chemotherapy toxicity reference
in review
2 min read
Updated 2026-07-30
Contents
chemotherapy toxicity reference
Quick-reference card for principal toxicities of commonly tested chemotherapy agents and radiation. Focus on what kills, what’s irreversible, and what changes management.
drug toxicity table
| Drug | Principal toxicity | High-yield pearls |
|---|---|---|
| doxorubicin (anthracycline) | cardiomyopathy | irreversible, cumulative dose-dependent; baseline and serial echo monitoring |
| trastuzumab (anti-HER2) | cardiomyopathy | reversible, occurs during active treatment; monitor LVEF; do not give concurrently with anthracyclines |
| bleomycin | pulmonary fibrosis / pneumonitis | dose-dependent; avoid high FiO₂ exposure (including perioperatively) |
| cisplatin | nephrotoxicity, ototoxicity, neuropathy | highly emetogenic; causes severe hypomagnesaemia/hypokalaemia; aggressive pre-hydration required |
| oxaliplatin | cold-induced peripheral neuropathy | paraesthesias triggered by cold fluids/weather; cumulative; may be dose-limiting |
| 5-FU / capecitabine | coronary vasospasm, hand-foot syndrome | mucositis and severe diarrhoea; DPD deficiency → fatal toxicity (consider testing) |
| vincristine | peripheral neuropathy | autonomic neuropathy/constipation; never give intrathecally (fatal) |
| cyclophosphamide | haemorrhagic cystitis | prophylaxis: aggressive hydration ± mesna |
| methotrexate | mucositis, myelosuppression, nephrotoxicity | leucovorin rescue required for high-dose regimens; renal clearance — avoid with NSAIDs |
| ifosfamide | encephalopathy, haemorrhagic cystitis | mesna mandatory; methylene blue for encephalopathy |
| taxanes (paclitaxel, docetaxel) | peripheral neuropathy, myelosuppression | hypersensitivity reactions (premedicate); fluid retention (docetaxel) |
radiation toxicity
| Syndrome | Timing | Features | Management |
|---|---|---|---|
| radiation pneumonitis | 1–3 months post-XRT | interstitial changes, ground-glass opacities confined to radiation field; cough, dyspnoea | systemic corticosteroids |
| radiation fibrosis | months–years | irreversible; restrictive pattern on PFTs | supportive |
| radiation enteritis | acute (during) or chronic (months–years) | diarrhoea, malabsorption, strictures, fistulae | supportive; surgery for complications |
| radiation myelopathy | months–years | progressive myelopathy at irradiated spinal level | no effective treatment; prevention via dose limits |
what NOT to do
critical safety points
- vincristine — never intrathecal (fatal)
- bleomycin — avoid high FiO₂ (even years later — alert anaesthesia)
- cisplatin — never without pre-hydration
- 5-FU — check for DPD deficiency in patients with unexpectedly severe toxicity
- methotrexate — avoid concomitant NSAIDs (reduced renal clearance → toxicity)