Chemotherapy Pill : Fludarabine

Chemotherapy Pill : Fludarabine

Chemotherapy Pill : Fludarabine

Fludarabine is a chemotherapy medicine used to treat certain types of cancer by destroying cancerous cells. It is known as the brand name Fludara. Fludarabine may also be referred to as Fludarabine phosphate, 2-fluoroadenine aribinoside 5-phosphate, and FAMP.

Fludarabine has been available for use since the early 1990s, and is a member of the group of chemotherapy drugs known as antimetabolites. Antimetabolites interfere with the genetic material (DNA) inside the cancer
cells and prevent them from further dividing and growing more cancer cells.

Chemotherapy Pill : Purpose

Fludarabine is approved by the Food and Drug Administration (FDA) to treat refractory chronic lymphocytic leukemia (CLL). Patients must have a disease that did not respond to other treatment or a disease that became worse during other treatment. Fludarabine has also been used to treat Hodgkin’s and non-Hodgkin’s lymphoma, cutaneous T-cell lymphoma, macroglobulinemic lymphoma, mycosis fungoides, and hairy cell leukemia.

Chemotherapy Pill : Dosage

Fludarabine is a clear solution that is administered
through a vein.

Afludarabine dose can be determined using a mathematical calculation that measures a person’s body surface area (BSA). This number is dependent upon a patient’s height and weight. The larger the person, the greater the body surface area. BSA is measured in the units known as square meter
(m2). The body surface area is calculated and then multiplied by the drug dosage in milligrams per square meter (mg/m2). This calculates the actual dose a patient is to receive.

The approved dose for chronic lymphocytic leukemia is 25 milligrams per square meter per day for 5 days in a row. The fludarabine is given intravenously into a vein over a 30-minute to 2-hour time period. This 5-day
cycle is repeated every 4 weeks.

The dose of fludarabine may need to be decreased in patients who have kidney problems. (Chemotherapy Pill)

Chemotherapy Pill : Precautions

Blood counts will be monitored regularly while on fludarabine therapy. During a certain time period after receiving fludarabine, there is an increased risk of getting infections.

Caution should be taken to avoid unnecessary exposure to crowds and people with infections. Patients with a known previous allergic reaction to
chemotherapy drugs should tell their doctor.

Patients who may be pregnant or are trying to become pregnant should tell their doctor before receiving fludarabine. Chemotherapy can cause men and
women to be sterile, or unable to have children. It is unknown if fludarabine has this effect on humans.

Patients should check with their doctors before receiving live virus vaccines while on chemotherapy.

Chemotherapy Pill : Side effects

The most common side effect expected from taking fludarabine is low blood counts (myelosuppression). When the white blood cell count is lower than normal (neutropenia), patients are at an increased risk of developing a fever and infections. Patients may need to be treated with antibiotics at this point. The platelet blood count can also be decreased due to fludarabine administration, but generally returns to normal within 2 weeks after the end of the infusion. Platelets are blood cells that cause clots to form to stop bleeding. When the platelet count is low, patients are at an increased risk for bruising and bleeding. Fludarabine causes low red blood cell counts (anemia).
Low red counts make people feel tired and dizzy.

Fludarabine can cause the development of autoimmune hemolytic anemia, which occurs when the body begins to destroy its own red blood cells. It is an uncommon side effect, but very serious when it occurs.

Common side effects from fludarabine include nausea and vomiting. If nausea and vomiting are a problem, patients can be given antiemetics before receiving fludarabine. This medication helps prevent or decrease these side
effects. Other common side effects include fever, chills, joint pain, fluid gain, fatigue, sleepiness, pain, muscle ache, weakness, and infection. Other less common side effects include loss of appetite (anorexia), diarrhea, abnormal touch sensation, cough, pneumonia, and shortness of breath.

Damage to the nerves and nervous system tissues can occur with fludarabine. Side effects due to this nerve damage include sleepiness, confusion, weakness, fatigue, irritability, numbness or tingling in the hands and feet, visual changes, and difficulty walking.

Infrequent side effects of fludarabine are skin rashes, pain, itching, fever, lung problems, insomnia, headache, muscle and joint aches, swelling, and
decreased blood pressure.

Rare side effects of fludarabine include mouth sores, constipation and abdominal cramping, bleeding from the bladder, hair loss, hearing problems, and liver and kidney problems.

Fludarabine can cause the rapid breakdown of cancer cells. Patients who have large numbers of cancer cells in their bloodstream can develop a problem known as tumor lysis syndrome. The symptoms of this syndrome
include pain in the lower back and blood in the urine. A patient can develop high or low levels of electrolytes and high levels of uric acid, which can lead to gout and kidney damage. The drug allopurinol may be given to patients prior to fludarabine treatment to prevent this from occurring. Drinking an increased amount of liquids also may help prevent the kidney damage.

Chemotherapy Pill

Chemotherapy Pill : Mitoxantrone

Chemotherapy Pill : Mitoxantrone

Chemotherapy Pill : Mitoxantrone

Mitoxantrone, also known by its trade name Novantrone, is an anticancer agent effective against certain kinds of leukemias. It is also used in Multiple Sclerosis (MS), and was approved by the Federal Drug Administration
in 1987.

Mitoxantrone is classified as an anthracycline antitumor antibiotic, and closely resembles another drug in this category, daunorubicin. Although its precise mechanism is not clear, mitoxantrone is cell cycle non-specific,
meaning that it is toxic to cells that are dividing, as well as those that are not.

Chemotherapy Pill : Purpose

Mitoxantrone is used with other drugs to treat acute non-lymphocytic leukemia (ANLL), a category that includes myelogenous, promyelocytic, monocytic and erythroid acute leukemia. In adults, ANLL accounts for
up to 85% of all adult leukemia cases. Mitoxantrone may also be used in the treatment of acute lymphocytic leukemia, chronic myelocytic leukemia, ovarian cancer, advanced or recurrent breast cancer, prostate cancer,
and MS.

Chemotherapy Pill : Dosage

Chemotherapy Pill : MitoxantroneMitoxantrone is given intravenously over a thirtyminute time period. Chemotherapy dosages are based on a person’s body surface area (BSA), which is calculated in square meters using height and weight measurements.
Drug dosages are ordered in milligrams per square meter (mg/m2).

In patients with cancer, the recommended dosage for induction therapy is 12mg/ mg/m2 administered on the first three days of treatment. After that time, another chemotherapy drug is usually infused. This course of treatment is often adequate to induce remission, but may be repeated if it does not. In the second induction course, the dosage remains the same, but mitoxantrone is given for two days, rather than three, followed by other chemotherapy agents. Dosages may be altered, depending on the level of bone marrow toxicity the patient develops.

For patients with solid tumors, such as advanced hormone-refractory prostate cancer, a single dose of 12mg/ mg/m2 is administered, and repeated every three to four weeks. Recent studies show that mitoxantrone used with glucocorticoids has resulted in improved pain control and quality of life in men with prostate cancer.

Chemotherapy Pill : Precautions

Mitoxantrone’s use in children has not been studied sufficiently to determine whether its use is safe and effective. It should not be used in individuals who have experienced a previous reaction to it.

Mitoxantrone is excreted by the liver and kidneys. It may alter the appearance of urine, causing it to be a bluegreen color for approximately 24 hours. The sclera, or whites of the eyes, may temporarily be blue-tinged. Patients should not be alarmed by this change, but should alert their doctors if it is prolonged or is accompanied by other symptoms.

Mitoxantrone should not be administered to pregnant women, as damage to the fetus may occur. Throughout treatment, women should use methods to prevent pregnancy. It is excreted in breast-milk, so breast-feeding should be avoided during treatment.

Chemotherapy Pill : Side effects

Mitoxantrone can cause severe and sometimes rapid myelosuppression leading to decreased white blood cell, red blood cell, and platelet counts. Blood counts should be monitored frequently throughout treatment.
The white blood cells tend to nadir, or drop to their lowest point, within ten to fourteen days after mitoxantrone is administered. Patients should also be examined for symptoms of low white blood cell count, which typically resemble those of an infection: sore throat, burning with urination, increased temperature, or swelling. Patients should also be carefully monitored for indications that platelet count is low. Symptoms may include unexplained
bruises, bleeding or increased bleeding with menstruation, and headache.

Mitoxantrone can damage the heart, possibly causing changes that lead to congestive heart failure (CHF). Patients especially at risk are those previously treated with anthracyclines or radiation to the chest area, or
those with an already existing heart condition. Symptoms to watch for include swelling of the hands and ankles, difficulty breathing, or heart palpitations.

Mitoxantrone can cause a severe, painful inflammation of the mucous membranes called mucositis. The condition may develop within a week of treatment. A patient may experience a burning sensation in his or her
throat, as well as mouth pain. Mucositis typically resolves in a few weeks on its own, but there are measures one can take to hasten the process and provide comfort during healing. Hydration is very important to keep
the mouth moist. Good oral hygiene is important—the teeth should be brushed with a very soft toothbrush, and flossed gently with unwaxed dental floss. (If bleeding occurs, using a toothbrush may not be safe. Patients
should talk to their health care providers should this occur.) Your doctor or nurse may recommend a special mouthwash that helps relieve pain.

Patients undergoing treatment with mitoxantrone may be at risk for tumor lysis syndrome, a potentially life-threatening condition that develops when large numbers of cells rupture and release their contents into the blood stream. Preventative measures should be implemented to prevent adverse effects.

Chemotherapy Pill  : Interactions

Because mitoxantrone can alter normal blood counts, medications that contain aspirin should be avoided. Aspirin acts as a blood-thinner, and can predispose a person to bleeding. Patients should discuss all medications, whether they are prescribed or over-thecounter drugs, with their doctor to ensure there are no potential interactions. Cytarabine, another drug used to
treat cancer, may increase the toxicity of mitixantrone if the drugs are used together.

Chemotherapy Pill

Chemotherapy Pill : Cyclophosphamide (Cytoxan, Neosar)

Chemotherapy Pill : Cyclophosphamide (Cytoxan, Neosar)Cyclophosphamide is an anticancer (antineoplastic) agent. It also acts as a suppressor of the immune system. It is available under the brand names Cytoxan and Neosar.

Cyclophosphamide chemically interferes with the synthesis of the genetic material (DNA and RNA) of cancer cells by cross-linking DNA strands, preventing these cells from being able to reproduce and continue the growth of the cancer.

Chemotherapy Pill : Purpose

Cyclophosphamide is approved by the Food and Drug Administration (FDA) to treat several forms of cancer. These include:
  • breast cancer
  • leukemia
  • malignant lymphoma
  • multiple myeloma
  • ovarian cancer
  • soft tissue sarcoma
  • mycosis fungoides
  • nephrotic syndrome
  • neuroblastoma
  • Wilms’ tumor
  • retinoblastoma

Cyclophosphamide has activity against a wide variety of other cancers and conditions not specifically approved by the FDA, and patients should be aware that it may be commonly prescribed for these other disease states:

  • bone cancer
  • cervical cancer
  • endometrial cancer
  • germ cell tumors
  • gestational trophoblastic tumors
  • histiocytosis X
  • lung cancer
  • prostate cancer
  • testicular cancer
  • Wilms’ tumor

Chemotherapy Pill : Dosage

Cyclophosphamide may be taken either orally (in pill form) or as an injection into the vein. The dosage prescribed may vary widely depending on the patient, the cancer being treated, and whether or not other medications
are also being taken.

A typical oral dosage for adults is 1 to 5 mg per kg of body weight per day for initial and maintenance dose, or 400 to 1000 milligrams per squared meter of body surface area for four to five days every three to four weeks. A typical dosage by injection is 40 to 50 mg per kg, divided in several smaller doses, for two to five days. Then dose for patients receiving bone marrow transplant may be as high as 60 mg per kg per day for two days.

Chemotherapy Pill : Precautions

Cyclophosphamide should be taken on an empty stomach. If stomach irritation occurs, it should be taken with small amounts of food or milk. Cyclophosphamide should always be taken with plenty of fluids.

Cyclophosphamide can cause an allergic reaction in some people. Patients with a prior allergic reaction to cyclophosphamide should not receive this drug.

Cyclophosphamide can cause serious birth defects if either the man or the woman is taking this drug at the time of conception or if the woman is taking this drug during pregnancy. Contraceptive measures should be taken by both men and women while on this drug. Sterility is a common side effect of cyclophosphamide. This sterility is dependent upon the dose, duration of therapy, and state of function of the ovary or testicle at the time of administration of the drug. The sterility may be irreversible in some patients.

Because cyclophosphamide is easily passed from mother to child through breast milk, breast feeding is not recommended while under treatment. Cyclophosphamide suppresses the immune system and interferes with the normal functioning of certain organs and tissues, and its excretion from the body is dependent on a normal functioning kidney and liver. For these reasons, it is important that the prescribing physician is aware of any of the following pre-existing medical conditions:

  • a current case of, or recent exposure to, chicken pox
  • herpes zoster (shingles)
  • all current infections
  • kidney disease
  • liver disease
  • a prior removal of one, or both, adrenal gland(s)

Also, because cyclophosphamide is such a potent immunosuppressant,
patients taking this drug must exercise extreme caution to avoid contracting any new infections.

Chemotherapy Pill : Side effects

Chemotherapy Pill : Cyclophosphamide (Cytoxan, Neosar)Inflammation and irritation of the bladder, causing blood in the urine, is a common and severe side effect of cyclophosphamide. However, this side effect can be prevented and controlled with the administration of vigorous
hydration with intravenous fluids before, during, and after chemotherapy. Patients should urinate frequently (at least every 2 hours) to enhance removal of the drug from the body, drink 3 to 4 liters of fluids a day while taking the drug by mouth and for 2 to 3 days after discontinuation of the drug unless otherwise instructed by the physician. Patients who are taking cyclophosphamide orally should avoid taking the drug at night so that they can go to the bathroom frequently during the day. The bladder-protectant drug mesna is usually administered if the patient is receiving more than 2,000 mg per square meter of body surface area of the cyclophosphamide.
Another common side effect of cyclophosphamide is increased susceptibility to infection due to decreased production of cells that fight infection. Increased risk of bleeding can occur due to decrease of platelets, which are involved with the clotting process. Decreased production of red blood cells can cause anemia and patients may experience fatigue, and shortness of breath.

Nausea and vomiting can occur, usually at the higher doses. Taking the appropriate antiemetics prescribed by the physician can prevent this side effect. Temporary hair loss (alopecia) usually begins three to six weeks after the start of therapy, but hair will regrow (although it may be a different color and/or texture). Sterility can occur in both men and women, and some women may also experience stoppage of menstruation. Diarrhea and ulcers of the mouth are also possible side effects of cyclophosphamide treatment.

Less common side effects include:

  • nasal stuffiness
  • runny eyes
  • runny nose
  • sinus congestion
  • dizziness
  • darkening of skin or fingernails
  • skin rash
  • sneezing (if the drug is given too rapidly by injection into the vein)
  • facial flushing

Some patients may also develop a second cancer years later with cyclophosphamide therapy alone or in combination with other anti cancer drugs. Patients should discuss this side effect with their physicians and
determine the risks versus the benefits of this drug for treatment of the immediate cancer.

A doctor should be consulted immediately if the patient experiences any of the following:

  • painful or difficult urination
  • increase in frequency or feeling of urgency to urinate
  • blood in the urine
  • shortness of breath
  • signs of infection such as cough, sore throat, fever and chills
  • pain in the lower back or sides
  • unusual bleeding or bruising
  • blood in the stool
  • tiny red dots on the skin
  • delayed healing of any wounds
  • skin rash
  • yellowing of the skin or eyes

Chemotherapy Pill : Dactinomycin

Chemotherapy Pill : Dactinomycin

chemotherapy pill-dactinomycin

Dactinomycin is a chemotherapeutic agent belonging to a family of medicines known as antineoplastic drugs. Alternative trade names or brand names for dactinomycin include Actinomycin-D and Cosmegen.

Dactinomycin is one of the older chemotherapy drugs, having gained approval from the Food and Drug Administration (FDA) in 1982. This highly potent and effective cytotoxic agent is a mixture of substances produced by the bacteria Streptomyces parvullus. Its toxic properties prevent its use as an antibiotic. Dactinomycin interferes with the growth of cancer cells by complexing with a cell’s genetic material (deoxyribonucleic acid, or DNA). This prevents the cell from producing the proteins necessary to function and grow, thereby killing it. Dactinomycin may be used as a single chemotherapeutic agent or in conjunction with other antineoplastics (such as vincristine and cyclophosphamide)
for greater efficacy.

Chemotherapy Pill : Purpose

Dactinomycin is used in the treatment of Ewing’s sarcoma, Wilms’ tumor, rhabdomyosarcoma, gestational trophoblastic tumors, Kaposi’s sarcoma, and soft tissue sarcomas. It is less commonly used for cancers of the uterus and testis.

Chemotherapy Pill : Dosage

chemotherapy pill-dactinomycin The exact schedule and method of dactinomycin administration will be prescribed by an oncologist based on the type and stage of the cancer. An appropriate starting treatment regimen for adult patients is 500 mg/day
for five consecutive days at two to four week intervals if the drug is tolerated. For children the dose is 15 mg/day over the same time course as prescribed for adults. Dactinomycin is not recommended for children less than one year of age; little clinical data is available on the use of dactinomycin in the elderly. Administration may be by intravenous (IV) injection, through a running IV infusion, or through a central line inserted under the skin into a vein near the collarbone.

Chemotherapy Pill : Precautions

To maximize treatment effects, patients receiving dactinomycin should observe the following guidelines, as well as any modifications given by the oncologist:
  • The area surrounding the injection site should be monitored.
  • Patients should have regular laboratory testing for white blood cell count and kidney, liver, and bone marrow function.
  • In order to reduce the possibility of immunosuppression, immunizations not approved or prescribed by the oncologist should be avoided.
  • Patients should avoid contact with individuals taking or that have recently taken the oral polio vaccine, or individuals that have an active infection. When necessary a protective facemask should be worn.
  • Oral hygiene procedures should be followed to reduce the risk of gum abrasion.
  • Patients should not touch eye and nasal areas unless hands have been properly washed immediately prior to contact.
  • To reduce bleeding and bruising complications, patients should exercise extreme caution when handling sharp instruments and decline participation in contact sports.
  • Prior to treatment, the patient’s medical history should be thoroughly reviewed to avoid complications that might arise from previous conditions such as gout, kidney stones, liver disease, chickenpox, shingles, or a history of allergic reactions to various drugs.
  • The oncologist should be made aware if the patient is pregnant or if there is the possibility the patient might be pregnant, or if the patient is a breast-feeding mother.
  • Only prescribed medications or over the counter (OTC) drugs approved by the oncologist should be taken by a patient receiving dactinomycin.

Chemotherapy Pill : Side effects

Possible side effects of treatment with dactinomycin should be discussed with the patient prior to initiation of treatment. The patient should be instructed to notify the oncologist of any side effects. Side effects that may not be life threatening but give the patient cause for concern include hair loss (alopecia), intermittent diarrhea, nausea and vomiting, loss of appetite, difficulty swallowing, mouth sores or ulcers, and a general rash or change
in skin tone. Side effects that should be reported immediately to the oncologist include unusual bleeding or bruising, black tarry stools, blood in the urine or stool, development of a cough, wheezing or hoarseness, fever
or chills, lower back or side pain, painful or difficult urination, pinpoint red spots on the skin, and pain at the site of the injection. The oncologist will decide what type of intervention is best suited to control or extinguish the
presented side effects, including changing the dosage, changing the treatment schedule, or discontinuing dactinomycin treatment.

Chemotherapy Pill : Interactions

Certain medications should never be used together, but there are cases in which multiple drug treatment may be advisable even when drug interaction is well documented. Dactinomycin may be used in conjunction with other antineoplastic drugs or radiation therapy for increased efficacy of treatment. Under such conditions the oncologist will balance dosage and treatment schedules to maximize the positive effects of all drugs given and minimize any negative interactions.
It is essential that the oncologist be aware of any drugs that the patient is presently taking or has recently taken, or if the patient has recently received radiation therapy. A careful review of drugs that may interact with dactinomycin to lower its efficiency should be covered with the patient prior to treatment. These may include, but are not limited to, amphotericin B, antithyroid agents, azathioprine, chloramphenicol, flucytosine, ganciclovir, interferon, plicamycin, zidovudine, probenecid, and sulfinpyrazone.