Organ toxicity of systemic cancer therapy

At a glance

• Systemic therapy toxicity depends on the drug class, cumulative dose and the patient's organ reserve. Learn the classic pairings: anthracyclines and heart, bleomycin and lung, cisplatin and kidney, ear and nerve, taxanes and vinca alkaloids and nerve.
• Myelosuppression is the commonest dose-limiting toxicity. Fever with neutropenia is an emergency: see Febrile neutropenia.
• Targeted drugs and antibody-drug conjugates have their own patterns (VEGF inhibitors and hypertension, trastuzumab deruxtecan and pneumonitis). Checkpoint inhibitors cause immune-related adverse events, covered in a separate note on checkpoint inhibitor toxicity.