Pentostatin

DAE Class; Rx

Common Brand Names; Nipent, DCF, 2Deoxycoformycin

• Antineoplastics, Antimetabolites

Purine nucleoside antimetabolite
Used for the treatment of hairy-cell leukemia
Use of higher than the FDA-approved doses or use with fludarabine is not recommended due to toxicity

Indicated for the treatment of hairy-cell leukemia.

For the treatment of chronic lymphocytic leukemia (CLL), in combination with cyclophosphamide and rituximab.

For stem cell transplant preparation prior to allogeneic stem cell transplantation, in combination with extracorporeal photopheresis and reduced dose total body irradiation.

For the treatment of graft-versus-host disease (GVHD). For the treatment of corticosteroid-refractory acute graft-versus-host disease (GVHD). 

For the treatment of advanced cutaneous T-cell lymphoma (CTCL), including mycosis fungoides and Sezary syndrome.

Hypersensitivity

Concomitant fludarabine: risk of fatal pulmonary toxicity

Relative: active infections

All grades of severity are listed unless otherwise indicated

>10%

Increased creatinine (93%)

Increased creatine phosphokinase (58%)

Increased gamma glutamyl transferase (GGT) (45%)

Fatigue (43%)

Nausea (41%)

Diarrhea (36%)

Anemia (36%)

Vomiting (30%)

Increased AST/ALT (27-29%)

Abdominal pain (28%)

Constipation (22%)

Rash (22%)

Increased alkaline phosphatase (21%)

Visual impairment (20%)

Serous retinopathy/retinal pigment epithelial dystrophy (RPED) (20%)

Hemorrhage (19%)

Hyponatremia (18%)

Pyrexia (18%)

Dizziness (15%)

Leukopenia (13%)

Lymphopenia (13%)

Neutropenia (13%)

Peripheral edema (13%)

Increased GGT, Grades 3 and 4 (11%)

Hypertension (11%)

Black Box Warnings

The drug should be administered under the supervision of an experienced cancer chemotherapy physician in a facility equipped to diagnose and manage complications

Do not exceed recommended doses. Nephrotoxicity, hepatotoxicity, CNS, and pulmonary toxicity occurred in phase 1 studies that used higher doses than recommended

Do not use with concurrent fludarabine because of increased risk of pulmonary toxicity

Cautions

Epilepsy, liver dz, bone marrow depression

Weigh risk/benefit for pts w/ infections

Withhold if elevated SCr, renal dysfunction

Withhold or discontinue if evidence of CNS toxicity

Avoid pregnancy

Pregnancy Category: D

Lactation: not known if excreted in breast milk, do not nurse

Adults

4 mg/m2 IV once every other week.

Geriatric

4 mg/m2 IV once every other week.

Adolescents

Safety and efficacy not established.

Children

Safety and efficacy not established.

Pentostatin