Generic Name: Cytarabine (Liposomal)

Trade name: DepoCyt^TM
Other name:  Liposomal Ara-C

Drug type:  Cytarabine (Liposomal) is a sustained-release form of cytarabine.  It is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug.  This medication is classified as an "antimetabolite."  (For more detail, see "How this drug works" section below). 

What This Drug Is Used For:

• Liposomal cytarabine is used to treat lymphomatous meningitis (lymphoma found in the lining of the brain and spinal cord).

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 This Drug Is Given:

• Liposomal cytarabine is given is by intraventricular or intrathecal infusion.  This method is used when drugs need to reach the cerebrospinal fluid (CSF) the fluid that is surrounding the brain and spinal cord, the drug is infused directly into the spinal fluid.  The body's blood-brain barrier does not allow many chemotherapy drugs given systemically (through the whole body) to get to the CSF.  There are two ways chemotherapy can be given to the CSF:
• Lumbar puncture (Intrathecal).  Chemotherapy can be given through a lumbar puncture (spinal tap).  In this case a small amount of chemotherapy is injected during the lumbar puncture, directly into the CSF.  Once the drug is administered the catheter is removed.
• Ommaya reservoir (Intraventricular).  The ommaya reservoir is a small dome-shaped device with an attached catheter.  It is placed into the subcutaneous tissue (the layer of tissue between the skin and the muscle) on the scalp.  The catheter is threaded into the lateral (outer) ventricle of the brain.  The nurse or doctor, who is specially trained on this method of giving chemotherapy, will insert a small needle through the skin on the scalp into the ommaya reservoir to inject the chemotherapy.
• The amount of liposomal cytarabine that you receive depends on many factors, including the type of cancer you have, your height and weight, your general health, any other health problems you may have.  Your doctor will determine your dose, how it should be given and the schedule.

Side Effects:

Important things to remember about the side effects of cytarabine:  

• 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 liposomal cytarabine:

• Inflammation of the sac surrounding the brain and spinal cord.  This can cause neck pain, neck rigidity, headache, fever, nausea, vomiting, and back pain.  Steroids are given before and for 5 days after the injection to prevent or lessen this reaction.

These side effects are less common side effects (occurring in about 10-29%) of patients receiving liposomal cytarabine:

• Headache
• Confusion (see central neurotoxicity)
• Weakness
• Excessive sleepiness (see central neurotoxicity)
• Nausea and vomiting
• Fever

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:

• Neck pain or rigidity.
• Headache.
• Fever of 100.4°F (38°C) or higher or chills (possible signs of infection).
• Nausea and/or vomiting.

The following symptoms require medical attention, but are not an emergency.  Contact your health care provider within 24 hours of noticing any of the following:

• Swelling of the feet or ankles
• Sudden weakness
• Changes in balance and coordination

Always inform your health care provider if you experience any unusual symptoms.

Precautions:

• Before starting liposomal cytarabine 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 permits this.
• Do not receive any kind of immunization or vaccination without your doctor's approval while taking liposomal cytarabine.
• Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (liposomal cytarabine 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 liposomal cytarabine. 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.

Self-Care Tips:

• 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 medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing:

You will be checked regularly by your doctor while you are taking liposomal cytarabine, to monitor side effects and check your response to therapy.  Periodic blood work to monitor your complete blood count (CBC), the function of other organs (such as your kidneys and liver) and check your uric acid levels will also be ordered by your doctor.   

How This Drug Works:

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.

Cytarabine belongs to the category of chemotherapy called antimetabolites.  Antimetabolites are very similar to normal substances within the cell.  When the cells incorporate these substances into the cellular metabolism, they are unable to divide.  Antimetabolites are cell-cycle specific.  They attack cells at very specific phases in the cycle.  Antimetabolites are classified according to the substances with which they interfere.

• Folic acid antagonist:  Methotrexate.
• Pyrimidine antagonist:  5-Fluorouracil, Foxuridine, Cytarabine, Capecitabine, and Gemcitabine.
• Purine antagonist:  6-Mercaptopurine and 6-Thioguanine.
• Adenosine deaminase inhibitor:  Cladribine, Fludarabine and Pentostatin.
• Liposomal cytarabine is an encapsulated form of the drug cytarabine. The encapsulation allows for slow release of the drug once it has been carried directly into the cell and proceeds to interfere with the function of the cancer cells. Because of this formulation and being administered directly into the fluid surrounding the brain and spinal cord, the systemic (throughout the body) side effects are lessened.

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