Ifosfamide 2 gramIfosfamide 2 g powder for concentrate for solution
for injection vials| 1 vialP£ 228. 09Melphalan
lINDICATIONS AND DOSE
High intravenous dose with haematopoietic stem cell
transplantation in the treatment of childhood
neuroblastoma and some other advanced embryonal
tumours
▶BY INTRAVENOUS INFUSION
▶Child:(consult local protocol)lUNLICENSED USENot licensed for use in embryonal
tumours.
IMPORTANT SAFETY INFORMATION
RISKS OF INCORRECT DOSING OF ORAL ANTI-CANCER MEDICINES
See Cytotoxic drugs p. 531.lCAUTIONSConsider use of prophylactic anti-infective
agents.for high-dose intravenous administration
establish adequate hydration.haematopoietic stem cell
transplantation essential for high dose treatment (consult
local treatment protocol for details)
lINTERACTIONS→Appendix 1 : alkylating agents
lSIDE-EFFECTS
▶Common or very commonAlopecia.anaemia.bone marrow
depression (delayed).diarrhoea.feeling hot.myalgia.
myopathy.nausea.paraesthesia.stomatitis.
thrombocytopenia.vomiting
▶Rare or very rareHaemolytic anaemia.hepatic disorders.
peripheral vascular disease.respiratory disorders.skin
reactions
SIDE-EFFECTS, FURTHER INFORMATION
Secondary malignancyUse of melphalan is associated
with an increased incidence of acute leukaemias.
Fluid retentionAlkylating drugs can causefluid retention
with oedema and dilutional hyponatraemia in younger
children; the risk of this complication is higher in thefirst
2 days and also when given with concomitant vinca
alkaloids.
lCONCEPTION AND CONTRACEPTIONManufacturer advises
adequate contraception during treatment in men or
women. See alsoPregnancy and reproductive functionin
Cytotoxic drugs p. 531.
lPREGNANCYAvoid. See alsoPregnancy and reproductive
functionin Cytotoxic drugs p. 531.
lBREAST FEEDINGDiscontinue breast-feeding.
lRENAL IMPAIRMENT
Dose adjustmentsReduce dose initially (consult product
literature).
lMONITORING REQUIREMENTSMonitor full blood count
before and throughout treatment.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Powder and solvent for solution for injection
▶Melphalan (Non-proprietary)
Melphalan (as Melphalan hydrochloride) 50 mgMelphalan 50 mg
powder and solvent for solution for injection vials| 1 vialP
£ 137. 37
Temozolomide
lDRUG ACTIONTemozolomide is structurally related to
dacarbazine.lINDICATIONS AND DOSE
Treatment of recurrent or progressive malignant glioma
▶BY MOUTH
▶Child 3–17 years:(consult local protocol)IMPORTANT SAFETY INFORMATION
RISKS OF INCORRECT DOSING OF ORAL ANTI-CANCER MEDICINES
See Cytotoxic drugs p. 531.lCAUTIONSPneumocystis jiroveciipneumonia—consult
product literature for monitoring and prophylaxis
requirements
lINTERACTIONS→Appendix 1 : alkylating agents
lSIDE-EFFECTS
▶Common or very commonAlopecia.anxiety.appetite
decreased.arthralgia.asthenia.chills.concentration
impaired.confusion.constipation.cough.decreased
leucocytes.diarrhoea.dizziness.drowsiness.dysphagia.
dyspnoea.emotional lability.fever.gastrointestinal
discomfort.haemorrhage.headache.hearing impairment
.hemiparesis.hyperglycaemia.hypersensitivity.
increased risk of infection.insomnia.level of
consciousness decreased.malaise.memory loss.
movement disorders.muscle weakness.nausea.
neutropenia.oedema.oral disorders.pain.peripheral
neuropathy.radiation injury.seizures.sensation
abnormal.skin reactions.speech impairment.taste
altered.thrombocytopenia.tremor.urinary disorders.
vision disorders.vomiting.weight changes
▶UncommonAltered smell sensation.anaemia.behaviour
disorder.bone marrow disorders.cognitive impairment.
condition aggravated.Cushing’s syndrome.depression.
diabetes insipidus.ear pain.erectile dysfunction.eye
pain.gait abnormal.hallucination.hepatic disorders.
hyperacusia.hyperbilirubinaemia.hypertension.
hypokalaemia.intracranial haemorrhage.myalgia.
myopathy.nasal congestion.nervous system disorder.
palpitations.photosensitivity reaction.reactivation of
infections.thirst.vasodilation
▶Rare or very rareNeoplasms.respiratory disorders.
secondary malignancy.severe cutaneous adverse
reactions (SCARs)
lCONCEPTION AND CONTRACEPTIONManufacturer advises
adequate contraception during treatment. Men should
avoid fathering a child during and for at least 6 months
after treatment. See alsoPregnancy and reproductive
functionin Cytotoxic drugs p. 531.
lPREGNANCYAvoid (teratogenic and embryotoxic inanimal
studies). See alsoPregnancy and reproductive functionin
Cytotoxic drugs p. 531.
lBREAST FEEDINGDiscontinue breast-feeding.
lHEPATIC IMPAIRMENTUse with caution in severe
impairment—no information available.
lRENAL IMPAIRMENTManufacturer advises caution—no
information available.
lMONITORING REQUIREMENTS
▶Monitor liver function before treatment initiation, after
each treatment cycle and midway through 42 -day
treatment cycles—consider the balance of benefits and
risks of treatment if results are abnormal at any point
(fatal liver injury reported).
▶Monitor for myelodysplastic syndrome.
▶Monitor for secondary malignancies.BNFC 2018 – 2019 Cytotoxic responsive malignancy 537
Immune system and malignant disease8