Cytotoxic drugs, monitoring

In oncology, to study the relationship between the normal and the tumour cell, to detect tumour-associated antigens (CEA, carcino-embryonic antigen, and AFP, a-fetoprotein) and subsequently to enable cancer therapy to be monitored, to locate tumour metastases, and to deliver cytotoxic drugs, toxins, radionuclides, or liposomes to tumour cells. 

Therapeutic Drug Monitoring in Conventional Cytotoxic Chemotherapy... 

Lennard L (2001) Therapeutic drug monitoring of cytotoxic drugs. Br J Clin Pharmacol 52(Suppl 1) 75S-87S... 

Patients receiving cytotoxic drug treatment should be evaluated for drug-related toxicities every week during the initial treatment period. After 1 month of treatment, the frequency of monitoring may be reduced. When the patient is on long-term steroid treatment, monthly visits are often required for assessment of both efficacy and toxicities. If a favorable response is obtained after a course of treatment, the patient may be evaluated every 3 to 4 months. The patient s renal function, proteinuria, urinalysis, blood pressure, lipid profile. 

CONSTRUCTION OF A NOVEL BIOLUMINESCENT BACTERIAL BIOSENSOR FOR REAL-TIME MONITORING OF CYTOTOXIC DRUGS ACTIVITY... 

TCAs FLUOROURACIL, IMATINIB, LEFLUNOMIDE Possible t plasma concentrations of these cytotoxics Inhibition of CYP2C9-mediated metabolism. The clinical significance of this depends upon whether alternative pathways of metabolism are also inhibited by co-administered drugs Warn patients to report t side-effects and monitor blood count carefully... 

MITOMYCIN CYTOTOXICS-VINCA ALKALOIDS t risk of abrupt onset of pulmonaiy toxicity in 3-6% of patients, when two courses of these drugs are administered concurrently Mechanism is uncertain possible additive pulmonary toxic effects Monitor clinically and with lung function tests for pulmonary toxicity. Advise patients to report immediately symptoms such as shortness of breath and wheezing... 

IL-2 CYTOTOXICS -DACARBAZINE 1 efficacy of dacarbazine -l AUC of dacarbazine due to 1 volume of distribution The clinical significance is uncertain as both drugs are used in the treatment of melanoma. It may be necessary to monitor clinically and by other appropriate measures of clinical response... 

LEVAMISOLE ANTICANCER AND IMMUNOMODULATING DRUGS-FLUOROURACIL t risk of hepatotoxicity and neurotoxicity despite t cytotoxic effects Antiphosphatase activity of levamisole may t fluorouracil cytotoxicity This combination has been used successfully in the treatment of colon cancer. Monitor FBC and LFTs regularly. Advise patients to report symptoms such as diarrhoea, numbness and tingling and peeling of the skin of the hands and feet (hand-foot syndrome)... 

In contrast to the case of a drug causing bone marrow depression as a pharmacodynamic dose-related effect, when blood counts are part of the essential routine monitoring of therapy, e.g. cytotoxics. 

Candida albicans) after they received high doses of cytotoxic, immunosuppressive, or corticosteroid drugs. By monitoring the D/L arabinitol ratio, fungal infections can be diagnosed early enough to permit effective—in some cases, life-saving—treatment. The separation of trifluoroacetylated arabinitol is depicted in Fig. 14,... 

Drugs for which concentration assays are clearly unsuited include acute therapies (i.e. not used at steady state), those with extraordinarily short half-times (e.g. injected or intranasal polypeptides) and those for which either treatment is indicated regardless (late acetaminophen/parace-tamol overdoses, see above), or when adverse events are almost automatic and should be monitored in other ways, for example CNS toxicity with salicylates (see above) or liability to bone marrow suppression with cytotoxic agents. Furthermore, the efficacy and tolerability of some drugs are known to be unrelated to circulating concentrations (e.g. penicillin anaphylaxis),... 

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