Antineoplastic Therapy and Supportive Care
Core concepts
Know drug classes and their signature toxicities: anthracyclines (cardiotoxicity), platinum (nephro/neuro/ototoxicity), taxanes (neuropathy, hypersensitivity), vinca alkaloids (vesicant, neurotoxicity), bleomycin (pulmonary fibrosis), methotrexate (mucositis, renal), and checkpoint inhibitors (immune-related adverse events). Understand antiemetic prophylaxis by emetogenicity (5-HT3 antagonist, NK1 antagonist, dexamethasone, olanzapine), growth factor use for febrile neutropenia risk, and tumor lysis syndrome prophylaxis. Extravasation management and vesicant safety are testable. Know fertility preservation, vaccination, and the principles of dose modification for organ dysfunction.
Traps
Questions test the emetogenicity classification and the correct antiemetic combination, when G-CSF is indicated (primary vs secondary prophylaxis), and recognition of immune-related colitis, pneumonitis, or hypophysitis. Watch for cumulative dose limits (e.g., doxorubicin) and for drugs requiring renal or hepatic dose adjustment.
Rule of thumb
For highly emetogenic regimens, use a three-drug (or four with olanzapine) prophylaxis; for febrile neutropenia risk ≥20%, use primary G-CSF prophylaxis.
Worked example
A patient on a highly emetogenic cisplatin regimen: NK1 antagonist + 5-HT3 antagonist + dexamethasone, with olanzapine added for added control.