User:TomtomRx/sandbox

History Successful clinical use of chlormethine (mechlorethamine) resulted in development of the field of anticancer chemotherapy, led by Cornelius P. Rhoads at Memorial Sloan-Kettering. The drug is a nitrogen-based analogue of mustard gas (which is sulfur-based) and was derived from chemical warfare research. Secret clinical trials of the agent for Hodgkin's disease and several other lymphomas and leukemias in humans began in December 1942. Because of wartime secrecy restrictions, it was not until 1946 that the results of these trials were published openly.[3]

Uses It has been derivatized into the estrogen analogue estramustine, used to treat prostate cancer. It can also be used in chemical warfare where it has the code-name HN2. This chemical is a form of nitrogen mustard gas and a powerful vesicant. Historically, some uses of mechlorethamine have included lymphoid malignancies such as Hodgkin’s disease, lymphosarcoma, chronic myelocytic leukemia, polycythemia vera, and bronchogenic carcinoma [Bunn 1994] Mechlorethamine is often administered intravenously, but when compounded into a topical formulation it is can also be used to treat skin diseases. There have been studies demonstrating that topical administration of mechlorethamine may have efficacy in mycosis fungoides-type cutaneous T cell lymphoma [, 20568590; 23069814]

Safety and Precautions It is important to remember that mechlorethamine is a highly toxic medication, and any unnecessary contact with any of its formulation should be avoided. The intravenous medication should only be administered under the supervision of a trained physician [Mustargen PI]. The topical formulation should be used with extreme caution and patients must follow directions for the special handling and disposal of the medication [Valchlor PI]. Mechlorethamine in all forms should be avoided in women who are pregnant, breastfeeding, or who are of childbearing age. Safety and effectiveness of mechlorethamine has not been established in pediatric populations [mustargen pi][valchlor pi]. For a complete analysis of the most relevant safety concerns, please read the prescribing information of mechlorethamine in the intravenous and topical formulation. Adverse Effects The adverse effects of mechlorethamine vary depending on the formulation of the medication. For complete information on the intravenous and topical formulations of mechlorethamine, refer to the prescribing information for Mustargen and Valchlor, respectively. Based on the PI, general adverse effects of intravenous administration of mechlorethamine include:

“Hypersensitivity reactions, including anaphylaxis…. Nausea, vomiting and depression of formed elements in the circulating blood are dose-limiting side effects and usually occur with the use of full doses of MUSTARGEN. Jaundice, alopecia, vertigo, tinnitus and diminished hearing may occur infrequently. Rarely, hemolytic anemia associated with such diseases as the lymphomas and chronic lymphocytic leukemia may be precipitated by treatment with alkylating agents including MUSTARGEN. Also, various chromosomal abnormalities have been reported in association with nitrogen mustard therapy.”