BNF for Children 2011-2012

414 BNFC 2011–20128 Malignant disease andimmunosuppression8 Malignant disease and immunosuppression8.1 Cytotoxic drugs 4148.1.1 Alkylating drugs 4198.1.2 Cytotoxic antibiotics 4218.1.3 Antimetabolites 4238.1.4 Vinca alkaloids and etoposide 4268.1.5 Other antineoplastic drugs 4278.2 Drugs affecting the immuneresponse 4318.2.1 Antiproliferative immunosuppressants4318.2.2 Corticosteroids and otherimmunosuppressants 4338.2.3 Rituximab and alemtuzumab 4388.2.4 Other immunomodulating drugs 4398.3 Sex hormones and hormoneantagonists in malignant disease4418.1 Cytotoxic drugs8.1.1 Alkylating drugs8.1.2 Cytotoxic antibiotics8.1.3 Antimetabolites8.1.4 Vinca alkaloids and etoposide8.1.5 Other antineoplastic drugsThe management of childhood cancer is complex and isgenerally confined to specialist regional centres andsome associated shared-care units.Cytotoxic drugs have both anti-cancer activity and thepotential for damage to normal tissue. In children,chemotherapy is almost always started with curativeintent, but may be continued as palliation if the diseaseis refractory.Chemotherapy with a combination of two or morecytotoxic drugs aims to reduce the development ofresistance and to improve cytotoxic effect. Treatmentprotocols generally incorporate a series of treatmentcourses at defined intervals with clear criteria forstarting each course, such as adequate bone-marrowrecovery and renal or cardiac function. The principalcomponent of treatment for leukaemias in children iscytotoxic therapy, whereas solid tumours may be managedwith surgery or radiotherapy in addition tochemotherapy.Guidelines for handling cytotoxic drugs. Trained personnel should reconstitute cytotoxics;. Reconstitution should be carried out in designatedpharmacy areas;. Protective clothing (including gloves, gowns,and masks) should be worn;. The eyes should be protected and means of firstaid should be specified;. Pregnant staff should avoid exposure to cytotoxicdrugs (all females of child-bearing ageshould be informed of the reproductive hazard);. Use local procedures for dealing with spillagesand safe disposal of waste material, includingsyringes, containers, and absorbent material;. Staff exposure to cytotoxic drugs should bemonitored.Only medical or nursing staff who have received appropriatetraining should administer parenteral cytotoxics.In most instances central venous access will be requiredfor the intravenous administration of cytotoxics to children;care is required to avoid the risk of extravasation(see Side-effects of Cytotoxic Drugs and their Management).