C H A P T E R 1 4
Antineoplastic agents
201
TABLE 14.2
DRUGS IN FOCUS Antimetabolites (continued)
Drug name
Dosage/route
Usual indications
clofarabine (Evoltra)
52 mg/m
2
by IV infusion over 2 hours daily for
5 days; repeat every 2–6 weeks, based on
baseline function
Treatment of people 1–21 years of age
with acute lymphocytic leukaemia (ALL)
after at least two relapses on other
regimens
Special considerations:
GI toxicity, bone
marrow suppression and infection are
common
colaspase (Leunase)
50–200 KU/kg IV daily or every alternate day
Treatment of acute lymphoblastic
leukaemia, myeloid leukaemia and
malignant lymphoma
Special considerations:
Test dose
usually administered to check for
hypersensitivity. Use with caution in
people with renal or hepatic impairment
cytarabine (generic)
200 mg/m
2
per day by continuous IV infusion
for 5 days, repeat every 2 weeks; intrathecal
use, 30 mg/m
2
every 4 days
Treatment of meningeal and myelocytic
leukaemias; used in combination with
other agents; lymphomatous meningitis;
non-Hodgkin’s lymphoma in children
Special considerations:
GI toxicity and
cytarabine syndrome (fever, myalgia,
bone pain, chest pain, rash, conjunctivitis,
and malaise) are common—this
syndrome sometimes responds to
corticosteroids; alopecia may occur
fludarabine (Farine,
Fludara)
25 mg/m
2
per day IV for 5 days; repeat every
28 days or 40 mg/m
2
/day PO for 5 days every
28 days
Treatment of chronic lymphocytic
leukaemia (CLL); unresponsive B cell CLL
with no progress with at least one other
treatment
Special considerations:
CNS toxicity
can be severe; GI toxicity, respiratory
complications, renal failure and a tumour
lysis syndrome are common
fluorouracil (Efudix)
12 mg/kg per day IV on days 1–3, then 6 mg/kg
IV on days 5, 7, 9; Maintenance: 5–10 mg/kg
once weekly
Palliative treatment of various GI cancers;
topical treatment of basal cell carcinoma
and actinic and solar keratoses
Special considerations:
GI toxicity,
bone marrow suppression, alopecia and
skin rash are common; avoid occlusive
dressings with topical forms; wash hands
thoroughly after coming in contact with
drug
gemcitabine (Gemcite,
Gemzar)
1000–1250 mg/m
2
IV over 30 minutes once a
week; timing based on other therapies and
response
Treatment of locally advanced or
metastatic adenocarcinoma of the
pancreas; given with cisplatin for the
treatment of inoperable non–small cell
lung cancer; metastatic breast cancer,
ovarian cancer after failure of a platinum-
based therapy
Special considerations:
can cause severe
bone marrow depression, GI toxicity,
pain, alopecia, interstitial pneumonitis
mercaptopurine
(Puri-Nethol)
2.5 mg/kg per day PO for 4 weeks; then
re-evaluate
Remission induction and maintenance
therapy in acute leukaemias
Special considerations:
bone marrow
toxicity and GI toxicity are common;
hyperuricaemia is a true concern—
ensure that the person is well hydrated
during therapy
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