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C H A P T E R 1 4  Antineoplastic agents

MITOTIC INHIBITORS Mitotic inhibitors (Table 14.4) are drugs that kill cells as the process of mitosis begins (see Figure 14.5). These cell cycle–specific agents inhibit DNA synthesis. Like other antineoplastics, the main adverse effects of the mitotic

inhibitors occur with cells that rapidly multiply: those in the bone marrow, GI tract and skin. Mitotic inhibitors include docetaxel ( Taxotere ), etoposide ( Etopophos , Vepesid ), paclitaxel ( Abraxane , Plaxel ), teniposide ( Vumon ), vinblastine (generic), vincristine (generic) and vinorelbine ( Navelbine ).

TABLE 14.4

DRUGS IN FOCUS Mitotic inhibitors

Drug name

Dosage/route

Usual indications

docetaxel (Taxotere)

60–100 mg/m 2 IV over 1 hour every 3 weeks

Treatment of breast cancer and non–small cell lung cancer; androgen-dependent prostate cancer; gastric adenocarcinoma Special considerations: monitor person closely—deaths have occurred during use; severe fluid retention can occur— premedicate with corticosteroids and monitor for weight gain; skin rash and nail disorders are usually reversible; monitor people closely during use Treatment of testicular cancers refractory to other agents; non–small cell lung carcinomas Special considerations: fatigue, GI toxicity, bone marrow depression and alopecia are common side effects; avoid direct skin contact with the drug; use protective clothing and goggles; monitor bone marrow function to adjust dose; rapid fall in blood pressure can occur during IV infusion—monitor person carefully Treatment of advanced ovarian cancer, breast cancer, non–small cell lung cancer and AIDS-related Kaposi’s sarcoma Special considerations: anaphylaxis and severe hypersensitivity reactions have occurred—monitor very closely during administration; also monitor for bone marrow suppression; cardiovascular toxicity and neuropathies have occurred In combination with other drugs for induction therapy in childhood acute lymphoblastic leukaemia Special considerations: GI toxicity, CNS effects, bone marrow suppression and alopecia are common effects; avoid direct skin contact with the drug—use protective clothing and goggles; monitor bone marrow function to adjust dose; rapid fall in blood pressure can occur during IV infusion—monitor person carefully Palliative treatment of various lymphomas and sarcomas; advanced Hodgkin’s disease; alone or as part of combination therapy for the treatment of advanced testicular germ cell cancers Special considerations: GI toxicity, CNS effects and total loss of hair are common; antiemetics may help; avoid contact with drug; monitor injection sites for reactions Continued on following page

etoposide (Etopophos, Vepesid)

35–100 mg/m 2 per day IV for 4–5 days or 100–200 mg/m 2 PO per day

paclitaxel (Abraxane, Plaxel)

260 mg/m 2 IV over 30 minutes every 3 weeks

teniposide (Vumon)

130–180 mg/m 2 IV weekly in combination with other drugs

vinblastine (generic)

Adult: 3.7 mg/m 2 IV once weekly Dose may then be increased based on leucocyte count and response