C H A P T E R 1 4
Antineoplastic agents
197
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.
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
lomustine (CeeNU)
130 mg/m
2
PO as a single dose every 6 weeks;
adjust dose based on blood counts
Palliative combination therapy for
Hodgkin’s disease and primary and
metastatic brain tumours
Special considerations:
immune
suppression and gastrointestinal effects
are common
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
Nitrogen mustard; treatment for multiple
myeloma,ovarian cancers
Special considerations:
oral route is
preferred; pulmonary fibrosis, bone
marrow suppression and alopecia are
common
oxaliplatin (Oxalatin, Xalox)
85–130 mg/m
2
IV, followed by fluorouracil at
2-week cycles
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
procarbazine (Natulan)
50 mg initially, increasing by 50 mg/day to
250–500 mg/day
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
temozolomide (Astromide,
Temizole, Temodal)
75 mg/m
2
/day PO with radiation
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
thiotepa (generic)
0.3–0.4 mg/kg IV at 1–4-week intervals;
intracavity, 0.6–0.8 mg/kg
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
