16 – Anticancer drugs and immunomodulators

Cytostatics belong to a class of drugs with a narrow therapeutic index resulting in frequent and severe adverse effects. In the past, considerable efforts have been made to avoid or decrease significant toxicity, of which preventive measures or optimal management have been emphasized, but acute overdose may still occur. Adverse effects in health-care workers handling cytostatics are also of great concern. Transcutaneous uptake and inhalation are the suggested routes of exposure in hospital nurses or pharmacists handling cytostatics. Accidental ingestion, inhalation of microparticles following aerosol, dermal, and ocular exposure are the primary routes of occupational exposure while preparing and/or administering these agents. Occurrence of neurological symptoms, hair loss, and liver injury in nurses after years of bleomycin, cyclophosphamide, and vincristine handling has been described in this chapter. Extravasation of anticancer drugs leads to effects ranging from mild erythema to severe necrosis at the site of injection. Besides conservative measures, intensive care, and symptomatic treatment, there are no established guidelines on the management of cytostatic overdose. The management of chemotherapy-induced myelotoxicity is a major step as fatalities after overdoses with such as melphalan, 6-mercaptopurine, methotrexate, or vincristine are often related to myelosuppression.