THERAPEUTICS

Brands

• Revimmune, Cytoxan, Neosar, Endoxan, Procytox

Generic?

• Yes

Class

• Immunosuppressant

Commonly Prescribed for

(FDA approved in bold)

• Treatment of malignancies, including lymphomas (lymphocytic, mixed-cell type, histiocytic, Burkitt’s, and Hodgkin’s disease), disseminated neuroblastoma, ovarian adenocarcinoma, and breast

• Other malignancies: bronchogenic, small cell lung, endometrial, prostate, testicular, and sarcomas

• Mycosis fungoides

• “Minimal change” nephrotic syndrome in children

• Myasthenia gravis (MG)

• Multiple sclerosis (MS) (relapsingremitting)

• Neuromyelitis optica

• Polymyositis and dermatomyositis

• Multifocal motor neuropathy

• Vasculitis including Wegener’s granulomatosis, polyarteritis nodosa

• Rheumatoid arthritis

• Systemic lupus erythematosus

• Bone marrow transplantation

How the Drug Works

• An alkylating agent and non-specific cellcycle inhibitor with metabolites that interfere with the growth of rapidly proliferating normal and malignant cells, most likely by cross-linking of tumor cell DNA

How Long Until It Works

• Within a week, but effect on neurological diseases may take months

If It Works

• MG: may allow improvement in symptoms or reduction in dose or discontinuation of corticosteroids or other agents

• MS: may reduce relapses and new lesions on MRI

• Other disorders: improves symptoms (weakness, sensory changes) and clinical marker of the disease

If It Doesn't Work

• Usually used as a disease modifying agent in refractory cases when first-line agents have failed

Best Augmenting Combos for Partial Response or Treatment-Resistance

• Often used in combination with other agents depending on the disease in question, such as corticosteroids for vasculitis or MG and plasma exchange for multifocal motor neuropathy

Tests

• Obtain CBC regularly during treatment to determine WBC and platelet counts. Examine urine

ADVERSE EFFECTS (AEs)

How the Drug Causes AEs

• Immunosupression, lymphopenia, and risk of secondary neoplasia

Notable AEs

• Nausea and vomiting, anorexia, abdominal pain, diarrhea, darkening of the skin/nails, alopecia, delay in wound healing, and lethargy. Hemorrhagic cystitis is common but preventable with the detoxifying agent mesna. May cause sterility (usually temporary) in women (amenorrhea is common) and men (decreased sperm count and increased gonadotropin levels)