McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 1 4  Antineoplastic agents

TABLE 14.6

DRUGS IN FOCUS Cancer cell–specific agents

Drug name

Dosage/route

Usual indications

Protein tyrosine kinase inhibitors everolimus (Afinitor, Certican)

10 mg/day PO with food

Treatment of people with advanced renal cell carcinoma after failure of treatment with sunitinib or sorafenib Special considerations: pneumonitis, serious-to- fatal infections, oral ulcerations, and elevations in blood glucose, lipid and creatinine levels may occur, monitor person very closely; do not use in pregnancy Monotherapy for treatment of people with locally advanced or metastatic non–small cell lung cancer after failure with platinum-based or docetaxel chemotherapies; use limited to people doing well on therapy—not for new use Special considerations: interstitial lung disease may occur; monitor pulmonary function closely; eye changes may require stopping the drug for a while; do not use during pregnancy; numerous drug–drug interactions are possible Treatment of CML people in blast crisis or in chronic phase after interferon-alpha therapy; treatment of people with Kit-positive malignant GIST; first-line treatment of CML Special considerations: administer with a meal and a full glass of water; arrange for small, frequent meals if GI upset is a problem; provide analgesics for headache and muscle pain; monitor full blood count and for oedema to arrange for dose reduction if needed; person should receive consultation to deal with high cost of drug In combination with capecitabine for the treatment of people with advanced or metastatic breast cancer whose tumours overexpress HER2 and who have received prior treatment including an anthracycline, taxane and trastuzumab Special considerations: monitor heart function closely and decrease dose as needed; monitor for rash, GI toxicity; avoid grapefruit juice; many drug–drug interactions are possible Treatment of chronic-phase and accelerated-phase Philadelphia chromosome–positive chronic myelogenous leukaemia in adult people resistant or intolerant to prior therapy that included imatinib Special considerations: monitor for prolonged QT interval, bone marrow suppression and possible liver toxicity Treatment of people with advanced renal cell carcinoma and unresectable hepatocellular carcinoma Special considerations: monitor for skin reactions, hand-foot syndrome, hypertension Treatment of GI stromal tumour if person is intolerant to or tumour progresses after imatinib therapy Special considerations: monitor for GI disturbances, bone marrow suppression; adjust dose as needed Continued on following page

gefitinib (Iressa)

250 mg/day PO

Chronic-phase chronic myelocytic leukaemia (CML): 400 mg/day PO, may be increased to 600 mg/d if needed Blast-crisis CML: 600 mg/day PO, may be increased to 400 mg PO b.d. First-line CML treatment: 400 mg/day PO GI stromal tumours: 400–600 mg/day PO 1250 mg (5 tablets) orally once daily on days 1–21 in combination with capecitabine 2000 mg/m2 per day PO in 2 doses approximately 12 hours apart on days 1–14; give in a repeating 21-day cycle; reduce dose to 750 mg/day PO with severe hepatic dysfunction

imatinib (Glivec)

lapatinib (Tykerb)

nilotinib (Tasigna)

400 mg PO b.d., approximately 12 hours apart without food

sorafenib (Nexavar)

400 mg PO b.d. on an empty stomach

sunitinib (Sutent)

50 mg/day PO for 4 weeks, followed by 2 weeks of rest; repeat cycle