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<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE" /><meta name="citation_inbook_title" content="LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]" /><meta name="citation_title" content="Altretamine" /><meta name="citation_publisher" content="National Institute of Diabetes and Digestive and Kidney Diseases" /><meta name="citation_date" content="2016/03/01" /><meta name="citation_pmid" content="31643842" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK548524/" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Altretamine" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="National Institute of Diabetes and Digestive and Kidney Diseases" /><meta name="DC.Date" content="2016/03/01" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK548524/" /><meta name="description" content="Altretamine is an orally administered alkylating agent, formerly known as hexamethylmelamine, which is currently used as a secondary therapy for advanced ovarian carcinoma. Altretamine therapy has been associated with low rates of serum enzyme elevations during therapy and with rare instances of acute, clinically apparent injury." /><meta name="og:title" content="Altretamine" /><meta name="og:type" content="book" /><meta name="og:description" content="Altretamine is an orally administered alkylating agent, formerly known as hexamethylmelamine, which is currently used as a secondary therapy for advanced ovarian carcinoma. Altretamine therapy has been associated with low rates of serum enzyme elevations during therapy and with rare instances of acute, clinically apparent injury." /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK548524/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-livertox-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="bk-non-canon-loc" content="/books/n/livertox/Altretamine/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK548524/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" media="print" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} .body-content h2, .body-content .h2 {border-bottom: 1px solid #97B0C8} .body-content h2.inline {border-bottom: none} a.page-toc-label , .jig-ncbismoothscroll a {text-decoration:none;border:0 !important} .temp-labeled-list .graphic {display:inline-block !important} .temp-labeled-list img{width:100%}</style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript" src="/corehtml/pmc/js/large-obj-scrollbars.min.js"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/book-toc.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script><meta name="book-collection" content="NONE" />
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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="All Drug Records" href="/books/n/livertox/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-livertox-lrg.png" alt="Cover of LiverTox" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK548524_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK548524_dtls__"><div>Bethesda (MD): <a href="https://www.niddk.nih.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Institute of Diabetes and Digestive and Kidney Diseases</a>; 2012-.</div></div><div class="half_rhythm"><ul class="inline_list"><li style="margin-right:1em"><a class="bk_cntns" href="/books/n/livertox/">Drug Records</a></li></ul></div><div class="bk_noprnt"><form method="get" action="/books/n/livertox/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div><div class="icnblk_cntnt two_col"><div class="pagination bk_noprnt"><a class="active page_link prev" href="/books/n/livertox/Alprazolam/" title="Previous page in this title">< Prev</a><a class="active page_link next" href="/books/n/livertox/AlzheimersDrugs/" title="Next page in this title">Next ></a></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK548524_"><span class="title" itemprop="name">Altretamine</span></h1><p class="small">Last Update: <span itemprop="dateModified">March 1, 2016</span>.</p></div><div class="body-content whole_rhythm" itemprop="text"><div id="Altretamine.OVERVIEW"><h2 id="_Altretamine_OVERVIEW_">OVERVIEW</h2><div id="Altretamine.Introduction"><h3>Introduction</h3><p>Altretamine is an orally administered alkylating agent, formerly known as hexamethylmelamine, which is currently used as a secondary therapy for advanced ovarian carcinoma. Altretamine therapy has been associated with low rates of serum enzyme elevations during therapy and with rare instances of acute, clinically apparent injury.</p></div><div id="Altretamine.Background"><h3>Background</h3><p>Altretamine (al tret' a meen) is a synthetic, orally available alkylating agent belonging to the methylmelamine class of these agents. The alkylating agents act by causing modification and cross linking of DNA, thus inhibiting DNA, RNA and protein synthesis and causing cell death in rapidly dividing cells. Altretamine was approved for use in the United States in 1990. Current indications are advanced ovarian carcinoma in patients who have failed primary therapy with platinum-containing or other alkylating agents. Altretamine is available in capsules of 50 mg under the brand name Hexalen. The recommended dose varies by indication and body surface area and it is typically given orally for 14 to 21 days in 28 day cycles. Altretamine shares common side effects with other alkylating agents such as nausea, vomiting, diarrhea, alopecia, bone marrow suppression, peripheral neuropathy and rash.</p></div><div id="Altretamine.Hepatotoxicity"><h3>Hepatotoxicity</h3><p>Altretamine therapy is associated with a low rate of serum enzyme elevations, but these are generally mild and self limited, not requiring dose adjustment. Rare instances of clinically apparent acute liver injury attributed to altretamine have been reported, but the clinical features have not been characterized. Altretamine has not been linked specifically to sinusoidal obstruction syndrome, but it is rarely used in high doses in neoplastic disease or in conditioning regimens for bone marrow transplantation, situations in which alkylating agents are commonly associated with this complication.</p><p><a class="def" href="/books/n/livertox/glossary/def-item/glossary.likelihood-score/">Likelihood score</a>: E* (unlikely but suspected rare cause of liver injury).</p></div><div id="Altretamine.Mechanism_of_Injury"><h3>Mechanism of Injury</h3><p>The cause of the idiosyncratic liver injury associated with altretamine use is probably related to a hypersensitivity reaction to a hepatic metabolite of the drug, which is extensively metabolized by the liver.</p></div><div id="Altretamine.Outcome_and_Management"><h3>Outcome and Management</h3><p>Liver injury is very rare after altretamine therapy. The severity of injury in reported cases has generally been mild-to-moderate and self limited in course. There have been no instances of acute liver failure, chronic hepatitis or vanishing bile duct syndrome definitely linked to chlorambucil therapy. In situations of acute liver injury after altretamine use, rechallenge should be avoided.</p><p>Drug Class: <a href="/books/n/livertox/AntineoplasticAgents/">Antineoplastic Agents</a>, <a href="/books/n/livertox/AlkylatingAgents/">Alkylating Agents</a></p></div></div><div id="Altretamine.PRODUCT_INFORMATION"><h2 id="_Altretamine_PRODUCT_INFORMATION_">PRODUCT INFORMATION</h2><div id="Altretamine.BPI" class="box"><p>
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<b>REPRESENTATIVE TRADE NAMES</b>
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</p><p>Altretamine – Hexalen®</p><p>
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<b>DRUG CLASS</b>
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</p><p>Antineoplastic Agents, Alkylating Agents</p><p>
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<a href="https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=Altretamine" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">COMPLETE LABELING</a>
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</p><p>Product labeling at DailyMed, National Library of Medicine, NIH</p></div></div><div id="Altretamine.CHEMICAL_FORMULA_AND_STRUCTU"><h2 id="_Altretamine_CHEMICAL_FORMULA_AND_STRUCTU_">CHEMICAL FORMULA AND STRUCTURE</h2><div id="Altretamine.T1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK548524/table/Altretamine.T1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Altretamine.T1_lrgtbl__"><table><thead><tr><th id="hd_h_Altretamine.T1_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">DRUG</th><th id="hd_h_Altretamine.T1_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">CAS REGISTRY NUMBER</th><th id="hd_h_Altretamine.T1_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">MOLECULAR FORMULA</th><th id="hd_h_Altretamine.T1_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">STRUCTURE</th></tr></thead><tbody><tr><td headers="hd_h_Altretamine.T1_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">Altretamine</td><td headers="hd_h_Altretamine.T1_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">
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<a href="https://pubchem.ncbi.nlm.nih.gov/substance/134976605" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem">645-05-6</a>
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</td><td headers="hd_h_Altretamine.T1_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">C9-H18-N6</td><td headers="hd_h_Altretamine.T1_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">
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<div class="graphic"><img src="/books/NBK548524/bin/Altretamine_Structure.jpg" alt="Altretamine Chemical Structure" /></div>
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</td></tr></tbody></table></div></div></div><div id="Altretamine.ANNOTATED_BIBLIOGRAPHY"><h2 id="_Altretamine_ANNOTATED_BIBLIOGRAPHY_">ANNOTATED BIBLIOGRAPHY</h2><p>References updated: 01 March 2016</p><ul class="first-line-outdent"><li><div class="bk_ref" id="Altretamine.R1">Zimmerman HJ. Oncotherapeutic and immunosuppressive agents. In, Zimmerman HJ. Hepatotoxicity: the adverse effects of drugs and other chemicals on the liver. 2nd ed. Philadelphia: Lippincott, 1999, pp. 673-708.<div><i>(Expert review of hepatotoxicity of cancer chemotherapeutic agents published in 1999; triethylenemelamine but not altretamine is discussed). </i></div></div></li><li><div class="bk_ref" id="Altretamine.R2">DeLeve LD. Cancer chemotherapy. In, Kaplowitz N, DeLeve LD, eds. Drug-induced liver disease. 3rd ed. Amsterdam: Elsevier, 2013, pp. 549-68.<div><i>(Review of hepatotoxicity of cancer chemotherapeutic agents; altretamine is not discussed).</i></div></div></li><li><div class="bk_ref" id="Altretamine.R3">Chabner BA, Bertino J, Clearly J, Ortiz T, Lane A, Supko JG, Ryan DP. Cytotoxic agents. Chemotherapy of neoplastic diseases. In, Brunton LL, Chabner BA, Knollman BC, eds. Goodman & Gilman's the pharmacological basis of therapeutics. 12th ed. New York: McGraw-Hill, 2011, pp. 1315-404.<div><i>(Textbook of pharmacology and therapeutics).</i></div></div></li><li><div class="bk_ref" id="Altretamine.R4">Ihde DC, Dutcher JS, Young RC, Cordes RS, Barlock AL, Hubbard SM, Jones RB, et al. Phase I trial of pentamethylmelamine: a clinical and pharmacologic study. Cancer Treat Rep 1981; 65: 755-62. [<a href="https://pubmed.ncbi.nlm.nih.gov/6791819" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6791819</span></a>]<div><i>(Phase 1 study of a derivative of altretamine in 34 patients with advanced solid tumors given in 1-24 intravenous infusions; 9 patients had elevations in ALT or AST, but no jaundice and most abnormalities occurred in patients with liver metastases).</i></div></div></li><li><div class="bk_ref" id="Altretamine.R5">Rollins BJ. Hepatic veno-occlusive disease. Am J Med 1986; 8: 297-306. [<a href="https://pubmed.ncbi.nlm.nih.gov/3526887" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3526887</span></a>]<div><i>(Review of the diagnosis, clinical course, histology and pathogenesis of veno-occlusive disease [sinusoidal obstruction syndrome: SOS]).</i></div></div></li><li><div class="bk_ref" id="Altretamine.R6">Jones RJ, Lee KS, Beschorner WE, Vogel VG, Grochow LB, Braine HG, Vogelsang GB, et al. Veno-occlusive disease of the liver following bone marrow transplantation. Transplantation 1987; 4: 778-83. [<a href="https://pubmed.ncbi.nlm.nih.gov/3321587" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3321587</span></a>]<div><i>(Among 235 patients undergoing bone marrow transplantation between 1982 and 1985, sinusoidal obstruction syndrome [SOS] developed in 52 [22%] of whom half died, making SOS the third most common cause of death in this population).</i></div></div></li><li><div class="bk_ref" id="Altretamine.R7">Manetta A, MacNeill C, Lyter JA, Scheffler B, Podczaski ES, Larson JE, Schein P. Hexamethylmelamine as a single second-line agent in ovarian cancer. Gynecol Oncol 1990; 36: 93-6. [<a href="https://pubmed.ncbi.nlm.nih.gov/2104819" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2104819</span></a>]<div><i>(Among 52 patients with advanced ovarian cancer given altretamine in cycles of 14 days, side effects were mainly nausea, vomiting and sensory neuropathy; Alk P elevations occurred in 7 patients, but no details given).</i></div></div></li><li><div class="bk_ref" id="Altretamine.R8">Ames MM. Hexamethylmelamine: pharmacology and mechanism of action. Cancer Treat Rep 1991; 18: 3-14. [<a href="https://pubmed.ncbi.nlm.nih.gov/1904306" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1904306</span></a>]<div><i>(Pharmacology of altretamine demonstrates variable absorption orally, dose related toxicity is nausea and vomiting; activity requires metabolic activation in the liver after which it binds to macromolecules).</i></div></div></li><li><div class="bk_ref" id="Altretamine.R9">Lee CR, Faulds D. Altretamine: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in cancer chemotherapy. Drugs 1995; 49: 932-53. [<a href="https://pubmed.ncbi.nlm.nih.gov/7641606" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7641606</span></a>]<div><i>(Review of pharmacology, clinical efficacy and safety of altretamine; no mention of hepatotoxicity).</i></div></div></li><li><div class="bk_ref" id="Altretamine.R10">Bearman SI. The syndrome of hepatic veno-occlusive disease after marrow transplantation. Blood 1995; 85: 3005-20. [<a href="https://pubmed.ncbi.nlm.nih.gov/7756636" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7756636</span></a>]<div><i>(Review of sinusoidal obstruction syndrome after hematopoietic cell transplantation; usually presents with painful hepatomegaly, weight gain [fluid and ascites] and jaundice within 3 weeks of myeloablation with occlusion of central veins and sinusoids and extensive zone 3 [centrolobular] injury).</i></div></div></li><li><div class="bk_ref" id="Altretamine.R11">Malik IA. Altretamine is an effective palliative therapy of patients with recurrent epithelial ovarian cancer. Jpn J Clin Oncol 2001; 31: 69-73. [<a href="https://pubmed.ncbi.nlm.nih.gov/11302345" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11302345</span></a>]<div><i>(Among 17 women with recurrent ovarian cancer treated with altretamine for an average of 6 months, toxicity was mainly nausea, vomiting and asthenia; 5 patients developed "Abdominal LFT", but no patient was withdrawn because of toxicity and no details were provided on ALT elevations or hepatotoxicity).</i></div></div></li></ul></div><div id="bk_toc_contnr"></div></div></div>
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<a href="https://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=pubmed&pubmedfilters=true&term=(Altretamine/AE)+AND+Human%5BMH%5D+AND+(drug+induced+liver+injury+OR+jaundice/CI+OR+bile+duct+diseases/CI+OR+liver/DE+OR+liver+diseases/CI)+AND+(%221900/1/1%22%5BEDat%5D%3A%222999/12/31%22%5BEDat%5D)" ref="pagearea=document-links&targetsite=external&targetcat=link&targettype=uri">Recent References on Altretamine: from PubMed.gov</a>
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<a href="https://clinicaltrials.gov/ct2/results?term=Altretamine" ref="pagearea=document-links&targetsite=external&targetcat=link&targettype=uri">Trials on Altretamine: from ClinicalTrials.gov</a>
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A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in cancer chemotherapy.</a><span class="source">[Drugs. 1995]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Altretamine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in cancer chemotherapy.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Lee CR, Faulds D. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">Drugs. 1995 Jun; 49(6):932-53. </em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/9648592" ref="ordinalpos=1&linkpos=2&log$=relatedarticles&logdbfrom=pubmed">Altretamine (hexamethylmelamine) in platinum-resistant and platinum-refractory ovarian cancer: a Gynecologic Oncology Group phase II trial.</a><span class="source">[Gynecol Oncol. 1998]</span><div class="brieflinkpop offscreen_noflow">Altretamine (hexamethylmelamine) in platinum-resistant and platinum-refractory ovarian cancer: a Gynecologic Oncology Group phase II trial.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Markman M, Blessing JA, Moore D, Ball H, Lentz SS. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">Gynecol Oncol. 1998 Jun; 69(3):226-9. </em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/11202196" ref="ordinalpos=1&linkpos=3&log$=relatedarticles&logdbfrom=pubmed">[Combination chemotherapy with hexamethylamine (Hexalen, Altretamine, Hexastat) and sarcolysine in advanced ovarian carcinoma].</a><span class="source">[Vopr Onkol. 2000]</span><div class="brieflinkpop offscreen_noflow">[Combination chemotherapy with hexamethylamine (Hexalen, Altretamine, Hexastat) and sarcolysine in advanced ovarian carcinoma].<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Gershanovich ML, Livshits ME, Antipenkova VI. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">Vopr Onkol. 2000; 46(5):604-7. </em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/102417" ref="ordinalpos=1&linkpos=4&log$=relatedarticles&logdbfrom=pubmed">Hexamethylmelamine in alkylating agent-resistant ovarian carcinoma.</a><span class="source">[Cancer. 1978]</span><div class="brieflinkpop offscreen_noflow">Hexamethylmelamine in alkylating agent-resistant ovarian carcinoma.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Johnson BL, Fisher RI, Bender RA, DeVita VT Jr, Chabner BA, Young RC. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">Cancer. 1978 Nov; 42(5):2157-61. </em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/1904314" ref="ordinalpos=1&linkpos=5&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Hexamethylmelamine: activity in lymphoma and other tumors.</a><span class="source">[Cancer Treat Rev. 1991]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Hexamethylmelamine: activity in lymphoma and other tumors.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Macdonald JS. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">Cancer Treat Rev. 1991 Mar; 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