types & Supportive Care Guidance

Class / Subclass Representative Drugs Mechanism of Action Tumors Treated Key Toxicities Monitoring Priorities Supportive Care Additions (Oncology Pharmacy Focus)
Alkylating Agents Cyclophosphamide, Ifosfamide, Busulfan, Melphalan, Carmustine DNA cross-linking Hematologic (AML, ALL, lymphoma, myeloma); Breast, ovarian, neuroblastoma, CNS tumors (BCNU) Myelosuppression, hemorrhagic cystitis (ifosfamide/cyclophosphamide), pulmonary fibrosis (busulfan) CBC, renal/liver labs MESNA + hydration for hemorrhagic cystitis; antiemetics (high-risk IV emetogenic); Busulfan – seizure prophylaxis (levetiracetam); G-CSF if prolonged neutropenia
Platinum Agents Cisplatin, Carboplatin, Oxaliplatin Platinum–DNA adducts Testicular, ovarian, lung, bladder, colorectal, head & neck Nephrotoxicity (cisplatin), ototoxicity, neuropathy, severe N/V CrCl, electrolytes (Mg, K), audiology Aggressive IV hydration; electrolyte repletion; NK1 + 5-HT3 + dexamethasone antiemetic triplet; neuropathy counseling; cryotherapy (oxaliplatin-induced neuropathy)
Antimetabolites (Folate) Methotrexate, Pemetrexed DHFR inhibition Leukemia, osteosarcoma, lymphoma, NSCLC, breast Mucositis, hepatic injury, renal failure (high-dose MTX) CBC, LFTs, urine pH Leucovorin rescue protocol; urine alkalinization (goal pH ≥ 7); hydration; MTX levels monitoring; folate/B12 supplements (pemetrexed)
Antimetabolites (Pyrimidine) 5-FU, Capecitabine, Cytarabine Thymidylate synthase & DNA inhibition Colorectal, pancreatic, gastric, AML, ALL Hand–foot syndrome, diarrhea, cerebellar toxicity CBC, neuro exams DPD deficiency screening; prophylactic urea-based creams; loperamide diarrhea protocol; dexamethasone eye drops for high-dose cytarabine to prevent conjunctivitis
Antimetabolites (Purine) Fludarabine, 6-MP, Cladribine Purine synthesis block CLL, hairy-cell leukemia, ALL maintenance Immunosuppression, hepatotoxicity CBC, hepatic function PJP prophylaxis (fludarabine), antiviral prophylaxis (HSV), TPMT testing before 6-MP
Anthracyclines Doxorubicin, Daunorubicin, Epirubicin Topo-II inhibition + free radicals Breast, sarcoma, lymphoma, leukemia Cardiotoxicity, vesicant extravasation Baseline & serial ECHO, cumulative dose Dexrazoxane cardioprotection; vesicant extravasation kit (DMSO, cold compress); strong antiemetic regimen; lifetime dose tracking
Topo I Inhibitors Irinotecan, Topotecan Prevent DNA break repair Colorectal, lung, ovarian, pancreas Delayed diarrhea, myelosuppression CBC, hydration Loperamide high-dose protocol for delayed diarrhea; atropine for acute diarrhea; hydration
Topo II Inhibitors Etoposide, Teniposide DNA strand break SCLC, testicular, lymphoma Myelosuppression, hypotension, alopecia CBC Infusion-rate monitoring; growth-factor prophylaxis depending on regimen
Vinca Alkaloids Vincristine, Vinblastine Microtubule inhibition ALL, lymphoma, sarcoma, breast, lung Peripheral neuropathy, constipation Neurologic exam Bowel regimen (senna + PEG); avoid intrathecal administration; neuropathy dose holds
Taxanes Paclitaxel, Docetaxel, Nab-paclitaxel Microtubule stabilization Breast, ovarian, prostate, lung Hypersensitivity reactions, neuropathy, edema CBC, neuropathy checks Premedication: steroid + H1/H2 blockers (except nab-PXL); cryotherapy on hands/feet; edema – dexamethasone prophylaxis (docetaxel)
Hypomethylating Agents Azacitidine, Decitabine Reactivate tumor suppressor genes AML (elderly), MDS Cytopenias CBC Infection prophylaxis (antiviral/antibacterial), transfusion support, ESA if needed
HDAC Inhibitors Vorinostat, Panobinostat ↑ Histone acetylation CTCL, multiple myeloma QT prolongation, electrolyte imbalance ECG, Mg/K levels ECG monitoring; electrolyte replacement; anti-diarrheal PRN
Proteasome Inhibitors Bortezomib, Carfilzomib Proteasome inhibition Multiple myeloma, mantle cell lymphoma Peripheral neuropathy, thrombocytopenia, cardiotoxicity CBC, cardiac/renal panels Give bortezomib SC instead of IV to reduce neuropathy; antiviral prophylaxis vs zoster; hydration + cardiac monitoring for carfilzomib
Small-Molecule TKIs Imatinib, Osimertinib, Alectinib, Sunitinib Block oncogenic kinases CML, GIST, NSCLC EGFR+, ALK+, RCC Diarrhea, rash, hepatotoxicity, hypertension Liver panel, BP, ECG BP control (ACE-I/ARB), anti-diarrheals, dermatologic prophylaxis (urea creams, doxycycline for EGFR-rash), TSH monitoring for VEGFR-TKIs
EGFR-mAbs Cetuximab, Panitumumab EGFR blockade RAS-WT colorectal; head/neck Severe acneiform rash, Mg loss Mg levels Skin toxicity protocol: sunscreen + doxycycline + topical steroids; Mg replacement
HER2-mAbs Trastuzumab, Pertuzumab HER2 receptor block Breast HER2+, gastric HER2+ Cardiotoxicity ECHO Q3-6 mo Hold therapy if LVEF drop; limit anthracycline overlap
CD20-mAbs Rituximab, Obinutuzumab B-cell depletion NHL, CLL Infusion reactions, HBV reactivation HBV screen, CBC Premeds: steroid + acetaminophen + H1 blocker; antiviral prophylaxis if HBV+; slow titration infusion
Checkpoint Inhibitors (ICI) Pembrolizumab, Nivolumab, Ipilimumab PD-1/PD-L1 or CTLA-4 blockade Melanoma, lung, bladder, RCC, MSI-H CRC, Hodgkin lymphoma Immune-mediated toxicities (colitis, hepatitis, thyroiditis) LFTs, TSH, cortisol, CXR if pneumonitis Immune management protocol: high-dose steroids for grade ≥ 2 toxicity; PJP prophylaxis if using steroids > 4 weeks
Antibody-Drug Conjugates (ADC) Brentuximab-vedotin, T-DM1, Enfortumab Targeted mAb + cytotoxic payload Hodgkin lymphoma, HER2+ metastatic breast, bladder Neuropathy, hepatotoxicity, cytopenias CBC, liver enzymes Neuropathy counseling; dose adjust hepatic impairment
Endocrine Therapy (Estrogen Blockade) Tamoxifen, Aromatase inhibitors, Fulvestrant ER/estrogen pathway block HR+ breast VTE risk, osteoporosis (AIs) Bone mineral density VTE prophylaxis risk review; Ca/Vit-D; bisphosphonates or denosumab if osteoporotic
Androgen-Targeting Agents Leuprolide, Abiraterone, Enzalutamide ↓ Testosterone or block AR Prostate cancer Hot flashes, metabolic syndrome, adrenal suppression (abiraterone) PSA, LFTs, BP, glucose Prednisone mandatory with abiraterone; bone protection therapy; metabolic monitoring
PARP Inhibitors Olaparib, Niraparib PARP inhibition (BRCA) Ovarian, BRCA+ breast, pancreatic, prostate Anemia, fatigue CBC RBC transfusion support; antiemetics; genetic counseling
IMiDs Lenalidomide, Pomalidomide Immunomodulation + anti-angiogenesis Multiple myeloma, MDS 5q- Cytopenias, VTE, neuropathy CBC Mandatory VTE prophylaxis (ASA or LMWH); REMS pregnancy program; antiviral prophylaxis optional

Additional Supportive Care Protocols (Quick-Use)

Supportive Care Category

Best Practices

Febrile Neutropenia

G-CSF primary prophylaxis if >20% regimen risk; empiric cefepime/zosyn; add antifungal if persistent fever

Tumor Lysis Syndrome (TLS)

Hydration, allopurinol (low–intermediate risk), rasburicase (high uric acid/high-risk lymphomas & leukemias), strict urine output monitoring

Antiemetic Strategy

High emetogenic chemo → NK1 inhibitor + 5-HT3 + dexamethasone; consider olanzapine if refractory

Mucositis

Oral cryotherapy (5-FU bolus), baking soda rinses, palifermin in HSCT

PJP/HSV/HBV Prevention

PJP: fludarabine + chronic steroids → TMP-SMX; HBV screen rituximab → prophylactic entecavir/tenofovir; HSV prophylaxis for proteasome inhibitors

 

Quick Oncology Pharmacist Application Guide

Matching Class to Tumor Biology

High-Risk Toxicity Watchpoints

Toxicity Culprit Classes Prevention
Cardiotoxicity Anthracyclines, HER2-mAbs Baseline & serial ECHO; dexrazoxane
Immune AEs Checkpoint inhibitors Early steroids, endocrine labs
Neuropathy Taxanes, vincas, platinum agents Dose-reduce if worsening
Hemorrhagic cystitis Cyclophosphamide/Ifosfamide MESNA + hydration

 

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