Cytostatics and Immunosuppressive Drugs: Toxicities and Management

The document from 1989 details the toxicities associated with various cytostatic and immunosuppressive drugs, highlighting cardiovascular, pulmonary, neurotoxic, and systemic side effects. Amsacrine can cause fatal ventricular dysrhythmias, which can be mitigated by correcting electrolyte imbalances. Cisplatin, bleomycin, and vinblastine are linked to life-threatening arterial diseases, with 21 cases and 5 deaths reported. Doxorubicin's cardiotoxicity is dose-limiting, but ICRF-187 has shown promise in reducing its clinical cardiotoxicity in a trial with 82 patients. Fluorouracil and floxuridine can cause cardiac symptoms in up to 1.5% of patients. Interleukin-2 may lead to 'vascular leak syndrome,' and mitoxantrone's cardiotoxicity risk increases with prior doxorubicin treatment. Bleomycin is associated with pulmonary toxicity, and ciclosporin can cause adult respiratory distress syndrome. Neurotoxicity is a concern with carmustine and cisplatin, the latter particularly causing peripheral neuropathy. The document also discusses the nephrotoxicity of cisplatin and ciclosporin, the neurotoxicity of cytarabine and vincristine, and the hepatotoxicity of various drugs, including cyclophosphamide, ifosfamide, dactinomycin, azathioprine, and methotrexate. It notes the potential of 5-HT3 antagonists as antiemetics and GMCSF to improve white cell counts, despite associated toxicity. The document underscores the necessity of careful monitoring and management of these side effects to enhance patient care.