II. Indications

  1. Breast Cancer (locally advanced or metastatic)

III. Contraindications

  1. Liver transaminases (AST, ALT) >2.5 times the upper limit of normal
  2. Serum Bilirubin > upper limit of normal
  3. Polyoxyethylated Castor Oil (Cremophor EL) allergy

IV. Mechanism

  1. See Mitotic Inhibitor Chemotherapy
  2. Ixabepilone is a semisynthetic analog of epothilone B with antineoplastic properties
    1. Used in Taxane-resistant neoplasms
    2. Available in an enteric coated oral formulation with good Bioavailability
  3. Ixabepilone is an anti-tubulin agent
    1. Ixabepilone binds to tubulin
    2. Ixabepilone promotes tubulin polymerization and microtubule stabilization
    3. Arrests cell cycle at G2/M phase

V. Medications

  1. Ixabepilone 15 and 45 mg powder for injection

VI. Dosing

  1. See other references for disease specific dosing protocols
  2. Pretreatment (given 1 hour before Ixabepilone )
    1. Anthistamine (H1 Blocker) AND
    2. H2 Blocker (e.g. Famotidine) AND
    3. If prior reaction, Corticosteroid

VII. Adverse Effects

VIII. Safety

  1. Avoid in Lactation
  2. Avoid in pregnancy (all trimesters)
    1. Use reliable Contraception

IX. Drug Interactions

  1. Agents that increase Ixabepilone levels
    1. CYP3A4 Inhibitors (e.g. Ketoconazole)
  2. Agents that decrease Ixabepilone levels
    1. CYP3A4 Inducers (e.g. Rifampin)

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