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.

1. Chemotherapy Side Effects: What
YOU Need to Know
Our webinar will begin shortly.
WELCOME!

2. • Speaker: Ashley Glode, PharmD
• Archived Webinars: FightColorectalCancer.org/Webinars
• AFTER THE WEBINAR: Expect an email with links to the
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• Ask a question in the panel on the RIGHT SIDE of your
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• Follow along via Twitter – use the hashtag #CRCWebinar
Today’s Webinar:

3. Resources:

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.

6. CHEMOTHERAPY SIDE EFFECTS
WHAT YOU NEED TO KNOW
ASHLEY GLODE, PHARMD, BCOP

7. WEBINAR ROAD MAP
Commonly
used agents
Side effects and
their management
Toxicity
monitoring
Communication
with your team

8. COMMONLY USED AGENTS

9. Traditional Cytotoxic Agents
• Fluorouracil
• Leucovorin
• Capecitabine
• Oxaliplatin
• Irinotecan
Monoclonal Antibodies
• Bevacizumab
• Ziv-aflibercept
• Cetuximab
• Panitumumab
• Nivolumab
• Pembrolizumb
Unique Oral Therapies
• Regorafenib
• Trifluridine +
tipiracil

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

15. SIDE EFFECTS AND THEIR MANAGEMENT

16. TRADITIONAL CYTOTOXIC AGENTS: GENERAL SIDE EFFECTS
 Decreased blood cell counts
 Anemia: fatigue, shortness of breath
 Transfusions, erythropoiesis-stimulating
agents (ESAs)
 Neutropenia: infection
 Granulocyte colony stimulating factors
(GCSFs), infection prophylaxis
 Thrombocytopenia: bleeding,
bruising
 Transfusions, avoid platelet inhibitors,
monitor anticoagulation closely
 Fatigue
 Exercise
 Prioritize tasks
 Naps
 Relax
 Sleep
 Eat well

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

18. TRADITIONAL CYTOTOXIC AGENTS: GENERAL SIDE EFFECTS
 Nausea/vomiting
 Serotonin receptor antagonists:
ondansetron, granisetron
 Corticosteroids: dexamethasone
 Neurokinin-1 receptor antagonists:
aprepitant, netupitant, rolapitant
 Phenothiazines: prochlorperazine,
promethazine
 Benzodiazepines: lorazepam
 Dopamine antagonists: haloperidol,
metoclopramide
 Atypical antipsychotics: olanzapine
 Ginger
 Diet
 Hydration
 Acupuncture/acupressure
 Aromatherapy

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

22. MONOCLONAL ANTIBODIES
 Bevacizumab
 Hypertension
 Proteinuria
 Rare: arterial thrombosis, mucosal
bleeding, gastrointestinal perforation,
delayed wound healing
 Ziv-aflibercept
 Fatigue
 Liver problems
 Hypertension
 Proteinuria
 Diarrhea
 Decreased blood cell counts
 Bleeding

23. MONOCLONAL ANTIBODIES
 Cetuximab and Panitumumab
 Acneiform rash
 Low magnesium
 Allergic reactions
 Nivolumab and Pembrolizumab
 Rash
 Diarrhea
 Adrenal problems
 Liver problems
 Fatigue

24. UNIQUE ORAL THERAPIES
 Regorafenib
 Hand foot syndrome
 Skin rash
 Fatigue
 Liver problems
 Hypertension
 Proteinuria
 Diarrhea
 Bleeding
 Drug-drug interactions
 Trifluridine + tipiracil
 Fatigue
 Decreased blood cell counts
 Nausea/vomiting
 Diarrhea

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

27. TOXICITY MONITORING

28. TOXICITY MONITORING
 Adverse effects
 Acute
 Delayed
 Cumulative
 Persistent
 Laboratory assessments
 CBC
 BMP/CMP: electrolytes, liver function,
renal function
 Physical exams
 Review of systems: head to toe
assessment
 Mental health/wellbeing
 Quality of life

29. COMMUNICATION WITH YOUR TEAM

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:
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37. Contact Us!