Part III Management of the Side Effects of Chemotherapy and Radiotherapy

Chapter 2

Drugs and Potential Drugs as Chemoprotectors 

In this chapter, we will discuss drugs and potential drugs (often referred to as agents) that may be used before chemotherapy to reduce the side effects. These drugs/agents are often referred to as chemoprotectors. Examples of chemoprotectors are listed below based on the individual targets to be protected.

1. Drugs to Increase White Blood Cell Count

Filgrastim

Filgrastim is a 175-amino acid human granulocyte colony-stimulating factor (G-CSF) manufactured by recombinant DNA technology in E Coli. It is a glyprotein naturally produced by a number of different tissues to stimulate the bone marrow cells to produce granulocytes and release them into the blood.

Filgrastim is used to stimulate the proliferation and differentiation of neutrophils, which are the most abundant type of WBCs. It is marketed as Neupogen® by Amgen, as Religrast® by Reliance Biopharmaceuticals, and as ShilgrastTM by Raichem Lifesciences.

Sargramostim

Sargramostim is a WBC stimulant sold as Leukine® by Genzyme. It is a human granulocyte macrophage colony stimulating factor (GM-CSF) produced by recombinant DNA technology in a yeast, S. cerevisiae. Sargramostim is a glycoprotein having 127 amino acids. Its amino acid sequence is different from the natural human GM-CSF by a substitution of leucine at position 23. It was originally approved by the FDA in March, 1991 for use following autologous bone marrow transplantation (BMT) and was approved in December 1991 to prevent death following BMT engraftment delay or failure. In September of 1995, it was subsequently licensed to shorten the time for neutrophil recovery to prevent early death from life- threatening infections following chemotherapy for older patients suffering from acute myelogenous leukemia (AML). 

© Jiajiu Shaw, 2023

Disclaimer: This blog is written solely for informational purposes. It does not constitute the practice of any medical, nursing or other medical professional health care advice, diagnosis, or treatment. All contents posted are extracted from the book, "SIDE EFFECTS OF CHEMOTHERAPY AND RADIOTHERAPY", prepared by Dr. Jiajiu Shaw, Dr. Frederick Valeriote, and Dr. Ben Chen. 

Part III Management of the Side Effects of Chemotherapy and Radiotherapy

Chapter 1

How to Cope with the Side Effects 

Dealing with Type 3 Side Effects

Liver and Kidney Injuries

Liver is the most critical organ in the body’s metabolism and detoxification. In addition, it is a vital organ capable of regenerating some of the lost tissue. For liver injury, some drugs may be helpful in protecting liver. For example, amifostine (Trade name Ethyol®) is indicated to reduce the cumulative renal toxicity associated with repeated administration of cisplatin in patients with advanced ovarian cancer. Other than amifostine, some natural products, such as milk thistle, may be useful in protecting or improving liver health.

Kidney toxicity is also referred to as nephrotoxicity, which is one of the most common toxicity resulted from chemotherapy. There are two important indicators of nephrotoxicity: BUN and creatinine. When kidney is damaged, blood levels of BUN and creatinine are usually elevated. Because urea is a waste form of nitrogen in the body, elevated BUN levels indicate that there is extra nitrogenous waste in the blood stream not properly filtered off by the kidney. As to creatinine, it is produced from creatine, an important molecule in energy production of muscle. Creatine is constantly converted into creatinine, which is constantly filtered off by the kidneys and disposed of in the urine.

In other words, kidney is critical in filtering off both BUN and creatinine to remove waste from the body. Therefore, when kidney function is affected by chemotherapy, blood levels of both BUN and creatinine are elevated. 

Peripheral Neuropathy

Neuropathy means disease or dysfunction of the nerves, which can be a side effect of chemotherapy. For peripheral neuropathy, the most commonly affected areas are the tips of fingers and toes. Common symptoms of peripheral neuropathy include tingling, burning, numbness/pain in the affected areas, and loss of balance, although sometimes other areas may also be affected. Massage one’s hands and feet may help improve blood circulation and temporarily relieve the pain. For a patient with peripheral neuropathy, he/she should see a doctor about any neuropathy symptoms to prevent further nerve damage. 

© Jiajiu Shaw, 2023

Disclaimer: This blog is written solely for informational purposes. It does not constitute the practice of any medical, nursing or other medical professional health care advice, diagnosis, or treatment. All contents posted are extracted from the book, "SIDE EFFECTS OF CHEMOTHERAPY AND RADIOTHERAPY", prepared by Dr. Jiajiu Shaw, Dr. Frederick Valeriote, and Dr. Ben Chen.