Cyclophosphamide | Health and Prostate

Posts Tagged ‘Cyclophosphamide’

Systemic Therapy for Bladder Cancer

Posted by admin on October 28th, 2011 No Comments

Despite radical treatments with curative intent, the chance of long-term survival for patients with muscle-invasive bladder cancer remains disappointing. In a large series of more than 1000 patients with apparently organ-confined disease, 5-year overall survival was only 47% for all muscle-invasive tumours, ranging from 72% for T2 tumours to only 33% for T4 disease. Death from bladder cancer following radical primary treatment is largely due to occult systemic disease, present at the time of surgery, which is below the limits of resolution of currently available cross-sectional imaging. This post reviews systemic therapy for muscle-invasive cancer of the urothelium and describes the common drugs that are used, the various clinical scenarios when they may be indicated and the selection of patients for treatment. Drugs in use Orthodox cytotoxic agents Transitional cell carcinoma (transitional cell carcinoma) is sensitive to a variety of drugs as shown by complete or partial response in patients with measurable metastatic or locally advanced disease. Of the older cytotoxic drugs, Read more [...]

Posted in Urological Oncology

Comparison of well-known combination regimens

Posted by admin on October 28th, 2011 No Comments

CMV and MVAC The CMV regimen is a combination of cisplatin, methotrexate and, vinblastine. In the context of a randomized controlled phase III clinical trial, treatment with CMV resulted in an objective response rate of 46%, with a median survival of 7 months. MVAC combines cisplatin with methotrexate, vinblastine and doxorubicin (Adriamycin®). In randomized controlled trials, this regimen has been found superior to single-agent cisplatin, combination chemotherapy with cisplatin, cyclophosphamide and doxorubicin (CISCA) and also methotrexate, carboplatin and vinblastine (MCAVI). For these phase III studies, overall response rates have varied between 39% and 65%, with median survivals up to 16 months. Dose escalation of MVAC has been attempted using recombinant haematopoietic growth factors. Better objective response rates have been reported with the more dose-intense regimen; this did not translate into improved time to disease progression or overall survival in a large randomized controlled trial. However, toxicity was significantly less in the accelerated arm, suggesting that the accelerated Read more [...]

Posted in Urological Oncology

Leuprolide Acetate

Posted by admin on June 24th, 2011 No Comments

C59H84N16O12•C2H4O2 • Leuprolide acetate, a synthetic nonapeptide analog of naturally occurring porcine or ovine gonadotropin releasing hormone (GnRH, luteinizing hormone releasing hormone, gonadorelin), may be used as an antineoplastic agent and for its endocrine effects. Drug Interactions The manufacturer states there are no reports to date of drug interactions with leuprolide. The manufacturer also states that because leuprolide is a peptide that is mainly degraded by peptidase and not by cytochrome P-450 microsomal enzymes and because of the drug's low degree of protein binding, drug interactions would not be expected to occur with leuprolide. There is some evidence from studies in mice to suggest that the inhibitory effect of leuprolide on spermatogenesis may be used to therapeutic advantage in the prevention of azoospermia or severe oligospermia that frequently results from therapy with cytotoxic agents. In mice receiving combined therapy with leuprolide and cyclophosphamide, testicular damage was less than that observed in animals receiving cyclophosphamide alone. It has been Read more [...]

Posted in Drugs

Chemotherapy and Immunotherapy

Posted by admin on June 21st, 2011 No Comments

Management of Hormone-Refractory Prostate Cancer: Chemotherapy and immunotherapy The effective treatment of prostate cancer patients with advanced disease is a major challenge. Metastatic disease can initially be effectively managed using the relatively nontoxic intervention of androgen ablation, that is, orchiectomy, diethylstilbestrol, and luteinizing hormone-releasing hormone analogues. As the response rate exceeds 80% and the approach affords little morbidity in comparison to the cytotoxic approaches necessary for the treatment of other epithelial malignancies, it is the therapy chosen by most patients and physicians. However, most patients eventually experience biochemical or clinical evidence of disease progression in a median time of 12 to 18 months. Second-line treatment options are then considered, and usually consist of additional hormonal manipulations. Despite this approach, progression is the norm with the development of androgen-independent or hormone-refractory prostate cancer. For patients with hormone-refractory prostate cancer, the prognosis is poor with a median survival of 9 Read more [...]

Posted in Chemotherapy and Immunotherapy

Combination Chemotherapy

Posted by admin on June 21st, 2011 No Comments

With a few notable exceptions, reported combinations of cytotoxic chemotherapeutic agents have added little benefit to single-agent chemotherapy in the treatment of hormone-refractory prostate cancer. It must be emphasized that early trials of combination chemotherapy were performed in the pre-prostate-specific antigen era with patients exhibiting very advanced and usually symptomatic hormone-refractory prostate cancer. In addition, an understanding of basic prostate cancer biology has provided insights for the rational selection of drug combinations such as Estramustine phosphate and paclitaxel targeting the cytoskeleton and nuclear matrix. Cytoxan + Methotrexate + 5-Fluorouracil The regimen of cytoxan (Cy), methotrexate, and 5-FU (CMF) is a combination active in epithelial malignancies including breast carcinoma. This regimen was evaluated in 52 eligible patients with measurable (19 patients), evaluable (29 patients), or bone scan only (4 patients) metastatic prostate cancer using a dosing schedule of 100 mg per m per day by mouth of cyclophosphamide, 15 mg per m weekly IV methotrexate, and Read more [...]

Posted in Chemotherapy and Immunotherapy

Studies in Early Stage Disease

Posted by admin on June 21st, 2011 No Comments

The bulk of the experience on "early" hormonal therapy is derived from studies conducted by the Veterans Administration Cooperative Urological Research Group (VAC-URG) (discussed in the next section) and adjuvant or neoadjuvant hormonal trials in conjunction with definitive local therapy. Data summarized below suggest that hormonal therapy as part of a multimodal approach in the initial management of localized prostate cancer resulted in an improvement in disease-free survival and delayed progression. Conclusive evidence for absolute improvement in survival is yet to be demonstrated. There was a significant disease-free survival advantage noted at 5, 10, and 15 years in favor of diethylstilbestrol plus radiation therapy compared to radiation therapy only in patients with locally advanced prostate cancer. The authors attributed the lack of an overall survival advantage to the greater intercurrent disease-related mortality in the diethylstilbestrol-treated patients. Another study conducted by the National Prostate Cancer Project (NPCP) randomized patients following radical prostatectomy or radiation Read more [...]

Posted in Hormonal Therapy

Docetaxel

Posted by admin on November 8th, 2010 No Comments

(British Approved Name, US Adopted Name, rINN) Drug Nomenclature International Nonproprietary Names (INNs) in main languages (French, Latin, Russian, and Spanish): Synonyms: Docetaxel; Docetaxol; Docetaxolum; Dosetaksoli; NSC-628503; RP-56976 BAN: Docetaxel USAN: Docetaxel INN: Docetaxel [rINN (en)] INN: Docetaxel [rINN (es)] INN: Docétaxel [rINN (fr)] INN: Docetaxelum [rINN (la)] INN: Доцетаксел [rINN (ru)] Chemical name: (2R,3S)-N-Carboxy-3-phenylisoserine, N-tert-butyl ester, 13-ester with 5β-20-epoxy-1,2α,4,7β,10β,13α-hexahydroxytax-11-en-9-one 4-acetate 2-benzoate; tert-Butyl {(1S,2S)-2-[(2S,5R,7S,10R,13S)-4-acetoxy-2-benzoyloxy-1,7,10-trihydroxy-9-oxo-5,20-epoxytax-11-en-13-yloxycarbonyl]-2-hydroxy-1-phenylethyl}carbamate Molecular formula: C43H53NO14 =807.9 CAS: 114977-28-5 (anhydrous docetaxel); 148408-66-6 (docetaxel trihydrate) ATC code: L01CD02 Read code: y08Xn Adverse Effects, Treatment, and Precautions As for Paclitaxel. Neutropenia, anaemia and skin reactions are common with docetaxel and may be severe. Fluid retention, resulting in oedema, Read more [...]

Posted in Drugs

Fluorouracil

Posted by admin on August 12th, 2010 No Comments

(British Approved Name, US Adopted Name, rINN) Drug Nomenclature International Nonproprietary Names (INNs) in main languages (French, Latin, Russian, and Spanish): Synonyms: 5-FU; 5-Fluorouracil; Fluorouracil; Fluorouracilas; Fluorouracilo; Fluorouracilum; Fluorourasiili; Fluorourasil; Fluoruracil; NSC-19893; Ro-2-9757; WR-69596 BAN: Fluorouracil USAN: Fluorouracil INN: Fluorouracil [rINN (en)] INN: Fluorouracilo [rINN (es)] INN: Fluorouracil [rINN (fr)] INN: Fluorouracilum [rINN (la)] INN: Флуороурацил [rINN (ru)] Chemical name: 5-Fluoropyrimidine-2,4(1H,3H)-dione Molecular formula: C4H3FN2O2 =130.1 CAS: 51-21-8 ATC code: L01BC02 Read code: y02l6 Pharmacopoeias. In China, Europe, International, Japan, and US. European Pharmacopoeia, 6th ed., 2008 and Supplements 6.1 and 6.2 (Fluorouracil). A white or almost white, crystalline powder. Sparingly soluble in water; slightly soluble in alcohol. A 1% solution in water has apH of 4.5 to 5.0. Protect from light. The United States Pharmacopeia 31, 2008 (Fluorouracil). A white to practically white, practically odourless, Read more [...]

Posted in Drugs

Posts Tagged ‘Cyclophosphamide’

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