Class: Chemotherapy

Generic Name: Cladribine (KLAD-rah-been), 2CdA, 2-Chlorodeoxyadenosine
Trade Name: Leustatin®

For which conditions is this drug approved? Cladribine is FDA approved for the treatment of hairy cell leukemia and chronic lymphocytic leukemia that does not respond to other chemotherapy agents referred to as alkylating agents. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action? Cladribine belongs to a group of drugs called antimetabolites. Cladribine produces its anti-cancer effects by inhibiting the ability of a cell to produce DNA or repair DNA. By inhibiting the production and repair of DNA, cladibine suppresses the ability of a cell to replicate or repair itself, ultimately causing cellular death.

How is cladribine typically given (administered)? Cladribine is given intravenously (into a vein) as a continous infusion over multiple days. The specific dose and schedule of cladribine is dependent on many factors, including the medical condition being treated, the particular treatment regimen being utilized, the size of the patient, and the tolerance a patient has for therapy.

How are patients typically monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with cladribine. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Physical examinations, scans or other measures may also be utilized to assess side effects and response to therapy.

What are the common (occur in 30% or more of patients) side effects of treatment with cladribine?

• Low white blood cell levels – increases risk of infection
• Low red blood cell levels – increases risk of anemia and blood transfusions
• Fever

What are the less common (occur in 10% to 29% of patients) side effects of treatment with cladribine?

• Low platelet levels – increases risk of bleeding
• Chills
• Fatigue
• Nausea and vomiting
• Skin reactions (rash, itching)
• Skin irritation at drug delivery site, including pain, itching and swelling
• Loss of appetite
• Constipation
• Headache
• Dizziness

This is not a complete list of side effects. Some patients may experience other side effects that are not listed here. Patients may wish to discuss with their physician the other less common side effects of this drug, some of which may be serious.

Some side effects may require medical attention. Other side effects do not require medical attention and may go away during treatment. Patients should check with their physician about any side effects that continue or are bothersome.

What can patients do to help alleviate or prevent discomfort and side effects?

• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• If possible, avoid large crowds or people who are sick or not feeling well, as this drug may leave some patients susceptible to infection.
• Wash hands often to reduce the risk of infection.
• Avoid activities that may cause injury or bruising.
• Use a soft toothbrush and an electric razor to prevent cuts on the mouth or skin.
• Eat small meals frequently to help alleviate nausea.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)

Are there any special precautions patients should be aware of before starting treatment?

• Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.

When should patients notify their physician?

• Fever
• Cough
• Flu or cold-like symptoms
• Signs of infection (redness, swelling, tenderness, drainage)
• Prolonged and severe nausea and vomiting
• Prolonged and severe constipation
• Extreme fatigue
• Unexplained bleedings (nosebleeds, blood in urine, black tarry stools, bruising, etc.)

What is a package insert?
A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers.  A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug. By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.

Copyright © 2010 CancerConnect Last updated 07/10.

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