BNF for Children 2011-2012

430 8.1.5 Other antineoplastic drugs BNFC 2011–20128 Malignant disease and immunosuppressionIndication and doseStage 4 neuroblastoma, germ cell tumours,low-grade gliomas (including astrocytomas),neuroectodermal tumours (including medulloblastoma),rhabdomyosarcoma (metastatic andnon-metastatic disease), soft-tissue sarcomas,retinoblastoma, high risk Wilms’ tumour, someliver tumours. By intravenous infusionConsult local treatment protocol for detailsCarboplatin (Non-proprietary) AInjection, carboplatin 10 mg/mL, net price 5-mL vial= £22.04, 15-mL vial = £56.92, 45-mL vial = £168.85,60-mL vial = £260.00CISPLATINCautions see section 8.1 and notes above; monitor fullblood count, renal function, audiology, and plasmaelectrolytes; interactions: Appendix 1 (platinumcompounds)Renal impairment avoid if possible—nephrotoxicPregnancy avoid (teratogenic and toxic in animalstudies); manufacturer advises effective contraceptionduring and for at least 3 months after treatment inmen or women; see also Pregnancy and ReproductiveFunction, p. 416Breast-feeding discontinue breast-feedingSide-effects see section 8.1 and notes above; alsoperipheral neuropathy; hypophosphataemia, hypocalcaemia,hyperuricaemia also reportedLicensed use not licensed for use in childrenIndication and doseOsteogenic sarcoma, stage 4 neuroblastoma,some liver tumours, infant brain tumours,intracranial germ-cell tumours. By intravenous infusionConsult local treatment protocol for detailsCisplatin (Non-proprietary) AInjection, cisplatin 1 mg/mL, net price 10-mL vial =£5.85, 50-mL vial = £24.50, 100-mL vial = £50.22Injection, powder for reconstitution, cisplatin, netprice 50-mg vial = £17.00ProcarbazineProcarbazine is most often used in Hodgkin’s disease. Itis given by mouth. It is a weak monoamine-oxidaseinhibitor and dietary restriction is rarely considerednecessary. Alcohol ingestion may cause a disulfiramlikereaction.PROCARBAZINECautions see section 8.1 and notes above; interactions:Appendix 1 (procarbazine)Hepatic impairment caution in mild to moderateimpairment; avoid in severe impairmentRenal impairment caution in mild to moderateimpairment; avoid in severe impairmentPregnancy avoid (teratogenic in animal studies andisolated reports in humans); see also Pregnancy andReproductive Function, p. 416Breast-feeding discontinue breast-feedingSide-effects see section 8.1 and notes above; hypersensitivityrash (discontinue treatment)Indication and doseHodgkin’s lymphoma, gliomas. By mouthConsult local treatment protocol for detailsProcarbazine (Non-proprietary) ACapsules, ivory, procarbazine (as hydrochloride)50 mg, net price 50-cap pack = £199.60. Label: 4Extemporaneous formulations available seeExtemporaneous Preparations, p. 6TretinoinTretinoin is licensed for the induction of remission inacute promyelocytic leukaemia. It is used in previouslyuntreated children as well as in those who have relapsedafter standard chemotherapy or who are refractory to it.TRETINOINNote Tretinoin is the acid form of vitamin ACautions exclude pregnancy before starting treatment,see also Pregnancy below; monitor full bloodcount and coagulation profile, liver function, serumcalcium and plasma lipids before and during treatment;increased risk of thrombo-embolism during firstmonth of treatment; interactions: Appendix 1 (retinoids)Hepatic impairment reduce dose—consult localtreatment protocol for detailsRenal impairment reduce dose—consult local treatmentprotocol for detailsPregnancy teratogenic; effective contraception mustbe used for at least 1 month before oral treatment,during treatment and for at least 1 month after stopping(oral progestogen-only contraceptives not consideredeffective); see also Pregnancy and ReproductiveFunction, p. 416Breast-feeding discontinue breast-feedingSide-effects retinoic acid syndrome (fever, dyspnoea,acute respiratory distress, pulmonary infiltrates,pleural effusion, hyperleukocytosis, hypotension,oedema, weight gain, hepatic, renal and multi-organfailure) requires immediate treatment—consult productliterature; gastro-intestinal disturbances, pancreatitis;arrhythmias, flushing, oedema; headache,benign intracranial hypertension (children particularlysusceptible—consider dose reduction if intractableheadache), shivering, dizziness, confusion, anxiety,depression, insomnia, paraesthesia, visual and hearingdisturbances (children particularly susceptible tonervous system effects); raised liver enzymes, serumcreatinine and lipids; bone and chest pain, alopecia,erythema, rash, pruritus, sweating, dry skin andmucous membranes, cheilitis; thromboembolism,hypercalcaemia, and genital ulceration reportedIndication and doseAcute promyelocytic leukaemia. By mouthConsult treatment protocol for detailsVesanoid c (Roche) ACapsules, yellow/brown, tretinoin 10 mg, net price100-cap pack = £160.63. Label: 21, 25