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