Annapolis

Lung Cancer Overview

Thu, 14 May 2009 18:40:59 +0000

Overview

Lung cancer is characterized by the uncontrolled growth of abnormal cells in one or both of the lungs. The majority of lung cancers begin in the bronchial tubes that conduct air in and out of the lungs. Cancers of the lung are classified by how they appear under a microscope. While there are more than a dozen different kinds of lung cancer, the two main types of lung cancer are non small cell and small cell, which together account for over 90% of all lung cancers. Non small cell lung cancer accounts for approximately 75% of these cancers and consists of squamous cell, adenocarcinoma and large cell types. Small cell lung cancer represents 20-25% of all lung cancers and is also referred to as “oat cell cancer” because of the shape of cells when examined under the microscope.

Diagnosing Lung Cancer

When lung cancer is diagnosed, the doctor must determine the type (small cell or non small cell) and the extent of spread or stage of the cancer in order to determine the best treatment. Lung cancer may grow locally in the lungs or spread distantly (metastasize) to other sites in the body, including lymph nodes, bones, and the brain. Determining the presence of a lung cancer and the type of lung cancer requires examination of tissues from the lung. A biopsy is the removal of a small piece of tissue for examination under a microscope and can be obtained using one or more of the following procedures.

Bronchoscopy: During a bronchoscopy, a surgeon inserts a bronchoscope (thin, lighted tube) through the nose or mouth into the trachea (windpipe) and bronchi (air passages that lead to the lung). Through this tube, the surgeon can examine the inside of the trachea, bronchi and lung and collect cells or small tissue samples.

Fine Needle Aspiration: During this procedure, a surgeon inserts a needle through the chest into the cancer to remove a tissue sample for examination under the microscope.

Thoracentesis: During a thoracentesis, a surgeon uses a needle to remove a sample of the fluid that surrounds the lungs in order to check for the presence of cancer cells.

Thoracotomy: A thoracotomy is a major operation, which involves opening the chest in order to diagnose lung cancer.

Sputum Cytology: Sputum cytology is a procedure used to examine mucus that is coughed up from the lungs or breathing tubes. The mucus is examined under a microscope in order to detect cancer cells.

Staging

When a diagnosis of lung cancer is confirmed, determining the stage or extent of spread of the cancer is essential in order to understand treatment options or interpret published cancer treatment information. Determining the stage of lung cancer may require many tests, which often include the following:

Mediastinoscopy: A mediastinoscopy is a procedure that can indicate whether the cancer has spread to the lymph nodes in the chest. During a mediastinoscopy, a surgeon inserts a mediastinoscope (lighted tube) through a small incision in the neck while a patient is under general anesthesia. This mediastinoscope allows the surgeon to examine the center of the chest (mediastinum) and nearby lymph nodes, as well as remove a tissue sample.

Computed Topography or CT Scan: A CT scan is a technique for imaging body tissues and organs, during which X-ray transmissions are converted to detailed images, using a computer to synthesize X-ray data. A CT scan is conducted with a large machine positioned outside the body that can rotate to capture detailed images of the oranges and tissues inside the body. This method is more sensitive and precise than the chest x-ray.

Magnetic Resonance Imagery or MRI: During MRI, a powerful magnet linked to a computer makes detailed pictures of areas inside the body.

Positron emission tomography (PET): Positron emission tomography (PET) scanning has been used to improve the detection of cancer in lymph nodes. One characteristic of living tissue is the metabolism of sugar. Prior to a PET scan, a substance containing a type of sugar attached to a radioactive isotope (a molecule that spontaneously emits radiation) is injected into the patient’s vein. The cancer cells “take up” the sugar and attached isotope, which emits positively charged, low energy radiation (positrons). The positrons react with electrons in the cancer cells, which creates the production of gamma rays. The gamma rays are then detected by the PET machine, which transforms the information into a picture. If no gamma rays are detected in the scanned area, it is unlikely that the mass in question contains living cancer cells. In one clinical study, PET scanning detected 85% of lymph nodes involved with cancer, which was significantly better than the detection rate with CT scanning.

Bone Scan: A bone scan is used to determine whether cancer has spread to the bones. Prior to a bone scan, a surgeon injects a small amount of radioactive substance into a vein. This substance travels through the bloodstream and collects in areas of abnormal bone growth. An instrument called a scanner measures the radioactivity levels in these areas and records them on x-ray film.

All new treatment information is categorized according to whether patients have small cell or non-small cell lung cancer and according to the stage of disease. To learn more about the general treatment of lung cancer and current results achieved with new treatments, select small cell or non-small cell lung cancer.

Non Small Cell Lung Cancer

Small Cell Lung Cancer

Ethyol®

Tue, 28 Apr 2009 11:29:37 +0000

Class: Supportive care

Generic Name: Amifostine (a-mi-FOSS-teen)

Trade Name: Ethyol®

For which conditions is this drug approved?

Amifostine is FDA approved to reduce side effects to the kidneys caused by repeated administration of the chemotherapy agent cisplatin (Platinol®) in patients with advanced ovarian cancer. It is also FDA approved to reduce dry mouth caused by radiation therapy following surgery in patients with head and neck cancer.

It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action?

Amifostine belongs to a group of agents called cytoprotectants, which protect normal tissue from some of the side effects caused by some treatments for cancer. Amifostine provides these protective effects after being broken down in the body to specific metabolites. Through chemical reactions, the metabolites from amifostine deactivate molecules from cisplatin or radiation therapy that cause side effects. The protective metabolites of amifostine tend to accumulate more in healthy cells than in cancerous cells, so that cancer cells are not protected from the anti-cancer effects of treatment.

How is amifostine typically given (administered)?

Amifostine is typically administered intravenously (into a vein). Amifostine is given approximately 15 to 30 minutes prior to treatment with chemotherapy or radiation therapy. Because low blood pressure may occur during amifostine administration, patients typically receive the drug while lying down, have their blood pressure frequently monitored, and may receive intraveneous fluid to help maintain their blood pressure. Uncommonly, patients may experience other side effects during the administration of amifostine. These side effects include fever, chills, difficulty breathing, low levels of oxygen in the blood, chest tightness, skin abnormalities, inflammation of the larynx, or heart attack. Patients should inform their healthcare provider if they are experiencing lightheadedness, fever, chills, difficulty breathing, chest tightness or pain, difficulty speaking, or skin abnormalities during the administration of amifostine.

How are patients typically monitored?

Patients will usually have their blood pressure monitored frequently – approximately every 5 minutes – during the administration of amifostine and periodically after administration. Patients may also be monitored for calcium levels in their blood.

What are the common (occur in 30% or more of patients) side effects of treatment with amifostine?

• Low blood pressure

• Nausea and vomiting

• Flushing

(All side effects occur during administration.)

What are the less common (occur in 10% to 29% of patients) side effects of treatment with amifostine?

• Dizziness

• Fatigue

• Somnolence

• Chills

• Hiccups

• Redness of the face or neck

• Sneezing

(All side effects occur during administration.)

This is not a complete list of side effects. Some patients may experience other side effects that are not listed here. Patients may wish to discuss with their physician the other less common side effects of this drug, some of which may be serious.

Some side effects may require medical attention. Other side effects do not require medical attention and may go away during treatment. Patients should check with their physician about any side effects that continue or are bothersome.

What can patients do to help alleviate or prevent discomfort and side effects?

• Pay careful attention to the physician’s instructions and inform the physician of any side effects.

• Wear sunscreen and protective clothing and try to minimize sun exposure.

• Drink plenty of water or liquid prior to receiving amifostine.

• Eat small meals frequently to help alleviate nausea.

• Maintain adequate rest and nutrition.

Are there any special precautions patients should be aware of before starting treatment?

• Patients should tell their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.

• It is important that patients inform their physician of any pre-existing conditions (chicken pox, infection, heart disease, kidney disease, liver disease, lung disease, thyroid disease, etc.) as they may worsen with this drug.

• Patients should inform their physician if they have ever had convulsions or seizures.

• Patients should inform their physician about any other medication they are taking (whether prescription or over the counter, including vitamins, herbs, etc.) as they may interfere with treatment.

• Patients should check with their physician before starting any new drug or nutritional supplement.

• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.

• Patients should inform their physician if they are taking antihypertensive medication (medication to treat high blood pressure) before receiving amifostine because amifostine causes low blood pressure.

When should patients notify their physician? (If any of these problems occur during infusion of amifostine)

• Difficulty breathing

• Skin reactions

• Lightheadedness, dizziness

• Prolonged or severe nausea or vomiting

• Chest pain or chest tightness

• Fever

• Chills

• Tremors or shaking

What is a package insert?

A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers. A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug. Click here to view the package insert

Important Limitations of Use

The information provided below on the chemotherapy drug you have selected is provided for your information only and is not a substitute for consultation with an appropriate medical doctor. We are providing this information solely as a courtesy and, as such, it is in no way a recommendation as to the safety, efficacy or appropriateness of any particular drug, regimen, dosing schedule for any particular cancer, condition or patient nor is it in any way to be considered medical advice. Patients should discuss the appropriateness of a particular drug or chemotherapy regimen with their physician.

As with any printed reference, the use of particular drugs, regimes and drug dosages may become out-of-date over time, since new information may have been published and become generally accepted after the latest update to this printed information. Please keep in mind that health care professionals are fully responsible for practicing within current standards, avoiding use of outdated regimens, employing good clinical judgment in selecting drugs and/or regimens, in calculating doses for individual patients, and verifying all dosage calculations.

DISCLAIMER OF WARRANTIES

CANCERCONSULTANTS.COM SPECIFICALLY DISCLAIMS AND EXCLUDES ALL EXPRESSED OR IMPLIED WARRANTIES, INCLUDING ANY IMPLIED WARRANTIES AS TO QUALITY, ACCURACY (INCLUDING TYPOGRAPHICAL ERRORS), MERCHANTABILITY, OR FITNESS FOR ANY PARTICULAR PURPOSE OF THE INFORMATION CONTAINED HEREIN. CANCERCONSULTANTS.COM DISCLAIMS ALL LIABILITY OR DAMAGES ARISING FROM ANY USE OF THE INFORMATION.

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

Salagen®

Tue, 28 Apr 2009 11:29:37 +0000

Class: Supportive care

Generic Name: Pilocarpine hydrochloride (PIE-loe-kar-peen HIE-druh-KLOR-ide)
Trade Name: Salagen®

For which conditions is this drug approved? Pilocarpine is FDA approved for the treatment of dry mouth caused by radiation therapy in patients with head and neck cancer. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.
What is the mechanism of action? Pilocarpine belongs to a class of drugs called cholinergic agonists. Pilocarpine stimulates the salivary glands to produce more saliva, thus relieving dry mouth.

How is pilocarpine typically given (administered)? Pilocarpine is taken orally, in the form of a tablet and the dose depends on several factors, including the condition being treated, the response to treatment and the overall health of the patient.

How are patients typically monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with pilocarpine. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy. Patients will be assessed on the extent of dry mouth. Patients may also have their lung and heart functions monitored.

What are the common (occur in 30% or more of patients) side effects of treatment with pilocarpine?

• Sweating

What are the less common (occur in 10% to 29% of patients) side effects of treatment with pilocarpine?

• Nausea
• Chills
• Runny nose
• Dizziness
• Weakness
• Reddening of the face or neck
• Diarrhea
• Urinary frequency
• Headache

Are there any special precautions patients should be aware of before starting treatment?

• Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
• Patients taking pilocarpine should exercise caution with driving vehicles or operating heavy machinery, as treatment may cause dizziness or blurry vision.
• If an oral dose is missed, do not double up on doses. Patients should contact their doctor in this event.
• Keep tablets out of reach of children and return to the pharmacy for safe disposal if treatment is terminated.

When should patients notify their physician?

• Difficulty breathing, wheezing
• Chest pain
• Noticeable changes in heart rate or rhythm
• Dizziness or blurry vision
• Increased tears
• Headache
• Yellowing of skin or eyes
• Right upper quadrant pain
• Severe abdominal pain
• Swelling of the ankles, feet, hands or face
• Mental confusion, abnormal thinking
• Persistent or extreme diarrhea
• Persistent or extreme nausea or vomiting
• Urinating more than usual

What is a package insert?
A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers. A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug. Click here to view the package insert

Important Limitations of Use
The information provided below on the chemotherapy drug you have selected is provided for your information only and is not a substitute for consultation with an appropriate medical doctor. We are providing this information solely as a courtesy and, as such, it is in no way a recommendation as to the safety, efficacy or appropriateness of any particular drug, regimen, dosing schedule for any particular cancer, condition or patient nor is it in any way to be considered medical advice. Patients should discuss the appropriateness of a particular drug or chemotherapy regimen with their physician.

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

ondansetron

Tue, 28 Apr 2009 11:29:37 +0000

Class: Supportive care

Generic Name: Ondansetron (on-DAN-se-tron)
Trade Name: Zofran®

How is this drug used? Ondansetron is FDA approved for the prevention of nausea and vomiting caused by chemotherapy that has a strong association to nausea and vomiting, including high-dose cisplatin. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.
What is the mechanism of action? Ondansetron belongs to a class of drugs called antiemetics. Nausea and vomiting may be caused by the release of serotonin with the use of some chemotherapy agents. The serotonin binds to cell receptors called 5-HT3 which stimulate the vomiting reflex. Ondansetron helps to prevent nausea and vomiting by blocking 5-HT3 receptors so that the serotonin is not able to bind to the receptor and initiate the vomiting reflex.

How is ondansetron given (administered)? Ondansetron may be administered into a vein (intravenous), into a muscle (intramuscular), or by mouth.

How are patients monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with ondansetron in association with chemotherapy treatment. Patients may undergo physical examinations or other measures to assess side effects and response to therapy. Monitoring for ondansetron includes assessments of its ability to prevent nausea and/or vomiting caused by chemotherapy.

What are the most common side effects of treatment with ondansetron?

• Headache
• Constipation
• Diarrhea
• Fatigue, weakness

• Patients should inform their doctors of any side effects.
• Wear sunscreen and protective clothing; try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day).
• Maintain adequate rest and nutrition.

Are there any special precautions patients should be aware of before starting treatment?

When should patients notify their physician?

• Yellowing of skin or eyes
• Sudden accumulation of fluid in the abdomen
• Severe abdominal pain
• Persistent or severe headache
• Noticeable changes in heart rate or rhythm
• Severe weakness
• Difficulty speaking
• Muscle stiffness or spasms
• Restlessness on uncontrolled movement of arms and legs
• Lightheadedness or dizziness
• Signs of allergic reaction (rash, itching, difficulty breathing, tightness of throat or chest)

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

sargramostim

Tue, 28 Apr 2009 11:29:37 +0000

Class: Supportive care

Generic Name: Sargramostim (sar-gram-OH-stim), GM-CSF, granulocyte-macrophage colony stimulating factor
Trade Name: Leukine®

How is this drug used? Sargramostim is FDA approved for increasing the number and function of white blood cell levels following chemotherapy for acute myelogenous leukemia in older patients, and after bone marrow transplant and autologous stem cell transplants using peripheral blood. Sargramostim is also FDA approved to stimulate the production of white blood cells prior to collection in a stem cell transplant. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.
What is the mechanism of action? Sargramostim is classified as a biologic response modifier. It is a man-made form of a protein, called a growth factor, that helps to increase the number and function of white blood cells. Sargramostim stimulates the body to produce white blood cells.

How is sargramostim given (administered)? Sargramostim is administered either as an injection under the skin (subcutaneous), or into a vein (intravenous), and the dose depends on several factors, including the condition being treated, the size of the patient, the particular regimen being used, and the overall health of the patient.

How are patients monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with sargramostim. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy. Levels of white blood cells are of particular importance in patients receiving sargramostim.

Patients will also be monitored for reactions that occur either during infusion or following infusion of sargramostim that include difficulty in breathing, wheezing, fainting, hives, increased heart rate, low blood pressure, and reddening of the face or neck. Patients experiencing these symptoms should tell their healthcare provider immediately.

Patients are also monitored for an uncommon (less than 1%) condition called capillary leak syndrome, in which fluid “leaks” from the veins and capillaries into surrounding tissues. This results in low fluid and blood volume to organs. Patients experiencing dizziness, sudden or extreme weight gain, difficulty breathing, little or no urine output or chest pain should notify their healthcare provider immediately.

In addition, patients may have their heart function monitored, as heart rhythm may be affected by sargramostim. Patients will also be monitored for blood clots. If patients experience redness, swelling or pain in one extremity and not the other, sudden difficulty or pain in breathing, a sudden and severe headache or visual changes should contact their healthcare provider immediately.

What are the most common side effects of treatment with sargramostim?

• A “first dose effect” may occur, which is characterized by an increased heart rate, feeling faint, low blood pressure and reddening of the face. This tends to only happen on the first dose of sargramostim
• Diarrhea or stomach upset
• Swelling, pain, redness, tenderness at the site of injection
• Flu-like symptoms that may include fever, headache, achiness or pain, weakness and fatigue
• Bone pain
• Swelling of feet or hands

What can patients do to help alleviate or prevent discomfort and side effects?

• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
• Patients being treated with sargramostim are often at risk of developing an infection from low immune cell levels caused by their treatment. Staying away from large crowds or other people that are not feeling well will reduce the risk of infection.
• Wash hands well to reduce the risk of infection.
• Rotate sites on the body where sargramostim is injected.
• Do not rub skin before or after injection.
• Ice applied to the site of injection prior to administration may help alleviate pain.

Are there any special precautions patients should be aware of before starting treatment?

• Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
• Sargramostim may enhance complications associated with the following pre-existing conditions: edema, pleura or pericardial infusion or capillary leak syndrome

When should patients notify their physician?

• Signs of an allergic reaction – difficulty breathing, chest pain, hives, fainting, increased heart rate or reddening of the face or neck, skin rash, hives
• Signs of capillary leak syndrome – dizziness, sudden or extreme weight gain, difficulty breathing, chest pain, little or no urine output or chest pain
• Chest pain, rapid or irregular pulse
• Fever
• Signs of infection – redness, swelling, pus
• Cold or flu-like symptoms – cough, sore throat, fever, chills, runny nose, achiness
• Signs of a blood clot – swelling, redness or pain of one extremity and not the other, sudden difficulty or pain in breathing, sudden and severe headache and/or visual disturbances
• Severe bone pain

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

rasburicase

Tue, 28 Apr 2009 11:29:37 +0000

Class: Supportive care

Generic Name: Rasburicase
Trade Name: Elitek®

How is this drug used? Rasburicase is FDA approved for the management of uric acid levels in pediatric patients with leukemia, lymphoma and solid tumor malignancies who are receiving anti-cancer therapy expected to result in tumor lysis syndrome and subsequent elevation of uric acid in the blood. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.
What is the mechanism of action? Rasburicase causes an reaction with an enzyme that turns uric acid into an inactive substance, allantoin, thereby reducing uric acid levels.

Tumor lysis syndrome (TLS) is the development of electrolyte and metabolic disturbances that may occur following the treatment of cancer and can result in life-threatening complications if not managed appropriately. Tumor lysis syndrome is caused by the sudden, rapid death of cells, particularly cancer cells in patients with leukemia or lymphoma, in response to cancer therapies. Tumor lysis syndrome may occur spontaneously, although the occurrence of this is rare. When cancer cells are killed by therapy, they may spill their inner (intracellular) contents, which accumulate in the body faster than can be eliminated. These intracellular contents cause the metabolic and electrolyte disturbances that result in TLS. Hyperuricemia is a component of TLS, and refers to excess uric acid in the blood. Uric acid is the end product of the digestion of certain proteins and is normally eliminated through the urine. When excess uric acid is present, it is converted to crystals formed of sodium urate. These crystals may deposit in the tiny tubes that are part of the kidney and cause acute kidney damage, which can ultimately lead to kidney failure.

How is rasburicase given (administered)? Rasburicase is administered into a vein (intravenous) and the dose depends on several factors, including the size of the patient, the particular treatment regimen being used, and the overall health of the patient.

How are patients monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with rasburicase. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. In addition, blood levels of electrolytes and products of digestion or metabolism will be measured frequently, to monitor the extent of TLS.

Patients will also be monitored for allergic-type reactions that may occur with treatment with rasburicase, including difficulty breathing, chest pain, rash, hives, low blood pressure, closing of the throat and lightheadedness. Allergic reactions may be severe, including shock. Patients of African or Mediterranean ancestry may be at higher risk of side effects.

What are the common (occur in 30% or more of patients) side effects of treatment with rasburicase?

• Vomiting
• Fever

What are the less common (occur in 10% to 29% of patients) side effects of treatment with rasburicase?

• Nausea
• Headache
• Abdominal pain
• Constipation
• Diarrhea
• Mouth sores
• Rash

• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
• Eat small meals frequently to help alleviate nausea.
• For mouth sores, patients should rinse their mouth three times a day with a salt and soda solution (8 ounces of water mixed with ½ to 1 tsp baking soda and/or ½ to 1 tsp salt) and brush their teeth with a soft toothbrush to help prevent the development of mouth sores.

Are there any special precautions patients should be aware of before starting treatment?

When should patients notify their physician?

• Difficulty breathing
• Closing of the throat
• Lightheadedness, dizziness
• Rash
• Chest pain
• Change in heart rate or rthythm
• Vision changes
• Swelling of ankles or feet
• Sudden weight gain
• Severe headache
• Swelling, pain or redness of one extremity and not the other
• Mouth sores
• Severe abdominal pain
• Prolonged constipation or diarrhea
• Prolonged or severe nausea or vomiting
• Fever

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

Palifermin

Tue, 28 Apr 2009 11:29:37 +0000

Class: Supportive care

Generic Name: Palifermin (pa-li-FER-min)
Trade Name: Kepivance™

For which conditions is this drug approved? Palifermin is FDA-approved to decrease the incidence or duration of severe oral mucositis in patients who have cancers affecting the blood (hematologic) and who will undergo treatment including a stem cell transplant. Oral mucositis is a condition that can be caused by treatment for cancer and it affects the lining of the mouth. Oral mucositis may result in a range of symptoms, including pain or irritation of the mouth, or severe ulceration in the mouth. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action? Palifermin belongs to a class of drugs called growth factors. Palifermin stimulates cells, called epithelial cells, to grow and divide. Epithelial cells comprise the outer layer of the mouth, and other digestive organs; therefore, stimulation of their growth helps reduce oral mucositis.

How is palifermin typically given (administered)? Palifermin is administered intravenously (into a vein) and the dose depends on the size or weight of the patient. Palifermin is given in 3 doses prior to therapy and 3 doses following therapy. Palifermin should not be administered within 24 hours of chemotherapy administration.

How are patients monitored? Patients will undergo assessments for oral mucositis. This may include the physical examination of the mouth, lips, gums, and tongue, as well as questions posed to the patient regarding pain, ability to swallow, ability to eat and drink, etc.

What are the most common side effects associated with treatment with palifermin?

Rash/Skin irritation
Altered taste
Water retention
Mouth or tongue thickness or discoloration
High blood pressure
Abnormal sensations related to the nervous system
Muscle aches
Pain
Changes in laboratory results regarding the digestive system

What can patients do to help alleviate or prevent discomfort and side effects?

Pay careful attention to the physician’s instructions and inform the physician of any side effects.
Maintain adequate rest and nutrition.
Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)

Are there any special precautions patients should be aware of before starting treatment?

Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
Patients should inform their physician if they have high blood pressure.
Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.), as they may interfere with treatment.
Patients should check with their physician before starting any new drug or nutritional supplement.
Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.

When should patients notify their physician?

Tongue thickening
Taste alteration
Increased fever
Sudden, sharp headache
Noticeable changes in heart rate or rhythm
Alteration in feeling in the mouth
Skin rash or other skin abnormalities
Tongue discoloration
Water retention, sudden weight gain
Severe pain

What is a package insert? A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers. A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug.

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

etidronate

Tue, 28 Apr 2009 11:29:37 +0000

Class: Supportive care

Generic Name: Etidronate (eh-TI-droe-nate)
Trade Name: Didronel®

For which conditions is this drug approved? Etidronate is FDA-approved for the treatment of hypercalcemia (high levels of calcium in the blood) caused by cancer. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action? Bone is in a constant state of remodeling in which old bone is removed by cells called osteoclasts (referred to as resorption) and new bone is laid down by cells called osteoblasts. Sometimes, patients with cancer have excessive resorption, leading to high levels of calcium in the blood. Etidronate helps prevent hypercalcemia by inhibiting excessive bone resorption.

How is etidronate typically given (administered)? Etidronate is given orally, in the form of a tablet, or may be given intravenously (into a vein) and the dose depends on several factors, including the condition being treated, the size of the patient, the particular regimen being used and the overall health of the patient.

How are patients typically monitored? Patients may have their blood taken to measure levels of calcium or other minerals or electrolytes, as well as to measure function of the kidneys or other organs.

What are the most common side effects of treatment with etidronate?

• Fever
• Diarrhea
• Nausea
• Changes in the levels of kidney function, as determined by blood tests

What can patients do to help alleviate or prevent discomfort and side effects?

Are there any special precautions patients should be aware of before starting treatment?

• Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
• Take tablets on an empty stomach. Avoid foods or supplements that contain calcium, iron or magnesium within 2 hours of taking etidronate.

When should patients notify their physician?

• Sudden weight gain
• Swelling of the ankles or feet
• Little or no urine output
• Signs of hypercalcemia – muscle twitching, frequent urination, loss of appetite, nausea or vomiting, constipation, weakness or fatigue, muscle, confusion, and coma.
• Severe pain
• Allergic reaction (rash, hives, fever, swelling of throat, tongue, lips)

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

palonosetron

Tue, 28 Apr 2009 11:29:37 +0000

Class: Supportive care

Generic Name: Palonosetron (pal-eh-OSS-eh-tron)
Trade Name: Aloxi®

How is this drug used? Palonosetron is FDA approved for the prevention of acute and delayed nausea and vomiting caused by chemotherapy that is strongly associated with nausea and vomiting. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.
What is the mechanism of action? Palonosetron belongs to a class of drugs called antiemetics. Nausea and vomiting may be caused by the release of serotonin with the use of some chemotherapy agents. The serotonin binds to cell receptors called 5-HT3 which stimulates the vomiting reflex. Palonosetron helps to prevent nausea and vomiting by blocking 5-HT3 receptors so that the serotonin is not able to bind to the receptor and initiate the vomiting reflex.

How is palonsetron given (administered)? Palonsetron is administered into a vein (intravenous) prior to chemotherapy.

How are patients monitored? Patients will usually have scheduled meetings and physical exams with their healthcare provider while they are being treated with palonosetron given in association with chemotherapy. Patients may undergo physical examinations or other measures to assess side effects and response to therapy. Monitoring for palonosetron includes assessments of its ability to prevent nausea and/or vomiting caused by chemotherapy.
What are the most common side effects of treatment with palonsetron?

• Headache
• Constipation
• Diarrhea
• Dizziness

Are there any special precautions patients should be aware of before starting treatment?

When should patients notify their physician?

• Severe or persistent headache
• Severe or persistent dizziness
• Confusion
• Severe weakness
• Swelling of the feet or ankles
• Change in heart rate or rhythm

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.

epoetin alfa

Tue, 28 Apr 2009 11:29:37 +0000

Class: Supportive care

Generic Name: Epoetin alfa (ee-POE-eh-tin AL-feh)
Trade Name: Procrit®

For which conditions is this drug approved? Epoetin alfa is FDA approved for the treatment of anemia in patients with non-hematologic cancers that are being treated with chemotherapy. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action? Epoetin alfa belongs to a class of agents called biologic response modifiers. Epoetin alfa alleviates anemia that can be caused by chemotherapy by increasing low levels of red blood cells to normal levels. Red blood cells transport necessary oxygen to tissues throughout the body and carry some waste products from cells. Epoetin alfa works by stimulating cells in the bone marrow to produce functioning red blood cells, ultimately providing sustained normal levels of red blood cells in the body.

How is epoetin alfa typically given (administered)? Epoetin alfa is administered as an injection under the skin (subcutaneous).

How are patients typically monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with epoetin alfa. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy. Two important blood levels will be checked, hemoglobin and hematocrit. Hemoglobin is an iron-containing molecule inside every red blood cell that is responsible for the delivery of oxygen to tissues that have low levels of oxygen. Hematocrit is the proportion of red blood cells that are in blood. Physicians will continue to schedule blood draws throughout treatment with epoetin alfa, as patient needs may change in response to chemotherapy or specific conditions. Iron levels may be assessed. Blood pressure will also be taken frequently. Patients will also be monitored for blood clots, including redness, pain or swelling of one extremity and not the other, sudden difficulty or pain in breathing, severe headache or blurry vision.

What are the common side effects of treatment with epoetin alfa?

• Diarrhea
• Swelling of the feet or hands (edema)
• Fever
• Shortness of breath
• Headache
• Fatigue
• Upper respiratory infection
• Nausea
• Local pain at injection site
• Change in blood pressure

What can patients do to help alleviate or prevent discomfort and side effects?

When should patients notify their physician?

• Difficulty or pain in breathing
• Acute back pain
• Chest pain
• Noticeable changes in heart rate or rhythm
• Redness, swelling or pain in one extremity and not the other
• Vision changes
• Extreme headache
• Swelling of the hands or feet
• Weight gain
• Rash
• Increased blood pressure
• Muscle tremors or seizures

What is a package insert?

DISCLAIMER OF WARRANTIES

The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.