Chemotherapy

Here is a list of some common chemotherapy therapy agents that are used in our practice. If you do not see the a particular chemotherapy agent that has been recommended to you, you can look it up on chemocare.com for more information.

Carboplatin

Drug type:
Carboplatin is an anticancer drug ("antineoplastic" or "cytotoxic") chemotherapy drug. Carboplatin is classified as an "alkylating agent."

What Carboplatin Is Used For:
● Carboplatin is used to treat ovarian cancer.
● Carboplatin is also used for other types of cancer, including lung, head and neck, endometrial, esophageal, bladder, breast, and cervical; central nervous system or germ cell tumors; osteogenic sarcoma; and as preparation for a stem cell or bone marrow transplant.
Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.

How Carboplatin Is Given:
● Carboplatin is usually given by infusion into a vein (intravenous, IV).
● Carboplatin can also be given intra-peritoneal, directly into the peritoneal cavity in the abdomen.
● The amount of Carboplatin you receive depends on many factors, including your height and weight, your general health or other health problems, and how your body responds to it. Your doctor will determine your dose and schedule.

Carboplatin Side Effects:
Important things to remember about the side effects of Carboplatin:
● Most people do not experience all of the side effects listed.
● Side effects are often predictable in terms of their onset and duration.
● Side effects are almost always reversible and will go away after treatment is complete.
● There are many options to help minimize or prevent side effects.
● There is no relationship between the presence or severity of side effects and the effectiveness of Carboplatin.
● The side effects of Carboplatin and their severity depend on how much of Carboplatin is
given. In other words, high doses may produce more severe side effects).

The following side effects are common (occurring in greater than 30%) for patients taking
Carboplatin:
● Low blood counts (including red blood cells, white blood cells and platelets)
Nadir: (Meaning low point, nadir is the point in time between chemotherapy cycles in which you
experience low blood counts.) 21 days. Recovery: 28 days
● Nausea and vomiting usually occurring within 24 hours of treatment
● Taste changes
● Hair loss
● Weakness
● Blood test abnormalities: Abnormal magnesium level
These are less common (occurring in 10-29%) side effects for patients receiving Carboplatin:
● Burning sensation at the injection site
● Abdominal pain
● Diarrhea
● Constipation
● Mouth sores
● Infection
● Peripheral neuropathy: Although uncommon, a serious side effect of decreased sensation and paresthesia (numbness and tingling of the extremities) may be noted. Sensory loss, numbness and tingling, and difficulty in walking may last for at least as long as therapy is continued. These side effects may become progressively more severe with continued treatment, and your doctor may decide to decrease your dose.
● Central neurotoxicity: Infrequent but patients over age 65 are at increased risk.
Symptoms include dizziness, confusion, visual changes, ringing in the ears.
● Nephrotoxicity (see kidney problems): More frequent when Carboplatin is given in high
doses or to people with kidney problems.
● Hearing loss (ototoxicity) - loss of high pitched sounds.
● Abnormal blood electrolyte levels (sodium, potassium, calcium).
● Abnormal blood liver enzymes (SGOT, Alkaline phosphatase) (see liver problems).
● Cardiovascular events. Although infrequent, heart failure, blood clots and strokes have been reported with Carboplatin use. Less than 1% were life-threatening.
● Allergic reaction may occur. It would occur during the actual transfusion. This may include itching, rash, shortness of breath or dizziness (especially in patients who have received cisplatin).
Not all side effects are listed above, some that are rare (occurring in less than 10% of patients)
are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms.

When To Contact Your Doctor or Health Care Provider:

Contact your health care provider immediately, day or night, if you should experience any of the
following symptoms:
● Fever of 100.4(F (38(C) or higher, or chills (possible signs of infection).
● Difficulty breathing or shortness of breath.
● Chest pain.
The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following:
● Unusual bleeding or bruising
● Black or tarry stools, or blood in your stools or urine
● Diarrhea (4-6 episodes in a 24-hour period)
● Nausea (interferes with ability to eat and unrelieved with prescribed medications).
● Vomiting (vomiting more than 4-5 times in a 24-hour period)
● Severe abdominal pain
● Lip or mouth sores (painful redness, swelling or ulcers)
● Extreme fatigue (unable to carry on self-care activities)
● Muscle cramps or twitching
● Change in hearing
● Dizziness, confusion or visual changes
Always inform your health care provider if you experience any unusual symptoms.

Carboplatin Precautions:
● Before starting Carboplatin treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc. Do not take aspirin, products containing aspirin unless your doctor specifically permits this.
● Carboplatin may be inadvisable if you have a history of severe allergic reaction to cisplatin, Carboplatin, other platinum-containing formulations or mannitol.
● Do not receive any kind of immunization or vaccination without your doctor's approval while taking Carboplatin.
● Decreased sensation, numbness and tingling in fingers and toes may become progressively worse with repeated doses of Carboplatin. It is important to report this to your doctor.
● Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (Carboplatin may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus).
● For both men and women: Do not conceive a child (get pregnant) while taking Carboplatin. Barrier methods of contraception, such as condoms, are recommended.
Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
● Do not breast feed while taking Carboplatin.

Carboplatin Self-Care Tips:
● Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
● You may be at risk of infection so try to avoid crowds or people with colds, and report
fever or any other signs of infection immediately to your health care provider.
● Wash your hands often.
● To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1/2 to 1 teaspoon of baking soda and/or 1/2 to 1 teaspoon of salt mixed with 8 ounces of water.
● Use an electric razor and a soft toothbrush to minimize bleeding.
● Avoid contact sports or activities that could cause injury.
● To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.
● Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing.
● In general, drinking alcoholic beverages should be kept to a minimum or avoided
completely. You should discuss this with your doctor.
● Get plenty of rest.
● Maintain good nutrition.
● If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing While Taking Carboplatin:
● You will be monitored regularly by your doctor while you are taking Carboplatin. Tests will include complete blood counts, electrolytes, kidney function tests and liver enzymes.
● Because drug toxicity is seen as numbness and tingling of fingers and toes, a periodic physical examination, which includes a check of your reflexes, is necessary to detect the need for decreased dosages.

How Carboplatin Works:
Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue. "Normal" cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition. Cancerous cells lose this ability. Cancer cells no longer have the normal checks and balances in place that control and limit cell division. The process of cell division, whether normal or cancerous cells, is through the cell cycle. The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division). The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division. Usually,the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division. If the cells are unable to divide, they die. The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink. They also induce cell suicide (selfdeath or apoptosis).

Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific. Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific. The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective. This is why chemotherapy is typically given in cycles.

Chemotherapy is most effective at killing cells that are rapidly dividing. Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The "normal" cells will grow back and be healthy but in the meantime, side effects occur. The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss. Different drugs may affect different parts of the body. Chemotherapy (anti-neoplastic drugs) is divided into five classes based on how they work to kill cancer. Although these drugs are divided into groups, there is some overlap among some of the specific drugs. The following are the types of chemotherapy:
Alkylating Agents
Alkylating agents are most active in the resting phase of the cell. These drugs are cell-cycle non-specific. There are several types of alkylating agents.
● Mustard gas derivatives: Mechlorethamine, Cyclophosphamide, Chlorambucil,
Melphalan, and Ifosfamide.
● Ethylenimines: Thiotepa and Hexamethylmelamine.
● Alkylsulfonates: Busulfan.
● Hydrazines and Triazines: Procarbazine, Dacarbazine and Temozolomide.
● Nitrosureas: Carmustine, Lomustine and Streptozocin. Nitrosureas are unique because,
unlike most chemotherapy, they can cross the blood-brain barrier. They can be useful in
treating brain tumors.
● Metal salts: Carboplatin, Cisplatin, and Oxaliplatin.

Note: We strongly encourage you to talk with your health care professional about your specific
medical condition and treatments. The information contained in this website is meant to be
helpful and educational, but is not a substitute for medical advice.

Cisplatin

Cisplatin is the generic name for the trade name drug Platinol® and Platinol®-AQ. In some cases, health care professionals may use the trade name Platinol® and Platinol®-AQ, or other names such as CDDP, when referring to the generic drug name cisplatin.

Drug Type:
Cisplatin is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. This medication is classified as an "alkylating agent." (For more detail, see "How Cisplatin Works" section below).

What Cisplatin Is Used For:
● Treatment of advanced bladder cancer, metastatic ovarian cancer, and metastatic testicular cancer. Testicular, ovarian, bladder, head and neck, esophageal, small and non-small cell lung, breast, cervical, stomach and prostate cancers. Also to treat Hodgkin's and non-Hodgkin's lymphomas, neuroblastoma, sarcomas, multiple myeloma,
melanoma, and mesothelioma.
Note: If a drug has been approved for one use, physicians may elect to use this same drug for
other problems if they believe it may be helpful.

How Cisplatin Is Given:
● Cisplatin is administered through a vein (intravenously or IV) as an infusion.
● There is no pill form of cisplatin.
● Cisplatin is an irritant. An irritant is a chemical that can cause inflammation of the vein through which it is given.
● If cisplatin escapes from the vein it can cause tissue damage. The nurse or doctor who gives cisplatin must be carefully trained. If you experience pain or notice redness or swelling at the IV site while you are receiving cisplatin, alert your health care professional immediately.
● Before and/or after the cisplatin infusion, extra IV fluids are given and care is taken to ensure adequate hydration before both during and after cisplatin, to protect your kidney function.
● Cisplatin also has been used as an infusion into the abdominal cavity (contains the abdominal organs).
The amount of cisplatin that you receive depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer that you have. Your
doctor will determine your dose and schedule.

Side Effects:
Important things to remember about cisplatin side effects:
● Most people do not experience all of the cisplatin side effects listed.
● Cisplatin side effects are often predictable in terms of their onset, duration, and severity.
● Cisplatin side effects will improve after therapy is complete.
● Cisplatin side effects may be quite manageable. There are many options to help minimize or prevent the side effects of cisplatin.
● There is no relationship between the presence or severity of Cisplatin side effects and effectiveness of cisplatin.
The following side effects are common (occurring in greater than 30%) for patients taking
Cisplatin:
● Nausea and vomiting. Nausea may last up to 1 week after therapy. Anti-nausea medication is given before the infusion, and a prescription is also given for use after.
● Low blood counts. Your white and red blood cells and platelets may temporarily decrease. This can put you at increased risk for infection, anemia, and/or bleeding.
Nadir: Meaning low point, is the point in time between chemotherapy cycles in which you
experience low blood counts.
● Nadir: 18-23 days. Recovery: 39 days
● Kidney toxicity. Effects on kidney function are dose related, observed 10-20 days after
therapy, and are generally reversible.
● Ototoxicity hearing loss, ringing in the ears.
● Blood test abnormalities (low magnesium, low calcium, low potassium)
These are less common side effects (occurring in 10-29%) for patients receiving Cisplatin:
● Peripheral neuropathy: Although less common, a serious side effect of decreased sensation and paresthesia (numbness and tingling of the extremities) may be noted. Sensory loss, numbness and tingling, and difficulty in walking may last for at least as long as therapy is continued. These side effects may become progressively more severe with continued treatment, and your doctor may decide to decrease your dose. Neurologic effects may be irreversible.
● Loss of appetite
● Taste changes, metallic taste
● Increases in blood tests measuring liver function. These return to normal once treatment is discontinued (see liver problems).
● Hair loss may cause hair loss; however, this side effect is uncommon.

Not all cisplatin side effects are listed above, some that are rare (occurring in less than 10% of patients) are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms.

When To Contact Your Doctor or Health Care Provider:

Contact your health care provide immediately, day or night, if you should experience any
of the following symptoms:
● Fever of 100.4°F (38°C) or higher or chills (possible signs of infection)
The following symptoms require medical attention, but are not an emergency. Contact
your health care provider within 24 hours of noticing any of the following:
● Nausea (interferes with ability to eat and unrelieved with prescribed medication)
● Vomiting (vomiting more than 4-5 times in a 24 hour period)
● Diarrhea (4-6 episodes in a 24 hour period)
● No urine output in a 12 hour period
● Blood in the urine
● Pain or burning with urination
● Unusual bleeding or bruising
● Black or tarry stools, or blood in your stools or urine
● Extreme fatigue (unable to carry on self-care activities)
● Swelling, redness and pain in one leg or arm and not the other
● Yellowing of the skin or eyes
● Mouth sores (painful redness, swelling or ulcers)

Always inform your health care provider if you experience any unusual symptoms.

Precautions:
● Before starting cisplatin treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). Do not take aspirin, products containing aspirin unless your doctor specifically permits this.
● Cisplatin may be inadvisable if you have a history of severe allergic reaction to cisplatin, carboplatin, other platinum-containing formulations or mannitol.
● Do not receive any kind of immunization or vaccination without your doctor's approval while taking cisplatin.
● Your fertility, meaning your ability to conceive or father a child, may be affected by cisplatin. Please discuss this issue with your health care provider.
● Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (Cisplatin may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus).
● For both men and women: Use contraceptives, and do not conceive a child (get pregnant) while taking cisplatin. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
● Do not breast feed while taking cisplatin.

Self-Care Tips:
● To reduce nausea, take anti-nausea medications as prescribed by your doctor, eat small
amounts of food frequently.
● Try dry cereal, toast, or crackers, especially in the morning, to help curb nausea.
● Maintaining a good fluid intake is very important to help to avoid kidney damage. Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
● You may be at risk of infection so try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your health care provider.
● Wash your hands often.
● To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1 teaspoon of baking soda mixed with 8 ounces of water.
● Use an electric razor and a soft toothbrush to minimize bleeding.
● In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
● Avoid sun exposure. Wear SPF 30 (or higher) sunblock and protective clothing.
● Get plenty of rest.
● Maintain good nutrition.
● If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing While Taking Cisplatin:
● You will be checked regularly by your doctor while you are taking cisplatin, to monitor side effects and check your response to therapy. Periodic blood work will be obtained to monitor your complete blood count (CBC) your electrolytes (such as calcium, magnesium, potassium, and sodium levels) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor.
● Because drug toxicity is seen as numbness and tingling of fingers and toes, a periodic physical examination, which includes a check of your reflexes, is necessary to detect the need for decreased dosages.
● With high dose therapy hearing tests may be ordered as baseline and monitored at times during therapy.

How Cisplatin Works:
Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue. "Normal" cell stop dividing when they come into contact with like cells, a mechanism known as contact inhibition. Cancerous cells lose this ability. Cancer cells no longer have the normal checks and balances in place that control and limit cell division. The process of cell division, whether normal or cancerous cells, is through the cell cycle. The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division). The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division. Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division. If the cells are unable to divide, they die. The faster the cells are dividing, the more likely it is that
chemotherapy will kill the cells, causing the tumor to shrink. They also induce cell suicide (selfdeath or apoptosis).

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

Paclitaxel

Trade Names: Taxol®, OnxalTM

Drug Type:
Paclitaxel is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. Paclitaxel is classified as a "plant alkaloid," a "taxane" and an "antimicrotubule agent." (For more detail, see "How Paclitaxel Works" section below).

What Paclitaxel Is Used For:
● Treatment of breast, ovarian, lung, bladder, prostate, melanoma, esophageal, as well as other types of solid tumor cancers. It has also been used in Kaposi's sarcoma.
Note: If a drug has been approved for one use, physicians may elect to use this same drug for
other problems if they believe it may be helpful.

How Paclitaxel Is Given:
● Paclitaxel is given as an injection or infusion into the vein (intravenous, IV).
● Paclitaxel is an irritant. An irritant is a chemical that can cause inflammation of the vein through which it is given. If the medication escapes from the vein it can cause tissue damage. The nurse or doctor who gives Paclitaxel must be carefully trained. If you
experience pain or notice redness or swelling at the IV site while you are receiving Paclitaxel, alert your health care professional immediately.
● Because severe allergic reactions have occurred in some people taking Paclitaxel, you will be asked to take medications to help prevent a reaction. Your doctor will prescribe the exact regimen.
● Paclitaxel is given over various amounts of times and in various schedules.
● There is no pill form of Paclitaxel.
● The amount of Paclitaxel and the schedule that it is given will receive depend on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition being treated. Your doctor will determine your dose and schedule.

Side Effects:
Important things to remember about the side effects of Paclitaxel include:
● Most people do not experience all of the side effects listed.
● Side effects are often predictable in terms of their onset and duration.
● Side effects are almost always reversible and will go away after treatment is complete.
● There are many options to help minimize or prevent side effects.
● There is no relationship between the presence or severity of side effects and the
effectiveness of the medication.
● The side effects of Paclitaxel and their severity vary depending on how much of the drug
is given, and/or the schedule in which it is given.
The following side effects are common (occurring in greater than 30%) for patients taking
Paclitaxel:
● Low blood counts. Your white and red blood cells and platelets may temporarily
decrease. This can put you at increased risk for infection, anemia and/or bleeding.
● Hair loss
● Arthralgias and myalgias, pain in the joints and muscles. (see pain) Usually temporary
occurring 2 to 3 days after Paclitaxel, and resolve within a few days.
● Peripheral neuropathy (numbness and tingling of the hands and feet)
● Nausea and vomiting (usually mild)
● Diarrhea
● Mouth sores
● Hypersensitivity reaction. Fever, facial flushing, chills, shortness of breath, or hives after
Paclitaxel is given (see allergic reaction). The majority of these reactions occur within the
first 10 minutes of an infusion. Notify your healthcare provider immediately
(premedication regimen has significantly decreased the incidence of this reaction).
The following are less common side effects (occurring in 10-29%) for patients receiving
Paclitaxel:
● Swelling of the feet or ankles (edema).
● Increases in blood tests measuring liver function. These return to normal once treatment
is discontinued (see liver problems).
● Low blood pressure (occurring during the first 3 hours of infusion).
● Darkening of the skin where previous radiation treatment has been given (radiation recall
- see skin reactions).
● Nail changes (discoloration of nail beds - rare) (see skin reactions).
Nadir: 15-21 days
This list includes common and less common side effects for individuals taking Paclitaxel. Side effects that are very rare, occurring in less than 10% of patients, are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms.

When to contact your doctor or health care provider:

Contact your health care provider immediately, day or night, if you should experience any of the
following symptoms:
● Fever of 100.4° F (38° C), chills (possible signs of infection)
● Shortness of breath, wheezing, difficulty breathing, closing up of the throat, swelling of
facial features, hives (possible allergic reaction).
The following symptoms require medical attention, but are not an emergency. Contact your
health care provider within 24 hours of noticing any of the following:
● If you notice any redness or pain at the site of injection
● Nausea (interferes with ability to eat and unrelieved with prescribed medication)
● Vomiting (vomiting more than 4-5 times in a 24 hour period)
● Diarrhea (4-6 episodes in a 24-hour period)
● Unusual bleeding or bruising
● Black or tarry stools, or blood in your stools or urine
● Extreme fatigue (unable to carry on self-care activities)
● Mouth sores (painful redness, swelling or ulcers)
● Yellowing of the skin or eyes
● Swelling of the feet or ankles. Sudden weight gain
● Signs of infection such as redness or swelling, pain on swallowing, coughing up mucous, or painful urination.
Always inform your health care provider if you experience any unusual symptoms.
Precautions:
● Before starting Paclitaxel treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). Do not take aspirin, or products containing aspirin unless your doctor specifically permits this.
● Do not receive any kind of immunization or vaccination without your doctor's approval while taking Paclitaxel.
● Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (Paclitaxel may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus).
● For both men and women: Do not conceive a child (get pregnant) while taking Paclitaxel. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
● Do not breast feed while taking Paclitaxel.

Self-Care Tips:
● Paclitaxel, or the medications that you take with Paclitaxel may cause you to feel dizzy or
drowsy. Do not operate any heavy machinery until you know how you respond to
Paclitaxel.
● If you notice any redness or pain at the injection site, place a warm compress, and notify
your healthcare provider.
● Drink at least two to three quarts of fluid every 24 hours, unless you are instructed
otherwise.
● You may be at risk of infection so try to avoid crowds or people with colds and those not
feeling well, and report fever or any other signs of infection immediately to your health
care provider.
● Wash your hands often.
● To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day
with 1/2 to 1 teaspoon of baking soda and/or 1/2 to 1 teaspoon of salt mixed with 8
ounces of water.
● Use an electric razor and a soft toothbrush to minimize bleeding.
● Avoid contact sports or activities that could cause injury.
● Paclitaxel causes little nausea. But if you should experience nausea, take anti-nausea
medications as prescribed by your doctor, and eat small frequent meals. Sucking on
lozenges and chewing gum may also help.
● Acetaminophen or ibuprofen may help relieve discomfort from fever, headache and/or
generalized aches and pains. However, be sure to talk with your doctor before taking it.
● You may experience drowsiness or dizziness; avoid driving or engaging in tasks that
require alertness until your response to the drug is known.
● Paclitaxel will make you sensitive to sunlight. You must wear sunglasses when outside,
and avoid sun exposure. Wear protective clothing, and also wear SPF 15 (or higher) sun
block.
● In general, drinking alcoholic beverages should be kept to a minimum or avoided
completely. You should discuss this with your doctor.
● Get plenty of rest.
● Maintain good nutrition.
● If you experience symptoms or side effects, be sure to discuss them with your health
care team. They can prescribe medications and/or offer other suggestions that are
effective in managing such problems.

Monitoring and Testing:
You will be checked regularly by your health care professional while you are taking Paclitaxel, to monitor side effects and check your response to therapy. Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor.

How Paclitaxel Works:
Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue. "Normal" cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition. Cancerous cells lose this ability. Cancer cells no longer have the normal checks and balances in place that control and limit cell division. The process of cell division, whether normal or cancerous cells, is through the cell cycle. The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division). The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division. Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division. If the cells are unable to divide, they die. The faster the cells are dividing, the more likely it is that
chemotherapy will kill the cells, causing the tumor to shrink. They also induce cell suicide (selfdeath or apoptosis).

Chemotherapy is most effective at killing cells that are rapidly dividing. Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The "normal" cells will grow back and be healthy but in the meantime, side effects occur. The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss. Different drugs may affect different parts of the body. Paclitaxel belongs to a class of chemotherapy drugs called plant alkaloids. Plant alkaloids are made from plants. The vinca alkaloids are made from the periwinkle plant (catharanthus rosea). The taxanes are made from the bark of the Pacific Yew tree (taxus). The vinca alkaloids and taxanes are also known as antimicrotubule agents. The podophyllotoxins are derived from the May Apple plant. Camptothecan analogs are derived from the Asian "Happy Tree" (Camptotheca acuminata). Podophyllotoxins and camptothecan analogs are also known as topoisomerase inhibitors. The plant alkaloids are cell-cycle specific. This means they attack the cells during various phases of division.

● Vinca alkaloids: Vincristine, Vinblastine and Vinorelbine.
● Taxanes: Paclitaxel and Docetaxel.
● Podophyllotoxins: Etoposide and Tenisopide.
● Camptothecan analogs: Irinotecan and Topotecan.

Antimicrotubule agents (such as Paclitaxel), inhibit the microtubule structures within the cell. Microtubules are part of the cell's apparatus for dividing and replicating itself. Inhibition of these structures ultimately results in cell death.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

Pembrolizumab

Trade name: Keytruda®
Pembrolizumab is the generic name for the trade drug name Keytruda®. In some cases, health care professionals may use the generic name pembrolizumab when referring to the trade drug name Keytruda®.

Drug type:
Pembrolizumab is a monoclonal antibody- (For more detail, see "How this drug works," below).

What Pembrolizumab Is Used For:
● Treatment of recurrent or metastatic cervical cancer in patients whose tumors express PD-L1 (combined positive score [CPS] ≥ 1), as determined by an approved test, and with disease progression on or after chemotherapy.
● Treatment of recurrent locally advanced or metastatic gastric or gastroesophageal junction adenocarcinoma in patients whose tumors express PD-L1 (CPS ≥ 1), as determined by an approved test, with disease progression on or after two or more prior lines of therapy including fluoropyrimidine- and platinum-containing chemotherapy, and if
appropriate, HER2/neu-targeted therapy.
● For the treatment of unresectable or metastatic melanoma.
● For the adjuvant treatment of patients with melanoma with involvement of lymph node(s) following complete resection
● Patients with metastatic non-small cell lung cancer (NSCLC) whose tumors express PDL1 as determined by an FDA-approved test and who have disease progression on or after platinum-containing chemotherapy.
● For treatment of patients with recurrent or metastatic head and neck squamous cell
carcinoma (HNSCC).
● Treatment of primary mediastinal large B-cell lymphoma (PMBCL) in adult or pediatric patients with refractory disease who have relapsed after 2 or more prior lines of therapy.
● For treatment of adult and pediatric patients with refractory classical Hodgkin lymphoma (cHL), or those who have relapsed after three or more prior lines of therapy.
● For treatment of locally advanced or metastatic urothelial carcinoma who have disease progression during or following platinum-containing chemotherapy.
● For treatment of adult and pediatric patients with unresectable or metastatic, microsatellite instability-high (MSI-H) or mismatch repair deficient solid tumors or colorectal cancer that have progressed following prior treatment.
● For treatment of patients with hepatocellular cancer (HCC) who have been previously treatment with sorafenib.
● For Treatment of adult and pediatric patients with recurrent locally advanced or metastatic Merkel cell cancer.
● For first-line treatment plus axitinib of patients with advanced renal cell carcinoma (RCC).
● For treatment of patients with metastatic small cell lung cancer (SCLC) with disease progression on or after platinum-based chemotherapy and at least one other prior line of therapy.
● For treatment of patients with advanced esophageal squamous cell cancer whose tumors express PD-L1 as determined by an FDA approved test.
● In combination with the drug lenvatinib for treatment of patients with advanced endometrial cancer.
Note: If a drug has been approved for one use, physicians may elect to use this same drug for
other problems if they believe it may be helpful.

How Pembrolizumab Is Given:
● Pembrolizumab is given as an intravenous injection through a vein (IV) over 30 minutes every 3 weeks.
● You may receive medications before the infusion to reduce allergic reactions.
● The amount of pembrolizumab that you will receive depends on many factors, including your weight, your general health or other health problems, and the type of cancer or condition being treated. Your doctor will determine your dose and schedule.

Side Effects:
Important things to remember about the side effects of pembrolizumab:
● Most people do not experience all of the side effects listed.
● Side effects are often predictable in terms of their onset and duration.
● A few side effects can occur weeks or months after discontinuation of treatment.
● There are many options to help manage and prevent worsening of side effects.
● There is no relationship between the presence or severity of side effects and the effectiveness of the medication.
The following side effects are common (occurring in greater than 30%) for patients taking pembrolizumab:
● Anemia
● Fatigue
● Hyperglycemia
● Hyponatremia
● Hypoalbuminemia
● Itching
● Cough
● Nausea
These side effects are less common side effects (occurring in about 10-29%) of patients receiving pembrolizumab:
● Rash
● Decreased appetite
● Hypertriglyceridemia
● Increased liver enzymes
● Hypocalcemia
● Constipation
● Diarrhea
● Arthralgia
● Pain in extremity
● Shortness of breath
● Swelling
● Headache
● Vomiting
● Chills
● Myalgia
● Insomnia
● Abdominal pain
● Back pain
● Fever
● Vitiligo
● Dizziness
● Upper respiratory tract infection

A serious, but uncommon side effect of pembrolizumab may be an immune-mediated reaction. When this side effect occurs, it affects primarily the bowels, liver, skin, nerves and the endocrine system. This immune reaction can occur during treatment but can also be seen weeks or months after discontinuation of treatment. Symptoms of this reaction will be monitored throughout treatment (diarrhea, rash, and neuropathy). Lab work will check for elevated liver enzymes and thyroid function.

Contact your health care provider right away if you have any new or worsening symptoms.
Not all side effects are listed above. Some that are rare (occurring in less than 10% of patients) are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms.

When to contact your doctor or health care provider:

Contact your health care provider immediately, day or night, if you should experience any
of the following symptoms:
● Fever of 100.4° F (38° or higher, chills)
● Signs of reaction to the drug (wheezing, chest tightness, itching, bad cough, swelling of
the face, lips, tongue or throat)
● New or worsening cough, chest pain, or shortness of breath
● Diarrhea or severe abdominal pain, especially right side
● Blood in your stools or dark stools
● Skin or the whites of your eyes turn yellow
● Persistent or unusual headache, extreme weakness, dizziness or fainting, or vision
changes
The following symptoms require medical attention, but are not an emergency. Contact your doctor or health care provider within 24 hours of noticing any of the following:
● Unable to eat or drink for 24 hours or have signs of dehydration: tiredness, thirst, dry
mouth, dark and decrease amount of urine, or dizziness
● Urine turns dark or brown (tea color)
● Decreased appetite
● Skin rash with or without itching
● Sores in the mouth
● Skin blisters and/or peels
● Numbness or tingling in hands or feet
● Bleed or bruise more easily than normal
● Nausea (interferes with ability to eat and unrelieved with prescribed medication)
● Vomiting (vomiting more than 4-5 times in a 24 hour period)
Always inform your health care provider if you experience any unusual symptoms.

Precautions:
● Before starting pembrolizumab treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.).
● Do not receive any kind of immunization or vaccination without your doctor's approval while taking pembrolizumab.
● Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (pembrolizumab may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus.)
● For both men and women: Do not conceive a child (get pregnant) while taking pembrolizumab. Barrier methods of contraception, such as condoms, are recommended during treatment and for at least 4 months following treatment. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
● Do not breast feed while taking this medication.

Self-Care Tips:
● Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
● If you should experience nausea, take anti-nausea medications as prescribed by your doctor, and eat small frequent meals. Sucking on lozenges and chewing gum may also help.
● Avoid sun exposure. Wear SPF 30 (or higher) sun block and protective clothing.
● In general, drinking alcoholic beverages should be kept to a minimum or avoided
completely. You should discuss this with your doctor.
● Use an electric razor to minimize bleeding
● Get plenty of rest.
● Maintain good nutrition.
● Wash your hands often.
● You may be at risk for infection, report fever or any other signs of infection immediately to your healthcare provider. Try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your healthcare provider.
● Discuss with your health care provider before taking any other medications including over the counter and herbal preparations.
● To help prevent mouth sores use a soft toothbrush, and rinse three times a day with ½ to 1 teaspoon of baking soda and/or ½ to 1 teaspoon of salt mixed with 8 ounces of water.
● If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing:
You will be checked regularly by your health care professional while you are taking pembrolizumab, to monitor side effects and check your response to therapy.

How Pembrolizumab Works:
Pembrolizumab is classified as a monoclonal antibody. Monoclonal antibodies are a relatively new type of “targeted” cancer therapy.

Antibodies are an integral part of the body’s immune system. Normally, the body creates antibodies in response to an antigen (such as a protein in a germ) that has entered the body. The antibodies attach to the antigen in order to mark it for destruction by the immune system. To make anti-cancer monoclonal antibodies in the laboratory, scientists analyze specific antigens on the surface of cancer cells (the targets). Then, using animal and human proteins, they create a specific antibody that will attach to the target antigen on the cancer cells. When given to the patient, these monoclonal antibodies will attach to matching antigens like a key fits a lock.

Since monoclonal antibodies target only specific cells, they may cause less toxicity to healthy cells. Monoclonal antibody therapy is usually only given for cancers in which antigens (and the respective antibodies) have been identified already.

Pembrolizumab is a highly selective humanized monoclonal IgG4 antibody directed against the PD-1 receptor on the cell surface. The drug blocks the PD-1 receptor, preventing binding and activation of PD-L1 and PD-L2. This mechanism causes the activation of T-cell mediated immune responses against tumor cells.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

Lenvatinib

Trade name: Lenvima™
Lenvatinib is the generic for the trade name drug Lenvima™. In some cases, health care professionals may use the trade name Lenvima™ when referring to the generic drug name lenvatinib.

Drug type:
Lenvatinib is a targeted therapy. It is an oral receptor tyrosine kinase inhibitor - (For moredetail, see "How this drug works," below.)

What Lenvatinib Is Used For:
● For the treatment of patients with locally recurrent or metastatic, progressive, radioactive iodine-refractory differentiated thyroid cancer.
● In combination with the drug everolimus, for the treatment of advanced renal cell carcinoma following one prior anti-angiogenic therapy.
● Treatment of hepatocellular (primary liver) cancer.
● In combination with the drug pembrolizumab for treatment of patients with advanced endometrial cancer.
Note: If a drug has been approved for one use, physicians may elect to use this same drug for other
problems if they believe it may be helpful.

How Lenvatinib Is Given:
● Lenvatinib is a pill, taken by mouth, once daily. It can be taken with or without food.
● Take lenvatinib exactly as prescribed.
● Swallow lenvatinib capsules whole. Do not crush, dissolve or open capsules.
● Do not change your dose or stop lenvatinib unless your health care provider tells you to.
● If you miss a dose, take it as soon as you remember. If your next dose is within 12 hours, skip the missed dose and take the next dose at your regular time.
● Do not take more than 1 dose of lenvatinib at one time. Call your health care provider right away if you take too much.
● The amount of lenvatinib that you will receive depends on many factors, your general health or other health problems, and the type of cancer or condition being treated.
● Dose modifications are often made so it is important to let your healthcare provider know of any side effects.

Side Effects:
Important things to remember about the side effects of lenvatinib:
● Most people do not experience all of the side effects listed.
● Side effects are often predictable in terms of their onset and duration.
● There are many options to help minimize or prevent side effects.
● There is no relationship between the presence or severity of side effects and the
effectiveness of the medication.

The following side effects are common (occurring in greater than 30%) for patients taking
lenvatinib:
● High blood pressure
● Diarrhea
● Fatigue
● Joint/muscle aches
● Decreased appetite
● Weight loss
● Nausea
● Stomatitis (mouth sores)
● Headache
● Vomiting
● Proteinuria (protein in the urine)
● Palmar-plantar erythrodysesthesia (hand-foot syndrome)
● Abdominal pain
● Dysphonia (difficulty speaking)
These side effects are less common side effects (occurring in about 10-29%) of patients
receiving lenvatinib:
● Constipation
● Oral pain
● Cough
● Swelling
● Rash
● Taste changes
● Dry mouth
● Dizziness
● Heartburn
● Hair loss
● Nose bleeds
● Insomnia (trouble sleeping)
● Urinary tract infection
● Dental & oral infections

Not all side effects are listed above. Some that are rare (occurring in less than 10% of patients) are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms.

When to contact your doctor or health care provider:

Contact your health care provider immediately, day or night, and go to the emergency room, if
you should experience any of the following symptoms:
● Fever of 100.4° F (38°C or higher, chills)
● Symptoms of heart problems such as shortness of breath or swelling
● Symptoms associated with a possible blood clot, such as: chest pain or pressure; pain in your arms, back, neck or jaw; numbness or weakness on one side of your body; trouble talking; sudden or severe headache; sudden vision changes
● Severe stomach (abdominal) pain
● Severe headache, seizures, weakness, confusion, blindness or change in vision. This could be a rare syndrome call Reversible Posterior Leukoencephalopathy.
The following symptoms require medical attention, but are not an emergency. Contact your
health care provider within 24 hours of noticing any of the following:
● High blood pressure
● Diarrhea (4-6 episodes in a 24-hour period).
● Nausea (interferes with ability to eat and unrelieved with prescribed medication).
● Vomiting (vomiting more than 4-5 times in a 24 hour period).
● Unable to eat or drink for 24 hours or have signs of dehydration: tiredness, thirst, dry mouth, dark and decrease amount of urine, or dizziness.
● Skin or the whites of your eyes turn yellow
● Urine turns dark or brown (tea color)
● Light-colored bowel movements
● Decreased appetite
● Pain on the right side of your stomach
● Bleed or bruise more easily than normal (nose bleeds, coughing up blood, heavy vaginal
bleeding, bleeding from the rectum)
● Skin changes (rash, acne, itching, blisters, peeling, redness or swelling).
Always inform your health care provider if you experience any unusual symptoms.

Precautions:
● Before starting lenvatinib treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.).
● Do not receive any kind of immunization or vaccination without your doctor's approval while
taking lenvatinib.
● Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (lenvatinib may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus.)
● For both men and women: Do not conceive a child (get pregnant) while taking lenvatinib. Barrier methods of contraception, such as condoms, are recommended during treatment and for at least 2 weeks following completion of therapy. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
● Do not breast feed while taking this medication.

Self-Care Tips:
● High blood pressure may be a side effect of lenvatinib. You blood pressure should be well controlled before starting lenvatinib. Your healthcare provider will check your blood pressure regularly during treatment.
● Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
● If you should experience nausea, take anti-nausea medications as prescribed by your doctor, and eat small frequent meals. Sucking on lozenges and chewing gum may also help.
● Avoid sun exposure. Wear SPF 30 (or higher) sun block and protective clothing.
● In general, drinking alcoholic beverages should be kept to a minimum or avoided completely.
You should discuss this with your doctor.
● Get plenty of rest.
● Maintain good nutrition.
● Lenvatinib can cause tiredness, weakness or blurred vision. If you have any of these symptoms, use caution when driving a car, using machinery, or anything that requires you to be alert.
● If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing:
You will be checked regularly by your health care professional while you are taking lenvatinib to monitor side effects and check your response to therapy. Testing may include but is not limited to:
● Blood pressure
● Liver and kidney functions
● Electrolytes
● Urine protein level
● Electrocardiogram (EKG)
● Thyroid hormone levels

How Lenvatinib Works:
Targeted therapy is the result of about 100 years of research dedicated to understanding the differences between cancer cells and normal cells. To date, cancer treatment has focused primarily on killing rapidly dividing cells because one feature of cancer cells is that they divide rapidly. Unfortunately, some of our normal cells divide rapidly too, causing multiple side effects. Targeted therapy is about identifying other features of cancer cells. Scientists look for specific differences in the cancer cells and the normal cells. This information is used to create a targeted therapy to attack the cancer cells without damaging the normal cells, thus leading to fewer side effects. Each type of targeted therapy works a little bit differently but all interfere with the ability of the cancer cell to grow, divide, repair and/or communicate with other cells.

There are different types of targeted therapies, defined in three broad categories. Some targeted therapies focus on the internal components and function of the cancer cell. The targeted therapies use small molecules that can get into the cell and disrupt the function of the cells, causing them to die. There are several types of targeted therapy that focus on the inner parts of the cells. Other targeted therapies target receptors that are on the outside of the cell. Therapies that target receptors are also known as monoclonal antibodies. Antiangiogenesis inhibitors target the blood vessels that supply oxygen to the cells, ultimately causing the cells to starve.

Lenvatinib is a targeted therapy that targets and binds to the tyrosine kinase receptors and inhibits vascular epidermal growth factor receptor (VEGFR), vascular endothelial growth factor (VEGF), and inhibits other kinase receptors that have been implicated in pathogenic angiogenesis, tumor growth, and cancer progression in addition to their normal cellular functions, including fibroblast growth factor (FGF) receptors and platelet derived growth factor receptor alpha (PDGFRa), KIT and RET on the surface of the cell. By binding to these receptors lenvatinib blocks important pathways that promote
cell division.

Research continues to identify which cancers may be best treated with targeted therapies and to identify additional targets for more types of cancer.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice

Doxil

Drug Type:
Doxil is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. It is the drugdoxorubicin encapsulated in a closed lipid sphere (liposome). Doxil is classified as an "anthracycline antibiotic." (For more detail, see "How Doxil Works" section below).

What Doxil Is Used For:
Doxil is used to treat AIDS-related Kaposi's sarcoma, breast cancer, ovarian cancer, and other solid tumors.
Note: If a drug has been approved for one use, physicians sometimes elect to use this same
drug for other problems if they believe it might be helpful.

How Doxil Is Given:
● Doxil is given by injection through a vein (intravenously, by IV).
● Doxil is an irritant. An irritant is a chemical that can cause inflammation of the veinthrough which it is given. If Doxil escapes from the vein it can cause tissue damage. The nurse or doctor who gives Doxil must be carefully trained. If you experience pain or notice redness or swelling at the IV site while you are receiving Doxil, alert your healthcare professional immediately.
● There is no pill form of Doxil.
● The amount of Doxil you will receive depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer you have.
Your doctor will determine your dose and schedule.

Side Effects:
Important things to remember about Doxil side effects:
● Most people do not experience all of the Doxil side effects listed.
● Doxil side effects are often predictable in terms of their onset and duration.
● Doxil side effects are almost always reversible and will go away after treatment is complete.
● There are many options to help minimize or prevent Doxil side effects.
● There is no relationship between the presence or severity of Doxil side effects and the effectiveness of Doxil.
● The side effects of Doxil and their severity depend on how much Doxil is given. In other words, higher doses may produce more severe side effects.
Infusion-related Doxil side effects (symptoms which may occur during the actual treatment) include:
● Infusion-related reaction: symptoms include flushing, shortness of breath, facial swelling, headache, back pain, flushing, tightness in the chest and throat and/or low bloodpressure. Happens in less than 10% of patients. Symptoms go away when the infusion is stopped and typically does not recur when the infusion is restarted at a slower rate. The first infusion is usually given at a slow rate to avoid the risk of these reactions.
The following Doxil side effects are common, meaning they occur in 30 percent or more of patients taking Doxil:
● Low blood counts. Your white and red blood cells may temporarily decrease. This can put you at increased risk for infection and/or anemia.
Nadir: Meaning low point, nadir is the point in time between chemotherapy cycles in
which you experience low blood counts.
Onset: 7 days
Nadir: 10-14 days
Recovery: 21-28 days
● Hand -foot syndrome (Palmar-plantar erythrodysesthesia or PPE) -skin rash, swelling, redness, pain and/or peeling of the skin on the palms of hands and soles of feet. Usually mild, starting 5-6 weeks after start of treatment. May require reductions in the dose of Doxil.
● Mouth sores
These Doxil side effects are less common, meaning they occur in 10-29 percent of patients receiving Doxil:
● Nausea and vomiting
● Low blood counts (low platelet counts). This may put you at an increased risk of bleeding.
● Weakness
● Hair loss
● Constipation
● Poor appetite
● Diarrhea
● Discoloration of the urine (red/orange color) for about 48 hours after treatment
● Darkening of skin at the site of previous radiation therapy (radiation recall - see skin
reactions).
● Darkening, discoloration of nail beds (see skin reactions)
A serious but uncommon side effect of Doxil can be interference with the pumping action of the heart. You can receive only up to a certain amount of Doxil during your lifetime. This "lifetime maximum dose" may be lower if you have heart disease risk factors such as radiation to the chest, advancing age, and use of other heart-toxic drugs. No "lifetime maximum dose" has been established for Doxil. You may be given Doxil for as long as the disease does not progress and
you show no evidence of heart toxicity.

Delayed Effects of Doxil:
There is a slight risk of developing a blood cancer such as leukemia years after taking drugs similar to Doxil. Talk to your doctor about this risk in relation to Doxil. Not all Doxil side effects are listed above, some that are rare (occurring in less than 10% of patients) are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms.

When to contact your doctor or health care provider:

Contact your health care provider immediately, day or night, if you should experience any of the
following symptoms:
● Fever of 100.4° F (38° C) or higher or chills (possible signs of infection).
The following symptoms require medical attention, but are not an emergency. Contact your
health care provider within 24 hours of noticing any of the following:
● Mouth sores (painful redness, swelling or ulcers)
● Nausea (interferes with ability to eat and unrelieved with prescribed medication)
● Vomiting (vomiting more than 4-5 times in a 24 hour period)
● Diarrhea (4-6 episodes in a 24-hour period)
● Fast or irregular heart beats
● Unusual bleeding or bruising
● Black or tarry stools, or blood in your stools or urine
● Extreme fatigue (unable to carry on self-care activities)
● Constipation
● Swelling of the feet or ankles
● Tingling or burning, redness, swelling or peeling of skin, blisters or small sores on the
palms of the hands or soles of feet.
Always inform your health care provider if you experience any unusual symptoms.

Precautions:
● Before starting Doxil treatment, make sure you tell your doctor about any other medications you are taking (including over-the-counter, vitamins, or herbal remedies).
Do not take aspirin or products containing aspirin unless your doctor permits this.
● Do not receive any kind of vaccination without your doctor's approval while taking Doxil.
● Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D Doxil may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus).
● For both men and women: Use contraceptives, and do not conceive a child (get pregnant) while taking Doxil. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant after therapy.
● Do not breast feed while taking Doxil.
● You may be more sensitive to sunlight, take extra care to avoid sun exposure.
● People with congestive heart failure, those who have already had high doses of Doxil or a similar drug, and those with permanent problems with blood counts (bone marrow suppression) cannot receive Doxil.
● Anyone who has had an allergic reaction to Doxil or any of its components cannot
receive it again.

Self-Care Tips:
● Apply ice if you have any pain, redness or swelling at the IV site, and notify your doctor.
● Prevention of hand-foot syndrome. Modification of normal activities of daily living to reduce friction and heat exposure to hands and feet, for about a week after treatment. (For more information see - Managing side effects: hand foot syndrome).
● You may be at risk of infection so try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your health care provider.
● Wash your hands often.
● To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.
● To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1/2 to 1 teaspoon of baking soda and/or 1/2 to 1 teaspoon of salt mixed with 8 ounces of water.
● Drink two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
● Use an electric razor and a soft toothbrush to minimize bleeding.
● Avoid contact sports or activities that could cause injury.
● Keep your bowels moving. Your health care provider may prescribe a stool softener to help prevent constipation that may be caused by Doxil.
● Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing.
● Get plenty of rest.
● Maintain good nutrition.
● In general, drinking alcoholic beverages should be minimized or avoided. You should discuss this with your doctor.
● If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing
A baseline heart evaluation is recommended before starting treatment, and a heart function test will be done as your doctor prescribes. You will be checked regularly by your health care professional while you are taking Doxil, to monitor side effects and check your response to therapy. Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor.

How Doxil Works:
Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue. "Normal" cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition. Cancerous cells lose this ability. Cancer cells no longer have the normal checks and balances in place that control and limit cell division. The process of cell division, whether normal or cancerous cells, is through the cell cycle. The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division). The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division. Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division. If the cells are unable to divide, they die. The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink. They also induce cell suicide (selfdeath or apoptosis).

Doxil is the drug doxorubicin encapsulated in a STEALTH® liposome. Liposomes are closed lipid spheres made of the basic components of natural human cell walls. The STEALTH® liposome have on their surface a substance to protect the liposome from detection by the body's immune system and to increase the time Doxil is circulating in the blood. By enclosing a drug in a STEALTH® liposome, scientists have shown that they are able to get close to the tumor and the encapsulated drug doxorubicin becomes available to work against the tumor cells.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

Olaparib

Trade name: Lynparza™
Olaparib is the generic for the trade chemotherapy drug Lynparza™. In some cases, health care professionals may use the trade name Lynparza™ when referring to the generic drug name olaparib.

Drug type:
Olaparib is a targeted therapy. It is poly (ADP-ribose) polymerase (PARP) inhibitor - (For more detail, see "How this drug works," below.)

What Olaparib Is Used For:
● Advanced ovarian cancer (with deleterious germline BRCA mutated (gBRCAm) as detected by an FDA-approved test) who have been treated with three or more prior lines of chemotherapy.
● HER2-negative metastatic breast cancer (with deleterious or suspected gBRCAm), who have been treated with chemotherapy.
Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful).

How Olaparib Is Given:
● Olaparib is a pill, taken by mouth, twice daily. It can be taken with or without food.
● Take olaparib exactly as prescribed.
● Swallow olaparib capsules whole. Do not crush, dissolve or open capsules.
● Do not take olaparib capsules if they look damaged or show signs of leakage.
● Do not change your dose or stop olaparib unless your health care provider tells you to.
● If you miss a dose, take your next dose at your usual scheduled time. Do not take an extra dose to make up for a missed dose.
● If you take too much olaparib, call your health care provider right away and go to the emergency room.
● Avoid grapefruit juice and Seville oranges during treatment with olaparib. Grapefruit and Seville oranges may increase the level of olaparib in your blood.
● Let your doctor know if you are starting any new medications as some common medications (i.e. ciprofloxacin, fluconazole, etc) interact with olaparib. The amount of olaparib that you will receive depends on many factors, your general health or other health problems, and the type of side effects that you may have.

Side Effects:
Important things to remember about the side effects of olaparib:
● Most people do not experience all of the side effects listed.
● Side effects are often predictable in terms of their onset and duration.
● There are many options to help minimize or prevent side effects.
● There is no relationship between the presence or severity of side effects and the effectiveness of the medication.
The following side effects are common (occurring in greater than 30%) for patients taking olaparib:
● Decreased Hemoglobin
● Nausea
● Fatigue (including weakness)
● Decreased white blood cell count
● Abdominal pain
● Vomiting
● Upper respiratory tract infection
● Anemia
● Decreased neutrophils
● Musculoskeletal pain
● Diarrhea
● Decreased platelet count
● Increased serum creatinine
These side effects are less common side effects (occurring in about 10-29%) of patients receiving olaparib:
● Heartburn
● Decreased appetite
● Myalgia
● Headache
● Skin rash
● Back pain
● Taste changes
● Cough
● Swelling
● Dizziness
● Constipation
● Urinary tract infection
● Shortness of breath
Not all side effects are listed above. Some that are rare (occurring in less than 10% of patients) are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms.

When to contact your doctor or health care provider:

Contact your health care provider immediately, day or night, and go to the emergency
room, if you should experience any of the following symptoms:
● Fever of 100.4° F (38°C or higher, chills)
● Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
● Trouble breathing, shortness of breath, or a cough that is new or worse.
The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following:
● Diarrhea (4-6 episodes in a 24-hour period).
● Nausea (interferes with ability to eat and unrelieved with prescribed medication).
● Vomiting (vomiting more than 4-5 times in a 24 hour period).
● Unable to eat or drink for 24 hours or have signs of dehydration: tiredness, thirst, dry mouth, dark and decreased amount of urine, or dizziness.
● Burning or pain with urination.
● Decreased appetite.
● Bleed or bruise more easily than normal, blood in your urine or stools.
● Back pain, muscle or joint pain.
● Dizziness.
● Headache.
● Stomach pain or heartburn.
● Nose or throat irritation.
● Feeling tired or weak.
Always inform your health care provider if you experience any unusual symptoms.

Precautions:
● Before starting olaparib treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.).
● Do not receive any kind of immunization or vaccination without your doctor's approval while taking olaparib.
● Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (olaparib may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus.)
● For both men and women: Do not conceive a child (get pregnant) while taking olaparib. Barrier methods of contraception, such as condoms, are recommended during treatment and for at least 1 month following completion of therapy. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
● Do not breast feed while taking this medication.

Self-Care Tips:
● High blood pressure may be a side effect of olaparib. You blood pressure should be well controlled before starting olaparib. Your healthcare provider will check your blood pressure regularly during treatment.
● Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
● If you should experience nausea, take anti-nausea medications as prescribed by your doctor, and eat small frequent meals. Sucking on lozenges and chewing gum may also help.
● Avoid sun exposure. Wear SPF 30 (or higher) sun block and protective clothing.
● In general, drinking alcoholic beverages should be kept to a minimum or avoided
completely. You should discuss this with your doctor.
● Get plenty of rest.
● Maintain good nutrition.
● Olaparib can cause tiredness, weakness or blurred vision. If you have any of these symptoms, use caution when driving a car, using machinery, or anything that requires you to be alert.
● If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing:
You will be checked regularly by your health care professional while you are taking olaparib to monitor side effects and check your response to therapy.

How Olaparib Works:
Targeted therapy is the result of about 100 years of research dedicated to understanding the differences between cancer cells and normal cells. To date, cancer treatment has focused primarily on killing rapidly dividing cells because one feature of cancer cells is that they divide rapidly. Unfortunately, some of our normal cells divide rapidly too, causing multiple side effects. Targeted therapy is about identifying other features of cancer cells. Scientists look for specific differences in the cancer cells and the normal cells. This information is used to create a targeted therapy to attack the cancer cells without damaging the normal cells, thus leading to fewer side effects. Each type of targeted therapy works a little bit differently but all interfere with the ability of the cancer cell to grow, divide, repair and/or communicate with other cells.

Olaparib is a targeted therapy. Olaparib is a poly (ADP-ribose) polymerase (PARP) enzyme inhibitor, including PARP1, PARP2, and PARP3. PARP enzymes are involved in DNA transcription, cell cycle regulation, and DNA repair. Olaparib is a potent oral PARP inhibitor which induces synthetic lethality in BRCA 1/2 deficient tumor cells through the formation of
double-stranded DNA breaks which cannot be accurately repaired, which leads to disruption of cellular homeostasis and cell death.

Research continues to identify which cancers may be best treated with targeted therapies and to identify additional targets for more types of cancer.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

Rucaparib

Trade Name: Rubraca™
Rucaparib is the generic name for the trade name drug Rubraca™. In some cases, health care professionals my use the trade name Rubraca™ when referring to the generic drug name rucaparib.

Drug Type:
Rucaparib is a targeted therapy. This medication is classified as a PARP (poly ADP ribose polymerase) inhibitor. (For more detail, see "How Rucaparib Works" below).

What Rucaparib Is Used For:
● Rucaparib is indicated as monotherapy (by itself) in patients with deleterious germline and/or somatic BCRA mutation associated (as detected by an FDA approved test) advanced ovarian cancer who have been treated with 2 or more prior lines of chemotherapy.
● The maintenance treatment of recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer who are in a complete or partial response to platinum-based chemotherapy.
Note: If a drug has been approved for one use, physicians may elect to use this same drug for other
problems if they believe it may be helpful.

How Rucaparib Is Given
● Rucaparib is a pill, taken by mouth, twice a day (about 12 hours apart).
● It may be taken with or without food.
● Swallow rucaparib tablets whole. Do not crush or dissolve the tablets.
● Do not change your dose or stop rucaparib unless your health care provider tells you to.
● If you miss a dose, take your next dose at your usually scheduled time. Do not take an extra dose to make up for a missed dose.
● If you take too much rucaparib, call your health care provider right away and go to the emergency room.
● Do not repeat a vomited dose.
● Let your doctor know if you are starting any new medications as some medications interact with rucaparib.
The amount of rucaparib that you will receive depends on many factors, your general health or other health problems, and the type of side effects that you may have. Your doctor will determine your exact dosage and schedule.

Side Effects
Important things to remember about the side effects of rucaparib:
● Most people will not experience all of the rucaparib side effects listed.
● Side effects are often predictable in terms of their onset, duration, and severity.
● There are many options to help minimize or prevent side effects.
● There is no relationship between the presence or severity of side effects and the effectiveness of the medication.
The following side effects are common (occurring in greater than 30%) for patients taking rucaparib:
● Increased serum creatinine (see kidney problems)
● Fatigue (including weakness)
● Nausea
● Increased liver function tests: ALT and/or AST (see liver problems)
● Vomiting
● Decrease lymphocyte count
● Anemia (low red blood cell count
● Constipation
● Increased cholesterol
● Decreased appetite
● Taste changes
● Diarrhea
● Abdominal pain
These are less common side effects (occurring in 10-29%) for patients receiving rucaparib:
● Decreased platelet count
● Shortness of breath
● Dizziness
● Decreased neutrophil count (white blood cells that fight infection)
● Skin rash
● Fever
● Photosensitivity
Not all side effects are listed above. Side effects that are very rare -- occurring in less than about 10 percent of patients -- are not listed here. Always inform your health care provider if you experience any unusual symptoms.

When to Contact Your Doctor or Health Care Provider

Contact your health care provider immediately, day or night, and go to the emergency room, if
you should experience any of the following symptoms:
● Fever of 100.4º F (38º C) or higher, chills (possible signs of infection)
● Signs of an allergic reaction, like rash, hives, itching, red, swollen, blistered or peeling skin with or without fever, wheezing, tightness in the chest or throat, trouble breathing or talking, shortness of breath, a cough that is new or worse, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat.
The following symptoms require medical attention, but are not a emergency. Contact your health care provider within 24 hours of noticing any of the following:
● Nausea (interferes with ability to eat and unrelieved with prescribed medication)
● Vomiting (vomiting more than 4-5 times in a 24 hour period)
● Diarrhea (4-6 episodes in a 24-hour period)
● Unusual bleeding or bruising
● Black or tarry stools, or blood in your stools
● Blood in the urine
● Pain or burning with urination
● Extreme fatigue (unable to carry on self-care activities)
Always inform your health care provider if you experience any unusual symptoms.

Precautions
● Before starting rucaparib treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.).
● Do not take aspirin, products containing aspirin unless your doctor specifically permits this.
● Do not receive any kind of immunization or vaccination without your doctor's approval while
taking rucaparib.
● Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (Rucaparib may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus.).
● For both men and women: Use contraceptives, and do not conceive a child (get pregnant) while taking rucaparib. Barrier methods of contraception, such as condoms, are recommended for up to 6 months after last dose of rucaparib.
● Do not breast feed while taking rucaparib and for 2 weeks after the final dose.

Self-Care Tips
● Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
● You may be at risk of infection so try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your health care provider.
● Wash your hands often.
● To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.
● Avoid sun exposure. Wear SPF 30 (or higher) sunblock and protective clothing.
● In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
● Get plenty of rest.
● Maintain good nutrition.
● Remain active as you are able. Gentle exercise is encouraged such as a daily walk.
● If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing While Taking
Rucaparib
You will be checked regularly by your doctor while you are taking rucaparib to monitor side effects and check your response to therapy. Periodic blood work will be obtained to monitor your complete blood count (CBC).

How Rucaparib Works
Targeted therapy is the result of about 100 years of research dedicated to understanding the differences between cancer cells and normal cells. To date, cancer treatment has focused primarily on killing rapidly dividing cells because one feature of cancer cells is that they divide rapidly. Unfortunately, some of our normal cells divide rapidly too, causing multiple side effects. Targeted therapy is about identifying other features of cancer cells. Scientists look for specific
differences in the cancer cells and the normal cells. This information is used to create a targeted therapy to attack the cancer cells without damaging the normal cells, this leading to fewer side effects. Each type of targeted therapy works a little bit differently but all interfere with the ability of the cancer cell to grow, divide, repair and/or communicate with other cells.

Rucaparib is a targeted therapy. Rucaparib is a poly ADP-ribose polymerase (PARP) enzyme inhibitor, including PARP1, PARP2, and PARP3. PARP enzymes are involved in DNA transcription,cell cycle regulation, and DNA repair. By inhibiting PARP, rucaparib may cause increased formation of PARP-DNA complexes, resulting in DNA damage, apoptosis, and cell death. Increased cytotoxicity due to rucaparib was observed in tumor cell lines deficient in BRCA 1/2 and other DNA repair genes.Research continues to identify which cancer may be best treated with targeted therapies and to identify additional targets for more types of cancer.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

Niraparib

Trade Name(s): Zejula
Niraparib is the generic name for the trade name drug Zejula. In some cases, health care professionals may use the trade name Zejula when referring to the generic drug name niraparib.

Drug Type:
Niraparib is an anti-cancer ("antineoplastic" or "cytotoxic") targeted therapy. This medication is classified as a PARP (poly ADP ribose polymerase) inhibitor. (For more detail, see "How Niraparib Works" below)

What Niraparib Is Used For:
● Niraparib is indicated as a maintenance treatment for recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer in patients who are in a complete or partial response to platinum based chemotherapy. It is usually started within 8 weeks following the most recent platinum containing regimen.
Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.

How Niraparib Is Given:
● Niraparib is a capsule, taken by mouth daily.
● Consider taking at bedtime to decrease the risk for nausea or vomiting.
● It may be taken with or without food.
● Swallow niraparib capsules whole. Do not open, crush or dissolve the capsules.
● Do not change your dose or stop niraparib unless your health care provider tells you to.
● If you miss a dose, take your next dose at your usually scheduled time. Do not take an extra dose to make up for a missed dose.
● If you take too much niraparib, call your health care provider right away and go to the emergency room.
● Do not repeat a vomited dose.
● Let your doctor know if you are starting any new medications as some medications interact with niraparib.
The amount of niraparib that you will receive depends on many factors, your general health or other health problems, and the type of side effects that you may have. Your doctor will determine you exact dosage and schedule.

Side Effects:
Important things to remember about the side effects of niraparib:
● Most people will not experience all of the niraparib side effects listed.
● Side effects are often predictable in terms of their onset, duration, and severity.
● There are many options to help minimize or prevent side effects.
● There is no relationship between the presence or severity of side effects and the effectiveness of the medication.

The following side effects are common (occurring in greater than 30%) for patients taking niraparib:
● Nausea
● Decreased platelet count
● Fatigue (including weakness)
● Anemia (low red blood cell count)
● Constipation
● Vomiting
● Decreased neutrophil count (white blood cells that fight infection)
● Increased liver function test: AST and/or ALT
These are less common side effects (occurring in 10-29%) for patients receiving niraparib:
● Insomnia (sleep disturbance)
● Headache
● Decreased appetite
● Nasopharyngitis (Irritated nose or throat)
● Skin rash
● Mouth sores
● Hypertension (high blood pressure)
● Dizziness
● Heartburn
● Back pain
● Low total white blood cell count
● Cough
● Urinary tract infections
● Anxiety
Note all side effects are listed above. Side effects that are very rare -- occurring in less than about 10
percent of patients -- are not listed here.
Always inform your health care provider if you experience any unusual symptoms.

When to Contact Your Health Care Provider:

Precautions:
● Before starting niraparib treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.).
● Do not take aspirin, products containing aspirin unless your doctor specifically permits this.
● Do not receive any kind of immunization or vaccination without your doctor's approval while
taking niraparib.
● Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (Niraparib may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus.).
● For both men and women: Use contraceptives, and do not conceive a child (get pregnant)while taking niraparib. Barrier methods of contraception, such as condoms, are recommended for up to 6 months after last dose of niraparib.
● Do not breast feed while taking niraparib.

Self-Care Tips:
● Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
● You may be at risk of infection so try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your health care provider.
● Wash your hands often.
● To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals. Try taking niraparib at bedtime.
● Avoid sun exposure. Wear SPF 30 (or higher) sunblock and protective clothing.
● In general, drinking alcoholic beverages should be kept to a minimum or avoided completely.
You should discuss this with your doctor.
● Get plenty of rest.
● Maintain good nutrition.
● Remain active as you are able. Gentle exercise is encouraged such as a daily walk.
● If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing While Taking Niraparib:
You will be checked regularly by your doctor while you are taking niraparib to monitor side effects and check your response to therapy. Periodic blood work will be obtained to monitor your complete blood count (CBC).

How Niraparib Works:
Targeted therapy is the result of about 100 years of research dedicated to understanding the differences between cancer cells and normal cells. To date, cancer treatment has focused primarily on killing rapidly dividing cells because one feature of cancer cells is that they divide rapidly. Unfortunately, some of our normal cells divide rapidly too, causing multiple side effects. Targeted therapy is about identifying other features of cancer cells. This information is used to create a targeted therapy to attack the cancer cells without damaging the normal cells, thus leading to fewer side effects. Each type of targeted therapy works a little bit differently but all interfere with the ability of the cancer cell to grow, divide, repair and/or communicate with other cells.

Niraparib is a targeted therapy. Niraparib is a poly ADP-ribose polymerase (PARP) enzyme inhibitor, which is highly selective for PARP1 and PARP2. PARP1 and PARP2 are involved in detecting DNA damage and promote repair. Inhibiting PARP1 and PARP2 enzymatic activity results in DNA damage, apoptosis, and cell death. Niraparib induces cytotoxicity in tumor cell lines with and without BRCA1/2 deficiencies.

Research continues to identify which cancer may be best treated with targeted therapies and to identify additional targets for more types of cancer.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.