Procarbazine


Procarbazine is a chemotherapy medication used for the treatment of Hodgkin's lymphoma and brain cancers. For Hodgkin's it is often used together with chlormethine, vincristine, and prednisone while for brain cancers such as glioblastoma multiforme it is used with lomustine and vincristine. It is typically taken by mouth.
Common side effect include low blood cell counts and vomiting. Other side effects include tiredness and depression. It is not recommended in people with severe liver or kidney problems. Use in pregnancy is known to harm the baby. Procarbazine is in the alkylating agents family of medication. How it works is not clearly known.
Procarbazine was approved for medical use in the United States in 1969. It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system. In the United Kingdom a month of treatment cost the NHS 450 to 750 pounds.

Medical uses

When used to treat Hodgkin's lymphoma, it is often delivered as part of the BEACOPP regimen that includes bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, prednisone, and procarbazine. The first combination chemotherapy developed for Hodgkin's lymphoma, MOPP also included procarbazine. Alternatively, when used to treat certain brain tumors, it is often dosed as PCV when combined with lomustine and vincristine.
Dose should be adjusted for kidney disease or liver disease.

Side effects

Very common adverse effects include loss of appetite, nausea and vomiting. Other side effects of unknown frequency include reduction in leukocytes, reduction in platelets, reduction in neutrophils, which can lead to increased infections including lung infections; severe allergy-like reactions that can lead to angioedema and skin reactions; lethargy; liver complications including jaundice and abnormal liver function tests; reproductive effects including reduction in sperm count and ovarian failure.
When combined with ethanol, procarbazine may cause a disulfiram-like reaction in some people.
It weakly inhibits MAO in the gastrointestinal system, so it can cause hypertensive crises if associated with the ingestion of tyramine-rich foods such as aged cheeses; this appears to be rare.
Procarbazine rarely causes chemotherapy-induced peripheral neuropathy, a progressive, enduring, often irreversible tingling numbness, intense pain, and hypersensitivity to cold, beginning in the hands and feet and sometimes involving the arms and legs.

Pharmacology

Its mechanism of action is not fully understood. Metabolism yields azo-procarbazine and hydrogen peroxide which results in the breaking of DNA strands.