Selected chemotherapeutic agents and their uses, dosages, and toxicities.
A–D
Abiraterone acetate
Use: Metastatic castration-resistant prostate cancer
Dosage: 1,000 mg PO qd (empty stomach) in combination with prednisone(Drug information on prednisone) 5 mg orally twice daily
Toxicities: Joint swelling or discomfort, hypokalemia, edema, muscle discomfort, hot flushes, diarrhea, urinary tract infection, cough, hypertension, arrhythmia, urinary frequency, nocturia, dyspepsia, upper respiratory tract infection, Increases in liver enzymes, adrenocortical insufficiency
Albumin-bound (nab) paclitaxel(Drug information on paclitaxel)
Use: Breast cancer (relapse)
Dosage: 260 mg/m2 IV over 30 min every 3 wk
Toxicities: Bone marrow depression, sensory neuropathy, arthralgia/myalgia, asthenia, abnormal ECG, alopecia
Alemtuzumab
Use: Chemotherapy-refractory B-cell chronic lymphocytic leukemia (CLL)
Dosage: Rapid daily-dose escalation, until tolerated, from 3 mg/d, and then 10 mg/d, to the recommended maintenance dose of 30 mg IV over 120 min, 3 times per wk on alternate days for up to 12 wk
Toxicities: Pancytopenia, infusion reaction, opportunistic infections, skin rash, nausea/vomiting
Altretamine
Use: Ovarian, lung, breast, and cervical cancers, non-Hodgkin lymphoma (NHL)
Dosage: 4–12 mg/kg/d or 260 mg/m2, PO divided in 3–4 doses for 14–21 d of a 28-d regimen
Toxicities: Nausea and vomiting, bone marrow depression, paresthesias, CNS toxicity
Asparaginase
Use: Acute lymphoblastic leukemia (ALL), chronic myelogenous leukemia (CML), acute myelogenous leukemia (AML)
Dosage: 6,000 IU/m2 IM 3 times weekly for 9 doses or 100 IU/kg/d IV for 10 continuous days, starting on D 22 of treatment; usually given with vincristine and prednisone
Toxicities: Allergic reactions (fever, chills, skin rash, anaphylaxis), nausea and vomiting, anorexia, liver dysfunction, CNS depression, coagulopathy, hyperglycemia
Bendamustine
Use: CLL, B-cell NHL (relapse)
Dosage: IV: 100 mg/m2 on D 1 and D 2 of a 28-d cycle, up to 6 cycles
Toxicities: Bone marrow depression, fever, nausea, and vomiting
Bevacizumab
Use: Breast cancer, colorectal cancer, non–small-cell lung cancer (NSCLC), renal cell carcinoma, glioblastoma (relapse)
Dosage: 5 mg/kg/wk IV over 60–90 min every 14–21 d
Toxicities: Asthenia, headache, epistaxis, proteinuria, GI perforations/wound-healing complications, hypertension/hypertensive crisis; hemorrhage, thromboembolic event, ovarian failure, osteonecrosis of the jaw
Bleomycin
Use: Testicular cancer, Hodgkin lymphoma (HL), reticulum cell sarcoma, lymphosarcoma, squamous cell cancer of the head and neck, skin, cervix, vulva, and penis
Dosage: 10–20 U/m2 given IV, IM, or SC weekly or twice weekly; maximum total dose, 400 U; a 2-U test dose should be given because of a possible anaphylactoid reaction
Toxicities: Pneumonitis and pulmonary fibrosis, fever and allergic reactions, anaphylaxis, hyperpigmentation, Raynaud’s phenomenon, alopecia
Bortezomib
Use: Multiple myeloma
Dosage: 1.3 mg/m2 on D 1, 4, 8, and 11 every 3 wk
Toxicities: Diarrhea, peripheral neuropathy, asthenia, fever, anorexia, Mantle cell lymphoma, nausea and vomiting, rash, headache, thrombocytopenia
Brentuximab vedotin
Use: Hodgkin lymphoma after failure of autologous stem cell transplant (ASCT) or after failure of at least 2 prior multiagent chemotherapy regimens in patients who are not ASCT candidates; The treatment of patients with systemic anaplastic large-cell lymphoma after failure of at least 1 prior multiagent chemotherapy regimen.
Dosage: 1.8 mg/kg IV infusion over 30 minutes every 3 weeks (maximum 16 cycles)
Toxicities: Neutropenia, peripheral sensory neuropathy, abdominal pain, fatigue, nausea, anemia, upper respiratory tract infection, diarrhea, pyrexia, rash, thrombocytopenia, cough, vomiting
Busulfan
Use: CML, bone marrow transplantation (BMT) for refractory leukemia, lymphomas
Dosage: 2–8 mg PO daily for remission induction; adjust dosage to white blood cell (WBC) count; 1–3 mg PO daily for maintenance; withhold induction if WBC count < 15,000/µL; resume therapy when WBC count > 50,000/µL
Toxicities: Bone marrow depression, pulmonary fibrosis, aplastic anemia, amenorrhea, gynecomastia, skin hyperpigmentation
Cabazitaxel
Use: Hormone-refractory metastatic prostate cancer previously treated with docetaxel(Drug information on docetaxel) regimens
Dosage: 25 mg/m2 IV every 3 weeks in combination with prednisone 10 mg PO daily throughout cabazitaxel treatment. Premedicate 30 minutes before each dose with antihistamine, corticosteroid, and H2 antagonist.
Toxicities: Febrile neutropenia (primary G-CSF prophylaxis should be considered in high-risk patients), nausea, vomiting, diarrhea, renal failure, hypersensitivity reactions
Capecitabine
Use: Breast cancer (relapsed), colorectal cancer, and other GI malignancies
Dosage: 1,250 mg/m2 bid PO with food (2 wk on drug, 1 wk of rest)
Toxicities: Diarrhea, stomatitis, nausea and vomiting, fatigue, hand-foot syndrome, bone marrow depression (minimal)
Carboplatin*
Use: Ovarian cancer; endometrial, head and neck, lung, testicular, and breast cancers; relapsed acute leukemia, NHL
Dosage: Single agent: 360 mg/m2 IV every 4 wk
Combination: 300 mg/m2 IV every 4 wk
Calvert formula: Total dose (mg) = Target area under the curve (AUC) × (glomerular filtration rate [GFR] + 25)
Toxicities: Bone marrow depression, nausea and vomiting, peripheral neuropathy, ototoxicity
*Total carboplatin(Drug information on carboplatin) dose calculation based on isotope dilution mass spectrometry (IDMS)-measured serum creatinine using the Calvert formula may result in overestimation of the GFR in some patients with normal renal function, and therefore increased drug-related toxicity. When actual GFR measurements are made to assess renal function, carboplatin can be safely dosed as outlined in the package insert.
Carmustine
Use: Brain tumor, multiple myeloma, HL, NHL, melanoma, BMT for refractory solid tumors and lymphomas
Dosage: 150–200 mg/m2 IV every 6–8 wk
Toxicities: Delayed bone marrow depression, nausea and vomiting, reversible hepatotoxicity, local phlebitis, pulmonary and renal damage (high dose)
Cetuximab
Use: KRAS wild type colorectal cancer, head and neck cancer
Dosage: 400 mg/m2 IV over 120 min, loading dose, and 250 mg/m2 IV over 60 min every 7 d, as maintenance
Toxicities: Skin rash, infusion reaction, asthenia, diarrhea, nausea, hypomagnesemia
Chlorambucil
Use: CLL, HL, NHL, ovarian cancer, choriocarcinoma, lymphosarcoma
Dosage: 0.1–0.2 mg/kg PO daily for 3–6 wk as required (usually 4–10 mg/d) or intermittent 0.4 mg/kg every 3–4 wk; increase by 0.1 mg/kg until control of disease or toxicity
Toxicities: Bone marrow depression, gonadal dysfunction, leukemia, hyperuricemia, pulmonary fibrosis
Cisplatin
Use: Testicular, ovarian, bladder, uterine, cervical, and lung cancers, squamous cell cancer of the head and neck, sarcoma, NHL
Dosage: 50 mg/m2 IV or more every 3 wk; or 20 mg/m2 IV daily for 4–5 d every 3–4 wk; give vigorous hydration before and after chemotherapy
Toxicities: Renal damage, nausea and vomiting, electrolyte disturbance, peripheral neuropathy, bone marrow depression, ototoxicity, radiosensitizer
Cladribine
Use: Hairy-cell leukemia, NHL, mycosis fungoides, AML, CML, CLL
Dosage: 0.09 mg/kg/d (4 mg/m2/d) by continuous IV infusion for 7 consecutive days
Toxicities: Bone marrow depression, febrile episodes, rash, infections, septicemia
Crizotinib
Use: NSCLC anaplastic lymphoma kinase (ALK)-mutation positive
Dosage: 250 mg orally twice daily
Toxicities: Vision disorder, nausea, diarrhea, vomiting, edema, constipation, increased ALT, neutropenia, pneumonitis
Cyclophosphamide
Use: AML, ALL, CLL, HL, and NHL, multiple myeloma, mycosis fungoides, neuroblastoma, ovarian and breast cancers, retinoblastoma, lung, testicular, and bladder cancers, sarcoma
Dosage: 40–50 mg/kg IV in divided doses over 2–5 d to start, followed by 10–15 mg/kg IV every 7–10 d; or 3–5 mg/kg IV twice weekly; or 1–5 mg/kg/d PO
Toxicities: Bone marrow depression, hemorrhagic cystitis, immunosuppression, alopecia, stomatitis, syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Cytarabine (Ara-C)
Use: AML, ALL, CML, NHL, CNS leukemia (intrathecal)
Dosage: AML induction: 100 mg/m2/d by continuous IV infusion on D 1–7; or 100 mg/m2 IV every 12 h on D 1–7; Relapsed ALL: 3 g/m2 IV over 1–3 h every 12 h for 4 doses
Toxicities: Bone marrow depression, nausea and vomiting, diarrhea, arachnoiditis (intrathecal), stomatitis, hepatic dysfunction, fever, conjunctivitis, confusion, somnolence, cerebellar toxicity
Dacarbazine
Use: Malignant melanoma, HL, soft-tissue sarcomas, neuroblastoma
Dosage: Melanoma: 2–4.5 mg/kg/d IV for 10 d every 4 wk; or 250 mg/m2/d IV for 5 d every 3 wk
HL: 375 mg/m2 IV on D 1, repeated every 15 d (single agent); 150 mg/m2/d IV for 5 d every 4 wk (combination therapy)
Toxicities: Bone marrow depression, nausea and vomiting, flu-like syndrome, transient hepatotoxicity, local irritation, facial flushing, alopecia
Dactinomycin
Use: Testicular cancer, gestational trophoblastic tumors, Wilms’ tumor, rhabdomyosarcoma, Ewing sarcoma
Dosage: 0.010–0.015 mg/kg IV daily for 5 d every 3 wk (usual adult dose, 0.5 mg) or 2 mg/m2 IV as a single dose every 3–4 wk
Toxicities: Stomatitis, bone marrow depression, anorexia, nausea and vomiting, diarrhea, alopecia, skin changes, anaphylactoid reaction
Dasatinib
Use: CML, Ph+ ALL
Dosage: 140 mg/d (divided doses; 70 mg bid) or 100 mg/d PO (chronic phase CML)
Toxicities: Fluid-retention events (eg, pleural effusion); GI events: diarrhea, nausea, abdominal pain, vomiting; bleeding events; hematologic toxicities: neutropenia, thrombocytopenia, anemia
Daunorubicin
Use: AML, ALL
Dosage: Remission induction: 30–45 mg/m2/d IV for 3 d in combination therapy; total cumulative dose, 550 mg/m²
Toxicities: Bone marrow depression, cardiotoxicity, alopecia, nausea and vomiting, diarrhea, stomatitis, fever, dermatitis at previously irradiated sites, red urine, anaphylactoid reaction
DaunoXome (liposomal daunorubicin(Drug information on daunorubicin))
Use: Kaposi sarcoma, ALL, AML
Dosage: Liposomal preparation: 40 mg/m2 IV every 2 wk
DepoCyt (liposomal cytarabine)
Use: CNS leukemia/lymphoma
Dosage: Intrathecal: DepoCyt, 50 mg over 1–5 min every 14 d, with dexamethasone(Drug information on dexamethasone), 4 mg PO bid × 5 d
Docetaxel
Use: Breast, NSCLC, prostate, ovarian, pancreatic, head and neck, esophagus, stomach, cervical, Kaposi sarcoma, uterine, and bladder cancers
Dosage: 60–100 mg/m2 IV over 1 h every 21 d or up to 42 mg/m2 IV every wk
Toxicities: Bone marrow depression, fluid retention, hypersensitivity reaction, paresthesias, rash, alopecia, myalgias
Doxil (liposomal doxorubicin(Drug information on doxorubicin))
Use: Ovarian cancer (refractory to paclitaxel- and platinum-based regimens), Kaposi sarcoma, breast cancer, multiple myeloma
Dosage: 50 mg/m2 IV every 4 wk 20 mg/m2 IV every 3 wk
Toxicities: Bone marrow depression, hand-foot syndrome, infusional reactions
Doxorubicin
Use: ALL, AML, breast, ovarian, bladder cancers, HL, NHL, small-cell lung cancer (SCLC), gastric cancer, sarcoma, Wilms’ tumor, neuroblastoma, thyroid cancer, soft-tissue and bone sarcomas
Dosage: 60–90 mg/m2 single IV injection every 21 d, 20–30 mg/m2/d IV for 3 d every 3–4 wk, or 20 mg/m2 IV weekly; total cumulative dose of 550 mg/m2; reduce dose for liver dysfunction
Toxicities: Bone marrow depression, cardiotoxicity, stomatitis (continuous infusion), alopecia, nausea and vomiting, diarrhea, fever, dermatitis at previously irradiated sites, red urine, anaphylactoid reaction
