¼±Åà - È­»ìǥŰ/¿£ÅÍŰ ´Ý±â - ESC

 

Ç×¾ÏÁ¦ÀÇ ºÐ·ù¿Í ¾à¸®ÀÛ¿ë
1.cytotoxic actineoplastics
1)Ankylating agent
A. Classic alkylators
a.Cyclophosphamide(Cytoxan,CTX)
¨çÀûÀÀÁõ : ¹éÇ÷º´, ÀÓÆÄÁ¾, ´Ù¹ß¼º °ñ¼öÁõ, ½Å°æ¾Æ¼¼Æ÷Á¾, À¯¹æ¾Ï, ÀڱþÏ, Æó¾Ï µîÀÇ solid tumor¿Í ¹é
Ç÷º´°ú °°Àº Ç÷¾×¾Ï¿¡µµ À¯È¿.
¨è¾à¹°µ¿·ÂÇÐ
-°æ±¸Èí¼öÀ² ¾çÈ£(»ýüÀÌ¿ë·ü 100%)
-°£¿¡¼­ ´ë»çµÇ¾î Ȱ¼ºÇüÀÎ 4-hydroxycyclophosphamide·Î º¯È¯µÇ¾î Ç×¾ÏÈ¿°ú¸¦ ³ªÅ¸³»¸ç, ´ë»çü
ÁßÀÇ ÇϳªÀÎ acroleinÀÌ ¹è¼³µÇ´Â °úÁ¤¿¡ ¹æ±¤À» ÀÚ±ØÇÏ¿© ÃâÇ÷¼º ¹æ±¤¿°À» À¯¹ß.
¨éºÎÀÛ¿ë
-¼ÒÈ­±â°è : °í¿ë·® Åõ¿© 6~10 ½Ã°£ ÈÄ ¿À½É, ±¸Åä, ½Ä¿åºÎÁø, ¼³»ç, Á¡¸·¿°
-½Éµ¶¼º : 60§·/§¸ ÀÌ»ó Åõ¿©½Ã ±Þ¼º ½É±Ù±«»ç À¯¹ß °¡´É¼º
-½Åµ¶¼º : 50§·/§¸ ÀÌ»ó Åõ¿©½Ã SIADH À¯¹ß
-È£Èí±â°è : Æó·Å, °£Áú¼º Æó¼¶À¯Áõ
-ºñ´¢±â°è : ÃâÇ÷¼º ¹æ±¤¿°¡æÀûÀýÇÑ ¼öÈ­¿Í ¹è´¢, ´ë»çü¿Í °áÇÕÇÏ¿© µ¶¼ºÀ» ¿¹¹æÇÏ´Â Mesna¸¦ º´¿ë
Åõ¿©ÇÑ´Ù.(ƯÈ÷ °í¿ë·® ¿ä¹ý½Ã)

b.Ifosfamide(Holoxan)
¨çÀûÀÀÁõ : cyclophosphamide¿Í À¯»ç
¨è¾à¹°µ¿·ÂÇÐ
- °æ±¸ Åõ¿©½Ã Èí¼öÀ²Àº ÁÁÀ¸³ª ÁßÃ߽Űæ°è ºÎÀÛ¿ëÀÇ ºó¹ß·Î ÁÖ»çÁ¦·Î °³¹ßµÊ.
- °£¿¡¼­ Èí¼öµÇ¾î Ȱ¼ºÇüÀÎ ifosformic mustard ¿Í acrolein(urotoxic metabolite, hemorrhagic
cystitis)ÀüȯµÊ.
¨éºÎÀÛ¿ë
- Cyclophosphamide¿Í ºÎÀÛ¿ë°ú À¯»ç
-ºñ´¢±â°è : ÃâÇ÷¼º ¹æ±¤¿°ÀÌ cyclophosphamide º¸´Ù µ¶¼ºÀÌ Å©¹Ç·Î ¿ë·®¿¡ »ó°ü¾øÀÌ ÀûÀýÇÑ ¼öÈ­
¿Í ¹è´¢, Mesna ¸¦ Åõ¿©ÇÑ´Ù. ÀÏ´Ü ¹ß»ýÇÏ¸é ºñ°¡¿ªÀûÀ̹ǷΠ¿¹¹æÀÌ Áß¿ä.

B. Platinum complex
a. Cisplatin(CDDP)
¨çÀûÀÀÁõ : °íȯ¾Ï, Æó¾Ï, µÎ°æºÎ¾Ï, ÀڱþÏ
¨è¾à¹°µ¿·ÂÇÐ
-´Ü¹é°áÇÕ·ü : 90% protein binding
-long half-life(up to 3 days)
-renal excretion : ½Å±â´É¿¡ µû¸¥ ¿ë·® Á¶Àý ÇÊ¿ä
¨éºÎÀÛ¿ë
-¼ÒÈ­±â°è : °­ÇÑ ¿À½É, ±¸Åä(¿¹¹æÀû ÁøÅäÁ¦ Åõ¿© ÇÊ¿ä)
-Á¶Ç÷°è : °ñ¼ö ±â´É ¾ïÁ¦
-½Åµ¶¼º : renal tubular necrosis : aggressive hydration, ÀÌ´¢Á¦, baseline renal function check
ÈÄ ½Å±â´É¿¡ µû¶ó ¿ë·® Á¶Àý
-À̵¶¼º : ÃàÀû¼º, ºñ°¡¿ªÀûÀÎ À̸í, û·ÂÀúÇÏ
-ÀüÇØÁú ÆòÇüÀÌ»ó : hypokalemia, hypomagnesemia
-½Å°æ°è : ¸»ÃʽŰ浶¼º
-Anaphylactic like reaction : ¾È¸éºÎÁ¾, ±â°üÁö ÇùÂø, ÀúÇ÷¾Ð

b.Carboplatin
¨çÀûÀÀÁõ : ³­¼Ò¾Ï, Æó¾Ï
¨è¾à¹°µ¿·ÂÇÐ
-carboplatin ÀÚü´Â Ç÷Àå ´Ü¹éÁú°ú °áÇÕÇÏÁö ¾ÊÀ½.
-renal excretion : ½Å±â´É¿¡ µû¶ó ¿ë·® Á¶Àý ÇÊ¿ä
-Calvert formula : Dose(§·) = target AUC * (GFR +25)
Target AUC = 4~6§·*min/§¢
¨éºÎÀÛ¿ë
-¼ÒÈ­±â°è : ¿À½É, ±¸Åä
-Á¶Ç÷°è : ¿ë¶ûÁ¦ÇÑÀû °ñ¼ö ¾ïÁ¦(ƯÈ÷ Ç÷¼ÒÆÇ °¨¼ÒÁõ)
-½Åµ¶¼º : Cisplatin¿¡ ºñÇÏ¿© °æ¹ÌÇÑ µ¶¼ºÀ» ³ªÅ¸³»¹Ç·Î hydration ÇÊ¿ä ¾øÀ½.
-Cisplatin¿¡ ºñÇÏ¿© ½Å°æµ¶¼º, À̵¶¼º ºóµµ ³·À½.

2)Anti-metabolities : S-phase specific
A. Methotrexate(MTX)
a. ÀÛ¿ë±âÀü : analog of reduced folic acid, dihydrofolate reductase(DHFR) inhibition
dihydrofolate---------------------->THF(tetrahydrofolate)
dihydrofolate reductase
b. ÀûÀÀÁõ : ±Þ¼º Àӯı¸¼º ¹éÇ÷º´(ALL), choriocarcinoma, À¯¹æ¾Ï, µÎ°æºÎ¾Ï, sarcoma
c. ¾à¹°µ¿·ÂÇÐ
-´Ü¹é°áÇÕ·ü(50~70%)
-3rd space disposition(pleural effusion ascites)
-½Å¹è¼³ : adequate hydration, urine alkalization, ½Å±â´É¿¡ µû¶ó ¿ë·®Á¶Àý
d. Åõ¿©¹æ¹ý : PO, IV, IM, IT, intraventricular
e. ºÎÀÛ¿ë
-¼ÒÈ­±â°è : Á¡¸·¿°, ¼³»ç, ¿À½É, ±¸Åä
-Á¶Ç÷°è : °ñ¼ö±â´É¾ïÁ¦
-°£µ¶¼º : LFTÀÇ °¡¿ªÀû »ó½Â
-½Åµ¶¼º : MTX, 7-OH MTXÀÇ Ä§ÀüÀ¸·Î ÀÎÇÑ renal tubular damage
high dose MTX(1g/§³ ÀÌ»ó) Åõ¿©½Ã hydration, urine alkalization Åõ¿© ÈÄ 24½Ã°£ºÎÅÍ
leucovorin(citrovorium factor) rescue, blood level check(48hrs level)

B. Cytosine arabinoside(Ara-C, Cytarabine)
a. ÀÛ¿ë±âÀü : competitive inhibitor of DNA polymerase
b. ÀûÀÀÁõ : ±Þ, ¸¸¼º °ñ¼ö¼º ¹éÇ÷º´(AML, CML), meningeal leukemia
c. ¾à¹°µ¿·ÂÇÐ
-¼¼Æ÷ ³»¿¡¼­ ´ë»ç È¿¼Ò¿¡ ÀÇÇØ Ȱ¼ºÇüÀÎ Ara-C triphosphate(Ara-CTP)·Î Àüȯ
-half life(7~20 mins) : IV infusion
-°æ±¸ Èí¼ö ºÒ·®, CSF ·Î ºÐÆ÷
d. Åõ¿©¹æ¹ý
-low dose : 20~30§· SC, IVP
-conventional dose : 100~200§·/§³ or 50§·
e. ºÎÀÛ¿ë
-¼ÒÈ­±â°è : ¿À½É, ±¸Åä, ¼³»ç, ±¸³»¿°
-Á¶Ç÷°è : °ñ¼ö ±â´É ¾ïÁ¦
-ÁßÃ߽Űæ°è : IT Åõ¿©½Ã °£Áú À¯¹ß, ¿îµ¿½ÇÁ¶, ¹ß¿­, ¹ßÁø, µÎÅë, ±Çۨ
-high dose Ara-C toxicity : °¡¿ªÀû cerebella toxicity (¿îµ¿½ÇÁ¶, ¾È±¸ÁøÅÁÁõ)
°¡¿ªÀû °á¸·¿°, °¢¸·¿°, (steroid eyes dropÀÇ ¿¹¹æÀû Åõ¿©), hand-foot syndrome
-Cytarabine syndrome : ¹ß¿­, ±ÙÀ°Åë, °ñÅë, °á¸·¿°, ÈäÅë, steroid ÀÇ Åõ¿©·Î ¿¹¹æ, Ä¡·á°¡´É

C. Fluorouracil(5-FU)
a. ÀÛ¿ë±âÀü : inhibitor of thymidylate synthetase - leucovorin °ú º´¿ë½Ã »ó½Â ÀÛ¿ë
b. ÀûÀÀÁõ : À¯¹æ¾Ï, ÃéÀå¾Ï, Á÷Àå/´ëÀå¾Ï, À§¾Ï, ÀڱþÏ
c. ¾à¹°µ¿·ÂÇÐ
-°æ±¸ Èí¼ö´Â ¸Å¿ì ºÒ±ÔÄ¢Àû : »ýü ÀÌ¿ë·üÀ» ³ôÀÎ pro-drug Á¦Á¦°¡ »óǰȭµÊ.
-È¿¼Ò¿¡ ÀÇÇÏ¿© Ȱ¼ºÇüÀÎ 5-fluorouridin-triphosphate(5-FUTP)·Î ÀüȯµÇ¾î DNA ÇÕ¼º¾ïÁ¦.
5-fluorodeoxyuridine monophosphate(5-FdUMP)´Â RNA ±â´ÉÀå¾Ö À¯µµ
d. ºÎÀÛ¿ë
-¼ÒÈ­±â°è : Á¡¸·¿°(±¸³»¿°, ¼³»ç)
-Á¶Ç÷°è : °ñ¼ö±â´É ¾ïÁ¦
-½ÉÇ÷°ü°è : ÈäÅë, È£Èí°ï¶õ, ºÎÁ¤¸Æ, ½ÉºÎÀü, ÀúÇ÷¾Ð
-½Å°æ°è : hand-foot syndrome(Àú¿ë·®, ¿¬¼Ó ÁÖÀÔ½Ã), B6(pyridoxine)ÀÇ Åõ¿©·Î °æ°¨°¡´É

3)Antitumor Antibiotics
A. Anthracyclines
a. Doxorubicin
¨çÀÛ¿ë±âÀü : intercalation by sliding the planar ring structure between the nucleotide pair of
the DNA helix¡ædistorting the shape, leading to a partial unwinding
¨èÀûÀÀÁõ : ±Þ¼º ¹éÇ÷º´, sarcoma, ÀÓÆÄÁ¾, À¯¹æ¾Ï
¨é¾à¹°µ¿·ÂÇÐ : ´ëºÎºÐ ´ãÁóÀ¸·Î ¹è¼³µÇ¾î °£±â´É¿¡ µû¶ó ¿ë·® Á¶Àý ÇÊ¿ä
¨êºÎÀÛ¿ë
-¼ÒÈ­±â°è : ¿À½É, ±¸Åä, Á¡¸·¿°
-Á¶Ç÷°è : °ñ¼ö±â´É¾ïÁ¦
-¼øÈ¯±â°è : ÃàÀû¼º ½Éµ¶¼º(¿ïÇ÷¼º ½ÉºÎÀü), ÃàÀû·® Á¦ÇÑ, dexrazoxane
-ÇǺΠ: Å»¸ð, extravasation½Ã ¼¼Æ÷±«»ç(vesicant), radiation recall
-ºñ´¢»ý½Ä°è : red urine
-¾È¸éÈ«Á¶ : histamine À¯¸®

B. Other Antitumor Antibiotics
a. Bleomycin
¨çÀÛ¿ë±âÀü : oxygen-free radical »ý¼º°ú intercalation
¨èÀûÀÀÁõ : ÆòÆí»óÇǾÏ, °íȯ¾Ï, ÀÓÆÄÁ¾, pleurodesis
¨é¾à¹°µ¿·ÂÇÐ
-°ÅÀÇ ´Ü¹é°áÇÕ ÇÏÁö ¾ÊÀ¸¸ç, CSF¿¡ ºÐÆ÷ÇÏÁö ¾ÊÀ½
-Bleomycin hydrolase¿¡ ÀÇÇÏ¿© °¡¼ö ºÐÇØµÇ¾î ºñȰ¼ºÈ­
¨êºÎÀÛ¿ë
-¼ÒÈ­±â°è : ¿À½É, ±¸Åä, Á¡¸·¿°
-Á¶Ç÷°è : ½É°¢ÇÑ °ñ¼ö±â´É ¾ïÁ¦´Â µå¹³
-È£Èí±â°è : °£Áú¼º Æó¼¶À¯È­(ÃàÀû·® : 300U/§³)
-ÇǺΠ: »ö¼ÒÄ§Âø, È«¹Ý, ±Ë¾ç
-Anaphylactoid reaction : ÀÓÆÄÁ¾ ȯÀÚ¿¡¼­ ÁÖ·Î ¹ßÇü, Åõ¿© 1,2ÀÏ¿¡ 1~2UÀÇ test dose¸¦ Åõ¿©
-±âŸ : ¹ß¿­(Åõ¿© ÈÄ 4~12½Ã°£¿¡ ¹ßÇö), ¿ÀÇÑ, ±ÙÀ°Åë, Raynaud Çö»ó

b. Dactinomycin(Actinomycin D)
¨çÀûÀÀÁõ : choriocarcinoma, Wilm's tumor, rhabdomyosarcoma, °íȯ¾Ï
¨èºÎÀÛ¿ë
-¼ÒÈ­±â°è : ¿À½É, ±¸Åä, ½Ä¿åºÎÁø, Á¡¸·¿°
-Á¶Ç÷°è : °ñ¼ö±â´É ¾ïÁ¦, Àç»ý ºÒ·®¼º ºóÇ÷
-±âŸ : Å»¸ð, ¹ßÀû, ºÎÁ¾, ÀÏÃâ½Ã ±«»ç
-¹æ»ç¼± Ä¡·á Áõ°­ ÀÛ¿ë : ¹æ»ç¼± Ä¡·á¿Í º´¿ë½Ã ÇǺΠ¹ßÀû, ¼öÆ÷

c. Mitomycin(Mitomycin C)
¨çÀûÀÀÁõ : À§¾Ï, ÃéÀå¾Ï, À¯¹æ¾Ï
¨è¾à¹° µ¿·ÂÇÐ
-°£°ú Á¶Á÷¿¡¼­ ½Å¼ÓÈ÷ ´ë»ç
¨éºÎÀÛ¿ë
-¼ÒÈ­±â°è : Áö¿¬¼º ¿À½É, ±¸Åä, ½Ä¿åºÎÁø
-Á¶Ç÷°è : Áö¿¬¼º °ñ¼ö±â´É ¾ïÁ¦(ÃàÀû¼º, Áö¼Ó¼º Ç÷¼ÒÆÇ °¨¼ÒÁõ)
-¼øÈ¯±â°è : anthracycline °è Ç×¾ÏÁ¦¿Í º´¿ë½Ã ºóµµ Áõ°¡
-Hemolytic uremic syndrome : ¹ß¿­, ½ÅÀå¾Ö, ºóÇ÷
-ÇǺΠ: extravasation½Ã Á¶Á÷±«»ç, Ç÷°ü¿°, Ç÷°üÀÚ±Ø, radiation recall

4)Plant alkaloids
A. Vinca Alkaloids
a. Vincristine(Oncovin, VCR)
¨çÀûÀÀÁõ : ALL, neuroblastoma, rhabdomyosarcoma, Hodgkin's disease, ÀÓÆÄÁ¾
¨è¾à¹°µ¿·ÂÇÐ
-BBB Åë°ú´Â ¼Ò·®À̸ç Ä¡·á ³óµµ¿¡¼­´Â CSF¿¡ µµ´ÞÇÏÁö ¾ÊÀ½
-ÁÖ·Î °£¿¡¼­ ´ë»çµÇ¾î ºÐº¯À¸·Î ¹è¼³
¨éºÎÀÛ¿ë
-¼ÒÈ­±â°è : º¯ºñ, ¼³»ç, ±¸Åä, ÀåÆó»ö
-Á¶Ç÷°è : °ñ¼ö±â´É ¾ïÁ¦(µå¹°)
-½Å°æ°è : ¸»ÃʽŰ浶¼º(foot drop), ÀÚÀ²½Å°æ°è µ¶¼º ÁÖ´ç ¿ë·®À» 2§·À¸·Î Á¦ÇÑ
-³»ºÐºñ°è : SIADH

b. Pacilitaxel(Taxol)
¨çÀÛ¿ë±âÀü : microtubule polymerization promotor¡ælate G2 or M phase blockade
¨èÀûÀÀÁõ : ÀüÀ̼º ÀڱþÏ, À¯¹æ¾Ï, Æó¾Ï, À§¾Ï
¨é¾à¹°µ¿·ÂÇÐ
-CSF¿¡ ºÐÆ÷ÇÏÁö ¾ÊÀ½
-ÁÖ·Î °£´ë»ç µÇ¾î ´ãÁó ¹è¼³
¨êÅõ¿© ¹æ¹ý : non-PVC container(glass bottle), IV administration set(non-PVC set)
¨ëºÎÀÛ¿ë
-¼ÒÈ­±â°è : ¿À½É, ±¸Åä
-Á¶Ç÷°è : °ñ¼ö±â´É¾ïÁ¦
-¸»ÃʽŰ浶¼º : °¨°¢ÀÌ»ó
-½ÉÀåµ¶¼º : ÀúÇ÷¾Ð, ¼­¸Æ(EKG monitoring)
-°ú¹Î¹ÝÀÀ : steroid, H1, H2 blocker·Î Àüóġ
-±âŸ : ±ÙÀ°Åë, °üÀýÅë

c. Docetaxel(Taxotere)
¨çÀÛ¿ë±âÀü : microtubule polymerization promotor ¡ælate G2 or M phase blockade
¨èÀûÀÀÁõ : Æó¾Ï, À¯¹æ¾Ï, ÀڱþÏ, À§¾Ï
¨éÅõ¿©¹æ¹ý : USA - non-PVC container(glass bottle) & IV administration set
¨êºÎÀÛ¿ë
-¼ÒÈ­±â°è : ¿À½É, ±¸Åä, ¼³»ç
-Á¶Ç÷°è : °ñ¼ö ±â´É ÀúÇÏ
-½Å°æ°è : °æ¹ÌÇÏ°í °¡¿ªÀûÀÎ °¨°¢ ÀÌ»ó
-½ÉÇ÷°ü°è : paclitaxel¿¡¼­ ³ªÅ¸³ª´Â ºÎÁ¤¸ÆÀº ³ªÅ¸³ªÁö ¾Ê°í fluid retention(¸»ÃʺÎÁ¾, È丷À¯Ãâ, º¹
¼ö, üÁßÁõ°¡ÀÇ ºÎÀÛ¿ë, dexamethasoneÀÇ º´¿ë Åõ¿©·Î ¿¹¹æ°¡´É)

B. Epidopodophylotoxins : cell cycle-phase specific G2 & M phase inhibitor of mitosis
a. Etoposide (VP-16, Vepesid)
¨çÀûÀÀÁõ : °íȯ¾Ï, Æó¾Ï, ¹éÇ÷º´
¨è¾à¹°µ¿·ÂÇÐ
-»ýü ÀÌ¿ë·ü 50%
-´Ü¹é°áÇÕ·üÀÌ 90~95%·Î CSF·Î Àß ÀÌÇàÇÏÁö ¾ÊÀ½
-°£¿¡¼­ P450 3A4 È¿¼Ò¿¡ ÀÇÇÏ¿© »êÈ­µÇ¸ç ºÒȰ¼ºÈ­
¨éºÎÀÛ¿ë
-¼ÒÈ­±â°è : ¿À½É, ±¸Åä, ±¸³»¿°
-Á¶Ç÷°è : °ñ¼ö±â´É ¾ïÁ¦
-°ú¹Î¹ÝÀÀ : infusion time related hypotension 30ºÐ ÀÌ»ó infusion
-ÇǺΠ: °¡¿ªÀû Å»¸ð, »ö¼ÒÄ§Âø, ÀÚ¹ÝÁõ, Stevens-Johnson syndrome
-±âŸ : µå¹°°Ô ¸»ÃÊ ½Å°æÅë

5)Topoisomerase I inhibitor
A. Topotecan
a. ÀûÀÀÁõ : ÀڱþÏ, ¼Ò¼¼Æ÷¾Ï
b. ºÎÀÛ¿ë
-¼ÒÈ­±â°è : ¿À½É, ±¸Åä, ¼³»ç, º¯ºñ
-Á¶Ç÷°è : °ñ¼ö±â´É ¾ïÁ¦(½ÉÇÑ È£Áß±¸ °¨¼ÒÁõ)
-½Å°æ°è : µÎÅë, °¨°¢ÀÌ»ó
-±âŸ : flu-like symptoms, fever

<< Ç×¾ÏÁ¦ÀÇ µ¶¼º >>

½ÉÇÑ Àü½Å ¼è¾à, °í·É, ¿µ¾ç°áÇÌ, ȤÀº Á¾¾ç ȤÀº ÀüÀÌÁ¾¾ç¿¡ ÀÇÇÑ direct organ involvementµîÀº Ç×¾ÏÁ¦Ä¡·á½Ã ¿¹Ãø¸øÇÑ ½ÉÇÑ ºÎÀÛ¿ëÀ» ÃÊ·¡ÇÒ ¼öÀÖÀ½.
¶ÇÇÑ Idiosyncratic drug reactions¿¡ ÀÇÇØ¼­µµ ½É°¢Çϰí, ¿¹ÃøÄ¡ ¸øÇÑ °á°ú°¡ ÃÊ·¡.
µû¶ó¼­ Ç×¾ÏÄ¡·á ¹Þ´Â ȯÀÚµéÀº ÁÖÀÇ ±í°Ô °üÂû µÇ¾î¾ßÇÔ.

1. Hematologic toxicity
* acute granulocytopenia
- ¹ß»ý: °ñ¼ö¾ïÁ¦ Ç×¾ÏÁ¦ Åõ¿©ÈÄ 6-12ÀÏ¿¡ ¹ß»ýµÊ.
- ȸº¹ : Åõ¿©ÈÄ 21-24ÀÏ ³».
Granulocytopenia : 500/mm3¹Ì¸¸ÀÇ absolute granulocyte°¡ 5ÀÏ ÀÌ»ó Áö¼ÓµÇ¸é ±Þ¼ÓÈ÷ ÁøÇàµÇ´Â fatal sepsisÀÇ ³ôÀº À§Ç輺¿¡ ³ëÃâµÊ. µû¶ó¼­ febril cancer and granulocytopeniaȯÀÚ¿¡°Ô´Â ¿¹¹æÀûÀÎ ±¤¹üÀ§ Ç×»ýÁ¦¸¦ Åõ¿©ÇÔÀ¸·Î½á »ý¸íÀÌ À§ÇèÇÑ °¨¿°¹ß»ýÀ» ÀǹÌÀÖ°Ô ÁÙÀÏ ¼öÀÖÀ½. Granulocytopenia ȯÀÚµéÀº ü¿ÂÀ» 4½Ã°£¸¶´Ù ÃøÁ¤ÇÏ°í °¨¿°ÀÇ Áõ°Å°¡ ÀÖ³ª ÀÚÁÖ »ìÆì¾ßÇÔ.
ÃÖ±Ù ÀÌ¿ëµÇ´Â G-CSF ¿Í GM-CSF°°Àº hematopoietic growth factors´Â ¾î¶² ȯÀÚ¿¡¼­´Â granulocytopeniaÀÇ ±â°£À» ´ÜÃà½ÃÄÑÁÖ³ª, Ç÷¼ÒÆÇ°¨¼Ò¿¡´Â À̵æÀÌ ¾øÀ½.

* Thrombocytopenia
Ç÷¼ÒÆÇ ¾ïÁ¦´Â granulocytopeniaº¸´Ù 4-5ÀÏ ÈÄ¿¡ ¹ß»ýÇÏ¿© WBC°¡ Á¤»óÈ­ µÈÈÄ¿¡ ȸº¹µÊ.
Thrombocytopenia : Ç÷¼ÒÆÇ ¼öÄ¡°¡ 20000/mm3¹Ì¸¸ÀΠȯÀÚ´Â ÀÚ¿¬ÃâÇ÷ÀÇ À§Ç輺ÀÌ ³ôÀ½(gastrointestinal or acute intracranial hemorrhage)
->routineÇÏ°Ô 6-10pintÀÇ Ç÷¼ÒÆÇ¼öÇ÷À» ½ÃÇàÇØÁÜÀ¸·Î½á ÀÚ¿¬ÃâÇ÷ÀÇ À§Ç輺À» ÀǹÌÀÖ°Ô °¨¼Ò½Ãų ¼öÀÖÀ¸¸ç, Áö¼ÓÀûÀÎ Ç÷¼ÒÆÇ °¨¼Ò°¡ ¿¹°ßµÇ´Â »óȲÀ̶ó¸é 2-3ÀÏ °£°ÝÀ¸·Î ¹Ýº¹¼öÇ÷À» ÇØÁÖ´Â °ÍÀÌ ÀûÀÀµÊ.
->¸¸¾à Ç÷¼ÒÆÇ ¼öÄ¡°¡ 50000/mm3ÃʰúÇÏ¸é ´ë°³ Ç÷¼ÒÆÇ ¼öÇ÷Àº ÇÊ¿äÄ¡ ¾ÊÀ¸³ª ¸¸¾à ÃâÇ÷ÀÌ Àְųª, ¼ö¼úÀû ½Ã¼úÀü¿¡ peptic ulcer°¡ ÀÖÀ» ½Ã´Â Ç÷¼ÒÆÇ ¼öÇ÷ÀÌ ÀûÀÀµÊ. Ç÷¼ÒÆÇ ¼öÇ÷ÈÄ 1½Ã°£ ÈÄ¿¡ ÃøÁ¤ÇÑ ¼öÄ¡°¡ ÀûÀýÇÏ°Ô Áõ°¡µÇ¾î¾ßÇÏ¸ç ¸¸¾à Áõ°¡ÇÏÁö ¾ÊÀ¸¸é ÀÌ´Â random dornor platelets¿¡ °¨À۵ǾîÀÖ¾úÀ½À» ÀǹÌÇϸç À̰æ¿ì ȯÀÚ´Â single-donor human leukocyte antigen(HLA) matched plateletsÀ» ¼öÇ÷ÇØ¾ßÇÔ.

2. Gastroinstinal toxicity
ÀåÁ¡¸· ¼¼Æ÷¿¡ ´ëÇÑ Á÷Á¢ÀûÀÎ ¿µÇâ¿¡ ÀÇÇØ mucositis ¾ß±â.
¸¸¾à granulcytopenia°¡ µ¿¹ÝµÇ¸é ¼Õ»óµÈ Á¡¸·À» ÅëÇØ °¨¿°µÇ¾î bacteria or fungi°¡ Ç÷¾×³»·Î µé¾î°¥ ¼öÀÖ°Ô µÊ. Mucositis´Â Á¾Á¾ myelosuppressionº¸´Ù ¾à 3-5ÀÏ ÀÏÂï ¹ß»ý.

- Mouth and pharynxÀÇ Á¡¸· ¼Õ»ó¿¡ ÀÇÇÑ º´º¯: candidiasis or HSV infection°ú ±¸º°ÀÌ Èûµé¸ç,¶ÇÇÑ Drug toxicity¿¡ ÀÇÇÑ esophagitis´Â radiation esophagitis ³ª bacteria, fungi, HSVµî¿¡ ÀÇÇÑ °¨¿°°ú È¥µ¿. ¸ðµç °æ¿ì¿¡¼­ Áõ»óÀº dysphagia and retrosternal burning pain.

- Oral candidiasis : oral chlortrimazole (10mg ÇÏ·ç 5ȸ)¿¡ ¹ÝÀÀ,
- esophageal or severe oral candidiasis : IV amphotericin B(0.5mg/kg/day, 7Àϰ£)»ç¿ë¿¡ ´ë°³ ¹ÝÀÀ .
- Mucocutaneous HSV infection: IV acyclovir(750mg/m2/day)¸¦ »ç¿ë.
- »óºÎÀ§Àå°ü ¿°Áõ¿¡ ÀÇÇÑ ÅëÁõÀÌ ÀÖÀ» ½ÃÀÇ ´ëÁõ¿ä¹ý: warm saline mouth rinses and topical anesthesia, IV fluid or hyperalimentationÀ» Æ÷ÇÔ.
- ÇϺΠÀ§Àå°ü¿¡»ý±ä mucositis : diarrhea°¡ ÀÖÀ½,
½É°¢ÇÑ ÇÕº´Áõ: Àåõ°ø, ÃâÇ÷, ±«»ç¼º Àå¿°(NEC)µî.
NEC°¡ granulcytopeniaȯÀÚ¿¡°Ô¼­ »ý±â¸é »ý¸íÀÌ À§Çè
NECÀÇ ¼±Çà¿äÀÎ: ±¤¹üÀ§Ç×»ýÁ¦ÀÇ »ç¿ë. (clindamycin, Çø±â¼º ¼¼±ÕÀÎ Clostridium difficile¿¡ ÀÇÇØ ¾ß±â)
Áõ»ó : watery or bloody diarrhea, abdominal pain, sore throat, nausea, vomiting, feverµî.
¾ÐÅë°ú ¹Ý»çÅëÀÌ µ¿¹Ý.
Ä¡·á : °æ±¸ ȤÀº Á¤¸Æ vancomycin 125mgÀ» ÇÏ·ç 4¹ø¾¿ 10-14Àϰ£.

3. Immunosuppression :
´ëºÎºÐÀÇ Ç×¾ÏÁ¦´Â celluar and humoral immunity¸¦ ¾î´Â Á¤µµ´Â ¾ïÁ¦.
ÇÏÁö¸¸ acute immunosuppressive side effect´Â Ä¡·á°¡ ³¡³­ÈıîÁö Áö¼ÓµÇÁö ¾ÊÀ½.
¿¬±¸¿¡ ÀÇÇϸé Ä¡·áµ¿¾È¿¡´Â host defenses°¡ »ó´ç·® °¨¼ÒÇϳª Ä¡·á°¡ ¿ÏÀüÈ÷ ³¡³­ ÈÄ 2-3ÀÏ¿¡ ¿ÏÀü ȤÀº °ÅÀÇ ¿ÏÀüÈ÷ ȸº¹µÇ¾úÀ½.

4. Dermatologic reaction

* ¸¸¼ºÀûÀÎ ±«¾ç¼º ±«»ç:Doxorubicin °ú actinomycin DÀÇ Ç÷°ü¹ÛÀ¯Ãâ½Ã.
Ä¡·á : IV lineÀ» Á¦°Å
corticosterioids¸¦ ±¹¼Ò ÁÖ»ç
¾óÀ½ÁָӴϸ¦ ÇÏ·ç 4¹ø¾¿ 3ÀÏ µ¿¾È »ç¿ë
À¯ÃâµÈ »çÁö¸¦ µé¾î ¿Ã¸²
* Allopecia : Ç×¾ÏÁ¦ »ç¿ëÀÇ °¡Àå ÈçÇÑ ºÎÀÛ¿ë
ȯÀڵ鿡°Ô major emotional consequence¸¦ ÁÜ
½ÉÇÑ hair loss¿Í ¿¬°üµÇ´Â ÈçÇÑ ¾àÁ¦´Â paclitaxel and cyclophosphamideÀ̳ª ÈçÇÏ°Ô »ç¿ëµÇ¾îÁö´Â ´ë°³ÀÇ ¾àÁ¦µéÀÌ ¾î´Â Á¤µµ´Â alopecia¸¦ ¾ß±âÇÔ.
°¡¿ªÀûÀ̾ Ç×¾ÏÁ¦ Ä¡·á°¡ ³¡³ª¸é ȸº¹µÇ´Âµ¥ ÀϹÝÀûÀ¸·Î Ä¡·á°¡ ³¡³­ ÈÄ 10ÀÏ¿¡¼­ ¼öÁÖÀϳ»¿¡ hair regrwoth°¡ ½ÃÀÛµÊ.
Alopecia¸¦ °¨¼Ò½Ã۱â À§ÇÑ cold caps°¡ ´Ù¾çÇÑ È¿°ú¸¦ º¸À̸鼭 »ç¿ë.

* Generalized allergic skin reactions: skin pigmentation(bleomycin), photosensitivity reactions , transverse banding or nail loss, folliculitis(actinomycin D, methotrexate), radiation recall reactions(doxorubicin)µî.

5. Hepatic toxicity : Ç×¾ÏÁ¦ »ç¿ë¿¡ ÀÇÇØ transaminase, alkaline phosphatase, bilirubin levelsÀÇ modest elevationÀÌ ÀÖÀ» ¼öÀÖÀ¸³ª Ä¡·áÈÄ¿¡´Â ´ë°³ ¿ÏÀü ȸº¹.
Methotrexate¸¦ Àå±â°£ »ç¿ëÇϸé hepatic fibrosis°¡ ¾ß±âµÇ¾î °£°æÈ­·Î ÁøÇà°¡´É.
°£°æÈ­ ȤÀº Ç×¾ÏÁ¦¿¡ ÀÇÇÑ °£¿°ÀÌ ¹ß»ýÇϸé À¯¹ß ¾àÁ¦¸¦ ²÷°í °£¿° ¹× °£°æÈ­¿¡ ÁØÇÑ Ä¡·á¸¦ ÇØ¾ßÇÔ.

6. Pulmonary Complications
lung metastasis, pulmonary emboli, radiation pneumonitis, tumor-induced neuromuscular dysfunction, pneumoniaµî¿¡ ÀÇÇÔ.
* Interstitial pneumonitis with pulmonary fibrosis: bleomycin, alkylating agents, nitrosoureaµî¿¡ ÀÇÇØ À¯¹ß. ´Ù¸¥ infectious agents, virus, cancer spread¿¡ ÀÇÇÑ interstitial pneumonitis¿Í °¨º°ÀÌ ½±Áö ¾ÊÀ½.
Ä¡·á: ÇØ´ç¾àÁ¦¸¦ ²÷°í º¸Á¸Àû Ä¡·á.

7. Cardiac toxicity
½É±ÙÀº ÁÖ·Î nondividing cells·Î ÀÌ·ç¾îÁ® ÀÖ±â´Â ÇÏÁö¸¸ doxorubicin°°Àº anthracycline antibiotic class¿¡ ÀÇÇØ severe cardiomyopathy°¡ »ý±è.
cardia toxicity risk´Â doxorubicinÀÇ total cumulative dose¿¡ µû¶ó Áõ°¡
µû¶ó¼­ ÃÑ 500mg/m2ÀÇ cumulative dose°¡ maximal tolerable dose·Î ¿©°ÜÁø´Ù.
±Þ¼º ºÎÁ¤¸Æ: anthracyclines and pacclitaxel ¿¡ÀÇÇØ.
´ë°³´Â Ä¡·áÈÄ ¼öÀÏÀ̳»¿¡ »ç¶óÁü. ÀÌ·¯ÇÑ ºÎÁ¤¸ÆÀº total drug dose¿Í´Â ¹«°ü. Anthracyline cardiac toxicity´Â radittion¿¡ ÀÇÇØ °­È­µË
Anthracyclins¿¡ ÀÇÇØ ¾ß±âµÈ cardiomyopathyÀÇ ³»°úÀû Ä¡·á´Â º¸Á¸ÀûÀ̳ª ±× °á°ú´Â ÀϹÝÀûÀ¸·Î ¸¸Á·½º·´Áö ¸øÇÔ.
Congestive heart failure: ÀÓ»óÁõ»óÀÌ ³ªÅ¸³ª±â Àü¿¡ radionuclide cardiac scintigraphy½ÃÇàÇÏ¿© cardiac compromise¸¦ Á¶±â¿¡ detectÇÏ´Â °ÍÀÌ Áß¿ä.

8. Genitourinary toxicity

Cisplatin : renal tubular toxicity associated with azotemia and magnesium wasting



Methotrexate : renal tubules¿¡ ħÀüµÇ¾î oliguric renal failure¸¦ ¾ß±â.
¿¹¹æ: high urin volumeÀ» À¯ÁöÇϰí, urin alkalizationÀ» À¯Áö.

Metabolites of cyclophosphamide : ¹æ±¤Á¡¸·À» ÀÚ±ØÇÏ¿© ƯÈ÷ °í¿ë·®À̰ųª Àå±â°£ »ç¿ë½Ã chonic hemorrhagic cystitis¸¦ ¾ß±â.
ÀÌ·¯ÇÑ complicationÀ» °¨¼Ò½Ã۱â À§Çؼ­´Â vigorous hydration and diuresis°¡ ÇÊ¿ä.

Drug related genitourinary toxicityÀÇ Ä¡·á
- Nephrotoxic drugs¸¦ ²÷°í glomerular filtrationÀ» Áõ°¡½Ã۱â À§ÇÑ volume expansionÀ» ½ÃÇà
- hyperuricemia ¿Í hypomagnesemia°°Àº ´ë»çÀÌ»óÀ» ±³Á¤.
¸¸¾àoliguria°¡ »ý±â°Å³ª ³»°úÀûÄ¡·á°¡ ½ÅÀå±â´Éȸº¹¿¡ ½ÇÆÐÇßÀ» °æ¿ì´Â ´Ü±â°£ÀÇ º¹¸·Åõ¼®À̳ª Ç÷¾×Åõ¼®ÀÌ ÇÊ¿ä.
- Liter´ç 100-150mEq of sodium bicarbonate¸¦ ÇÔÀ¯ÇÏ´Â ¼ö¾×À» ÇÏ·ç 3 literÅõÀÔÇØÁÜÀ¸·Î½á urinary PH¸¦ 7ÀÌ»óÀ¸·Î À¯Áö.

Methotrexate: poorly dialyzedµÇ±â ¶§¹®¿¡ leucovorin rescue therapy°¡ ÇàÇØÁöÁö ¾ÊÀ¸¸é toxic levelÀÌ ¿À·§µ¿¾È Áö¼ÓµÉ ¼öÀÖÀ½.
N-acetylcysteine or mesna : °í¿ë·®ÀÇ cyclophosphamide or iphosphamide»ç¿ë½Ã °°ÀÌ »ç¿ëÇØ ÁÜÀ¸·Î½á toxic metaboliteÀÎ acroleinÀ» inactivating½ÃÅ´À¸·Î½á bladder toxicity¸¦ ¿¹¹æ.
º¸Á¸Àû Ä¡·á¿¡ ¹ÝÀÀÇÏÁö ¾Ê´Â persistent hemorrhagic cystitis: v-aminocaproic acid·Î Ä¡·á°¡´É

9. Nerotoxicity
¸¹Àº Ç×¾ÏÁ¦°¡ central or peripheral neurotoxicity¿Í ¿¬°üµÇ³ª ´ë°³´Â mildÇϳª Á¾Á¾ severe
* Cisplatin : ototoxicity, peripheral neuropathy, rarely retrobulbar neuritis and blindnessµîÀ» ¹ß »ý. °í¿ë·®¿¡¼­´Â progressive and somewhat delayed peripheral neuropathy°¡ »ý±â´Âµ¥ sensory impairment and loss of proprioceptionÀ» ¾ß±âÇϳª ¹Ý¸é¿¡ motor strength´Â ÀϹÝÀûÀ¸·Î À¯ÁöµÊ.
* Paclitaxel : peripheral neuropathy¸¦ ¶ÇÇÑ ¾ß±âÇÒ ¼öÀֱ⠶§¹®¿¡ cisplatin°ú °°ÀÌ »ç¿ëµÉ ¶§´Â µ¶¼ºÀÌ °­È­ µÉ ¼ö ÀÖÀ½.
* 5-FU : µå¹°°Ô acute cerebellar toxicity¸¦ º¸À̴µ¥ ÀÌ´Â neurotoxic metaboliteÀÎ fluorocitrate¿Í ¿¬°ü.
* Hexamethylmelamine : peripheral neuropathy and encephalopathy¿Í ¿¬°üµÈ´Ù´Â º¸°í ÀÖÀ½.

10. Vascular and hypersensitivity reactions
Á¾Á¾ anaphylaxixÇüÅ·Πhyper sensitivity reactionsÀÌ »ý±â´Âµ¥ µå¹°°Ô´Â cyclophosphamide, doxorubicin, cisplatin, intravenous melphalan,high dose methotrexate°°Àº ¾àÁ¦ÀÇ »ç¿ë¿¡ ÀÇÇÒ ¼öÀÖÀ½.
Bleomycin : marked fever reaction, anaphylaxis, Raynaude's phenomenon, chronic scleroderma-like reactionµî°ú ¿¬°üµÉ¼öÀÖÀ½.
Paclitaxel : cremophor vehicle¿¡ ´ëÇÑ hypersensitivity¿¡ ÀÇÇØ ¾ß±âµÈ´Ù°í ¹Ï¾îÁö´Âµ¥ ,ÀÌ·¯ÇÑ ¹ÝÀÀÀº IV Dexamethasone 20mg, diphenhydramine 50mg, cimetidine 300mgÀ» paclitaxel»ç¿ë 30ºÐ Àü¿¡ ÁÖÀÔÇÔÀ¸·Î½á °³¼±ÇÒ ¼öÀÖÀ½.

11. Second malignancies
Alkylating agent(ƯÈ÷ mephalan): 1³âÀÌ»ó mephalanÀ¸·Î Ä¡·á¹ÞÀº ȯÀÚÀÇ 7³â cumulative risk of AMLÀº 9.6%ÀÓ. Hodgkin's lymphomaȯÀÚ¿¡¼­ Ç×¾ÏÄ¡·á¿Í ¹æ»ç¼± Ä¡·á¸¦ º´¿ëÇÑ °æ¿ì acute leukemia and solid tumorÀÇ risk°¡ Áõ°¡ÇÔ.

* High risk ¿¬°ü.
- extensive radiation therapy plus combination chemotherapy
- prolonged alkylating agent therapy ( 1³âÀÌ»ó )
- prolonged maintenance therapy
- age at initial treatment older than 40years

12. Gonadal dysfunction
ƯÈ÷ aklylating agents´Â azoospermia and amenorrhea¸¦ ¾ß±â.
Amenorrhea and ovarian failure´Â Áõ°¡µÈ FSH and LH ¹× °¨¼ÒµÈ E2 level¿¡ µ¿¹Ý.
Á¾Á¾ ÀÌ·¯ÇÑ È£¸£¸ó º¯È­´Â ¹«¿ù°æÀÌ »ý±â±â Àü¿¡ ¹ß»ýÇÒ ¼öÀÖÀ½.
Antimetabolites, vinca alkaloids, antitumor antibiotics°°Àº ¾àÁ¦¸¦ ´Ü±â°£¿¡ intensiveÇÏ°Ô »ç¿ëÇÏ´Â °Í¿¡ ÀÇÇØ¼­´Â »ý½Ä±â°ü ¼Õ»óÀÌ ÈçÄ¡ ¾Ê¾Æ¼­ Ä¡·áÈÄ¿¡´Â »ý½Ä´ÉÀ» ȸº¹.
Chemotherapy in pregnancy : first trimesterµ¿¾È¿¡ »ç¿ëµÇ¸é congenital anomalies risk°¡ °¡Àå ³ôÀºµ¥, ƯÈ÷ antimetabolites(methotrexate) ¿Í alkylating agents°¡ °¡Àå ½ÉÇÔ . Second trimester or third trimester¿¡ »ç¿ëµÇ¸é fetal anomaliesÁõ°¡¿Í ¿¬°üµÇÁö ¾ÊÀ½.

13. Metabolic abnormalities
Lung small cell ca¿¡ ÀÇÇØ ºÎÀûÀýÇÑ antiduretic hormone(ADH)°¡ ºÐºñµÇ´Âµ¥, ¶ÇÇÑ Vinca alkaloid chemotherapy¿¡ ÀÇÇØ »ý±æ ¼ö ÀÖÀ½.
- Ư¡: hyponatremia, high urine osmolarity, high urinar sodium valueµî.
- Áõ»óÀº altered mental status, confusion, lethargy, seizure, comaµî,
hyponatremia¹ß»ý ¼Óµµ¿¡ ÀÇÇÔ.
- Áø´ÜÀº hyponatremiaº¸À̸鼭 urine¿¡¼­°¡ plasmaº¸´Ù ´õ hypertonicÇϸç, hypothyroidism À̳ª adrenal insufficiency°¡ ¹èÁ¦µÈ °æ¿ì¿¡ ³»¸± ¼öÀÖÀ½.
* Tumor lysis syndrome : intracellular ions and uric acid¸¦ ¹æÃâÇÔÀ¸·Î½á »ý¸í¿¡ À§ÇùÀ» ÁÙ ¼ö ÀÖ´Â hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemiaµîÀÌ »ý±æ ¼öÀÖ´Ù. Hyperuricemia¿Í ¿¬°üµÇ´Â renal failure´Â ½É°¢ÇØÁú ¼ö ÀÖÀ½ .
- tumor lysis syndromeÀ» ¿¹¹æ
- High urine outputÀ» À¯Áö
- High urein PH (above 7)À¯Áö
- allopurinol°°Àº xanthine oxidase inhibitor¸¦ ¿¹¹æÀûÀ¸·Î »ç¿ë