McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 1 4  Antineoplastic agents

TABLE 14.1

DRUGS IN FOCUS Alkylating agents (continued)

Drug name

Dosage/route

Usual indications

ifosfamide (Holoxan)

8–10 g/m2/day x 5 days or 5–6 g/m 2 as a 24-hour infusion. Repeated every 2–4 weeks

Combination therapy as a third-line agent in treating germ cell testicular cancers; being tested for treatment of other cancers Special considerations: alopecia is common Palliative combination therapy for Hodgkin’s disease and primary and metastatic brain tumours Special considerations: immune suppression and gastrointestinal effects are common Nitrogen mustard; treatment for multiple myeloma,ovarian cancers Special considerations: oral route is preferred; pulmonary fibrosis, bone marrow suppression and alopecia are common Treatment of metastatic carcinoma of the colon or rectum when disease progresses after standard therapy; used in combination therapy Special considerations: premedicate with antiemetics and dexamethasone; monitor for potentially dangerous anaphylactic reactions Used in combination therapy for treatment of stages III and IV of Hodgkin’s disease Special considerations: bone marrow toxicity; GI toxicity and skin lesions also limit use in some people; severity of adverse effects regulates the dose of the drug Treatment of refractory astrocytoma or glioblastoma in people refractory to other treatments Special considerations: monitor bone marrow closely; especially toxic in women and the elderly Treatment of adenocarcinoma of the breast and uterus and papillary carcinoma of the bladder; available intrathecally to treat effusion Special considerations: infertility, rash, gastrointestinal toxicity, dizziness, headache and bone marrow suppression are common

lomustine (CeeNU)

130 mg/m 2 PO as a single dose every 6 weeks; adjust dose based on blood counts

melphalan (Alkeran)

Multiple myeloma: 0.15 mg/kg/day × 4 days. Repeated every 6 weeks Ovarian cancer: 0.2 mg/kg per day PO for 5 days; repeat course every 4–5 weeks

oxaliplatin (Oxalatin, Xalox)

85–130 mg/m 2 IV, followed by fluorouracil at 2-week cycles

procarbazine (Natulan)

50 mg initially, increasing by 50 mg/day to 250–500 mg/day

temozolomide (Astromide, Temizole, Temodal)

75 mg/m 2 /day PO with radiation

thiotepa (generic)

0.3–0.4 mg/kg IV at 1–4-week intervals; intracavity, 0.6–0.8 mg/kg

or with suppressed renal or hepatic function, which may interfere with metabolism or excretion of these drugs and often indicates a need to change the dose. Adverse effects Adverse effects frequently encountered with the use of these alkylating agents are listed here; see Table 14.1 for a list of adverse effects specific to each agent. Amifostine

( Ethyol ) and mesna ( Uromitexan ) are cytoprotective (cell-protecting) drugs that may be given to limit certain effects of cisplatin and ifosfamide, respectively (see Box 14.3). Haematological effects include bone marrow sup­ pression, with leucopenia, thrombocytopenia, anaemia and pancytopenia, secondary to the effects of the drugs on the rapidly multiplying cells of the bone marrow.