C H A P T E R 1 4
Antineoplastic agents
209
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
etoposide (Etopophos,
Vepesid)
35–100 mg/m
2
per day IV for 4–5 days or
100–200 mg/m
2
PO per day
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
paclitaxel (Abraxane,
Plaxel)
260 mg/m
2
IV over 30 minutes every 3 weeks
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
teniposide (Vumon)
130–180 mg/m
2
IV weekly in combination
with other drugs
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
vinblastine (generic)
Adult: 3.7 mg/m
2
IV once weekly
Dose may then be increased based on
leucocyte count and response
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
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