DOCSLIB.ORG

2015 Antiemesis.Pdf

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
2015 Antiemesis.Pdf NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Antiemesis Version 2.2015 NCCN.org Continue Version 2.2015, 09/22/15 © National Comprehensive Cancer Network, Inc. 2015, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®. Printed by Alexandre Ferreira on 10/25/2015 6:12:07 AM. For personal use only. Not approved for distribution. Copyright © 2015 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Version 2.2015 Panel Members NCCN Guidelines Index Antiemesis Table of Contents Antiemesis Discussion David S. Ettinger, MD/Chair † Steve Kirkegaard, PharmD Σ Eric Roeland, MD The Sidney Kimmel Comprehensive Huntsman Cancer Institute UC San Diego Moores Cancer Cancer Center at Johns Hopkins at the University of Utah Center Michael J. Berger, PharmD/Vice Chair, BCOP Σ Dwight D. Kloth, PharmD, BCOP Σ Hope S. Rugo, MD † ‡ The Ohio State University Comprehensive Fox Chase Cancer Center UCSF Helen Diller Family Cancer Center - James Cancer Hospital Comprehensive Cancer Center and Solove Research Institute Ruth Lagman, MD £ Mayo Clinic Cancer Center Bridget Scullion, PharmD, BCOP Jonathan Aston, PharmD, BCOP, BCPS Σ Dana-Farber/Brigham and Women’s Vanderbilt-Ingram Cancer Center Dean Lim, MD † Cancer Center | Massachusetts City of Hope Comprehensive Cancer Center General Hospital Cancer Center Sally Barbour, PharmD, BCOP, CCP Σ Duke Cancer Institute Cynthia Ma, MD, PhD † John Timoney, PharmD, BCOP † Siteman Cancer Center at Barnes-Jewish Memorial Sloan Kettering Cancer Philip J. Bierman, MD † ‡ Hospital and Washington University School Center Fred & Pamela Buffet Cancer Center of Medicine Barbara Todaro, PharmD Σ Debra Brandt, DO Belinda Mandrell, PhD, RN † Roswell Park Cancer Institute Yale Cancer Center/Smilow Cancer Hospital St. Jude Children’s Research Hospital/ University of Tennessee Cancer Institute Susan G. Urba, MD † £ Dawn E. Dolan, PharmD, BCOP Σ University of Michigan Moffitt Cancer Center Laura Boehnke Michaud, PharmD, BCOP Σ Comprehensive Cancer Center The University of Texas Georgiana Ellis, MD † M.D. Anderson Cancer Center Fred Hutchinson Cancer Research Center/ Seattle Cancer Care Alliance Lisle M. Nabell, MD University of Alabama at Birmingham Eun Jeong Kim, PharmD, MS Σ Comprehensive Cancer Center Stanford Cancer Institute Kim Noonan, MS, RN, ANP, AOCN # Dana-Farber/Brigham and Women’s ‡ Hematology/hematology oncology Cancer Center | Massachusetts General Þ Internal medicine Hospital Cancer Center † Medical oncology # Nurse Σ Pharmacology NCCN Continue £ Supportive care including palliative, Miranda Hughes, PhD pain management, pastoral care, Dorothy A. Shead, MS and oncology social work NCCN Guidelines Panel Disclosures * Writing committee member Version 2.2015, 09/22/15 © National Comprehensive Cancer Network, Inc. 2015, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®. Printed by Alexandre Ferreira on 10/25/2015 6:12:07 AM. For personal use only. Not approved for distribution. Copyright © 2015 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Version 2.2015 Table of Contents NCCN Guidelines Index Antiemesis Table of Contents Antiemesis Discussion NCCN Antiemesis Panel Members Clinical Trials: NCCN believes that Guidelines Updates the best management for any cancer Principles of Emesis Control for the Cancer Patient (AE-1) patient is in a clinical trial. Participation in clinical trials is especially encouraged. CHEMOTHERAPY-INDUCED EMESIS: To find clinical trials online at NCCN High Emetic Risk Intravenous Chemotherapy - member institutions, click here: Acute and Delayed Emesis Prevention (AE-2) nccn.org/clinical_trials/physician.html. Moderate Emetic Risk Intravenous Chemotherapy - Emesis Prevention (AE-3) NCCN Categories of Evidence and Low and Minimal Emetic Risk Intravenous Chemotherapy - Emesis Prevention (AE-4) Consensus: All recommendations Oral Chemotherapy - Emesis Prevention (AE-5) are Category 2A unless otherwise specified. Breakthrough Treatment for Chemotherapy-Induced Nausea/Vomiting (AE-6) Emetogenic Potential of Intravenous Antineoplastic Agents (AE-7) See NCCN Categories of Evidence and Consensus. Emetogenic Potential of Oral Antineoplastic Agents (AE-9) Principles of Managing Multiday Emetogenic Chemotherapy Regimens (AE-A) Principles for Managing Breakthrough Emesis (AE-B) RADIATION-INDUCED EMESIS: Radiation-Induced Emesis Prevention/Treatment (AE-10) ANTICIPATORY EMESIS: Anticipatory Emesis Prevention/Treatment (AE-11) The NCCN Guidelines® are a statement of evidence and consensus of the authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult the NCCN Guidelines is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient’s care or treatment. The National Comprehensive Cancer Network® (NCCN®) makes no representations or warranties of any kind regarding their content, use or application and disclaims any responsibility for their application or use in any way. The NCCN Guidelines are copyrighted by National Comprehensive Cancer Network®. All rights reserved. The NCCN Guidelines and the illustrations herein may not be reproduced in any form without the express written permission of NCCN. ©2015. Version 2.2015, 09/22/15 © National Comprehensive Cancer Network, Inc. 2015, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®. Printed by Alexandre Ferreira on 10/25/2015 6:12:07 AM. For personal use only. Not approved for distribution. Copyright © 2015 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Version 2.2015 Updates NCCN Guidelines Index Antiemesis Table of Contents Antiemesis Discussion Updates in Version 2.2015 of the NCCN Guidelines for Antiemesis from Version 1.2015 include: AE-2 AE-3 • High emetic risk intravenous chemotherapy - acute and delayed • Moderate emetic risk intravenous chemotherapy - emesis emesis prevention: prevention: Day 1 added: Day 1 added: ◊ Rolapitant 180 mg PO once (category 1). ◊ Rolapitant 180 mg PO once (category 1). ◊ If rolapitant given: Dexamethasone 20 mg PO/IV once ◊ Schwartzberg LS, et al. Lancet Oncol 2015;16:1071-1078. ◊ Rapoport BL, et al. Lancet Oncol 2015;16:1079-1089. Day 2 and 3 added: Day 2, 3, 4 added: ◊ Rolapitant used day 1: ± dexamethasone 8 mg PO/IV daily on ◊ If rolapitant is given on day 1, dexamethasone 8 mg PO/IV twice daily days 2, 3 days 2, 3, 4 Note: All recommendations are category 2A unless otherwise indicated. Clinical Trials: NCCN believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. UPDATES Version 2.2015, 09/22/15 © National Comprehensive Cancer Network, Inc. 2015, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®. 1 OF 2 Printed by Alexandre Ferreira on 10/25/2015 6:12:07 AM. For personal use only. Not approved for distribution. Copyright © 2015 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines® Version 2.2015 Updates NCCN Guidelines Index Antiemesis Table of Contents Antiemesis Discussion Updates in Version 1.2015 of the NCCN Guidelines for Antiemesis from Version 2.2014 include: AE-2 AE-5 • The information on this page has been reformatted for clarity and • Oral chemotherapy - emesis prevention: consistency. High to moderate emetic risk, clarified ondansetron 16-24 mg(total dose) • High emetic risk intravenous chemotherapy - acute and delayed emesis PO daily. prevention: Low to minimal emetic risk, clarified Removed “Preferred” from palonosetron 0.25 mg IV day 1 ◊ Dolasetron 100 mg PO daily added “PRN” Day 1, added the following netupitant-containing regimen: ◊ Granisetron 1-2 mg (total dose) PO added “PRN” ◊ Netupitant 300 mg/palonosetron 0.5 mg PO once ◊ Ondansetron 8-16 mg (total dose) PO daily added “PRN” ◊ Dexamethasone 12 mg PO day 1 AE-8 ◊ Hesketh P, Rossi G, Rizzi G et al. Efficacy and safety of NEPA, an • Emetogenic potential of Intravenous antineoplastic agents oral combination of netupitant and palonosetron, for prevention Added the following agents to low emetic risk: of chemotherapy-induced nausea and vomiting following highly ◊ Belinostat emetogenic chemotherapy: a randomized dose ranging pivotal study. ◊ Blinatumomab Ann Oncol 2014; 25: 1340–1346 Added the following agents to minimal emetic risk: Changed lorazepam from every 4-6 h to every 6 h. (also applies to AE-3 ◊ Nivolumab and AE-6) ◊ Obinutuzumab Added a new footnote, “If neither aprepitant nor fosaprepitant are given ◊ Pembrolizumab on day 1, then dexamethasone 20 mg PO/IV once on day 1, followed by 8 ◊ Ramucirumab mg BID PO/IV on days 2, 3, 4. ◊ Siltuximab AE-3 AE-9 • Moderate emetic risk intravenous chemotherapy - emesis prevention: • Emetogenic potential of oral antineoplastic agents Day 1, added the following netupitant-containing regimen: Added the following agents to moderate to high emetic risk: ◊ Netupitant 300 mg/palonosetron 0.5 mg PO once ◊ Ceritinib ◊ Dexamethasone 12 mg PO day 1 ◊ Lenvatinib ◊ Aapro M, Rugo H, Rossi G, et al. A randomized phase III study ◊ Olaparib evaluating the efficacy and safety of NEPA, a fixed-dose
Load more

Recommended publications
  • Summary of Product Characteristics
    Health Products Regulatory Authority Summary of Product Characteristics 1 NAME OF THE MEDICINAL PRODUCT NIPENT 10 mg powder for solution for injection, powder for solution for infusion 2 QUALITATIVE AND QUANTITATIVE COMPOSITION One vial contains 10 mg Pentostatin. When reconstituted (see Section 6.6), the resulting solution contains pentostatin 2 mg/ml. For a full list of excipients see section 6.1. 3 PHARMACEUTICAL FORM Powder for solution for injection, powder for solution for infusion. The vials contain a solid white to off-white cake or powder. The pH of reconstituted solution is 7.0 – 8.2. 4 CLINICAL PARTICULARS 4.1 Therapeutic Indications Pentostatin is indicated as single agent therapy in the treatment of adult patients with hairy cell leukaemia. 4.2 Posology and method of administration Pentostatin is indicated for adult patients. Administration to patient It is recommended that patients receive hydration with 500 to 1,000 ml of 5% glucose only or 5% glucose in 0.18% or 0.9% saline or glucose 3.3% in 0.3% saline or 2.5% glucose in 0.45% saline or equivalent before pentostatin administration. An additional 500 ml of 5% glucose only or 5% glucose in 0.18% or 0.9% saline or 2.5% glucose in 0.45% saline or equivalent should be administered after pentostatin is given. The recommended dosage of pentostatin for the treatment of hairy cell leukaemia is 4 mg/m2 in a single administration every other week. Pentostatin may be given intravenously by bolus injection or diluted in a larger volume and given over 20 to 30 minutes.
    [Show full text]
  • LYSODREN Safely and Effectively
    HIGHLIGHTS OF PRESCRIBING INFORMATION -----------------------WARNINGS AND PRECAUTIONS------------------------ These highlights do not include all the information needed to use • Central Nervous System (CNS) Toxicity: Plasma concentrations LYSODREN safely and effectively. See full prescribing information for exceeding 20 mcg/mL are associated with a greater incidence of toxicity. LYSODREN. (5.2) • Adrenal Insufficiency: Institute steroid replacement as clinically LYSODREN® (mitotane) tablets, for oral use indicated. Measure free cortisol and corticotropin (ACTH) levels to Initial U.S. Approval: 1970 achieve optimal steroid replacement. (5.3) • Embryo-Fetal Toxicity: Can cause fetal harm. Advise women of WARNING: ADRENAL CRISIS IN THE SETTING OF SHOCK OR reproductive potential of the potential risk to a fetus and use of effective SEVERE TRAUMA contraception. (5.4, 8.1, 8.3) See full prescribing information for complete boxed warning. • Ovarian Macrocysts in Premenopausal Women: Advise women to seek medical advice if they experience gynecological symptoms such as In patients taking LYSODREN, adrenal crisis occurs in the setting of vaginal bleeding and/or pelvic pain. (5.5) shock or severe trauma and response to shock is impaired. Administer hydrocortisone, monitor for escalating signs of shock and discontinue -------------------------------ADVERSE REACTIONS------------------------------ LYSODREN until recovery. (2.2, 5.1) Common adverse reactions (≥15%) include: anorexia, nausea, vomiting and diarrhea; depression, dizziness or vertigo; and rash. (6) ---------------------------INDICATIONS AND USAGE---------------------------- LYSODREN is an adrenal cytotoxic agent indicated for the treatment of To report SUSPECTED ADVERSE REACTIONS, contact Bristol-Myers inoperable, functional or nonfunctional, adrenal cortical carcinoma. (1) Squibb at 1-800-721-5072 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
    [Show full text]
  • EDP & Mitotane Protocol
    THE CLATTERBRIDGE CANCER CENTRE NHS FOUNDATION TRUST Systemic Anti Cancer Treatment Protocol EDP + mitotane PROCEDURE REF: MPHA HANEDP (Version No: 1.0) Approved for use in: Symptomatic treatment for advanced (unresectable, metastatic or relapsed) adrenocortical carcinoma ECOG performance status of 0 - 2 All possible tumour tissues should be surgically removed from large metastatic masses before mitotane administration is instituted. This is necessary to minimise the possibility of infarction and haemorrhage in the tumour due to a rapid cytotoxic effect of mitotane Exclusion criteria: Previous complete cumulative doses of anthracyclines Decompensated heart failure (ejection fraction <50%) Unstable angina, uncontrolled cardiac arrhythmias, MI or revascularisation procedure within last 6 months Dosage: Drug Dosage Route Frequency Etoposide 100mg/m2 IV Daily on days 2, 3 and 4 of each cycle Doxorubicin 40mg/m2 IV Once only on day 1 of each cycle Cisplatin 40mg/m2 IV Daily on days 3 and 4 of each cycle Variable, max Continuous, started a week prior to IV Mitotane PO 6g daily chemotherapy if not already taking With cycles repeated at 28 day intervals until disease progression Supportive treatments: Domperidone 10mg oral tablets maximum 3 times a day or as required Issue Date: May 2017 Page 1 of 8 Protocol reference: MPHAHANEDP 1 Authorised by: Drugs & Therapeutics Author: Helen Flint Committee & Dr D Husband Version No: 1.0 THE CLATTERBRIDGE CANCER CENTRE NHS FOUNDATION TRUST Extravasation risk: Doxorubicin is a vesicant and must be observed during administration. Follow the procedure for anthracycline extravasation. Erythematous streaking (a histamine release phenomenon) along the vein proximal to the site of injection has been reported, and must be differentiated from an extravasation event.
    [Show full text]
  • MASCC/ESMO ANTIEMETIC GUIDELINE 2016 with Updates in 2019
    1 ANTIEMETIC GUIDELINES: MASCC/ESMO MASCC/ESMO ANTIEMETIC GUIDELINE 2016 With Updates in 2019 Organizing and Overall Meeting Chairs: Matti Aapro, MD Richard J. Gralla, MD Jørn Herrstedt, MD, DMSci Alex Molassiotis, RN, PhD Fausto Roila, MD © Multinational Association of Supportive Care in CancerTM All rights reserved worldwide. 2 ANTIEMETIC GUIDELINES: MASCC/ESMO These slides are provided to all by the Multinational Association of Supportive Care in Cancer and can be used freely, provided no changes are made and the MASCC and ESMO logos, as well as date of the information are retained. For questions please contact: Matti Aapro at [email protected] Chair, MASCC Antiemetic Study Group or Alex Molassiotis at [email protected] Past Chair, MASCC Antiemetic Study Group 3 ANTIEMETIC GUIDELINES: MASCC/ESMO Consensus A few comments on this guideline set: • This set of guideline slides represents the latest edition of the guideline process. • This set of slides has been endorsed by the MASCC Antiemetic Guideline Committee and ESMO Guideline Committee. • The guidelines are based on the votes of the panel at the Copenhagen Consensus Conference on Antiemetic Therapy, June 2015. • Latest version: March 2016, with updates in 2019. 4 ANTIEMETIC GUIDELINES: MASCC/ESMO Changes: The Steering Committee has clarified some points: 2016: • A footnote clarified that aprepitant 165 mg is approved by regulatory authorities in some parts of the world ( although no randomised clinical trial has investigated this dose ). Thus use of aprepitant 80 mg in the delayed phase is only for those cases where aprepitant 125 mg is used on day 1. • A probable modification in pediatric guidelines based on the recent Cochrane meta-analysis is indicated.
    [Show full text]
  • Clinical Practice Guideline for Emergency Department Ketamine Dissociative Sedation: 2011 Update
    PAIN MANAGEMENT/CONCEPTS Clinical Practice Guideline for Emergency Department Ketamine Dissociative Sedation: 2011 Update Steven M. Green, MD, Mark G. Roback, MD, Robert M. Kennedy, MD, Baruch Krauss, MD, EdM From the Department of Emergency Medicine, Loma Linda University Medical Center and Children’s Hospital, Loma Linda, CA (Green); the Department of Pediatrics, University of Minnesota, Minneapolis, MN (Roback); the Division of Emergency Medicine, St. Louis Children’s Hospital, Washington University, St. Louis, MO (Kennedy); and the Division of Emergency Medicine, Children’s Hospital Boston and Department of Pediatrics, Harvard Medical School, Boston, MA (Krauss). We update an evidence-based clinical practice guideline for the administration of the dissociative agent ketamine for emergency department procedural sedation and analgesia. Substantial new research warrants revision of the widely disseminated 2004 guideline, particularly with respect to contraindications, age recommendations, potential neurotoxicity, and the role of coadministered anticholinergics and benzodiazepines. We critically discuss indications, contraindications, personnel requirements, monitoring, dosing, coadministered medications, recovery issues, and future research questions for ketamine dissociative sedation. [Ann Emerg Med. 2011;xx:xxx.] 0196-0644/$-see front matter Copyright © 2011 by the American College of Emergency Physicians. doi:10.1016/j.annemergmed.2010.11.030 INTRODUCTION thalamocortical and limbic systems, effectively dissociating the The dissociative
    [Show full text]
  • Antiemetics/Antivertigo Agents
    Antiemetic Agents Therapeutic Class Review (TCR) May 1, 2019 No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, digital scanning, or via any information storage or retrieval system without the express written consent of Magellan Rx Management. All requests for permission should be mailed to: Magellan Rx Management Attention: Legal Department 6950 Columbia Gateway Drive Columbia, Maryland 21046 The materials contained herein represent the opinions of the collective authors and editors and should not be construed to be the official representation of any professional organization or group, any state Pharmacy and Therapeutics committee, any state Medicaid Agency, or any other clinical committee. This material is not intended to be relied upon as medical advice for specific medical cases and nothing contained herein should be relied upon by any patient, medical professional or layperson seeking information about a specific course of treatment for a specific medical condition. All readers of this material are responsible for independently obtaining medical advice and guidance from their own physician and/or other medical professional in regard to the best course of treatment for their specific medical condition. This publication, inclusive of all forms contained herein, is intended to be educational in nature and is intended to be used for informational purposes only. Send comments and suggestions to [email protected]. May 2019 Proprietary Information. Restricted Access – Do not disseminate or copy without approval. © 2004-2019 Magellan Rx Management. All Rights Reserved. 3 FDA-APPROVED INDICATIONS Drug Manufacturer Indication(s) NK1 receptor antagonists aprepitant capsules generic, Merck In combination with other antiemetic agents for: (Emend®)1 .
    [Show full text]
  • Revised Use-Function Classification (2007)
    INTERNATIONAL PROGRAMME ON CHEMICAL SAFETY IPCS INTOX Data Management System (INTOX DMS) Revised Use-Function Classification (2007) The Use-Function Classification is used in two places in the INTOX Data Management System: the Communication Record and the Agent/Product Record. The two records are linked: if there is an agent record for a Centre Agent that is the subject of a call, the appropriate Intended Use-Function can be selected automatically in the Communication Record. The Use-Function Classification is used when generating reports, both standard and customized, and for searching the case and agent databases. In particular, INTOX standard reports use the top level headings of the Intended Use-Functions that were selected for Centre Agents in the Communication Record (e.g. if an agent was classified as an Analgesic for Human Use in the Communication Record, it would be logged as a Pharmaceutical for Human Use in the report). The Use-Function classification is very important for ensuring harmonized data collection. In version 4.4 of the software, 5 new additions were made to the top levels of the classification provided with the system for the classification of organisms (items XIV to XVIII). This is a 'convenience' classification to facilitate searching of the Communications database. A taxonomic classification for organisms is provided within the INTOX DMS Agent Explorer. In May/June 2006 INTOX users were surveyed to find out whether they had made any changes to the Use-Function Classification. These changes were then discussed at the 4th and 5th Meetings of INTOX Users. Version 4.5 of the INTOX DMS includes the revised pesticides classification (shown in full below).
    [Show full text]
  • The New Therapeutic Strategies in Pediatric T-Cell Acute Lymphoblastic Leukemia
    International Journal of Molecular Sciences Review The New Therapeutic Strategies in Pediatric T-Cell Acute Lymphoblastic Leukemia Marta Weronika Lato 1 , Anna Przysucha 1, Sylwia Grosman 1, Joanna Zawitkowska 2 and Monika Lejman 3,* 1 Student Scientific Society, Laboratory of Genetic Diagnostics, Medical University of Lublin, 20-093 Lublin, Poland; [email protected] (M.W.L.); [email protected] (A.P.); [email protected] (S.G.) 2 Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, 20-093 Lublin, Poland; [email protected] 3 Laboratory of Genetic Diagnostics, Medical University of Lublin, 20-093 Lublin, Poland * Correspondence: [email protected] Abstract: Childhood acute lymphoblastic leukemia is a genetically heterogeneous cancer that ac- counts for 10–15% of T-cell acute lymphoblastic leukemia (T-ALL) cases. The T-ALL event-free survival rate (EFS) is 85%. The evaluation of structural and numerical chromosomal changes is important for a comprehensive biological characterization of T-ALL, but there are currently no ge- netic prognostic markers. Despite chemotherapy regimens, steroids, and allogeneic transplantation, relapse is the main problem in children with T-ALL. Due to the development of high-throughput molecular methods, the ability to define subgroups of T-ALL has significantly improved in the last few years. The profiling of the gene expression of T-ALL has led to the identification of T-ALL subgroups, and it is important in determining prognostic factors and choosing an appropriate treatment. Novel therapies targeting molecular aberrations offer promise in achieving better first remission with the Citation: Lato, M.W.; Przysucha, A.; hope of preventing relapse.
    [Show full text]
  • Cancer Drug Pharmacology Table
    CANCER DRUG PHARMACOLOGY TABLE Cytotoxic Chemotherapy Drugs are classified according to the BC Cancer Drug Manual Monographs, unless otherwise specified (see asterisks). Subclassifications are in brackets where applicable. Alkylating Agents have reactive groups (usually alkyl) that attach to Antimetabolites are structural analogues of naturally occurring molecules DNA or RNA, leading to interruption in synthesis of DNA, RNA, or required for DNA and RNA synthesis. When substituted for the natural body proteins. substances, they disrupt DNA and RNA synthesis. bendamustine (nitrogen mustard) azacitidine (pyrimidine analogue) busulfan (alkyl sulfonate) capecitabine (pyrimidine analogue) carboplatin (platinum) cladribine (adenosine analogue) carmustine (nitrosurea) cytarabine (pyrimidine analogue) chlorambucil (nitrogen mustard) fludarabine (purine analogue) cisplatin (platinum) fluorouracil (pyrimidine analogue) cyclophosphamide (nitrogen mustard) gemcitabine (pyrimidine analogue) dacarbazine (triazine) mercaptopurine (purine analogue) estramustine (nitrogen mustard with 17-beta-estradiol) methotrexate (folate analogue) hydroxyurea pralatrexate (folate analogue) ifosfamide (nitrogen mustard) pemetrexed (folate analogue) lomustine (nitrosurea) pentostatin (purine analogue) mechlorethamine (nitrogen mustard) raltitrexed (folate analogue) melphalan (nitrogen mustard) thioguanine (purine analogue) oxaliplatin (platinum) trifluridine-tipiracil (pyrimidine analogue/thymidine phosphorylase procarbazine (triazine) inhibitor)
    [Show full text]
  • Targeting the Mitochondrial Metabolic Network: a Promising Strategy in Cancer Treatment
    International Journal of Molecular Sciences Review Targeting the Mitochondrial Metabolic Network: A Promising Strategy in Cancer Treatment Luca Frattaruolo y , Matteo Brindisi y , Rosita Curcio, Federica Marra, Vincenza Dolce and Anna Rita Cappello * Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Via P. Bucci, 87036 Rende (CS), Italy; [email protected] (L.F.); [email protected] (M.B.); [email protected] (R.C.); [email protected] (F.M.); [email protected] (V.D.) * Correspondence: [email protected] These authors contributed equally and should be considered co-first authors. y Received: 31 July 2020; Accepted: 19 August 2020; Published: 21 August 2020 Abstract: Metabolic reprogramming is a hallmark of cancer, which implements a profound metabolic rewiring in order to support a high proliferation rate and to ensure cell survival in its complex microenvironment. Although initial studies considered glycolysis as a crucial metabolic pathway in tumor metabolism reprogramming (i.e., the Warburg effect), recently, the critical role of mitochondria in oncogenesis, tumor progression, and neoplastic dissemination has emerged. In this report, we examined the main mitochondrial metabolic pathways that are altered in cancer, which play key roles in the different stages of tumor progression. Furthermore, we reviewed the function of important molecules inhibiting the main mitochondrial metabolic processes, which have been proven to be promising anticancer candidates in recent years. In particular, inhibitors of oxidative phosphorylation (OXPHOS), heme flux, the tricarboxylic acid cycle (TCA), glutaminolysis, mitochondrial dynamics, and biogenesis are discussed. The examined mitochondrial metabolic network inhibitors have produced interesting results in both preclinical and clinical studies, advancing cancer research and emphasizing that mitochondrial targeting may represent an effective anticancer strategy.
    [Show full text]
  • Drugs to Avoid in Patients with Dementia
    Detail-Document #240510 -This Detail-Document accompanies the related article published in- PHARMACIST’S LETTER / PRESCRIBER’S LETTER May 2008 ~ Volume 24 ~ Number 240510 Drugs To Avoid in Patients with Dementia Elderly people with dementia often tolerate drugs less favorably than healthy older adults. Reasons include increased sensitivity to certain side effects, difficulty with adhering to drug regimens, and decreased ability to recognize and report adverse events. Elderly adults with dementia are also more prone than healthy older persons to develop drug-induced cognitive impairment.1 Medications with strong anticholinergic (AC) side effects, such as sedating antihistamines, are well- known for causing acute cognitive impairment in people with dementia.1-3 Anticholinergic-like effects, such as urinary retention and dry mouth, have also been identified in drugs not typically associated with major AC side effects (e.g., narcotics, benzodiazepines).3 These drugs are also important causes of acute confusional states. Factors that may determine whether a patient will develop cognitive impairment when exposed to ACs include: 1) total AC load (determined by number of AC drugs and dose of agents utilized), 2) baseline cognitive function, and 3) individual patient pharmacodynamic and pharmacokinetic features (e.g., renal/hepatic function).1 Evidence suggests that impairment of cholinergic transmission plays a key role in the development of Alzheimer’s dementia. Thus, the development of the cholinesterase inhibitors (CIs). When used appropriately, the CIs (donepezil [Aricept], rivastigmine [Exelon], and galantamine [Razadyne, Reminyl in Canada]) may slow the decline of cognitive and functional impairment in people with dementia. In order to achieve maximum therapeutic effect, they ideally should not be used in combination with ACs, agents known to have an opposing mechanism of action.1,2 Roe et al studied AC use in 836 elderly patients.1 Use of ACs was found to be greater in patients with probable dementia than healthy older adults (33% vs.
    [Show full text]
  • Nelarabine) Injection • Severe Neurologic Reactions Have Been Reported
    HIGHLIGHTS OF PRESCRIBING INFORMATION --------------------- DOSAGE FORMS AND STRENGTHS -------------- These highlights do not include all the information needed to use 250 mg/50 mL (5 mg/mL) vial (3) ARRANON safely and effectively. See full prescribing information for -------------------------------CONTRAINDICATIONS------------------------ ARRANON. None. ----------------------- WARNINGS AND PRECAUTIONS ---------------- ARRANON (nelarabine) Injection • Severe neurologic reactions have been reported. Monitor for signs and Initial U.S. Approval: 2005 symptoms of neurologic toxicity. (5.1) WARNING: NEUROLOGIC ADVERSE REACTIONS • Hematologic Reactions: Complete blood counts including platelets should See full prescribing information for complete boxed warning. be monitored regularly. (5.2) Severe neurologic adverse reactions have been reported with the use of • Fetal harm can occur if administered to a pregnant woman. Women should ARRANON. These adverse reactions have included altered mental states be advised not to become pregnant when taking ARRANON. (5.3) including severe somnolence, central nervous system effects including ------------------------------ ADVERSE REACTIONS ----------------------- convulsions, and peripheral neuropathy ranging from numbness and The most common (≥ 20%) adverse reactions were: paresthesias to motor weakness and paralysis. There have also been • Adult: anemia, thrombocytopenia, neutropenia, nausea, diarrhea, reports of adverse reactions associated with demyelination, and ascending vomiting, constipation, fatigue,
    [Show full text]