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Cyclophosphamide

    Brands

    DEA Class;  Rx

    Common Brand Names; Cytoxan

    • Antineoplastics, Alkylating; 
    • DMARDs, Immunomodulators

    Alkylating agent; has activity as both an antineoplastic and immunosuppressant
    Used for the treatment of a variety of solid tumors, NHL, Hodgkin lymphoma, and ALL; oral cyclophosphamide used for nephrotic syndrome in pediatric patients; several off-label uses
    Contraindicated in patients with urinary outflow obstruction

    Indicated for the treatment of acute lymphocytic leukemia (ALL).

    For the treatment of breast cancer.
    For the treatment of Hodgkin lymphoma.
    For the treatment of non-Hodgkin’s lymphoma (NHL) including Burkitt lymphoma and cutaneous T-cell lymphoma (CTCL) (mycosis fungoides).
    For the treatment of chronic lymphocytic leukemia (CLL).
    For the treatment of multiple myeloma.
    For the treatment of ovarian cancer.
    For the treatment of retinoblastoma.
    For the treatment of acute myelogenous leukemia (AML) or chronic myelogenous leukemia (CML).
    For the treatment of neuroblastoma.
    For the treatment of minimal change nephrotic syndrome, in patients who failed to adequately respond to or are unable to tolerate adrenocorticosteroid therapy.
    For the treatment of osteogenic sarcoma† in combination with bleomycin and dactinomycin.
    For the treatment of metastatic rhabdomyosarcoma† in combination with topotecan and vincristine alternating with VAC.

    Severe myelosuppression

    Hypersensitivity

    Urinary outflow obstruction

    • Neutropenia
    • Fever
    • Nausea
    • Vomiting
    • Anorexia
    • Abdominal discomfort or pain
    • Diarrhea
    • Hemorrhagic colitis
    • Oral mucosal ulceration
    • Jaundice
    • Alopecia
    • Skin rash
    • Pigmentation of skin and changes in nails

    Use with caution in patients with hepatic or renal impairment, leukopenia, thrombocytopenia, recent radiation therapy or chemotherapy

    Pelvic irradiation potentiates hemorrhagic cystitis

    Potential for radiation recall when used in conjunction with radiation therapy

    Risk of potentially fatal and irreversible interstitial pulmonary fibrosis if given over prolonged periods

    May cause infertility in male patients who received high doses as children

    Monitor for secondary malignancies

    Heart Failure risk

    • Acute heart failure, often occurring within 1 to 10 days of treatment, has been reported
    • Subclinical decreases in LVEF in up to 50% of cases have also been seen
    • The onset of HF usually resolves over 3 to 4 weeks; However, fatalities caused by HF have been reported
    • Large individual doses (greater than 120–170 mg/kg or 1.55 mg/m 2 per day), old age, mediastinal radiation, and anthracycline use have been identified as risk factors

    Based on mechanism of action and published reports of effects in pregnant patients or animals, drug can cause fetal harm when administered to pregnant woman; exposure to cyclophosphamide during pregnancy may cause fetal malformations, miscarriage, fetal growth retardation, and toxic effects in the newborn; drug is teratogenic and embryo-fetal toxic in mice, rats, rabbits and monkeys; advise pregnant women and females of reproductive potential of the potential risk to the fetus

    Drug is present in breast milk; neutropenia, thrombocytopenia, low hemoglobin, and diarrhea have been reported in infants breast fed by women treated with cyclophosphamide; because of potential for serious adverse reactions in a breastfed child from therapy, advise lactating women not to breastfeed during treatment and for 1 week after last dose

    The suggested maximum tolerated dose (MTD) for cyclophosphamide is dependent on the disease state, performance status, and other chemotherapy agents or radiation therapy given in combination.

    Adults

    In conjunction with bone marrow transplantation, 240 mg/kg IV over a 4 day period (60 mg/kg/day IV) or 7 g/m2 (240 mg/kg) IV as a 96-hour continuous infusion have been reported as the MTD with acceptable myelosuppression and dose-limiting cardiotoxicity. Orally, 50 mg/m2/day PO for 14 days has been reported as the MTD.

    Elderly

    In conjunction with bone marrow transplantation, 240 mg/kg IV over a 4 day period (60 mg/kg/day IV) or 7 g/m2 (240 mg/kg) IV as a 96-hour continuous infusion have been reported as the MTD with acceptable myelosuppression and dose-limiting cardiotoxicity. Orally, 50 mg/m2/day PO for 14 days has been reported as the MTD.

    Adolescents

    50 mg/kg IV in divided doses over a period of 2—5 days; 5 mg/kg/day PO.

    Children

    50 mg/kg IV in divided doses over a period of 2—5 days; 5 mg/kg/day PO.

    Cyclophosphamide

    powder for injection

    • 500mg
    • 1g
    • 2g

    tablet

    • 25mg
    • 50mg