Antineuoplastic agents include-

Interferon ALFA 2a, Interferon ALFA -2b, Interferon ALFA -n3, Levamisole, Altretamine, Cladribine, Hydroxyurea, Aldesleukin, Paclitaxel, Docetaxel,Tretinion, Procarbazine,Dacarbazine, Gemcitabine, Mitotane, Asparaginase, Pegaspargase,Porfimer Sodium

Photosensitising agents- concomittant usuage of any photosensitizing agents (eg tetracycline, sulfonamides,phenothiazines, sulfonamides, phenothiazines,sulfonylureas, thiazide diuretiics, griseofulvin) could increase the photosentivity reaction.

Esophageal cancer

 Antineuoplastic agents include-

Interferon ALFA 2a, Interferon ALFA -2b, Interferon ALFA -n3, Levamisole, Altretamine, Cladribine, Hydroxyurea, Aldesleukin, Paclitaxel, Docetaxel,Tretinion, Procarbazine,Dacarbazine, Gemcitabine, Mitotane, Asparaginase, Pegaspargase,Porfimer Sodium

 
The adverse reactions are charaterstic of an inflammatory response induced by photodynamic
effect.

Cardiovascular -  atrial fibrillation   8%    cardiac failure 6%  tachycardia 4%

CNS -   anorexia   6%   anxiety 5%    confusion 6%  hypertension  4%  insomnia  10%

Dermatologic -  photesensitivity reactions  15%

GI -    abdominal pain    16%        constipation 20%     diarrhea  3%   dyspepsia  4%
          dysphagia   8%                 eructation  3%          esophageal edema   6%
            esophageal tumor bleeding   6%                  esophagitis  3%
           hematermesia  6%             nausea  20%        vomiting   13%

GU-   urinary tract infection  5%  

Hematologic -      anemia     25%        

Metabolic/ nutritional -       dehyfration     5%        weight decrease   7%

Respiratory -       coughing   5%           dyspnea   16%        pharyngitis   9%
                              plueral effusion   26%              pneumonia   15%
                              respiratory insufficiency    8%

Miscellaneous -    asthenia   4%      back pain  9%    chest pain  18%  edema  3%
                                edema peripheral  5%        fever  25%            monilasis  7%
                                pain  17%     

Porphyria or in patients with known allergies to porphyrins.

Special precautions:

Occular sensitivity- ocular discomfort, sensitivity to,sun, bright lights, or car head lights. Chest pain  may complain.

Endobronchial cancer - patients should be assessed for the possibility that a tumor may be eroding into a pulmonary blood vessel.

Fistula - if the endobronchial invades deeply into the bronchial wall the possibility exists for
fistula formation upon resolution of cancer

Respiratory distress - if respiratory distress occurs the physician should be prepared to carry out immediate bronchoscopy to remove secretions and debris to open the airway.

Pregnancy- women of childbearing age should practice efective method of contrception during therapy

Lactation- infants from porfirmer women receiving porfimer sodium must not breastfeed.

Children- safety and efficacy in children have not been established

Approved by FDA on December 27, 1995

Indications:

Esophageal cancer

Dosage:

Adminster porfimer as a single slow IV injection over 3 to 5 minutes at 2mg/kg.

1. Advice patients that this medicine should  be prepared and administered by healthcare
provider in a medical setting.

2. Advice patients to contact a doctor, if they experience chest pain, difficulty in breathing
or abnormal blood loss.

3. Inform patients that this drug will cause sensitivity to sun, bright lights, or car head lights.
for 30 days they should avoid exposure of skin and eyes to direct sunlight from skylight  or
undraped  windows or bright indoor light.

4. Advice patients to test skin sensitivity before exposing skin to bright  indoor light or
direct sunlight. To test the skin expose a small skin area to sunlight for 10 minutes.
If no sensitivity reactions eg rash, swelling, blistering occur within 24 hours, gradually resume normal outdoor activites.

5. If patients must go out during day light hours,  instruct patients to cover the skin as
much as possible  and wear dark  sunglasses even on a cloudy days or when in a car.  

6. Contraceptive measures are recommended during treatment to avoid birth defects.
Inform your doctor if you become pregnant, are planning to become pregnant or if you are
breast feeding.

7. Inform patients that lab tests may be required  to monitor treatment

Pharmacology: Pofimer is a photosensitizing agent used in the photodynamic therapy (PDT) of tumors. The cytotoxic and antitumor actions of pofimer are light and oxygen dependent. Pharmcokinetics: Following a 2mg/kg dose,the average peak plasma concentration was 15mcg/ml, the elimination half-life was 250 hrs.

Pregnancy-
Women of childbearing age should practice efective method of contrception during
therapy

Lactation-
Infants from porfirmer women receiving porfimer sodium must not breastfeed.

Children-
Safety and efficacy in children have not been established