15A Oncology agents
ONCOLOGY
Adults: Apply once every other day for the 1st week;
then increase frequency at weekly intervals to once
daily, then twice daily, then 3 times daily, then 4
times daily based on lesion tolerance. Usual dosing
frequency: 2–4 times daily; may reduce if application
site toxicity occurs. Allow gel to dry. Do not occlude.
Children: Not recommended.
Contraindications: Pregnancy (Cat.X).
Warnings/Precautions: Be fully familiar with this
drug’s toxicity before use. Counsel patients monthly
about need for contraception. Women of childbearing
potential: obtain reliable negative pregnancy test
within 1 week of start; repeat monthly. Start therapy
on 2nd or 3rd day of normal menstrual period. Use
two effective forms of contraception 1 month prior
to, during, and for 1 month after therapy. Max 1
month/;. Men with partners who are or may become
pregnant: use condoms during and for at least 1
month after therapy. Hepatic or renal insufficiency.
Discontinue temporarily if severe irritation occurs.
Avoid sun, UV light, and mucosal membranes. Nursing
mothers: not recommended.
Interactions: Avoid concomitant products that
contain DEET. May be potentiated by CYP3A4
inhibitors (eg, ketoconazole, itraconazole,
erythromycin, grapefruit juice). Caution with
gemfibrozil. Limit Vit. A supplements to avoid toxicity.
Adverse reactions: Application site reactions (eg,
rash, pruritus, skin disorders, pain, contact dermatitis).
How supplied: Gel–60g
;BICALUTAMIDE
CASODEX AstraZeneca
Antiandrogen. Bicalutamide 50mg; tabs.
Indications: In combination with luteinizing
hormone-releasing hormone (LHRH) analogue in stage
D2 metastatic prostate carcinoma.
Adults: Take at the same time each day. 50mg
daily. Start treatment at same time as starting LHRH
analogue.
Children: Not applicable.
Contraindications: Women of childbearing
potential. Pregnancy (Cat.X).
Warnings/Precautions: Moderate to severe
hepatic impairment. Monitor prostate specific antigen
and hepatic function (discontinue if ALT ;
2;ULN or
if jaundice occurs). Nursing mothers.
Interactions: Monitor oral anticoagulants.
Adverse reactions: Hot flashes, gynecomastia,
breast pain, diarrhea, pain, asthenia, infection,
dyspnea, impotence, loss of libido, others (see
literature); rare: hepatitis.
How supplied: Tabs– 30, 100
;BLEOMYCIN
BLEOMYCIN (various)
Cytotoxic glycopeptide antibiotic. Bleomycin
15units/vial, 30units/vial; lyophilized pwd for IM, IV,
SC, or intrapleural administration after reconstitution.
Indications: Palliative treatment for squamous
cell carcinoma (head and neck, penis, cervix, vulva),
lymphomas (Hodgkin’s disease, non-Hodgkin’s
lymphoma), testicular carcinoma (embryonal cell,
choriocarcinoma, teratocarcinoma). Sclerosing agent
for the treatment of malignant pleural effusion and
prevention of recurrent pleural effusions.
Adults: Lymphomas: treat with ;
2 units for the
first two doses, if no acute reaction occurs, follow
regular dosage schedule. Squamous cell carcinoma,
non-Hodgkin’s lymphoma, testicular carcinoma:
0.25–0.5 units/kg IV, IM, or SC weekly or twice
weekly. Hodgkin’s disease: 0.25–0.5 units/kg IV, IM,
or SC weekly or twice weekly; after a 50% response,
a maintenance dose of 1 unit daily or 5 units weekly
IV or IM should be given. Malignant pleural effusion:
60 units as a single dose bolus intrapleural injection.
Renal impairment: see literature. Total doses ;
400
units: increased risk of pulmonary toxicity.
Children: Not recommended.
Warnings/Precautions: Renal impairment.
Compromised pulmonary function. Monitor renal
function. Elderly. Pregnancy (Cat.D); avoid use.
Nursing mothers: not recommended.
Interactions: May be potentiated by nephrotoxic
drugs.
Adverse reactions: Erythema, rash, striae,
vesiculation, hyperpigmentation, tenderness of
the skin, hyperkeratosis, nail changes, alopecia,
pruritus, stomatitis; pneumonitis, pulmonary fibrosis,
idiosyncratic reaction (hypotension, mental confusion,
fever, chills, wheezing).
How supplied: Contact supplier.
;BORTEZOMIB
VELCADE Millennium
Proteasome inhibitor. Bortezomib 3.5mg/vial; pwd for
IV inj after reconstitution; contains mannitol.
Indications: Multiple myeloma. Mantle cell
lymphoma in patients who have received at least one
prior therapy.
Adults: Give as a 3–5 second IV bolus inj. Previously
untreated multiple myeloma: Treat for nine 6-week
cycles in combination with oral melphalan and oral
prednisone. Cycles 1–4: 1.3mg/m2 twice weekly (days
1, 4, 8, 11, 22, 25, 29, 32); Cycles 5–9: 1.3mg/m2
once weekly (days 1, 8, 22, 29). Relapsed multiple
myeloma or mantle cell lymphoma: Standard schedule:
1.3mg/m2 twice weekly for 2 weeks (days 1, 4, 8,
11) then 10 day rest period (days 12–21); Extended
therapy (if using ;
8 cycles): may use standard
schedule, or maintenance schedule: 1.3mg/m2 once
weekly for 4 weeks (days 1, 8, 15, 22) then 13 day
rest period (days 23–35). Allow at least 72 hours
between consecutive doses. Adjust dose if toxicity
develops: see literature. Moderate-to-severe hepatic
impairment: reduce to 0.7mg/m2 in 1st cycle; may
consider dose increase to 1mg/m2 or decrease to
0.5mg/m2 in subsequent cycles based on tolerance.
Children: Not recommended.
Contraindications: Boron or mannitol sensitivity.
Warnings/Precautions: Hepatic impairment.
Monitor for development or worsening of peripheral
