BNF for Children 2011-2012

428 8.1.5 Other antineoplastic drugs BNFC 2011–20128 Malignant disease and immunosuppressionIndication and doseAcute lymphoblastic leukaemia, acute myeloidleukaemia, non-Hodgkin’s lymphoma. By intravenous, intramuscular or subcutaneousinjectionConsult local treatment protocol for detailsErwinase c (EUSA Pharma) AInjection, powder for reconstitution, crisantaspase,net price 10 000-unit vial = £301.70PreparationsPreparations of asparaginase derived from Escherichiacoli are available but they are not licensed, theyinclude: Medac c asparaginase, Elspar c asparaginase,and Oncaspar c pegaspargase.Dacarbazine and temozolomideDacarbazine is a component of a commonly usedcombination for Hodgkin’s disease (ABVD—doxorubicin[previously Adriamycin c ], bleomycin, vinblastine,and dacarbazine). It is given intravenously.Temozolomide is structurally related to dacarbazineand is used in children for second-line treatment ofmalignant glioma.DACARBAZINECautions see section 8.1; caution in handlingHepatic impairment dose reduction may be requiredin combined hepatic and renal impairment; avoid insevere impairmentRenal impairment dose reduction may be required incombined renal and hepatic impairment; avoid insevere impairmentPregnancy avoid (carcinogenic and teratogenic inanimal studies); ensure effective contraception duringand for at least 6 months after treatment in men orwomen; see also Pregnancy and Reproductive Function,p. 416Breast-feeding discontinue breast-feedingSide-effects see section 8.1; also anorexia; less commonlyfacial flushing, confusion, headache, seizures,facial paraesthesia, influenza-like symptoms, blurredvision, renal impairment, rash; rarely diarrhoea,hepatotoxicity including liver necrosis and hepaticvein thrombosis, photosensitivity, irritant to skin andtissues, injection-site reactionsIndication and doseHodgkin’s disease, paediatric solid tumours. By intravenous injection or by intravenousinfusionConsult local treatment protocol for detailsDacarbazine (Non-proprietary) AInjection, powder for reconstitution, dacarbazine (ascitrate), net price 100-mg vial = £5.05; 200-mg vial =£7.16; 500-mg vial = £16.50; 600-mg vial = £22.50; 1-gvial = £31.80TEMOZOLOMIDECautions see section 8.1; interactions: Appendix 1(temozolomide)Hepatic impairment use with caution in severeimpairment—no information availableRenal impairment manufacturer advises caution—noinformation availablePregnancy avoid (teratogenic and embryotoxic inanimal studies); manufacturer advises adequatecontraception during treatment; men should avoidfathering a child during and for at least 6 months aftertreatment; see also Pregnancy and ReproductiveFunction, p. 416Breast-feeding discontinue breast-feedingSide-effects see section 8.1Indication and doseTreatment of malignant glioma. By mouthConsult local treatment protocol for detailsTemozolomide (Non-proprietary) ACapsules, temozolomide 5 mg, net price 5-cap pack =£13.58; 20 mg, 5-cap pack = £54.30; 100 mg, 5-cappack = £271.52; 140 mg, 5-cap pack = £380.18;180 mg, 5-cap pack = £488.74; 250 mg, 5-cap pack =£678.80. Label: 23, 25Brands include Temomedac cTemodal c (Schering-Plough) ACapsules, temozolomide 5 mg (green/white), netprice 5-cap pack = £16.29; 20 mg (yellow/white), 5-cap pack = £65.16; 100 mg (pink/white), 5-cap pack =£325.80; 140 mg (blue/white), 5-cap pack = £456.12;180 mg (orange/white), 5-cap pack = £586.44; 250 mg(white), 5-cap pack = £814.50. Label: 23, 25ImatinibImatinib, a tyrosine kinase inhibitor, has recently beenlicensed in children for the treatment of newly diagnosedPhiladelphia-chromosome-positive chronicmyeloid leukaemia when bone marrow transplantationis not considered first line treatment, and for Philadelphia-chromosome-positivechronic myeloid leukaemiain chronic phase after failure of interferon alfa, or inaccelerated phase, or in blast crisis.IMATINIBCautions see section 8.1; cardiac disease; monitor forfluid retention; monitor liver function (see alsoHepatic Impairment, below); interactions: Appendix1 (imatinib)Hepatic impairment start with minimum recommendeddose; reduce dose further if not tolerated;consult local treatment protocolRenal impairment start with minimum recommendeddose; reduce dose further if not tolerated; consultlocal treatment protocolPregnancy manufacturer advises avoid unless potentialbenefit outweighs risk; effective contraceptionrequired during treatment; see also Pregnancy andReproductive Function, p. 416Breast-feeding discontinue breast-feedingSide-effects see section 8.1; also abdominal pain,appetite changes, constipation, diarrhoea, flatulence,gastro-oesophageal reflux, taste disturbance, weightchanges, dry mouth; oedema (including pulmonaryoedema, pleural effusion, and ascites), flushing,haemorrhage; cough, dyspnoea; dizziness, headache,insomnia, hypoaesthesia, paraesthesia, fatigue; influenza-likesymptoms; cramps, arthralgia; visual disturbances,lacrimation, conjunctivitis, dry eyes; epis-