Oral Chemotherapy Nathan Brashear, PharmD Candidate 2017 University of Kentucky College of Pharmacy

Size: px

Start display at page:

Download "Oral Chemotherapy Nathan Brashear, PharmD Candidate 2017 University of Kentucky College of Pharmacy"

Claire Chapman
5 years ago
Views:

1 Oral Chemotherapy Nathan Brashear, PharmD Candidate 2017 University of Kentucky College of Pharmacy 1

2 Objectives Identify the more commonly dispensed oral chemotherapy drugs and their indications/dosage Discuss the mechanisms of action of these drugs Analyze the adverse drug reactions Discuss any clinical pearls of these oral chemotherapy drugs Review oral chemotherapy administration and education protocols 2

Xeloda (capecitabine) Indications: Colon/colorectal cancer, breast cancer Usual dose: 1250mg/m 2 twice daily for 14 days, followed by a 7 day rest period Mechanism of action: Converted by the body to

3 Xeloda (capecitabine) Indications: Colon/colorectal cancer, breast cancer Usual dose: 1250mg/m 2 twice daily for 14 days, followed by a 7 day rest period Mechanism of action: Converted by the body to 5-FU, integrating into DNA and disrupting DNA & RNA synthesis. Adverse reactions: Nausea/vomiting, diarrhea, fatigue, hand-and-foot syndrome. Pearls: Take with a full glass of water 30 minutes after a meal for optimal absorption. 3

4 Hand-and-Foot Syndrome A potentially severe skin reaction involving the palms of the hands and soles of the feet. Mild symptoms include: numbness, tingling, swelling, erythema. Severe symptoms include: desquamation, ulceration, blistering, or pain that affects the patient s ADLs. If severe symptoms are seen, discontinue treatment until HFS resolves. 4

Tarceva (erlotinib) Indications: EGFR+ non-small cell lung cancer, pancreatic cancer Usual dose: 150mg daily (NSCLC), 100mg daily (pancreatic) Mechanism of action: Targets the epidermal growth factor

5 Tarceva (erlotinib) Indications: EGFR+ non-small cell lung cancer, pancreatic cancer Usual dose: 150mg daily (NSCLC), 100mg daily (pancreatic) Mechanism of action: Targets the epidermal growth factor receptor that is expressed on EGFR+ cancer cells, disrupting cell proliferation. Adverse reactions: Rash, sun sensitivity, diarrhea, loss of appetite, cough, fatigue, N/V Pearls: Presence of rash could be an indicator of efficacy. Rash can be treated with steroids or tetracyclines (due to anti-inflammatory properties) Take the same time each day on an empty stomach Store at room temperature 5

Ibrance (palbociclib) Indications: Breast cancer Usual dose: 125mg daily for 21 days, followed by a 7 day rest period Mechanism of action: Targets the signaling pathway of ER+ breast cancer cells,

6 Ibrance (palbociclib) Indications: Breast cancer Usual dose: 125mg daily for 21 days, followed by a 7 day rest period Mechanism of action: Targets the signaling pathway of ER+ breast cancer cells, leading to cell senescence. Adverse reactions: infection (URI), neutropenia, leukopenia, neuropathy, N/V/D Pearls: Take the same time each day with food Must be used in combination with another endocrine-based treatment, such as letrozole or fulvestrant. Avoid drinking/eating grapefruit while on treatment. Store at room temperature 6

Arimidex (anastrozole), Femara (letrozole) Indications: ER+ breast cancer Usual dose: 1mg daily Mechanism of action: Aromatase inhibitor; disrupting conversion of androgens to estrone & estradiol,

7 Arimidex (anastrozole), Femara (letrozole) Indications: ER+ breast cancer Usual dose: 1mg daily Mechanism of action: Aromatase inhibitor; disrupting conversion of androgens to estrone & estradiol, slowing/halting growth of cancer cells Adverse reactions: hot flashes, arthralgia, hypertension, depression, osteoporosis, vaginal dryness, ischemic cardiovascular events Pearls: Can take with or without food Take 600mg calcium/vit D supplement twice daily to help counter bone losses New/worsening chest pain/tightness should be assessed ASAP Store at room temperature 7

Leukeran (chlorambucil) Indications: Chronic lymphocytic leukemia, malignant lymphomas including lymphosarcoma, giant follicular lymphoma, and Hodgkin s lymphoma. Usual dose: 0.1-0.

8 Leukeran (chlorambucil) Indications: Chronic lymphocytic leukemia, malignant lymphomas including lymphosarcoma, giant follicular lymphoma, and Hodgkin s lymphoma. Usual dose: mg/kg daily for 3-6 weeks as required. This can change based on indication. Mechanism of action: Nitrogen mustard alkylating agent. Cross-links strands of DNA, preventing transcription. Adverse reactions: neutropenia, anemia, thrombocytopenia. CNS toxicity, such as tremors, confusion, agitation, ataxia, and hallucinations can also occur. Pearls: Skin reactions, escalating to Steven-Johnson syndrome, is very rare, but can occur. Store in a refrigerator. 8

Imbruvica (ibrutinib) Indications: Mantle cell lymphoma, chronic lymphocytic leukemia, small lymphocytic leukemia, Waldenström s macroglobulinemia Usual dose: MCL: 560mg daily (4 capsules) CLL, SLL,

9 Imbruvica (ibrutinib) Indications: Mantle cell lymphoma, chronic lymphocytic leukemia, small lymphocytic leukemia, Waldenström s macroglobulinemia Usual dose: MCL: 560mg daily (4 capsules) CLL, SLL, & WM: 420mg daily (3 capsules) Mechanism of action: Inhibits Bruton s tyrosine kinase (BTK), which is part of the B-cell receptor, decreasing cell proliferation and survival. Adverse reactions: thrombocytopenia, neutropenia, anemia, rash, nausea, diarrhea, constipation, fatigue, musculoskeletal pain, peripheral edema, dyspnea, abdominal pain, vomiting, & decreased appetite Pearls: Take the same time each day with a full glass of water, with or without meals. Store at room temperature 9

They will be identified with red or yellow alert stickers attached on the unit

10 Chemotherapy: Labels Chemotherapy should be labeled or otherwise identified as such to prevent improper handling. They will be identified with red or yellow alert stickers attached on the unit dose packaging for dispensing of first and subsequent doses and with MAR alerts for continuing dosages for inpatient units. 10

11 Oral Chemotherapy: Administration Before administration, at least two nurses who have completed the safe handling and administration education for oral cytotoxic agents must: Complete an independent dose recalculation. Verify patient identification using at least two identifiers from patient armband (medical record number, DOB, etc). Verify the accuracy of the drug name, dose, route, expiration dates/times, appearance and physical integrity of the drug. Sign in the medical record that this verification was done 11

Oral Chemotherapy: Administration Wash hands before and after administration When an intact capsule or tablet from a unit based package is administered, a single pair of chemotherapy gloves may be

12 Oral Chemotherapy: Administration Wash hands before and after administration When an intact capsule or tablet from a unit based package is administered, a single pair of chemotherapy gloves may be worn. A gown and two sets of chemotherapy gloves must be worn when the medication is handled in any other situation. A gown, respiratory and eye protection must be worn if there is a risk for powder or splash generation, such as oral liquid via gastric tube. 12

Oral Chemotherapy: Administration Avoid crushing or otherwise manipulating the dosage form Patients should be instructed to not chew or crush tablets or open capsules without first consulting with a

13 Oral Chemotherapy: Administration Avoid crushing or otherwise manipulating the dosage form Patients should be instructed to not chew or crush tablets or open capsules without first consulting with a pharmacist If compounding is required this should only be done in the pharmacy and NOT on the unit or in the patient room. Any chemotherapy waste (including medication and gloves) should be disposed of only in receptacles designated for chemotherapy waste 13

14 Oral Chemotherapy: Education Written consent must be obtained from the patient upon initiation after appropriate counseling of the risks/benefits. Appropriate educational materials must also be given to the patient. Patients should know specific symptoms that should trigger a call to the nurses When chemotherapy is to be discontinued, held, or dose changed, appropriate action should be taken, documented, and the patient notified. 14

15 Oral Chemotherapy Be smart! Be safe! 15

What is Abemaciclib (ABEM-a-si-clib) and how does it work?

What is Abemaciclib (ABEM-a-si-clib) and how does it work? PATIENT EDUCATION patienteducation.osumc.edu What is (ABEM-a-si-clib) and how does it work? is a type of oral, targeted cancer therapy called a cyclin D kinase inhibitor. Another name for this medicine