C H A P T E R 1 4
Antineoplastic agents
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TABLE 14.5
DRUGS IN FOCUS Hormones and hormone modulators
Drug name
Dosage/route
Usual indications
abiraterone (Zytiga)
1 g PO once daily
Treatment of metastatic advanced prostate cancer
Actions:
Reduces androgen levels
Special considerations:
Administered
with prednisone or prednisolone. Monitor
cardiovascular and hepatic function
anastrazole (Arianna,
Arimidex)
1 mg/day PO
Treatment of advanced breast cancer in
postmenopausal women after tamoxifen
therapy; first-line and adjunctive treatment of
postmenopausal women with locally advanced
breast cancer
Actions:
antioestrogen drug; blocks oestradiol
production without effects on adrenal hormones
Special considerations:
GI effects, signs
and symptoms of menopause—hot flushes,
mood swings, oedema, vaginal dryness and
itching—as well as bone pain and back pain,
treatable with analgesics, may occur; monitor
lipid concentrations in people at risk for high
cholesterol level
bicalutamide (Calutex,
Cosamide, Cosudex)
50 mg/day PO
In combination with a luteinising hormone for the
treatment of advanced prostate cancer
Actions:
antiandrogen drug that competitively
binds androgen-receptor sites
Special considerations:
gynaecomastia and
breast tenderness occur in 33% of people; GI
complaints are common; pregnancy category X
cabazitaxel (Jevtana)
25 mg/m
2
by IV infusion over 1 hour
every 3 weeks
Treatment of hormone refractory metastatic
prostate cancer
Actions:
Inhibits mitotic and interphase cellular
functions
Special considerations:
Administered with
prednisone or prednisolone. Weekly blood
counts during cycle one and prior to each
subsequent treatment. Closely monitor hydration
status
degarelix (Firmagon)
240 mg by subcutaneous given in two
120-mg injections, then 80 mg SC
every 28 days for maintenance
Treatment of people with advanced prostate
cancer
Actions:
Gonadotropin-releasing hormone–
receptor-site antagonist, leads to decreased
follicle-stimulating hormone and luteinising
hormone and decreased testosterone levels
Special considerations:
pregnancy category X;
risk of prolonged QT interval; injection-site
reactions, hot flushes, increased weight are
common
exemestane (Aromasin)
25 mg/day PO with meals
Treatment of advanced, metastatic breast cancer
in postmenopausal women whose disease has
progressed after tamoxifen therapy
Actions:
inactivates steroid aromatase, lowering
circulating oestrogen levels and preventing the
conversion of androgens to oestrogen
Special considerations:
avoid use in
premenopausal women or in people with liver
or renal dysfunction; hot flushes, headache, GI
upset, anxiety and depression are common
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