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Targeted therapy
Targeted therapies such as tyrosine kinase inhibitors (TKIs), monoclonal antibodies (MABs), and other small molecules are used to treat various cancers. TKIs like gefitinib, erlotinib, sorafenib, sunitinib, and imatinib are indicated for lung cancer, gastrointestinal stromal tumor, kidney cancer, and chronic myeloid leukemia. They can cause diarrhea, rash, hypertension, and myelosuppression. MABs including trastuzumab, rituximab, cetuximab, and bevacizumab are used for breast cancer, lymphoma, colorectal cancer, and lung cancer. Potential toxicities are cardiomyopathy, hypersensitivity
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Targeted therapy
- 1. Targeted Therapy Dr. Mohammed Fathy,MD Lecturer of Clinical Oncology Zagazig University
- 2. Introduction Target Imatinib Specific Tyrosine Kinase Inhibitors(TKI) B-RAF Inhibitors MEK Inhibitors Monoclonal Antibodies (Mab) Small molecule Trastuzumab
- 3.
- 4. Indications Gefitinib Toxicity Diarrhea Supplied as Trade name Tablet NSCLCnon- squamous advanced Interstitial lung disease Skin rash & reactions Iressa (AstraZeneca) 250 mg Dose limiting
- 5. Indications Erlotinib Toxicity Supplied as Trade name Tablet NSCLCnon- squamous advanced Diarrhea Skin rash Tarceva (Roche) 150 mg25 mg Interstitial lung disease Pancreatic cancer 100 mg Dose limiting
- 6. Indications Sorafenib Toxicity Supplied as Trade name Tablet HCCUnresectable Hand-foot skin reaction Skin reactions Nexavar (Bayer) 200 mg Met. RCC Dose limiting Hypertension Diarrhea
- 7. Indications Sunitinib Toxicity Supplied as Trade name Tablet Met.RCC Bleeding events Hematosuppression Sutent (Pfizer) 12.5 mg GIST (2L) Dose limiting Hypertension Diarrhea Bleeding Mucositis N&V Fatigue 25 mg 50 mg Dose 50 mg once daily 4 weeks out of 6weeks
- 8. Indications Imatinib Toxicity Supplied as Trade name TabletCML Myelosuppression Glivec (Novartis) GIST+ve c-kit (1L) Dose limiting Taken with food + large glass of water 100 mg Administration
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- 10. Introduction Specific to proteinon cell membrane Naked Drug conjugate Radio conjugate Immunotoxin Oncotoxin Selective Minimal toxicity Infusion-related cytokine release syndrome (IRCRS)
- 11. Indications Trastuzumab Toxicity Supplied as Trade name VialBreastCancer HER2+ve Cardiomyopathy Herceptin(Roche) Dose limiting Monitor ECG, ECHO (EF%) 440 mg Administration IRCRS Storage Refrigeration at 2ā8oC, Do not freeze Dilute 250ml NS Reconstituted solution Stable for 28 days upon refrigeration Hematosuppression Powder Reconstitute Sterile water + Benzyl alcohol Do not shake
- 12. Indications Rituximab Toxicity Supplied as Trade name VialB-cellNHL +ve CD20 Hypersensitivity reactions Mabthera (Roche) Dose limiting Premedication 100 mg Administration IRCRS Storage Refrigeration at 2ā8oC, protect from light Dilute NS, D5% (1-4 mg/mL) Reconstituted solution Stable for 24 hours upon refrigeration Arrhythmias 500 mg Initial rate 50mg/hr ļ¢ ļ£ rate by 50mg/hr upto 400mg/hr Watch for TLS
- 13. Indications Cetuximab Toxicity Supplied as Trade name VialMet.CRC wild k-ras Severe IRCRS Erbitux (BMS/Merk) Dose limiting Premedication 100 mg Administration Storage Refrigeration at 2ā8oC, Do not freeze, shake Dilute Do not dilute Reconstituted solution Stable upto 12 hours at 2ā8oC & for 8hrs at room temp. Acneform rash Monitor for hypoMg SCC H&N
- 14. Indications Bevacizumab Toxicity Supplied as Trade name VialMet.CRC Thromboembolism Avastin (Roche) Dose limiting Hypertension 100 mg Administration Storage Refrigeration at 2ā8oC, Do not freeze, shake, protect from light Dilute NS Reconstituted solution Stable upto 8 hours upon refrigerationGI perforation NSCLC Met. RCC Wound dehiscence Bleeding Nephrotic S IRCRS Impair wound healing 400 mg 28 days after surgery