Agent Orange
Agent Orange Isn ’ t Orange
Before it became known for its more sinister applications , Agent Orange was a relatively innocuous weed-killer and defoliant ( a chemical sprayed or dusted on plants to cause their leaves to fall off ). Though its notoriety is tied to the U . S . government ’ s extensive use of it as a weapon during the Vietnam War , Agent Orange is actually a British invention . Both the U . S . and British militaries considered the idea of using herbicides to destroy enemy crops during the later stages of World War II , but never pulled the trigger . Just a few years later , though , the British opted to use eco-warfare to gain the upper hand in an unruly colony .
Starting in 1953 , the British military commenced aerial spraying of trioxone ( a compound that was virtually identical to Agent Orange ) to destroy crops and flush guerillas out of the jungle during a communist insurgency in Malaya , then a British colony .
Allegations in the press that this amounted to “ chemical warfare ” were dismissed by the British government , which claimed that trioxone and similar herbicides had been tested and were considered “ harmless to human and animal life .” 1
The U . S . military ’ s aerial herbicide spray mission in Vietnam was called Operation Ranch Hand ; the military personnel who conducted it are referred to as the Ranch Hand veterans . According to a report from the National Academy of Sciences , approximately 20 million gallons of Agent Orange were sprayed in Vietnam during the operation , which ran from 1962 to 1971 . 2 The defoliants were used to clear plants that provided cover to hostile forces and to disrupt agricultural production in enemy areas .
The herbicides used in Vietnam were identified by the color of the band on the 55-gallon drums they were shipped in : Agent Pink , Agent Green , Agent Purple , Agent White , Agent Blue , and Agent Orange . Each agent used slightly different herbicide formulations to achieve maximum defoliant efficacy and clear strategic plots of land . Agent Orange refers specifically to a 50:50 formulation of 2,4-dichlorophenoxyacetic acid ( 2,4 , -D ) and 2,4,5-trichlorophenoxyacetic acid ( 2,4,5-T ), but the term is used generically to refer to all of the herbicides sprayed by the U . S . military in Vietnam .
TCDD , or 2,3,7,8-tetrachlorodibenzo-pdioxin , or just “ dioxin ,” is formed during the production of 2,4,5-T and is classified as a carcinogen by the International Agency for Research on Cancer . It is also considered possibly teratogenic , although the scientific data supporting a link between Agent Orange / dioxin exposure and birth defects are controversial .
REFERENCES
1 . “ The UK ’ s use of Agent Orange in Malaysia .” Accessed March 13 , 2017 , from http :// www . toxicremnantsofwar . info / uk-agent-orange-malaysia /.
2 . National Academy of Sciences . “ Air Force Health Study ( Ranch Hand ) research assets .” Accessed March 29 , 2017 , from http :// www . nationalacademies . org / hmd / Activities / Veterans / AirForceHealthStudyResearchAssets . aspx .
50 ASH Clinical News
Sergeant Foster . The law would provide presumptive Agent Orange exposure status to Vietnam War-era veterans who served in Guam , the Commonwealth of the Northern Mariana Islands , and American Samoa . 4
Other servicemen have corroborated Master Sergeant Foster ’ s claims that Agent Orange was used at Andersen , and the government of Guam recently announced that newly appointed Administrator of the
IMPORTANT SAFETY INFORMATION
Contraindication : History of hypersensitivity to BOSULIF . Reactions have included anaphylaxis . Anaphylactic shock occurred in less than 0.2 % of treated patients in clinical trials .
Gastrointestinal Toxicity : Diarrhea , nausea , vomiting , and abdominal pain can occur . In the clinical trial , median time to onset for diarrhea was 2 days , median duration was 1 day , and median number of episodes per patient was 3 ( range 1-221 ). Monitor and manage patients using standards of care , including antidiarrheals , antiemetics , and / or fluid replacement . Withhold , dose reduce , or discontinue BOSULIF as necessary .
Myelosuppression : Thrombocytopenia , anemia , and neutropenia can occur . Perform complete blood counts weekly for the first month and then monthly or as clinically indicated . Withhold , dose reduce , or discontinue BOSULIF as necessary .
Hepatic Toxicity : Twenty percent of patients experienced an increase in either ALT or AST . Liver enzyme elevation usually occurs early in treatment . Perform
U . S . Environmental Protection Agency Scott Pruitt has promised to help test for signs of the toxic herbicide residue on and around the island . 5
The Big Question
The question of whether Agent Orange causes cancer and a multitude of other diseases has been extensively studied for more than 45 years . These studies are not limited to Vietnam veterans ; researchers are
BOSULIF is indicated for the treatment of adult patients with chronic , accelerated , or blast phase Philadelphia chromosome – positive ( Ph +) chronic myelogenous leukemia ( CML ) with resistance or intolerance to prior therapy .
In the treatment of adult patients with Ph + CML with resistance or intolerance to prior therapy
Everyone has a distinct profile
Consider your patient . Consider BOSULIF .
( bosutinib )
Bosutinib ( BOSULIF ®) is recommended by the NCCN Clinical Practice Guidelines in Oncology ( NCCN Guidelines ®) as a treatment option for patients with CML in need of 2nd- or later-line TKI therapy . 1
Study design : BOSULIF 500 mg once-daily treatment was studied in a single-arm , Phase 1 / 2 , open-label , multicenter trial ( N = 546 ) in patients with CP , AP , or BP CML in second line ( after imatinib ) or in third line ( after imatinib followed by dasatinib and / or nilotinib ). Of the 546 patients enrolled , 73 % were imatinib resistant and 27 % were imatinib intolerant . 2
AP = accelerated phase ; BP = blast phase ; CP = chronic phase .
hepatic enzyme tests monthly for the first 3 months and as clinically indicated . In patients with transaminase elevations , monitor liver enzymes more frequently . Drug-induced liver injury has occurred . Withhold , dose reduce , or discontinue BOSULIF as necessary . In patients with mild , moderate , or severe hepatic impairment , the recommended starting dose is 200 mg daily .
Renal Toxicity : An on-treatment decline in estimated glomerular filtration rate has occurred in patients treated with BOSULIF . Monitor renal function at baseline and during therapy , with particular attention to patients with preexisting renal impairment or risk factors . Consider dose adjustment in patients with baseline and treatment emergent renal impairment . The recommended starting doses for patients with severe renal impairment ( CrCL < 30 mL / min ) or moderate renal impairment ( CrCL 30-50 mL / min ) are 300 mg and 400 mg daily , respectively .
Fluid Retention : Fluid retention can occur and may cause pericardial effusion , pleural effusion , pulmonary edema , and / or peripheral edema . Monitor and manage patients using standards of care . Interrupt , dose reduce , or discontinue BOSULIF as necessary .