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Pharmacy Tips
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Novel
targeted-therapeutics in the treatment of lymphoma and leukaemia
Monoclonal
antibodies are a new class of agents targeted at specific
receptors on cancer cells. In addition to having direct cellular
effects, antibodies can carry substances such as radioactive
isotopes, toxins, and anti-neoplastic agents, to the targeted
cells. The table below lists five monoclonal antibodies that
have a significant role in the management of patients with
advanced refractory or relapsed lymphomas and leukaemias.
|
| Generic
name |
Brand
name |
Target
antigen |
Indication |
Common
side-effects |
Availability |
| Alemtuzumab |
Campath® |
CD52 |
FDA
approved use: Treatment of B-cell chronic lymphocytic
leukaemia (B-CLL)
Unlabeled/investigational use: Treatment
of refractory T-cell prolymphocytic leukaemia (T-PLL);
CD52 positive B and T cell NHL; rheumatoid arthritis;
graft versus host disease; multiple myeloma
|
Cardiovascular:
Hypotension (15% to 32%, infusion-related), peripheral
edema (13%), hypertension (11%), tachycardia/supraventricular
tachycardia (11%)
Central nervous system: Drug-related
fever (83%, infusion-related), fatigue (22% to 34%,
infusion-related), headache (13% to 24%), dysaesthesias
(15%), dizziness (12%), neutropenic fever (10%)
Dermatologic: Rash (30% to 40%, infusion-related),
urticaria (22% to 30%, infusion-related), pruritus (14%
to 24%, infusion-related) Gastrointestinal:
Nausea (47% to 54%), vomiting (33% to 41%), anorexia
(20%), diarrhoea (13% to 22%), stomatitis/mucositis
(14%), abdominal pain (11%) Haematologic:
Lymphopenia, severe neutropenia (64% to 70%); severe
anaemia (38% to 47%) and severe thrombocytopenia (50%
to 52%) may be prolonged and dose-limiting
Neuromuscular & skeletal: Rigors
(89%, infusion-related), skeletal muscle pain (24%),
weakness (13%), myalgia (11%)
Respiratory: Dyspnoea (17% to 26%,
infusion-related), cough (25%), bronchitis/pneumonitis
(21%), pharyngitis (12%) |
30mg
vials |
| Ibritumomab |
Zevalin® |
CD20 |
FDA
approved use: Treatment of relapsed or refractory
low-grade, follicular, or transformed B-cell non-Hodgkin's
lymphoma (including rituximab-refractory follicular
non-Hodgkin's lymphoma) as part of a therapeutic regimen
with rituximab |
Central
nervous system: Chills (24%), fever (17%),
pain (13%), headache (12%)
Gastrointestinal: Nausea (31%), abdominal
pain (16%), vomiting (12%)
Haematologic: Thrombocytopenia (95%),
neutropenia (77%), anaemia (61%) Nadir: 7-9 weeks Recovery:
22-35 days
Neuromuscular & skeletal: Weakness
(43%)
Respiratory: Dyspnoea (14%) |
3.2
mg vials
|
| Rituximab |
Mabthera® |
CD20 |
FDA
approved use: Treatment of relapsed or refractory
CD20- positive, B-cell non-Hodgkin's lymphoma
|
>10%:
Central nervous system: Headache, fever,
chills.
Gastrointestinal: Nausea Hematologic:
Leukcopenia Neuromuscular & skeletal:
Asthenia
Infusion-related: An infusion-related
symptom complex consisting of fever and chills/rigors
occurred in the majority of patients during the first
rituximab infusion. The incidence of infusion-related
events decreased from 80% during the first to ~40% with
subsequent infusions. Mild to moderate hypotension requiring
interruption of rituximab infusion, with or without
the intravenous infusion of saline, occurred in 10%.
Angio-oedema was reported in 13%. |
100
mg and 500 mg vials |
| Tositumomab |
BexxarR |
CD20 |
FDA
approved use: Treatment of relapsed or refractory
CD20 positive, follicular, non-Hodgkin's lymphoma |
Central
nervous system: Fever (37%), pain (19%), chills
(18%), headache (16%)
Dermatologic: Rash (17%) Gastrointestinal:
Nausea (36%), abdominal pain (15%), vomiting (15%),
anorexia (14%), diarrhoea (12%)
Haematologic: Neutropenia (grade 3
or 4, 63%); thrombocytopenia (grade 3 or 4, 53%) Time
to nadir: 4-7 weeks Duration: 30 days (>90 days in
5% to 7% of patients) Neuromuscular & skeletal:
Weakness (46%), myalgia (13%) Respiratory:
Cough (21%), pharyngitis (12%), dyspnoea (11%)
Infusion-related: (26%) Occurred within
14 days of infusion, included bronchospasm, chills,
dyspnea, fever, hypotension, nausea, rigors, diaphoresis.
|
35
mg and 225 mg vials |
| Gemtuzumab |
Mylotarg® |
CD33 |
FDA
approved use: Treatment of acute myeloid leukaemia
(CD33 positive) in first relapse in patients who are
60 years of age and who are not considered candidates
for cytotoxic chemotherapy.
|
Cardiovascular:
Peripheral edema (21%), hypertension (20%), hypotension
(16%) Central nervous system: Chills
(66%), fever (80%), headache (26%), pain (25%), dizziness
(11%), insomnia (18%) Dermatologic:
Rash (23%), petechiae (21%), ecchymosis (15%)
Endocrine & metabolic: Hypokalaemia
(30%) Gastrointestinal: Nausea (64%),
vomiting (55%), diarrhoea (38%), anorexia (31%), abdominal
pain (29%), constipation (28%), stomatitis/mucositis
(25%), abdominal distention (11%), dyspepsia (11%)
Haematologic: Neutropenia (98%; median
recovery 40.5 days), thrombocytopenia (99%; median recovery
39 days); anaemia (47%), bleeding (15%), lymphopenia
Hepatic: Hyperbilirubinemia (23%)
increased LDH (18%), increased transaminases (9% to
17%)
Local: Local reaction (25%) Neuromuscular
& skeletal: Weakness (45%), back pain (18%)
Respiratory: Dyspnoea (36%), epistaxis
(29%; severe 3%), cough (19%), pharyngitis (14%) |
5
mg vials |
|
Ms Lita Chew
Manager
Onco Pharmacy
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