All you need to know about Pegaspargase

What is Pegaspargase?

Pegaspargase (Oncaspar) is used for the treatment of patients with acute lymphoblastic leukemia (ALL).

The pegaspargase is a composition of Oncaspar, which is an enzyme that breaks down asparagine, an essential building block of proteins without which it is difficult to survive for cells. Healthy cells often produce asparagine for themselves, while cancer cells cannot. This medication decreases the level of asparagine in the blood cancer cells and resists the cancerous cells in order to grow.

How does pegaspargase work?

Pegaspargase is specifically involved in breaking down the amino acid asparagine to aspartic acid as well as ammonia. 

The leukemic cells are not able to produce their asparagine and depend on circulating the asparagine for the growth; apart from this, the asparaginase deprives the leukemic cells in order to circulate the asparagine responsible for death of the leukemic cell.

How Oncaspar is given?

Pegaspargase Injection should be administered as an intravenous (IV) infusion over 1-2 hours or maybe given as an intramuscular injection (IM).

Possible side effects: Like all medications, oncaspar can cause side effects, although not everybody gets them.

Very common side effects are as follows:

• Weight loss
• Leg pain
• Chest pain
• Shortness of breath
• Loss of appetite
• General weakness
• Vomiting
• Diarrhoea
• Nausea
• Increased blood sugar levels
• Changes in the function of the pancreas

Common adverse reactions may include:

• Ascites
• Fever and flu-like symptoms
• Mouth sores
• Back, joint or abdominal pain
• High levels of fat
• Increased cholesterol
• Low potassium in blood
• Decreased number of red blood cells

There are some rare pegaspargase side effects, which may include:

• Headache
• Confusion
• Seizures and visual loss 
• Reversible posterior leukoencephalopathy syndrome (RPLS)

warnings and precautions:

Discuss with your doctor prior to receiving pegaspargase. It may inappropriate or not suitable for individuals:

1. If individuals have had serious allergic reactions, for instance itching, flushing or swelling of the airways, because major allergic reactions to this drug may occur.
2. If individuals suffer from a bleeding disorder or have serious blood clots.
3. If individuals get a fever. It may make you comparatively more susceptible to the infections.
4. If individuals have had poor liver function or are taking other medicines which may be harmful for liver. When this drug  is used along with other cancer treatments, liver and central nervous system damage may occur.
5. If individuals suffer from abdominal pain. Inflammation of the pancreas, that in some cases causes death, may develop with pegaspargase injection treatment.
6. This medicine may lead to fluctuations in clotting factors and can increase the risk of bleeding/clotting.
7. If individuals are the parents of a child and are taking treatment with this drug, talk to your doctor if any of the above terms apply to your child.
8. If individuals are pregnant or breast-feeding, or are planning to have a baby, ask your healthcare team for advice prior to using this medication. 

Who should not use Pegaspargase? 

1. Patients who are allergic to pegaspargase or to any of the other ingredients of this medicine.
2. Patients who have severe hepatic disease.
3. Patients who have ever had pancreatitis.
4. Patients who have ever had severe bleeding following asparaginase therapy.
5. Patients who have ever had blood clots following asparaginase therapy.

Inform your doctor in case any of such terms apply to you. In case you are a parent of a child who is taking treatment with pegaspargase, please discuss with your doctor if any of them apply to your child.

If you are given too much Oncaspar: As a healthcare practitioner will administer the oncaspar, it is quite unlikely patients will be given wrong dosage. 

In the event of an accidental drug overdose, patients will be monitored by the healthcare team and treated accordingly.

In case you want to know something on the use of this drug, ask your doctor.

How to store Oncaspar? 

Keep the oncaspar 3750 out of the sight and reach of children. Should be stored in the refrigerator (2°C-8°C).

Freezing of medication is not recommended. Following the medicinal product has been reconstituted and diluted, the solution must be used as soon as possible. If the diluted solution can not be used immediately, it should be stored at 2°C-8°C for up to 48 hours.

NOTE: The information provided in this article is only for informational purposes and is not served as a substitute for the medical treatment, consultation, diagnosis, of a qualified healthcare practitioner.

Addition of Pemetrexed and Carboplatin to Gefitinib Doubled PFS in Patients with EGFR-Mutant NSCLC

On behalf of derived outcomes of a randomized phase 3 study came into view in the Journal of Clinical Oncology, adding pemetrexed and carboplatin to gefitinib significantly enhanced the progression free survival and OS for participants with NSCLC and EGFR-sensitizing mutations. 

Although data suggests that the clinically relevant severe toxicities have been observed twice as often with the combination regimen than with gefitinib alone.

According to Vanita Noronha, MD, MBBS, professor in the department of medical oncology at Tata Memorial Hospital in Mumbai, India, and colleagues, “Apart from the detection of molecular target and using medications, believed to bind to the target, cure and long-term remission elude us,” “Resistance inevitably occurs within 8-12 months. Number of ways have been implemented in order to reduce the emergence of resistance. One strategy involved in order to combine the cytotoxic chemotherapy with an EGFR TKI.” She added. 

Between August 2016 and August 2018, in an open-label study conducted by Noronha and colleagues, total 350 participants enrolled with advanced, chemotherapy-naive, EGFR-mutated Non-Small Cell Lung Cancer. About 18% of participants had brain metastases and 21% found with an ECOG performance status of 2.

The investigators differentiated patients on the basis of performance status and EGFR mutation type and randomly assigned them 1:1 to gefitinib 250 mg orally once per day alone (n = 176; median age, 56 years; range, 27-78) or with pemetrexed 500 mg/m2 IV and carboplatin IV area under the curve 5 each 3 weeks for the four cycles (n =174; median age, 54 years; range, 27-75). The combination regimen was followed by maintenance pemetrexed 500 mg/m2 IV every three weeks.

The progression free survival represents as the primary endpoint, and OS, toxicity and RR represent as the secondary endpoints. The researchers specified survival endpoints in the intention in order to treat the population. The median follow-up reported about 17 months.

About 80% of participants treated with gefitinib and chemotherapy, completed all four cycles of pemetrexed and carboplatin. Outcomes represented ORR of about 75.3% among participants in the combination population and 62.5% in the gefitinib-only population. Participants in the combination population had longer median progression free survival than those in the gefitinib-only population. The combination population had significantly longer median overall survival than the gefitinib population.

About 50% of patients in the combination population experienced grade 3 or higher toxicities; maximum because of the chemo induced myelosuppression and nephrotoxicity, compared with 25.3% of those in the gefitinib population.

Researchers have written, “Adding pemetrexed and carboplatin to gefitinib prolonged PFS (progression free survival) and overall survival, but also be responsible for increasing the toxicity."

Also, Jennifer Byrne stated that, "The pemetrexed, carboplatin and gefitinib, together appeared as a new standard first-line therapy for patients with the EGFR-mutant Non-Small Cell Lung Cancer.” 

Spinal cord Tumor: All you need to know about

The spinal cord tumours specifically occur when abnormal cells grow and form a mass or a lump. The tumour is known as benign (not cancerous) or malignant (cancerous), but both types may be serious and may need urgent treatment. 

Types of Spinal Tumors: 

There are basically three main types of spinal tumors, which are classified on behalf of their location:

Extradural and Intradural (intradural-intramedullary and intradural-extramedullary): Intradural-intramedullary tumors occurs within the dura and spinal cord parenchyma, although Intradural-extramedullary tumors occurs within the dura but outside the spinal cord parenchyma.

Extradural: Extradural tumors occur outside the dura mater lining and are most commonly known as metastatic.

Intradural: Intradural tumors occur inside the dura mater lining and are further subdivided into intramedullary and extramedullary tumors. 

Symptoms of Spinal Tumours:

The most commonly reported symptom of spinal tumors is nocturnal back pain. Other common symptoms may include:

• Muscle weakness
• Sensory loss
• Difficulty walking
• Loss of bowel and bladder control 

Tests & Investigations: Tests as well as investigations carried out in a local hospital or local neuroscience centre. Your healthcare provider will refer you required tests accordingly. If you are taking treatment for any other cancer and your healthcare team find that your symptoms are caused by the cancer spreading to your spine they will perform the tests. Your care team may refer you to a neurosurgeon or spinal surgeon, specialises in operations on the spine.

X-rays of your spine may provide the piece of important information. Apart from this, spinal tumours are usually investigated with the help of MRI scan or a CT scan and possibly by a biopsy or a bone scan.

MRI scan: It mainly uses strong magnetic fields and radio waves in order to produce the pictures of the spine that provide more details than an X-ray.

CT scan: This computerised tomography scan is a specifically X-ray that is able to take pictures of your spine from different angles.

Bone scan: This test is used in order to diagnose the tumours or cancer located in the bone. For this test, a very small amount of a radioactive chemical is injected into your vein.

Biopsy: This is basically an operation in order to remove a small sample of a tumour that is sent to a pathologist for examination. You will be prescribed for a biopsy if your healthcare provider is unsure from the results of your scans what type of tumour you have.

Treatments of Spinal cord tumor: 

There are 4 major types of treatment options for spinal tumours named surgery, radiotherapy, radiosurgery and chemotherapy.

Surgery: In order to treat non-malignant spinal tumours, surgery is most commonly used but it may also be used for the treatment of some malignant tumours. 

Surgery is prescribed in order to remove as much of the tumour as possible without damaging the spinal cord or the nerves surrounding the tumour. Following successful removal of all of a tumour may increase the probability of a good or full recovery. Although it may also reduce the risk of the tumour recurring. Surgery may not be suitable for every individual. Your healthcare provider team will discuss the appropriate treatment options with you.

Radiotherapy: It is basically prescribed in order to treat malignant tumours and tumours that can’t be removed with surgery.

Radiotherapy may also be prescribed following surgery for the treatment of any tumour cells that are difficult to be removed. In case you have had surgery, you will be given time in order to recover before receiving radiotherapy treatment.

Radiotherapy specifically uses X-rays as well as gamma rays in order to damage or destroy the tumour. The treatment also helps by slowing down the growth of tumour and lengthens the time prior to it regrows. Sometimes, the radiotherapy destroyed the tumour completely.

Side Effects of Radiotherapy: 

The commonly reported side effects of radiotherapy may include:

• Inflammation of the skin
• Similar to sunburn
• Bone fractures
• Bone marrow suppression 

Radiosurgery: Likewise radiotherapy, radiosurgery may be prescribed when surgery is not appropriate or as an additional treatment following surgery. This treatment is basically not a surgical and does not involve any cuts. It acts by targeting a higher dose of radiation at the tumour for damaging and destroying the tumour cells. The treatment takes place by a machine named a linear accelerator (LINAC) or gamma knife.

Chemotherapy: It specifically uses drugs to destroy the tumour cells. There are several types of chemotherapy. A few chemotherapy medicines are consumed by mouth and others are recommended to be given via a drip into a vein. 

The drug Temozolomide is recommended as a chemotherapy for treating spinal cord tumor. 

Chemotherapy mainly used for patients with secondary (metastatic) spinal tumours. 

Side Effects of Chemotherapy: The possible side effects of chemo may vary depending on the specific drug used. They include:

• nausea 
• vomiting
• tiredness
• hair loss
• reduced resistance to infection

You should discuss these possible side effects with the specialist providing your treatment.

Steroids: These are prescribed in order to reduce the spine swelling. This relieves pressure on the spinal cord and nerves and reduces the risk of damage to the spinal cord. Steroids are recommended to be given with radiotherapy or surgery. You need to keep taking steroids for a while following your radiotherapy or surgery.

Dexamethasone is one of the most widely used steroid for the spinal cord tumor. 

Steroids may be responsible for causing side effects. Signs and symptoms may include:

• increased appetite
• weight gain
• indigestion
• acne
• stretch marks
• muscle weakness
• diabetes
• sleep disturbance
• feeling restless or agitated

Pain-relief Medications: For people with spinal tumours, pain-relief drugs are used mainly to control back or neck pain. They might be combined with other drugs to control nausea and vomiting. If a morphine-based drug is used it might be combined with a drug to reduce the risk of constipation, which can be a side effect.

Apart from all these, there are some other type of treatment options exists, which are as follows:

• Orthotics
• Physiotherapy
• Occupational therapy
• Bladder and bowel management

Read:- All about skin cancer

Detailed discussion on Skin Cancer

Skin cancer: All cells in the body, including skin cells, repair and are replaced all the time in order to ensure the health of the tissue they form.

In the case of an unbalanced process, growth may become uncontrolled and a collection of abnormal cells may develop in a part of the skin.

Risk Factors: Any individual may develop skin cancer, but it is quite common in older people. The risk is also higher in those people who have:

• Freckled or fair skin.
• Fair hair & blue/green eyes. 
• Had short but intense exposure to UV radiation.
• Actively tanned or used solariums
• Worked outdoors
• A weakened immune system
• Lots of moles on the body or moles with an irregular shape and uneven color. 
• Family history of skin cancer. 
• Certain skin conditions such as sunspots. 

Types of Skin Cancer: 

The 4 main skin cancer are BCC (basal cell carcinoma), SCC (squamous cell carcinoma), melanoma and Merkel cell Carcinoma. 

BCC and SCC are also known as non-melanoma skin cancer or keratinocyte cancers. 

Merkel cell carcinoma and angiosarcoma are the rare non-melanoma skin cancer. They are treated in a different way from BCC and SCC.

Solar Keratoses (Sunspots): These are basically not a skin cancer, but are a warning that you are more likely to get skin cancer.

It is associated with red, flattish scaling areas, and appears on the sun-exposed skin.

Signs: flat, scaly spot that feels rough; often the colour of your skin or red. 

1. BCC - Basal Cell Carcinoma:

Basal cell carcinoma is the most common of all skin cancers. It occurs from the bottom layer of the skin surface and grows gradually over several months. It virtually never spreads to other areas of the body. It can exist in several ways ranging from the red scaly patch of the skin, to pearly lump (prominent blood vessels) on the surface. If it is not treated on time, it will continue to grow and may be responsible for causing ulceration of the skin. 

Signs:

• Occurs on the body that have more exposure to the sun, such as the face, head, neck, shoulders,  lower legs, lower arms but may occur anywhere on the body. 
• May seems as a pearl-coloured lump.
• May bleed and turned inflamed; may appear to heal then turned inflamed again. 

2. SCC - Squamous Cell Carcinoma: 

Squamous cell carcinoma is the second most common type of skin cancer. Unlike BCCs, it has the ability in order to spread to other areas of the body. The risk of this occurring depends on its location, size, and its subtype. It exists on sun-damaged skin as a pink/red lump on the skin which may be tender. Often it may have an ulcerated centre. Generally, they grow rapidly than BCCs.

Signs:

• Occurs on areas of the body most often exposed to the sun, such as the neck, head, hands, forearms and lower legs, but may develop anywhere on the body. 
• May bleed and turned inflamed, and is often tender to touch. 
• Often appears as a thickened, red, scaly or rapidly growing lump. 
• Quite common as you get older. 

3. Melanoma: 

It is basically the most serious form of skin cancer, that arises from the pigment-producing cells in the skin called melanocytes. It is one of the most common causes of death due to skin cancer worldwide.

Cure of melanoma is related to how deep it has spread on the skin when diagnosed. The earlier it is found, the greater the chance of cure. Melanoma mainly arises from a new or changing mole on the skin, although rarely may occur on the palms skin, the soles and even the nails.

Knowing about the ABCDE warning signs of the melanoma may help you find an initial stage melanoma.

A: Stands for the ASYMMETRY; one half is unlike the other half. 

B: Stands for the BORDER; irregular, scalloped or poorly defined border.

C: Stands for the COLOR; may vary from one part to another; shades of tan & brown, black; sometimes white, red or blue. 

D: Stands for the DIAMETER; while melanomas are usually higher than the 6mm when diagnosed, they may be smaller.

E: Represents EVOLVING; a mole or skin lesion that seems different.

Signs:

• Occurs as a maiden or existing spot on the body that changes shape, size, or color over a few weeks to months. 
• Often has either a flat or raised surface. 
• Probably more than 1 color (blue, brown, black, red, white, pink light grey, or the color of skin). 

4. Merkel cell carcinoma: 

It is mainly a kind of rare cancer associated with skin. Merkel cell carcinoma traditionally believed to arise from the Merkel cells, specialised cells involved in the sensation of “touch”, situated in the basal layer of the skin epidermis. 

Signs:

The initial sign is a fast-growing, painless tumor on the skin. The tumor may be skin-colored and may appear in shades of blue, red, or purple. The maximum Merkel cell carcinomas occur on the face, neck or head, but they may appear anywhere on the body, even on parts not exposed to the sunlight.

Causes of Skin Cancer: 

The major cause of all sorts of skin cancer is overexposure to the Ultraviolet radiation. Approximately 95% of skin cancers are due to UV exposure. When the unprotected skin is exposed to the UV radiation, the structure, as well as behaviour of the cells, may change. 

Sun produced the UV radiation, but it may also come from artificial sources, such as sun beds. 

UV radiation can't be felt or seen and it is not related to the temperature. It may cause:

• sunburn
• premature skin ageing
• damage to skin cells, which may lead to skin cancer.

Treatment of Skin Cancer: 

Skin cancer is treated in different ways. Treatment basically depends on your general health, size, type, and location of the cancer, , any medications you are consuming (these may affect the amount of bleeding as well as healing time), whether the cancer has reached other organs of your body.

In case the biopsy has removed all the cancer, you may be not recommended for any further treatment.

SURGERY: For skin cancer, surgery is one of the most common treatments. The procedure type you have basically depends on the size as well as position of the cancer. 

Maximum small skin cancers are removed by a dermatologist or GP. A surgeon is required in order to treat more complex cases.

Mohs surgery: Mohs surgery is usually performed under the local anaesthetic by a dermatologist. 

It is prescribed for the treatment of skin cancers that have started to spread deep into the skin or recurred. It may also be prescribed for cancers in areas that are difficult to treat, such as close the eye or on the nose, ears and lips. Mohs surgery is more expensive than other types of surgery. 

CURETTAGE & ELECTRODESSICATION: Curettage and electrodessication (or cautery) is prescribed for the treatment of some BCCs and squamous cell carcinoma in situ (Bowen’s disease). It is performed by a dermatologist. 

The healthcare provider will give you a local anaesthetic and then scoop out the cancer using a small, sharp, spoon-shaped instrument addressed as a curette. 

Low-level heat (cautery or electrodessication) will be applied in order to stop the bleeding and destroy any remaining cancer. The wound would heal within a few weeks, leaving a flat, round, small, white scar.

CRYOTHERAPY: Cryotherapy/Cryosurgery, is a way that uses the liquid nitrogen in order to remove some small BCCs & sunspots. 

The healthcare provider, usually a dermatologist, sprays liquid nitrogen onto the sunspot or skin cancer and a small area of skin around it. You may experience a stinging or burning sensation, which may last a few minutes. The liquid nitrogen basically freezes and kills the abnormal skin cells and creates a wound. In a few cases, the procedure may be required to be repeated. 

The treated area will be sore and red. A blister may be formed within a day. 

TOPICAL TREATMENTS: Some skin spots and cancers should be treated with creams or gels. These are known as topical treatments. They may contain immunotherapy or chemo drugs, and are prescribed by healthcare practitioners. You need to use these treatments only on the particular spots or parts that your healthcare professional has asked you in order to treat. Never use leftover cream for the treatment of new spots that have not been assessed by your healthcare provider.

Imiquimod: It is a sort of immunotherapy that causes the body’s immune system in order to destroy cancerous cells. 

It is prescribed in order to treat superficial BCCs, Bowen’s disease (squamous cell carcinoma in situ) and sunspots. 

You should apply it directly to the affected area every night, usually 5 days a week for 6 weeks.

5-fluorouracil (5-FU): The fluorouracil 5 cream is mainly a type of chemo drug. 

It is prescribed for treating superficial BCCs, sunspots &, sometimes Bowen’s disease. 

The fluorouracil cream acts more effectively on the face and scalp. Your healthcare provider or dermatologist will instruct you how to apply the cream and how often. Many people use this cream twice daily for 2 to 3 weeks. Fluorouracil may need to be used for longer for some skin cancers. While using the cream, you will be more sensitive to the ultraviolet radiation and you should stay out of the sun. 

Ingenol mebutate: It should be applied to the affected sunspots once daily for 2-3 days.

Adverse reactions may include skin flaking or scaling, reddening, crusting or scabbing, blisters, and mild swelling. 

These adverse reactions should disappear within the 2 weeks of treatment finishing.

TARGETED THERAPY: Targeted therapy drugs are prescribed in order to treat melanoma and some non-melanoma skin cancers, such as rare cases of advanced basal cell carcinoma.

Dabrafenib (Tafinlar): Dabrafenib may be used (together with MEK inhibitor trametinib) following surgery in patients with stage III melanoma, where it is effective in order to lower the risk of the cancer coming back.

Trametinib (Mekinist): It is prescribed for the treatment of melanoma that has spread or difficult to be removed completely.

Trametinib may also be recommended together with dabrafenib following surgery in patients with stage III melanoma, where it may act by lowering the risk of the cancer coming back.

Some other drugs can be also recommended, these are as follows:

• Cobimetinib (Cotellic)
• Binimetinib (Mektovi)
• Encorafenib (Braftovi)
• Vismodegib (Erivedge)
• Sonidegib (Odomzo)
• Vemurafenib (Zelboraf)

IMMUNOTHERAPY: Checkpoint inhibitors and cytokines are a couple of types of immunotherapy medications that may be prescribed for treating some cases of Merkel cell carcinoma and melanoma. The medicines are designed in order to trigger the immune system to identify and attack cancer cells.

Some major immunotherapy medications are as follows:

• Pembrolizumab (Keytruda)
• Nivolumab (Opdivo)
• Atezolizumab (Tecentriq)
• Ipilimumab (Yervoy)
• Interleukin-2 (IL-2)

PHOTODYNAMIC THERAPY: PDT uses a cream and a light source in order to make your cancer sensitive to light. It is recommended for the treatment of sunspots, superficial BCCs and squamous cell carcinoma in situ/Bowen’s disease. 

Adverse reactions may include swelling and redness, which usually ease following a few days. PDT is commonly responsible for causing stinging, burning or tender feeling in the treatment area, mainly to the face. 

RADIATION THERAPY: Radiotherapy mainly uses radiation (x-rays or electron beams) in order to damage or kill cancerous cells. It is recommended for BCC or SCC in such areas that are hard to treat with the help of surgery, such as the face. Sometimes this therapy is also recommended following surgery in order to block the cancer from coming back or spreading.

REMOVING LYMPH NODES: In case your cancer has spread, your healthcare provider may remove the lymph nodes in an operation that is known as lymph node dissection. This is effective by reducing the chance of the cancer spreading to other organs or coming back. In order to know more, speak to your doctor.

Prognosis: Prognosis indicates expected outcome of a particular disease. Your treating healthcare professional is an appropriate person in order to interact about your prognosis. Maximum BCCs as well as SCCs can be successfully treated, especially if detected early.

Apart from this, most of the non-melanoma skin cancers do not pose a serious risk to your health. 

How can I prevent skin cancer? 

It is believed that sun exposure is the most preventable risk factor for all skin cancers.

Following several things you must need to do:

• Use a broad-spectrum, water-resistant sunscreen with SPF of 30 or more to the entire area not covered by clothes. The potential of “Broad-spectrum” helps in order to protect ultraviolet A (UVA) as well as ultraviolet B (UVB) rays.
• Always wear a long-sleeved shirt, pants, a wide-brimmed hat, and sunglasses, where possible.
• Seek shade when appropriate.
• Caution is required near water, snow, and sand because they reflect and intensify the damaging rays of the sun, which may increase the chances of sunburn.
• Vitamin D should be taken through a healthy diet that may include vitamin supplements. Avoid seeking the sun.
• Tanning beds should be avoided. UV light from the sun and tanning beds may be responsible for causing skin cancer as well as wrinkling. 

Afatinib: Precautions and Warnings

Afatinib is specifically indicated for treating certain sorts of non-small cell lung cancer that has developed to the nearby tissues or to other organs of the body. It belongs to the class of medicines known as kinase inhibitors and acts by blocking the action of a certain naturally occurring substance that helps cancer cells to multiply.

The pills of afatinib should be taken by mouth on an empty stomach at least 1 hour prior to or 2 hours following a meal.

Consume afatinib exactly as instructed. Gulped the afatinib tablets whole with the help of water. Neither crushed nor dissolved the tablets.

Precautions:

• You must ensure that the wholesaler or pharmacy you are purchasing from is genuine & licensed.
• Always choose wholesalers or pharmacies that need a genuine prescription letter. 
• It is always a good idea to check online reviews, prior to making the purchase of afatinib. 
• You should always choose an online pharmacy/wholesaler that has an experienced pharmacist.
• Do not choose a pharmacy/wholesaler that offers afatinib at cheap prices. It may be a trick to attract customers.
• Always go with the reputable pharmacies/wholesalers that hold the certification of WHO-GDP & ISO. 
• You must not provide your personal information such as credit card numbers unless you are sure the site/pharmacy/wholesaler can protect them.
• Never accept afatinib if the packaging seems damaged or puffed up.
• Never accept afatinib if it doesn't look authentic.

Warnings:

• This drug must be administered under the supervision of an experienced health professional.
• The afatinib 40 mg should be discontinued in patients who develop life-threatening bullous, exfoliating lesions or blistering.
• This medicine may be responsible for causing fetal harm if given to a pregnant woman.
• Diarrhea, including severe diarrhea, may occur during treatment with this medicine.
• Patients need to avoid products that contain lactose or any foods known to aggravate diarrhea.
• Hepatic failure has been reported while on treatment with this medicinal product.
• This medicine is used with caution in patients with a history of keratitis, ulcerative keratitis or severe dry eye.

All you need to know about Carmustine Injection

What is Carmustine:

It belongs to a group of anticancer substances known as nitrosourea that act by resisting the growth of cancer cells.

Indication: Carmustine is prescribed as a single agent or in combination therapy with other anticancer medications in certain sorts of cancers, like:

• Multiple myeloma
• Hodgkin’s disease
• Non-Hodgkin’s lymphomas
• Malignant melanoma
• Tumours of digestive system tract or gastrointestinal tract
• Brain tumours; medulloblastoma, glioblastoma, astrocytoma and metastatic brain tumours. 

Dosage: Dosage directly depends on the body size, medical condition and response to treatment. It is usually recommended at least every 6 weeks. As a single agent, the recommended dose in previously untreated patients is carmustine 150 - 200 mg/m2, should be given intravenously every 6 weeks.

Dosage may also depend on whether carmustine is given together with other anti-cancer drugs. Doses can be adjusted according to how you respond to the treatment.

Administration of Carmustine: 

The carmustine 100 mg should always be given to you by a healthcare provider with experience in the use of anticancer medications.

It is given into a vein by a drip over a 1 to 2 hour period. The duration of infusion should not be less than 1  hour in order to avoid the burning and pain at the injected area. The injected area needs to be monitored while administration.

The treatment duration is specified by the healthcare provider and may vary for every patient.

Avoid the use of Carmustine: Do not use this medication:

• in case of the allergic to carmustine or any of the other ingredients of this drug. 
• if you have decreased blood platelets, white blood cells or red blood cells, either as a result of chemo or from other causes.
• in patients with severe kidney function impairment. 
• in patients with less than 18 years. 
• if you are breast-feeding. 

Possible side effects: Like all drugs, carmustine injection may cause side effects, although not everybody gets them.

Inform your healthcare provider immediately if you notice any of the following:

Very common: The most common carmustine side effects are following:

• Ataxia
• Dizziness
• Headache
• Blurred vision
• Retinal bleeding
• Fall in blood pressure
• Inflammation of the veins
• Shortness of breath
• Persistent cough, 
• Chest pain
• Persistent tiredness
• Delayed myelosuppression
• Severe nausea and vomiting
• Inflammation of the iris and optic nerve

Common: Some commonly reported side effects include;

• Acute leukemias
• Bone marrow dysplasias
• Anaemia 
• Anorexia
• Constipation
• Diarrhoea
• Inflammation of the mouth and lips
• Loss of hair
• Flushing of the skin
• Reactions on the injection site

Warnings & Precautions:

1. Interact with your doctor, pharmacist or nurse prior to using carmustine 100 mg injection.
2. Since the major adverse reactions of this medication is delayed bone marrow suppression, your doctor will monitor blood counts weekly for at least 6 weeks following a dose.
3. Notify your doctor if you have symptoms; unusual tiredness, fever, persistent sore throat, enhanced tendency to bruising, throbbing heartbeat. 
4. Prior to and during treatment, your liver as well as kidney function should be tested and observed regularly.
5. Use of carmustine 100 mg may lead to lung damage, an X-ray of the chest region and the lung function tests should be conducted prior to initiating treatment.
6. Your healthcare provider will talk to you about the possibility of lung damage and allergic reactions and their signs. If such signs appear, call your doctor right away.
7. Women, as well as male of childbearing potential, must use effective contraception while on treatment and for at least 6 months after treatment. 
8. Avoid breast-feeding while taking this medicine and up to 7 days after completion of treatment. A risk to the infant/newborn cannot be excluded.

Overdose & Missed Dose: As a healthcare provider will be giving you this medicine, it is unlikely that you will be given an incorrect or missed dose. 

Tell your healthcare provider if you have any concerns about the missed dose and quantity of drug that you receive.

How to store Carmustine:

Keep carmustine injection out of the sight and reach of children.

Store and transport refrigerated (2°C – 8°C). Avoid using this medication after the expiry date. 

FAQ's

What is the best source to buy Carmustine? 

In India, the carmustine price is very reasonable. Buy this cost-effective medication from a WHO-GDP & ISO certified pharma wholesaler company. Prices may vary from branded to non-branded drugs. 

How is Carmustine (BiCNU) supplied? 

Each package mainly includes a vial containing 100mg carmustine and an ampule containing 3mL sterile diluent.

Is use of Carmustine safe?

Carmustine is completely safe in case taken at prescribed dose and duration as instructed by your healthcare practitioner.

Who should not take Carmustine? 

Carmustine should not be taken by individuals who have shown a previous hypersensitivity to this medicine.

Is Carmustine a vesicant?

Carmustine falls under irritants amongst chemo drugs. Although when administered at the high doses it may act as vesicant.

What need to avoid while taking carmustine treatment?

Follow your healthcare provider's instructions regarding any kind of restrictions on foods, beverages, or activity. 

Does Carmustine inhibit DNA replication?

Yes, Carmustine acts in order to prevent DNA replication.

What if I overdose?

You need to seek emergency medical attention or call your healthcare professionals promptly.

What if I miss a carmustine dose?

Call your healthcare practitioner promptly for instructions in case you miss an appointment for your carmustine injection.

NOTE: The piece of information mentioned about "All you need to know about Carmustine Injection" in this article is just for the informational purposes and is not served as a substitute for medical treatment, consultation, diagnosis of an experienced/qualified healthcare practitioner.

All you need to know Pazopanib

Pazopanib(votrient) is specifically a selective multi-targeted receptor TKI (tyrosine kinase inhibitor). This drug is marketed under the brand name Votrient. It prevents the activity of proteins, involved in the growth and spread of cancer cells. The pazopanib 400mg is prescribed for adults to treat:

• advance renal cell carcinoma
• certain forms of soft-tissue sarcoma

Most Common Side Effects of Pazopanib: 

• diarrhoea
• feeling or being sick
• stomach pain
• loss of appetite
• weight loss
• loss of taste
• sore mouth
• headache
• tumour pain
• skin rash
• high blood pressure
• feeling weak or tired
• loss of skin pigment
• changes in hair colour
• unusual hair loss or thinning

Tell your doctor or pharmacist if any of these pazopanib side effects becomes troublesome.

Warnings and Precautions:

• The votrient 400 mg can raise your blood pressure, and it should be checked prior to taking this drug and while you are taking it. 
• If you're scheduled for an operation, votrient 200 mg should be stopped at least 7 days prior to your operation as it may affect the wound healing.
• The pazopanib 400mg is not prescribed for people aged under 18 and children younger than 2 years of age because of safety concerns.
• Avoid taking pazopanib 200mg with food, as it affects the way the drug is absorbed. Consume it at least a couple of hours following a meal or 1 hour prior to a meal.
• Drinking grapefruit juice should be avoided while you are being treated with the pazopanib tablet as it may increase the chance of side effects.
• Do not take this medication during pregnancy. Notify your doctor if you want to get pregnant.
• Don’t breast-feed while on treatment with this medicine. 
• Avoid driving or using machines if you feel weak, dizzy, or tired, or if your energy levels are low. 
• Discuss with your doctor prior to taking pazopanib 200mg, if you have heart and liver disease.

How Does Pazopanib Works: This multiple kinase inhibitor mainly acts by limiting the growth of tumor by targeting angiogenesis via inhibition of the enzymes including VEGFR (vascular endothelial growth factor receptor), PDGFR (platelet derived growth factor receptor), c-KIT and FGFR. 

How to take Pazopanib: Always take this drug exactly as your doctor has told you. Check with your healthcare professionals if you are not sure.

How much to take: The usual recommended dose is two 400 mg tablets (800 mg pazopanib) consumed once a day. This is the maximum recommended dose per day. Your healthcare provider may need to reduce your dose if you get adverse reactions.

When to take: Don’t take pazopanib together with food. Consume it at least a couple of hours following your meal, or 1 hour prior to a meal.

For instance, you could consume it a couple of hours following breakfast or 1 hour prior to lunch. Consume your pills at about the same time every day.

Tablets should be swallowed whole with the help of water, one after the other. Do not crush or break the tablets as this affects the way the drug is absorbed and may increase the chance of adverse reactions.

If you take more Pazopanib than you should: If you take excess pills, contact a doctor or pharmacist in order to seek the appropriate medical advice. 

If you forget to take Pazopanib: Avoid the consumption of double dose in order to make up for a missed or forgotten dose. Just consume your very next dose at about the usual time.

What is the Best Price of Pazopanib: The pazopanib cost will be very reasonable if you choose to buy this medication from any WHO-GDP & ISO certified wholesaler company.