Chromic Phosphate P 32 (Injection)

Chromic phosphate P 32 is a radiopharmaceutical which is used to treat internal cancers, most notably of the stomach, liver, intestines and lungs.

Overview

As a radiopharmaceutical, chromic phosphate P 32 (often marketed in the US as Phosphocol P-32) is inserted via catheter in the sac that contains the lungs (known as the pleura) and/or the sac that containers the stomach, liver and intestines (known as the peritoneum) in order to treat leaking fluid within these areas, which is caused by cancer. In some circumstances, it can also be administered by injection to treat cancer of organs such as the prostate or ovaries.

This medication should only be given under the direct supervision of a doctor who specializes in nuclear medicine. It is supplied as a sterile, nonpryogenic suspension in a 30 per cent dextrose solution, with 2 per cent alcohol added as a preservative.

Conditions treated

  • Cancer

Type of medicine

  • Radiopharmaceutical

Side effects

Along with the desired effects, chromic phosphate P 32 can also cause some unwanted side effects. The most common side effects reported by patients undergoing treatment with this medication include the following: chest pain, severe abdominal or stomach pain, fever, chills, nausea, vomiting, dry cough, difficulty breathing, unusual tiredness or weakness, diarrhea, appetite loss.

As the patient continues treatment with this drug as prescribed, many (if not all) of the previously mentioned side effects should begin to lessen. If side effects persist over a prolonged period or the effects appear to worsen, the patient is advised to contact their doctor or healthcare provider as soon as possible. In some instances, a doctor may be able to recommend ways to alleviate side effects that are causing mild discomfort via natural or over-the-counter remedies.

Many patients only experience minimal side effects while undergoing treatment with chromic phosphate P 32, if they observe any whatsoever. The drug is intended to alleviate symptoms associated with serious and life-threatening cancers, therefore most healthcare professionals agree that the benefits of this medicine far outweigh the risks of experiencing side effects.

Some side effects associated with chromic phosphate P 32 may not have been reported. Patients are advised to report any undocumented side effects to the FDA and to discuss these effects with their doctor.

In addition to commonly observed minor side effects mentioned above, patients may also experience untoward effects associated with radiopharmaceuticals. These include transitory radiation sickness, peritonitis, abdominal cramps, pleuritis, bone marrow depression and radiation damage if the solution is accidentally injected interstitially, or injected in loculation.

Dosage

As with all medicines, it is incredibly important for patients to be administered with chromic phosphate P 32 only as prescribed by a doctor with specialized training in radiopharmaceuticals. This means that healthcare practitioners should avoid administering more of this medication than advised, either in size of dose or frequency. In addition to this, treatment should cease if the doctor advises so - even if there is still a supply of the medication remaining.

Although the manufacturer provides generalized dosage instructions, it should be reiterated that these recommendations can be altered by the doctor who is overseeing treatment. Numerous factors, which should be discussed between patient and doctor, will be used to establish the optimal dose size. These include the height and weight of the patient, along with their current condition, taking into consideration any other pre-existing health conditions.

The typically suggested dose in the average patient (70kg weight) for intraperitoneal instillation is 370 to 740 megabecquerels (10 to 20 millicuries).

The typically suggested dose in the average patient (70kg weight) for intrapleural instillation is 222 to 444 megabecquerels (6 to 12 millicuries).

Doses for interstitial use will depend on the estimated weight of the tumor, in grams. Approximately 3.7 to 18.5 megabecquerels (0.1 to 0.5 millicuries) per gram should be administered, based on the aggressiveness of the tumor.

Patient dose must be measured by a radioactivity calibration system prior to administration in order to prevent accidental overexposure to radiation.

Healthcare providers are advised against administering excess or double doses. If a patient misses a dose, the next dose should be rearranged as soon as possible. If it is too close to the next scheduled dose, the patient should simply receive the next dose as standard and continue with normal dosage from there onwards.

Interactions

Most medications have the potential to interact with other chemicals or drugs within the human body. These interactions can change the effects of one or more medicines, causing a drug to become ineffective in treating the condition it was prescribed for. In other instances, interactions can cause dangerous and even fatal side effects. For these reasons, it is important for a patient to keep a detailed list of all medications they are currently undergoing treatment with. This extends to over the counter remedies, complementary medicines, vitamins and herbal supplements.

There are currently no known drug interactions with chromic phosphate P 32. However, this does not mean that no interactions exist. Patients who experience (or think they may have experienced) an interaction between a medicine they are currently undergoing treatment with and chromic phosphate P 32 should contact the FDA and inform them of their findings. The Patient's doctor should also be notified.

Chromic phosphate is not suitable for use in the presence of ulcerative tumors. It should not be administered where there are exposed cavities or if there is evidence of loculation, unless the extent of the loculation has been determined to be safe.

Warnings

As with all radioactive materials, great care should be taken to ensure that the patient is exposed to minimal levels of radiation, in consistency with proper patient management. A risk assessment should also be undertaken in order to prevent radiation exposure as an occupational hazard among healthcare workers.

Great care must be taken during intracavitary instillation to prevent placing the dose of chromic phosphate P 32 into intraperitoneal or intrapleural loculations, the body wall or bowel lumen. Unrecognized misplacement of this therapeutic agent has resulted in chronic fibrosis, necrosis and intestinal fibrosis, according to reports.

Chromic phosphate P 32 decays by beta emission, and has a physical half-life of 14 days. The effective half-life of this medicine has been determined to be half that of its physical HL, with a residency time of 495 hours.

Along with chromic phosphate, this medicine contains the following inactive ingredients:

  • Dextrose (0.3g per ml)
  • Benzyl alcohol (0.02ml per ml)
  • Sodium acetate (1g per ml)
  • Sodium hydroxide (trace)
  • Hydrochloric acid (trace)

The effectiveness and safety of this medicine in pediatric patients has yet to be established. It is therefore not approved for use in children, although it may be used at the discretion of a qualified doctor. However, it has been reported that chromic phosphate P 32 may increase the risk of leukemia in younger patients, approximately 10 months after receiving intra-articular injections at levels of 0.6 to 1.5 millicuries.

This radiopharmaceutical should not be administered to patients who are pregnant or breastfeeding unless the therapeutic benefits have been deemed to outweigh the potential hazards. Radiopharmaceuticals should only be used by physicians who hold relevant and/or specific qualifications in the safe and effective handling and use of radionuclides produced by particle accelerator or nuclear reactor, and whose training and experience has been deemed appropriate by the governing body of the state or country in which the treatment is taking place.

Storage

This medication is provided in 10ml vials containing 555 megabecquerels (15 millicuries) in concentrations of up to 185 megabecquerels (5 millicuries) per ml. It may only be distributed to persons licensed to use materials listed in Section 35.300 by the US Nuclear Regulatory Commission.

Chromic phosphate P 32 should be stored at room temperature (20C to 25C). Because this medicine is only administered in a clinical setting, the correct storage and administration is typically the responsibility of the patient's healthcare provider.

Summary

Chromic phosphate P 32 is an effective treatment of cancer and related conditions. However, it is only to be administered in a clinical setting by a qualified doctor. While it is a greatly beneficial medication, it can also pose a risk to patients if administered incorrectly. It functions by reducing the levels of fluid caused by cancer within the internal organs, and the correct course of treatment can help the patient defeat even the most aggressive or fast-onset cancers.

As with all radiopharmaceuticals, chromic phosphate P 32 poses a risk of exposure to patients, who may experience radiation sickness, peritonitis, abdominal cramps, pleuritis, bone marrow depression or leukemia as a result of treatment with this medicine. As of 2009, this drug has been discontinued by the manufacturer - although it may still be in use outside of the US, or within the US as a generic.

To get the best out of this medicine, patient and doctor should work together in order to ascertain the optimal dosage and best course of action, which may involve regular injections with chromic phosphate P 32 alongside other cancer treatment methods.

Resources
Last Reviewed:
December 23, 2017
Last Updated:
April 04, 2018