Overcoming multidrug resistance: valspodar as a paradigm for nursing care.
OBJECTIVE
To review the mechanisms of multidrug resistance (MDR) in human cancer and the clinical use of MDR modulators to overcome or reverse P-glycoprotein (P-gp)-mediated MDR.


METHODS
Current literature, ongoing clinical trials, and clinical experience.


RESULTS
Agents, such as valspodar, that block the activity of P-gp can reverse or overcome MDR caused by overexpression of P-gp. The MDR modulator valspodar (PSC 833; Novartis Pharmaceuticals Corporation, East Hanover, NJ) is examined as a model for establishing nursing guidelines for this new class of therapeutic agents.


CONCLUSIONS
The dose of some chemotherapy agents must be modified with concurrent valspodar administration. Studies examining the safety and efficacy of valspodar as a prototype of MDR modulators provide the basis for establishing nursing care guidelines.


CONCLUSIONS
Nursing care for the administration of valspodar includes understanding patient selection, criteria, dosing, and administration; side-effect management; patient monitoring and follow-up; and patient education.
Berg
D
D
Dana-Farber Cancer Institute, Boston, MA, USA.
Centrilla
L
L
Halsey
J
J
Silvester
P
P
Jones
B
B
Guynn
K
K
Mayer
D K
DK
D018435:ATP Binding Cassette Transporter, Subfamily B / Q000037:antagonists & inhibitors*; D003524:Cyclosporins / Q000627:therapeutic use*; D018432:Drug Resistance, Multiple; D019008:Drug Resistance, Neoplasm; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy / Q000451:nursing*; D009732:Nursing Care; D009859:Oncology Nursing; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic
D018435:ATP Binding Cassette Transporter, Subfamily B; D003524:Cyclosporins; C070272:valspodar