15A Oncology agents
ONCOLOGY
impairment (Child-Pugh B): 0.7mg/m² on Days
1 and 8 of a 21-day cycle. Hold dose for ANC
;1000/mm³, platelets ;75000/mm³, or grade 3
or 4 non-hematological toxicities. Delay or reduce
dose according to toxicities; see literature. Do not
re-escalate dose after it is reduced.
Children: ;18yrs: not recommended.
Warnings/Precautions: Monitor CBCs; increase
frequency of monitoring if grade 3 or 4 cytopenias
develop, delay and reduce subsequent doses if febrile
neutropenia or grade 4 neutropenia lasting ;
7 days
develops. Monitor for peripheral neuropathy; withhold
dose if grade 3 or 4 peripheral neuropathy develops
until resolution to grade 2 or less. Congenital
long QT syndrome: avoid. CHF, bradyarrhythmias,
electrolyte abnormalities: monitor ECG for prolonged
QT interval. Correct electrolyte abnormalities (K;,
Mg;) before treatment; monitor. Severe hepatic
impairment (Child-Pugh C) or severe renal impairment
(CrCl;30mL/min): insufficient data. Pregnancy
(Cat. D), nursing mothers: not recommended.
Interactions: Caution with other drugs that prolong
QT interval (eg, Class IA and III antiarrhythmics);
monitor.
Adverse reactions: Neutropenia, anemia,
asthenia/fatigue, alopecia, peripheral neuropathy,
nausea, constipation, febrile neutropenia; possible QT
prolongation, elevated liver enzymes.
Note: Do not mix with dextrose-containing solutions.
Do not administer in same line as other drugs or
fluids.
How supplied: Single-use vial (2mL)– 1
;ERLOTINIB
TARCEVA Genentech
Human epidermal growth factor receptor type
1/epidermal growth factor receptor tyrosine kinase
inhibitor. Erlotinib (as HCl) 25mg, 100mg, 150mg;
tabs.
Indications: Maintenance treatment of patients
with locally advanced or metastatic non-small
cell lung cancer (NSCLC) whose disease has not
progressed after four cycles of platinum-based first-line chemotherapy. Treatment of locally advanced or
metastatic non-small cell lung cancer (NSCLC) after
failure of at least one prior chemotherapy regimen.
In combination with gemcitabine: first-line treatment
of locally advanced, unresectable or metastatic
pancreatic cancer.
Adults: Take on empty stomach. NSCLC: 150mg
once daily. Pancreatic cancer: 100mg once daily ;
gemcitabine (see literature). Both: use until disease
progression or unacceptable toxicity occurs. Diarrhea
unresponsive to loperamide, severe skin reactions,
strong CYP3A4 inhibitors (see Interactions), hepatic
impairment: reduce in 50mg decrements. CYP3A4
inducers (see Interactions): consider increased dose
(see literature).
Children: Not recommended.
Warnings/Precautions: Discontinue if interstitial
lung disease, hepatic failure, or GI perforation occurs;
interrupt or discontinue therapy in patients with
dehydration at risk for renal failure, or with severe
bullous, blistering or exfoliative skin conditions,
or with acute/worsening ocular disorders. Hepatic
impairment. Monitor liver function tests periodically; if
tests worsen, consider withholding or reducing dose;
interrupt or discontinue therapy if severe changes
(eg, total bilirubin ;
3;ULN, and/or transaminases
;
5;ULN) occur. Monitor renal function, serum
electrolytes, pulmonary function, INR, prothrombin
time. History of peptic ulcers or diverticular disease.
Pregnancy (Cat.D); use adequate contraception (see
literature). Nursing mothers: not recommended.
Interactions: Potentiated by CYP3A4 inhibitors
(eg, clarithromycin, ritonavir, ketoconazole). Plasma
levels decreased by CYP3A4 inducers (eg, rifampicin,
phenytoin, carbamazepine, phenobarbital, St. John’s
wort), proton pump inhibitors or H2 blockers, and
smoking. Antagonizes midazolam. Increased risk of GI
perforation with concomitant anti-angiogenic agents,
steroids, NSAIDs, taxane-based chemotherapy.
Monitor for bleeding with oral anticoagulants, NSAIDs.
Adverse reactions: Rash, diarrhea, GI upset,
anorexia, fatigue, elevated LFTs, unexplained
pulmonary symptoms (eg, dyspnea, cough, fever;
discontinue and follow-up if occurs), stomatitis,
infection; rare: GI perforation (may be fatal), ocular
disorders (eg, conjunctivitis, keratitis, corneal
ulceration/perforation), MI/ischemia, hemolytic
anemia, cerebrovascular accidents, interstitial lung
disease; hepatic or renal failure and hepatorenal
syndrome (may be fatal); bullous, blistering and
exfoliative skin conditions (eg, Stevens-Johnson
syndrome, toxic epidermal necrolysis).
Testing considerations: K-RAS mutation analysis,
EGFR amplification analysis
How supplied: Tabs– 30
;ESTRADIOL
ESTRACE Warner Chilcott
Estrogen. Estradiol 0.5mg, 1mg, 2mg;; scored tabs;
;contains tartrazine.
Indications: Palliative treatment of androgen-dependent advanced prostate cancer. Palliative
treatment of metastatic breast cancer in select
patients (see literature).
Adults: Prostate cancer: 1–2mg 3 times daily.
Breast cancer: 10mg 3 times daily for at least 3
months.
Children: Not applicable.
Contraindications: Thrombophlebitis.
Thromboembolic disorders. Cerebrovascular
disorders. Abnormal undiagnosed genital bleeding.
Estrogen-depended neoplasias. Liver dysfunction or
disease. Pregnancy (Cat. X).
Warnings/Precautions: Asthma (2mg tabs).
Hepatic dysfunction. Conditions aggravated by
fluid retention. Cardiovascular disorders, arterial
vascular disease, and risks factors (eg, hypertension,
diabetes, obesity, SLE). Familial hyperlipoprotenemia.
Monitor BP. Discontinue if jaundice occurs and before
