Episode 286: Pharmacology 101: Alkylating Agents

“When I meet with patients, I try and remind them, ‘Yes, you do have these side effects that can happen’ and make sure that they’re informed, but also try and reassure them that not everyone gets it as severe as maybe the movies and TV shows portray,” Dane Fritzsche, PharmD, BCOP, informatics pharmacist from the Fred Hutchinson Cancer Center at the University of Washington Medicine in Seattle, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a discussion about what oncology nurses need to know about alkylating agents for patients with cancer. This episode is the first in a series about drug classes, which we’ll include a link to in the episode notes. 

You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below.  

Music Credit: “Fireflies and Stardust” by Kevin MacLeod 

Licensed under Creative Commons by Attribution 3.0 

Earn 0.75 contact hours of nursing continuing professional development (NCPD), which may be applied to the oncology nursing practice and treatment ILNA categories, by listening to the full recording and completing an evaluation at myoutcomes.ons.org by November 17, 2025. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center’s Commission on Accreditation. 

Learning outcome: The learner will report an increase in knowledge related to alkylating agents.  

Episode Notes 

To discuss the information in this episode with other oncology nurses, visit the ONS Communities.  

To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library

To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org

Highlights From Today’s Episode 

“Alkylating agents are a very interesting class of chemotherapy agents, both mechanistically as well as historically. I remember back in pharmacy school learning this was actually the first class of medicines used to treat cancer, and it actually starts way back in World War I with the use of sulfur mustard gas, in kind of a military fashion, and then noticing some of the responses that soldiers as well as civilians who were actually exposed to that. They would develop things like bone marrow suppression, as well as other antitumor effects. Sadly, it's rough to see mustard gas as being the first agent to lead to something so remarkable, because it was a weapon of devastation, but it did lead to some breakthroughs.” TS 1:43 

“The first thing that jumps to my mind when thinking about alkylating agents is their toxicities and then their supportive care agents that we use to make sure that we're treating our patients well and making their care optimum. So, when I, as an oncology pharmacist, would look at these orders, I immediately am jumping to, are we giving them appropriate antiemetics? Because a lot of these agents are highly emetogenic or moderately emetogenic by NCCN. A lot of them have other organ toxicities, like are really harsh on the kidneys. Are they getting their pre- and post-hydration? And then also many of these agents are very bone marrow suppressing, meaning they’re targeting the red blood cells, they’re hitting platelets, they’re reducing our ANCs and making patients at higher risk for infection, you know, so do we need growth factor support here? Are the patients—their current labs—are they able to take another dose at this time or do we need to dose reduce or delay therapy because their platelets are just too low now?” TS 09:54 

“Honestly, it's probably one of the most important things is collaborating together to help provide optimal patient care. And to me, kind of the biggest thing that jumps out is just good communication between the various team members. I can't tell you how many times I would learn crucial information either from an infusion nurse chatting with the patient or walking down the hall or giving a call to one of our lovely clinical nurse coordinators here at Fred Hutch. You know, I always wanted to make sure that I go in and have the full picture of where the patient's at, what, if any, challenges there have been with this patient's particular case, just to make sure that I'm up to date about them and able to provide as good of care as I can.” TS 14:55 

“Unfortunately, this class of drugs does come with kind of those generic chemotherapy side effects that we think of: hair loss, nausea and vomiting, and bone marrow suppression. That just comes as a function of how these work. These agents are not selective for just cancer. They’re more selective for rapidly dividing cells. So, that leaves our normal cells that rapidly divide like our hair, our GI tract, our bone marrow, you know, to get hit by these.” TS 17:50 

“The next thing I always drill my residents on, when I’m teaching them how to provide actionable and helpful information about their regimens that they're getting, is kind of like you're saying, outlining those expectations. How do you prevent these side effects? When do these side effects even start to show up? Like, am I going to immediately be nauseous right when the cisplatin gets turned on? Well, maybe, not super common, but it's more common that we'll see it in, you know, at the end, in the next couple of days and within the next 72 hours or going into the nuances between acute versus chronic nausea and things like that. So, it’s really trying to empower the patients with information. How do they prevent this? What are we doing to help prevent it? And then when should they call us? When is the stuff that we’re preventing didn’t help? When should they call us to get more help?” TS 24:04 

“I think that’s a misconception that we as healthcare professionals can really help alleviate with our patients, reminding them that, yes, they do carry risks, but we also have a lot of supportive care agents to kind of help minimize that toxicity. And then we have this whole team of professionals behind you to help carry you through the treatment.” TS 29:34 

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