Drugs: Chemotherapy Drugs and Other Pharmaceuticals

Many different types of drugs are used during treatment for childhood cancers: chemotherapy drugs, antibiotics, anti-emetics, and others. The coverage on this Candlelighters web page is intended to help you keep track of what drug does what, to provide basic information about each drug, to give you an overview of short- and long-term side effects of chemotherapy drugs, and to provide links to external web sites that have in-depth information. Contact Candlelighters if you need information about a drug that is not listed.

In addition to this current page, also see the Candlelighters web site special chemotherapy drug sections.

  • Administration (IV, IT, etc., and drug dose calculations)
  • Chemotherapy drug actions: How these drugs kill cancer cells.
  • General side effects of chemotherapy: Descriptions and remedies.

References

Web sites that provide good information on pharmaceuticals:

  • MedlinePlus (National Institutes of Health web site)
  • MedScape (the first time you visit MedScape, you will be asked to fill out a free registration) MedScape has complete information on drugs, including pictures of what the pills look like (important for double-checking that the pharmacist has filled the prescription properly).
  • CancerBackup (a UK site)
  • Wikipedia
  • Drug Dictionary (on the National Cancer Institute web site)
  • RX List, the Internet Drug Index. This site is noteworthy because through the advanced search you to look up drug from imprint code on tablet. (If you find a pill and do not know what it is, you can look it up using the drug ID.)
  • BC Cancer Agency Drug Manual Oncology Drug information, side effects, and drug interactions.

Web site for long-term effects of chemotherapy drugs:


Asparaginase 

A chemotherapy drug. Asparaginase is an enzyme that depletes asparagine, a necessary amino acid in cancer cells (especially acute lymphoblastic leukemia cells) and causes these cancer cells to die. Asparaginase is isolated from either E Coli or Erwinia bacteria and is thus labeled E Coli or Erwinia asparaginase. PEG-asparaginase is a form of this asparaginase that has been chemically stabilized so that it lasts longer in the body.

Administration: Asparaginase is given by injection directly into the muscle (IM, intramuscularly).

Types of pediatric cancers: Leukemias, lymphomas.

Side effects (during/soon after treatment): A mild allergic reaction to this drug is not uncommon. A significant number of patients will show a severe allergic reaction, therefore, each child will be carefully observed for about an hour after injection. PEG-asparaginase causes fewer allergic reactions than the other forms of this drug.

Possible long term effects: There are no known long term late effects from asparaginase.

Other names: Elspar, L-asparaginase, PEG-asparaginase.

Links to more information:


Bactrim

An antibiotic that most children on chemotherapy take weekly to prevent a type of pneumonia called PCP (pneumocystis pneumonia). Bactrim is a combination of two drugs: sulfamethoxazole and trimethoprim. If Bactrim is not tolerated, other antibiotics can be tried.

Bactrim can cause blood counts to drop when it is given at the same time as some chemotherapy agents. Be sure to ask your child's doctor if you think this might be an issue.

Other names: Septra.

Link to more information:


Bleomycin

A chemotherapy drug. An anti-tumor antibiotic, bleomycin is a mixture of cytotoxic glycopeptides isolated from a bacterium (Streptomyces verticillus).

Administration: IV, IM. Common pediatric IV dose is 5-10 U/m2.

Types of pediatric cancers: Osteosarcoma, lymphomas.

Side effects (during/soon after treatment): High fever, chills, Raynaud's phenomenon (low blood flow in the extremities causing coldness in fingers), hyperpigmentation, and mouth sores. Occasional effects include rash, taste changes, anorexia and weight loss, and pneumonitis (inflammation of the lungs).

Possible long term effects: Pulmonary toxicity (pneumonitis, pulmonary fibrosis). High risk factors include: Bleomycin cumulative dose greater than 400 U/m2; if bleomycin was combined with radiation (chest, TBI); if bleomycin was combined with busulfan, carmustine, lomustine. (From the COG Late Effects Guidelines. 11/06)

Other names: Blenoxane, Bleocin, Cytorich.

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Busulfan

A chemotherapy drug. Busulfan is an alkylating agent that slows or stops the growth of cancer cells.

Administration: Busulfan is given by IV.

Types of pediatric cancers: CML. In high doses, busulfan is used in combination with other drugs to destroy the bone marrow in preparation for a bone marrow transplant (transplant conditioning).

Side effects (during/soon after treatment): Loss of appetite, nausea, vomiting, myelosuppression, gonadal dysfunction/sterility, and irritation of the bladder. Raised levels of uric acid (allopurinol may be given to prevent this), changes in the lungs, sore mouth, hair loss, and diarrhea are less common side effects.

Possible long term effects: Gonadal dysfunction (testicular), delayed/arrested puberty, premature menopause, infertility, especially when combined with radiation or higher cumulative doses. (Busulfan greater than 600 mg/m2 is considered high cumulative dose.) Secondary cancer (AML). Pulmonary fibrosis: survivors at higher risk for pulmonary fibrosis if bleomycin was also given. Cataracts: higher risk if steroids were given. (From the COG Late Effects Guidelines. 11/06)

Other names: Busulfex, Myleran.

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Carboplatin

A chemotherapy drug. Carboplatin is a platinum (heavy metal)-containing DNA alkylating agent that stops the growth of cancer cells. It is similar to cisplatin, but has the benefit of fewer side effects.

Administration: IV. Usual pediatric dose is 425 mg/m2.

Types of pediatric cancers: Used in solid tumors, such as Wilms, osteosarcoma, neuroblastoma, and retinoblastoma.

Side effects (during/soon after treatment): Nausea and vomiting, myelosuppression, electrolyte disturbances. Occasional side effects include diarrhea or constipation, ototoxicity (hearing loss), hypersensitivity reactions (such as anaphylaxis), sore mouth, and hair loss. Rare: peripheral neuropathy.

Possible long term effects: Gonadal dysfunction (testicular), delayed/arrested puberty, premature menopause, infertility, especially when combined with radiation or higher cumulative doses. Secondary cancer (AML). Hearing loss if carboplatin was used in conditioning for HCT (transplant). Patients who received carboplatin in lower doses than given for HCT do not appear to be at risk for significant hearing loss. Peripheral sensory neuropathy is sometimes seen as a late onset effect, but more commonly, this effect begins at treatment and continues. There is a high risk for renal (kidney) toxicity if carboplatin was administered with certain other chemotherapy agents or radiation. (From the COG Late Effects Guidelines. 11/06)

Other names: Paraplatin.

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Cisplatin

A chemotherapy drug. Cisplatin is a platinum (heavy metal)-containing DNA alkylating agent that stops the growth of cancer cells. Cisplatin is used in solid tumors.

Administration: Given by IV. Common pediatric dose is 50 mg/m2.

Types of pediatric cancers: Neuroblastoma, osteosarcoma, brain tumors. It is also used as conditioning for stem cell transplant.

Side effects (during/soon after treatment): Nausea and vomiting, myelosuppression, electrolyte disturbances, and numbness/tingling in hands or feet. Occasional side effects include: allergic reactions (for instance, anaphylaxis), diarrhea, constipation, stomach pain, nephrotoxicity (toxic to the kidney), and ototoxicity (tinnitus, hearing loss).

Possible long term effects: Ototoxicity (hearing loss, tinnitus, vertigo); high risk for this late effect is a cumulative cisplatin dose "e 360 mg/m2. Peripheral sensory neuropathy (effects on nerves); this late effect presents as a persistent effect soon after therapy and is typically not late in onset (highest risk factor if the cumulative cisplatin dose was greater than 300 mg/m2). Kidney problems (highest risk factor >200 mg/m2 or when radiation was also given). (From the COG Late Effects Guidelines. 11/06)

Other names: Platinol, Platinol-AQ.

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Clofarabine

A chemotherapy drug. Clofarabine is an antimetabolite; it resembles a building block of DNA, and when incorporated into DNA, it causes cell death. Clofarabine is a relatively new chemotherapy drug that has shown promise in relapsed ALL (2006).

Administration: IV.

Types of pediatric cancers: ALL.

Side effects (during/soon after treatment): See the link to the Medline drug summary, below, under "links to more information". From this Medline document, the side effects appear to be similar to those of cytarabine.

Possible long term effects: Not known (a new drug).

Other names: Clolar, Ilex, Evoltra.

Links to more information:


Cyclophosphamide

A chemotherapy drug. Cyclophosphamide alkylates DNA, thus interfering with cell division and causing cell death.

Administration: IV. Usual pediatric dose is 1 gm/m2.

Types of pediatric cancers: Leukemias, lymphomas, neuroblastoma, retinoblastoma, osteosarcoma, Ewing's, rhabdomyosarcoma, Wilms, and conditioning for stem cell transplants.

Side effects (during/soon after treatment): Loss of appetite, nausea, vomiting, myelosuppression, gonadal dysfunction/sterility, irritation of the bladder, hair loss. Occasional side effects are mouth sores and diarrhea. Rare: SIADH, heart toxicity problems.

Possible long term effects: Gonadal dysfunction (testicular), delayed/arrested puberty, premature menopause, infertility, especially when combined with radiation or higher cumulative doses. (Higher risk for cyclophosphamide cumulative dose greater than 7.5 gm/m2.) Secondary cancers (AML and bladder). Bladder and urinary tract problems. (From the COG Late Effects Guidelines. 11/06)

Other name: Cytoxin.

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 Cyclosporin

An immunosuppressant drug given after organ and bone marrow transplants to prevent organ rejection.

Other names: Ciclosporin.

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Cytarabine

A chemotherapy drug. Cytarabine is an anti-metabolite that interferes with DNA synthesis.

Administration: SQ, IV, and/or IT. The normal IV dose is 75mg/m2, high dose 3 g/m2. IT dose is usually determined by the age of the child. High-dose IV is defined as any single dose "e 1000 mg/m2.

Types of pediatric cancers: ALL, lymphomas.

Side effects (during/soon after treatment): Nausea, vomiting, loss of appetite, tiredness, myelosuppression (within a few days), sore mouth, sometimes diarrhea and hair loss, gritty eyes, and rash. Flu-like symptoms, including fever, are sometimes experienced. Rare: neurotoxicity, liver damage.

Possible long term effects: No known late effects are listed for low-dose cytarabine. High dose cytarabine can lead to neurocognitive deficits or leukoencephalopathy. (From the COG Late Effects Guidelines. 11/06)

Other names: Cytosar-U, ara C, cytosine arabinoside.

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Dactinomycin

A chemotherapy drug. Dactinomycin is a polypeptide antibiotic isolated from a type of bacteria. It binds to DNA and interferes with cell replication.

Administration: Dactinomycin is given by IV. The usual pediatric dose is 0.045 mg/kg. (If it leaks out of the vein, watch for redness, swelling or leaking at the drip site.)

Types of pediatric cancers: Wilms, Ewings, rhabdomyosarcoma, and osteosarcoma.

Side effects (during/soon after treatment): Nausea, vomiting, myelosuppression, and hair loss. A rare side effect is liver toxicity in patients who are given vincristine-dactinomycin combination therapy. Dactinomycin enhances radiation therapy damage, especially if dactinomycin and radiation treatments are given at the same time. Dactinomycin causes redness and swelling if it leaks out of the IV drip site.

Possible long term effects: No known late effects.

Other names: Cosmegen, actinomycin D.

Link to more information:


Daunorubicin

A chemotherapy drug. Daunorubicin is a member of the "anthracycline antibiotics" family of chemotherapy drugs. It is thought to act by intercalating into the double strands of DNA and interfering with DNA synthesis and cell replication.

Administration: Daunorubicin is given by IV. The usual pediatric dose is 25 mg/m2.

Types of pediatric cancers: Leukemias, Ewing's, neuroblastoma, Wilms, NHL.

Side effects (during/soon after treatment): Nausea and vomiting, cardiac arrhythmias (rarely clinically significant), myelosuppression, and hair loss within a couple weeks. Occasional stomach pain and mouth sores, liver toxicity. If daunorubicin extravasates (leaks from a vein) during administration, it will cause redness and swelling around the injection site.

Possible long term effects: Cardiotoxicity, cardiomyopathy, arrhythmias, and subclinical left ventricular dysfunction (higher risk with cumulative dose "e 300 mg/m2 or any dose in infants). Secondary malignancy (AML). (From the COG Late Effects Guidelines. 11/06) See the current Survivorship Guidelines for detailed information on risk factors and recommended follow-up care. Also see the CCCF newsletter articles on cardiotoxicity.

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Dexrazoxane

A drug sometimes given with doxorubicin to prevent therapy-related cardiomyopathy in pediatric patients. Several journal articles (available upon request) have shown that dexrazoxane protects the heart while not reducing the chemotherapy-effectiveness of doxorubicin.

Other names: Zinecard.

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Doxorubicin

A chemotherapy drug. Doxorubicin is a member of the "anthracycline antibiotics" family of chemotherapy drugs. It intercalates into the double strands of DNA and prevents cell replication.

Administration: IV. The usual pediatric dose is 25 mg/m2.

Types of pediatric cancers: Leukemias, lymphomas, Ewing's, neuroblastoma, Wilms, osteosarcoma.

Side effects (during/soon after treatment): Nausea and vomiting, cardiac arrhythmias (rarely clinically significant), myelosuppression, and hair loss within a couple weeks. Occasional stomach pain and mouth sores, and liver toxicity. If doxorubicin extravasates (leaks from a vein) during administration, it will cause redness and swelling around the injection site.

Possible long term effects: Cardiotoxicity, cardiomyopathy, arrhythmias, subclinical left ventricular dysfunction (higher risk with cumulative dose "e 300 mg/m2 or any dose in infants). Secondary malignancy (AML). (From the COG Late Effects Guidelines. 11/06) See the current Survivorship Guidelines for detailed information on risk factors and recommended follow-up care. Also see the CCCF newsletter articles on cardiotoxicity.

Other name: Adriamycin.

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EMLA

A topical pain reliever. EMLA is a cream that contains lidocaine. It is placed on the skin and covered with a bandage a few hours before any needle poke to prevent local pain.

Ped-onc resource center on controlling pain during procedures.


Etoposide

A chemotherapy drug. Etoposide is a topoisomerase inhibitor; it inhibits the enzyme topoisomerase II and causes the death of rapidly growing cancer cells.

Administration: Etoposide can be given IV or PO . The usual pediatric dose is 3.3 mg/kg.

Types of pediatric cancers: AML, Ewing 's, lymphomas, Wilms, neuroblastoma, osteosarcoma, retinoblastoma, and conditioning prior to stem cell transplants.

Side effects (during/soon after treatment): Nausea and vomiting, possible sore mouth, hair loss. Myelosuppression occurs about 2 weeks after treatment. Rare: severe anaphylactic reactions.

Possible long term effects: Secondary cancer (AML). Higher risk for AML is noted when etoposide was given weekly or twice-weekly. Since 1990, the administration of etoposide has been changed to reduce the risk of AML. (From the COG Late Effects Guidelines. 11/06)

Other names: Toposar, Vepesid, VP-16.

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Gleevec

A chemotherapy drug. Unlike the cytotoxic chemotherapy drugs, Gleevec is a targeted therapy. It specifically targets tyrosine kinase in CML (and ALL) that has the Philadelphia chromosome (Ph+).

Administration: PO .

Types of pediatric cancers: CML and Ph+ ALL.

Side effects: Gleevec has few immediate side effects and no known late effects.

Other names: Glivec, STI-571, Imatinib.

Links to more information:


Idarubicin

A chemotherapy drug. Idarubicin is a member of the "anthracycline antibiotics" family of chemotherapy drugs.

Administration: IV. The usual pediatric dose is 10 mg/m2.

Types of pediatric cancers: AML, ALL.

Side effects (during/soon after treatment): Nausea and vomiting, cardiac arrhythmias (rarely clinically significant), myelosuppression, and hair loss within a couple weeks. Occasional side effects include stomach pain, mouth sores, and liver toxicity. If it extravasates (leaks from a vein) during administration, it will cause redness and swelling around the injection site.

Possible long term effects: Secondary malignancy (AML). Cardiotoxicity, cardiomyopathy, arrhythmias, and subclinical left ventricular dysfunction (higher risk with cumulative anthracycline dose "e 300 mg/m2 or any dose in infants). Idarubicin is more cardiotoxic than doxo/daunorubicin; multiply the patient's dose of idarubicin by 5 to calculate the comparative high-risk cumulative dose. (From the COG Late Effects Guidelines. 11/06) See the current Survivorship Guidelines for detailed information on risk factors and recommended follow-up care. Also see the CCCF newsletter articles on cardiotoxicity.

Other names: Idamycin, zavedos.

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Ifosfamide

A chemotherapy drug. Ifosfamide is an alkylating agent related to cyclophosphamide.

Administration: IV. Pediatric dose is about 1.5g/m2. Patient is hydrated during administration; MESNA might be given.

Types of pediatric cancers: Bone cancers, neuroblastoma.

Side effects (during/soon after treatment): Nausea and vomiting, fatigue, bladder irritation, mouth sores, myelosuppression (within a few days), and hair loss. Rare: neurotoxic effects.

Possible long term effects: Gonadal dysfunction (testicular), premature menopause, infertility (especially with higher cumulative doses and/or radiation), bladder and kidney problems. Secondary cancer (AML). (From the COG Late Effects Guidelines. 11/06)

Other names: IFOS.

Links to more information:


Ketamine

An anaesthetic. Ketamine is administered under the supervision of an anesthesiologist. It causes children to lose consciousness for a longer period than does Propofol, and sometimes it causes hallucinations upon awakening.

Ped-onc resource center on controlling pain during procedures.


Kytril

A drug used to prevent nausea and vomiting caused by chemotherapy. Kytril is a serotonin receptor antagonist, similar to SSRIs such as Prosac. It is usually given a little before treatment begins, and can be given either orally or by IV. It has only rare side effects, but its use is limited by the fact that it is very expensive (about $60/pill in 2006).

Other names: Granisetron.

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Leucovorin

A medicine used during high-dose systemic methotrexate chemotherapy to lessen toxic effects. Leucovorin, an antidote for methotrexate, restores the patient's levels of folic acid.


Mercaptopurine, or 6MP

A chemotherapy drug. Mercaptopurine, often called "6MP", is an antimetabolite that interferes with DNA synthesis.

Administration: Given PO (by mouth) as tablets (also available as a liquid). The usual pediatric dose is 75 mg/m2.

Something that your child's doctor might forget to tell you: It's best to take 6-MP at night (at least an hour after a meal) and without milk or citrus (see Patty's Chemo Drugs pages).

Types of pediatric cancers: ALL, NHL.

TPMT and 6MP. Across the population, some people have different forms of TPMT (thiopurine methyltranserase), the enzyme that metabolizes 6MP (and 6TG). As a result, 1 in 300 individuals cannot break down 6MP at all. Some oncologists advise new patients to be tested for TPMT activity before any dose of 6MP is administered; some doctors do not. There is a chance that the initial dose of 6MP will cause the ANC to plummet so far that the patient will die from infection. More information in the CCCF Fall 2003 journal:

Side effects (during/soon after treatment): Myelosuppression (also see the TPMT discussion, above). Nausea and vomiting, anorexia, and diarrhea are occasional side effects.

Possible long term effects: If acute VOD occurs during treatment, liver dysfunction can be seen as a late effect. (From the COG Late Effects Guidelines. 11/06)

Other names: Purinethol, 6-MP.

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Methotrexate

A chemotherapy drug. Methotrexate is antimetabolite, a folic acid antagonist: It interferes with an enzyme needed for DNA synthesis. Specifically, it is similar in structure to folic acid, and binds to the enzyme folic acid reductase and inhibits the enzyme's activity, thus preventing the production of tetrahydrofolic acid, a compound needed for DNA synthesis.

Administration: IV, IT, and PO . In the treatment of ALL, IV intermediate dose of methotrexate is 1 g/m2, high dose is 2.5 g/m2, as given IV over 4-24 hours, usually with leukovorin rescue. "Escalating" IV methotrexate means that the dose is initially 0.10 g/m2 over 10-15 min, then escalated in each subsequent dose by 50 mg/m2/dose to toxicity. Osteosarcoma protocols use doses as high as 8 to 12 g/m2. When given PO , methotrexate is 15-100 mg/m2/day.

Leucovorin rescue: Some protocols call for (or allow) leucovorin rescue. Leucovorin, or folinic acid, is antidote for folic acid antagonists. It increases the levels of folic acid to alleviate the effects of methotrexate. Theoretically, normal cells can be rescued more effectively than tumor cells, which may lack active folate transporters. (See the listing for leucovorin.)

Types of pediatric cancers: ALL, lymphomas, osteosarcoma.

Side effects (during/soon after treatment): Nausea, vomiting, anorexia, diarrhea, mouth sores, and myelosuppression. A rare but quite serious side effect is stroke (especially with IT administration of methotrexate). Other rare side effects include sensitivity of the skin to sunlight, dizziness, hair loss, acute neurotoxicity, seizures, liver and kidney toxicity, osteonecrosis, learning disabilities, leukoencephalopathy, and progressive CNS deterioration (these last three with IT administration).

Possible long term effects: Osteopenia or osteoporosis. High dose IV or IT methotrexate possible late effects include: Renal toxicity, hepatic dysfunction, neurocognitive deficits, and clinical leukoencephalopathy. High dose IV is defined in the Survivorship Guidelines as any single dose greater than 1g/m2. (From the COG Late Effects Guidelines. 11/06)

Other names: Amethopterin, MTX.

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Pentamidine

An antibiotic that prevents PCP (pneumocystis pneumonia), a type of pneumonia. Most children on chemotherapy take Bactrim as the preventative antibiotic, but if Bactrim causes a low ANC or other side effects, Pentamidine might be tried. It is usually given by inhalation in a 30-45 minute session once a month.

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Propofol

An anaesthetic. Propofol is administered under the supervision of an anesthesiologist. It causes your child to become unconscious during procedures.


Rituximab

A chemotherapy drug. Rituximab is a monoclonal antibody directed against the CD20 antigen of pre-B and B lymphocytes. It binds to CD20-positive cells and triggers an immune response against these cells, causing them to die. Normal B cells as well as cancerous ones die, but the bone marrow eventually generates a new, healthy population of B cells.

Administration: IV.

Types of pediatric cancers: B-cell non-Hodgkins lymphomas, B-cell leukemias.

Side effects (during/soon after treatment): Mild to moderate fever, shaking chills, weakness, nausea, and headache. In most cases, side effects occur in the first 30 minutes to 2 hours after the treatment is started, and usually they go away before it is finished. Serious reactions (including death) to the drug have been reported, but they are rare.

Possible long term effects: Not known.

Other names: Rituxan and MabThera.

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Steroids (Prednisone, Dexamethasone or Decadron)

Steroids are used as chemotherapy drugs in the treatment of both ALL and some lymphomas. Steroids are also used as immunosuppressants or anti-inflammatory in the treatment of a variety of pediatric cancers. This discussion focuses on the chemotherapy aspect of steroids. The usual steroids are prednisone and dexamethasone (also called decadron).

Prednisone and dexamethasone are known as glucocorticoids, or corticosteroids. Similar in structure to the natural steroid hydrocortisone, these synthetic glucocorticoids bind with steroid receptors on the nuclear membrane, block mitosis, and inhibit protein synthesis. Dexamethasone has been shown to be a more effective chemotherapy agent than prednisone in some ALL treatment studies, but it also (in general) causes more severe side effects, including osteonecrosis (ON).

Administration: PO. Chemotherapy doses: dexamethasone is 10 mg/m2/day and prednisone is 60 mg/m2/day.

Types of pediatric cancers: Leukemias, lymphomas.

Side effects (during/soon after treatment): Steroids cause immediate side effects such as moodiness, hunger, irritability, acne, trouble sleeping, and puffiness (redistribution of body fat to the face and abdomen). Immunosuppression usually occurs within about 2 weeks. Stomach upset and muscle weakness are occasional side effects.

Possible long term effects: Osteopenia or osteoporosis; higher risk factors include being a teen during treatment and a larger cumulative dose. Osteonecrosis or avascular necrosis. Osteonecrosis typically begins during treatment phase and may progress over time; high risk factors are age greater than 10 years and/or combination with high-dose radiation. Dexamethasone puts the survivor at higher risk for these effects than does prednisone. Cataracts; higher risk with radiation and years from treatment. See the Survivors' Guidelines for recommended periodic evaluations for all of these conditions. (From the COG Late Effects Guidelines. 11/06)

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Thioguanine

A chemotherapy drug. Thioguanine is an antimetabolite: it interferes with DNA synthesis. In the treatment for ALL, it is sometimes used instead of mercaptopurine, although in some studies it showed higher liver toxicity than mercaptopurine.

Administration: PO . Like mercaptopurine, thioguanine should be taken at night (at least an hour after a meal) and without milk or citrus (see Patty's Chemo Drugs pages). The usual pediatric dose is 60 mg/m2.

Side effects (during/soon after treatment): Myelosuppression (also see TPMT discussion, above, under mercaptopurine). Nausea and vomiting, anorexia, and diarrhea are occasional side effects.

Possible long term effects: If acute VOD occurs during treatment, sometimes liver dysfunction is seen as a late effect. If acute hepatotoxicity was reported with thioguanine used in CCG 1952 (regimens B1 and B2) for ALL maintenance therapy, longer follow-up is required. (From the COG Late Effects Guidelines. 11/06)

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Vancomycin

An antibiotic used for serious, life-threatening infections by gram-positive bacteria, traditionally used after all other antibiotics have failed. It is given by IV and sometimes causes pain.

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Versed

An anaesthetic. Versed is administered by an anesthesiologist to produce conscious sedation to relieve the pain of procedures.


Vinblastine

A chemotherapy drug. Vinblastine is a vinca alkaloid that is closely related to vincristine. It is used less often than vincristine in pediatric cancers.

Administration: IV. The usual pediatric dose is 1 mg/m2/d.

Types of pediatric cancers: Lymphomas, neuroblastoma, Ewings (metastatic).

Side effects (during/soon after treatment): Myelosuppression and hair loss within 2-3 weeks. Occasional peripheral sensory or motor neuropathy symptoms (see the discussion under vincristine). Occasional constipation. Nausea, vomiting, and mouth sores are rare.

Possible long term effects: Peripheral sensory or motor neuropathy as listed just above (loss of knee jerk reaction, weakness, foot drop, odd feelings of the lips, tongue, fingers and feet). Rather than being late in onset, these sensory/neuropathy effects begin during treatment and continue after treatment ends. High risk factors for neuropathies include combined treatment with platinum chemotherapy agents, gemcitabine, or taxanes. An occasional late effect is Raynaud's Phenomenon, a condition that results from poor circulation in the extremities, causing hands and feet to turn blue and feel cold. High risk factors for this condition are smoking and illicit drug use. (From the COG Late Effects Guidelines. 11/06)

Other names: VBL, vincaleukoblastine, Velban.

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Vincristine

A chemotherapy drug. Vincristine is a plant alkaloid that inhibits cell division. It was originally isolated from the Madagascar periwinkle plant.

Administration: IV. The common pediatric dose is 1.5mg/m2.

Types of cancer: ALL, lymphomas, Ewing 's, neuroblastoma, rhabdomyosarcoma, retinoblastoma, Wilms, and osteosarcoma.

Warning: If vincristine is accidentally given IT (intrathecally, into the spinal fluid), it is fatal. In certain treatment protocols, such as those for ALL, vincristine is given the same day as IT therapy. Check your child's meds, especially in such circumstances.

Side effects (during/soon after treatment): Local ulceration if it leaks out of the blood vessels into the surrounding tissues (extravasate is the medical term for this). Hair loss within 2-3 weeks. Loss of deep tendon reflexes. Officially, peripheral sensory or motor neuropathy symptoms are listed as "occasional" side effects, but most parents report some symptoms within the following list: loss of knee jerk reaction, weakness, foot drop, odd feelings of the lips, tongue, fingers and feet. Occasional jaw pain, abdominal pain, and constipation. (Most parents report constipation as a common side effect of vincristine.)

Possible long term effects: Peripheral sensory or motor neuropathy as listed just above (loss of knee jerk reaction, weakness, foot drop, odd feelings of the lips, tongue, fingers and feet). Rather than being late in onset, these sensory/neuropathy effects begin during treatment and continue after treatment ends. High risk factors for neuropathies include combined treatment with platinum chemotherapy agents, gemcitabine, or taxanes. An occasional late effect is Raynaud's Phenomenon, a condition that results from poor circulation in the extremities, causing hands and feet to turn blue and feel cold. High risk factors for this condition are smoking and illicit drug use. (From the COG Late Effects Guidelines. 11/06)

Other names: VCR, Oncovin, Vincasar.

Links to more information:


 Zofran

A drug used to prevent the nausea and vomiting caused by chemotherapy. It is a serotonin receptor antagonist (similar to SSRIs such as Prosac). It is usually given a little before treatment begins, and can be given either orally or by IV. It has only rare side effects, but its use is limited by the fact that it is very expensive (about $25/pill in 2006).

Other name: Ondansetron.

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Disclaimer

This section on common drugs used during treatment for childhood cancers has been compiled using information from a number of reliable sources, including online resources (MedScape, MedLine, CancerBackup, among others), protocols from COG (parents are given these by their treatment facilities), and general knowledge acquired from listening to comments of parents of children with cancer in the ACOR online discussion groups. To the best of our knowledge, this information is correct, but it is presented here for informational use only and is not intended as a substitute for professional advice.