- Surgery is the treatment of choice for patients with non–small cell lung cancer (NSCLC) stages I through IIIA. [14] In addition, patients with resected.
- Has been administered intraperitoneally† for treatment of advanced ovarian cancer confined to the peritoneal cavity and/or associated with malignant ascites. 101.
- THE PALLIATIVE CARE HANDBOOK Advice on clinical management SEVENTH EDITION October 2010 In association with Wessex and Avon, Somerset & Wiltshire Cancer Services.
- Credible, current cancer information from the U.S. National Cancer Institute.
![Handbook Of Cancer Chemotherapy 7Th Edition Handbook Of Cancer Chemotherapy 7Th Edition](http://geekymedics.com/wp-content/uploads/2011/01/hyperthyroid-360x240.png)
![Handbook Of Cancer Chemotherapy 7Th Edition Handbook Of Cancer Chemotherapy 7Th Edition](http://i1046.photobucket.com/albums/b462/dr_ghost79/medicalbooks/563736_544333278982233_1056960280_n.jpg)
Alkeran Monograph for Professionals - Drugs. Generic Name: Melphalan. Class: Antineoplastic Agents. VA Class: AN1. 00. CAS Number: 1. 48- 8. Warning(s)Experience of Supervising Clinician.
![Handbook Of Cancer Chemotherapy 7Th Edition Handbook Of Cancer Chemotherapy 7Th Edition](http://www.ipazin.net/wp-content/uploads/maturalna-zabava-2010.jpg)
The latest edition of Cancer Management: A Multidisciplinary Approach for medical, surgical, and radiation oncologists, a complete treatment guide for solid and. The BJC is owned by Cancer Research UK, a charity dedicated to understanding the causes, prevention and treatment of cancer and to making sure that the. The incidence of ovarian carcinoma increases with advancing age, peaking during the 7th decade of life and remaining elevated until age 80 years. Despite the high. Incidence and Mortality. Bladder cancer is the sixth most common cancer in the United States after lung cancer, prostate cancer, breast cancer, colon cancer, and.
For administration only by individuals experienced in the administration of chemotherapeutic agents. Hematologic Toxicity. Risk of severe bone marrow suppression (e.
See Hematologic Effects under Cautions.)Mutagenicity and Carcinogenicity. Known carcinogen. See Mutagenicity and Carcinogenicity under Cautions.)Produces chromosomal aberrations in vitro and in vivo; considered potentially mutagenic in humans. See Mutagenicity and Carcinogenicity under Cautions.)Hypersensitivity Reactions.
Hypersensitivity reactions, including anaphylaxis, reported. Introduction. Antineoplastic agent; nitrogen mustard derivative; alkylating agent. Uses for Alkeran. Multiple Myeloma. Used alone and as a component of various chemotherapeutic regimens in the palliative treatment of multiple myeloma.
As effective as cyclophosphamide; combination of either agent with prednisone is considered treatment of choice. Ovarian Cancer. Palliative treatment of nonresectable epithelial ovarian cancer.
Has been administered intraperitoneally† for treatment of advanced ovarian cancer confined to the peritoneal cavity and/or associated with malignant ascites. Breast Cancer. Has been used alone or as a component of various chemotherapeutic regimens as an adjunct to surgery in the treatment of breast cancer†. Melanoma. Has been used alone and in combination regimens in isolated limb perfusion† for palliative treatment of locally recurrent or unresectable in- transit metastatic melanoma† of the extremities. Amyloidosis. Has been used with prednisone in the treatment of amyloidosis†. Alkeran Dosage and Administration.
General. Adjust dosage carefully according to clinical and hematologic response, based on weekly blood counts, and tolerance of the patient to obtain optimum therapeutic results with minimum adverse effects. Consult specialized references for procedures for proper handling and disposal of antineoplastics. Administration. Administer orally or by IV infusion.
Has been administered by regional isolation perfusion† (e. Usually administered orally; 1.
IV in the palliative treatment of multiple myeloma. Oral Administration. Administer orally on an empty stomach. Administer continuously (as single daily doses) or intermittently (e. IV Administration. For solution and drug compatibility information, see Compatibility under Stability.
Administer IV only by individuals experienced in the administration of the drug. Administer diluted solution slowly into a freely running IV infusion via an injection port or into a central venous line.
Avoid extravasation; do not administer by direct injection into a peripheral vein. See Local Effects under Cautions.)Handle cautiously (e. IV solution. c If skin or mucosal contact occurs, immediately wash skin or mucosa with soap and water and flush with water. Reconstitution. Reconstitute vial containing 5. L of the diluent provided by the manufacturer with a 2.
L. 1. 06. 11. 81. Shake vigorously until a clear solution is obtained. Must be diluted (immediately after reconstitution) prior to IV infusion. Dilution. Immediately dilute reconstituted solution with 0. L. 1. 06. 11. 81.
Rate of Administration. Administer by IV infusion over > 1. Administration should be completed within 6. Dosage. Available as melphalan and melphalan hydrochloride; dosage expressed in terms of melphalan.
Consult published protocols for the dosage of melphalan and other chemotherapeutic agents and the method and sequence of administration. Consider dosage adjustments based on the blood cell nadir and blood counts taken on the day of therapy. Generally, maintain leukocyte count between 3. Therapeutic response may occur gradually over several months. Adults. Multiple Myeloma.
Oral. Usual initial and maintenance dosage regimen: 6 mg daily for 2–3 weeks. Withhold therapy until leukocyte and platelet counts increase (i. Adjust dosage, as required, to maintain a degree of bone marrow depression. Alternatively, 1. Withhold therapy until platelet and leukocyte counts exceed 1. Adjust dosage, as required, to between 1–3 mg daily, depending on hematologic response. Alternatively, 0.
Withhold therapy until platelet and leukocyte counts increase (i. Adjust dosage, as required, depending on hematologic response. Alternatively, 0. IVUsual dosage: 1. After satisfactory recovery from toxicity, initiate maintenance therapy of 1. Ovarian Cancer. Oral.
Usual dosage: 0. 2 mg/kg daily for 5 successive days; administer at intervals of 4–5 weeks. Special Populations. Hepatic Impairment. No specific dosage recommendations at this time. Renal Impairment.
Oral. In patients with moderate to severe renal impairment, consider reducing initial dosage; however, no specific dosage recommendations at this time. IVIn patients with renal impairment (BUN ≥3. L), reduce dosage by 5. Geriatric Patients. Select dosage with caution because of age- related decreases in hepatic, renal, and/or cardiac function and potential for concomitant disease and drug therapy. Cautions for Alkeran.
Contraindications. Prior resistance to melphalan therapy. Known hypersensitivity to melphalan or any ingredient in the formulation. Warnings/Precautions.
Warnings. Adequate Patient Evaluation and Monitoring. Administer only under constant supervision by clinicians experienced in therapy with cytotoxic agents. Hematologic Effects. Risk of dose- limiting myelosuppression, manifested principally by leukopenia and thrombocytopenia; anemia also may occur.
Severe myelosuppression more common with IV melphalan than with oral melphalan. Leukocyte and platelet nadirs generally occur 2–3 weeks after treatment; recovery usually occurs 4–5 weeks after treatment.
Irreversible bone marrow depression has been reported. Careful hematologic monitoring required. Perform CBCs (leukocyte count with differential, platelet count, hemoglobin) prior to and at periodic intervals during therapy (i.
IV melphalan). 1. Withhold therapy until leukocyte count is > 3. Monitor closely for symptoms of bone marrow suppression (e.
Use with caution in patients with compromised bone marrow reserve (i. Positive direct Coombs’ test results and concurrent hemolytic anemia have been reported. Mutagenicity and Carcinogenicity. Possible leukemia or secondary malignancies; assess risk/benefits of therapy.
Causes chromatid or chromosome damage in humans. Fetal/Neonatal Morbidity and Mortality. May cause fetal harm; teratogenicity and embryolethality demonstrated in animals. Avoid pregnancy during therapy. If used during pregnancy or patient becomes pregnant, apprise of potential fetal hazard.
Fertility. Reversible and irreversible testicular suppression reported. Ovarian suppression and amenorrhea reported in premenopausal females. Local Effects. Extravasation may produce severe local tissue necrosis. Administration by regional isolation perfusion may cause erythema and/or edema of perfused area, thrombophlebitis, necrotizing fasciitis, and varying degrees of vesiculation and tissue necrosis; amputation sometimes has been necessary. Sensitivity Reactions. Hypersensitivity Reactions. Hypersensitivity reactions, including anaphylaxis, urticaria, pruritus, edema, rashes, tachycardia, bronchospasm, dyspnea, and hypotension reported in 2% of patients receiving IV melphalan and rarely in patients receiving oral melphalan.
If hypersensitivity reaction occurs, discontinue immediately and initiate appropriate therapy as indicated (e. Cross- Sensitivity.
Potential for cross- sensitivity (rash) between melphalan and other alkylating agents. General Precautions. Immunization. Avoid administration of live vaccines to immunocompromised patients.
Pulmonary Toxicity. Pulmonary embolism, sometimes fatal,1. Specific Populations. Pregnancy. Category D.
See Fetal/Neonatal Morbidity and Mortality and also Fertility, under Cautions.)Lactation. Not known whether melphalan is distributed into milk; 1.
Pediatric Use. Safety and efficacy not established. Geriatric Use. Insufficient experience in patients ≥6. Renal Impairment. Increased bone marrow suppression and risk of severe leukopenia in patients with renal impairment receiving IV melphalan; dosage reduction should be considered. Closely monitor patients with azotemia receiving oral melphalan; oral dosage reductions may be required.
See Renal Impairment under Dosage and Administration.)Common Adverse Effects. Bone marrow suppression, mild nausea.
Interactions for Alkeran. Specific Drugs. Drug. Interaction. Comments. Carmustine. Possible reduced threshold for carmustine- induced pulmonary toxicity with IV melphalan. Cimetidine. Possible reduced serum melphalan concentrations secondary to cimetidine- induced inhibition of GI absorption of melphalan 1. Monitor for decreased melphalan activity.
Cisplatin. Possible decreased clearance of melphalan secondary to cisplatin- induced renal impairment. Cyclosporine. Possible increased risk of cyclosporine- induced nephrotoxicity. Monitor renal function. Consider reducing cyclosporine dosage in patients receiving high- dose melphalan. Interferon alfa. Interferon alfa- induced fever may increase plasma elimination of melphalan. Nalidixic acid. Possible increased incidence of severe hemorrhagic necrotic enterocolitis in pediatric patients. Alkeran Pharmacokinetics.
Absorption. Bioavailability. Absorption from the GI tract is incomplete and extremely variable. Food. Food decreases bioavailability by about 3. Distribution. Extent. Rapidly distributed throughout total body water; a distributes into CSF in low concentrations. Not known whether melphalan crosses the placenta or is distributed into milk. Plasma Protein Binding.
About 6. 0–9. 0% (3. Elimination. Metabolism. Undergoes spontaneous hydrolysis in plasma to monohydroxymelphalan and dihydroxymelphalan.
Elimination Route. Not removed by hemodialysis. Half- life. Following oral administration, terminal half- life of unchanged drug is 1.