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Organ toxicity of chemotherapy — heart, lung, kidney, nerve and bladder
Every cytotoxic drug has a "signature organ" — anthracyclines the heart, bleomycin the lung, cisplatin the kidney and hearing, oxaliplatin and taxanes the nerves, ifosfamide the bladder and brain — and almost every one has a preventive measure or an antidote.
Why it matters in the exam
Toxicity questions are among the most frequent in the bank, and they are almost always written as a scenario: a patient receiving a given drug presents with a symptom, and the question asks the cause or the treatment. Examples: what reduces doxorubicin cardiotoxicity, what to do with vinorelbine extravasation, and the side effects of gemcitabine and paclitaxel.
The exam logic is to remember one or two clear toxicities for each drug and its prevention: hydration and magnesium for cisplatin, mesna for ifosfamide and cyclophosphamide, dexrazoxane for anthracyclines, atropine for early irinotecan diarrhoea. Also remember the difference between anthracycline cardiotoxicity, which depends on cumulative dose and is usually permanent, and that of trastuzumab, which is usually reversible.
Key points
- Anthracyclines cause cumulative-dose cardiomyopathy, and dexrazoxane, a liposomal formulation or prolonged infusion reduce it.
- Bleomycin harms the lung, cisplatin the kidney, magnesium and hearing, and ifosfamide the bladder, kidney and brain.
- Oxaliplatin causes acute cold-triggered neuropathy and cumulative neuropathy, and taxanes cause sensory neuropathy in the hands and feet.
- Anthracycline extravasation is treated with cooling and dexrazoxane, and vinca extravasation with warming and hyaluronidase.
- Gemcitabine causes low platelets, fever, rash, oedema and sometimes TMA, and increases radiosensitivity.
Summary table
| Organ | Drugs and features | Prevention or treatment |
|---|---|---|
| Heart | Anthracyclines — cumulative-dose cardiomyopathy, usually permanent; trastuzumab — reversible fall in EF; 5-FU and capecitabine — coronary vasospasm | Dexrazoxane, a liposomal formulation or prolonged infusion reduce anthracycline toxicity; echo monitoring |
| Lung | Bleomycin — fibrosis; also methotrexate, gemcitabine, busulfan, T-DXd and immunotherapy | Stop the drug and give steroids; with bleomycin — caution with high-concentration oxygen |
| Kidney | Cisplatin — tubular necrosis and magnesium wasting; high-dose methotrexate — crystal deposition; ifosfamide — Fanconi syndrome | Hydration and magnesium; urine alkalinisation and leucovorin for methotrexate, and glucarpidase for severe toxicity |
| Nerves | Oxaliplatin — acute cold-induced neuropathy and cumulative neuropathy; taxanes — sensory in hands and feet; vincristine — constipation and ileus; cisplatin — hearing loss | Dose reduction or stopping; vincristine never into the spinal canal |
| Bladder and brain | Cyclophosphamide and ifosfamide — haemorrhagic cystitis from acrolein; ifosfamide — encephalopathy | Mesna and hydration; methylene blue for encephalopathy |
| Bowel and skin | Irinotecan — early cholinergic and late diarrhoea; capecitabine — hand-foot; gemcitabine — fever, rash, thrombocytopenia, oedema and TMA | Atropine for early diarrhoea, high-dose loperamide for late |
| Extravasation | Anthracyclines — tissue necrosis; vinca alkaloids (including vinorelbine) — pain and necrosis | Anthracyclines: cooling and dexrazoxane; vinca: local warming and hyaluronidase |
In the full version for subscribers
- A simple algorithm
- Memory aid
- Exam traps
- 5 review cards
- Enough for IMLE
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Sources
- NCCN Clinical Practice Guidelines in Oncology: Survivorship; Cardio-oncology principles, 2026 — Cardiotoxicity and late effects
- ESC Guidelines on cardio-oncology, 2022 — Cancer therapy-related cardiac dysfunction
- ESMO-EONS Clinical Practice Guideline: Management of chemotherapy extravasation, 2012 — Antidotes and local measures
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.