Many colorectal cancer patients take chemotherapy as part of their treatment plan. Join Ashley Glode, Pharm.D, as she discusses chemo information and education, supportive care management for patients, and toxicity monitoring. She will discuss the importance of communicating with your doctors and care team to ensure you stay safe and comfortable throughout your treatment plan.
2. • Speaker: Ashley Glode, PharmD
• Archived Webinars: FightColorectalCancer.org/Webinars
• AFTER THE WEBINAR: Expect an email with links to the
material & a survey. If you fill it out, we’ll send you an “I
booty” bracelet.
• Ask a question in the panel on the RIGHT SIDE of your
screen
• Follow along via Twitter – use the hashtag #CRCWebinar
Today’s Webinar:
4. Disclaimer
:
The information and services provided by Fight Colorectal
Cancer are for general informational purposes only. The
information and services are not intended to be substitutes
for professional medical advice, diagnoses or treatment.
If you are ill, or suspect that you are ill, see a doctor
immediately. In an emergency, call 911 or go to the nearest
emergency room.
Fight Colorectal Cancer never recommends or endorses any
specific physicians, products or treatments for any condition.
5. Speaker:
Ashley E. Glode, PharmD, Assistant Professor,
Department of Clinical Pharmacy, is a Board
Certified Oncology Pharmacist practicing at the
University of Colorado Cancer Center, Anschutz
Outpatient Cancer Pavilion. The services she
provides include provision of drug information and
education, supportive care management for
patients, drug counseling on chemotherapy and
investigational agents, toxicity monitoring for
patients on phase 1clinical trials and pharmacy-
based chemotherapy-induced anemia clinic.
10. TRADITIONAL CYTOTOXIC AGENTS
Fluorouracil (5-FU)
Infusion as bolus and/or continuous
Used in combination with leucovorin
Leucovorin (LV/folinic acid)
Increases efficacy of 5-FU
Capecitabine (CAP)
Given orally
Transformed into 5-FU in the body
Oxaliplatin (OX)
Infusion over 2 hours
Usually given in combination with other
agents
Irinotecan (IRI)
Infusion over 90 minutes
Rarely given alone
11. COMMON REGIMENS
FOLFOX: 5-FU, LV and oxaliplatin
FOLFIRI: 5-FU, LV and irinotecan
FOLFOXIRI: 5-FU, LV, oxaliplatin and irinotecan
CAPOX: capecitabine and oxaliplatin
12. MONOCLONAL ANTIBODIES
Bevacizumab
Infused over 30-90 minutes
Can be given in combination with any of
the chemotherapy regimens listed
previously
Ziv-aflibercept
Usually given over 60 minutes
Only in combination with FOLFIRI after
oxaliplatin-based therapy
Cetuximab
Infused over 1-2 hours
Can be given alone or in combination
with chemotherapy
Panitumumab
Infused over 1 hour
Can be given alone or in combination
with chemotherapy
13. MONOCLONAL ANTIBODIES
Nivolumab
Infused over 60 minutes
Administered as a single drug
Pembrolizumab
Infused over 30 minutes
Administered as a single drug
14. UNIQUE ORAL THERAPIES
Regorafenib
Given orally
Administered as a single drug
Option for those who have failed other
treatment options
Trifluridine + tipiracil
Given orally
Administered as a single drug
Option for those who have failed other
treatment options
17. TRADITIONAL CYTOTOXIC AGENTS: GENERAL SIDE EFFECTS
Chemo brain
Make lists
Keep a schedule of tasks
Don’t multitask
Try mind building activities
Rest
Ask for help
19. TRADITIONAL CYTOTOXIC AGENTS: GENERAL SIDE EFFECTS
Diarrhea
Irinotecan: I run to the can
Loperamide, lomotil, octreotide
Diet
Hydration
Constipation
Opioid medications
Sennosides, bisacodyl, docusate
Diet
Hydration
20. TRADITIONAL CYTOTOXIC AGENTS: GENERAL SIDE EFFECTS
Sore mouth or mouth ulcers
Mouth rinses
Diet
Avoid alcohol and tobacco
Taste changes
Mint or lemon candy
Mouth rinses
Herbs and spices
Plastic or wooden utensils
21. TRADITIONAL CYTOTOXIC AGENTS
Fluorouracil (5-FU)
Skin sensitivity to sunlight
Hand foot syndrome (palmo-plantar
erythema)
Capecitabine
Hand foot syndrome
Drug-drug interactions
Oxaliplatin
Numbness of the lips, hands or feet
Tingling of hands or feet
Sensitivity to cold
Irinotecan
Sweating
Watery eyes
Increased production of saliva
Cramping stomach pain
Diarrhea starting the day after treatment
25. MANAGEMENT OF UNIQUE SIDE EFFECTS
Hand foot syndrome
Moisturizing creams and lotions
White cotton gloves and socks
Avoid friction/ tight shoes
Cool water with washing
Acneiform rash
Topical hydrocortisone and clindamycin
Oral antibiotics: doxycycline, minocycline
NO acne medications
Keep skin well moisturized
Avoid topical agents with alcohol,
perfumes and dyes
Sunscreen
Cool water with washing
26. MANAGEMENT OF UNIQUE SIDE EFFECTS
Neuropathy
Pins and needles, numbness and tingling
Cumulative
May improve after treatment
Antidepressants, anticonvulsants,
lidocaine patches
Cold-induced neuropathy
Avoid cold 7-10 days
Have room temperature food and
beverages
Wear gloves and scarves to cover your
face
30. BEFORE STARTING THERAPY
Current Medication List
OTCs, herbals, and supplements
Vaccinations
Alcohol/Tobacco intake
Current medical history
Pregnancy and contraception
31. TEAMWORK
You are an active team member
Speak openly and honestly
Make sure you are being understood
Ask questions and gather information
Make a plan for your treatment and care
32. MAKE SURE YOU DISCUSS…
Treatment options
How side effects and symptoms will be managed
Any other issues you find important
33. PERSONAL INFORMATION TO SHARE WITH YOUR TEAM
Type of work and degree of physical work or mental stress involved
Close relatives who have had cancer and their types
Idea of how much you know about cancer and its treatment
How much you are affected by family problems, money problems, work-
related stress, or other issues
Hobbies and other interests
Goals for your quality of life during and after treatment
Desire for children in the future
Any important cultural beliefs
34. KNOW YOUR RESOURCES
Complementary and alternative therapies
Dietary/nutritional support
Emotional/social support
Financial counseling
Physical activities
Support groups
Palliative care
35. HELPFUL RESOURCES/WEBSITES
Fight Colorectal Cancer
http://fightcolorectalcancer.org/fight-it/managing-side-effects/
American Cancer Society
http://www.cancer.org/
Chemo Care
http://www.chemocare.com/about/default.aspx
National Cancer Institute: Resources for Patients
https://www.cancer.gov/resources-for/patients
Your health care team!
36. Question & Answer:
SNAP A
#STRONGARMSELFIE
Bayer HealthCare will donate $1 for every
photo posted (up to $25,000).
Flex a “strong arm” & post it to Twitter or
Instagram! (Use the hashtag!)