Pentostatin

Information about Pentostatin

Pentostatin is a purine analogue and antineoplastic agent used in the therapy of hairy cell leukemia and T cell lymphomas.

Liver safety of Pentostatin

Pentostatin is associated with a low rate of serum enzyme elevations during therapy and has been linked to rare instances of severe acute liver injury with jaundice. 

Mechanism of action of Pentostatin

Pentostatin (pen" toe stat' in) is a purine analogue (2'-deoxycoformycin) that is used in the treatment of hairy cell leukemia and T cell lymphomas.  Pentostatin is a transition state analogue of a major intermediate in the pathway of the adenosine deaminase reaction.  As a consequence, pentostatin inhibits adenosine deaminase and causes accumulation of intracellular adenosine and deoxyadenosine which cause a block DNA synthesis.  This imbalance of nucleotide pools is particularly toxic to lymphocytes. 

FDA approval information for Pentostatin

Pentostatin was found to have marked activity against hairy leukemia and T cell lymphomas and was approved for this use in the United States in 1991. 

Dosage and administration for Pentostatin

Pentostatin is available as a solution for injection generically and under the trade name Nipent.  The typical dose regimen is 4 mg/m2 given intravenously every other week for 6 months.  Repeat courses are recommended only for patients who have a response and later relapse. 

Side effects of Pentostatin

Common side effects include bone marrow suppression, fever, infections, nausea, vomiting, anorexia, diarrhea, headache, fatigue and skin rash.  Because pentostatin tends to deplete normal T cells, opportunistic infections can occur and immunosuppression can persist for months or years after discontinuation.  At high doses, pentostatin can cause severe renal and neurologic toxicity and in combination with fludarabine can cause pulmonary toxicity. 

Antineoplastic Agents
Alkylating Agents - Altretamine, Bendamustine, Busulfan, Carmustine, Chlorambucil, Cyclophosphamide, Dacarbazine, Ifosfamide, Lomustine, Mechlorethamine, Melphalan, Procarbazine, Streptozocin, Temozolomide, Thiotepa, Trabectedin
Platinum Coordination Complexes - Carboplatin, Cisplatin, Oxaliplatin
Antibiotics Cytotoxic - Bleomycin, Dactinomycin, Daunorubicin, Doxorubicin, Epirubicin, Idarubicin, Mitomycin, Mitoxantrone, Plicamycin, Mithramycin, Valrubicin
Antimetabolites Antifolates - Methotrexate, Pemetrexed, Pralatrexate, Trimetrexate
Purine Analogues - Azathioprine, Cladribine, Clofarabine, Fludarabine, Mercaptopurine, Nelarabine, Pentostatin, Thioguanine
Pyrimidine Analogues - Azacitidine, Capecitabine, Cytarabine, Decitabine, Floxuridine, Fluorouracil, Gemcitabine, Trifluridine/Tipracil
Biologic Response Modifiers - Aldesleukin (IL-2), Denileukin Diftitox, Interferon gamma
Histone Deacetylase Inhibitors - Belinostat, Panobinostat, Romidepsin, Vorinostat
Hormonal Agents Antiandrogens - Abiraterone, Bicalutamide, Cyproterone, Enzalutamide, Flutamide, Nilutamide
Antiestrogens (including Aromatase Inhibitors) - Anastrozole, Exemestane, Fulvestrant, Letrozole
Selective Estrogen Receptor Modulators - Raloxifene, Tamoxifen, Toremifene
Gonadotropin Releasing Hormone Analogues - Degarelix, Goserelin, Histrelin, Leuprolide, Triptorelin
Peptide Hormones - Lanreotide, Octreotide, Pasireotide
Monoclonal Antibodies - Alemtuzumab, Atezolizumab, Avelumab, Bevacizumab, Blinatumomab, Brentuximab, Cetuximab, Daratumumab, Dinutuximab, Durvalumab, Elotuzumab, Gemtuzumab, Inotuzumab Ozogamicin, Ipilimumab, Necitumumab, Nivolumab, Ofatumumab, Olaratumab, Panitumumab, Pembrolizumab, Pertuzumab, Ramucirumab, Rituximab, Tositumomab, Trastuzumab
Protein Kinase Inhibitors - Abemaciclib, Acalabrutinib, Afatinib, Alectinib, Axitinib, Bortezomib, Bosutinib, Brigatinib, Cabozantinib, Carfilzomib, Ceritinib, Cobimetinib, Copanlisib, Crizotinib, Dabrafenib, Dasatinib, Enasidenib, Erlotinib, Gefitinib, Ibrutinib, Idelalisib, Imatinib, Ivosidenib, Ixazomib, Lapatinib, Lenvatinib, Neratinib, Nilotinib, Niraparib, Olaparib, Osimertinib, Palbociclib, Pazopanib, Ponatinib, Regorafenib, Ribociclib, Rucaparib, Ruxolitinib, Sonidegib, Sorafenib, Sunitinib, Trametinib, Vandetanib, Vemurafenib, Vismodegib
Taxanes - Cabazitaxel, Docetaxel, Paclitaxel
Topoisomerase Inhibitors - Etoposide, Irinotecan, Teniposide, Topotecan
Tyrosine Kinase Receptor Inhibitors See Protein Kinase Inhibitors
Vinca Alkaloids - Vinblastine, Vincristine, Vinorelbine
Miscellaneous - Asparaginase (Pegaspargase), Bexarotene, Eribulin, Everolimus, Hydroxyurea, Ixabepilone, Lenalidomide, Mitotane, Omacetaxine, Pomalidomide, Temsirolimus, Thalidomide, Venetoclax

 

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