196
P A R T 2
Chemotherapeutic agents
TABLE 14.1
DRUGS IN FOCUS Alkylating agents
Drug name
Dosage/route
Usual indications
busulfan (Busulfex,
Myleran)
Induction: 0.06 mg/kg/day PO up to 4 mg
maximum
Maintenance: 0.5–2 mg/day PO
Injection: 0.8 mg/kg as a 2-hour IV infusion
q 6 hours for 4 days via a central venous
catheter
Treatment of chronic myelogenous
leukaemia; not effective in blastic phase
or without the Philadelphia chromosome
Special considerations:
dosing
monitored by effects on bone marrow;
always push fluids to decrease toxic renal
effects; alopecia is common
carboplatin (Carbaccord)
400 mg/m
2
IV on day one every 4 weeks;
reduce dose as needed based on blood
counts and with renal impairment
Palliative or initial treatment of returning
ovarian cancer after prior chemotherapy;
initial treatment of ovarian cancer with
other chemotherapy; may be useful in
several other cancers
Special considerations:
dose and timing
determined by bone marrow response;
alopecia is common
carmustine (BiCNU,
Gliadel)
150–200 mg/m
2
IV every 6 weeks as a single
dose or divided daily injections; implanted
into brain at time of surgery
Treatment of brain tumours, Hodgkin’s
disease and multiple myelomas; available
in implantable wafer form for treatment
of glioblastoma
Special considerations:
dose determined
by bone marrow toxicity; do not repeat
for 6 weeks because of delayed toxicity;
often used in combination therapy
chlorambucil
(Leukeran)
0.1–0.2 mg/kg per day PO for 3–6 weeks;
or 0.4 mg/kg PO every 2 weeks with
maintenance dose of 0.03–0.1 mg/kg per
day PO
Palliative treatment of lymphomas and
leukaemias including Hodgkin’s disease;
being considered for the treatment of
rheumatoid arthritis and other conditions
Special considerations:
toxic to liver and
bone marrow; dosing based on bone
marrow response
cisplatin (generic)
50–100 mg/m
2
IV as single infusion q
3–4 weeks, or slow IV 15–20 mg/m
2
/day ×
5 days every 3–4 weeks
Combination therapy for metastatic
testicular or ovarian tumours, advanced
bladder cancers
Special considerations:
neurotoxic,
nephrotoxic, and can cause serious
hypersensitivity reactions
cyclophosphamide
(Cytoxan, Endoxan)
Induction: 40–50 mg/kg per day IV over
2–5 days, or 1–5 mg/kg per day PO
Maintenance: 1–5 mg/kg per day PO, or
10–15 mg/kg IV q 7–10 days
Treatment of lymphoma, myelomas,
leukaemias and other cancers in
combination with other drugs
Special considerations:
haemorrhagic
cystitis is a potentially fatal side effect;
alopecia is common
dacarbazine (generic)
2 mg/kg per day IV for 10 days, repeat at
4-week intervals; or 250 mg/m
2
per day IV for
5 days in combination with other drugs
Treatment of metastatic malignant
melanoma and as second-line therapy
with other drugs for the treatment of
Hodgkin’s disease
Special considerations:
bone
marrow depression, GI toxicity,
severe photosensitivity are common;
extravasation can cause tissue necrosis
or cellulitis—use extreme care, and
monitor injection sites regularly
fotemustine (Muphoran)
100 mg/m
2
IV. Initially, three consecutive
doses at weekly intervals, followed by one
administration every 3 weeks
Management of disseminated malignant
melanoma, including cerebral metastases
Special considerations:
monitor liver
function, blood counts prior to each
administration
