Rasburicase is currently approved at a dosage of 0.15-0.2 mg/kg once/day for 5 days in pediatric patients with cancer to lower plasma uric acid concentrations and manage tumor lysis syndrome (TLS). Information on rasburicase dosing in adults is limited, with some data on using rasburicase as a single dose instead of multiple daily doses. Therefore, we evaluated the efficacy of a single dose of rasburicase for preventing or managing TLS in adults. We collected retrospective data for 11 adults with hematologic malignancies who received a single 6-mg dose of rasburicase. All patients received intravenous hydration with urinary alkalinization and allopurinol; however, due to adverse reactions, two patients received short courses of allopurinol. Only patients at high risk for TLS (e.g., large tumor burden, increasing uric acid concentration) or those with TLS received rasburicase. The single dose of rasburicase 6 mg resulted in a median 0.0773-mg/kg dose (range 0.0232-0.1361 mg/kg). The single 6-mg dose rapidly lowered uric acid concentrations in 10 of the 11 patients. The median uric acid concentration of 11.7 mg/dl (range 7.4-17.4 mg/dl) declined to 2.0 mg/dl (range 0.5-15.4 mg/dl) within a day after rasburicase administration (p=0.022). In these 10 patients, uric acid concentrations remained low despite subsequent chemotherapy, and none required additional rasburicase doses. The only patient who did not respond to the single 6-mg rasburicase dose was a morbidly obese man (259 kg, body mass index 87 kg/m2) who subsequently responded to an additional dose of rasburicase 12 mg. These results warrant further investigation of a single 6-mg dose of rasburicase in adults with TLS or at high-risk for developing TLS.

Triple antiemetic therapy with aprepitant, a corticosteroid, and a 5-HT3 antagonist appears to provide improved efficacy in the prevention of emesis in patients receiving highly emetogenic chemotherapy. Due to its novel mechanism of action and demonstrated efficacy in this combination, aprepitant should be considered for formulary addition.

Treatment with palifermin appears to decrease the severity and duration of severe mucositis following autologous stem cell transplant. Use in these patients appears justified; however, use in non-stem cell transplant patients should be discouraged until more efficacy and toxicity data are available.

Continuous fentanyl infusion should be considered for the treatment of cancer pain in patients requiring high doses who become refractory to other opioids, when other opioids cause intolerable adverse effects, when patients have a true morphine allergy, or when high-dose requirements threaten to deplete existing stock of alternate opioids.

This case report describes the successful treatment of severe methotrexate intoxication in a 72-year-old female patient. Following two prior uneventful courses of a polychemotherapy regimen including low-dose intravenous (i.v.) methotrexate, the patient presented with fever, polymucositis, incipient pyodermia, acute renal failure and pancytopenia 9 days after the third application. Severe methotrexate overdose was confirmed by serum levels. Using a polypragmatic treatment approach focusing on renal function and including granulocyte-macrophage-colony-stimulating factor (GM-CSF) this life threatening and nearly fatal intoxication was successfully treated. This case report demonstrates that GM-CSF might contribute to rapid reconstitution of leukopoiesis once methotrexate serum levels are in the subtoxic range.

The people in India have an outstanding knowledge of medicinal plants acquired over centuries. A passion for studying medicinal plants is evident both in folk and scholarly traditions. The indigenous mode of understanding and using plants is different from the modern scientific way. It includes botanical, medical and astrological elements. This is the basis of green pharmacy. Indians obviously care for medicinal plants because they know so many of them, so much about them and have worked extensively on their application. It is a remarkable fact that the use of medicinal plants is still a living tradition in the form of a million village-based folk carriers. These traditional birth attendants, bonesetters, herbal healers and wandering monks are invisible to policy makers and therefore not taken into account as a public health resource. Apart from these specialised folk healers there are also millions of women and elders with traditional knowledge of food and nutrition and herbal home-remedies. However, the revitalisation of this vast and diverse folk tradition does not appear on the Governments agenda. Here is an attempt to introduce these traditional knowledge with an emphasis of Nevadensin that holds a promising substance to cure many of the diseases naturally. INTRODUCTION: The Indian system of medicine consists of two major tendencies;The folk and the codified traditions. Folk traditions are handed over orally from generation to generation. The codified tradition consists of medical knowledge with sophisticated theoretical foundations expressed in thousands of manuscripts covering all branches of medicine. Examples are ayurveda, siddha, unani and the Tibetan tradition. Siddha is one of the oldest systems of medicine in India, largely therapeutic in nature and specialises in pharmacy. The largest number of medicinal plants is used in the folk traditions (4671 species), followed by ayurveda (1769 species), siddha (1121 species), Tibetan (279 species), homeopathy (182 species), modern bio-medicine (105 species) and unani (59 species) 1. Bridge between Traditions: It is interesting to observe that Indian knowledge about plants and plant products is not based on the application of western categories and approaches like chemistry and pharmacology. Unfortunately, there is a lack of rigorous cross cultural studies and, in fact, a well accepted methodology for such studies is still missing. Green Pharmacy: Materia-Medica: The in-depth study required about a plant before it can be admitted into the indigenous Materia-Medica is quite impressive. This includes aspects like nomenclature, parts used, methods of purification, contra-indications, effect on physiological systems, effect on body tissues, effect on organs, effect on excretory system, qualities, metabolic activity, post

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Of the over one million patients diagnosed with cancer each year, 30 percent will have pain at diagnosis and up to 85 percent will have pain as their disease progresses. Adequate pain management continues to be hindered by multiple patient-and clinician-related barriers; however, with increased awareness and knowledge, the pharmacy practitioner can play a key role in facilitating pain management. This review will focus on the mechanisms of cancer pain, the role of non-opioids, opioids, and adjuvant agents in the treatment of cancer pain, and the basic principles of cancer pain management that allow 70 to 90 percent of patients to achieve excellent pain control.