Complications
Cisplatin is a key part of the treatment regimen and may cause significant nausea and vomiting. This may be acute or delayed, appearing several days after the chemotherapy administration. Intravenous antiemetics are commonly given with each infusion to prevent this adverse effect, and home antiemetics are also prescribed. Combination regimens of antiemetic medications including dexamethasone, aprepitant, and 5-HT3 antagonists effectively reduce nausea and vomiting.[105]
Neutropenia is common during chemotherapy. Patients with an absolute neutrophil count of <500/microlitre or <1000/microlitre and falling are considered neutropenic. A fever in this setting is defined as any temperature of ≥38.3ºC (101ºF) or a sustained temperature of ≥37.8ºC (100ºF) for 1 hour.
Neutropenic fevers require urgent evaluation and treatment. (Complete physical examination, blood cultures, full blood count, creatinine, and liver function tests are mandatory. A chest x-ray and urine analysis are also performed. Empirical broad-spectrum antibiotic therapy should be given without delay.) Cytokine support should be considered as appropriate to ensure compliance with dosing schedules.
Cisplatin may cause significant kidney damage including acute kidney injury. Patients with baseline renal dysfunction may be at greater risk. The renal tubular damage from cisplatin may cause the inappropriate loss of electrolytes, including magnesium. Hydration with intravenous fluids may be given to reduce the possibility of kidney damage.
In the year after treatment, bleomycin-etoposide-cisplatin was associated with highly increased risks of myocardial infarction, cerebrovascular accident, and venous thromboembolism. The risk of CVD decreased to normal levels when past 1 year of treatment with BEP.[108] The risk of developing CVD in the long term increased in those who were treated with platinum-based chemotherapy; were obese or smoking at diagnosis; developed dyslipidaemia during follow-up, had a positive family history of CVD, or developed Raynaud's phenomenon.[109]
Generally occurs within 6 months of bleomycin treatment. Etoposide has rare pulmonary toxicity as well.
Bleomycin-induced pneumonitis and fibrosis are uncommon but potentially fatal complications of testis cancer treatment (fatal in <2%).[105]
The risk appears to be dose related.
Age over 40 years, pre-existing lung disease, and chronic kidney disease appear to increase risk.
Deterioration of pulmonary function tests may herald the development of this complication.
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