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8.1.5 Other antineoplastic drugs

First line drugs Second line drugs Specialist drugs Secondary care drugs

Amsacrine

  • Concentrate for IV infusion 75mg in 1.5ml       

Bortezomib

  • Injection, powder for reconstitution 3.5g vial       

For use in line with:

Cetuximab

  • IV infusion 5mg/ml, 20ml vial       

For use in line with: 

  • NICE (Jan 2007): Cetuximab in combination with irinotecan is not recommended for the second-line or subsequent treatment of metastatic colorectal cancer after the failure of an irinotecan containing chemotherapy regimen.  

Crisantaspase

  • Injection, powder for reconstitution 10000 unit vial       

Side effects in addition to those listed in Adverse effects (Click here) Crisantapase may increase or decrease blood-clotting factors; therefore there is an increased risk of bruising or bleeding and thrombosis. Temporary changes in liver function may occur.

Dacarbazine

  • Injection, powder for reconstitution 100mg, 200mg,1g vial       

Temozolomide

  • Capsules 5mg, 20mg, 100mg, 140mg, 180mg, 250mg       

Side effects in addition to those listed in Adverse effects (Click here) Constipation may occur with temozolomide.

For use in line with: 

Hydroxycarbamide

Please refer to Shared Care Information - Chapter 20

  • Capsules 500mg       

Side effects in addition to those listed in Adverse effects (Click here) There may be raised uric acid levels in the blood with hydroxycarbamide, allopurinol may be prescribed to address this, the patient should be given advice to increase fluid intake.

Ipilimumab

  • Concentrate for I/V infusion 5mg/mL

For use in line with NICE TA268 Ipilimumab for previously treated advanced (unresectable or metastatic) melanoma (December 2012)

Pentostatin

  • Injection, powder for reconstitution 10mg vial       

Side effects in addition to those listed in Adverse effects (Click here) Acne type spots may occur with pentostatin. The skin usually returns to normal after treatment finishes.
Patients may experience gritty eyes due to inflamed conjunctiva, which should be treated appropriately.       

Platinum compounds      

Carboplatin

  • Injection 50mg in 5ml, 150mg in 15ml, 450mg in 45ml, 600mg in 60ml  

Cisplatin

  • Injection 10mg in 10ml, 50mg in 50ml, 100mg in 100ml       

Side effects in addition to those listed in Adverse effects (Click here) Kidney function may be affected with cisplantin, patients may be asked to measure what they drink and urine that they pass, a diuretic may be given if necessary. Peripheral neuropathy and hearing loss may also occur.       

Oxaliplatin

  • Injection, powder for reconstitution 50mg vial, 100mg vial       

Side effects in addition to those listed in Adverse effects (Click here) Peripheral neuropathy may occur with oxaliplatin, sometimes triggered by cold.    

For use in line with:
NICE: Irinotecan, oxaliplatin & raltitrexed for advances colorectal cancer (Aug 2005)   

Procarbazine

  • Capsules 50mg       

Side effects in addition to those listed in Adverse effects (Click here) The patient may experience symptoms of a flu-like illness with procarbazine, it is important for the patient to increase fluids and rest.
Note: Procarbazine is a mild monoamine-oxidase inhibitor but dietary restriction is not considered necessary. Alcohol ingestion may cause a disulfiram-like reaction.       

Protein kinase inhibitors       

Erlotinib

  • Tablets 25mg, 100mg, 150mg      

For use in line with:
NICE: Erlotinib for the treatment of non-small-cell lung cancer (Nov 2008)
NICE TA258: Erlotinib for the first-line treatment of locally advanced or metastatic EGFR-TK mutation-positive non-small-cell lung cancer (June 2012)

Gefitinib

  • Tablets 250mg

For use in line with:
NICE TA192: Gefitinib for the first-line treatment of locally advance or metastatic non-small-cell lung cancer (July 2010)

Imatinib

  • Tablets 100mg, 400mg       

Side effects in addition to those listed in Adverse effects (Click here) Leg aches/cramps may be experienced with imatinib. Fluid retention may also be experienced, diuretics may help but it usually settles on its own. Visual disturbances may be experienced, also watery eyes.       

For use in line with:

Nilotinib

  • Capsules 150mg, 200mg 

For use in line with:
NICE: Leukaemia (chronic myeloid) - dasatinib, nilotinib, imatinib (intolerant, resistant) (TA241) (January 2012)

NICE: Dasatinib, nilotinib and standard-dose imatinib for the first-line treatment of chronic myeloid leukaemia (TA251) (April 2012)

Pazopanib

  • Tablets 200mg, 400mg 

For use in line with:
NICE: Pazopanib for the first line treatment of metastatic renal cell carcinoma (February 2011)

Sunitinib

  • Capsules 12.5mg. 25mg, 50mg       

For use in line with:

MHRA Drug Safety Update (January 2011)

  • Treatment with bevacizumab or sunitinib may be a risk factor for the development of ONU
  • Patients treated who have previously received, or are treated concurrently with, bisphosphonates may be particularly at risk
  • Dental examination and appropriate preventative dentistry should be considered before treatment with bevacizumab or sunitinib. Invasive dental procedures should be avoided, if possible, in patients treated with bevacizumab or sunitinib who have previously received, or who are receiving, I/V bisphosphonates

Vemurafenib

  • Tablets 240mg

To be used in line with NICE TA269 Vemurafenib for treating locally advanced or metastatic BRAF V600 mutation-positive malignant melanoma (Dec 2012)

Taxanes

Cabazitaxel

  • Concentrate for IV infusion 40mg/ml in 1.5ml vial

Note: Cabazitaxel is not routinely commissioned. Only to be used after approval for funding by the Cancer Drugs Fund.    

Docetaxel

  • Concentrate for IV infusion 20mg in 0.5ml, 80mg in 2ml       

Side effects in addition to those listed in Adverse effects (Click here) Palmar planter may occur with docetaxel which is temporary but can be treated with pyridoxine 50mg TDS. Hypersensitivity reactions may occur such as skin rashes, itching, high temperature, shivering, and redness of the face, dizziness, headache, breathlessness, anxiety and a need to pass urine. Fluid retention may occur which will decrease slowly after treatment finish.
Note: Dexamethasone by mouth 8mg bd for 3 days, starting on the day before each course of docetaxel, is recommended for reducing fluid retention and hypersensitivity reactions.

For use in line with:
NICE: Docetaxel for the treatment of hormone refractory prostate cancer (Jun 2006)

Paclitaxel

  • Concentrate for IV infusion 30mg in 5ml, 100mg in 16.7ml, 300mg in 50ml       

Side effects in addition to those listed in Adverse effects (Click here) Temporary aching/pain in joints may occur with paclitaxel at the time of treatment. Peripheral neuropathy may also occur which usually improves a few months after treatment has been completed. Headaches may also be experienced. Hypersensitivity reactions may occur such as skin rashes, itching, high temperature, shivering, and redness of the face, dizziness, headache, breathlessness, anxiety and a need to pass urine.
Note: Paclitaxel contains polyethoxylated castor oil, which has been associated with anaphylaxis. Routine premedication with a corticosteroid, an antihistamine and a histamine H2-receptor antagonist is recommended to prevent severe hypersensitivity reactions to paclitaxel; hypersensitivity reactions may occur rarely despite premedication, although more commonly only bradycardia or asymptomatic hypotension occur.       

For use in line with:

Topoisomerase I inhibitors

Irinotecan

  • Concentrate for IV infusion 100mg in 5ml, 300mg in 15ml       

Topotecan

  • Capsules 250 micrograms, 1mg
  • IV infusion, powder for reconstitution 1mg, 4mg vial

For use in line with:
NICE guidance: Topetecan for the treatment of relapsed small-cell lung cancer (November 2009) 

Trabectedin

  •   Injection, powder for reconstitution 250 microgram vial, 1mg vial

For use in line with:
NICE TAG185: Trabectedin for the treatment of advanced soft tissue sarcoma (Feb 2010)

Trastuzumab

  • Injection, powder for reconstitution 150mg vial       

Side effects in addition to those listed in Adverse effects (Click here) The patient may experience symptoms of a flu-like illness and headaches with trastuzumab. There may be mild tumour pain experienced that can be relieved with mild analgesia. Trastuzumab may also have an effect on the heart so heart function should be assed before treatment.

For use in line with:

Tretinoin

  • Capsules 10mg       

Side effects in addition to those listed in Adverse effects (Click here) Retinoic acid syndrome – requires immediate treatment – consult product literature.

Return to Chapter: 8. Malignant Disease and Immunossuppression

Last updated by: Carol Webb on 17-04-2013 10:47