CLOFARABINE

Clofarabine
(clo-fa-ra'been)
Clolar
Classifications: antineoplastic; purine antimetabolite;
Therapeutic: antineoplastic; antimetabolite
Prototype: 6-Mercaptopurine
Pregnancy Category: D

Availability

1 mg/mL injection.

Action

Clofarabine inhibits DNA repair within cancer cells, thus interfering with mitosis; it also disrupts the mitochondrial membrane, leading to cancer cell death.

Therapeutic Effect

Cytotoxic to rapidly proliferating and quiescent cancer cells.

Uses

Treatment of persons 1–21 y of age with relapsed or refractory acute lymphocytic leukemia (ALL) after at least 2 prior regimens.

Contraindications

Severe bone marrow suppression; active infection; pregnancy (category D); lactation.

Cautious Use

Renal or hepatic function impairment; thrombocytopenia; neutropenia; previous chemotherapy or radiation therapy; females of childbearing age; history of viral infections such as herpes; history of cardiac disease or hypotension.

Route & Dosage

Acute Lymphocytic Leukemia
Adult/Adolescent/Child: IV 52 mg/m²/d for 5 d

Administration

Do not give drugs with known renal toxicity during the 5 d of clofarabine administration.

Intravenous

PREPARE: IV Infusion: Withdraw required dose from vial using a 0.2 micron filter syringe. Further dilute with D5W or NS prior to infusion.

ADMINISTER: IV Infusion: Give over 2 h. Note: It is recommended that IV fluids be given continuously throughout the 5 d of clofarabine administration.

Store diluted solution at room temperature. Use within 24 h of mixing.

Adverse Effects (≥1%)

CNS: Anxiety, depression, dizziness, headache, irritability, somnolence. CV: Tachycardia, pericardial infusion, left ventricular systolic dysfunction (LSVT). GI: Vomiting, nausea, and diarrhea, abdominal pain, constipation. Hematologic/Lymphatic: Anemia, leukopenia, thrombocytopenia, neutropenia, febrile neutropenia. Hepatic: Jaundice, hepatomegaly. Metabolic: Anorexia, decreased appetite, edema, decreased weight. Musculoskeletal: Arthralgia, back pain, myalgia. Respiratory: Cough, dyspnea, epistaxis, pleural effusion, respiratory distress. Skin: Dermatitis, contusion, dry skin, erythema, palmar-plantar erythrodysesthesia syndrome, pruritus. Body as a Whole: Increase risk of infection.

Pharmacokinetics

Distribution: 47% protein bound. Metabolism: Negligible. Elimination: Primarily unchanged in the urine. Half-Life: 5.2 h.

Nursing Implications

Assessment & Drug Effects

Monitor vital signs frequently during infusion of clofarabine.
Monitor closely for S&S of capillary leak syndrome or systemic inflammatory response syndrome (e.g., tachypnea, tachycardia, hypotension, pulmonary edema). If either is suspected, immediately DC IV, institute supportive measures and notify physician.
Monitor I&O rates and pattern and watch for S&S of dehydration, including dizziness, lightheadedness, fainting spells, or decreased urine output.
Withhold drug and notify physician if hypotension develops for any reason during 5-d period of drug administration.
Lab tests: Baseline and periodic CBC and platelet counts (more frequent with cytopenias); frequent LFTs and kidney function test during the 5 d of clofarabine therapy.

Patient & Family Education

Report any distressing adverse effect of therapy to physician.
Use effective measures to avoid pregnancy while taking this drug.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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