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Action/Kinetics:
Chromopeptide antibiotic produced by
Streptomyces parvullus. Acts by intercalating into the purine-pyrimidine base pair, thereby inhibiting synthesis of messenger RNA. Is cell-cycle nonspecific, although the maximum number of cells are destroyed in the G
1 phase. Cleared from the blood within 2 min and concentrated in nucleated cells.
t
1/2: 36 hr. Does not cross the blood-brain barrier and is excreted mainly unchanged.
Uses:
In combination with vincristine, surgery, and/or irradiation for treatment of Wilms' tumor (nephroblastoma) and its metastases. In combination with methotrexate to treat metastatic and nonmetastatic choriocarcinoma. In combination with cyclophosphamide, doxorubicin, and vincristine to treat rhabdomyosarcoma. Nonseminomatous testicular carcinoma. With cyclophosphamide and radiotherapy to treat Ewing's sarcoma. In combination with radiotherapy to treat sarcoma botryoides. Endometrial carcinoma.
Investigational: Ovarian cancer, Kaposi's sarcoma, osteosarcoma, malignant melanoma.
Contraindications:
Concurrent infection with chickenpox or herpes zoster (death may result). Lactation. Infants less than 6-12 months of age.
Special Concerns:
When used with X-ray therapy, erythema is seen in normal skin and the buccal and pharyngeal mucosa.
Additional Side Effects:
Appearance of toxic manifestations may be delayed by several weeks.
Anaphylaxis. Due to corrosiveness, extravasation causes severe damage to soft tissues. Hypocalcemia. When combined with radiation, increased severity of skin reactions, GI toxicity, and
bone marrow depression (irreversible in clients with preexisting renal, hepatic, or bone marrow impairment).
Laboratory Test Alterations:
Interferes with bioassay tests used to determine antibacterial drug levels.
How Supplied:
Powder for injection: 0.5 mg
Dosage
?IV
Carcinomas.
Adults, usual: 0.5 mg/m
2/week for 3 weeks; or, 0.01-0.015 mg/kg/day for a maximum of 5 days q 4-6 weeks. Dose is individualized.
Pediatric: 10-15 mcg/kg (0.45 mg/m
2) daily for 5 days;
alternatively, a total dose of 2.4 mg/m
2 over 1 week. Total daily dosage for both adults and children should not exceed 15 mcg/kg over a 5-day period. Course of treatment may be repeated after 3 weeks unless contraindicated due to toxicity. If no toxicity, second course can be given after 3 weeks.
?Isolation Perfusion
Ewing's sarcoma/sarcoma botryoides.
0.05 mg/kg for pelvis and lower extremities and 0.035 mg/kg for upper extremities.
