🔑 Key Learning

  • Anthracyclines like doxorubicin → cardiotoxicity.
  • Bleomycin → pulmonary fibrosis.
  • Vincristine → peripheral neuropathy.
  • Cyclophosphamide → haemorrhagic cystitis.
    • Prevent with mesna co-prescription 
  • Cisplatin → nephrotoxicity, ototoxicity, and electrolyte disturbances.

🧪 Drug-Specific Toxicities

Vincristine

  • Peripheral neuropathy (glove and stocking pattern)
  • Common uses: Acute lymphoblastic leukaemia (ALL), chronic myeloid leukaemia (CML), lymphomas

Cisplatin

  • Nephrotoxicity
  • Ototoxicity (sensorineural hearing loss)
  • Peripheral neuropathy
  • Electrolyte abnormalities: hypomagnesaemia, hypokalaemia, hypocalcaemia
  • Pre-hydration protocols often used to reduce renal toxicity

Bleomycin

  • Pulmonary fibrosis
  • Baseline and follow-up pulmonary function tests (PFTs) are recommended
  • Classic MCQ clue: dry cough and exertional dyspnoea in a patient post chemo

Doxorubicin (Anthracyclines)

  • Acute cardiotoxicity (e.g. myopericarditis): presents with chest pain, palpitations, arrhythmia within days
  • Long-term cardiomyopathy
  • Other anthracyclines: daunorubicin, epirubicin
  • Baseline echocardiography is essential before treatment

Cyclophosphamide

  • Haemorrhagic cystitis
    • Caused by toxic metabolite acrolein
  • Prevented by co-prescribing Mesna (binds and detoxifies acrolein in urine)

Dexamethasone (Decadron)

  • Water retention: facial puffiness, ankle swelling
  • Hyperglycaemia
  • Also associated with mood changes, insomnia, and increased appetite with longer use

Chemotox Man


Figure 199: Chemotox Man

      

đź“ť Exam Clues & Clinchers

  • Peripheral neuropathy = vincristine or cisplatin
  • Ototoxicity + renal failure + low magnesium = cisplatin
  • Dry cough + SOB = bleomycin
  • Chest pain 2–3 days post-chemotherapy = doxorubicin
  • Haematuria on chemotherapy = cyclophosphamide
    • Prevent with Mesna co-prescription 
  • Puffy face + hyperglycaemia = dexamethasone