Chemotherapeutic Agents and Their Uses, Dosages, and Toxicities

Drug and its uses

Dosages

Toxicities

Albumin-bound (nab)
paclitaxel(Drug information on paclitaxel)
Breast cancer (relapse)

260 mg/m² IV over 30 min every 3 wk

Bone marrow depression, sensory neuropathy, arthralgia/myalgia, asthenia, abnormal ECG, alopecia

Alemtuzumab
Chemotherapy-refractory B-cell CLL

Rapid daily-dose escalation, until tolerated, from 3 mg/d, and then 10 mg/d, to the recommended maintenance dose of 30 mg IV over 120 min, 3 times per wk on alternate days for up to 12 wk

Pancytopenia, infusion reaction, opportunistic infections, skin rash, nausea/vomiting

Altretamine
Ovarian, lung, breast, and cervical cancers, NHL

4–12 mg/kg/d or 260 mg/m², PO divided in 3–4 doses for 14–21 d of a 28-d regimen

Nausea and vomiting, bone marrow depression, paresthesias, CNS toxicity

Asparaginase
ALL, CML, AML

6,000 IU/m² IM 3 times weekly for 9 doses or 100 IU/kg/d IV for 10 continuous days, starting on Day 22 of treatment; usually given with vincristine and prednisone(Drug information on prednisone)

Allergic reactions (fever, chills, skin rash, anaphylaxis), nausea and vomiting, anorexia, liver dysfunction, CNS depression, coagulopathy, hyperglycemia

Bendamustine
CLL, B-cell NHL (relapse)

IV: 100 mg/m² on D 1 and D 2 of a 28-d cycle, up to 6 cycles

Bone marrow depression, fever, nausea, and vomiting

Bevacizumab
Breast cancer, colorectal cancer, NSCLC, renal cell carcinoma, glioblastoma (relapse)

5 mg/kg/wk IV over 60–90 min every 14–21 d

Asthenia, headache, epistaxis, proteinuria, GI perforations/wound-healing complications, hypertension/hypertensive crisis; hemorrhage, thromboembolic events

Bleomycin
Testicular cancer, HL, reticulum cell sarcoma, lymphosarcoma, squamous cell cancer of the head and neck, skin, cervix, vulva, and penis

10–20 U/m² given IV, IM, or SC weekly or twice weekly; maximum total dose, 400 U; a 2-U test dose should be given because of a possible anaphylactoid reaction

Pneumonitis and pulmonary fibrosis, fever and allergic reactions, anaphylaxis, hyperpigmentation, Raynaud’s phenomenon, alopecia

Bortezomib
Multiple myeloma

1.3 mg/m² on Days 1, 4, 8, and 11 every 3 wk

Diarrhea, peripheral neuropathy, asthenia, fever, anorexia, Mantle cell lymphoma, nausea and vomiting, rash, headache, thrombocytopenia

Busulfan
CML, BMT for refractory leukemia, lymphomas

2–8 mg PO daily for remission induction; adjust dosage to WBC count; 1–3 mg PO daily for maintenance; withhold induction if WBC count < 15,000/µL; resume therapy when WBC count > 50,000/µL

Bone marrow depression, pulmonary fibrosis, aplastic anemia, amenorrhea, gynecomastia, skin hyperpigmentation

Cabazitaxel
Hormone-refractory metastatic prostate cancer previously treated with docetaxel(Drug information on docetaxel) regimens

25 mg/m² IV every 3 weeks in combination with prednisone 10 mg PO daily throughout cabazitaxel treatment. Premedicate 30 minutes before each dose with antihistamine, corticosteroid, and H2 antagonist.

Febrile neutropenia (primary G-CSF prophylaxis should be considered in high-risk patients), nausea, vomiting, diarrhea, renal failure, hypersensitivity reactions

Capecitabine
Breast cancer (relapsed), colorectal cancer, and other GI malignancies

1,250 mg/m² bid PO with food (2 wk on drug, 1 wk of rest)

Diarrhea, stomatitis, nausea and vomiting, fatigue, hand-foot syndrome, bone marrow depression (minimal)

Carboplatin^a
Ovarian cancer; endometrial, head and neck, lung, testicular, and breast cancers; relapsed acute leukemia, NHL

Single agent: 360 mg/m² IV every 4 wk; Combination: 300 mg/m² IV every 4 wk; Calvert formula: Total dose (mg) = Target AUC × (GFR + 25)

Bone marrow depression, nausea and vomiting, peripheral neuropathy, ototoxicity

Carmustine
Brain tumor, multiple myeloma, HL, NHL, melanoma, BMT for refractory solid tumors and lymphomas

150–200 mg/m² IV every 6–8 wk

Delayed bone marrow depression, nausea and vomiting, reversible hepatotoxicity, local phlebitis, pulmonary and renal damage (high dose)

Cetuximab
KRAS wild type colorectal cancer, head and neck cancer

400 mg/m² IV over 120 min, loading dose, and 250 mg/m² IV over 60 min every 7 d, as maintenance

Skin rash, infusion reaction, asthenia, diarrhea, nausea

Chlorambucil
CLL, HL, NHL, ovarian cancer, choriocarcinoma, lymphosarcoma

0.1–0.2 mg/kg PO daily for 3–6 wk as required (usually 4–10 mg/d) or intermittent 0.4 mg/kg every 3–4 wk; increase by 0.1 mg/kg until control of disease or toxicity

Bone marrow depression, gonadal dysfunction, leukemia, hyperuricemia, pulmonary fibrosis

Cisplatin
Testicular, ovarian, bladder, uterine, cervical, and lung cancers, squamous cell cancer of the head and neck, sarcoma, NHL

50 mg/m² IV or more every 3 wk; or 20 mg/m² IV daily for 4–5 d every 3–4 wk; give vigorous hydration before and after chemotherapy

Renal damage, nausea and vomiting, electrolyte disturbance, peripheral neuropathy, bone marrow depression, ototoxicity, radiosensitizer

Cladribine
Hairy-cell leukemia, NHL, mycosis fungoides, AML, CML, CLL

0.09 mg/kg/d (4 mg/m²/d) by continuous IV infusion for 7 consecutive days

Bone marrow depression, febrile episodes, rash, infections, septicemia

Cyclophosphamide
AML, ALL, CLL, HL, and NHL, multiple myeloma, mycosis fungoides, neuroblastoma, ovarian and breast cancers, retinoblastoma, lung, testicular, and bladder cancers, sarcoma

40–50 mg/kg IV in divided doses over 2–5 d to start, followed by 10–15 mg/kg IV every 7–10 d; or 3–5 mg/kg IV twice weekly; or 1–5 mg/kg/d PO

Bone marrow depression, hemorrhagic cystitis, immunosuppression, alopecia, stomatitis, SIADH

Cytarabine (Ara-C)
AML, ALL, CML, NHL, CNS leukemia (intrathecal)

AML induction: 100 mg/m²/d by continuous IV infusion on Days 1–7; or 100 mg/m² IV every 12 h on Days 1–7 Relapsed ALL: 3 g/m² IV over 1–3 h every 12 h for 4 doses

Bone marrow depression, nausea and vomiting, diarrhea, arachnoiditis (intrathecal), stomatitis, hepatic dysfunction, fever, conjunctivitis, confusion, somnolence, cerebellar toxicity

Dacarbazine
Malignant melanoma, HL, soft-tissue sarcomas, neuroblastoma

Melanoma: 2.0–4.5 mg/kg/d IV for 10 d every 4 wk; or 250 mg/m²/d IV for 5 d every 3 wk HL: 375 mg/m² IV on D 1, repeated every 15 d (single agent); 150 mg/m²/d IV for 5 d every 4 wk (combination therapy)

Bone marrow depression, nausea and vomiting, flu-like syndrome, transient hepatotoxicity, local irritation, facial flushing, alopecia

Dactinomycin
Testicular cancer, gestational trophoblastic tumors, Wilms’ tumor, rhabdomyosarcoma, Ewing sarcoma

0.010–0.015 mg/kg IV daily for 5 d every 3 wk (usual adult dose, 0.5 mg) or 2 mg/m² IV as a single dose every 3–4 wk

Stomatitis, bone marrow depression, anorexia, nausea and vomiting, diarrhea, alopecia, skin changes, anaphylactoid reaction

Dasatinib
CML, Ph+ ALL

140 mg/d (divided doses; 70 mg bid) or 100 mg/d PO (chronic phase CML)

Fluid-retention events (eg, pleural effusion); GI events: diarrhea, nausea, abdominal pain, vomiting; bleeding events; hematologic toxicities: neutropenia, thrombocytopenia, anemia

Daunorubicin
AML, ALL

Remission induction: 30–45 mg/m²/d IV for 3 d in combination therapy; total cumulative dose, 550 mg/m²

Bone marrow depression, cardiotoxicity, alopecia, nausea and vomiting, diarrhea, stomatitis, fever, dermatitis at previously irradiated sites, red urine, anaphylactoid reaction

DaunoXome (liposomal daunorubicin(Drug information on daunorubicin))
Kaposi sarcoma, ALL, AML

Liposomal preparation: 40 mg/m² IV every 2 wk

DepoCyt (liposomal cytarabine(Drug information on cytarabine))
CNS leukemia/lymphoma

Intrathecal: DepoCyt, 50 mg over 1–5 min every 14 d, with dexamethasone(Drug information on dexamethasone), 4 mg PO bid × 5 d

Docetaxel
Breast, NSCLC, prostate, ovarian, pancreatic, head and neck, esophagus, stomach, cervical, Kaposi sarcoma, uterine, and bladder cancers

60–100 mg/m² IV over 1 h every 21 d or up to 42 mg/m² IV every wk

Bone marrow depression, fluid retention, hypersensitivity reaction, paresthesias, rash, alopecia, myalgias

Doxil (liposomal doxorubicin(Drug information on doxorubicin))
Ovarian cancer (refractory to paclitaxel- and platinum-based regimens), Kaposi sarcoma, breast cancer, multiple myeloma

50 mg/m² IV every 4 wk 20 mg/m² IV every 3 wk

Bone marrow depression, hand-foot syndrome, infusional reactions

Doxorubicin
ALL, AML, breast, ovarian, bladder cancers, HL, NHL, SCLC, gastric cancer, sarcoma, Wilms’ tumor, neuroblastoma, thyroid cancer, soft-tissue and bone sarcomas

60–90 mg/m² single IV injection every 21 d, 20–30 mg/m²/d IV for 3 d every 3–4 wk, or 20 mg/m² IV weekly; total cumulative dose of 550 mg/m²; reduce dose for liver dysfunction

Bone marrow depression, cardiotoxicity, stomatitis (continuous infusion), alopecia, nausea and vomiting, diarrhea, fever, dermatitis at previously irradiated sites, red urine, anaphylactoid reaction

Epirubicin
Breast cancer

100 mg/m² IV on Day 1 or 60 mg/m² IV on Days 1 and 8 in combination therapy

Bone marrow depression, cardiotoxicity, stomatitis, alopecia

Erlotinib
NSCLC, pancreas

150 mg/d PO; 100 mg/d PO (pancreatic
cancer)

Acne-form skin rash, diarrhea, anorexia, fatigue, dyspnea

Estramustine
Prostate, renal cell carcinomas

14 mg/kg/d PO in 3–4 equally divided doses; 300 mg/d IV for 3–4 wk, followed by 300–450 mg/wk IV over 3–8 wk

Bone marrow depression, ischemic heart disease, thromboembolism, thrombophlebitis gynecomastia, nausea and vomiting, hepatotoxicity

Etoposide
Testicular cancer (refractory) SCLC, HL, NHL, AML, gestational trophoblastic tumors [For both indications, given with combination therapy and repeated every 3–4 wk]

Testicular: 50–100 mg/m²/d IV for 5 d or 100 mg/m²/d IV on Days 1, 3, and 5 Lung: 35–50 mg/m²/d IV for 5 d or 100 mg/m²/d PO for 5 d

Bone marrow depression, nausea and vomiting, diarrhea, fever, hypotension with rapid infusion, alopecia, rash, AML (late effect)

Everolimus
Renal cell carcinoma (progression to TKI)

10 mg/d PO

Stomatitis, infections, asthenia, diarrhea, pneumonitis, dyslipidemia, hyperglycemia, elevated serum creatinine

Floxuridine
GI adenocarcinomas metastatic to liver, including oral, pancreatic, biliary, colon, and hepatic cancers, and metastatic breast cancer

0.1–0.6 mg/kg/d over several days via continuous arterial infusion supplying well-defined tumor; treatments given over 1–6 wk

Stomatitis and GI ulcers, bone marrow depression, abdominal pain, nausea and vomiting, diarrhea, liver dysfunction (transient)

Fludarabine
CLL, AML, NHL (low-grade)

25 mg/m²/d IV over 30 min for 5 d; repeat every 28 d

Bone marrow depression, nausea and vomiting, fever, malaise, pulmonary infiltrates, tumor lysis syndrome, CNS effects (high dose)

Fluorouracil
Colon, rectal, stomach, pancreatic, breast, head and neck, renal cell, prostate, and ovarian cancers, squamous cell carcinomas of esophagus, basal and squamous cell carcinoma of skin (topical), hepatic cancer (intraarterial)

Loading dose: 300–500 mg/m²; or 12 mg/kg IV daily for 3–5 d, followed by weekly maintenance Maintenance: 10–15 mg/kg IV weekly, as toxicity permits Infusion: 20–25 mg/kg by continuous IV over 24 h for 4–5 d, every 4 wk

Stomatitis and GI ulcers (infusion), bone marrow depression (bolus), diarrhea, nausea and vomiting, esophagitis, angina, cerebellar ataxia, radiosensitizer

Gefitinib
NSCLC

250 mg/d PO

Acne-form skin rash, diarrhea, transaminitis, asthenia, nausea/vomiting, interstitial lung disease

Gemcitabine
Pancreatic, lung, breast, ovarian, and bladder cancers

1,000 mg/m² IV over 30 min, once weekly for up to 7 wk (or until toxicity necessitates reducing or withholding a dose), followed by 1 wk of rest Subsequent cycles: Infusions once weekly for 3 consecutive wk out of every 4 wk

Bone marrow depression, transient fever, flu-like syndrome, skin rash, mild nausea and vomiting

Gliadel wafers
Glioblastoma multiforme

Up to 8 in brain cavity created by tumor removal

Fever, pain, and abnormal healing

Hydroxyurea
CML, acute leukemia (emergent treatment), head and neck cancer, ovarian cancer, melanoma, essential thrombocytosis, polycythemia vera

Intermittent: 80 mg/kg PO every third day Continuous: 20–30 mg/kg PO daily

Bone marrow depression, mild nausea and vomiting, skin rashes, radiosensitizer

Ibritumomab
CD20+ low grade follicular B-cell NHL (relapse)

Dosimetric step: Rituximab(Drug information on rituximab) 250 mg/m² IV; 5 mCi In-111 Ibritumomab on Day 1 Therapeutic step: Day 7, 8, or 9 Rituximab 250 mg/m² IV; 0.4–0.3 mCi/kg Y-90 Ibritumomab

Myelosuppression, infection, GI symptoms, MDS/AML

Idarubicin
AML, CML (blast phase), ALL

12 mg/m²/d IV for 3 d every 3 wk in combination therapy

Bone marrow depression, nausea and vomiting,
stomatitis, alopecia, cardiotoxicity

Ifosfamide
Germ-cell testicular cancer, sarcoma, NHL, lung cancer

1.2 g/m²/d via slow IV infusion for 5 consecutive days; repeat every 3 wk; give with mesna(Drug information on mesna)

Bone marrow depression, hemorrhagic cystitis, confusion, somnolence

Imatinib
CML, GIST, Ph+ ALL, dermatofibrosarcoma protuberans, mastocytosis, MDS/MPD

400 mg/d PO in chronic-phase CML and GIST and 600 mg/d PO for CML in accelerated phase or blast crisis/800 mg/d PO (DFSP)

Nausea and vomiting, edema and fluid retention, myalgias, diarrhea, myelosuppression, transaminitis

Irinotecan
Colorectal cancer, lung, ovarian, and cervical cancers

125 mg/m² IV over 90 min once weekly for 4 wk; then 2 wk rest or 350 mg/m² every 21 d or 180 mg/m² every 2 wk

Bone marrow depression, diarrhea, nausea and vomiting, anorexia, weight loss

Lapatinib
HER2-positive metastatic breast cancer

1,250 mg PO qd × 21 d in combination with capecitabine(Drug information on capecitabine) 2,000 mg/m²/d PO (divided doses) on D 1–14 of a repeating 21-d cycle

Diarrhea, hand-foot syndrome, nausea, rash, vomiting, fatigue, LVEF decrease, pneumonitis, QT prolongation

Lenalidomide
Multiple myeloma (relapse)

10 mg/d PO

Birth defects, neutropenia and thrombocytopenia, thrombosis

Lomustine
Brain tumors, HL, GI carcinomas, NSCLC

130 mg/m² PO every 6 wk; adjust dose in combination chemotherapy

Delayed bone marrow depression, nausea and vomiting, reversible hepatotoxicity, pulmonary and renal damage, neurologic reactions, leukemia

Mechlorethamine
HL, NHL, CML, CLL, mycosis fungoides, bronchogenic carcinoma, lymphosarcoma, polycythemia vera, malignant effusions (intracavitary)

0.4 mg/kg ideal body weight given as single dose or in divided doses of 0.1–0.2 mg/kg/d

Bone marrow depression, nausea and vomiting, local phlebitis, severe skin necrosis if extravasated, gonadal dysfunction

Melphalan
Multiple myeloma, breast and ovarian cancers, sarcoma, testicular and lung cancers

Continuous therapy: 6 mg PO daily for 2–3 wk, no therapy for 2–4 wk, then maintenance with 2–4 mg PO daily Pulse: 10 mg/m² PO daily for 4 d every 4–6 wk

Bone marrow depression, anorexia, nausea and vomiting, gonadal testicular dysfunction, leukemia

Mercaptopurine
ALL, CML, AML

1.5–2.5 mg/kg/d PO (100– 200 mg in average adult) until response or toxic effects are seen; may increase dose to 5 mg/kg/d; adjust for maintenance dose; reduce dose by 50%–75% if given with allopurinol(Drug information on allopurinol) or if renal or hepatic insufficiency ensues

Bone marrow depression, nausea and vomiting, anorexia, diarrhea, cholestasis

Methotrexate
Breast, head and neck, GI, and lung cancers, ALL, CNS leukemia (intrathecal), gestational trophoblastic tumors, NHL (advanced stage), Burkitt lymphoma, osteosarcoma, mycosis fungoides

Numerous dosing schedules with combination therapy: Low dose: 2.5–5.0 mg PO daily; or 5–25 mg/m² PO, IM, IV twice weekly; or 50 mg/m² IV every 2–3 wk High dose: 1–12 g/m² IV with leucovorin rescue every 1–3 wk Intrathecal: 5–10 mg/m² (up to 15 mg) every 3–7 d

Mucositis, GI ulceration (may produce hemorrhage or perforation), bone marrow depression, pulmonary fibrosis (previously irradiated area), nerve root irritation and convulsion (intrathecal), liver cirrhosis and osteoporosis (chronic therapy), renal damage (high dose), diarrhea, skin erythema

Mitomycin
Gastric, colorectal, anal cancer, pancreatic adenocarcinomas, NSCLC, breast, uterine, cervical, and head and neck cancers

20 mg/m² IV every 6–8 wk as a single agent or 5–10 mg/m² IV every 6 wk in combination therapy fibrosis

Bone marrow depression (cumulative), nausea and vomiting, anorexia, alopecia, stomatitis, fever, pulmonary

Mitoxantrone
AML, prostate, ALL, CML, breast and ovarian cancers

Remission induction: 12 mg/m²/d IV for 3 d, in combination with Ara-C

Bone marrow depression, cardiotoxicity, alopecia, stomatitis, nausea and vomiting, blue urine and sclera

Nilotinib
CML

Newly diagnosed CML-chronic phase: 300 mg PO twice daily. Resistant or intolerant CML-chronic phase or accelerated phase: 400 mg PO twice daily

Myelosuppression, hyperbilirubinemia, rash, pruritus, nausea, headache, fatigue, constipation, elevated lipase, QTc prolongation

Ofatumumab
CLL refractory to fludarabine and alemtuzumab(Drug information on alemtuzumab)

12 doses administered as follows: 300 mg initial dose, followed 1 week later by 2,000 mg weekly for 7 doses, followed 4 weeks later by 2,000 mg every 4 weeks for 4 doses. Premedicate with acetaminophen PO, antihistamine PO or IV, and corticosteroids IV.

Neutropenia, infection, infusion reaction, fatigue, rash

Oxaliplatin
Colorectal, ovarian cancers

85 mg/m² oxaliplatin(Drug information on oxaliplatin) and 200 mg/m² leucovorin (lv) IV infusion over 120 min on D 1 followed by 400 mg/m² 5-FU IV bolus, then 600 mg/m² 5-FU by IV infusion over 22 h. On D 2, 200 mg/m² IV over 120 min IV, followed by 400 mg/m² 5-FU IV bolus, 600 mg/m² 5-FU IV infusion over 22 h. Repeat every 2 wk

Bone marrow depression, diarrhea, nausea and vomiting, neuropathies exacerbated by cold exposure, pharyngolaryngeal dysesthesia, pulmonary toxicity

Paclitaxel
Ovarian cancer (relapsed), NSCLC (in combination with cisplatin(Drug information on cisplatin)), Kaposi sarcoma, breast cancer, head and neck, gastric, colon, esophagus, uterine, prostate, bladder cancers, and melanomas

135–175 mg/m² by IV infusion (ranging from 3–96 h) every 3 wk or 80 mg/m² IV every wk

Bone marrow depression, peripheral neuropathy, alopecia, mucositis, anaphylaxis, dyspnea, myalgias

Panitumumab
KRAS wild type colorectal cancer

6 mg/kg IV over 60 minutes every 14 days

Skin rash, hypomagnesemia, paronychia, fatigue, infusion reactions, nausea/vomiting, diarrhea

Pazopanib
Renal cell cancer

800 mg po once daily, without food

Diarrhea, hypertension, hair color change, nausea/ vomiting, fatigue, anorexia

Pemetrexed
Mesothelioma, NSCLC

500 mg/m² IV over 10 min every 21 d. Premedication needed with corticosteroid and vitamin supplementation

Bone marrow depression, stomatitis/pharyngitis, rash/skin desquamation, diarrhea

Pentostatin
Hairy-cell leukemia, ALL, CLL, lymphoblastic lymphoma, mycosis fungoides

4 mg/m² IV over 30 min every other wk or for 3 consecutive wk; give vigorous hydration before and after chemotherapy

Nephrotoxicity, CNS depression, bone marrow depression, nausea and vomiting, conjunctivitis

Pralatrexate
Relapsed and refractory T-cell lymphoma (PTCL)

30 mg/m² administered as an IV push over 3 to 5 min once weekly in 7-week cycles. Supplement with Vitamin B-12, 1 mg IM every 8–10 weeks and folic acid(Drug information on folic acid) 1.0–1.25 mg PO daily

Mucositis, thrombocytopenia, nausea, fatigue, febrile neutropenia

Procarbazine
HL, NHL, brain tumors, lung cancer

Single agent: 4–6 mg/kg/d PO until maximum response HL (MOPP): 100 mg/m²/d PO for 14 d

Bone marrow depression, nausea and vomiting, lethargy, depression, paresthesias, headache, flu-like symptoms

Rituximab
CD20-positive B-cell NHL, CLL

375 mg/m² IV infusion (50–100 mg/h) once weekly in combination with fludarabine and cyclophosphamide(Drug information on cyclophosphamide). Rituxamab 375 mg/m² (first cycle) and 500 mg/m² in cycles 2–6

Infusion reactions, asthenia, headache, skin rash/pruritus, leukopenia/infection, nausea, tumor lysis syndrome, hepatitis B reactivation, PML

Romidepsin
Cutaneous T-cell lymphoma refractory to 1 prior systemic therapy

14 mg/m² IV over 4 hours on Days, 1, 8, 15 of a 28-day cycle

Myelosuppression, QT prolongation (make sure magnesium and potassium are normal prior to adminis tration), nausea, fatigue

Sipuleucel-T
Asymptomatic or minimally symptomatic metastatic castrate-resistant (hormone-refractory) prostate cancer

Administer 3 doses at approximately 2-week intervals. Premedicate patients with acetaminophen and antihistamine. Infuse sipuleucel-T IV over a period of 60 minutes. Each dose contains a minimum of 50 million autologous CD54+ cells activated with PAP-GM-CSF suspended in 250 mL of Lactated Ringer’s Injection.

Chills, fever, back pain, nausea, joint ache, headache

Sorafenib
Renal cell cancer, hepatocellular carcinoma

400 mg bid PO

Diarrhea, nausea, stomatitis, asthenia, cardiac ischemia, hand-foot syndrome, hypertension, bleeding, anorexia

Streptozocin
Pancreatic islet-cell, carcinoid, colon, hepatoma, NSCLC, HL

Daily: 500 mg/m² IV for 5 d every 6 wk until maximum benefit or toxicity Weekly: 1,000 mg/m² IV weekly for first 2 wk, then escalate dose to response or toxicity, not to exceed a single dose of 1,500 mg/m²

Renal damage, nausea and vomiting, diarrhea, altered glucose metabolism, liver dysfunction

Sunitinib
Renal cell cancer, GIST

50 mg/d PO for 4 wk, then 2-wk rest period

Diarrhea, nausea, stomatitis, asthenia, skin discoloration, hand-foot syndrome, hypertension, bleeding, anorexia

Temozolomide
Glioblastoma, anaplastic astrocytoma (relapsed), renal cell cancer, melanoma

150–200 mg/m²/d PO for 5 d every 28 d 75 mg/m² PO/d concomitant with radiotherapy

Bone marrow depression, nausea and vomiting

Temsirolimus
Renal cell cancer

25 mg IV weekly over 30–60 mins

Rash, asthenia, mucositis, edema, dyslipidemia, hyperglycemia, elevated serum creatinine. Rarely, interstitial lung disease

Teniposide
Relapsed ALL in children, SCLC

ALL: 100 mg/m² once or twice weekly or 20–60 mg/m²/d for 5 d in combination with Ara-C Lung: 80–90 mg/m²/d for 5 d as a single agent

Bone marrow depression, nausea and vomiting, alopecia, hypotension with rapid infusion, increased liver enzymes, AML (late effect)

Thalidomide
Multiple myeloma

200 mg/d PO

Birth defects, thrombotic events, somnolence, peripheral neuropathy, neutropenia

Thioguanine
AML, ALL, CML, advanced colorectal cancer, multiple myeloma

2 mg/kg/d PO until response or toxic effects are seen; may cautiously increase to 3 mg/kg/d

Bone marrow depression, liver damage, stomatitis

Thiotepa
Ovarian, breast, and superficial bladder cancers, HL, CML, CLL, bronchogenic carcinoma, malignant effusions (intracavitary), BMT for refractory leukemia, lymphomas

IV: 0.3–0.4 mg/kg by rapid IV infusion Intravesical: 60 mg/60 mL sterile water instilled and retained in bladder for 2 h; repeat weekly for 4 wk Intracavitary: 0.6–0.8 mg/kg

Bone marrow depression, nausea and vomiting, mucositis, skin rashes

Topotecan
Cervical cancer, ovarian cancer (relapsed), SCLC (relapsed), MDS, CMML

1.5 mg/m² IV over 30 min for 5 consecutive days at 21-d intervals or 2.3 mg/ m²/d PO for 5 consecutive days every 21 d

Bone marrow depression, fever, flu-like symptoms, nausea and vomiting

Tositumomab
CD20+ low grade follicular or transformed NHL (relapse)

Dosimetric step: Day 1: Tositumomab 450 mg IV over 60 min; I-131 tositumomab (5 mCi and 35 mg tositumomab) IV over 20 min Therapeutic step: Days 7–14: Tositumomab 450 mg IV over 60 min; I-131 tositumomab calculated

Myelosuppression, hypothyroidism, second malignancies

Trastuzumab
HER2-overexpressing breast cancer

4 mg/kg IV over 90 min, loading dose, and 2 mg/kg IV over 30 min every 7 d, as maintenance or 8 mg/kg loading dose and 6 mg/kg every 21 d as maintenance

Cardiac failure, infusion reaction, diarrhea

Valrubicin
Bladder

800 mg intravesically once a wk for 6 wk

Local bladder symptoms

Vinblastine
HL, NHL, gestational trophoblastic tumors, testicular and breast cancers, mycosis fungoides, Kaposi sarcoma, histiocytosis X, bladder and renal cancers, NSCLC, CML (blast crisis)

4–12 mg/m² IV as a single agent every 1–2 wk; titrate dose to myelosuppression; adjust for hepatic insufficiency

Bone marrow depression, nausea and vomiting, ileus, alopecia, stomatitis, myalgias, vesication

Vincristine
ALL, HL, NHL, rhabdomyosarcoma, neuroblastoma, Wilms’ tumor, multiple myeloma, sarcomas, breast cancer

0.4–1.4 mg/m² IV weekly; maximum total dose, 2 mg/wk; reduce dose for hepatic insufficiency

Peripheral neuropathy, ileus, abdominal pain, SIADH, bone marrow depression (mild)

Vinorelbine
NSCLC, breast, ovarian, head and neck cancers, HL

30 mg/m² IV over 10 min; repeat weekly

Peripheral neuropathy, bone marrow depression, nausea, vomiting, hepatic dysfunction