Care During Chemotherapy and Beyond
Generic name: Altretamine
Trade name: Hexalen®
Other names: Hexamethylmelamine
Drug type: HMM is an anti-cancer ("antineoplastic" or "cytotoxic")
chemotherapy drug. HMM is classified as an "alkylating agent." (For more detail,
see "How this drug works" section below).
What HMM Is Used For:
Note: If a drug has been approved for one use, physicians may elect
to use this same drug for other problems if they believe it may be helpful.
How HMM Is Given:
- HMM is taken by mouth in capsule form.
- HMM should be taken after meals.
- The amount of HMM that you will receive depends on many factors, including your
height and weight, your general health or other health problems, and the type of
cancer or condition being treated. Your doctor will determine your dose and
Important things to remember about the side effects of HMM:
- Most people do not experience all of the side effects listed.
- Side effects are often predictable in terms of their onset and duration.
- Side effects are almost always reversible and will go away after treatment is complete.
- There are many options to help minimize or prevent side effects.
- There is no relationship between the presence or severity of side effects and the
effectiveness of the medication.
The following side effects are common (occurring in greater than 30%) for
patients taking HMM:
- Nausea and vomiting
- Loss of appetite
- Low blood counts. Your white and red blood cells and platelets may temporarily
decrease, putting you at increased risk for infection, anemia and or bleeding.
These side effects are less common side effects (occurring in about 10-29%)
of patients receiving HMM:
- Peripheral neuropathy: (numbness and/or tingling of the fingers and/or toes).
- Stomach cramping (see abdominal pain).
- Dizziness, sleepiness or weakness. (see central neurotoxicity).
- Depression, agitation, mood changes.
Not all side effects are listed above. Some that are rare (occurring in less than
10% of patients) are not listed here. However, you should always inform your
health care provider if you experience any unusual symptoms.
When to contact your doctor or health care provider:
Contact your health care provider immediately, day or night, if you
should experience any of the following symptoms:
- Fever of 100.4°F (38°C) or higher, chills (possible signs of infection).
The following symptoms require medical attention, but are not an emergency.
Contact your health care provider within 24 hours after noticing any of
- Nausea (interferes with ability to eat and unrelieved with prescribed medication)
- Vomiting (vomiting more than 4-5 times in a 24 hour period)
- Unusual bleeding or bruising
- Black or tarry stools, or blood in your stools or urine
- Diarrhea (4-6 episodes in a 24-hour period)
- Extreme fatigue (unable to carry on self-care activities)
- Excessive sleepiness or confusion
Always inform your health care provider if you experience any unusual symptoms.
- Before starting HMM treatment, make sure you tell your doctor about any other medications
you are taking (including prescription, over-the-counter, vitamins, herbal remedies,
etc.). Do not take aspirin, products containing aspirin unless your doctor specifically
- Do not receive any kind of immunization or vaccination without your doctor's approval
while taking altretamine.
- Inform your health care professional if you are pregnant or may be pregnant prior
to starting this treatment. Pregnancy category D (altretamine may be hazardous
to the fetus. Women who are pregnant or become pregnant must be advised of
the potential hazard to the fetus.)
- For both men and women: Do not conceive a child (get pregnant) while taking altretamine.
Barrier methods of contraception, such as condoms, are recommended. Discuss with
your doctor when you may safely become pregnant or conceive a child after therapy.
- Do not breast feed while taking this medication
- Take medication after meals - this decreases stomach upset.
- You may be at risk of infection so try to avoid crowds or people with colds, and
report fever or any other signs of infection immediately to your health care provider.
- Wash your hands often.
- To help treat/prevent mouth sores use a soft toothbrush, and rinse three times a
day with 1/2 to 1 teaspoon of baking soda and/or salt mixed with 8 ounces of water.
- Use an electric razor and a soft toothbrush to minimize bleeding.
- Avoid contact sports or activities that could cause injury.
- To reduce nausea, take anti-nausea medications as prescribed by your doctor, and
eat small, frequent meals.
- Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing.
- Avoid driving and tasks that require being alert until your response to this drug
is well understood.
- In general, drinking alcoholic beverages should be kept to a minimum or avoided
completely. You should discuss this with your doctor.
- Get plenty of rest.
- Maintain good nutrition.
- If you experience symptoms or side effects, be sure to discuss them with your health
care team. They can prescribe several medications that can help you tolerate
these side effects, significantly reduce their impact, and make you feel better.
Monitoring and Testing:
You will be checked regularly by your doctor while you are taking altretamine, to
monitor side effects and check your response to therapy. Periodic blood work
to monitor your complete blood count (CBC) as well as the function of other organs
(such as your kidneys and liver) will also be ordered by your doctor.
How HMM Works:
Chemotherapy (anti-neoplastic drugs)
Cancerous tumors are characterized by cell division, which is no longer controlled
as it is in normal tissue. "Normal" cells stop dividing when they come
into contact with like cells, a mechanism known as contact inhibition. Cancerous
cells lose this ability. Cancer cells no longer have the normal checks and
balances in place that control and limit cell division. The process of cell
division, whether normal or cancerous cells, is through the cell cycle. The
cell cycle goes from the resting phase, through active growing phases, and then
to mitosis (division).
The ability of chemotherapy to kill cancer cells depends on its ability to halt
cell division. Usually, the drugs work by damaging the RNA or DNA that tells
the cell how to copy itself in division. If the cells are unable to divide,
they die. The faster the cells are dividing, the more likely it is that chemotherapy
will kill the cells, causing the tumor to shrink. They also induce cell suicide
(self-death or apoptosis).
Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle
specific. Chemotherapy drugs that affect cells when they are at rest are called
cell-cycle non-specific. The scheduling of chemotherapy is set based on the
type of cells, rate at which they divide, and the time at which a given drug is
likely to be effective. This is why chemotherapy is typically given in cycles.
Chemotherapy is most effective at killing cells that are rapidly dividing.
Unfortunately, chemotherapy does not know the difference between the cancerous cells
and the normal cells. The "normal" cells will grow back and be healthy but in the
meantime, side effects occur. The "normal" cells most commonly affected by
chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and
the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea,
and/or hair loss. Different drugs may affect different parts of the body.
Altretamine is classified as an alkylating agent. Alkylating agents are most
active in the resting phase of the cell. These drugs are cell cycle non-specific.
There are several types of alkylating agents.
- Mustard gas derivatives: Mechlorethamine, Cyclophosphamide, Chlorambucil,
Melphalan, and Ifosfamide.
- Ethylenimines: Thiotepa and Hexamethylmelamine.
- Alkylsulfonates: Busulfan.
- Hydrazines and Triazines: Altretamine, Procarbazine, Dacarbazine
- Nitrosureas: Carmustine, Lomustine and Streptozocin.
Nitrosureas are unique because, unlike most chemotherapy, they can cross the blood-brain
barrier. They can be useful in treating brain tumors.
- Metal salts: Carboplatin, Cisplatin, and Oxaliplatin.
Note: We strongly encourage you to talk with your health care professional
about your specific medical condition and treatments. The information contained
in this website is meant to be helpful and educational, but is not a substitute
for medical advice.
Chemocare.com is designed to provide the latest information about chemotherapy to patients and their families, caregivers and friends. For information about the 4th Angel Mentoring Program visit www.4thangel.org