Clofarabine is a substance that is being studied in the treatment
of cancer. It is a purine nucleoside antimetabolite. It is marketed in
the U.S. and Canada as Clolar. In Europe and Australia/New Zealand the
product is marketed under the name Evoltra.

It is used in paediatrics to treat a type of leukaemia called relapsed
or refractory acute lymphoblastic leukaemia (ALL), only after at least
two other types of treatment have failed. It is not known if extends life
expectancy. Some investigations of effectiveness in cases of acute myeloid
leukaemia (AML) and juvenile myelomonocytic leukaemia (JMML) have been
carried out.

Side effects

* Tumor lysis syndrome (TLS). clofarabine quickly kills leukaemia cells
in the blood. The body may react to this. Symptoms include fast breathing,
fast heartbeat, low blood pressure, and fluid in the lungs. TLS is very
serious and can lead to death if it is not treated right away.
* Bone marrow problems (suppression). clofarabine can stop the bone marrow
from making enough red blood cells, white blood cells, and platelets.
Serious side effects that can happen because of bone marrow suppression
include severe infection (sepsis), bleeding, and anemia.
* Effects on pregnancy and breastfeeding. Girls and women should not become
pregnant or breastfeed during treatment which harm the baby.
* Dehydration and low blood pressure. clofarabine can cause vomiting and
diarrhea which may lead to low body fluid (dehydration). Signs and symptoms
of dehydration include dizziness, lightheadedness, fainting spells, or
decreased urination.
* Other side effects. The most common side effects are stomach problems
(including vomiting, diarrhea, and nausea), and effects on blood cells
(including low red blood cells count, low white blood cell count, low
platelet count, fever, and infection. clofarabine can also cause tachycardia
and can affect the liver and kidneys.

Contraindications

* pregnancy or planned pregnancy
* breast-feeding
* liver problems
* kidney problems

Drug interactions

* nephrotoxic drugs
* hepatotoxic drugs

Delivery

* By intravenous infusion.
* Dosage is a 2 hour infusion (52 mg/m²) every day for five days.
The cycle is repeated every 2 to 6 weeks.
* Regular blood tests to monitor his or her blood cells, kidney function,
and liver function.

Cladribine is a drug commonly used to treat
hairy cell leukemia (leukemic reticuloendotheliosis). Its brand name is
Leustatin, and it is commonly referred to as 2CDA.

A purine analog, it is a synthetic antineoplastic agent with immunosuppressive
effects. Chemically, it mimics the nucleoside adenosine and thus inhibits
the enzyme adenosine deaminase, which interferes with the cell’s ability
to process DNA. It is easily destroyed by normal cells in the body except
for blood cells, with the result that it produces relatively few side
effects and results in very little non-target cell loss.
Pharmacology

Side Effects

About half of patients have no significant side effects from this treatment.

Most other patients have a high fever that is caused by cancerous and
non-cancerous white blood cells dying from the drug. This fever usually
starts on the second or third day of treatment (in a one-week/every-day
treatment program). As patients are at risk, from the disease as well
as from the drug, for infections, most physicians give antibiotics to
all patients with this fever just in case the fever is caused by a sudden
infection instead of from the drug. High fevers late in treatment are
much more likely to be caused by infection.

Patients are expected to experience a decline in blood cell counts during
treatment. Several weeks after successful treatment, cell counts will
begin to rebound, with platelet and neutrophil counts recovering before
red blood cells and T cells. T4 cell counts may never reach pre-disease
levels. Patients are usually advised to avoid sick people and large crowds
of people as well as to wash their hands and keep their hands away from
their eyes, nose, and mouth until their neutrophil counts have recovered.

Many patients experience fatigue, but since fatigue is a common feature
of the disease, this may be caused by the disease instead of by the drug.

This drug does not cause hair loss, vomiting, or other side effects that
are commonly associated with "old style" alkylating chemotherapy
drugs. However, peripheral neuropathy has been reported occasionally after
repeated doses of cladribine in the treatment of hairy cell leukemia.

Cisplatin or cis-diamminedichloroplatinum(II)
(CDDP) is a platinum-based chemotherapy drug used to treat various types
of cancers, including sarcomas, some carcinomas (e.g. small cell lung
cancer and ovarian cancer), lymphomas and germ cell tumors. It was the
first member of its class, which now also includes carboplatin and oxaliplatin.

Pharmacology

Mode of action

Cisplatin acts by crosslinking DNA in several different ways,
making it impossible for rapidly dividing cells to duplicate their DNA
for mitosis. The damaged DNA sets off DNA repair mechanisms, which activate
apoptosis when repair proves impossible. The trans isomer does not have
this pharmacological effect. The chlorine undergoes slow displacement
with water molecules forming a positively charged molecule which then
crosslinks the DNA. Thus the drug need to be administered in saline solution,
to prevent inactivation.

Most notable among the DNA changes are the intrastrand GpG adducts which
form nearly 90% of the adducts. Other adducts include inter-strand crosslinks
and nonfunctional adducts that have been postulated to contribute to its
activity. Interaction with cellular proteins has also been advanced as
a mechanism of interfering with mitosis, although this is probably not
its main action.

Side effects

Cisplatin has a number of side-effects that can limit its use:

* Nephrotoxicity (kidney damage) is a major concern when cisplatin is
prescribed as a chemotherapy agent. The dose is reduced when the patient’s
creatinine clearance (a measure of renal function) is reduced. Adequate
hydration and diuresis is used to prevent renal damage. The nephrotoxicity
of platinum-class drugs seems to be related to reactive oxygen species
and in animal models can be ameliorated by free radical scavenging agents.
This is a dose limiting toxicity.
* Neurotoxicity (nerve damage) can be anticipated by performing nerve
conduction studies before and after treatment.
* Nausea and vomiting. cisplatin is one of the most emetogenic chemotherapy
agents, but this is managed with prophylactic antiemetics (e.g. ondansetron,
granisetron, etc.) in combination with corticosteroids.
* Ototoxicity (hearing loss): unfortunately there is at present no effective
treatment to prevent this side effect, which may be severe. Audiometric
analysis may be necessary to assess the severity of ototoxicity. Other
drugs (such as the aminoglycoside antibiotic class) may also cause ototoxicity,
and the administration of this class of antibiotics in patients receiving
cisplatin is generally avoided. The ototoxicity of both the aminoglycosides
and cisplatin may be related to their ability to bind to melanin in the
stria vascularis of the inner ear or the generation of reactive oxygen
species.
* Alopecia (hair loss): this is generally not a major problem in patients
treated with cisplatin.

Chlorambucil (marketed as Leukeran by GlaxoSmithKline) is a
chemotherapy drug that has been mainly used in the treatment of chronic
lymphocytic leukemia. It is a nitrogen mustard alkylating agent and can
be given orally.

In the past, it has been used for treating some types of non-Hodgkin
lymphoma, Waldenström macroglobulinemia, polycythemia vera, trophoblastic
neoplasms, ovarian carcinoma. It also has been used as an immunosuppressive
drug for various autoimmune and inflammatory conditions, e.g. nephrotic
syndrome. Its current use is mainly for CLL as it is well tolerated by
most patients, though this has been primarily replaced by fludarabine.

Side Effects

Myelosuppression (anemia, neutropenia, thrombocytopenia), or bone marrow
suppression is the most commonly occurring side effect of chlorambucil.
Withdrawn from the drug, this side effect may be reversible, but bone
marrow failure can occur in rare cases.

Less commonly occurring side effects include:

* Gastrointestinal Distress (nausea, vomiting, diarrhea, and oral ulcerations).
* Central Nervous System: Seizures, tremors, muscular twitching, confusion,
agitation, ataxia, and hallucinations.
* Skin reactions
* Hepatotoxicity
* Infertility

Cetuximab is a cancer (antineoplastic) medication. cetuximab
interferes with the growth of cancer cells and slows their growth and
spread in the body.

Cetuximab is used in the treatment of cancers of the colon and
rectum.

Cetuximab may also be used for purposes other than those listed
in this medication guide.

Cetuximab should only be administered under the supervision of a
qualified healthcare provider experienced in the use of cancer chemotherapeutic
agents.

Cetuximab is administered as an intravenous (into the vein) infusion.
Most often, cetuximab is administered in a hospital or clinic setting.
If you are administering cetuximab at home, your healthcare provider
will give you detailed instructions regarding preparation, administration,
and storage of the medication.

Your doctor will determine the correct amount and frequency of treatment
with cetuximab depending upon the type of cancer being treated and other
factors. Talk to your doctor if you have any questions or concerns regarding
the treatment schedule.

Your doctor will probably want you to have regularly scheduled blood
tests and other medical evaluations during treatment with cetuximab to
monitor progress and side effects.

Your healthcare provider will store cetuximab as directed by the manufacturer.
If you are storing cetuximab at home, follow the directions provided by
your healthcare provider.

Serious side effects have been reported with the use of cetuximab including:
severe allergic reactions (difficulty breathing; closing of the throat;
swelling of the lips, tongue, or face; hives; and low blood pressure); lung
problems (cough, difficulty breathing); skin problems (rash, dryness, inflammation,
infection); and others. Talk to your doctor about the possible side effects
from treatment with cetuximab.

If you experience any of the following serious side effects from cetuximab,
seek emergency medical attention or contact your doctor immediately:

* an allergic reaction (including difficulty breathing; closing of the
throat; swelling of the lips, tongue, or face; hives; or low blood pressure);
* cough or difficulty breathing;
* skin rash, dryness, or inflammation;
* inflammation at the injection site;
* fever; or
* little or no urine production.

Other, less serious side effects may also occur. Continue taking cetuximab
and talk to your doctor if you experience:

* nausea, vomiting, diarrhea, decreased appetite, or abdominal pain;
* weakness;
* swelling;
* insomnia;
* headache;
* hair loss; or
* itching.

Other side effects have also been reported. Discuss with your doctor
any side effect that occurs during treatment with cetuximab.

Celecoxib is used to treat rheumatoid arthritis and osteoarthritis;
it is in a class of medications known as selective COX-2 inhibitor non-steroidal
anti-inflammatory drugs (NSAIDs).

An asterisk (*) next to an item in the summary indicates that the interaction
is supported only by weak, fragmentary, and/or contradictory scientific
evidence.

Interactions with Supplements

Sodium and Potassium

Controlled studies indicate that individuals on low-salt diets who take
celecoxib retain sodium and potassium, which might result in higher than
normal blood levels of these minerals.1 More research is needed to determine
whether potassium supplements might produce unwanted side effects in people
taking celecoxib. Until more information is available, people taking celecoxib
should have their sodium and potassium blood levels monitored by their
healthcare practitioner.

Lithium

Lithium is a mineral that may be present in some supplements and is also
used in large amounts to treat mood disorders such as manic-depression.
Taking celecoxib together with the mineral can result in significant increases
in lithium blood levels,2 which might cause unwanted side effects. Consequently,
people taking celecoxib and lithium-containing supplements should consult
their healthcare practitioner about having their lithium blood levels
checked regularly.

Interactions with Herbs

Willow(Salix alba)

Willow bark contains salicin, which is related to aspirin. Both salicin
and aspirin produce anti-inflammatory effects after they have been converted
to salicylic acid in the body. Taking aspirin and celecoxib together increases
the likelihood of developing stomach and intestinal ulcers.3 Though no
studies have investigated a similar interaction between willow bark and
celecoxib, people taking the drug should avoid the herb until more information
is available.

Carmustine

Brand name(s):
BiCNU,Gliadel

What is the most important information I should know about carmustine?

Carmustine should only be administered under the supervision of
a qualified healthcare provider experienced in the use of cancer chemotherapeutic
agents.

Serious side effects have been reported with the use of carmustine including:
allergic reactions (difficulty breathing; closing of the throat; swelling
of the lips, tongue, or face; or hives); decreased bone marrow function
and blood problems (extreme fatigue; easy bruising or bleeding; black,
bloody or tarry stools; fever or chills; or signs of infection such as
fever; chills, or sore throat); severe nausea, vomiting, diarrhea, and
loss of appetite; and others. Talk to your doctor about the possible side
effects from treatment with carmustine.

In some cases, second cancers have been reported to occur during and
following treatment with carmustine. Also, carmustine has been associated
with the lung disorder pulmonary fibrosis. Talk to your doctor about the
risks and benefits of this medication.
What is carmustine?

Carmustine is a cancer (antineoplastic) medication. carmustine
interferes with the growth of cancer cells and slows their growth and
spread in the body.

Carmustine is used to treat cancerous brain tumors and some types
of blood cancer (multiple myeloma, Hodgkin’s disease, and non-Hodgkin’s
lymphomas).

carmustine may also be used for purposes other than those listed in this
medication guide.
Who should not take carmustine?

Before taking carmustine, tell your doctor if you have

* had recent vaccinations;
* blood or bone marrow problems;
* kidney disease; or
* liver disease.

You may not be able to take carmustine, or you may require a dosage adjustment
or special monitoring during treatment if you have any of the conditions
listed above.
carmustine is in the FDA pregnancy category D. This means that carmustine
is known to cause birth defects in an unborn baby. Do not take carmustine
without first talking to your doctor if you are pregnant or if you could
become pregnant during treatment. Contraceptive measures are recommended
during treatment with carmustine. It is not known whether carmustine passes
into breast milk. Do not take carmustine without first talking to your
doctor if you are breast feeding a baby.
How should I take carmustine?

Carmustine should only be administered under the supervision of
a qualified healthcare provider experienced in the use of cancer chemotherapeutic
agents.

Your doctor will determine the correct amount and frequency of treatment
with carmustine depending upon the type of cancer being treated and other
factors. Talk to your doctor if you have any questions or concerns regarding
the treatment schedule.

The Gliadel wafers are surgically implanted in the brain where they release
the medication and gradually dissolve.

Your doctor will probably want you to have regularly scheduled blood
tests and other medical evaluations during treatment with carmustine to
monitor progress and side effects.

Your healthcare provider will store carmustine injection or wafers as
directed by the manufacturer. If you are storing carmustine injection
at home, follow the directions provided by your healthcare provider
What happens if I miss a dose?

Contact your doctor if you miss a dose of carmustine.
What should I avoid while taking carmustine?

Carmustine can lower the activity of your immune system making
you susceptible to infections. Avoid contact with people who have colds,
the flu, or other contagious illnesses and do not receive vaccines that
contain live strains of a virus (e.g., live oral polio vaccine) during
treatment with carmustine. In addition, avoid contact with individuals
who have recently been vaccinated with a live vaccine. There is a chance
that the virus can be passed on to you.

Skin accidentally exposed to carmustine injection should be rinsed thoroughly
with soap and warm water.
What are the possible side effects of carmustine?
If you experience any of the following serious side effects, seek emergency
medical attention or contact your doctor immediately:

* an allergic reaction (shortness of breath; closing of your throat;
difficulty breathing; swelling of your lips, face, or tongue; or hives);
* decreased bone marrow function and blood problems (extreme fatigue;
unusual easy bruising or bleeding; black, bloody or tarry stools; or fever,
chills, sore throat or signs of infection);
* seizures, brain swelling, or brain infection (Gliadel wafers only);
* shortness of breath or dry cough;
* abdominal pain or yellowing of the eyes or skin; or
* little or no urine production.

Other less serious side effects may be more likely to occur. Talk to
your doctor if you experience

* nausea or vomiting;
* intense flushing of the skin and reddening of the eyes;
* redness, burning, or irritation at the injection site.
* headache; or
* rash.

In some cases, second cancers have been reported to occur during and
following treatment with carmustine. Also, carmustine has been associated
with the lung disorders pulmonary fibrosis. Talk to your doctor about
the risks and benefits of this medication.

Side effects other than those listed here may also occur. Talk to your
doctor about any side effect that seems unusual or that is especially
bothersome.
What other drugs will affect carmustine?
Do not receive "live" vaccines during treatment with carmustine.
Administration of a live vaccine may be dangerous during treatment with
carmustine.

Other drugs may interact with carmustine. Talk to your doctor and pharmacist
before taking any other prescription or over-the-counter medicines, including
herbal products, during treatment with carmustine.
Where can I get more information?

Your pharmacist has additional information about carmustine written for
health professionals that you may read.
What does my medication look like?

Carmustine is available with a prescription under the brand name
BiCNU for injection and Gliadel Wafer for implantation. Other brand or
generic formulations may also be available. Ask your doctor or pharmacist
any questions you have about this medication, especially if it is new
to you.

* BiCNU 100 mg-powder in vials for injection
* Gliadel Wafer 7.7 mg -wafer for implantation

How It Works

Carboplatin is an intravenous (IV) medication usually given in
a dose based on body surface area. The type and extent of a cancer determines
the exact dose and schedule of administering this drug.

Why It Is Used

Carboplatin is an alkylating agent that slows or stops the growth
of the cancer cells. carboplatin is used to treat ovarian cancer.
It may also be used to treat bladder, breast, lung, esophageal, testicular,
or endometrial cancer, lymphoma, and malignant melanoma.

How Well It Works

Carboplatin is an effective antitumor medication. However, the
type and extent of a cancer determines how effectively this medication
slows or stops the growth of cancer cells in the body.

Side Effects

Side effects of carboplatin include:

* Decreased white blood counts. Red blood cell counts and platelet counts
can also be reduced.
* Nausea, vomiting, and loss of appetite.
* Diarrhea or constipation.
* Numbness and tingling in the hands or feet (peripheral neuropathy).
* Hearing changes or hearing loss.
* Mild rash.
* Hair loss. This is reversible, and hair will grow back when treatment
ends.
* Mouth sores (stomatitis).
* Changes in kidney and liver function tests.

See Drug Reference for a full list of side effects. (Drug Reference is
not available in all systems.)

What To Think About

Carboplatin should be administered only under the supervision
of a medical oncologist.

Your doctor can order drugs to help manage any nausea or vomiting caused
by carboplatin.

Men and women may not be able to have children after taking carboplatin.
Discuss fertility with your doctor before starting treatment.

Carboplatin can cause birth defects. Do not use this medication
if you are pregnant or wish to become pregnant or wish to father a child
while you are taking it.

Do not use this medication if you have:

* Kidney or liver disease.
* Chickenpox or shingles.
* Hearing problems.

What is capecitabine?

Capecitabine is a cancer (chemotherapeutic) medication. capecitabine
interferes with the growth of cancer cells and slows their growth and
spread in the body.

Capecitabine is used in the treatment of some types of breast
and colorectal cancers.

Capecitabine may also be used for purposes other than those listed
in this medication guide.

What should I discuss with my healthcare provider before taking capecitabine?
donot Do not take capecitabine without first talking to your doctor if
you are allergic to fluorouracil (Adrucil).

Before taking capecitabine, tell your doctor if you

* have liver disease or a history of liver problems;
* have kidney disease;
* have heart or coronary artery disease; or
* are taking any other medicines especially warfarin (Coumadin), phenytoin
(Dilantin), folic acid (found in some vitamins), or leucovorin (Wellcovorin).

You may not be able to take capecitabine, or you may require a dosage
adjustment or special monitoring during therapy if you have any of the
conditions listed above.
nopreg Do not take this medication if you are pregnant or could become
pregnant during treatment. capecitabine is in the FDA pregnancy category
D. This means that it is known to cause birth defects in an unborn baby.
Contraceptive measures are recommended for both men and women during treatment
with capecitabine.
nobrfeed It is not known whether capecitabine will harm a nursing infant.
Do not take capecitabine without first talking to your doctor if you are
breast-feeding.
nochild The safety and effectiveness of capecitabine in patients younger
than 18 years of age have not been established.

If you are over the age of 80, you may be more likely to experience side
effects from capecitabine.

How should I take capecitabine?

Capecitabine should only be prescribed by a qualified healthcare
provider experienced in the use of cancer chemotherapeutic agents.

Take capecitabine exactly as directed by your doctor. If you do not understand
these instructions, ask your pharmacist, nurse, or doctor to explain them
to you.
water Each dose of capecitabine should be swallowed with water.
food Take capecitabine within 30 minutes after the end of a meal (usually
breakfast and dinner).

If the dose of capecitabine prescribed for you requires a combination
of different strength tablets, it is very important that you correctly
identify the tablets to ensure the correct dose. Contact your doctor or
pharmacist if you have questions regarding a dose.

Capecitabine is usually taken for 14 days followed by a 7 day
rest period (no drug given), in a 21 day cycle. Follow your doctor’s instructions.
finish Take all of the capecitabine that has been prescribed for you.
rt Store capecitabine at room temperature away from moisture and heat.

What happens if I miss a dose?
donot If you miss a dose of capecitabine, do not take the missed dose
at all and do not double the next one. Instead, continue your regular
dosing schedule and check with your doctor.

What happens if I overdose?
emt Seek emergency medical attention.

Symptoms of a capecitabine overdose include nausea, vomiting, diarrhea,
stomach upset, and bleeding.

What should I avoid while taking capecitabine?

There are no restrictions on foods, beverages, or activities while taking
capecitabine, unless otherwise directed by your doctor.

What are the possible side effects of capecitabine?
emt If you experience any of the following serious side effects, stop
taking capecitabine and seek emergency medical attention or contact your
doctor immediately:

* an allergic reaction (shortness of breath; closing of your throat;
difficulty breathing; swelling of your lips, face, or tongue; or hives);
* diarrhea (more than 4 bowel movements each day or any diarrhea at night);
* vomiting (more than once in 24 hours);
* nausea or a loss of appetite (if the amount of food you eat each day
is much less than usual or if you are only able to eat at certain times);
* fever (temperature greater than 100.5 degrees) or other signs of infection;
* tingling, numbness, pain, swelling, or redness of the hands and/or feet
(hand-and-foot syndrome); or
* pain, redness, swelling, or sores in or around the mouth.

Other less serious side effects may occur more frequently. Continue to
take capecitabine and talk to your doctor if you experience:

* dehydration;
* a rash or dry or itchy skin;
* tiredness;
* dizziness;
* headache;
* constipation;
* sleeplessness; or
* eye irritation.

Side effects other than those listed here may also occur. Talk to your
doctor about any side effect that seems unusual or that is especially
bothersome.

What other drugs will affect capecitabine?
donot Talk to your doctor if you are taking the blood thinner warfarin
(Coumadin). In some cases, severe bleeding and death have resulted when
these medications were taken together, or when treatment with warfarin
(Coumadin) was started in the month following treatment with capecitabine.
If treatment with both medications is determined by your doctor to be
necessary, special monitoring will be required.
donot Do not take any of the following medicines during treatment with
capecitabine without first talking to your doctor:

* phenytoin (Dilantin);
* leucovorin (Wellcovorin); or
* folic acid.

You may not be able to take capecitabine, or you may require a dosage
adjustment or special monitoring during treatment if you are taking any
of the medicines listed above.

Drugs other than those listed here may also interact with capecitabine.
Talk to your doctor and pharmacist before taking any prescription or over-the-counter
medicines, including herbal products.

Where can I get more information?

Your pharmacist has additional information about capecitabine written
for health professionals that you may read.

What does my medication look like?

Capecitabine is available with a prescription under the brand
name Xeloda. Other brand or generic formulations may also be available.
Ask your pharmacist any questions you have about this medication, especially
if it is new to you.

* Xeloda 150 mg–oblong light peach-colored tablets
* Xeloda 500 mg-oblong peach-colored tablets

What is busulfan?

busulfan is a cancer (antineoplastic) medication. busulfan interferes
with the growth of cancer cells and slows their growth and spread in the
body.

busulfan is used to treat chronic myelogenous leukemia (a type of blood
cancer).

busulfan may also be used for purposes other than those listed in this
medication guide.

Who should not take busulfan?

Before taking busulfan, tell your doctor if you have

* bone marrow problems;
* a history of lung or breathing problems; or
* a seizure disorder.

You may not be able to take busulfan, or you may require a dosage adjustment
or special monitoring during treatment if you have any of the conditions
listed above.
nopreg busulfan is in the FDA pregnancy category D. This means that busulfan
is known to cause birth defects in an unborn baby. busulfan may also affect
egg production in women and sperm production in men. Do not take busulfan
without first talking to your doctor if you are pregnant or could become
pregnant during treatment. Contraceptive measures are recommended during
treatment with busulfan.
nobrfeed It is not known whether busulfan passes into breast milk. Do
not take busulfan without first talking to your doctor if you are breast
feeding a baby.

How should I take busulfan?

Take oral busulfan exactly as directed by your doctor. If you do not
understand these instructions, ask your doctor, nurse or pharmacist to
explain them to you.
water Take each oral dose with a large glass of water.

Take busulfan tablets at the same time each day.
stomach Taking busulfan on an empty stomach is preferable. Continue to
take busulfan even if nausea and vomiting occurs. Do not stop taking the
medicine without first talking to your doctor. Check with your doctor
if vomiting occurs shortly after taking a dose of busulfan. Your doctor
may want you to take another dose, but do not do this without checking
with your doctor first.

Injectable busulfan should only be administered under the supervision
of a qualified healthcare provider experienced in the use of cancer chemotherapeutic
agents.

Your doctor will determine the correct amount and frequency of treatment
with busulfan depending upon the type of cancer being treated and other
factors. Talk to your doctor if you have any questions or concerns regarding
the treatment schedule.
water Adequate hydration is important during treatment with busulfan.
Your doctor may prescribe the administration of intravenous fluids and/or
recommend additional fluid intake by mouth during treatment.

Your doctor will probably want you to have regularly scheduled blood
tests and other medical evaluations during treatment with busulfan to
monitor progress and side effects.
rt Store busulfan tablets at room temperature away from heat and moisture.
Keep this product out of the reach of children.

Your healthcare provider will store busulfan injection as directed by
the manufacturer. If you are storing busulfan injection at home, follow
the directions provided by your healthcare provider.

What happens if I miss a dose?

Contact your doctor if you miss a dose of busulfan.

What happens if I overdose?
emt If for any reason an overdose of busulfan is suspected, seek emergency
medical attention or contact your healthcare provider immediately.

Symptoms of a busulfan overdose tend to be similar to side effects caused
by the medication, although often more severe.

What should I avoid while taking busulfan?

busulfan can lower the activity of your immune system making you susceptible
to infections. Avoid contact with people who have colds, the flu, or other
contagious illnesses and do not receive vaccines that contain live strains
of a virus (e.g., live oral polio vaccine) during treatment with busulfan.
In addition, avoid contact with individuals who have recently been vaccinated
with a live vaccine. There is a chance that the virus can be passed on
to you.

Skin accidentally exposed to busulfan injection should be rinsed thoroughly
with soap and warm water.

What are the possible side effects of busulfan?
emt If you experience any of the following serious side effects, seek
emergency medical attention or contact your doctor immediately:

* an allergic reaction (shortness of breath; closing of the throat;
difficulty breathing; swelling of your lips, face, or tongue; or hives);
* unusual bleeding or bruising;
* fever or chills;
* sudden weakness or unusual fatigue;
* persistent cough, congestion, or shortness of breath;
* flank, stomach or joint pain;
* decreased appetite or weight loss; or
* pronounced nausea, vomiting, diarrhea, dizziness, confusion, or darkening
of the skin.

In some cases, secondary cancers have been reported to occur during and
following treatment with busulfan. Also, busulfan has been associated
with development of pulmonary fibrosis, a lung disorder which may be fatal.
Talk to your doctor about the risks and benefits of this medication.

Other less serious side effects may be more likely to occur. Talk to
your doctor if you experience

* dryness of the mouth, nose, and throat;
* mouth sores;
* stopping of normal menstruation and beginning symptoms of menopause;
* infertility;
* temporary hair loss;
* itching and rash; or
* changes in skin color.

Side effects other than those listed here may also occur. Talk to your
doctor about any side effect that seems unusual or that is especially
bothersome.

What other drugs will affect busulfan?

Before taking busulfan, tell your doctor if you are taking any other
medicines, especially any of the following:

* acetaminophen (Tylenol, others);
* cyclophosphamide (Cytoxan, Neosar);
* itraconazole (Sporanox);
* phenytoin (Dilantin); or
* metronidazole (Flagyl).

You may require a dosage adjustment or special monitoring during treatment
if you are taking any of the medicines listed above.
donot Do not receive "live" vaccines during treatment with busulfan.
Administration of a live vaccine may be dangerous during treatment with
busulfan.

Drugs other than those listed here may also interact with busulfan. Talk
to your doctor and pharmacist before taking any other prescription or
over-the-counter medicines, including vitamins, minerals, and herbal products,
during treatment with busulfan.

Where can I get more information?

Your pharmacist has additional information about busulfan written for
health professionals that you may read.

What does my medication look like?

busulfan is available with a prescription under the brand name Myleran
for tablets and Busulfex for injection. Other brand or generic formulations
may also be available. Ask your pharmacist any questions you have about
this medication, especially if it is new to you.

* Myleran 2 mg-round, white tablets
* Busulfex 6mg/mL -10 mL ampules for injection

What is the most important information I should know about bortezomib?

Bortezomib should only be administered under the supervision
of a qualified healthcare provider experienced in the use of cancer chemotherapeutic
agents.nochild Because bortezomib is known to cause birth
defects in an unborn baby, women of childbearing age should not become
pregnant during treatment.
dizzy Use caution when driving, operating machinery, or performing other
hazardous activities. bortezomib may cause drowsiness, dizziness, fainting,
or blurred or double vision. If you experience any of these side effects,
avoid hazardous activities.

Dizziness may be more likely to occur when rising from sitting or lying
down. Rise slowly to minimize dizziness and prevent a possible fall.

Treatment with bortezomib may cause dehydration due to vomiting and/or
diarrhea. Follow your healthcare provider’s instructions for maintaining
adequate fluid intake to reduce the chance of dehydration. Contact your
healthcare provider if you experience dizziness, light headedness, or
fainting, as these may be signs of dehydration.

Peripheral neuropathy (nerve problems) is one of the potential side effects
of treatment with bortezomib. Contact your healthcare provider immediately
if you experience new or worsening symptoms of peripheral neuropathy such
as burning sensation, numbness, increased or decreased sensation, pain,
or discomfort.

Bortezomib can lower the activity of the immune system
making you susceptible to infections. Avoid contact with people who have
colds, the flu, or other contagious illnesses and do not receive vaccines
that contain live strains of a virus (e.g., live oral polio vaccine) during
treatment with bortezomib. In addition, avoid contact
with individuals who have recently been vaccinated with a live vaccine.
There is a chance that the virus can be passed on to you. Contact your
doctor if you develop fever, chills, sore throat, or other symptoms of
a cold or flu or painful or difficult urination.

What is bortezomib?

Bortezomib interferes with the growth of some cancer
cells.

Bortezomib is used in the treatment of the blood cancer
multiple myeloma.

Bortezomib may also be used for purposes other than
those listed in this medication guide.

What should I discuss with my healthcare provider before taking bortezomib?
donot Do not take bortezomib without first talking to your doctor if you
have

* an allergy or sensitivity to bortezomib, boron, or mannitol;
* liver disease;
* kidney disease;
* a bleeding or blood clotting disorder;
* a low level of platelets or white or red blood cells;
* a history of low blood pressure or if you are taking medicine to lower
blood pressure; or
* peripheral neuropathy (nerve problems such as burning sensation, numbness,
increased or decreased sensation, pain, or discomfort).

You may not be able to take bortezomib, or you may require a dosage adjustment
or special monitoring during treatment if you have any of the conditions
listed above.
nopreg bortezomib is in the FDA pregnancy category D. This means that
it is known to be harmful to an unborn baby.Do not take this medication
if you are pregnant. Pregnancy should be avoided during treatment with
bortezomib.
nobrfeed It is not known whether bortezomib passes into breast milk. Do
not take bortezomib without first talking to your doctor if you are breast-feeding
a baby.

How should I take bortezomib?

Bortezomib should only be administered under the supervision
of a qualified healthcare provider experienced in the use of cancer chemotherapeutic
agents.

Bortezomib is administered by intravenous injection
(into a vein). It is usually administered in a hospital or clinic setting
by a healthcare professional.

Your doctor will determine the correct amount and frequency of treatment
with bortezomib depending upon the type of cancer being treated and other
factors. Talk to your doctor if you have any questions or concerns regarding
the treatment schedule.

Your doctor will probably want you to have blood tests and other medical
evaluations during treatment with bortezomib to monitor progress and side
effects.

Your healthcare provider will store bortezomib as directed by the manufacturer.
If you are storing bortezomib at home, follow the directions provided
by your healthcare provider.

What happens if I miss a dose?

It is important not to miss a dose of bortezomib. Contact your doctor
if you are unable to keep an appointment.

What happens if I overdose?
emt Seek emergency medical attention if an overdose of bortezomib is suspected.

Symptoms of a bortezomib overdose are not known.

What should I avoid while taking bortezomib?
dizzy Use caution when driving, operating machinery, or performing other
hazardous activities. bortezomib may cause drowsiness, dizziness, fainting,
or blurred or double vision. If you experience any of these side effects,
avoid hazardous activities.

Dizziness may be more likely to occur when rising from sitting or lying
down. Rise slowly to minimize dizziness and prevent a possible fall.

Treatment with bortezomib may cause dehydration due to vomiting and/or
diarrhea. Follow your healthcare provider’s instructions for maintaining
adequate fluid intake to reduce the chance of dehydration. Contact your
healthcare provider if you experience dizziness, light headedness, or
fainting, as these may be signs of dehydration.

Tell your doctor and dentist that you are taking bortezomib before having
surgery or dental work. You may bleed more easily or be more likely to
get an infection while taking bortezomib.

Bortezomib can lower the activity of the immune system
making you susceptible to infections. Avoid contact with people who have
colds, the flu, or other contagious illnesses and do not receive vaccines
that contain live strains of a virus (e.g., live oral polio vaccine) during
treatment with bortezomib. In addition, avoid contact
with individuals who have recently been vaccinated with a live vaccine.
There is a chance that the virus can be passed on to you. Contact your
doctor if you develop fever, chills, sore throat, or other symptoms of
a cold or flu or painful or difficult urination.

What are the possible side effects of bortezomib?
emt If you experience any of the following serious side effects, seek
emergency medical attention or contact your doctor as soon as possible:

* an allergic reaction (shortness of breath; closing of the throat;
difficulty breathing; swelling of the lips, face, or tongue; or hives);
* unusual bruising or bleeding, nosebleeds, pinpoint red spots on the
skin, or black, bloody or tarry stools (may be signs of low platelets
in the blood);
* new or worsening nerve problems such as a burning sensation, numbness,
increased or decreased sensation, pain, or discomfort (may indicate peripheral
neuropathy);
* fever, chills, sore throat, other symptoms of a cold or flu or painful
or difficult urination (may indicate an infection);
* fainting;
* diarrhea or vomiting; or
* a skin rash.

Other less serious side effects may occur more frequently. Continue to
take bortezomib and talk to your doctor if you experience:

* nausea or decreased appetite;
* anxiety;
* headache;
* blurred or double vision;
* dizziness or light headedness;
* tiredness or weakness; or
* muscle or bone pain.

Side effects other than those listed here may also occur. Talk to your
doctor about any side effect that seems unusual or that is especially
bothersome.

What other drugs will affect bortezomib?

Many medications may interact with bortezomib. Do not take any other
prescription or over-the-counter medicines, including vitamins, minerals,
and herbal supplements, without first talking to your healthcare provider.

Where can I get more information?

Your pharmacist has additional information about bortezomib written for
health professionals that you may read.

What does my medication look like?

Bortezomib is available with a prescription under the
brand name Velcade. Other brand or generic formulations may also be available.
Ask your pharmacist any questions you have about this medication, especially
if it is new to you.

Bleomycin is an intravenous (IV) chemotherapy medication used
to treat several types of cancers including testicular cancer and lymphoma,
as well as cancers of the head and neck.

How It Works

Bleomycin interferes with a cell’s ability to divide and reproduce,
resulting in the death of the cell. Each dose is usually given over a
period of 10 minutes or continuously for 24 hours.

Why It Is Used

Bleomycin is used to slow or stop the spread of cancer cells in
the body.

How Well It Works

Bleomycin is an effective antitumor medication. However, the type
and extent of a cancer determines how effectively this medication slows
or stops the growth of cancer cells in the body.

Side Effects

As with many chemotherapy medications, bleomycin is associated with some
side effects, including:

* Nausea, vomiting, and loss of appetite.
* Fever and chills.
* Hair loss. This is reversible, and hair will grow back when treatment
ends.
* Sores in the mouth or on the lips.

Other, less common side effects include:

* Scarring of lung tissue.
* Pain at tumor sites.
* Pain where medication is injected into the bloodstream.
* Lung irritation.
* Allergic (anaphylactic) reaction, which may cause decreased blood pressure,
confusion, rapid heart rate, wheezing, and facial swelling.

See Drug Reference for a full list of side effects. (Drug Reference is
not available in all systems.)

What To Think About

Bleomycin should be administered only under the supervision of
a medical oncologist.

For both men and women, bleomycin can affect your ability to have children.
You may not be able to get pregnant or father a child after taking this
medication. Discuss fertility with your doctor before starting treatment.

Bleomycin can cause birth defects. Do not use this medication
if you are pregnant or wish to become pregnant or father a child while
you are taking it.

Because bleomycin can damage the lungs, you may have tests to measure
the function of your lungs before your doctor prescribes bleomycin. These
tests may be repeated over the course of your treatment. Tell your doctor
if you have any shortness of breath or other problems breathing after
you begin taking bleomycin. Lung toxicity occurs in about 10% of treated
patients.

Talk to your doctor before taking bleomycin if you:

* Are using oral contraceptives.
* Have any of the following medical problems:
o Chickenpox or have recently been exposed to chickenpox.
o Gout.
o Heart disease.
o Congestive heart failure.
o Shingles.
o Kidney stones.
o Liver disease.
o Other forms of cancer.

What is the most important information I should know about bexarotene?
nosun Avoid prolonged exposure to sunlight or artificial ultraviolet light
(e.g. sunlamps). bexarotene may increase the sensitivity of your skin
to sunlight. Use a sunscreen and wear protective clothing when exposure
to the sun is unavoidable.
nopreg Do not take bexarotene if you are pregnant or if you could become
pregnant. bexarotene is in the FDA pregnancy category X. This means that
bexarotene will cause birth defects in an unborn baby. You must take a
pregnancy test and have negative results within one week before starting
treatment with bexarotene, and a pregnancy test should be repeated monthly
during treatment. bexarotene should be started on the second or third
day of a normal menstrual period. Also, you will need to use two reliable
forms of birth control at the same time for one month before starting
treatment with bexarotene, during treatment with bexarotene, and for at
least 1 month following the end of your treatment. If you become pregnant,
stop using birth control, or miss your menstrual period, immediately stop
taking bexarotene and notify your doctor. Men taking bexarotene with sexual
partners who are pregnant, possibly pregnant, or who could become pregnant,
must use condoms during sexual intercourse while using bexarotene and
for at least one month after the last dose of bexarotene.
nocrush Swallow each capsule whole. Do not chew them, dissolve them in
liquid, or allow them to dissolve in your mouth.

Your doctor will want to monitor the levels of lipids (triglycerides
and cholesterol) and thyroid hormones in your blood periodically during
treatment with bexarotene. Treatment may be necessary if your cholesterol
or triglyceride levels become elevated, or if your thyroid hormone levels
are low.
donot Grapefruit and grapefruit juice may interact with bexarotene. The
interaction could have potentially dangerous effects. Discuss the use
of grapefruit and grapefruit juice with your doctor. Do not increase or
decrease the amount of grapefruit products in your diet without first
talking to your doctor.

What is bexarotene ?

The exact way bexarotene works is unknown, but it is believed to inhibit
the growth of tumor cells.

bexarotene is used to treat skin lesions of cutaneous T-cell lymphoma
(CTCL) in patients who have not responded to or not tolerated other therapies.

bexarotene may also be used for purposes other than those listed in this
medication guide.

Who should not use bexarotene ?
donot Do not take bexarotene without first talking to your doctor if you

* are allergic to other retinoids such as isotretinoin (Accutane), acitretin
(Soriatane), etretinate (Tegison), or tretinoin (Vesinoid);
* have or ever have had pancreatitis (inflammation of the pancreas);
* have high triglyceride levels in your blood;
* have diabetes mellitus;
* have or ever have had gall bladder disease;
* have or ever have had liver disease;
* regularly drink alcohol;
* are taking gemfibrozil (Lopid);
* are taking any prescription medication especially for fungal infections,
bacterial infections, diabetes, or seizures; or,
* eat grapefruit or drink grapefruit juice.

You may not be able to take bexarotene, or you may require a dosage adjustment
or special monitoring during treatment if you have any of the conditions,
or are taking any of the medications listed above.
nopreg Do not take bexarotene if you are pregnant or if you could become
pregnant. bexarotene is in the FDA pregnancy category X. This means that
bexarotene will cause birth defects in an unborn baby. You must take a
pregnancy test and have negative results within one week before starting
treatment with bexarotene, and a pregnancy test should be repeated monthly
during treatment. bexarotene should be started on the second or third
day of a normal menstrual period. Also, you will need to use two reliable
forms of birth control at the same time for one month before starting
treatment with bexarotene, during treatment with bexarotene, and for at
least 1 month following the end of your treatment. If you become pregnant,
stop using birth control, or miss your menstrual period, immediately stop
taking bexarotene and notify your doctor. Men taking bexarotene with sexual
partners who are pregnant, possibly pregnant, or who could become pregnant,
must use condoms during sexual intercourse while using bexarotene and
for at least one month after the last dose of bexarotene.
nobrfeed It is not known whether bexarotene passes into breast milk. Do
not take bexarotene without first talking to your doctor if you are breast-feeding
a baby.

How should I use bexarotene ?

Take bexarotene exactly as directed by your doctor. If you do not understand
these instructions, ask your pharmacist, nurse, or doctor to explain them
to you.
food Your doctor will tell you how many bexarotene capsules to take each
day. Take your daily dose of bexarotene all at once. Take bexarotene once
a day with or immediately following a meal.
nocrush Swallow each capsule whole. Do not chew them, dissolve them in
liquid, or allow them to dissolve in your mouth.
donot Do not take any bexarotene capsules after the expiration date printed
on the label.

If any bexarotene capsules are broken or leaking, do not touch the capsules
or the contents and notify your pharmacist immediately. If the contents
of a broken capsule get on your skin, immediately wash the area with soap
and water and notify your physician.

Your doctor will want to monitor the levels of lipids (triglycerides
and cholesterol) and thyroid hormones in your blood periodically during
treatment with bexarotene. Treatment may be necessary if your cholesterol
or triglyceride levels become elevated, or if your thyroid hormone levels
are low.

It may take many weeks of treatment to see the effects of this drug.
Do not stop taking bexarotene if you do not see results immediately. Some
patients treated with bexarotene see improvement within the first several
weeks of treatment, however most patients require several months or more
of treatment to improve.
rt Store bexarotene at room temperature away from moisture and heat. Keep
this product out of the reach of children.

What happens if I miss a dose?

Take the missed dose, with food, as soon as you remember. However, if
it is almost time for your next dose, skip the missed dose and take only
your next regularly scheduled dose. Do not take a double dose of this
medication.

What happens if I overdose?
emt Seek emergency medical attention.

Symptoms of a bexarotene overdose are unknown.

What should I avoid while using bexarotene ?
nosun Avoid prolonged exposure to sunlight or artificial ultraviolet light
(e.g. sunlamps). bexarotene may increase the sensitivity of your skin
to sunlight. Use a sunscreen and wear protective clothing when exposure
to the sun is unavoidable.

Vitamin A may increase side effects when taking bexarotene. Limit your
use of vitamin A supplements to not more than the recommended daily allowance
(RDA) of 4000 to 5000 International Units (IU) a day. If you take vitamins,
check the label to see how much vitamin A they contain. If you are not
sure, ask your doctor or pharmacist.
donot Grapefruit and grapefruit juice may interact with bexarotene. The
interaction could have potentially dangerous effects. Discuss the use
of grapefruit and grapefruit juice with your doctor. Do not increase or
decrease the amount of grapefruit products in your diet without first
talking to your doctor.

What are the possible side effects of bexarotene ?
emt If you experience any of the following serious side effects, stop
taking bexarotene and seek emergency medical attention:

* an allergic reaction (difficulty breathing; closing of your throat;
swelling of your lips, tongue, or face; or hives); or
* symptoms of pancreatitis (inflammation of the pancreas) such as persistent
nausea, vomiting, and abdominal or back pain.

Other, less serious side effects may be more likely to occur. Continue
to take bexarotene and talk to your doctor if you experience:

* an increase in fats in the blood (blood lipids) such as cholesterol
or triglycerides (blood tests will detect this);
* a underactive thyroid (blood tests will detect this);
* blood problems;
* headache;
* fatigue;
* weakness or loss of strength;
* swelling;
* rash;
* dry skin;
* infections;
* nausea; or
* diarrhea.

Side effects other than those listed here may also occur. Talk to your
doctor about any side effect that seems unusual or that is especially
bothersome.

What other drugs will affect bexarotene ?

Vitamin A may increase side effects when taking bexarotene. Limit your
use of vitamin A supplements to not more than the recommended daily allowance
(RDA) of 4000 to 5000 International Units (IU) a day. If you take vitamins,
check the label to see how much vitamin A they contain. If you are not
sure, ask your doctor or pharmacist.
donot Do not take bexarotene without first talking to your doctor if you
are taking any of the following drugs:

* gemfibrozil (Lopid);
* ketoconazole (Nizoral) or itraconazole (Sporanox);
* erythromycin (E.E.S., E-Mycin, Eryc, Ery-Tab, Ilosone, others);
* rifampin (Rifadin, Rimactane);
* phenobarbital (Luminal, Solfoton);
* phenytoin (Dilantin, others); or
* a diabetes medicine such as insulin, glipizide (Glucotrol), glyburide
(Diabeta, Micronase, Glynase), chlorpropamide (Diabinese), tolbutamide
(Orinase), tolazamide (Tolinase), glimepiride (Amaryl), rosiglitazone
(Avandia), pioglitazone (Actos), metformin (Glucophage), and others.

You may not be able to take bexarotene, or you may require a dosage adjustment
or special monitoring during treatment if you are taking any of the medicines
listed above.

Drugs other than those listed here may also interact with bexarotene.
Talk to your doctor and pharmacist before taking any prescription or over-the-counter
medicines.

Where can I get more information?

Your pharmacist has additional information about bexarotene written for
health professionals that you may read.

What does my medication look like?

bexarotene is available with a prescription under the brand name Targretin.
Other brand or generic formulations may also be available. Ask your pharmacist
any questions you have about this medication, especially if it is new
to you.

* Targretin 75 mg–off-white, oblong, soft gelatin capsule

Remember, keep this and all other medicines out of the reach of children,
never share your medicines with others, and use this medication only for
the indication prescribed.

Every effort has been made to ensure that the information provided by
Cerner Multum, Inc. (’Multum’) is accurate, up-to-date, and complete,
but no guarantee is made to that effect. Drug information contained herein
may be time sensitive. Multum information has been compiled for use by
healthcare practitioners and consumers in the United States and therefore
Multum does not warrant that uses outside of the United States are appropriate,
unless specifically indicated otherwise. Multum’s drug information does
not endorse drugs, diagnose patients or recommend therapy. Multum’s drug
information is an informational resource designed to assist licensed healthcare
practitioners in caring for their patients and/or to serve consumers viewing
this service as a supplement to, and not a substitute for, the expertise,
skill, knowledge and judgment of healthcare practitioners. The absence
of a warning for a given drug or drug combination in no way should be
construed to indicate that the drug or drug combination is safe, effective
or appropriate for any given patient. Multum does not assume any responsibility
for any aspect of healthcare administered with the aid of information
Multum provides. The information contained herein is not intended to cover
all possible uses, directions, precautions, warnings, drug interactions,
allergic reactions, or adverse effects. If you have questions about the
drugs you are taking, check with your doctor, nurse or pharmacist

What is the most important information I should know about bevacizumab?

Bevacizumab should only be administered under the supervision
of a qualified healthcare provider experienced in the use of cancer chemotherapeutic
agents.

Serious side effects have been reported with the use of bevacizumab including:
severe allergic reactions (difficulty breathing; closing of the throat;
swelling of the lips, tongue, or face; hives; and low blood pressure);
stomach problems (holes in the stomach or intestines); bleeding problems
(nosebleeds; bleeding in the lungs, stomach, or head); poor wound healing
or wound reopening; severe high blood pressure; kidney problems; heart
problems; stroke; chest pain; and others. Talk to your doctor about the
possible side effects from treatment with bevacizumab.

Do not have surgery without first talking to your doctor during or in
the month following treatment with bevacizumab. Wound healing may be poor
during and immediately following treatment with bevacizumab, possibly
resulting in bleeding or infection. It may be necessary to stop treatment
with bevacizumab for a period of time if surgery is necessary.

What is bevacizumab?

Bevacizumab is a cancer (antineoplastic) medication. bevacizumab
interferes with the growth of cancer cells and slows their growth and
spread in the body.

Bevacizumab is used in the treatment of cancers of the colon and
rectum.

Bevacizumab may also be used for purposes other than those listed
in this medication guide.

What should I discuss with my healthcare provider before using bevacizumab?
donot Do not have surgery without first talking to your doctor during
or in the month following treatment with bevacizumab. Wound healing may
be poor during and immediately following treatment with bevacizumab, possibly
resulting in bleeding or infection. It may be necessary to stop treatment
with bevacizumab for a period of time if surgery is necessary.

Before using bevacizumab, tell your doctor if you have

* liver disease;
* kidney disease;
* heart disease or high blood pressure;
* a history of stroke, transient ischemic attack (mini-stroke), or bleeding
in the brain; or
* an open wound.

You may not be able to use bevacizumab, or you may require a dosage adjustment
or special monitoring during treatment.
nopreg bevacizumab is in the FDA pregnancy category C. This means that
it is not known whether bevacizumab will be harmful to an unborn baby.
Do not use bevacizumab without first talking to your doctor if you are
pregnant or could become pregnant during treatment. Discuss with your
doctor the appropriate use of birth control during treatment with bevacizumab
if necessary.
nobrfeed It is not known whether bevacizumab passes into breast milk.
Do not take bevacizumab without first talking to your doctor if you are
breast feeding a baby.

If you are over 60 years of age, you may be more likely to experience
side effects from bevacizumab. You may require a lower dose of this medication.

How should I use bevacizumab?

Bevacizumab should only be administered under the supervision
of a qualified healthcare provider experienced in the use of cancer chemotherapeutic
agents.

Bevacizumab is administered as an intravenous (into the vein)
infusion. Most often, bevacizumab is administered in a hospital
or clinic setting. If you are administering bevacizumab at home,
your healthcare provider will give you detailed instructions regarding
preparation, administration, and storage of the medication.

Your doctor will determine the correct amount and frequency of treatment
with bevacizumab depending upon the type of cancer being treated and other
factors. Talk to your doctor if you have any questions or concerns regarding
the treatment schedule.

Your doctor will probably want you to have regularly scheduled blood
tests and other medical evaluations during treatment with bevacizumab
to monitor progress and side effects.

Bevacizumab vials should be stored in the refrigerator. bevacizumab
vials should be protected from light. Store bevacizumab in the
original carton until it is used. Do not freeze or shake bevacizumab
products.

What happens if I miss a dose?

Contact your doctor if you miss a dose of bevacizumab.

What happens if I overdose?
emt If an overdose of bevacizumab is suspected, seek emergency medical
attention or contact your healthcare provider immediately.

Symptoms of a bevacizumab overdose are not well known but may include
headache.

What should I avoid while using bevacizumab?
donot Do not have surgery without first talking to your doctor during
or in the month following treatment with bevacizumab. Wound healing may
be poor during and immediately following treatment with bevacizumab, possibly
resulting in bleeding or infection. It may be necessary to stop treatment
with bevacizumab for a period of time if surgery is necessary.

What are the possible side effects of bevacizumab?

Serious side effects have been reported with the use of bevacizumab including:
severe allergic reactions (difficulty breathing; closing of the throat;
swelling of the lips, tongue, or face; hives; and low blood pressure);
stomach problems (perforation of the stomach or intestines); bleeding
problems (nosebleeds; bleeding in the lungs, stomach, or head); poor wound
healing or wound reopening; severe high blood pressure; kidney problems;
heart problems; stroke; chest pain; and others. Talk to your doctor about
the possible side effects from treatment with bevacizumab.

If you experience any of the following serious side effects from bevacizumab,
seek emergency medical attention or contact your doctor immediately:

* constipation, vomiting, abdominal pain (may indicate stomach problems);
* leukopenia (an abnormal lowering of the white blood cell count). Symptoms
of leukopenia including fever or signs of infection;
* proteinuria (the presence of excessive amounts of protein in the urine);
* nosebleed, coughing up blood, blood in vomit or stools, dizziness, loss
of consciousness, severe weakness or paralysis (may indicate bleeding
problems such as bleeding in the lungs, stomach, or head);
* poor wound healing;
* redness of the face, severe headache (may indicate severe high blood
pressure);
* little or no urine production (may indicate kidney problems);
* chest pain, difficulty breathing, swelling or water retention (may indicate
heart problems);
* redness, pain, or swelling of the leg (may indicate blood clot in the
leg); or
* chest pain or shortness of breath (may indicate blood clot in the lung).

Other, less serious side effects may also occur. Continue to use bevacizumab
and talk to your doctor if you experience:

* diarrhea;
* nausea or decreased appetite;
* weakness;
* headache;
* dizziness;
* skin rash;
* swelling of the tongue or sores in the mouth; or
* hair loss.

Side effects other than those listed here have also been reported. Discuss
with your doctor any side effect that occurs during treatment with bevacizumab.

What other drugs will affect bevacizumab?

Other medications may interact with bevacizumab. Talk to your doctor
and pharmacist before taking any other prescription or over-the-counter
medicines, including vitamins, minerals, and herbal products, during treatment
with bevacizumab.

Where can I get more information?

Your healthcare provider may have additional information about bevacizumab
that you may read.
What does my medication look like?

Bevacizumab injection is available with a prescription under the
brand name avastin. Other brand or generic formulations may also be available.
Ask your healthcare provider or pharmacist any questions you have about
this medication, especially if it is new to you.

* avastin 100 mg/4 mL
* avastin 400 mg/16 mL

Remember, keep this and all other medicines out of the reach of children,
never share your medicines with others, and use this medication only for
the indication prescribed.

Every effort has been made to ensure that the information provided by
Cerner Multum, Inc. (’Multum’) is accurate, up-to-date, and complete,
but no guarantee is made to that effect. Drug information contained herein
may be time sensitive. Multum information has been compiled for use by
healthcare practitioners and consumers in the United States and therefore
Multum does not warrant that uses outside of the United States are appropriate,
unless specifically indicated otherwise. Multum’s drug information does
not endorse drugs, diagnose patients or recommend therapy. Multum’s drug
information is an informational resource designed to assist licensed healthcare
practitioners in caring for their patients and/or to serve consumers viewing
this service as a supplement to, and not a substitute for, the expertise,
skill, knowledge and judgment of healthcare practitioners. The absence
of a warning for a given drug or drug combination in no way should be
construed to indicate that the drug or drug combination is safe, effective
or appropriate for any given patient. Multum does not assume any responsibility
for any aspect of healthcare administered with the aid of information
Multum provides. The information contained herein is not intended to cover
all possible uses, directions, precautions, warnings, drug interactions,
allergic reactions, or adverse effects. If you have questions about the
drugs you are taking, check with your doctor, nurse or pharmacist.

If you have stage 1 bladder cancer, surgery is the most common form
of treatment. After surgery, your doctor may use drugs to decrease the
risk of the cancer coming back in your body.

In stage I, cancer invades the subepithelial (below the surface) connective
tissue. Stage 1 cancer is classified as "superficial bladder cancer"
because it does not invade the muscle wall of the bladder and has not
spread to lymph nodes or other organs.

Transurethral resection (TUR) using electrical or laser thermal to destroy
visible cancer is the standard initial treatment for all patients in this
stage. A TUR is an operation that is performed to diagnose and manage
bladder cancer.

During a TUR, a urologist inserts a thin, lighted tube -called a cystoscope
- into the bladder through the urethra to examine the lining of the bladder.
The urologist can remove samples of tissue (a biopsy) through this tube
or can remove some or all of the cancer in the bladder.

Rarely, for more extensive or multiple superficial cancers, a segmental
cystectomy (partial removal of the bladder) is necessary. More rarely,
a surgeon performs a radical cystectomy (complete removal of the bladder)
to treat the cancer. Surgery (TUR) alone is effective in preventing recurrences
in approximately 50 percent of patients with superficial bladder cancer.

Failure of treatment is usually due to the appearance of new superficial
cancers. This cancer also is treatable with TUR. Within 15 or 20 years,
more than half of surviving patients will experience progressive cancer
or more commonly will develop new cancers.

These may include cancers of the upper urinary tract (ureters and renal
pelvis). Approximately 20 percent to 30 percent of these cancers will
require complete removal of the bladder.

Frequent follow-up exams are important to detect new cancer formation.
Early detection is vital because treatment is more effective for small
advanced bladder cancers.
After Surgery Treatment

Because bladder cancer can come back frequently, it is important to develop
strategies to prevent it. Treatment after surgery (adjuvant therapy) provides
further benefits.

The goal of adjuvant therapy is to improve the chances of a cure, prevent
cancer from recurring or progressing to a worse stage, and to prolong
life. Adjuvant therapy for papillary carcinoma and carcinoma in situ typically
consists of chemotherapy and/or biologic therapy following surgery.

Delivery methods for adjuvant therapy differ depending on the needs of
the patient. Although some adjuvant treatments enter the patient’s blood
system through a vein, others go directly into the bladder.
Bacille Calmette-Guérin (BCG)

Bacille Calmette-Guérin (BCG) is one of the most
common adjuvant therapies for treatment of superficial and other bladder
cancers. BCG is a weak form of a bacteria similar to the one that causes
tuberculosis.

BCG enters directly into the bladder through the urethra and tells your
body’s immune system to kill cancer cells. The primary side effects of
BCG are pain in the bladder, blood in urine, and rarely, autoimmune disorders
(where the body’s immune system attacks its own cells). Because BCG is
live bacteria, it may occasionally grow and cause an infection requiring
antibiotic treatment.

Approximately 70 percent of patients with superficial bladder cancer
respond to the periodic insertion of BCG into the bladder. Treatment with
BCG delays progression into the muscle and/or the overall spread of bladder
cancer, reduces damage to the bladder, and decreases the risk of death
from the disease.

· With BCG immunotherapy, 65 percent of patients with the disappearance
of tumors will remain cancer-free for 5 years.

· Using booster doses of BCG every 3 months for up to 2 to 3 years
increases the percentage of patients with no signs of tumors to more than
80 percent. In addition, 80 percent of patients who experience the complete
disappearance of tumors remain disease-free.

BCG also can be injected into the skin, similar to the method for prevention
of tuberculosis; however, most urologists no longer use this method.
Chemotherapy

Placing chemotherapy drugs into the bladder through a needle into your
vein is considered a good second choice for adjuvant therapy. Chemotherapy
is very effective in patients who have a low risk of cancer returning.

Injection of chemotherapy drugs (Mutamycin®, Thioplex®, or doxorubicin)
into the bladder can reduce the possibility of having of superficial cancer
again. However, no single drug has been confirmed to prevent superficial
cancer from becoming invasive (spreading) bladder cancer. This means that
multiple small new cancers can be prevented, but progression to a more
invasive bladder cancer may occur despite treatment.

The optimal time to administer chemotherapy is immediately after TUR
because the drugs might prevent new cancer cells from forming. Among potential
drugs to use, Mutamycin produces few side effects and more of the drug
remains in the bladder than with other treatments. Thioplex is rapidly
absorbed in the body and produces low blood counts. Doxorubicin produces
the most local side effects.

Azacitidine

Brand name(s):
Vidaza

What is the most important information I should know about azacitidine?

azacitidine should only be administered under the supervision of a qualified
healthcare provider experienced in the use of cancer chemotherapeutic
agents.

Serious side effects have been reported with the use of azacitidine including:
allergic reactions (difficulty breathing; closing of the throat; swelling
of the lips, tongue, or face; or hives); decreased bone marrow function
and blood problems (extreme fatigue; easy bruising or bleeding; black,
bloody or tarry stools; fever or chills; or signs of infection); kidney
failure; severe nausea, vomiting, diarrhea, and loss of appetite; and
others. Talk to your doctor about the possible side effects from treatment
with azacitidine.
What is azacitidine?

azacitidine is a cancer (antineoplastic) medication. azacitidine interferes
with the growth of cancer cells and slows their growth and spread in the
body.

Azacitidine is used in the treatment myelodysplastic
syndromes and certain cancers.

azacitidine may also be used for purposes other than those listed in
this medication guide.
What should I discuss with my healthcare provider before using azacitidine?
Do not use azacitidine without first talking to your doctor if you have

* kidney disease;
* liver disease or tumors;
* had an allergic reaction to mannitol; or
* poor bone marrow function.

The use of azacitidine may be dangerous if you have any of the conditions
listed above.
It is not recommended for men to father a child while receiving azacitidine.
Please discuss the risks with your doctor. azacitidine is in the FDA pregnancy
category D. This means that azacitidine is known to be harmful to an unborn
baby. Do not use azacitidine without first talking to your doctor if you
are pregnant or thinking of becoming pregnant. Discuss with your doctor
the appropriate use of birth control during treatment with azacitidine.
It is not known whether azacitidine passes into breast milk. Do not take
azacitidine without first talking to your doctor if you are breast feeding
a baby.
How should I use azacitidine?

Azacitidine should only be administered under the supervision
of a qualified healthcare provider experienced in the use of cancer chemotherapeutic
agents.

Your doctor will determine the correct amount and frequency of treatment
with azacitidine depending upon the type of cancer being treated and other
factors. Talk to your doctor if you have any questions or concerns regarding
the treatment schedule.

Your doctor will probably want you to have regularly scheduled blood
tests and other medical evaluations during treatment with azacitidine
to monitor progress and side effects.

Skin accidentally exposed to azacitidine should be rinsed thoroughly
with soap and warm water.

Unopened azacitidine vials can be stored at room temperature. Talk to
your healthcare provider if you are storing azacitidine at home, follow
the directions provided by your healthcare provider.
What happens if I miss a dose?

Contact your doctor if you miss a dose of azacitidine.
What should I avoid while using azacitidine?

azacitidine can lower the activity of your immune system making you susceptible
to infections. Avoid contact with people who have colds, the flu, or other
contagious illnesses and do not receive vaccines that contain live strains
of a virus (e.g., live oral polio vaccine) during treatment with azacitidine.
In addition, avoid contact with individuals who have recently been vaccinated
with a live vaccine. There is a chance that the virus can be passed on
to you.

Skin accidentally exposed to azacitidine should be rinsed thoroughly
with soap and warm water.
What are the possible side effects of azacitidine?

If you experience any of the following serious side effects from azacitidine,
seek emergency medical attention or contact your doctor immediately:

* an allergic reaction (including difficulty breathing; closing of the
throat; swelling of the lips, tongue, or face; or hives);
* decreased bone marrow function and blood problems (extreme fatigue;
easy bruising or bleeding; black, bloody or tarry stools; or fever, chills,
or signs of infection);
* tissue or vein reactions near the site of administration;
* blood in the urine;
* little or no urine production;
* severe nausea, vomiting, or diarrhea; or
* difficulty in breathing.

Other, less serious side effects may be more likely to occur. Continue
taking azacitidine and talk to your doctor if you experience:

* flu-like symptoms (fever, weakness, loss of appetite, cough, chills
and muscle pain);
* mouth or lip sores;
* headache, loss of appetite, dizziness, or insomnia;
* mild to moderate nausea, vomiting, constipation or diarrhea;
* nerve problems such as burning, pricking or tingling;
* swelling of the feet or ankles;
* rash, itching, or hives; or
* temporary hair loss.

Other side effects have also been reported. Discuss with your doctor
any side effect that occurs during treatment with azacitidine.
What other drugs will affect azacitidine?
Do not receive "live" vaccines during treatment with azacitidine.
Administration of a live vaccine may be dangerous during treatment with
azacitidine.

Drugs other than those listed here may also interact with azacitidine.
Talk to your doctor or other healthcare professional about all other medications
you are currently taking. In addition, talk to your doctor and pharmacist
before taking any other prescription or over-the-counter medicines including
vitamins, minerals, and herbal products.
Where can I get more information?

Your healthcare provider may have additional information about azacitidine
that you may read.
What does my medication look like?

Azacitidine is available with a prescription under the
brand name Vidaza. Other brand or generic formulations may also be available.
Ask your healthcare provider or pharmacist any questions you have about
this medication, especially if it is new to you.

Asparaginase is an enzyme which is used to treat
acute lymphoblastic leukemia (ALL). It is marketed under the brand name
Elspar®. It can be given intramuscularly
or intravenously.

Mechanism of action

The rationale behind asparaginase is that it takes advantage
of the fact that ALL cells are unable to synthesize the non-essential
amino acid asparagine whereas normal cells are able to make their own
asparagine. These leukemic cells depend on circulating asparagine. Asparaginase
however catalyzes the conversion of L-asparagine to aspartic acid and
ammonia. This deprives the leukemic cell of circulating asparagine.

Side effects

The main side effect is an allergic or hypersensitivity reaction. Asparaginase
has also been associated with pancreatitis. Additionally, it can also
be associated with a coagulopathy as it decreases protein synthesis, including
synthesis of coagulation factors and anticoagulant factor, leading to
bleeding or thrombotic events.

Name of the Medicinal Product

Trisenox is indicated for induction of remission and
consolidation in adult patients with relapsed/refactory acute promyelocytic
leukaemia (APL), characertised by the presence trisenox
of the t(15;17) translocation and/or the presence of the Pro-Myelocytic
Leukaemia/Retinoic-Acid Receptor-alpha (PML/RAR-alpha) gene. Previous
treatment should have included a retinoid and trisenox
chemotherapy.

The response rate of other acute myelogenous leukaemia subtypes to trisenox
has not been examined.

Active Substance
Arsenic trioxide

International Nonproprietary Name or Common Name
Arsenic trioxide

Pharmaco-therapeutic Group
Other antioneoplastic agents

ATC Code
LO1XX27

Therapeutic Indication

Name of the Medicinal Product

Trisenox is indicated for induction of remission and
consolidation in adult patients with relapsed/refactory acute promyelocytic
leukaemia (APL), characertised by the presence trisenox
of the t(15;17) translocation and/or the presence of the Pro-Myelocytic
Leukaemia/Retinoic-Acid Receptor-alpha (PML/RAR-alpha) gene. Previous
treatment should have included a retinoid and trisenox
chemotherapy.

The response rate of other acute myelogenous leukaemia subtypes to trisenox
has not been examined.

Active Substance
Arsenic trioxide

International Nonproprietary Name or Common Name
Arsenic trioxide

Pharmaco-therapeutic Group
Other antioneoplastic agents

ATC Code
LO1XX27

Therapeutic Indication