Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Escalate
Fever or clinical deterioration during or after systemic anticancer treatment is neutropenic sepsis until assessed. Arrange immediate hospital evaluation, full blood count, cultures and protocol-led intravenous antibiotics without waiting for neutrophil confirmation. Also escalate anaphylaxis, chest pain, severe diarrhoea, uncontrolled vomiting, bleeding, confusion, oliguria and suspected extravasation.
Synopsis
Explain how cytotoxic regimens are selected and delivered, verify treatment safety before every cycle, prevent dosing and route errors, and respond rapidly to neutropenic sepsis and organ-specific toxicity.
Cytotoxic medicines damage dividing cells through DNA injury, antimetabolite action, mitotic disruption or topoisomerase effects; combinations attack different vulnerabilities but compound toxicity.
Regimen choice depends on histology, stage, intent, biomarkers, prior therapy, organ function and patient goals; the protocol specifies medicines, sequence, cycle and modifications.
Before every cycle verify identity, consent, intent, performance, blood count, renal and hepatic function, toxicity, infection and dose changes through an independent SACT process.
Key red flags
Neutropenic sepsis
Fever, shivering, hypotension, confusion or unexplained deterioration after treatment needs immediate emergency antibiotics and sepsis care.
Investigation priorities
01
Full blood count before each cycleFirst step
Confirm marrow recovery and detect anaemia or thrombocytopenia.
Management branches
AuthoriseVerify every treatment cycle
A patient attends for protocol-based cytotoxic treatment.
Confirm identity, diagnosis, intent, consent, regimen, cycle, body size or renal calculation, allergies and previous dose modifications.
Review performance, infection, toxicity, full blood count, renal, hepatic and agent-specific results against the current protocol.
Key medicines
Capecitabine (oral cytotoxic example)A licensed monotherapy schedule is 1,250 mg/m² orally twice daily on days 1–14 of a 21-day cycle, taken within 30 minutes after food; combination protocols commonly use different starting doses. Calculate each dose and apply protocol, renal and toxicity modifications rather than copying this example.
Piperacillin/tazobactam for suspected neutropenic sepsisGive the first adult dose 4.5 g intravenously immediately; the licensed febrile-neutropenia schedule is 4.5 g every 6 hours, then modify to local microbiology, allergy, prior resistance, cultures and renal function. Do not add an aminoglycoside or glycopeptide routinely without a patient-specific or local indication.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.