Palifermin

(pal-uh-fer-min)

Trade/other name(s): Kepivance

Why would this drug be used?

Palifermin belongs to a group of drugs known as cytoprotective (cell-protecting) agents. It helps reduce the risk of severe mouth sores that can be caused by certain cancer treatments such as high doses of chemotherapy and radiation that are often used in stem cell or bone marrow transplants. This drug is used only in people with cancers of the blood, such as leukemia, lymphoma, or multiple myeloma.

How does this drug work?

Palifermin is a manmade version of keratinocyte growth factor (KGF), a protein normally made by some cells in the body. KGF causes epithelial cells, such as those that line the mouth and throat, to multiply and mature faster. These cells are often damaged by cancer treatments, which can lead to painful mouth sores and trouble eating.

Palifermin is thought to have the same effect as KGF when injected into the body. Cells lining the mouth and throat that are damaged by cancer treatment are replaced more quickly, reducing the side effects.

Before taking this medicine

Tell your doctor…

• If you are allergic to any medicines, dyes, additives, or foods.
• If you have ever had high blood pressure. This drug may cause your blood pressure to increase for a short period of time.
• If you have any other medical conditions such as kidney disease, liver disease (including hepatitis), heart disease, congestive heart failure, lung disease, diabetes, gout, or infections. You may need closer monitoring of these conditions while being treated, or the drug dose, regimen, or timing may need to be changed.
• If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. It is not known if this drug might cause problems if either the male or female is taking it at the time of conception or during pregnancy. Men and women who are taking this drug should use some kind of birth control during treatment. It is important to check with your doctor about what kinds of birth control can be used with this medicine. This drug should be used during pregnancy only if the potential benefit is thought to justify the potential risk to the fetus.
• If you are breast-feeding. While studies are not available, this drug may pass into breast milk and affect the baby. Talk with your doctor about the possible risks of breast-feeding while taking this drug.
• If you think you might want to have children in the future. It is not known whether or not this drug can affect fertility. Talk with your doctor about the possible risk with this drug and the options that may preserve your ability to have children.
• About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Palifermin may interact with heparin if the 2 liquids get mixed together. If heparin is used to keep your IV line from clotting, your IV must be flushed with salt water (saline) before and after getting palifermin.

No other serious interactions are known at this time. But this does not necessarily mean that none exist. Check with your doctor, nurse, or pharmacist about all of your medicines, herbs, and supplements, and whether alcohol can cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether some foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Palifermin is given as an injection into a vein (intravenous, or IV) over a few minutes. It may be given in a hospital or doctor's office. It is given daily for 3 days, with the third dose at least 24 to 48 hours before getting chemotherapy. It is then given for 3 days after chemo, starting after stem cells are given, at least 4 days after the most recent dose of palifermin. The actual dose depends on your weight.

Precautions

This drug is only for use in people with cancers of the blood (leukemias, lymphomas, etc.). It has not been tested in people with solid tumors because of the theoretical possibility it might make these tumors grow faster.

This drug may cause skin rashes. In rare cases, the rash may become severe enough to require that you stop taking the drug. Tell your doctor or nurse right away if you notice any type of rash.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

• skin rash (mild)*
• abnormal blood tests that suggest the drug is affecting the pancreas (Your doctor will discuss the importance of this finding, if any.)

Less common

• fever
• swelling in the hands or feet
• skin redness
• itching
• pain or numbness in or around the mouth
• altered taste
• tongue changing color
• tongue thickening
• joint pain
• protein in the urine (Your doctor will discuss the importance of this finding, if any.)

Rare

• skin rash (severe)*
• high blood pressure
• allergic reaction with rash, hives, trouble breathing, swelling in the mouth, face, or throat

*See the "Precautions" section for more detailed information.

There are other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved in 2004.

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.