Romidepsin, Istodax

  • Indications
  1. Cutaneous T Cell Lymphoma (relapsed, refractory)
  2. Peripheral T Cell Lymphoma (refractory)
  • Mechanism
  1. Antimetabolite, Antineoplastic Agent
  2. Romidepsin is a bicyclic depsipeptide antibiotic extracted from the bacterium Chromobacterium violaceum
  3. Romidepsin, once activated intracellularly, is a Histone Deacetylase Inhibitor (HDAC Inhibitor)
    1. Histones are the spools around which DNA are wrapped, and which play a role in gene expression
      1. Cancers may be facilitated by abnormally expressed genes in specific histone regions
    2. HDAC Inhibitors block histone deacetylase
      1. Histone deacetylase is an enzyme that catalyzes removal of acetyl groups from core histones
      2. Results in hyperacetylation of histones, suppressing gene expression and cell differentiation
  4. Romidepsin other effects
    1. Inhibits Hypoxia-induced Angiogenesis
    2. Decreases heat shock Protein 90 (Hsp90)-dependent oncoproteins
  • Medications
  1. Romidepsin powder for IV solution
  • Dosing
  1. See other references for disease specific dosing protocols
  2. Adults: 14 mg/m2 IV on days 1, 8 and 15 of 28 day cycles
  • Adverse Effects
  • Safety
  1. Avoid in Pregnancy (any trimester)
    1. Use reliable Contraception
  2. Avoid in Lactation
  3. Monitoring
    1. Complete Blood Count
    2. Electrocardiogram
  • Drug Interactions
  1. Strong CYP3A4 Inhibitors and Inducers
    1. Avoid in combination with Romidepsin