Hexamethylamine (Hexalen, Altretamine, Hexastat) is an alkylating agent with restricted activity for which the exact anti-mitotic mode of action is not very precise.
Formula of Hexamethylamine
A few indications have been approved:
Second line treatment of ovarian carcinoma (alone or in polychemotherapy protocol CHAP: cyclophosphamide, hexamethylamine, adriamycin, cisplatin)
Salvage treatment of small cell lung cancer.
It is given orally.
In monotherapy, the usual dosage is 150 to 250 mg/m2 , the dose may be given in 2 to 3 intakes at mealtimes or in one intake just before going to bed. The treatment is given for 14 to 21 consecutive days every 4 weeks.
Only specific toxicities (or major toxicities) are described here. Other commonj chemotherapy toxicities are described in the chapter on chemotherapy toxicity.
Due to its daily repeated intake (and to its prescription as second or third line treatment), haematological monitoring should be instituted (every week). Haematological toxicity concerns the three lineages.
During prolonged (efficient) treatment, peripheral neuropathies, mental confusion, psychomotric excitation, hallucinations and depressive mood have been observed. Brain metastases should be excluded before incriminating the drug.