4 · Oncology & Bladder-Cancer Agents

Intravesical therapy plus the systemic chemo/targeted agents on the blueprint.

Intravesical (non-muscle-invasive bladder cancer)

Agent	Pearls
BCG	Live attenuated M. bovis; most effective for carcinoma in situ & prophylaxis after TURBT. ADR: dysuria, cystitis, flu-like → sepsis, pneumonitis. CI: immunocompromised, active TB, UTI, gross hematuria, recent traumatic cath
Mitomycin	Intravesical for low-grade NMIBC after TURBT; ADR: dysuria, hematuria, ↑Cr; CI: perforated bladder
Gemcitabine	Intravesical for BCG-refractory; with cisplatin = systemic tx for metastatic urothelial ca
Pembrolizumab / atezolizumab	Checkpoint inhibitors (2nd-line) for advanced urothelial carcinoma

Systemic chemo & targeted therapy (breast/colon high-yield)

Agent	Signature toxicity / reversal
Doxorubicin (anthracycline)	Cardiotoxicity (CI if EF<50%), red urine; reverse with dexrazoxane
Bleomycin	Pulmonary fibrosis (BBW)
Cyclophosphamide	Hemorrhagic cystitis — prevent with hydration + mesna
Cisplatin	Nephrotoxic, ototoxic, neuropathy
5-FU / capecitabine	Mucositis, hand-foot syndrome; CI: DPD deficiency (fatal); reverse OD with uridine triacetate
Taxanes (paclitaxel/docetaxel)	Neuropathy, neutropenia, hypersensitivity — premedicate with steroids/antihistamines
Irinotecan	Diarrhea (early cholinergic + delayed dose-limiting)
Tamoxifen (SERM)	ER+ breast ca; ADR: hot flashes, VTE, endometrial cancer; avoid CYP2D6 inhibitors
Aromatase inhibitors (letrozole)	Postmenopausal ER+; bone loss/arthralgia; give Ca/vit D
Trastuzumab (HER2)	HER2+ breast ca; cardiotoxicity (monitor LVEF); avoid concurrent anthracyclines
CDK4/6 inhibitors (palbociclib)	HR+/HER2−; neutropenia; monitor CBC
PD-1/PD-L1 inhibitors	Immune-mediated pneumonitis/colitis/hepatitis/endocrinopathies — treat with steroids; monitor LFTs, TSH, cortisol, glucose

⭐ Memorize the signature toxicities: doxorubicin→heart, bleomycin→lungs, cisplatin→kidney/ears, cyclophosphamide→bladder, vincristine/taxanes→nerves. Checkpoint inhibitors cause immune-mediated organ toxicity managed with corticosteroids.