• Palliative treatment of the following:
  • Hodgkin's lymphoma,
  • Lymphocytic lymphoma,
  • Histiocytic lymphoma,
  • Advanced mycosis fungoides,
  • Testicular carcinoma,
  • Kaposi's sarcoma,
  • Breast cancer.

Contraindicated in:

• Hypersensitivity
• OB: Pregnancy
• Lactation: Lactation.

Use Cautiously in:

• Infection
• ↓bone marrow reserve
• Hepatic impairment (↓ dose by 50% if serum bilirubin >3 mg/dL)
• Women of reproductive potential

Derm: alopecia, dermatitis, vesiculation.

Endo: syndrome of inappropriate antidiuretic hormone (SIADH).

GI: nausea, vomiting, anorexia, constipation, diarrhea, stomatitis.

GU: gonadal suppression.

Hemat: anemia, leukopenia, thrombocytopenia.

Local: phlebitis at IV site.

Metab: hyperuricemia.

Neuro: depression, neuritis, paresthesia, peripheral neuropathy, SEIZURES, weakness.

Resp: BRONCHOSPASM.

Drug-Drug:

• Additive bone marrow depression with other antineoplastics or radiation therapy.
• Bronchospasm may occur in patients who have been previously treated with mitomycin.
• May ↓ antibody response to live-virus vaccines and ↑ risk of adverse reactions.
• May ↓ phenytoin levels.

(Generic available)

• Solution for injection: 1 mg/mL;

• IV (Adults): Initial: 3.7 mg/m² (100 mcg/kg), single dose; ↑ weekly as tolerated by 1.8 mg/m² (50 mcg/kg) to maximum of 18.5 mg/m² (usual dose is 5.5–7.4 mg/m²). Maintenance: 10 mg 1–2 times/mo or one increment less than last dose every 7–14 days.
• IV (Children): Initial: 2.5 mg/m², single dose; ↑ weekly as tolerated by 1.25 mg/m² to maximum of 7.5 mg/m². Maintenance: one increment less than last dose every 7 days.

• Binds to proteins of mitotic spindle, causing metaphase arrest. Cell replication is stopped as a result (cell cycle–specific for M phase).

• Death of rapidly replicating cells, particularly malignant ones.

Therapeutic Classification: antineoplastics

Pharmacologic Classification: vinca alkaloids

Absorption: IV administration results in complete bioavailability.

Distribution: Does not cross the blood-brain barrier well.

Metabolism/Excretion: Converted by the liver to an active antineoplastic compound; excreted in the feces via biliary excretion, with some renal elimination.

Half-life: 24 hr.

(effects on WBC counts)

• Advise patient to notify health care professional if fever; chills; sore throat; signs of infection; bleeding gums; bruising; petechiae; or blood in urine, stool, or emesis occurs. Caution patient to avoid crowds and persons with known infections. Instruct patient to use soft toothbrush and electric razor. Caution patient not to drink alcoholic beverages or take products containing aspirin or NSAIDs.
• Instruct patient to inspect oral mucosa for redness and ulceration. Advise patient that, if ulceration occurs, to avoid spicy foods, use sponge brush, and rinse mouth with water after eating and drinking. Topical agents may be used if mouth pain interferes with eating. Stomatitis pain may require treatment with opioid analgesics.
• Instruct patient to report symptoms of neurotoxicity (paresthesia, pain, difficulty walking, persistent constipation).
• Advise patient that jaw pain, pain in organs containing tumor tissue, nausea, and vomiting may occur. Avoid constipation and report other adverse reactions.
• Discuss with patient the possibility of hair loss. Explore coping strategies.
• Instruct patient not to receive any vaccinations without advice of health care professional.
• Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
• May cause fetal harm. Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected and to avoid breastfeeding during therapy. Contraception should be used during and for at least 2 mo after therapy is concluded. If chemotherapy is indicated, avoid during the first trimester, leave a 3-wk time period between the last chemotherapy dose and anticipated delivery, and do not administer chemotherapy beyond week 33 of gestation. If treatment cannot be deferred until after delivery in patients with early stage Hodgkin's lymphoma, may be administered safely and effectively in the latter phase of pregnancy. Advise patient to enroll in the pregnancy registry for all cancers diagnosed during pregnancy at Cooper Health (877-635-4499).
• Emphasize need for periodic lab tests to monitor for side effects.

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