Usual Adult Dose for Breast Cancer

0.3 to 0.4 mg/kg by rapid IV administration once every 1 to 4 weeks

Comments:

• Dose schedules of this drug vary widely according to the route of administration and the indication. Local/institutional protocol should be consulted.
• The dose of this drug should be individualized.
• A slow response to this drug does not necessarily indicate a lack of effect; therefore, increasing the frequency of dosing may only increase toxicity.
• After maximum benefit is obtained by initial therapy, the patient should continue maintenance therapy no more frequently than weekly to preserve correlation between dose and blood counts.
• Initially the higher dose in the given range is commonly administered. The maintenance dose should be adjusted weekly based on pretreatment control blood counts and subsequent blood counts.

Use: Adenocarcinoma of the breast

Usual Adult Dose for Ovarian Cancer

0.3 to 0.4 mg/kg by rapid IV administration once every 1 to 4 weeks

Comments:

• Dose schedules of this drug vary widely according to the route of administration and the indication. Local/institutional protocol should be consulted.
• The dose of this drug should be individualized.
• A slow response to this drug does not necessarily indicate a lack of effect; therefore, increasing the frequency of dosing may only increase toxicity.
• After maximum benefit is obtained by initial therapy, the patient should continue maintenance therapy no more frequently than weekly to preserve correlation between dose and blood counts.
• Initially the higher dose in the given range is commonly administered. The maintenance dose should be adjusted weekly based on pretreatment control blood counts and subsequent blood counts.

Use: Adenocarcinoma of the ovary

Usual Adult Dose for Serosal Cavity Neoplastic Disease

0.6 to 0.8 mg/kg by intracavitary injection once

Comments:

• Dose schedules of this drug vary widely according to the route of administration and the indication. Local/institutional protocol should be consulted.
• Administration is usually through the same tubing which is used to remove the fluid from the cavity involved.

Use: For controlling intracavitary effusions secondary to diffuse or localized neoplastic diseases of various serosal cavities

Usual Adult Dose for Bladder Cancer

30 to 60 mg by intravesical instillation into the bladder once; for maximum effect, the solution should be retained for 2 hours; if the patient cannot retain 60 mL for 2 hours, the dose may be given in a volume of 30 mL

• The patient may be positioned every 15 minutes for maximum area contact.
• The usual course of therapy is once a week for 4 weeks.
• The course may be repeated if necessary, but second and third courses must be given with caution since bone-marrow depression may be increased.

Comments:

• Dose schedules of this drug vary widely according to the route of administration and the indication. Local/institutional protocol should be consulted.
• Patients with papillary carcinoma of the bladder are dehydrated for 8 to 12 hours prior to therapy with this drug.
• Deaths have occurred after intravesical administration due to bone-marrow depression from systemically absorbed drug.

Use: For the treatment of superficial papillary carcinoma of the urinary bladder

Renal Dose Adjustments

The manufacturer states that therapy is probably contraindicated in cases of existing renal damage; however, if the need outweighs the risk this drug may be used in low dosage, accompanied by appropriate testing.

Liver Dose Adjustments

The manufacturer states that therapy is probably contraindicated in cases of existing hepatic damage; however, if the need outweighs the risk this drug may be used in low dosage, accompanied by appropriate testing.

Dose Adjustments

• The most reliable guide to toxicity of this drug is the white blood cell count; if it falls to 3000 or less, the dose should be discontinued.
• Another good index of the toxicity of this drug is the platelet count; if it falls to 150,000, therapy should be discontinued.
• Red blood cell count is a less accurate indicator of the toxicity of this drug.

Precautions

CONTRAINDICATIONS:

• Hypersensitivity to the active component or any of the ingredients
• Renal impairment (unless need outweighs risk, this drug is used at low doses, and regular renal function tests are done)
• Hepatic impairment (unless need outweighs risk, this drug is used at low doses, and regular hepatic function tests are done)
• Bone marrow damage (unless need outweighs risk, this drug is used at low doses, and regular hemopoietic function tests are done)

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

This drug is dialyzable; however, the manufacturer does not specify dosing instructions for dialysis patients.

Other Comments

Administration advice:

• To eliminate haze, filter solutions through a 0.22-micron filter prior to administration. Filtering does not alter solution potency. Reconstituted solutions should be clear. Solutions that remain opaque or precipitate after filtration should not be used.

Storage requirements:

• Store unopened product in a refrigerator between 2C to 8C (36F to 46F).
• Protect from light.
• When reconstituted with sterile water for injection, the solution should be stored in a refrigerator and used within 8 hours.
• Reconstituted solutions further diluted with sodium chloride injection should be used immediately.

Reconstitution/preparation techniques:

• This drug should be reconstituted with 1.5 mL of sterile water for injection resulting in a drug concentration of approximately 10 mg/mL. The reconstituted solution is hypotonic and should be further diluted with sodium chloride injection (0. 9% sodium chloride) before use.
• Consult the manufacturer product information for reconstitution directions.

IV compatibility:

• Sterile water for injection
• Sodium chloride injection

General:

• This drug has largely been replaced for the treatment of lymphomas by newer therapies.

Monitoring:

• Hepatic function
• Renal function
• Pregnancy

Patient advice:

• The patient should notify the physician in the case of any bleeding (e.g., epistaxis, easy bruising, change in color of urine, black stool) or infection (e.g., fever, chills) or for possible pregnancy to patient or partner.
• Effective contraception should be used during therapy if either the patient or the partner is of childbearing potential.