Drug

Vincristine

Dose-Limiting Toxicity
Peripheral/autonomic
neuropathy

Other Toxicities
Constipation, bone (jaw) pain,
ptosis, foot drop, extravasation,
alopecia

Doxorubicin

Myelosuppression,
cardiomyopathy, CHF

EKG changes, arrhythmia,

mucositis/stomatitis, n/v, red
urine, alopecia, extravasation,
2ndary AML/MDS
Mucositis/stomatitis, diarrhea,
n/v, transaminitis, renal
dysfunction, encephalopathy,
encephalopathy, ocular toxicity,
pulmonary fibrosis, osteonecrosis,
photosensitivity
Pancreatitis, venous thrombosis,
hypertriglyceridemia,
hyperglycemia, azotemia,
hyperammonemia, seizure, fever
Cerebellar toxicity, rash,
conjunctivitis, n/v, diarrhea,
metallic taste,
mucositis/stomatitis, respiratory
distress
CHF/LV dysfunction,
hepatotoxicity, QTc prolongation,
myalgia, fever, pancytopenia

Methotrexate

Asparaginase

Cytarabine

Myelosuppression

Allergic reactions

Myelosuppression

Imatinib

Edema/Fluid Retention,
pancytopenia

Dasatinib

Pleural effusion,
pancytopenia

Methylprednisolone

n/a

Less fluid retention, more

superficial edema, QTc
prolongation, thrombocytopenia,
myelosuppression
Fluid retention, hypernatremia,
HTN, impaired wound healing,

Metabolism/Elimination
CYP3A4
Fecal elimination (80%)
Renal elimination (20%)
Non-Dialyzable
CYP3A4
Biliary elimination (50%)
Renal elimination (10%)
Non-Dialyzable
Polyglutamation in
marrow progenitor cells
Renal elimination (90%)
Biliary elimination (10%)
Non-Dialyzable

Emetic Risk
Minimal

ModerateHigh
(>60mg/m2)
Minimal
(<50mg/m2)
Low
(50-250mg/m2)
Moderate
(>250mg/m2)
Minimal

Non-Dialyzable
Renal elimination (80%)

Dialyzable
Food for absorption
CYP 3A4, 2D6, 2C9 (3A4
inhibitor)
Fecal elimination (68%)
Renal elimination (13%)
Non-Dialyzable
CYP3A4 (also weak
inhibitor)
Fecal excretion (85%)
Renal excretion (4%)
CYP3A4
Renal excretion

Low
(100-200mg/m2)
Moderate
(>1g/m2)
Minimal

Minimal

n/a

Dexrazoxane

n/a

skin breakdown, lymphotoxicity,

glaucoma, PUD, mood changes,
myopathy, glaucoma, cataracts,
osteoporosis/necrosis, adrenal
insufficiency
Myelosuppression, extravasation,
2ndary AML/MDS

*Tumor Lysis Syndrome Fluids:

-2-4x maintenance: 2-4(1500mL/m2/day)
-Alkalization with NaHCO3 40-80mEq/m2/hr
*Ethnicities with likely G6PD Deficiency
-Asian, Middle Eastern, Tropical African, Papa New Guinea
*Development of late anthracycline toxicity much less common at <300mg/m2

n/a
Renal elimination (42%)