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Cyclophosphamide-Etoposide PO Ver
Chemotherapy Protocol LYMPHOMA CYCLOPHOSPHAMIDE-ETOPOSIDE ORAL Regimen Lymphoma – Cyclophosphamide-Etoposide PO Indication Palliative treatment of malignant lymphoma Toxicity Drug Adverse Effect Cyclophosphamide Dysuria, haemorrragic cystitis (rare), taste disturbances Etoposide Alopecia, hyperbilirubinaemia The adverse effects listed are not exhaustive. Please refer to the relevant Summary of Product Characteristics for full details. Patients diagnosed with Hodgkin’s Lymphoma carry a lifelong risk of transfusion associated graft versus host disease (TA-GVHD). Where blood products are required these patients must receive only irradiated blood products for life. Local blood transfusion departments must be notified as soon as a diagnosis is made and the patient must be issued with an alert card to carry with them at all times. Monitoring Drugs FBC, LFTs and U&Es prior to day one of treatment Albumin prior to each cycle Dose Modifications The dose modifications listed are for haematological, liver and renal function and drug specific toxicities only. Dose adjustments may be necessary for other toxicities as well. In principle all dose reductions due to adverse drug reactions should not be re-escalated in subsequent cycles without consultant approval. It is also a general rule for chemotherapy that if a third dose reduction is necessary treatment should be stopped. Please discuss all dose reductions / delays with the relevant consultant before prescribing, if appropriate. The approach may be different depending on the clinical circumstances. Version 1.1 (Jan 2015) Page 1 of 6 Lymphoma- Cyclophosphamide-Etoposide PO Haematological Dose modifications for haematological toxicity in the table below are for general guidance only. Always refer to the responsible consultant as any dose reductions or delays will be dependent on clinical circumstances and treatment intent. -
PEMD-91-12BR Off-Label Drugs: Initial Results of a National Survey
11 1; -- __...._-----. ^.-- ______ -..._._ _.__ - _........ - t Ji Jo United States General Accounting Office Washington, D.C. 20648 Program Evaluation and Methodology Division B-242851 February 25,199l The Honorable Edward M. Kennedy Chairman, Committee on Labor and Human Resources United States Senate Dear Mr. Chairman: In September 1989, you asked us to conduct a study on reimbursement denials by health insurers for off-label drug use. As you know, the Food and Drug Administration designates the specific clinical indications for which a drug has been proven effective on a label insert for each approved drug, “Off-label” drug use occurs when physicians prescribe a drug for clinical indications other than those listed on the label. In response to your request, we surveyed a nationally representative sample of oncologists to determine: . the prevalence of off-label use of anticancer drugs by oncologists and how use varies by clinical, demographic, and geographic factors; l the extent to which third-party payers (for example, Medicare intermediaries, private health insurers) are denying payment for such use; and l whether the policies of third-party payers are influencing the treatment of cancer patients. We randomly selected 1,470 members of the American Society of Clinical Oncologists and sent them our survey in March 1990. The sam- pling was structured to ensure that our results would be generalizable both to the nation and to the 11 states with the largest number of oncologists. Our response rate was 56 percent, and a comparison of respondents to nonrespondents shows no noteworthy differences between the two groups. -
Inhibition of Cyclophosphamide and Mitomycin C-Induced Sister Chromatid Exchanges in Mice by Vitamin C
ICANCERRESEARCH46,2670-2674, June 19861 Inhibition of Cyclophosphamide and Mitomycin C-induced Sister Chromatid Exchanges in Mice by Vitamin C G. Krishna,' J. Nath, and T. Ong Natio,wilnstitutefor OccupationaiSafety and Health, Division ofRespiratory Disease Studies, Morgansown, West Virginia 26505-2888 fG. K., T. 0.], andDivision of PlantandSoil Sciences,West VirginiaUniversity,Morgantown,West Visijnia 265O6fJ.N.J ABSTRACF The research reported here was performed to determine the effect of ascorbic acid on SCEs induced by CPA and MMC in Ascorbic acid (vitamin C) is known to act as an antimutagen and in vivo and in vivo/in vitro conditions in bone marrow and anticarcinogen in several test systems. However, there is no report of its spleen cells of mice. Analysis of SCEs is a sensitive cytogenetic effect on carcinogen-induced chromosomal damage in vii'o in animals. technique for detecting cellular chromosomal damage (11). The present study was performed to determine whether or not ascorbic SCEs are visualized as reciprocal exchangesof staining inten acid affects sister ébromatidexchanges (SCEs) induced by cyclophos sities between sister chromatid arms in metaphase cells that phamide (CPA) and mitomycin C (MMC) in bone marrow and spleen cells in mice. The results indicate that ascorbic acid per se did not cause have replicated twice in the presenceof BrdUrd. a significantincreaseinSCEsin mice.However,increasingconcentra tions of ascorbic acid caused decreasing levels of CPA- and MMC induced SCEs in both cell types in rho. At the highest concentration of MATERIALS AND METHODS ascorbic acid, 6.68 gfkg, approximately 75 and 40% SCE inhibition in Animals. Male CD-I mice were purchased from Charles River Breed both cell types was noted for CPA and MMC, respectively. -
Re-Visiting Hypersensitivity Reactions to Taxanes: a Comprehensive Review
Clinic Rev Allerg Immunol DOI 10.1007/s12016-014-8416-0 Re-visiting Hypersensitivity Reactions to Taxanes: A Comprehensive Review Matthieu Picard & Mariana C. Castells # Springer Science+Business Media New York 2014 Abstract Taxanes (a class of chemotherapeutic agents) Keywords Taxane . Paclitaxel . Taxol . Docetaxel . are an important cause of hypersensitivity reactions Taxotere . Nab-paclitaxel . Abraxane . Cabazitaxel . (HSRs) in cancer patients. During the last decade, the Chemotherapy . Hypersensitivity . Allergy . Skin test . development of rapid drug desensitization has been key Desensitization . Challenge . Diagnosis . Review . IgE . to allow patients with HSRs to taxanes to be safely re- Complement . Mechanism treated although the mechanisms of these HSRs are not fully understood. Earlier studies suggested that solvents, such as Cremophor EL used to solubilize paclitaxel, Introduction were responsible for HSRs through complement activa- tion, but recent findings have raised the possibility that Hypersensitivity reactions (HSRs) to chemotherapy are in- some of these HSRs are IgE-mediated. Taxane skin creasingly common and represent an important impediment testing, which identifies patients with an IgE-mediated to the care of cancer patients as they may entail serious sensitivity, appears as a promising diagnostic and risk consequences and prevent patients from being treated with stratification tool in the management of patients with the most efficacious agent against their cancer [1]. During the HSRs to taxanes. The management of patients following last decade, different groups have developed rapid drug de- a HSR involves risk stratification and re-exposure could sensitization (RDD) protocols that allow the safe re- be performed either through rapid drug desensitization introduction of a chemotherapeutic agent to which a patient or graded challenge based on the severity of the initial is allergic, and their use have recently been endorsed by the HSR and the skin test result. -
Antiproliferative Effects of Free and Encapsulated Hypericum Perforatum L
ISSN 2093-6966 [Print], ISSN 2234-6856 [Online] Journal of Pharmacopuncture 2019;22[2]:102-108 DOI: https://doi.org/10.3831/KPI.2019.22.013 Original article Antiproliferative Effects of Free and Encapsulated Hypericum Perforatum L. Extract and Its Potential Interaction with Doxorubicin for Esophageal Squamous Cell Carcinoma Issa Amjadi1, Mohammad Mohajeri2, Andrei Borisov3 , Motahare-Sadat Hosseini4* 1 Department of Biomedical Engineering, Wayne State University, Detroit, United States 2 Department of Medical Biotechnology, Mashhad University of Medical Sciences, Mashhad, Iran 3 Department of Biomedical Engineering, Wayne State University, Detroit, United States 4 Biomaterials Group, Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran Key Words Results: Free drugs and nanoparticles significantly inhibited KYSE30 cells by 55-73% and slightly affected doxorubicin, hypericum perforatum extract, nano- normal cells up to 29%. The IC50 of Dox NPs and HP particles, esophageal squamous cell carcinoma, drug NPs was ~ 0.04-0.06 mg/mL and ~ 0.6-0.7 mg/mL, re- resistance spectively. Significant decrease occurred in cyclin D1 expression by Dox NPs and HP NPs (P < 0.05). Expo- Abstract sure of KYSE-30 cells to combined treatments includ- ing both Dox and HP extract significantly increased the Objectives: Esophageal squamous cell carcinoma level of cyclin D1 expression as compared to those with (ESCC) is considered as a deadly medical condition that individual treatments (P < 0.05). affects a growing number of people worldwide. Target- ed therapy of ESCC has been suggested recently and Conclusion: Dox NPs and HP NPs can successfully and required extensive research. With cyclin D1 as a thera- specifically target ESCC cells through downregulation peutic target, the present study aimed at evaluating the of cyclin D1. -
Inhibition of Tumour Cell Growth by Hyperforin, a Novel Anticancer Drug from St
Oncogene (2002) 21, 1242 ± 1250 ã 2002 Nature Publishing Group All rights reserved 0950 ± 9232/02 $25.00 www.nature.com/onc Inhibition of tumour cell growth by hyperforin, a novel anticancer drug from St. John's wort that acts by induction of apoptosis Christoph M Schempp*,1, Vladimir Kirkin2, Birgit Simon-Haarhaus1, Astrid Kersten3, Judit Kiss1, Christian C Termeer1, Bernhard Gilb4, Thomas Kaufmann5, Christoph Borner5, Jonathan P Sleeman2 and Jan C Simon1 1Department of Dermatology, University of Freiburg, Hauptstrasse 7, D-79104 Freiburg, Germany; 2Institute of Genetics, Forschungszentrum Karlsruhe, PO Box 3640, D-76021 Karlsruhe, Germany; 3Institute of Pathology, University of Freiburg, Albertstrasse 19, D-79104 Freiburg, Germany; 4HWI Analytik, Hauptstrasse 28, 78106 Rheinzabern, Germany; 5Institute of Molecular Medicine, University of Freiburg, Breisacherstr. 66, D-79106 Freiburg, Germany Hyperforin is a plant derived antibiotic from St. John's Introduction wort. Here we describe a novel activity of hyperforin, namely its ability to inhibit the growth of tumour cells by An exciting aspect of apoptosis is that it can be utilized induction of apoptosis. Hyperforin inhibited the growth of in the treatment of cancer (Revillard et al., 1998; various human and rat tumour cell lines in vivo, with IC50 Nicholson, 2000). Anticancer agents with dierent values between 3 ± 15 mM. Treatment of tumour cells with modes of action have been reported to trigger hyperforin resulted in a dose-dependent generation of apoptosis in chemosensitive cells (Hickman, 1992; apoptotic oligonucleosomes, typical DNA-laddering and Debatin, 1999). The process of apoptosis consists of apoptosis-speci®c morphological changes. In MT-450 dierent phases, including initiation, execution and mammary carcinoma cells hyperforin increased the activity degradation (Kroemer, 1997), and is activated by two of caspase-9 and caspase-3, and hyperforin-mediated major pathways. -
5-Fluorouracil + Adriamycin + Cyclophosphamide) Combination in Differentiated H9c2 Cells
Article Doxorubicin Is Key for the Cardiotoxicity of FAC (5-Fluorouracil + Adriamycin + Cyclophosphamide) Combination in Differentiated H9c2 Cells Maria Pereira-Oliveira, Ana Reis-Mendes, Félix Carvalho, Fernando Remião, Maria de Lourdes Bastos and Vera Marisa Costa * UCIBIO, REQUIMTE, Laboratory of Toxicology, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal; [email protected] (M.P.-O.); [email protected] (A.R.-M.); [email protected] (F.C.); [email protected] (F.R.); [email protected] (M.L.B.) * Correspondence: [email protected] Received: 4 October 2018; Accepted: 3 January 2019; Published: 10 January 2019 Abstract: Currently, a common therapeutic approach in cancer treatment encompasses a drug combination to attain an overall better efficacy. Unfortunately, it leads to a higher incidence of severe side effects, namely cardiotoxicity. This work aimed to assess the cytotoxicity of doxorubicin (DOX, also known as Adriamycin), 5-fluorouracil (5-FU), cyclophosphamide (CYA), and their combination (5-Fluorouracil + Adriamycin + Cyclophosphamide, FAC) in H9c2 cardiac cells, for a better understanding of the contribution of each drug to FAC-induced cardiotoxicity. Differentiated H9c2 cells were exposed to pharmacological relevant concentrations of DOX (0.13–5 μM), 5-FU (0.13–5 μM), CYA (0.13–5 μM) for 24 or 48 h. Cells were also exposed to FAC mixtures (0.2, 1 or 5 μM of each drug and 50 μM 5-FU + 1 μM DOX + 50 μM CYA). DOX was the most cytotoxic drug, followed by 5-FU and lastly CYA in both cytotoxicity assays (reduction of 3-(4,5-dimethylthiazol-2- yl)-2,5-diphenyl tetrazolium bromide (MTT) and neutral red (NR) uptake). -
A-Kinase Anchoring Protein 79/150 Scaffolds Transient Receptor Potential a 1 Phosphorylation and Sensitization by Metabotropic G
www.nature.com/scientificreports OPEN A-Kinase Anchoring Protein 79/150 Scaffolds Transient Receptor Potential A 1 Phosphorylation and Received: 25 November 2016 Accepted: 5 April 2017 Sensitization by Metabotropic Published: xx xx xxxx Glutamate Receptor Activation Allison Doyle Brackley1, Ruben Gomez2, Kristi A. Guerrero2, Armen N. Akopian3, Marc J. Glucksman5, Junhui Du5, Susan M. Carlton6 & Nathaniel A. Jeske1,2,4 Mechanical pain serves as a base clinical symptom for many of the world’s most debilitating syndromes. Ion channels expressed by peripheral sensory neurons largely contribute to mechanical hypersensitivity. Transient Receptor Potential A 1 (TRPA1) is a ligand-gated ion channel that contributes to inflammatory mechanical hypersensitivity, yet little is known as to the post-translational mechanism behind its somatosensitization. Here, we utilize biochemical, electrophysiological, and behavioral measures to demonstrate that metabotropic glutamate receptor-induced sensitization of TRPA1 nociceptors stimulates targeted modification of the receptor. Type 1 mGluR5 activation increases TRPA1 receptor agonist sensitivity in an AKA-dependent manner. As a scaffolding protein for Protein Kinases A and C (PKA and PKC, respectively), AKAP facilitates phosphorylation and sensitization of TRPA1 in ex vivo sensory neuronal preparations. Furthermore, hyperalgesic priming of mechanical hypersensitivity requires both TRPA1 and AKAP. Collectively, these results identify a novel AKAP-mediated biochemical mechanism that increases TRPA1 sensitivity in peripheral sensory neurons, and likely contributes to persistent mechanical hypersensitivity. A-kinase Anchoring Protein 79/150 (AKAP) is a scaffolding protein expressed throughout neural tissues1. Importantly, AKAP facilitates post-translational modifications of plasma membrane receptors by kinases includ- ing Protein Kinase A (PKA) and Protein Kinase C (PKC2). -
BC Cancer Protocol Summary for Neoadjuvant Or Adjuvant Therapy for Breast Cancer Using Fluorouracil, Epirubicin, Cyclophosphamide and Docetaxel
BC Cancer Protocol Summary for Neoadjuvant or Adjuvant Therapy for Breast Cancer Using Fluorouracil, Epirubicin, Cyclophosphamide and DOCEtaxel Protocol Code BRAJFECD Tumour Group Breast Contact Physician Dr. Stephen Chia ELIGIBILITY: . Node positive (any T, N1-3) or high risk, node negative early stage breast cancer . Less than or equal to 65 years of age or fit patients greater than 65 years deemed appropriate by supervising physician . ECOG 0-1 . HER-2 negative . Adequate renal and hepatic function . Adequate cardiac function EXCLUSIONS: . ECOG 2-4 . Significant hepatic dysfunction . Congestive heart failure (LVEF less than 45%) or other significant heart disease . Greater than or equal to grade 2 sensory or motor neuropathy . Pregnancy or lactation . Unsuitable for aggressive adjuvant chemotherapy TESTS: . Baseline: CBC & diff, platelets, creatinine, bilirubin, ALT, Alk Phos, LDH, GGT . Before each treatment (Day 1): CBC & diff, platelets. Prior to Cycle #4: CBC & diff, platelets, bilirubin, ALT, Alk Phos (see Precaution #5 for guidelines regarding hepatic dysfunction and DOCEtaxel). If clinically indicated: bilirubin, ALT, Alk Phos, creatinine, protein level, albumin, GGT, LDH, urea, MUGA scan or echocardiogram PREMEDICATIONS: . For the 3 cycles of epirubicin, fluorouracil and cyclophosphamide, antiemetic protocol for highly emetogenic chemotherapy (see protocol SCNAUSEA) . For the 3 cycles of DOCEtaxel: Dexamethasone 8 mg PO bid for 3 days, starting one day prior to each DOCEtaxel administration. Patient must receive minimum of 3 doses pre-treatment. Additional antiemetics not usually required. DOCEtaxel-induced onycholysis and cutaneous toxicity of the hands may be prevented by wearing frozen gloves starting 15 minutes before DOCEtaxel infusion until 15 minutes after end of DOCEtaxel infusion; gloves should be changed after 45 minutes of wearing to ensure they remain cold during the entire DOCEtaxel infusion. -
In Advanced Upper Tract Urothelial Carcinoma
ANTICANCER RESEARCH 37 : 1875-1883 (2017) doi:10.21873/anticanres.11525 Comparison of Efficacy of Adjuvant MEC (Methotrexate, Epirubicin and Cisplatin) and GC (Gemcitabine and Cisplatin) in Advanced Upper Tract Urothelial Carcinoma SHENG-CHUN HUNG 1, SHIAN-SHIANG WANG 1,2,3 , CHUN-KUANG YANG 1, JIAN-RI LI 1, CHEN-LI CHENG 1, YEN-CHUAN OU 1, HAO-CHUNG HO 1, KUN-YUAN CHIU 1 and CHUAN-SHU CHEN 1 1Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.; 2School of Medicine, Chung Shan Medical University, Taichung, Taiwan, R.O.C.; 3Department of Applied Chemistry, National Chi Nan University, Puli, Taiwan, R.O.C. Abstract. Aim: To evaluate the efficacy of methotrexate, (3). Its behavior appears multi-focal and in 17% of cases, epirubicin and cisplatin (MEC) or gemcitabine and cisplatin concurrent bladder cancer is present (4). Furthermore, an (GC) as adjuvant chemotherapy in advanced upper tract estimated 22-47% of patients with UTUC may suffer from urothelium carcinoma (UTUC). Patients and Methods: From bladder recurrence (5) and 2-6% of patients suffer from 2002 January to 2008 December, a total of 70 patients with contralateral recurrence (6). advanced UTUC received radical nephroureterctomy at our A radical nephroureterectomy and bladder cuff excision is Institute with MEC and GC as adjuvant chemotherapy. Disease- standard treatment for UTUC, while offering the benefits of free survival (DFS), cancer-specific survival (CSS) and overall preventing tumor spreading and an entire urinary tract resection survival (OS) among the two groups were evaluated. Results: (7). However, after definite and en bloc surgical removal of the The MEC (n=30) and GC group (n=40) were compared and kidney, it still appears to be a poor prognosis for advanced showed no significant differences in DFS (p=0.859), CSS disease, with a <50% 5-year cancer-specific survival rate in (p=0.722) and OS (p=0.691). -
Cyclophosphamide-Doxorubicin Ver
Chemotherapy Protocol BREAST CANCER CYCLOPHOSPHAMIDE-DOXORUBICIN Regimen Breast Cancer – Cyclophosphamide-Doxorubicin Indication Primary systemic (neoadjuvant) therapy of breast cancer Adjuvant therapy of high risk (greater than 5%) node negative breast cancer WHO Performance status 0, 1, 2 Toxicity Drug Adverse Effect Cyclophosphamide Dysuria, haemorrhagic cystitis, taste disturbances Doxorubicin Cardio toxicity, urinary discolourisation (red) The adverse effects listed are not exhaustive. Please refer to the relevant Summary of Product Characteristics for full details. Monitoring Regimen FBC, U&E’s and LFT’s prior to each cycle. Ensure adequate cardiac function before starting treatment with doxorubicin. Baseline LVEF should be measured, particularly in patients with a history of cardiac problems or in the elderly. Dose Modifications The dose modifications listed are for haematological, liver and renal function only. Dose adjustments may be necessary for other toxicities as well. In principle all dose reductions due to adverse drug reactions should not be re- escalated in subsequent cycles without consultant approval. It is also a general rule for chemotherapy that if a third dose reduction is necessary treatment should be stopped. Version 1.1 (Aug 2014) Page 1 of 6 Breast – Cyclophosphamide-Doxorubicin Please discuss all dose reductions / delays with the relevant consultant before prescribing if appropriate. The approach may be different depending on the clinical circumstances. The following is a general guide only. Haematological Prior to prescribing the following treatment criteria must be met on day 1 of treatment. Criteria Eligible Level Neutrophil equal to or more than 1x109/L Platelets equal to or more than 100x109/L Consider blood transfusion if patient symptomatic of anaemia or has a haemoglobin of less than 8g/dL If counts on day one are below these criteria for neutrophil and/or platelets then delay treatment for seven days. -
Assessment Report for Zytiga (Abiraterone) Procedure
21 July 2011 EMA/CHMP/542871/2011 Committee for Medicinal Products for Human Use (CHMP) Assessment Report For Zytiga (abiraterone) Procedure No.: EMEA/H/C/002321 Assessment Report as adopted by the CHMP with all information of a commercially confidential nature deleted 7 Westferry Circus ● Canary Wharf ● London E14 4HB ● United Kingdom Telephone +44 (0)20 7418 8400 Facsimle +44 (0)20 7523 7455 E-mail [email protected] Website www.ema.europa.eu An agency of the European Union TABLE OF CONTENTS 1. Background information on the procedure .............................................. 5 1.1. Submission of the dossier .................................................................................... 5 1.2. Steps taken for the assessment of the product........................................................ 5 2. Scientific discussion................................................................................ 6 2.1. Introduction....................................................................................................... 6 2.2. Quality aspects .................................................................................................. 8 2.2.1. Introduction.................................................................................................... 8 2.2.2. Active Substance ............................................................................................. 9 2.2.3. Finished Medicinal Product .............................................................................. 10 2.2.4. Discussion on chemical, pharmaceutical