Xelpac 6 mg/ml Vial30 mg

Ovarian Carcinoma: Xelpac 6 mg/ml Vial 30 mg is indicated as first line and subsequent therapy for the treatment of advanced carcinoma of the ovary. As first line therapy, Xelpac 6 mg/ml Vial 30 mg is indicated in combination with cisplatin.Breast Carcinoma: Xelpac 6 mg/ml Vial 30 mg is indicated for ... Read moreOvarian Carcinoma: Xelpac 6 mg/ml Vial 30 mg is indicated as first line and subsequent therapy for the treatment of advanced carcinoma of the ovary. As first line therapy, Xelpac 6 mg/ml Vial 30 mg is indicated in combination with cisplatin.Breast Carcinoma: Xelpac 6 mg/ml Vial 30 mg is indicated for the adjuvant treatment of node-positive breast cancer administered sequentially to standard doxorubicin-containing combination chemotherapy. Xelpac 6 mg/ml Vial 30 mg is indicated for the treatment of breast cancer after failure of combination chemotherapy for metastatic disease or relapse within 6 months of adjuvant chemotherapy. Prior therapy should have included an anthracline unless clinically contraindicated. Xelpac 6 mg/ml Vial 30 mg is indicated for the first-line therapy of advanced or metastatic breast cancer either in combination with an anthracycline in patients for whom anthracline therapy is suitable or in combination with trastuzumab in patients who overexpress HER2 at a 2+ or 3+ level as determined by immuno-histochemistry.Gemcitabine, in combination of Xelpac 6 mg/ml Vial 30 mg, is indicated in the treatment of patients with unresectable, locally recurrent or metastatic breast cancer who have relapsed following adjuvant/neoadjuvant chemotherapy. Prior chemotherapy should have included an anthracycline unless clinically contraindicated.Xelpac 6 mg/ml Vial 30 mg is indicated for the treatment of metastatic cancer of the breast, in combination with trastuzumab, in patients who have tumors that over-express HER2 and who have not received previous chemotherapy for their metastatic disease.Non-Small Cell Lung Carcinoma: Xelpac 6 mg/ml Vial 30 mg, in combination with cisplatin, is indicated for the first line treatment of non-small cell lung cancerin patients who are not candidates for potential curative surgery and/or radiation therapy.Kaposi's Sarcoma: Xelpac 6 mg/ml Vial 30 mg is indicated for the second line treatment of AIDS related Kaposi's Sarcoma.Gastric Carcinoma: Xelpac 6 mg/ml Vial 30 mg is indicated for the treatment of Gastric Carcinoma.

Cytotoxic Chemotherapy

Xelpac 6 mg/ml Vial 30 mg promotes microtubule formation by enhancing the action of tubulin dimers, stabilising existing microtubules and preventing their disassembly, thereby disrupting normal cell division in the late G2 mitotic phase of the cell cycle. This results in the inhibition of cell replication.

Advanced non-small cell lung cancer: 135 mg/m2 over 24 hr or 175 mg/m2 over 3 hr, followed by cisplatin and repeated at 3 wk intervals.Ovarian carcinoma: Primary treatment (in combination with cisplatin or carboplatin): 135 mg/m2 infused over 24 hr followed by cisplatin and repeated at 3 wk intervals. Secondary treatment (as a single agent): 135 or 175 mg/m2 infused over 3 hr once every 3 weeks.Breast cancer: Adjuvant therapy; 2nd line monotherapy or 1st line treatment with trastuzumab: 175 mg/m2 infused over 3 hr once every 3 wk for 4 courses; when used with trastuzumab, the dose should be given the day after the 1st dose of trastuzumab or immediately after subsequent doses if well-tolerated. 1st line with doxorubicin: 220 mg/m2 over 3 hr every 3 wk, the dose to be administered 24 hr after doxorubicin.AIDS-related Kaposi's sarcoma: 135 mg/m2 over 3 hr every 3 weeks. Alternatively, 100 mg/m2 over 3 hr every 2 wk especially in patients with poor performance status.

All patients should be premedicated prior to Xelpac 6 mg/ml Vial 30 mg administration in order to prevent severe hypersensitivity reactions. Such premedication may consist of dexamethasone 20 mg PO administered approximately 12 and 6 hours before Xelpac 6 mg/ml Vial 30 mg, diphenhydramine (or its equivalent) 50 mg IV 30 to 60 minutes prior to Xelpac 6 mg/ml Vial 30 mg, and cimetidine (300 mg) or ranitidine (50 mg) IV 30 to 60 minutes before Xelpac 6 mg/ml Vial 30 mg.First-line treatment of ovarian cancer: Although alternative medication regimens for Xelpac 6 mg/ml Vial 30 mg are under investigation at present, a combination therapy of Xelpac 6 mg/ml Vial 30 mg and cisplatin is recommended. Depending on the duration of infusion, two different dosages are recommended for Xelpac 6 mg/ml Vial 30 mg treatment: 175 mg/m2 of Xelpac 6 mg/ml Vial 30 mg is administered as an intravenous infusion over a period of three hours followed thereafter by 75 mg/m2 of cisplatin and the therapy is repeated at 3-week intervals, or 135 mg/m2 of Xelpac 6 mg/ml Vial 30 mg is administered as an intravenous infusion over a period of 24 hours followed thereafter by 75 mg/m2 of cisplatin and the therapy is repeated at 3-week intervals.Second-line treatment of ovarian cancer: The recommended dose of Xelpac 6 mg/ml Vial 30 mg is 175 mg/m2 administered over 3 hours, with a 3-week interval between courses.Adjuvant chemotherapy in breast carcinoma: The recommended dose of Xelpac 6 mg/ml Vial 30 mg is 175 mg/m2 administered over a period of 3 hours every 3 weeks for four courses, following AC therapy.First-line chemotherapy of breast carcinoma: When used in combination with doxorubicin (50 mg/m2), Xelpac 6 mg/ml Vial 30 mg should be administered 24 hours after doxorubicin. The recommended dose of Xelpac 6 mg/ml Vial 30 mg is 220 mg/m2 administered intravenously over a period of 3 hours, with a 3-week interval between courses. When used in combination with trastuzumab, the recommended dose of Xelpac 6 mg/ml Vial 30 mg is 175 mg/m2 administered intravenously over a period of 3 hours, with a 3-week interval between courses. Xelpac 6 mg/ml Vial 30 mg infusion may be started the day following the first dose of trastuzumab or immediately after the subsequent doses of trastuzumab if the preceding dose of trastuzumab was well tolerated.Second-line chemotherapy of breast carcinoma: The recommended dose of Xelpac 6 mg/ml Vial 30 mg is 175 mg/m2 administered over a period of 3 hours, with a 3-week interval between courses.Advanced non-small-cell lung cancer: The recommended dose of Xelpac 6 mg/ml Vial 30 mg is 175 mg/m2 administered over 3 hours followed by 80 mg/m2 of cisplatin, with a 3-week interval between courses.Treatment of AIDS-related KS: The recommended dose of Xelpac 6 mg/ml Vial 30 mg is 100 mg/m2 administered as a 3-hour intravenous infusion every two weeks.Dose adjustment: Subsequent doses of Xelpac 6 mg/ml Vial 30 mg should be administered according to individual patient tolerance. Xelpac 6 mg/ml Vial 30 mg should not be re-administered until the neutrophil count is >1.5 x 109/1 (>1 x 109/1 for KS patients) and the platelet count is >100 x 109/1 (>75 x 109/1 for KS patients).

Xelpac 6 mg/ml Vial 30 mg clearance is not affected by cimetidine premedication.Cisplatin: Administration of Xelpac 6 mg/ml Vial 30 mg after cisplatin treatment leads to greater myelosuppression and about a 20% decrease in Xelpac 6 mg/ml Vial 30 mg clearance. Patients treated with Xelpac 6 mg/ml Vial 30 mg and cisplatin may have an increased risk of renal failure as compared to cisplatin alone in gynecological cancers.Doxorubicin: Since the elimination of doxorubicin and its active metabolites can be reduced when Xelpac 6 mg/ml Vial 30 mg and doxorubicin are given closer in time, Xelpac 6 mg/ml Vial 30 mg for initial treatment of metastatic breast cancer should be administered 24 hours after doxorubicin. Sequence effects characterized by more profound neutropenic and stomatitis episodes have been observed with combination use of Xelpac 6 mg/ml Vial 30 mg and doxorubicin when Xelpac 6 mg/ml Vial 30 mg was administered before doxorubicin and using longer than recommended infusion times (Xelpac 6 mg/ml Vial 30 mg administered over 24 hours; doxorubicin over 48 hours).Active substances metabolized in the liver: The metabolism of Xelpac 6 mg/ml Vial 30 mg is catalysed, in part, by cytochrome P450 isoenzymes CYP2C8 and CYP3A4. Therefore, in the absence of a PK drug-drug interaction study, caution should be exercised when administering Xelpac 6 mg/ml Vial 30 mg concomitantly with medicines known to inhibit either CYP2C8 or CYP3A4 (e.g. ketoconazole and other imidazole antifungals, erythromycin, fluoxetine, gemfibrozil, clopidogrel, cimetidine, ritonavir, saquinavir, indinavir, and nelfinavir) because toxicity of Xelpac 6 mg/ml Vial 30 mg may be increased due to higher Xelpac 6 mg/ml Vial 30 mg exposure. Administering Xelpac 6 mg/ml Vial 30 mg concomitantly with medicines known to induce either CYP2C8 or CYP3A4 (e.g. rifampicin, carbamazepine, phenytoin, efavirenz, nevirapine) is not recommended because efficacy may be compromised because of lower Xelpac 6 mg/ml Vial 30 mg exposures.

Xelpac 6 mg/ml Vial 30 mg is contraindicated in patients with severe hypersensitivity reactions to Xelpac 6 mg/ml Vial 30 mg, macrogolglycerol ricinoleate (polyoxyl castor oil.) Xelpac 6 mg/ml Vial 30 mg is contraindicated during lactation. Xelpac 6 mg/ml Vial 30 mg should not be used in patients with baseline neutrophils <1.5x109/I (<1x109/I for KS patients) or platelets <100x109/I (<75x109/I for KS patients). In KS, Xelpac 6 mg/ml Vial 30 mg is also contraindicated in patients with concurrent, serious, uncontrolled infections. Patients with severe hepatic impairment must not be treated with Xelpac 6 mg/ml Vial 30 mg.

Common: Low blood counts leading to increased risk for infection, anemia and/or bleeding, hair loss, arthralgias and myalgias, pain in the joints and muscles, peripheral neuropathy, nausea, vomiting (usually mild), diarrhea, Mouth sores, hypersensitivity reaction, fever, facial flushing, chills, shortness of breath, or hives after Xelpac 6 mg/ml Vial 30 mg is given.Rare: swelling of the feet or ankles (edema), liver problems, low blood pressure, darkening of the skin where previous radiation treatment has been given.

Category D: There is positive evidence of human fetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).

Xelpac 6 mg/ml Vial 30 mg should be administered under the supervision of a physician experienced in the use of cancer chemotherapeutic agents. Since significant hypersensitivity reactions may occur, appropriate supportive equipment should be available. Given the possibility of extravasation, it is advisable to closely monitor the infusion site for possible infiltration during drug administration. Xelpac 6 mg/ml Vial 30 mg should be given before cisplatin when used in combination.Significant hypersensitivity reactions, as characterised by dyspnoea and hypotension requiring treatment, angioedema, and generalised urticaria have occurred in <1% of patients receiving Xelpac 6 mg/ml Vial 30 mg after adequate premedication. Fatal hypersensitivity reactions have occurred in patients despite premedication. These reactions are probably histamine-mediated. In the case of severe hypersensitivity reactions, Xelpac 6 mg/ml Vial 30 mg infusion should be discontinued immediately. Bone marrow suppression, primarily neutropenia, is the dose-limiting toxicity. Neutrophil nadirs occurred at a median of 11 days. Frequent monitoring of blood counts should be instituted. Patients should not be retreated until the neutrophil count is ≥1.5 x 109/1 (≥1 x 109/1 for KS patients) and the platelets recover to ≥100 x 109/1 (≥75 x 109/1 for KS patients).Severe cardiac conduction abnormalities have been reported rarely with single agent Xelpac 6 mg/ml Vial 30 mg. If patients develop significant conduction abnormalities during Xelpac 6 mg/ml Vial 30 mg administration, appropriate therapy should be administered and continuous cardiac monitoring should be performed during subsequent therapy with Xelpac 6 mg/ml Vial 30 mg.

There is no known antidote for Xelpac 6 mg/ml Vial 30 mg overdose. In case of overdose, the patient should be closely monitored. Treatment should be directed at the primary anticipated toxicities, which consist of bone marrow suppression, peripheral neurotoxicity and mucositis. Overdoses in paediatric patients may be associated with acute ethanol toxicity.

Keep in a dry place and store below 30°C. Protect from light and keep out of the reach of children. Use only freshly prepared solution.

Hepatic Impairment:Advanced non-small cell lung cancer: Do not use in severe impairment, increased risk of hepatotoxicity. For detailed dosing recommendation, consult local protocol.Ovarian carcinoma: Do not use in severe impairment, increased risk of hepatotoxicity. For detailed dosing recommendations, consult local protocol.Breast cancer: Do not use in severe impairment, increased risk of hepatotoxicity. For detailed dosing recommendation, consult local protocol.AIDS-related Kaposi's sarcoma: Do not use in severe impairment, increased risk of hepatotoxicity. For detailed dosing recommendation, consult local protocol.

Xelpac 6 mg/ml Vial 30 mg must be diluted before infusion. It can be diluted in 0.9% sodium chloride inj, 5% dextrose inj, 5% dextrose and 0.9% sodium chloride inj or 5% dextrose in lactated Ringer's inj to a concentration of 0.3-1.2 mg/ml.

Xelpac 6 mg/ml Vial 30 mg is a novel anti-microtubule agent that promotes the assembly of microtubules from tubulin dimers and stabilizes microtubules by preventing depolymerization. This stability results in the inhibition of the normal dynamic reorganization of the microtubule network that is essential for vital interphase and mitotic cellular functions. In addition, Xelpac 6 mg/ml Vial 30 mg induces abnormal arrays or “bundles” of microtubules throughout the cell cycle and multiple asters of microtubules during mitosis. Following intravenous administration of Xelpac 6 mg/ml Vial 30 mg, Xelpac 6 mg/ml Vial 30 mg plasma concentrations declined in a biphasic manner. The initial rapid decline represents distribution to the peripheral compartment and elimination of the drug. The later phase is due, in part, to a relatively slow efflux of Xelpac 6 mg/ml Vial 30 mg from the peripheral compartment.

Pregnancy Category D. There is no adequate data from the use of Xelpac 6 mg/ml Vial 30 mg in pregnant women, however as with other cytotoxic medicinal products, Xelpac 6 mg/ml Vial 30 mg may cause foetal harm when administered to pregnant women. Xelpac 6 mg/ml Vial 30 mg is contraindicated during lactation.

Patients who experience severe neutropenia: (neutrophil count <0.5 x 109/1 for a minimum of 7 days) or severe peripheral neuropathy, should receive a dose reduction of 20% for subsequent courses (25% for KS patients).Patients with hepatic impairment: Inadequate data are available to recommend dosage alterations in patients with mild to moderate hepatic impairments. Patients with severe hepatic impairment must not be treated with Xelpac 6 mg/ml Vial 30 mg.Pediatric use: Xelpac 6 mg/ml Vial 30 mg is not recommended for use in children below 18 years due to lack of data on safety and efficacy