By Bruce Chabner, Jr., Thomas Lynch, Dan Longo
A CONCISE but THOROUGH evaluation OF THE drugs AND ways utilized in melanoma CARE--BACKED by way of THE AUTHORITY OF HARRISON'S
Harrison's handbook of Oncology is a carry-anywhere consultant to the care of sufferers with melanoma. superior by way of the newest released effects, this priceless medical significant other good points a variety of tables and succinct, outline-style textual content that places vital details at your fingertips. you'll find content material that is going past the remedy of basic or metastatic illness to surround the therapy of all healing complications.
The establishing sections of Harrison's guide of Oncology are dedicated to the periods of brokers used to regard melanoma and experiences their pharmacology and mechanisms of motion. This part is by way of a close dialogue of the prognosis, staging, and therapy of all significant forms of melanoma. there's a robust specialize in symptom administration and problems of remedy, together with discomfort, nausea and vomiting, anemia, febrile neutropenia, metabolic emergencies, thrombosis, mental matters, and end-of-life care.
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Additional resources for Harrison's Manual of Oncology
Both molecules are complex esters containing a 15-member taxane ring system linked to a four-member oxetan ring at the C-4 and C-5 positions of the molecule. The structures of paclitaxel and docetaxel differ in substitutions at the C-10 taxane ring position and on the ester side chain attached at the C-13 ring position. Docetaxel is slightly more water-soluble than paclitaxel and a more potent inhibitor of tubulin in cell free systems. The substitutions at C-13 position are essential for antimicrotubule activity.
The first step should be to increase and extend leucovorin administration (up to 500 mg every 6 h), along with hydration to prevent drug precipitation in the renal tubules. In extreme cases, when drug levels remain above 10 μM and show a very slow decline, leucovorin may be ineffective, and other measures need to be instituted. Continuous flow hemodialysis is able to reduce drug levels at a clearance rate of about 50 ml/min, but very rapid clearance of drug and effective rescue from toxicity can be achieved through the use of a bacterial folate-cleaving enzyme, Carboxypeptidase G-2, which is available from the Cancer Therapy Evaluation Program at the National Cancer Institute (11).
The primary toxicity encountered at low doses (2 mg/m2/day for 5 days) in nonleukemic patients is myelosuppression. However, in patients with leukemia, treated with much higher doses, hepatic dysfunction (enzyme elevations and increased bilirubin) develops in 50–75%. Hepatic function tests normalize within 14 days after drug discontinuation. A skin rash is noted in 50% of leukemia patients receiving clofarabine, and palmoplantar dysesthesia may also develop. It is not known whether clofarabine treatment is associated with long-term immunosuppression, as occurs after fludarabine and cladribine.
Harrison's Manual of Oncology by Bruce Chabner, Jr., Thomas Lynch, Dan Longo