Guidelines for Complications of Cancer Treatment Vol VIII Part B

o Treatment of febrile neutropenia requires risk assessmentas per the Infectious disease society of America (IDSA)guidelines and administration of oral or intravenousantibiotics and growth factors. – (LOE-2)o Development of nephrotoxicity requires temporary orpermanent discontinuation or dose modification ofcisplatin. Aggressive hydration, potassium, sodium andmagnesium supplementation helps to avoid furthertubular damage.- (LOE-3)o For the drug-induced grade 3 /4 neuropathy andototoxicity, discontinuation of cisplatin or paclitaxel isrequired. In patients with lesser grade of toxicity dosemodification can be considered. Amitriptyline andgabapentin help reducing the neuropathic pain.- (LOE-4)o Chemotherapy-induced diarrhea requires hydration andelectrolyte replacement .Lopermaide can be used inpatients with 5-FU related diarrhea. Octreotide is helpfulin patients who do not respond to loperamide(LOE-2)o Treatment of mucositis requires good pain managementwith opioid or non-opioid analgesics depending on theseverity of pain and response to first line therapy.- (LOE-3)o There is no role of acyclovir or chlorhexidine mouthwashin treatment of mucositis.-(LOE-2).Targeted therapy :The role of targeted therapy is gradually increasing in headneck cancer. Presently the only FDA approved drug iscetuximan (monoclonal antibody directed against epidermalgrowth factor receptor) - along with radiation for treatment oflocally advanced head neck cancer and in patients withrecurrent/metastatic head neck cancer as first line treatmentalong with chemotherapy - (LOE-1). This drug is well tolerated258