Bortezomib is an inhibitor of the 26S proteasome. This proteasome normally regulates the intracellular concentration of specific proteins that are required for controlling homeostasis. Disruption to this pathway results in disruption to multiple signaling pathways encouraging cell death. Its current application is in multiple myeloma.22
Denileukin difitox is a fusion protein that contains diphtheria toxin fragments fused to IL-2. It targets cells that have IL-2 receptors containing the CD25 component. The IL-2 portion of the protein binds to IL-2 receptors, the diphtheria toxin fragments are transferred into the cell and ultimately inhibit protein synthesis, resulting in cell death. Its application has been in individuals with:10
- cutaneous T-cell lymphoma
- Hodgkin and non-Hodgkin's lymphoma.
Temsirolimus is an inhibitor of the mammalian target of rapamycin (mTOR). mTOR is a kinase enzyme inside the cell. When activated it is involved in the control of cell proliferation and angiogenesis.23, 24 Temsirolimus interferes with the synthesis of proteins that regulate proliferation, growth, and survival, leading to cell cycle arrest in G1. It also inhibits angiogenesis by reducing synthesis of VEGF.12
Tretinoin or all-trans-retinoic acid (ATRA) is a vitamin A derivative used to treat acute promyelocytic leukaemia (APML). The chromosomal abnormality in APML produces an oncogenic protein that blocks cellular differentiation and maturation of promyelocytes. Tretinoin functions as a differentiating agent allowing the leukemic cells to grow into mature granulocytes.25
Identify a miscellaneous agent used in cancer treatment, and describe the:
- mechanism of action
- indications for its use in clinical practice
- nursing care considerations.
Define 'ATRA Syndrome' and discuss the nursing and medical approaches to its prevention and management.