Tomudex

Tomudex is the brand name for raltitrexed, a chemotherapy medication that belongs to the class of quinazoline antifolates. It inhibits thymidylate synthase, an enzyme essential for DNA synthesis, leading to reduced thymidine pools and impaired replication in rapidly dividing cells such as cancer cells.

Medical use

Tomudex is primarily used to treat advanced colorectal cancer. It is typically employed as a single-agent therapy and may be offered to patients who have progressed after fluoropyrimidine therapy or who cannot tolerate such treatment. Its use and dosing can vary by country and clinical guidelines, and it is not universally first-line for all patients.

Administration

The drug is given as an intravenous infusion, usually over 10 to 15 minutes, at a dose of 3 mg per square meter of body surface area every three weeks. Tomudex is mainly excreted by the kidneys, and dose adjustments are recommended for renal impairment. Folinic acid rescue is not standard practice with this agent, and routine monitoring of blood counts and liver function is advised during treatment.

Adverse effects

Common toxicities include myelosuppression (neutropenia and anemia), mucositis, nausea, vomiting, diarrhea, fatigue, and elevations in liver enzymes. Less frequently, patients may experience rash, alopecia, or interstitial pneumonitis. Many adverse effects are manageable with dose modifications, supportive care, or treatment discontinuation if needed.

Interactions and precautions

Caution is advised when Tomudex is used with other nephrotoxic or myelosuppressive agents. Some drugs, including certain NSAIDs, may alter drug clearance or increase toxicity. The medication is contraindicated in pregnancy; effective contraception should be used during treatment.

History and context

Tomudex has been studied in colorectal cancer regimens and in comparative trials, but its use has declined in some regions with the adoption of alternative fluoropyrimidine–based therapies and newer cancer treatments.