Table 2.
Chemotherapeutic drugs causing only dizziness but not other symptoms of ototoxicity
| Dizziness (incidence rate > 30%) | ||
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| Generic/Other Name | Brand Name | Mechanism of Action |
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| Axicabtagene Ciloleucel | Yescarta | chimeric antigen receptor T-cell immunotherapy agent, binds CD19 B-lymphocyte antigen |
| Entrectinib | Rozlytrek | protein-tyrosine kinase inhibitor, inhibits tropomyosin receptor tyrosine kinases - inhibits high affinity nerve growth factor receptor, BDNF/NT-3 growth factor receptors, NT-3 growth factor receptor, proto-oncogene tyrosine-protein kinase ROS, tyrosine-protein kinase JAK2 |
| Tisagenlecleucel | Kymriah | chimeric antigen receptor T-cell immunotherapy agent, binds CD19-expressing cells and promotes T-cell expansion, activation, target cell elimination |
| Larotrectinib | Vitrakvi | tropomyosin receptor kinase (TRK) inhibitor, inhibits TRKA, TRKB, TRKC preventing neurotrophin-Trk interaction and Trk activation inducing apoptosis and inhibition of cell growth |
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| Dizziness (incidence rate 10-29%) | ||
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| Generic/Other Name | Brand Name | Mechanism of Action |
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| 13-cis-Retinoic Acid | Accutane, Isotretinoin | retinoid, acts on nuclear receptors RAR or RXR |
| 5-Azacitidine, Azacitidine | Vidaza, Onureg | antimetabolite and demethylating agent |
| Abemaciclib | Verzenio | cyclin-dependent kinase inhibitor (CDK4 and CDK6), arrests G1 to S phase |
| Brentuximab vedotin | Adcetris | CD30-direct antibody drug conjugate (monoclonal antibody that disrupts microtubules) |
| Ado-Trastuzumab Emtansin | Kadcyla | Anti-HER2 monoclonal antibody combined with microtubule inhibitor DM1 (maytansine derivative) |
| Anagrelide | Agrylin | phospholipase A2 inhibitor (prevents maturation of megakaryocytes) |
| Hydrocortisone, Hydrocortone Phosphate, Ala-Cort, Cortisone, Hydrocortisone Sodium Succinate, Hydrocortisone Sodium Phosphate | Solu-Cortef, Hydrocort Acetate, Lanacort | glucocorticosteroid |
| Aldesleukin, Interleukin-2, IL-2 | Proleukin | cytokine, increases production of T lymphocytes and NK cells and improves function of lymphokine-activated killer cells and tumor-infiltrating lymphocytes |
| Alemtuzumab | Campath | CD52 monoclonal antibody |
| All-Trans Retinoic Acid, Tretinoin | Vesanoid | Retinoid, acts on nuclear receptors RAR or RXR |
| Interferon Alfa, alpha interferon, IFN-alpha | Intron A, Roferon-A | cytokine and biologic response modifier |
| Altretamine, Hexamethylmelamine, HMM | Hexalen | alkylating agent, hydrazine and triazine |
| Amifostine | Ethyol | chemoprotective agent, deactivates harmful components of chemotherapy drugs; scavenger, binds free radicals produced by cisplatin or radiation therapy |
| Aminoglutethimide | Cytadren | adrenal cortex corticosteroid production inhibitor, decreases production of estrogens and androgens |
| Nilutamide | Nilandron, Anandron | antiandrogen, blocks androgen/testosterone receptors |
| Apalutamide | Erleada | antiandrogen, blocks androgen/testosterone receptors |
| Arabinosylcytosine, Cytarabine, Ara-C | Cytosar-U | antimetabolite, inhibits DNA polymerase beta; cross-linking/alkylation of DNA, blocks G1/S |
| Nelarabine | Arranon | antimetabolite, adenosine deaminase inhibitor, incorporates into and destabilizes DNA, inhibits DNA polymerase alpha catalytic subunit; S phase-specific arrest |
| Arsenic Trioxide | Trisenox | not well understood, DNA fragmentation in leukemia cells; also damages or degrades the fusion protein PML-RAR |
| Avapritinib | Ayvakit | tyrosine kinase inhibitor, small molecule inhibitor of platelet-derived growth factor receptor alpha (PDGFR-A), targets PDGFRA and PDGFRA D842 mutants as well as multiple KIT mutations |
| Bevacizumab | Avastin, Mvasi, Zirabrev | targets and inhibits VEGF preventing angiogenesis |
| Belinostat | Beleodaq | histone deacetylase inhibitor |
| Carmustine, BCNU | BiCNU, Gliadel wafer | alkylating agent, nitrosurea, cross-links DNA and RNA |
| Binimetinib | Mektovi | oral MEK inhibitor, targets MEK1 and MEK2 protein kinase; usually given with a BRAF kinase inhibitor |
| Blinatumomab | Blincyto | bispecific T-cell engager monoclonal antibody, induces T-cells to bind CD19 on surface of B-cell leukemia or lymphoma cells |
| Bortezomib | Velcade | proteasome inhibitor, inhibits 26S proteasome, inhibits proteasome subunit beta type-5 and type-1; cell arrest in G2-M phase; in multiple myeloma, works by blocking adhesion molecule activation |
| Bosutinib | Bosulif | kinase inhibitor, targets ABL and SRC kinases |
| Encorafenib | Braftovi | BRAF kinase inhibitor |
| Busulfan | Busulfex, Myleran | alkylating agent, alkylsulfonate |
| Cabozantinib | Cometriq, Cabometyx | oral receptor tyrosine kinase inhibitor (RET, MET, VEGF), blocks cell division pathways |
| Carfilzomib | Kyprolis | tetrapeptide epoxyketone proteasome inhibitor, irreversibly binds to N-terminal threonine-containing active sites of 20S proteasome |
| Crizotinib | Xalkori capsules | oral receptor tyrosine kinase inhibitor, inhibits ALK, hepatocyte growth factor receptor (HGFR, c-Met) and receptor d’origine natais (RON); blocks cell division pathway |
| Decitabine | Dacogen | antimetabolite and demethylating agent, restores function of tumor suppressor genes and cytotoxic effect on rapidly dividing cells |
| Daratumumab and Hyaluronidase | Darzalex Faspro | CD38 monoclonal antibody (present on myeloma cells), IgG1k human monoclonal antibody binds CD38 and induces apoptosis through mediated cross linking and immune mediated tumor cell lysis through complement dependent cytotoxicity, antibody mediated cytotoxicity, and antibody dependent cellular phagocytosis; hyaluronidase helps with absorption into blood |
| Daunorubicin and Cytarabine (Liposomal) | Vyxeos | Daunorubicin is an anthracycline, intercalates between DNA base pairs inhibiting DNA synthesis and DNA-dependent RNA synthesis; Cytarabine is an antimetabolite (S phase); liposome helps with drug distribution and lengthens time of effect of the drug allowing for extended treatment effect |
| Glasdegib | Daurismo | hedgehog pathway inhibitor, inhibits increases in tumor size and decrease the amount of CD45+/CD33+ cells in the bone marrow; binds and inhibits Smoothened (SMO) receptor |
| Dexamethasone, Dexamethasone Sodium Phosphate, Dexamethasone Acetate | Decadron, Dexasone, Diodex, Hexadrol, Maxidex | glucocorticosteroid |
| Prednisolone | Delta-Cortef, Orapred, Pediapred, Prelone | glucocorticosteroid |
| Prednisone | Deltasone, Liquid Pred, Meticorten, Orasone | glucocorticosteroid |
| Denileukin Diftitox | Ontak | biologic response modifier agent, a fusion protein (combination of diphtheria toxin and IL-2), selectively delivers the cell-killing activity of diphtheria toxin to targeted cells; binds to lymphoma cells that express high affinity IL-2 receptor (IL-2 part of fusion protein binds cell surface) and halts protein synthesis |
| Dexrazoxane | Zinecard | chemoprotectant agent, binds free radicals formed by doxorubicin; extravasation antidote, binds chemotherapy drug that leaked from vein preventing damage to surrounding tissue |
| Methylprednisolone | Duralone, Medrol, Medralone, M-Prednisol, Solu-Medrol | glucocorticosteroid |
| Eculizumab | Soliris | monoclonal antibody, binds C5 complement protein preventing formation of MAC, prevents hemolysis and stabilizes hemoglobin |
| Eltrombopag | Promacta | colony stimulating factor, thrombopoietic agent, growth factor that stimulates platelet production by binding to and activating the thrombopoietin (TPO) receptor; a thrombopoietin nonpeptide agonist |
| Tagraxofusp-erzs | Elzonris | biologic response modulator and cytokine, combination of recombinant human IL-3 and truncated diphtheria toxin, binds CD123 (alpha chain of IL-3 receptor) and delivers diphtheria toxin to cells, blocks protein synthesis; binds ADP-ribosylation factor-like protein 2 |
| Fam-trastuzumab deruxtecan-nxki | Enhertu | anti-HER2 monoclonal antibody (anti-HER2 IgG1) combined with a topoisomerase I inhibitor; antibody attached to chemotherapy, allows selective delivery into HER2 overexpressing cells, DNA damage |
| Enzalutamide | Xtandi | antiandrogen (second generation), blocks androgen/testosterone receptors |
| Toremifene | Fareston | anti-estrogen, estrogen receptor antagonist, blocks estrogen binding and uptake into cells |
| Gilteritinib | Xospata | protein-tyrosine kinase inhibitor, inhibits FLT3 receptor, serotonin receptors, TPKR UFO, and ALK tyrosine kinase receptor |
| Trastuzumab | Herceptin (Biosimilars: Herzuma, Kanjinti, Ogivri, Ontruzant) | HER2/neu receptor monoclonal antibody |
| Ibritumomab, Ibritumomab Tiuxetan | Zevalin | CD20 monoclonal antibody linked with Yttrium-90 (radioactive substance), directly delivers radiation to CD20+ cells |
| Ibrutinib | Imbruvica | binds to and inhibits the bruton’s tyrosine kinase (BTK) signaling molecule of the B-cell receptor signaling complex |
| Ponatinib | Iclusig | tyrosine kinase inhibitor |
| IL-11, Oprelvekin, Interleukin-11 | Neumega | biologic response modifier and cytokine, stimulates production, maturation and activation of platelets |
| Talimogene Laherparepvec, T-VEC | Imlygic | genetically modified weakened form of live HSV (oncolytic), replicates within tumors and produces GM-CSF to promote anti-tumor immune response |
| Interferon Alfa-2b (PEG Conjugate), PEG Interferon | PEG-Intron | biologic response modifier and cytokine, activates human type 1 interferon causing them to dimerize which activates JAK/STAT pathway |
| Ruxolitinib | Jakafi | oral receptor tyrosine kinase inhibitor, inhibits JAK1 and JAK2 |
| Pembrolizumab | Keytruda | highly selective humanized monoclonal IgG4 antibody directed against the PD-1 receptor on cell surface, prevents binding and activation of PD-L1 and PD-L2 which activates T-cell mediated immune response against tumor cells |
| Lenalidomide | Revlimid | immunomodulatory agent and antiangiogenic agent, inhibits protein cereblon and TNF ligand superfamily member 11, antagonizes cadherin-5, negative modulator of prostaglandin G/H synthase 2 |
| Lenvatinib | Lenvima | oral receptor tyrosine kinase inhibitor, inhibits VEGF, VEGFR, FGF, PDGFR alpha, KIT and RET |
| Lorlatinib | Lorbrena | reversible tyrosine kinase inhibitor, blocks abnormal ALK protein |
| Luspatercept | Reblozyl | recombinant fusion protein, hematopoiesis agent (contains modified form of the extracellular domain of human activin receptor), binds and inhibits transforming growth factor beta super family molecules increasing expression of blood cell precursors |
| Olaparib | Lynparza | poly (ADP-ribose) polymerase (PARP) enzyme inhibitor (PARP1, PARP2, PARP3), induces synthetic lethality in BRCA1/2 deficient tumor cells through formation of double-strand DNA breaks |
| Procarbazine | Matulane | alkylating agent, hydrazine and triazine |
| Midostaurin | Rydapt | tyrosine kinase inhibitor, inhibits FLT3 inhibiting leukemic cell production |
| Niraparib | Zejula | PARP inhibitor, highly selective for PARP1 and PARP2 resulting in DNA damage and apoptosis, induces cytotoxicity in tumor cell lines w/ and w/o BRCA1/2 deficiencies |
| Romiplostim | Nplate | biologic response modifier, colony stimulating factor, promotes platelet production via the thrombopoietin receptor |
| Pertuzumab | Perjeta | HER2 monoclonal antibody (binds different area of HER2 protein than trastuzumab) |
| Pomalidomide | Pomalyst | thalidomide analogue, inhibits protein cereblon, TNF and prostaglandin G/H synthase 2 |
| Sipuleucel-T | Provenge | autologous cellular immunotherapy, selectively targets prostatic acid phosphatase (PAP), a PSA |
| Rucaparib | Rubraca | PARP inhibitor (PARP1, PARP2, PARP3), increases formation of PARP-DNA complexes; cytotoxicity in BRCA1/2 deficient tumor cell lines and other DNA repair genes |
| Sacituzumab Govitecan-hziy | Trodelvy | trop-2-directed antibody-drug conjugate combined with a topoisomerase I inhibitor (SN-38) attached by a linker, binds trop-2-expressing cancer cells and is internalized, SN-38 is released in cancer cell by breaking the linker |
| Sunitinib, SU11248 | Sutent | receptor protein-tyrosine kinase inhibitor, inhibits VEGF |
| Talazoparib | Talzenna | PARP inhibitor (PARP1, PARP2), strong catalytic inhibition and a PARP-trapping potential |
| Temozolomide | Temodar | alkylating agent, hydrazine and triazine (similar to dacarbazine, acts as a pro-drug) |
| Vorinostat | Zolinza | not fully understood, histone deacetylase inhibitor, inhibits HDAC2, HDAC2, HDAC3, HDAC6 |
| Zoledronic Acid | Zometa | bisphosphonate, decreases osteoclast actions on bone |