Nelarabine (Nelarabine-Reach) is a pro‑drug of the deoxyguanosine analogue ara‑G. Nelarabine is rapidly demethylated by adenosine deaminase (ADA) to ara‑G and then phosphorylated intracellularly by deoxyguanosine kinase and deoxycytidine kinase to its 5'-monophosphate metabolite. The monophosphate metabolite is subsequently converted to the active 5'‑triphosphate form, ara‑GTP. Accumulation of ara‑GTP in leukaemic blasts allows for preferential incorporation of ara‑GTP into deoxyribonucleic acid (DNA) leading to inhibition of DNA synthesis. This results in cell death. Induction and liberation of soluble Fas ligand from T‑cells also contributes to the cytotoxic effects of nelarabine. In vitro, T‑cells are more sensitive than B‑cells to the cytotoxic effects of nelarabine. Nelarabine is indicated for the treatment of patients with relapsing/ refractory T‑cell acute lymphoblastic leukaemia and T‑cell lymphoblastic lymphoma whose disease has not responded to or has relapsed following treatment. Nelarabine-Reach solution for infusion contains nelarabine 250 mg/50 mL and is available in packs of 6 vials. It has been available since 13 September 2023 under Section 19A through early access to a medicine under evaluation for inclusion on the ARTG, and it has now been listed on the ARTG.
New Presentation
Trametinib (as dimethyl sulfoxide) (Mekinist)is now available as a powder for oral solution containing trametinib 0.05 mg/mL after reconstitution. It is available in packs of 1 bottle.
New Indications
Irinotecan (as sucrosofate) (Onivyde) is now indicated in combination with oxaliplatin, 5‑FU, and leucovorin for the first-line treatment of metastatic pancreatic adenocarcinoma.
Trametinib (as dimethyl sulfoxide) (Mekinist) is now indicated in combination with dabrafenib for the treatment of paediatric patients 1 year of age and older with BRAF V600E mutation and low-grade glioma who require systemic therapy or high‑grade glioma who have progressed following prior treatment and have no satisfactory alternative treatment options.
New Contraindications
Atazanavir (Reyataz)is now contraindicated in combination with carbamazepine, phenobarbital, phenytoin, encorafenib, and ivosidenib.
This list is a summary of only some of the changes that have occurred over the last month.
Before prescribing, always refer to the full product information.
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