Alkylating Agents—Nitrogen Mustards |
| Bendamustine (Treanda) | 100–120 mg/m2 intravenously every 3–4 weeks | Acute: hypersensitivity, nausea, vomiting Delayed: myelosuppression, rash, pyrexia, fatigue |
| Cyclophosphamide (Cytoxan) | 500–1000 mg/m2 intravenously every 3 weeks; 100 mg/m2/day orally for 14 days every 4 weeks; various doses | Acute: nausea and vomiting Delayed: myelosuppression, alopecia, hemorrhagic cystitis, cardiotoxicity (high dose) |
| Ifosfamide (Ifex) | 1200 mg/m2 intravenously daily for 5 days every 3 weeks; various doses | Acute: nausea and vomiting Delayed: alopecia, myelosuppression, hemorrhagic cystitis, neurotoxicity |
| Melphalan (Alkeran) | 0.25 mg/kg/day or 8–10 mg/m2/day orally for 4 days every 4–6 weeks; 16 mg/m2 intravenously every 2–4 weeks; various doses | Acute: nausea, vomiting, diarrhea, hypersensitivity (intravenously) Delayed: mucositis (intravenously), myelosuppression, increased risk of secondary malignancies |
Alkylating Agents—Platinum Analogs |
| Carboplatin (Paraplatin) | Area under the curve (AUC)-based dosing use Calvert equation [Dose (mg) = AUC × (GFR + 25)] AUC = 2–7 mg/mL/min every 2–4 weeks | Acute: nausea and vomiting Delayed: myelosuppression, electrolyte disturbances, peripheral neuropathy, nephrotoxicity, hypersensitivity |
| Cisplatin (Platinol) | 50–100 mg/m2 intravenously every 3–4 weeks; 20 mg/m2/day intravenously for 5 days every 3 weeks; various doses | Acute: nausea and vomiting Delayed: nephrotoxicity, ototoxicity, neurotoxicity, myelosuppression, electrolyte disturbances |
| Oxaliplatin (Eloxatin) | 85–130 mg/m2 intravenously every 2–3 weeks | Acute: peripheral neuropathy exacerbated by cold, nausea, vomiting, diarrhea Delayed: myelosuppression, elevated transaminases |
Alkylating Agents—Triazenes |
| Dacarbazine (DTIC-Dome) | 375 mg/m2 intravenously on days 1 and 15 every 4 weeks; 900–1000 mg/m2 intravenously over 3 to 4 days; various doses | Acute: nausea, vomiting, photosensitivity Delayed: myelosuppression, anorexia, hypotension, flu-like syndrome |
| Procarbazine (Matulane) | 60–100 mg/m2 orally for 14 days every 4 weeks; various doses | Acute: nausea and vomiting Delayed: myelosuppression, disulfiram-like reaction, MAO inhibition, rash |
| Temozolomide (Temodar) | 75 mg/m2 orally daily during radiation for 42 days; 150–200 mg/m2 orally for 5 days every 4 weeks | Acute: nausea, vomiting, constipation Delayed: myelosuppression, fatigue |
Alkylating Agent—Miscellaneous |
| Chlorambucil (Leukeran) | 0.1–0.2 mg/kg/day orally for 3–6 weeks; 0.4 mg/kg pulse every 4 weeks | Acute: nausea Delayed: myelosuppression, rash |
Antimetabolites—Folate Antagonists |
| Methotrexate (MTX; Trexall) | Intrathecal: 12 mg High dose: 1000–12,000 mg/m2 intravenously every 2–3 weeks | Acute: nausea, vomiting, mucositis Delayed: myelosuppression, nephrotoxicity, hepatotoxicity, neurotoxicity, photosensitivity, pulmonary toxicity |
| Pemetrexed (Alimta) | 500 mg/m2 intravenously every 3 weeks | Acute: nausea, vomiting, diarrhea, rash Delayed: myelosuppression, fatigue, mucositis |
Antimetabolites—Purine Analogs |
| Cladribine (Leustatin) | 0.1 mg/kg/day subcutaneously daily for 5 days or 0.09 mg/kg/day intravenously via continuous infusion for 7 days | Acute: nausea, injection site reaction Delayed: myelosuppression, immunosuppression, fever, fatigue, rash |
| Fludarabine (Fludara) | 25 mg/m2 intravenously for 5 days every 4 weeks | Acute: fever, nausea, vomiting Delayed: asthenia, myelosuppression, immunosuppression, neurotoxicity, anorexia |
| Mercaptopurine (6-MP; Purinethol) | Induction: 2.5–5 mg/kg/day orally Maintenance: 1.5–2.5 mg/kg/day orally | Acute: nausea, vomiting, diarrhea, rash Delayed: myelosuppression, immunosuppression, hepatotoxicity, mucositis |
Antimetabolites—Pyrimidine Analogs |
| Azacitidine (Vidaza) | 75–100 mg/m2 subcutaneously or intravenously for 7 days every 4 weeks | Acute: injection site reaction (subcutaneously), nausea, diarrhea, fever Delayed: myelosuppression, dyspnea, arthralgia |
| Capecitabine (Xeloda) | 1000–1250 mg/m2 orally twice a day for 14 days every 3 weeks | Acute: nausea, vomiting, diarrhea Delayed: hand-foot syndrome, mucositis, hyperbilirubinemia, myelosuppression |
| Cytarabine (Ara-C, Cytosar U) | Standard dose: 100 mg/m2/day intravenously via continuous infusion for 7 days High dose: 1000–3000 mg/m2 intravenously every 12 hours for 2–6 days | Acute: nausea, vomiting, rash, flu-like syndrome Delayed: myelosuppression High-dose: neurotoxicity, ocular toxicities |
| Decitabine (Dacogen) | 15 mg/m2 intravenously every 8 hours for 3 days every 8 weeks; 20 mg/m2 intravenously daily for 5 days | Acute: nausea, vomiting, hyperglycemia Delayed: myelosuppression, fever, fatigue, cough |
| Fluorouracil (Adrucil) | 400 mg/m2 intravenous bolus followed by 2400 mg/m2 intravenously over 46 hours every 2 weeks; 1000 mg/m2 intravenously via continuous infusion for 4–5 days every 3–4 weeks; various doses | Acute: nausea, vomiting, diarrhea Delayed: myelosuppression, hand-foot syndrome, mucositis, photosensitivity, cardiotoxicity (rare) |
| Gemcitabine (Gemzar) | 1000–1250 mg/m2 intravenously on days 1 and 8 every 3 weeks or days 1, 8, 15 every 4 weeks | Acute: nausea, vomiting, rash, flu-like symptoms, fever, diarrhea Delayed: myelosuppression, edema, elevated transaminases |
Antimicrotubules—Vinca Alkaloids |
| Vinblastine (Velban) | 6 mg/m2 intravenously on days 1 and 15 every 4 weeks; various doses | Acute: constipation Delayed: myelosuppression, alopecia, bone pain, malaise |
| Vincristine (Oncovin) | 0.5–1.4 mg/m2 intravenously every 3 weeks; various doses; maximum single dose usually limited to 2 mg | Acute: constipation, nausea Delayed: peripheral neuropathy, alopecia |
| Vinorelbine (Navelbine) | 25–30 mg/m2 intravenously weekly | Acute: nausea, vomiting Delayed: myelosuppression, peripheral neuropathy, constipation, alopecia, asthenia |
Antimicrotubules—Taxanes |
| Docetaxel (Taxotere) | 60–100 mg/m2 intravenously every 3 weeks | Acute: nausea, vomiting, diarrhea, hypersensitivity, rash Delayed: myelosuppression, asthenia, peripheral neuropathy, alopecia, edema, mucositis |
| Paclitaxel (Taxol) | 135–175 mg/m2 intravenously every 3 weeks; 50–80 mg/m2 intravenously weekly; various doses | Acute: diarrhea, nausea, vomiting, hypersensitivity Delayed: myelosuppression, peripheral neuropathy, alopecia, mucositis, arthralgia |
| Paclitaxel protein-bound (Abraxane) | 100–125 mg/m2 on days 1, 8, 15 every 3–4 weeks; 260 mg/m2 intravenously every 3 weeks | Acute: nausea, vomiting, diarrhea Delayed: myelosuppression, peripheral neuropathy, alopecia, asthenia |
Enzyme Inhibitors—Anthracyclines |
| Daunorubicin (Cerubidine) | 30–60 mg/m2 intravenously for 3 days | Acute: nausea, vomiting, diarrhea, red/orange discoloration of urine, infusion-related reactions (liposomal products) Delayed: myelosuppression, mucositis, alopecia, hand-foot syndrome (liposomal doxorubicin), cardiotoxicity (dose related) |
| Doxorubicin (Adriamycin) | 45–75 mg/m2 intravenously every 3 weeks; various doses | |
| Epirubicin (Ellence) | 60–120 mg/m2 intravenously every 3–4 weeks | |
| Idarubicin (Idamycin) | 10–12 mg/m2 intravenously for 3 days | |
| Liposomal doxorubicin (Doxil, Lipodox) | 20–50 mg/m2 intravenously every 3–4 weeks | |
Enzyme Inhibitors—Topoisomerase Inhibitors |
| Etoposide (Vepesid) | 50–100 mg/m2 intravenously for 3–5 days every 3 weeks | Acute: nausea, vomiting, diarrhea, hypersensitivity, fever, hypotension Delayed: myelosuppression, alopecia, fatigue |
| Irinotecan (Camptosar) | 180 mg/m2 intravenously every other week; various doses | Acute: diarrhea, cholinergic syndrome, nausea, vomiting Delayed: myelosuppression, alopecia, asthenia |
| Topotecan (Hycamtin) | 1.5 mg/m2 intravenously for 5 days every 3 weeks; 2.3 mg/m2 orally for 5 days every 3 weeks | Acute: nausea, vomiting, diarrhea Delayed: myelosuppression, alopecia, asthenia |
Targeted Therapy—Monoclonal Antibodies |
| Alemtuzumab (Campath) | 3–10 mg intravenously or subcutaneously three times weekly | Acute: infusion-related reaction, nausea, vomiting, hypotension, rash Delayed: myelosuppression, immunosuppression |
| Atezolizumab (Tecentriq) | 1200 mg intravenously every 3 weeks | Acute: infusion-related reaction Delayed: immune-mediated reactions, fatigue, decreased appetite |
| Bevacizumab (Avastin) | 5–15 mg/kg intravenously every 2–3 weeks | Acute: infusion-related reaction Delayed: hypertension, proteinuria, wound healing complications, gastrointestinal perforation, hemorrhage |
| Cetuximab (Erbitux) | Loading dose 400 mg/m2 intravenously, maintenance dose 250 mg/m2 intravenously weekly | Acute: infusion-related reaction, nausea, diarrhea Delayed: acneiform skin rash, hypomagnesemia, asthenia, paronychial inflammation, dyspnea |
| Daratumumab (Darzalex) | 16 mg/kg intravenously weekly for weeks 1–8, every 2 weeks for weeks 9–24, and every 4 weeks from week 25 until disease progression | Acute: infusion-related reaction, nausea Delayed: myelosuppression, fatigue, upper respiratory tract infection |
| Ipilimumab (Yervoy) | 1–10 mg/kg intravenously every 3 weeks for a total of four doses | Acute: infusion-related reaction Delayed: immune-related reactions, fatigue |
| Nivolumab (Opdivo) | 240 mg intravenously every 2 weeks or 480 mg every 4 weeks | Acute: vomiting Delayed: fatigue, musculoskeletal pain, rash, pruritus, cough, elevated transaminases |
| Obinutuzumab (Gazyva) | Cycle 1: 100 mg intravenously on day 1, 900 mg on day 2, 1000 mg on days 8 and 15 of a 28-day cycle; cycles 2–6: 1000 mg intravenously on day 1 | Acute: infusion-related reaction, tumor lysis syndrome Delayed: myelosuppression, pyrexia, cough, musculoskeletal disorder, potential hepatitis B reactivation |
| Panitumumab (Vectibix) | 6 mg/kg intravenously every 2 weeks | Acute: infusion-related reaction, nausea Delayed: acneiform skin rash, hypomagnesemia, asthenia, paronychia, fatigue, dyspnea |
| Pembrolizumab (Keytruda) | 200 mg intravenously every 3 weeks | Acute: infusion-related reaction, nausea Delayed: immune-mediated reactions, fatigue, cough |
| Pertuzumab (Perjeta) | 840 mg intravenously once followed by 420 mg intravenously every 3 weeks | Acute: infusion-related reaction, diarrhea, nausea Delayed: fatigue, alopecia, neutropenia, rash, peripheral neuropathy, cardiomyopathy |
| Rituximab (Rituxan) | 375 mg/m2 intravenously weekly for 4 weeks, or every 3–4 weeks | Acute: infusion-related reaction, tumor lysis syndrome Delayed: lymphopenia, asthenia, rash, potential hepatitis B reactivation |
| Trastuzumab (Herceptin) | Initial dose 4 mg/kg intravenously, then 2 mg/kg intravenously weekly; or initial dose 8 mg/kg, then 6 mg/kg, intravenously every 3 weeks | Acute: headache, nausea, diarrhea, infusion-related reaction Delayed: myelosuppression, pyrexia, cardiomyopathy, pulmonary toxicity (rare) |
Targeted Therapy—Kinase Inhibitors |
| Afatinib (Gilotrif) | 40 mg orally once daily without food | Acute: diarrhea Delayed: acneiform rash, stomatitis, paronychia |
| Alectinib (Alecensa) | 600 mg orally twice daily with food | Acute: none Delayed: myelosuppression, fatigue, edema, myalgia, dyspnea, elevated transaminases |
| Axitinib (Inlyta) | 5–10 mg orally twice daily | Acute: diarrhea, nausea, vomiting Delayed: hypertension, fatigue, dysphonia, hand-foot syndrome, elevated transaminases |
| Bosutinib (Bosulif) | 500–600 mg orally once daily with food | Acute: diarrhea, nausea, vomiting Delayed: myelosuppression, rash, abdominal pain, hepatotoxicity, fluid retention |
| Ceritinib (Zykadia) | 740 mg orally once daily | Acute: diarrhea, nausea, vomiting Delayed: elevated transaminases, abdominal pain, fatigue, decreased appetite |
| Cobimetinib (Cotellic) | 60 mg orally once daily on days 1 to 21 of a 28-day cycle | Acute: diarrhea, photosensitivity reaction, nausea, vomiting Delayed: myelosuppression, hepatotoxicity, rash, cardiomyopathy (with vemurafenib) |
| Crizotinib (Xalkori) | 250 mg orally twice daily | Acute: nausea, vomiting, diarrhea, constipation Delayed: vision disorder, edema, elevated transaminases, fatigue |
| Dabrafenib (Tafinlar) | 150 mg orally twice daily without food | Acute: headache Delayed: hyperkeratosis, fever, hand-foot syndrome, hyperglycemia, hypophosphatemia |
| Dacomitinib (Vizimpro) | 45 mg orally once daily | Acute: diarrhea Delayed: rash, paronychia, mucositis, cough, interstitial lung disease |
| Dasatinib (Sprycel) | 100–180 mg orally once daily | Acute: diarrhea, nausea, vomiting Delayed: myelosuppression, fluid retention, fatigue, dyspnea, musculoskeletal pain, rash |
| Entrectinib (Rozlytrek) | 600 mg orally daily | Acute: nausea, vomiting, diarrhea Delayed: fatigue, cognitive impairment, congestive heart failure, potential for birth defects, hepatotoxicity, vision disorder, prolonged QT interval (rare) |
| Erlotinib (Tarceva) | 100 or 150 mg orally once daily without food | Acute: diarrhea, nausea, vomiting Delayed: acneiform skin rash, fatigue, anorexia, dyspnea |
| Everolimus (Afinitor) | 10 mg orally once daily | Acute: mucositis, diarrhea, nausea Delayed: myelosuppression, fatigue, edema, hypercholesterolemia, hypertriglyceridemia, hyperglycemia |
| Gefitinib (Iressa) | 250 mg orally once daily | Acute: diarrhea Delayed: acneiform skin rash |
| Ibrutinib (Imbruvica) | 420 or 560 mg orally once daily | Acute: diarrhea, nausea Delayed: myelosuppression, fatigue, edema, rash, elevated serum creatinine, hemorrhage |
| Imatinib (Gleevec) | 100–800 mg orally once daily with food | Acute: nausea, vomiting, diarrhea Delayed: edema, muscle cramps, rash, myelosuppression, hepatotoxicity |
| Larotrectinib (Vitrakvi) | 100 mg orally twice daily | Acute: nausea, vomiting, diarrhea Delayed: fatigue, cognitive impairment, potential for birth defects, hepatotoxicity |
| Lenvatinib (Lenvima) | 24 mg orally daily | Acute: hypertension, nausea, vomiting, diarrhea Delayed: fatigue, arthralgia/myalgia, stomatitis, hand-foot syndrome |
| Nilotinib (Tasigna) | 300 or 400 mg orally twice daily without food | Acute: nausea, vomiting, diarrhea Delayed: rash, fatigue, myelosuppression, prolonged QT interval (rare) |
| Osimertinib (Tagrisso) | 80 mg orally once daily | Acute: diarrhea Delayed: myelosuppression, rash, dry skin, nail toxicity, cardiomyopathy (rare), QTc interval prolongation (rare) |
| Pazopanib (Votrient) | 800 mg orally once daily without food | Acute: diarrhea, nausea, vomiting Delayed: hypertension, hair color changes, hepatotoxicity, hemorrhage |
| Regorafenib (Stivarga) | 160 mg orally once daily with food (low-fat breakfast) | Acute: diarrhea Delayed: asthenia, hand-foot syndrome, anorexia, hypertension, mucositis, myelosuppression, hepatotoxicity |
| Sorafenib (Nexavar) | 400 mg orally twice daily without food | Acute: diarrhea and nausea Delayed: fatigue, hand-foot syndrome, rash, hypertension, hemorrhage |
| Sunitinib (Sutent) | 50 mg orally once daily for 4 weeks followed by 2 weeks rest; 37.5 mg orally daily | Acute: diarrhea and nausea Delayed: hypertension, hand-foot syndrome, rash, yellow discoloration of skin, fatigue, hypothyroidism, mucositis, left ventricular dysfunction, bleeding, hepatotoxicity |
| Trametinib (Mekinist) | 2 mg orally once daily without food | Acute: rash, diarrhea Delayed: elevated transaminases, lymphedema, cardiomyopathy |
| Vemurafenib (Zelboraf) | 960 mg orally twice daily | Acute: nausea, hypersensitivity (rare) Delayed: photosensitivity, rash, arthralgia, alopecia, fatigue, prolonged QT interval, cutaneous squamous cell carcinoma |
Miscellaneous Agents |
| Abiraterone (Zytiga) | 1000 mg orally once daily | Acute: diarrhea, edema Delayed: adrenal insufficiency, hepatotoxicity, joint pain, hypokalemia |
| Arsenic trioxide (Trisenox) | 0.15 mg/kg intravenously daily | Acute: nausea, dizziness Delayed: acute promyelocytic leukemia differentiation syndrome, prolonged QT interval |
| Bleomycin (Blenoxane) | 10 units/m2 intravenously on days 1 and 15 every 28 days; 30 units intravenously on days 2, 9, and 16 every 21 days | Acute: hypersensitivity, fever Delayed: skin reaction (rash, hyperpigmentation of skin, striae), mucositis, pneumonitis |
| Bortezomib (Velcade) | 1.3 mg/m2 intravenous bolus or subcutaneously on days 1, 4, 8, 11 followed by a 10-day rest, or weekly for 4 weeks followed by 13-day rest | Acute: nausea, vomiting, diarrhea Delayed: peripheral neuropathy, fatigue, myelosuppression |
| Dactinomycin (Cosmegen) | 15 mcg/kg or 400–600 mcg/m2 intravenously daily for 5 days | Acute: nausea, vomiting Delayed: myelosuppression, mucositis, rash, diarrhea, hepatoveno-occlusive disease (rare) |
| Hydroxyurea (Hydrea) | 20–30 mg/kg orally daily | Acute: none Delayed: myelosuppression |
| Lenalidomide (Revlimid) | 5–25 mg orally once daily on days 1–21 of 28-day cycle; or continuously | Acute: diarrhea, rash Delayed: myelosuppression, fatigue, venous thromboembolism, potential for birth defects |
| Mitomycin (Mutamycin) | 10–20 mg/m2 intravenously every 4–8 weeks; 20–40 mg intravesically | Acute: cystitis (intravesically), nausea, vomiting Delayed: myelosuppression, mucositis, anorexia |
| Olaparib (Lynparza) | 400 mg orally twice daily | Acute: nausea, vomiting, diarrhea Delayed: myelosuppression, elevated serum creatinine, MCV elevation, fatigue, abdominal pain |
| Pegaspargase (Oncaspar) | 2000–2500 international units/m2 intramuscularly every 14 days | Acute: hypersensitivity Delayed: febrile neutropenia, coagulation abnormalities, hepatotoxicity, pancreatitis |
| Tretinoin (All-Trans-Retinoic Acid, ATRA, Vesanoid) | 45 mg/m2 orally divided twice daily for 45–90 days or 30 days past complete remission | Acute: headache, nausea Delayed: vitamin A toxicity, retinoic acid-acute promyelocytic leukemia syndrome |
| Venetoclax (Venclexta) | 20 mg orally daily during week 1; 50 mg daily during week 2; 100 mg daily during week 3; 200 mg daily during week 4; then 400 mg orally daily thereafter | Acute: diarrhea, nausea, vomiting, tumor lysis syndrome Delayed: myelosuppression, upper respiratory infections, fatigue |
Antiandrogens |
| Apalutamide (Erleada) | 240 mg orally daily | Acute: fatigue, diarrhea Delayed: arthralgia, hot flashes, falls, peripheral edema, seizure (rare) |
| Bicalutamide (Casodex) | 50 mg orally once daily | Acute: none Delayed: hot flashes, back pain, asthenia |
| Enzalutamide (Xtandi) | 160 mg orally once daily | Acute: asthenia, diarrhea Delayed: hot flashes, arthralgia, peripheral edema, seizure (rare) |
| Flutamide (Eulexin) | 250 mg orally every 8 hours | Acute: diarrhea Delayed: hot flashes, hepatotoxicity |
| Nilutamide (Nilandron) | 300 mg orally for 30 days, then 150 mg orally once daily | Acute: none Delayed: visual disturbances (impaired adaptation to dark), hot flashes, disulfiram-like reaction |
Selective Estrogen Receptor Modulators |
| Tamoxifen (Nolvadex) | 20–40 mg orally once daily | Acute: none Delayed: hot flashes, vaginal discharge, menstrual irregularities, arthralgia |
Aromatase Inhibitors |
| Anastrozole (Arimidex) | 1 mg orally once daily | Acute: nausea Delayed: hot flashes, peripheral edema, asthenia, hypercholesterolemia, arthralgia/myalgia, osteoporosis |
| Exemestane (Aromasin) | 25 mg orally once daily | |
| Letrozole (Femara) | 2.5 mg orally once daily | |
Pure Estrogen Receptor Antagonist |
| Fulvestrant (Faslodex) | 500 mg intramuscularly on days 1, 15, 29, then monthly | Acute: injection site reaction, nausea Delayed: hot flashes, bone pain, elevated transaminases |
LHRH Analogs |
| Goserelin acetate (Zoladex) | 3.6 mg subcutaneously every month; 10.8 mg subcutaneously every 3 months | Acute: injection site discomfort Delayed: hot flashes, tumor flare, edema, decreased libido, erectile dysfunction, osteoporosis |
| Leuprolide (Lupron) | 7.5 mg intramuscularly or subcutaneously every month; 22.5 mg intramuscularly or subcutaneously every 3 months; 30 mg intramuscularly or subcutaneously every 4 months; 45 mg intramuscularly or subcutaneously every 6 months | |
| Triptorelin pamoate (Trelstar) | 3.75 mg intramuscularly every 4 weeks; 11.25 mg intramuscularly every 12 weeks; 22.5 mg intramuscularly every 24 weeks | |
LHRH Antagonist |
| Degarelix (Firmagon) | 240 mg subcutaneously once, then 80 mg subcutaneously every 28 days | Acute: injection site reaction Delayed: hot flashes, weight gain, elevated transaminases, QT prolongation |