Cytoprotective and supportive care agents:
Indications for TOTECT:
To treat extravasation resulting from IV anthracycline chemotherapy. To reduce incidence and severity of cardiomyopathy associated with doxorubicin administration in women with metastatic breast cancer who have received a cumulative doxorubicin dose of 300mg/m2 and will continue to receive doxorubicin therapy to maintain tumor control.
Extravasation: give once daily for 3 consecutive days by IV infusion over 1–2hrs. Initiate 1st dose as soon as possible and within 1st 6hrs after extravasation. Days 1 and 2: 1000mg/m2; max 2000mg. Day 3: 500mg/m2; max 1000mg. Cardiomyopathy: give by IV infusion over 15mins. Initiate prior to and until discontinuation of doxorubicin. Dose ratio: 10:1 (eg, Totect 500mg/m2 to doxorubicin 50mg/m2). May administer doxorubicin within 30mins after completion of Totect infusion. Renal impairment (CrCl <40mL/min): reduce dose by 50%. Hepatic impairment (extravasation): not recommended; (cardiomyopathy): reduce Totect dose proportionately to doxorubicin (maintaining 10:1 ratio).
Myelosuppression. Obtain CBCs prior to each course of therapy for cardiomyopathy. Monitor cardiac function prior to and during therapy (eg, LVEF). Renal impairment: monitor for hematological toxicity. Hepatic impairment (see Adult dose). Elderly. Embryo-fetal toxicity. Use effective contraception during treatment and for 6 months (females of reproductive potential) or 3 months (males w. female partners) after the last dose. Pregnancy: exclude status prior to chemotherapy initiation. Nursing mothers: not recommended (during and for 2 weeks after the last dose).
Avoid with chemotherapy initiation; may interfere with antitumor activity of the chemo regimen. Increased risk of secondary malignancies concomitant with chemotherapy. Extravasation: concomitant topical dimethylsulfoxide (DMSO); not recommended.
Inj site pain/discomfort, nausea, vomiting, pyrexia, post-op infection; leukopenia, neutropenia, thrombocytopenia, lab abnormalities, cardiac toxicity, hypersensitivity reactions (if severe, consider permanent discontinuation).