Esophageal Lymphoma Medication
- Author: Vivek V Gumaste, MD; Chief Editor: BS Anand, MD more...
The primary medical therapy for esophageal lymphoma is chemotherapy, with the most common regimen consisting of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). Cyclophosphamide, doxorubicin, and vincristine are administered on day 1 of a 5-day cycle. Prednisone is administered on days 1-5 of the 5-day cycle. Cycles are repeated every 21-28 days for a total of 6 or more cycles. Rituximab may be added as an adjunct therapy.
These agents inhibit cell growth and proliferation.
Cyclophosphamide has antineoplastic activity mediated by its 2 active metabolites. These metabolites are alkylating agents that prevent cell division by cross-linking DNA strands. Cyclophosphamide is absorbed almost completely from the GI tract, making it bioavailable in either oral (PO) or intravenous (IV) forms. Excretion is primarily via urine. Because of the rarity of esophageal lymphoma, the dose should be determined on a case-by-case basis.
Doxorubicin is an anthracycline antibiotic that can intercalate with DNA, affecting many of the functions of DNA, including synthesis. This agent is administered intravenously. Doxorubicin distributes widely into bodily tissues, including the heart, kidneys, lungs, liver, and spleen. It does not cross the blood-brain barrier and is excreted primarily in bile.
Vincristine is a vinca alkaloid that is cell cycle–specific (M phase). The mitotic apparatus is arrested in metaphase via disruption of the microtubules. Absorption of vincristine through the GI tract is variable; therefore, administer the drug intravenously. It is metabolized extensively in the liver and excreted primarily via bile. Neurotoxicity is the limiting factor during therapy. Peripheral neuropathy is vincristine's most common adverse effect at usual doses.
Corticosteroids have anti-inflammatory properties and cause profound and varied metabolic effects. These agents modify the body's immune response to diverse stimuli.
Prednisone is a glucocorticoid that acts as an immunosuppressant by stimulating the synthesis of enzymes needed to decrease the inflammatory response. It also acts as an anti-inflammatory agent by inhibiting the recruitment of leukocytes and monocyte-macrophages into affected areas via inhibition of chemotactic factors and factors that increase capillary permeability. Prednisone is readily absorbed via the GI tract and is metabolized in the liver. Inactive metabolites of prednisone are excreted via the kidneys. Most of the adverse effects of corticosteroids are dose or duration dependent.
Monoclonal antibodies are antibodies targeted against specific antigenic determinants. They can be specific to growth factors, cytokines, and cell surface molecules found on tumor cells.
The rituximab antibody is a genetically engineered chimeric mouse/human monoclonal antibody directed against the CD20 antigen found on the surface of normal and neoplastic B lymphocytes.
The most common adverse reactions to rituximab were infusion reactions, some of which were fatal. Bowel perforation has been reported with rituximab. Patients reporting abdominal pain during therapy should be evaluated for perforation of the intestinal tract.
Reactivation of hepatitis B has been demonstrated; patients at high risk for hepatitis B should be screened prior to initiation of therapy. No studies have been conducted to determine if dose adjustment is necessary in patients with hepatic or renal dysfunction.
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