Chemotherapy cyclophosphamide

Besides being used as an alkylating agent in cancer chemotherapy, cyclophosphamide is a unique drug when used as an immunosuppressant. First, it is the most powerful of all such drugs. Second, it kills proliferating cells, and evidently alkylates a certain region of... 

The following drug classes may have a potential drug interaction with nevirapine Antiarrhythmics, anticonvulsants, antifungals, calcium channel blockers, cancer chemotherapy (cyclophosphamide), ergot alkaloids, immunosuppressants, motility agents, opiate agonists. 

The NCIC randomized patients to radiation therapy started either early or late with concurrent chemotherapy (cyclophosphamide, doxorubicin, and vincristine alternating with cisplatin and etoposide) (6). The radiation therapy dose was 40 Gy given in 15 fractions over three weeks with the cisplatin and etoposide portion of the chemotherapy. In the early arm the radiation was started on d 21 of cycle 2 (after the first cycle... 

Chemotherapy Cyclophosphamide, erlotlnlb, ifos-famide, paclitaxel, tamoxifen, vinblastine, vincristine HIV protease inhibitors Amprenavir, atazanavir, indinavir, nelfinavir, ritonavir, saquinavir HMG-CoA reductase inhibitors Atorvastatin, lovastatin, simvastatin... 

Non-Hodgkin s lymphoma Combination chemotherapy cyclophosphamide, doxorubicin, vincristine, prednisone Bleomycin, lomustine, carmustine, etoposide, interferon, mitoxantrone, ifosfamide, rituximab... 

Multiple myeloma Melphalan plus prednisone or multiagent combination chemotherapy Cyclophosphamide, vincristine, carmustine, interferon, doxorubicin, epoetin alfa1... 

Etretinate. A man with T-cell lymphoma who had recently been given chemotherapy (cyclophosphamide, doxorubicin, vincristine and prednisolone) was anticoagulated with warfarin after developing a pulmonary embolism. About three weeks later, he started etretinate 40 mg daily and it was found necessary to increase his warfarin dosage from 7 to 10 mg daily. His liver function tests were normal. This patient had also recently started taking co-proxamol , (p.436), tolbutamide , (p.380) and cimeti-dine , (p.412) , but all of these have been reported to only rarely increase the effect of warfarin. 

Ligustrum preparations (i.g. or i.m.) inhibited or prevented the leukopenia caused by chemotherapy (cyclophosphamide) and... 

Risk factors for the development of AML include exposure to environmental toxins, Hispanic ethnicity, and genetics.6 Of greater concern is the increased prevalence of AML as a secondary malignancy, resulting from chemotherapy and radiation treatment for other cancers. Alkylating agents, such as ifosfamide and cyclophosphamide, and topoisomerase inhibitors, such as etoposide, are linked to an increased risk of myelodysplastic syndrome (MDS) and AML.8... 

Moderate Anthracydine + cyclophosphamide Days 2 and 3 after chemotherapy ... 

Recurrent SCLC is usually less sensitive to chemotherapy. If recurrence is more than 6 months after induction chemotherapy, the original regimen can be repeated. If recurrence occurs in less than 6 months but >3 months, treatment options include a taxane, gemcitabine, topotecan, irinotecan, CAV (cyclophosphamide, doxorubicin, and vincristine), and vinorelbine. 

Standard combination regimens (e.g., CHOP) yield disappointing results. Newer approaches including dose-adjusted EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin), and rituximab-containing combination chemotherapy are promising. 

Cyclophosphamide (Cytotoxin) Alkylating agent cancer chemotherapy transplant rejection rheumatoid arthritis Decreased Ts cells, B cells, and NK cells... 

Some lymphomas, for example, are related to overexpression of Bcl-2. Antisense oligonucleotides are specially designed to target the overexpression of Bcl-2. Oblimersen (Genasense) is an antisense drug by Genta to block Bcl-2 production and enhance the efficacy of other standard chemotherapy drugs such as paclitaxel, fludarabine, irinotecan, and cyclophosphamide. 

THC is effective in several chemotherapy regimens, including methotrexate and the doxorubicin/cyclophosphamide/fluorouracil combination. Cisplatin treatment, however, is more resistant. Side effects of THC are generally well tolerated, and use may be limited in the elderly or with higher doses. Nabilone is a synthetic cannabinoid that is more effective than prochlorperazine in chemotherapy-induced emesis, including cisplatin. Its side effects are similar to THC. Levonantradol is another synthetic cannabinoid with antiemetic effects, and may be administered orally or intramuscularly. The side effect of dysphoria may limit its use. 

CyEP, cyclophosphamide/etoposide/cisplatin EP, etoposide/cisplatin NCI, National Cancer Institute PIM, cisplatin/ifosfarnide/mitomycin VdP, vindesine/ cisplatin preop., preoperatively postop., postoperatively ChT, chemotherapy NS, not significant. 

Other studies evaluated the question of whether early delivery of radiation concurrently with chemotherapy was better than late delivery. A study performed by the C ALGB randomized patients to early (d 1, cycle 1), late (d 64, cycle 4), or no radiation therapy. The radiation therapy dose was 50 Gy over 6 wk. Chemotherapy used in this trial was cyclophosphamide, etoposide, and vincristine. The local recurrence rate for the early, late, and no radiation therapy arms was 49%, 68%, and 82%, respectively. The 2-yr progression-free survival rate was 15% for the early schedule arm vs 25% for the late schedule (p = 0.078). The 5-yr survival rate for the early, late, and no radiation therapy arms was 6.6%, 12%, and 3%, respectively (p = 0.007). The poor 5-yr survival rate for the early schedule was felt to be due to the significant decrease in chemotherapy dose needed for the early schedule group (4,49). 

The EORTC randomized patients to either start radiation therapy during wk 6 (early) or after the chemotherapy during wk 14 (late). The chemotherapy regimen used was cyclophosphamide, doxorubicin, and etoposide. The dose of radiation given in the early arm was 50 Gy in 20 fractions in 89 d. The dose of radiation given in the late arm was 50 Gy in 20 fractions in 26 d. No significant differences were noted for local recurrence (50.5% early radiation vs 45.5% late radiation) or 3-yr survival (14% for both early and late radiation therapy) (51). 

Maloisel F, Dufour P, Bergerat JP, et al. Results of initial doxorubicin, 5-fluorouracil, and cyclophosphamide combination chemotherapy for inflammatory carcinoma of the breast. Cancer 1990 65 851-855. 

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