The Golden Guide to Oncologic Pharmacy

Description

This book fills an important gap in the professional’s daily practice of both Oncology and Hematology. From the understanding of oncological and hematological diseases, drugs and protocols, to the administration of an oncology pharmacy, this book is an essential guide to supporting health professionals working or that intend to work in this area. This golden standard to practice is featured as a pocket guide easy to be carried around the hospital or clinic. The chapters cover topics such as support drugs; immunotherapy; CART-cells; chemotherapy for rheumatology, surgery and ICU; tumor lysis; extravasation; adverse effects; and stem cell transplantation. The content gathered in this volume is an invaluable resource not only to oncologic, clinical and hospital pharmacists, but also residents, postgraduate and undergraduate students. Preface Contents Editors and Contributors About the Editors Contributors 1: The Pharmacist in Oncology and Hematology 1.1 The Oncology Pharmacist 1.2 The Roles of an Oncology Pharmacist 1.3 Becoming an Oncology Pharmacist 1.4 Resources 1.5 Oncology Pharmacist: A Valuable Resource in the Workforce References 2: Oncological Diseases 2.1 Breast 2.1.1 Introduction and Epidemiology 2.1.2 Risk Factors 2.1.3 Signs and Symptoms 2.1.4 Detection 2.1.5 Staging 2.1.6 Histopathological and Molecular Classification [10] 2.1.6.1 Non-invasive Breast Conditions 2.1.6.2 Invasive Breast Cancer 2.1.6.3 Molecular Classification 2.2 Cervix Uteri 2.2.1 Introduction and Epidemiology 2.2.2 Risk Factors 2.2.3 Signs and Symptoms [13, 14, 15] 2.2.4 Detection 2.2.5 Staging [16] 2.2.6 Histopathological and Molecular Classification 2.2.6.1 Types of Endometrial Cancer [18, 19] 2.3 Colorectum 2.3.1 Introduction and Epidemiology 2.3.2 Risk Factors 2.3.3 Signs and Symptoms 2.3.4 Detection 2.3.5 Staging 2.3.6 Histopathological and Molecular Classification 2.3.6.1 Histological Classification (OMS, 2010) [26] 2.3.6.2 Molecular Classification 2.4 Kidney 2.4.1 Introduction and Epidemiology 2.4.2 Risk Factors [27, 29, 30, 31] 2.4.3 Signs and Symptoms [32, 33, 34] 2.4.4 Detection 2.4.5 Staging [35] 2.4.6 Histopathological and Molecular Classification 2.4.6.1 Histopathological Classification 2.4.6.2 Other Types of Kidney Cancers [37] 2.4.6.3 Molecular Classification [38] 2.5 Liver 2.5.1 Introduction and Epidemiology 2.5.2 Risk Factors 2.5.3 Signs and Symptoms 2.5.4 Detection 2.5.5 Staging 2.5.6 Histopathological and Molecular Classification 2.5.6.1 Molecular Classification 2.6 Lung 2.6.1 Introduction and Epidemiology 2.6.2 Risk Factors [50, 51] 2.6.3 Signs and Symptoms 2.6.4 Detection 2.6.5 Staging 2.6.6 Histopathological and Molecular Classification 2.6.6.1 Histopathological Classification 2.6.6.2 Molecular Classification 2.7 Melanoma 2.7.1 Introduction and Epidemiology 2.7.2 Risk Factors 2.7.3 Signs and Symptoms 2.7.4 Detection 2.7.5 Staging 2.7.6 Histopathological and Molecular Classification 2.7.6.1 Melanoma Subtypes [60] 2.7.6.2 Molecular Subtypes [56] 2.8 Prostate Cancer 2.8.1 Introduction and Epidemiology 2.8.2 Risk Factors 2.8.3 Signs and Symptoms 2.8.4 Detection 2.8.5 Staging 2.8.5.1 TNM Classification [62, 63, 68] 2.8.5.2 TNM Stages of Prostate Cancer [63] 2.8.5.3 Gleason Score [69] 2.8.5.4 Grade Groups [69, 70] 2.8.6 Histopathological and Molecular Classification 2.8.6.1 Molecular Classification 2.9 Stomach 2.9.1 Introduction and Epidemiology 2.9.2 Risk Factors 2.9.3 Signs and Symptoms 2.9.4 Detection 2.9.5 Staging 2.9.6 Histopathological and Molecular Classification 2.9.6.1 Molecular Classification 2.10 Thyroid Cancer 2.10.1 Introduction and Epidemiology 2.10.2 Risk Factors 2.10.3 Signs and Symptoms 2.10.4 Detection 2.10.5 Staging 2.10.6 Histopathological and Molecular Classification 2.10.6.1 Molecular Classification References 3: Hematological Diseases 3.1 Leukemias 3.2 Chronic Lymphocytic Leukemia (CLL) 3.2.1 Introduction and Epidemiology 3.2.2 Risk Factors 3.2.3 Signs and Symptoms 3.2.4 Diagnosis 3.2.5 Staging 3.3 Chronic Myeloid Leukemia (CML) 3.3.1 Introduction and Epidemiology 3.3.2 Risk Factors 3.3.3 Signs and Symptoms 3.3.4 Diagnosis 3.3.5 Staging 3.3.6 Histological and Molecular Classification 3.4 Acute Lymphoblastic Leukemia (ALL) 3.4.1 Introduction and Epidemiology 3.4.2 Risk Factors 3.4.3 Signs and Symptoms 3.4.4 Diagnosis 3.4.5 Histological and Molecular Classification 3.5 Acute Myeloid Leukemia (AML) 3.5.1 Introduction and Epidemiology 3.5.2 Risk Factors 3.5.3 Signs and Symptoms 3.5.4 Diagnosis 3.5.5 Histological and Molecular Classification 3.6 Lymphomas 3.6.1 Hodgkin Lymphoma 3.6.1.1 Disease Overview 3.6.1.2 Introduction and Epidemiology 3.6.1.3 Risk Factors 3.6.1.4 Signs and Symptoms 3.6.1.5 Diagnosis Immunohistochemistry Evaluation HIV and Hepatitis B/C Testing 3.6.1.6 Types of Hodgkin Lymphoma 3.6.1.7 Classification of Hodgkin Lymphoma Classic Hodgkin Lymphoma (cHL) Nodular Lymphocyte-Predominant Hodgkin Lymphoma 3.6.1.8 Hodgkin Lymphoma Staging 3.6.2 Non-Hodgkin Lymphoma 3.6.2.1 Disease Overview 3.6.2.2 Introduction and Epidemiology 3.6.2.3 Risk Factors 3.6.2.4 Symptoms and Signs 3.6.2.5 Diagnosis 3.6.2.6 Non-Hodgkin Lymphoma Types Subtypes of B-Cell Lymphoma Subtypes of T-Cell and NK-Cell Lymphoma 3.6.2.7 Non-Hodgkin Lymphoma Staging 3.6.3 Multiple Myeloma 3.6.3.1 Introduction and Epidemiology 3.6.3.2 Pathogenesis and Risk Factors 3.6.3.3 Signs and Symptoms 3.6.3.4 Diagnosis 3.6.3.5 Staging and Prognosis 3.6.3.6 Drug-Related Biomarkers 3.6.3.7 Response Assessment 3.6.3.8 Minimum Residual Disease 3.6.4 Myelodysplastic Syndrome 3.6.4.1 Introduction and Epidemiology 3.6.4.2 Risk Factors 3.6.4.3 Signs and Symptoms 3.6.4.4 Detection Diagnostic problems in MDS 3.6.4.5 Staging and Differentiation 3.6.4.6 Risk Stratification Allogenic Stem-Cell Transplantation 3.6.4.7 Molecular Considerations References 4: Drugs Used in Chemotherapy 4.1 Introduction 4.2 Alkylating Agents 4.2.1 Nitrogen Mustards 4.2.2 Nitrosureas 4.2.3 Triazenes 4.2.4 Alkyl Sulfonate 4.2.5 Platinum Coordination Complexes 4.2.6 Other Alkylating Agents 4.3 Antimetabolites 4.3.1 Folate Analogues 4.3.2 Purine Analogues 4.3.3 Pyrimidine Analogues 4.3.4 Hypomethylating Agents 4.3.5 Other Antimetabolites 4.4 Anti-Tumor Antibiotics 4.4.1 Anthracyclines 4.4.2 Other Anti-Tumor Antibiotics 4.5 Topoisomerase Inhibitors 4.5.1 Topoisomerase I Inhibitors (Also Known as Camptothecins) 4.5.2 Topoisomerase II Inhibitors (Also Known Epipodophyllotoxins) 4.6 Mitotic Inhibitors 4.6.1 Microtubule Binders 4.6.2 Vinca Alkaloids 4.7 Histone Inhibitors 4.7.1 Histone Deacetylase Inhibitors 4.8 Proteasome Inhibitors 4.9 Hedgehog Inhibitors 4.10 Enzymes 4.11 Corticosteroids 4.12 Hormone Therapy 4.12.1 The Effect of Testosterone on Prostate Cancer 4.12.2 Androgen Deprivation Therapies (ADT) 4.12.2.1 Luteinizing Hormone-Releasing Hormone (LHRH) Agonists and Antagonists 4.12.2.2 Antiandrogens 4.12.3 Hormone Therapy in Breast Cancer 4.12.3.1 Antiestrogens 4.12.3.2 Antiprogestins 4.12.3.3 Somatostatin Analogs 4.13 Main Therapies: Target for the Treatment of Cancer 4.13.1 The Role of Protein Kinases (PTKs) 4.14 The Main Types of Signal Transduction Pathways 4.14.1 Via Ras/Raf/MEK/ERK 4.14.1.1 Via PI3K/PTEN/AKT/mTOR 4.14.2 Description of the Main PTKs Involved in the Signaling Pathways 4.14.2.1 RAS 4.14.2.2 RAF 4.14.2.3 MEK (Methyl Ethyl Ketone) 4.14.2.4 ERK 4.14.2.5 PI3K 4.14.2.6 AKT 4.14.2.7 mTOR 4.14.2.8 PTEN 4.14.3 Description of Top RTKs 4.14.3.1 VEGFR/VEGF 4.14.3.2 EGFR/EGF 4.14.3.3 HER 4.14.3.4 FGFR 4.14.3.5 c-KIT 4.15 Immunomodulators 4.16 Radiopharmaceuticals 4.17 Other Drugs References 5: Protocols 5.1 Introduction 5.2 Oncohematological Cancers 5.2.1 Leukemias 5.2.1.1 Acute Lymphoid Leukemia (ALL) 5.2.1.2 Acute Myeloid Leukemia (AML) 5.2.1.3 Chronic Lymphoid Leukemia (LLC) 5.2.1.4 Chronic Myeloid Leukemia (CML) 5.2.2 Lymphoma 5.2.3 Myeloma 5.3 Pediatric Cancer 5.3.1 Wilms’ Tumor 5.4 Solid Tumors: Breast Carcinoma 5.4.1 Classification 5.4.2 Chemotherapeutic Protocols 5.4.3 Main Effects Caused by Drugs Used in Breast Cancer Therapeutic Schemes 5.5 Cancers of the Head and Neck 5.5.1 Nasopharynx Carcinoma 5.5.2 Salivary Gland References 6: Handling Chemotherapy 6.1 Occupational Exposure to Antineoplastic Drugs 6.2 Individual and Collective Protection Equipment 6.3 Collective Protection Equipment (CPE) 6.3.1 Biological Safety Cabinet (BSC) 6.3.2 Biological Safety Cabinet Certification 6.3.3 Shower and Eye-Wash 6.3.3.1 Personal Protective Equipment (PPE) Waterproof Overalls or Apron Surgical Glove Respiratory Protection Eye Protection Beanie or Disposable Head Cover Is There a Difference Between Shoe Covers and Protective Foot Covers? 6.3.3.2 Closed-System Drug-Transfer Device (CSTD) 6.3.4 Medical Surveillance 6.3.5 Physical Area 6.3.6 Area Classification 6.3.7 Manipulation Area 6.4 Technique of Handling Antineoplastic Drugs 6.4.1 Decontamination of the Biological Safety Cabinet 6.5 Dressing Technique 6.6 Biological Safety Cabinet Use 6.6.1 Technique of Filling Secondary Equipment with Diluent 6.6.2 Aseptic Technique for Handling Dangerous Drugs (Powder Reconstitution) 6.6.3 Aseptic Technique for Handling Dangerous Drugs (Ready-to-Use Liquid Medicines) 6.6.4 Removal of the Finished Product From the Interior of the Biological Safety Cabinet (BSC) 6.6.5 Aseptic Technique for Handling Dangerous Drugs in Elastomeric Infusers 6.7 Spill of Dangerous Drugs 6.7.1 Procedure in the Case of Spillage into the Environment 6.8 Disposal of Hazardous Waste 6.9 Certifications and Quality Assurance References 7: Immunotherapy 7.1 Introduction 7.2 Immune Checkpoint Inhibitors (ICIs) 7.2.1 CTLA-4 7.2.2 PD-1 7.3 Immunotherapy 7.3.1 Atezolizumab 7.3.1.1 Indications 7.3.1.2 Pharmacokinetics 7.3.1.3 Dosage 7.3.1.4 Maximum Adult Dose 7.3.1.5 Pediatric Dose 7.3.1.6 Maximum Dose in Geriatric Population 7.3.1.7 Dose Adjustment 7.3.1.8 Drug Interactions 7.3.1.9 Dilution, Infusion Time, and Stability 7.3.1.10 Main Adverse Reactions 7.3.2 Bevacizumab 7.3.2.1 Indications 7.3.2.2 Pharmacokinetics 7.3.2.3 Dosage 7.3.2.4 Pediatric Dose 7.3.2.5 Maximum Adult Dose 7.3.2.6 Maximum Dose in Geriatric Population 7.3.2.7 Dose Adjustment 7.3.2.8 Drug Interactions 7.3.2.9 Dilution, Infusion Time, and Stability 7.3.2.10 Main Adverse Reactions 7.3.3 Cetuximab 7.3.3.1 Indication 7.3.3.2 Pharmacokinetics 7.3.3.3 Dosage 7.3.3.4 Maximum Adult Dose 7.3.3.5 Pediatric Dose 7.3.3.6 Maximum Dose in Geriatric Population 7.3.3.7 Dose Adjustment 7.3.3.8 Drug Interactions 7.3.3.9 Dilution, Infusion Time, and Stability 7.3.3.10 Main Adverse Reactions 7.3.4 Durvalumab 7.3.4.1 Indication 7.3.4.2 Pharmacokinetics 7.3.4.3 Dosage 7.3.4.4 Maximum Adult Dose 7.3.4.5 Pediatric Dose 7.3.4.6 Maximum Dose in Geriatric Population 7.3.4.7 Dose Adjustment 7.3.4.8 Drug Interactions 7.3.4.9 Dilution, Infusion Time, and Stability 7.3.4.10 Main Adverse Reactions 7.3.5 Panitumumab 7.3.5.1 Indication 7.3.5.2 Pharmacokinetics 7.3.5.3 Dosage 7.3.5.4 Maximum Adult Dose 7.3.5.5 Pediatric Dose 7.3.5.6 Maximum Dose in Geriatric Population 7.3.5.7 Dose Adjustment 7.3.5.8 Drug Interactions 7.3.5.9 Dilution, Infusion Time, and Stability 7.3.5.10 Main Adverse Reactions 7.3.6 Pertuzumab 7.3.6.1 Indication 7.3.6.2 Pharmacokinetics 7.3.6.3 Dosage 7.3.6.4 Maximum Adult Dose 7.3.6.5 Pediatric Dose 7.3.6.6 Maximum Dose in Geriatric Population 7.3.6.7 Dose Adjustment 7.3.6.8 Drug Interactions 7.3.6.9 Dilution, Infusion Time, and Stability 7.3.6.10 Main Adverse Reactions 7.3.7 Panitumumab 7.3.7.1 Indications 7.3.7.2 Pharmacokinetics 7.3.7.3 Dosage 7.3.7.4 Maximum Adult Dose 7.3.7.5 Dose in Pediatrics 7.3.7.6 Maximum Dose in Geriatric Population 7.3.7.7 Dose Adjustment 7.3.7.8 Drug Interactions 7.3.7.9 Dilution, Infusion Time, and Stability 7.3.7.10 Main Adverse Reactions 7.3.8 Ramucirumab 7.3.8.1 Indications 7.3.8.2 Pharmacokinetics 7.3.8.3 Dosage 7.3.8.4 Maximum Adult Dose 7.3.8.5 Dose in Pediatrics 7.3.8.6 Maximum Dose in Geriatric Population 7.3.8.7 Dose Adjustment 7.3.8.8 Drug Interactions 7.3.8.9 Dilution, Infusion Time, and Stability 7.3.8.10 Main Adverse Reactions 7.3.9 Trastuzumab 7.3.9.1 Indications 7.3.9.2 Pharmacokinetics 7.3.9.3 Dosage 7.3.9.4 Maximum Adult Dose 7.3.9.5 Dose in Pediatrics 7.3.9.6 Maximum Dose in Geriatric Population 7.3.9.7 Dose Adjustment 7.3.9.8 Drug Interactions 7.3.9.9 Dilution, Infusion Time, and Stability 7.3.9.10 Main Adverse Reactions 7.3.9.11 Immune-Related Adverse Events (IRAEs) 7.3.10 Gastrointestinal Adverse Event and Its Management 7.3.11 Hepatic Adverse Event and Its Management 7.3.12 Pulmonary Adverse Event and Its Management 7.3.13 Cutaneous Adverse Event and Its Management 7.3.14 Endocrine Adverse Event and Its Management 7.4 Conclusion References 8: CAR-T Cells and Other Related Technologies 8.1 Conventional CAR Structure and Its Variations 8.1.1 Source of Co-stimulatory Domains 8.1.2 Generations of CAR 8.2 Lymphocyte Activation and Cell Death Signals Promoted by CAR Cells 8.3 Immunological Synapse Quality 8.3.1 Molecular Mechanisms of Cell Death Induction 8.3.2 Morphological Changes 8.4 Overview of CAR Cell Clinical Targets 8.5 Toxicological and Adverse Events Related to CAR-T Cell Therapies 8.5.1 “On-Target Off-Tumor” Toxicity 8.5.2 Overactivation of Immune Effector Cells and Cytokine Release Syndrome 8.5.3 Graft-Versus-Host Disease 8.6 Design of New CAR Cells—scFv, VHH, and Other Specificity Domains 8.7 Future Perspectives 8.7.1 Switchable CAR Cells 8.7.2 CAR Cells in Solid Tumors 8.7.3 CAR-NK Cells References 9: Intrathecal Chemotherapy 9.1 Introduction 9.2 Procedures 9.2.1 Lumbar Puncture 9.2.2 Ommaya Reservoir 9.2.3 Intralumbar Catheter 9.3 Dosage 9.4 Standard Cytostatic Agents for Intrathecal Administration 9.5 Methotrexate 9.6 Cytarabine 9.7 DepoCyt® (DTC101) 9.8 Thiotepa 9.9 Topotecan 9.10 Mafosfamide 9.11 Busulfan 9.12 Vincristine 9.13 Monoclonal Antibodies: Rituximab and Trastuzumab 9.14 Albumin-Bound Paclitaxel 9.15 Considerations References Suggested Reading 10: Support Drugs 10.1 Hypersensitivity Reaction 10.1.1 Treatment and Monitoring of Hypersensitivity Reactions 10.2 Tumor Lysis Syndrome 10.2.1 Treatment and Monitoring of Tumor Lysis 10.3 Hematotoxicity 10.3.1 Treatment and Monitoring of Hematological Toxicities 10.4 Nausea and Vomiting 10.4.1 Nausea 10.4.2 Emesis/Vomiting 10.5 Dermatological Adverse Events 10.5.1 Exanthema 5.1.1 Prevention 5.1.2 Therapeutic Management 10.5.2 Hand-Foot Syndrome 10.5.3 Alopecia 5.3.1 Therapeutic Management 10.5.4 Itching 5.4.1 Therapeutic Management 10.5.5 Paronychia 5.5.1 Prevention 5.5.2 Therapeutic Management 10.5.6 Onycholysis 5.6.1 Prevention 5.6.2 Therapeutic Management 10.5.7 Diarrhea 10.5.8 Treatment References 11: Managing Issues: Tumor Lysis, Extravasation, Adverse Effects, and Others 11.1 Adverse Effects 11.1.1 Most Common ADRs 11.1.2 Anticancer Drugs Classes and ADRs 11.2 Tumor Lysis 11.2.1 Hyperuricemia 11.2.2 Hyperphosphatemia 11.2.3 Malignancy and Tumor Lysis Syndrome Risk 11.3 Extravasation 11.3.1 Others: Chemotherapy-Induced Emergencies References Adverse Effects Tumor Lysis Tumor Extravasation Others 12: Administration of an Oncology Pharmacy 12.1 Concepts and Definitions 12.2 Pharmaceutical Assistance X Pharmaceutical Attention 12.3 Supply Chain 12.4 Programming and Acquisition 12.5 Inventory Management Techniques 12.5.1 ABC Classification 12.5.2 XYZ Classification 12.6 Storage and Inventory Control 12.7 Bags Preparation 12.8 Safety in Bags Production 12.8.1 Separation 12.8.2 Sanitation 12.8.3 Preparation 12.8.4 Dispensation/Shipping 12.9 People Management 12.9.1 Selection 12.9.2 Development and Monitoring 12.9.3 Feedback 12.9.4 Promotions 12.9.5 Task Distributions 12.10 Drug Management 12.10.1 Acquisition 12.10.2 Storage and Control 12.10.3 Losses 12.11 Indicators in the Oncology Pharmacy 12.11.1 The Application 12.11.2 Management in Practice Bibliography 13: Stem Cell Transplantation 13.1 Pre-transplant Evaluation 13.1.1 Stem Cell Transplantation 13.1.2 Stem Cell Transplantation Indication 13.1.3 Pre-transplant Phase 13.1.4 Multidisciplinary Team in Stem Cell Transplantation 13.1.5 Pre-transplant Pharmaceutical Evaluation 13.1.6 Drug Therapy Management 13.2 Pre-hematopoietic Stem Cell Transplantation Conditionings 13.2.1 Conditioning Types 13.2.1.1 Myeloablative Conditioning (MAC) 13.2.1.2 Reduced Intensity Conditioning (RIC) 13.2.1.3 Non-myeloablative Conditioning (NMA) 13.2.2 Irradiation 13.2.3 Pharmacotherapeutic Follow-Up 13.2.3.1 Busulfan Pharmacokinetics of Busulfan Prophylaxis of Seizures 13.2.3.2 Drug Interactions 13.2.3.3 Cyclophosphamide and Uroprotection 13.2.3.4 Melphalan and Mucositis 13.2.3.5 Cytarabine and Conjunctivitis 13.3 Care Before Engraftment 13.3.1 Introduction 13.3.2 Drug Toxicity 13.3.2.1 Nausea and Vomiting 13.3.2.2 Oral Mucositis 13.3.2.3 Diarrhea 13.3.2.4 Liver Complications 13.3.3 Infections 13.3.4 Immunosuppression 13.3.5 Laboratory Tests 13.4 Complication in Progenitor Cell Transplantation 13.4.1 Febrile Neutropenia and Bacterial, Fungal, and Viral Infections 13.4.2 Toxoplasmosis (Toxoplasma gondii) 13.4.3 Complications of Bleeding, Thrombosis, and Endothelial Origin 13.4.4 Graft-Versus-Host Disease (GvHD) 13.4.5 Lymphoproliferative Syndrome 13.5 Hospital Discharge and Outpatient Follow-Up 13.5.1 Chronic Graft-Versus-Host Disease (cGVHD) 13.5.2 Other Late Complications 13.5.3 Vaccination 13.5.4 Withdrawal of Prophylactic Infectious Therapies and Immunosuppressants References 14: Oncology and Hematology in the ICU 14.1 Introduction 14.2 Insertion of the Pharmacist in Hospitals and Their Activities in This Service Location 14.3 Pharmacists in Intensive Care 14.4 Critical Oncohematologic Patient 14.5 ICU Admission Criteria 14.6 Reasons for Hospitalization of Cancer and Hematological Patients 14.7 Importance of Pharmaceutical Follow-Up in the ICU 14.7.1 Feeding 14.7.2 Analgesia 14.7.3 Sedation 14.7.4 Thromboprophylaxis 14.7.5 Hyperactive or Hypoactive Delirium 14.7.6 Stress Ulcer Phophylaxis 14.7.7 Glucose Control 14.7.8 Medication Reconciliation 14.7.9 Antibiotics or Anti-infectives 14.7.10 Indications for Medications 14.7.11 Drug Dosing 14.7.12 Electrolytes, Hematology, and Other Laboratory Results 14.7.13 No Drug Interactions, Allergies, Duplications, Side Effects 14.7.14 Stop Dates 14.8 Hematopoietic Stem Cell Transplantation 14.9 Toxicity Managment 14.9.1 Hypersensitivity Reactions 14.9.2 Corticosteroid Treatment 14.10 Transfusion of Blood Components 14.11 Antimicrobial Therapy 14.12 Palliative Care References 15: Chemotherapy for the Surgery Center 15.1 Introduction 15.2 Hyperthermic Intraperitoneal Chemotherapy (HIPEC) 15.2.1 Overview 15.2.2 Pharmacokinetics 15.2.3 Temperature Effects 15.2.4 Drug Choice 15.2.5 Techniques 15.2.6 Safety 15.3 Aerosolized and Pressurized Intraperitoneal Chemotherapy (PIPAC) 15.3.1 Overview 15.3.2 Technique 15.3.3 Safety 15.4 Chemoembolization 15.4.1 Overview 15.4.2 Safety 15.5 Intrathecal Chemotherapy 15.5.1 Overview 15.5.2 Techniques 15.5.2.1 Lumbar Puncture 15.5.2.2 Ommaya Catheter 15.5.3 Drug Choice 15.5.4 Safety 15.6 Clinical Repercussions of Chemotherapy 15.7 Drug Interactions of Chemotherapy Agents 15.8 Conclusion References 16: Chemotherapy for Rheumatology 16.1 Introduction 16.2 Systemic Lupus Erythematosus 16.3 Sjögren’s Syndrome 16.4 Psoriatic Arthritis 16.5 Takayasu’s Arteritis 16.6 Rheumatoid Arthritis 16.7 Spondyloarthritis 16.8 Scleroderma 16.8.1 Behçet’s Disease 16.9 Gout References Index