Other immunomodulating drugs 492 surgery or both as either neoadjuvant treatment (initial chemotherapy aimed at shrinking the primary tumour,

8.2.4 Other immunomodulating drugs 492 surgery or both as either neoadjuvant treatment (initial chemotherapy aimed at shrinking the primary tumour,

8.3 Sex hormones and hormone

thereby rendering local therapy less destructive or more

antagonists in malignant dis-

effective) or as adjuvant treatment (which follows defi-

ease

496 nitive treatment of the primary disease, when the risk of

8.3.1 Oestrogens

sub-clinical metastatic disease is known to be high). All chemotherapy drugs cause side-effects and a balance

8.3.2 Progestogens

has to be struck between likely benefit and acceptable

8.3.3 Androgens

toxicity.

8.3.4 Hormone antagonists

Guidelines for handling cytotoxic drugs:

Malignant

8.3.4.1 Breast cancer

1. Trained personnel should reconstitute cyto-

8.3.4.2 Prostate cancer and gonadorelin

toxics;

analogues

2. Reconstitution should be carried out in desig-

8.3.4.3 nated areas; Somatostatin analogues

disease

3. Protective clothing (including gloves, gowns, and masks) should be worn;

4. The eyes should be protected and means of first aid should be specified;

and

5. Pregnant staff should avoid exposure to cyto- toxic drugs (all females of child-bearing age

immunosupp

should be informed of the reproductive hazard);

6. Use local procedures for dealing with spillages and safe disposal of waste material, including syringes, containers, and absorbent material;

7. Staff exposure to cytotoxic drugs should be monitored.

ressio n

8.1 Cytotoxic drugs BNF 57 Intrathecal chemotherapy Once a sore mouth has developed, treatment is much

less effective. Saline mouthwashes should be used but

A Health Service Circular (HSC 2003/010) provides there is no good evidence to support the use of anti- guidance on the introduction of safe practice in NHS

septic or anti-inflammatory mouthwashes. In general, Trusts where intrathecal chemotherapy is adminis-

mucositis is self-limiting but with poor oral hygiene it tered. Support for training programmes is also avail-

can be a focus for blood-borne infection. able.

Tumour lysis syndrome Tumour lysis syndrome can Department of Health

Copies, and further information may be obtained from:

occur as a result of massive cell breakdown following PO Box 777

treatment of cancer sensitive to the chemotherapy. London SE1 6XH

Features include hyperkalaemia, hyperuricaemia (see Fax: 01623 724524

below), and hyperphosphataemia with hypocalcaemia; It is also available from the Department of Health

renal damage and arrhythmias can follow. website ( www.dh.gov.uk )

Hyperuricaemia Hyperuricaemia, which may be pre- sent in high-grade lymphoma and leukaemia, can be

n markedly worsened by chemotherapy and is associated

Combinations of cytotoxic drugs are frequently more

toxic than single drugs but have the advantage in certain with acute renal failure. Allopurinol (section 10.1.4) tumours of enhanced response, reduced development of

should be started 24 hours before treating such tumours essio drug resistance and increased survival. However for and patients should be adequately hydrated. The dose of some tumours, single-agent chemotherapy remains the mercaptopurine or azathioprine should be reduced if

treatment of choice. allopurinol needs to be given concomitantly (see Appen-

osuppr

Most cytotoxic drugs are teratogenic and all may

dix 1).

cause life-threatening toxicity; administration should Rasburicase (section 10.1.4), a recombinant urate oxi-

immun dase, is licensed for hyperuricaemia in patients with

Because of the complexity of dosage regimens in the haematological malignancy, for details, see p. 575. It

be confined to those experienced in their use.

and

treatment of malignant disease, dose statements rapidly reduces plasma uric acid and may be of parti- have been omitted from some of the drug entries

cular value in reducing complications following treat- in this chapter. In all cases detailed specialist literature

ment of leukaemias or bulky lymphomas.

should be consulted disease .

Prescriptions should not be repeated except on the Nausea and vomiting Nausea and vomiting cause instructions of a specialist.

considerable distress to many patients who receive

gnant chemotherapy and, to a lesser extent, abdominal radio-

Cytotoxic drugs fall into a number of classes, each with therapy; it may lead to refusal of further treatment. characteristic antitumour activity, sites of action, and

Mali Symptoms may be acute (occurring within 24 hours of

toxicity. A knowledge of sites of metabolism and excre- treatment), delayed (first occurring more than 24 hours