New cancer therapies in 2009: A review for the oncology nurse

New cancer therapies in 2009: A review for the oncology nurse
New cancer therapies in 2009: A review for the oncology nurse

Accreditation Statement: Postgraduate Institute for Medicine is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

This article reviews three therapeutic options that recently became available for the treatment of cancer or conditions related to cancer:

• The hematopoietic stem cell mobilizer plerixafor (Mozobil), for use in combination with granulocyte-colony stimulating factor to mobilize hematopoietic stem cells to the peripheral blood for collection and autologous transplantation in patients with non-Hodgkin's lymphoma or multiple myeloma;

• A transdermal form of the selective 5-hydroxytryptamine type 3 receptor antagonist granisetron (Sancuso), used to prevent nausea and vomiting in patients receiving moderately or highly emetogenic chemotherapy regimens of up to 5 consecutive days' duration; and

• The mTOR kinase inhibitor everolimus (Afinitor), for the treatment of patients with advanced renal cell carcinoma after failure of treatment with sunitinib or sorafenib.

Plerixafor was approved by the FDA in December 2008; granisetron was approved in September 2008; and everolimus was approved in March 2009.

PLERIXAFOR (MOZOBIL)

Indication: Plerixafor, a small-molecule CXCR4 chemokine receptor antagonist, is indicated for use in combination with granulocyte-colony stimulating factor (G-CSF) to mobilize hematopoietic stem cells to the peripheral blood for collection and autologous transplantation in patients with non-Hodgkin's lymphoma or multiple myeloma.

Pharmacology: Plerixafor is a chemokine CXC receptor 4 (CXCR4) antagonist that is designed to mobilize hematopoietic stem cells from the bone marrow to the bloodstream for harvest, enabling certain patients to proceed to transplant.1 It blocks the binding of stromal cell-derived factor-1a, which, with CXCR4, plays a role in the homing and trafficking of stem cells in the bone marrow. Treatment with plerixafor causes increases in circulating leukocytes and stem cells.

Patients with non-Hodgkin's lymphoma or multiple myeloma may be candidates for autologous hematopoietic stem cell transplantation as part of their treatment. Before the transplant can take place, a minimum number of stem cells, generally about 2 million/kg, must be collected. For some patients, this may be a lengthy process or may not occur satisfactorily.

Clinical trials: Two placebo-controlled studies were conducted to evaluate the safety and efficacy of plerixafor in combination with G-CSF for stem-cell mobilization.1 In the first study, conducted in patients with non-Hodgkin's lymphoma, 59% of 150 patients given plerixafor + G-CSF collected ≥ 5 × 106 CD34+ cells/kg in four or fewer apheresis sessions, compared to 20% of 148 patients given placebo + G-CSF. In the second study, conducted in patients with multiple myeloma, 72% of 148 patients who were treated with plerixafor + G-CSF collected ≥ 6 × 106 CD34+ cells/kg from the peripheral blood in two or fewer apheresis sessions, compared with 34% of 154 patients given placebo + G-CSF. The target numbers of stem cells in the studies were selected based on literature that suggests that reaching these targets can help to facilitate engraftment. Updated 12-month follow-up findings showed that graft durability rates for patients in the plerixafor + G-CSF and placebo + G-CSF arms were comparable.2

In the literature: Researchers investigating the efficacy and toxicity of combining G-CSF at standard doses with plerixafor to mobilize stem cells in patients with non-Hodgkin's lymphoma and multiple myeloma found that the combination increased circulating CD34 cells/mL and led to the adequate collection of stem cells for autotransplant in 96% of 49 patients studied, 28 of whom were classified as heavily pretreated. They concluded that this combination may have particular value in heavily pretreated patients.3

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