Louisville Lectures

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Taking the Complication out of Chemotherapy by Dr. Maxwell M. Krem

Dr. Krem presents this lecture by first describing chemotherapy indications and which patients should receive chemotherapy.  He then explains common toxicities and their treatments along with drug-specific toxicities.

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'Chemotherapy and Complications' Notes

In this lecture, Dr. Krem gives an overview on the options for chemotherapy and how to manage complications arising from its use. The lecture walks us through the vital aspects of patient selection and routes of administration but also focuses specifically on the various toxicities using a case based approach. While chemotherapy is a vast subject, as internists it is important to recognize the ways to deal with the most commonly seen adverse effects.


  • Not all patients are suited to withstand chemotherapy
  • Some adverse effects from chemotherapy can be anticipated and pre-treated
  • Thinking through the mechanism of toxicity allows one to tailor pharmacotherapy effectively
  • Drugs used to treat toxicity can precipitate their own toxicities


  • Intent of chemotherapy
  • Patient selection
  • Routes of delivery 
  • Toxicity
    o   Nausea
    o   Mucositis
    o   Hypersensitivity reactions
    o   Tumor lysis syndrome
    o   Cancer related anemia
    o   Neutropenic fever
  • Agent specific toxicities: Platins, vincristine, anthracyclines


1.  McQuade RM, Stojanovska V, Abalo R, Bornstein JC, Nurgali K.  Chemotherapy-Induced Constipation and Diarrhea: Pathophysiology, Current and Emerging Treatments. Front Pharmacol. 2016 Nov 3;7:414. eCollection 2016.

Dr. Maxwell M. Krem, MD, Ph.D.

Dr. Maxwell Krem is a medical oncologist who sees patients with hematologic malignancies at James Graham Brown Cancer Center (JGBCC), University of Louisville School of Medicine. His primary specialty is bone marrow transplantation. Dr. Krem recalls an experience he had as a young person when his grandfather had cancer. “I saw a lack of bedside manner and a lack of sensitivity,” he says, adding “It really made a big impression on me... I knew I could do better so I’ve tried to develop a humanistic approach in my rapport with patients and their families. I try to be a source of support, whatever the outcome.”

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