Gastric Cancer Drug Summary

Last updated: 26 January 2026
Reviewed by

Cytotoxic Chemotherapy

Drug Dosage Remarks
Combination Therapy
Docetaxel + Cisplatin
+ 5-Fluorouracil		 Docetaxel:
75 mg/m2 IV infusion over 1 hour followed by
Cisplatin:
75 mg/m2 IV infusion over 1-3 hours followed by
5-Fluorouracil:
750 mg/m2 IV infusion over 24 hours for 5 days
Repeat every 3 weeks		 Adverse Reactions
  • Hematologic effects (neutropenia, thrombocytopenia, anemia, bone marrow suppression); Dermatologic effects (alopecia, rash, nail disorders); CNS effects (asthenia, neuropathy, dizziness, paresthesia, dysesthesia); GI effects (nausea/vomiting, stomatitis, diarrhea, taste perversion, abdominal pain, constipation, esophagitis, GI bleeding, anorexia); Other effects (fluid retention, arthralgia, myalgia, generalized or localized pain)
Special Instructions
  • Contraindicated in patients with neutrophil count <1,500 cells/mm3 and severe liver impairment
  • Monitor patients for hypersensitivity, fluid retention, liver impairment and cardiac toxicity
  • Contraceptive measures should be taken by both men and women during treatment and for men at least 6 months after cessation of therapy
Gimeracil + Oteracil
potassium + Tegafur		 BSA (body surface area) ≥1.5 m2:
60 mg PO 12 hourly
BSA 1.25-<1.5 m2:
50 mg PO 12 hourly
BSA <1.25 m2:
40 mg PO 12 hourly
All taken for 28 consecutive days, followed by a 14-day rest period
Combination treatment with Cisplatin:
Same dose as above for 21 days with Cisplatin administered on day 8 followed by a 14-day rest period repeated 5 weekly 		Adverse Reactions
  • Hematologic effects (leukopenia, neutropenia, thrombocytopenia, erythrocytopenia, decreased Hb, decreased hematocrit value, lymphopenia); GI effects (anorexia, nausea/vomiting, diarrhea, stomatitis, taste abnormality); Dermatologic effects (pigmentation, rash); Other effects (increased AST, ALT, bilirubin and creatinine, general malaise, increased LDH, decreased total protein, decreased albumin)
Special Instructions
  • Contraindicated in patients with severe bone marrow depression, severe renal and hepatic disorder and those receiving other fluoropyrimidine-group anti-cancer drugs or Flucytosine
  • Use with caution in patients with bone marrow depression, hepatic and renal disorders, infectious disease, abnormal glucose tolerance, current or previous history of interstitial pneumonia, heart disease, varicella, GI ulcer or hemorrhage, acute leukemia and history of infarction
Tegafur + Uracil 300-600 mg/day PO divided 8-12 hourly Adverse Reactions
  • Hepatic effects (hepatic cirrhosis, severe hepatic disorder); GI effects (GI ulcer and hemorrhage, nausea/vomiting, severe diarrhea, severe stomatitis); CV effects (angina pectoris, MI, arrhythmia); Renal effects (acute renal failure, nephrotic syndrome); Other effects (blood dyscrasias, anosmia, severe psychoneurologic disorder, interstitial pneumonia, acute pancreatitis, Stevens-Johnson and Lyell's syndrome)
Special Instructions
  • Use with caution in patients with bone marrow depression, hepatic or renal disorders, heart disease, infectious diseases, GI ulcer or hemorrhage, abnormal glucose tolerance and varicella
Trifluridine + Tipiracil 35 mg/m2 PO 12 hourly on days 1-5 and days 8-12 of a 28-day cycle
Max dose: 80 mg/dose
Continue until disease progression or unacceptable toxicity 		Adverse Reactions
  • Hematologic effects (neutropenia, leukopenia, anemia, thrombocytopenia, lymphopenia); GI effects (nausea/vomiting, decreased appetite, abdominal pain, constipation, stomatitis, oral disorder, dysgeusia, decreased weight); CNS effect (peripheral neuropathy); Dermatologic effects (palmar-plantar erythrodysaesthesia syndrome, rash, alopecia, dry skin, pruritus); Hepatic effects (increased hepatic enzyme and blood alkaline phosphatase, hyperbilirubinemia); Respiratory effects (dyspnea, lower respiratory tract infection); Other effects (pyrexia, edema, malaise, hypoalbuminemia)
Special Instructions
  • Contraindicated in patients with absolute neutrophil counts <1.5 x 109/L, platelet counts <75 x 109/L or with unresolved grade 3-4 non-hematological clinically relevant toxicity from previous therapies, moderate to severe renal impairment, end-stage renal disease
  • Use with caution in patients with galactose intolerance, total lactase deficiency, moderate to severe hepatic impairment
  • Perform CBC prior to and on day 15 of each cycle
Monotherapy
Capecitabine In combination with Oxaliplatin:
850-1,000 mg/m2 PO 12 hourly x 2 weeks followed by 1-week rest period
In combination with platinum-containing chemotherapy:
625 mg/m2 PO 12 hourly administered continuously on days 1-21 of a 21-day cycle x 8 cycles 		Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, abdominal pain, stomatitis, constipation, dyspepsia, flatulence); Hematologic effects (neutropenia, anemia, lymphopenia); CNS effects (anorexia, insomnia, depression, headache, dizziness); Respiratory effects (nasopharyngitis, lower respiratory tract infection, rhinorrhea, cough, dyspnea); CV effect (edema); Other effects (hand-foot syndrome, fatigue, increased blood bilirubin)
Special Instructions
  • Doses should be taken with water within 30 minutes after a meal
  • Contraindicated in patients with severe renal/hepatic impairment, dihydropyrimidine dehydrogenase deficiency, severe leukopenia, neutropenia or thrombocytopenia
  • Use with caution in patients with renal impairment, mild-moderate hepatic dysfunction, history of coronary artery disease, galactose intolerance, and those taking oral coumarin-derivative anticoagulants
  • Avoid concomitant use with Sorivudine or its analogue
  • Monitor ALT, AST and serum electrolytes
Cisplatin 15-20 mg/m2 IV infusion for 5 days every 3 weeks or
70-90 mg/m2 single IV dose every 4 weeks or
25-35 mg/m2 single IV dose every 2 weeks		 Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, anorexia, stomatitis); CNS effects (peripheral neuropathy, seizures); Hematologic effects (leukopenia, anemia, thrombocytopenia); Dermatologic effects (rash, mild alopecia); Other effects (tinnitus and/or hearing loss, anaphylactic-like reaction, transient elevations of serum ALT, AST and bilirubin, nephrotoxicity)
Special Instructions
  • Avoid using in patients with pre-existing severe renal impairment
  • Use with caution in patients with renal and hearing impairment, hepatic disorder and myelosuppression
  • Discontinue use if there are elevated BUN and serum creatinine and decreased CrCl
Doxorubicin 60-75 mg/m2 as a single IV dose for 21 days
or
20 mg/m2 weekly 		Adverse Reactions
  • GI effects (GI disturbances, nausea/vomiting); Other effects (myelosuppression, cardiotoxicity, alopecia, hypersensitivity reactions, tissue necrosis, severe cellulitis)
Special Instructions
  • Avoid using in patients with myelosuppression, severe hepatic impairment, preexisting heart disease and previous treatment with complete cumulative doses of Doxorubicin or Daunorubicin
  • Monitor ECG, hepatic and hematologic function and blood uric levels
Epirubicin 60-90 mg/m2 IV infusion over 3-5 minutes at 21-day intervals Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, stomatitis, esophagitis, anorexia); Other effects (myelosuppression, cardiotoxicity, alopecia, mucositis, hyperpyrexia, infection)
Special Instructions
  • Avoid using in patients with marked myelosuppression, cardiac impairment, and those treated with maximal cumulative doses of other anthracyclines
  • Monitor lab parameters and cardiac function
Etoposide 50-100 mg/m2 IV x 5 consecutive days then repeat after 2-3 weeks or
120-150 mg/m2 on days 1, 3 and 5 of the treatment cycle then repeat after 2-3 weeks		 Adverse Reactions
  • GI effect (GI upset); Hematologic effects (anemia, inhibition of hematopoietic system); Other effects (alopecia, hypotension, allergic reactions, neuropathy)
Special Instructions
  • Contraindicated in patients with severe myelosuppression, severe hepatic and renal impairment
  • Monitor hematologic function regularly
Fluorouracil
(5-Fluorouracil,
5-FU)		 IV injection: 12 mg/kg/day IV injection (max of 0.8-1 g daily) for 3-4 days, followed by 6 mg/kg IV every other day if there are no signs of toxicity or 15 mg/kg IV weekly
Course may be repeated after 1 month or maintenance dose of 5-15 mg/kg (max of 1 g) may be given weekly
IV infusion: 15 mg/kg IV infusion over 4 hours daily (max of 1 g) and repeated on successive days until 12-15 g has been given. Continuous infusion may also be used.
Course may be repeated after 4-6 weeks		 Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea); Hematologic effects (leukopenia, thrombocytopenia, anemia); CV effects (precordial pain and transient change in ECG); Dermatologic effects (alopecia, maculopapular rash)
Special Instructions
  • Contraindicated in patients with severe changes in blood count, bone marrow depression, hemorrhage, malabsorption, severe liver and renal impairment, severe infections, herpes zoster, varicella, stomatitis, ulcerations of the oral cavity and GIT, pseudomembranous enteritis, extensive liver metastasis
  • Use with caution in patients after high-dose pelvic irradiation, after therapy with alkylating substances and in severe bone metastasis
  • Monitor blood count, liver and renal functions regularly
Irinotecan HCl 100 mg/m2 IV infusion weekly followed by at least 2 weeks rest in 3-4 repeated cycles or
150 mg/m2 IV infusion once every 2 weeks followed by at least 3 weeks rest in 2 or 3 repeated cycles
Combination treatment with Cisplatin:
65 mg/m2 IV infusion over 90 minutes on days 1, 8, 15 and 22 of a 6-week treatment cycle 		Adverse Reactions
  • CV effects (thrombosis/embolism, cardiac ischemia/infarction, hypertension); GI effects (delayed diarrhea, nausea/vomiting, dehydration, constipation); Hematologic effects (neutropenia, anemia, thrombocytopenia); Dermatologic effect (alopecia); CNS effects (paresthesia, asthenia); Metabolic effects (increased creatinine, serum level transaminases, alkaline phosphatase or bilirubin); Other effects (fever, dyspnea, muscular contraction or cramps)
Special Instructions
  • Contraindicated in patients with chronic inflammatory bowel disease and/or bowel obstruction, severe bone marrow failure and WHO performance status 3 or 4
  • Avoid vaccination with live vaccine
  • Use with caution in patients who had previous abdominal/pelvic radiotherapy, renal and hepatic impairment
  • Monitor CBC with differential and platelet count with each dose and perform LFTs at baseline and before each cycle
Methotrexate Conventional therapy:
15-20 mg/m2 IV twice weekly
or 30-50 mg/m2 IV once weekly
or 15 mg/m2 IV/IM 24 hourly x 5 days
Intermediate-dose therapy:
50-150 mg/m2 IV injection, repeated after 2-3 weeks or
240 mg/m2 IV infusion over 24 hours, repeated after 4-7 days or
0.5-1 g/m2 IV infusion over 36-42 hours, repeated after 2-3 weeks
High-dose therapy:
1-12 g/m2 IV infusion over 1-6 hours, repeated after 1-3 weeks		 Adverse Reactions
  • GI effects (ulcerative stomatitis, abdominal distress, nausea); Other effects (leukopenia, eye irritation, malaise, undue fatigue, chills and fever, dizziness, loss of libido, decreased resistance to infection)
Special Instructions
  • Contraindicated in patients with pre-existing blood dyscrasias, active infection, immunodeficiency, severe renal impairment, significant hepatic impairment, alcoholic liver disease, known active gastrointestinal ulcer disease
  • Use with caution in patients with pleural effusion, ascites, folic acid deficiency, inactive and chronic infection, ulcerative colitis, mild to moderate renal impairment
  • Monitor CBC with differential count, renal and hepatic function before and regularly during therapy
Mitomycin 4-6 mg IV once or twice weekly or
20 mg/m2 IV single dose every 6-8 weeks		 Adverse Reactions
  • Dermatologic effects (alopecia, delayed erythema and/or ulceration, cellulitis at injection site); GI effects (nausea/vomiting, diarrhea, anorexia); CNS effects (confusion, drowsiness, syncope, headache); Other effects (hemolytic-uremic syndrome, microangiopathic hemolytic anemia, nephropathy, marrow depression, interstitial pneumonia, fatigue, edema, pain, blurred vision)
Special Instructions
  • Contraindicated in patients with coagulation disorder or increased bleeding tendencies, thrombocytopenia
  • Use with caution in patients with infectious disease, bone marrow suppression, renal and hepatic impairment
  • Monitor CBC with differential and platelet counts regularly
Oxaliplatin In combination with 5-FU/Folinic acid base regimen: 85 or 100 mg/m2 IV repeated every 2 weeks
or
In combination with Capecitabine or 5-FU: 130 mg/m2 IV repeated every 3 weeks		 Adverse Reactions
  • Hematologic effects (anemia, leukopenia, granulocytopenia, thrombocytopenia); GI effects (nausea/vomiting, diarrhea); CNS effects (sensory peripheral neuropathies characterized by paresthesia in the extremities, neurological toxicity, fever, rash, malaise)
Special Instructions
  • Contraindicated in patients with bone marrow depression and peripheral sensory neuropathy with functional impairment prior to treatment
  • Neurologic examination should be done prior to each administration and then periodically
  • Infusion rate should be reduced for patients who develop acute laryngopharyngeal dysesthesia
  • Therapy should be postponed if there is hematological toxicity and resumed when toxicity has resolved
  • Monitor blood counts prior to start of treatment and before each subsequent course
Paclitaxel Monotherapy: 80 mg/m2 IV infusion on days 1, 8 and 15 of a 28-day treatment cycle
Continue until disease progression or unacceptable toxicity
In combination with Ramucirumab:
80 mg/m2 IV infusion over 60 minutes on days 1, 8 and 15 of a 28-day treatment cycle, after Ramucirumab infusion
Continue until disease progression or unacceptable toxicity
In combination with Carboplatin:
200 mg/m2 on cycle 1 and may be increased to 225 mg/m2 if with adequate absolute neutrophil count on cycle 2 given as IV infusion over 3 hours on day 1 3 weekly 		Adverse Reactions
  • CV effects (hypo-/hypertension, bradycardia, ECG abnormality); GI effects (nausea/vomiting, diarrhea); CNS effect (sensory/peripheral neuropathy); Other effects (myelosuppression, sepsis, hypersensitivity, and injection site reactions, alopecia, hepatic enzyme elevation, myalgia/arthralgia)
Special Instructions
  • Contraindicated in patients with hypersensitivity to drugs formulated in polyoxyethylated castor oil, baseline neutrophil counts <1,500 cells/mm3, severe hepatic impairment
  • Use with caution in patients with pre-existing neuropathies, cardiac conduction abnormalities and hepatic impairment
  • Perform CBC and LFTs prior to each Paclitaxel dose
  • Monitor vital signs and hypersensitivity reactions frequently during the first hour of infusion

Targeted Cancer Therapy

Drug Dosage Remarks
Dabrafenib Unresectable or metastatic solid tumors with BRAF V600E mutation: 150 mg PO 12 hourly Adverse Reactions
  • Ophthalmologic effects (uveitis, iritis); Other effects (arthralgia, cough, fever, headache, hyperglycemia, new primary skin neoplasm)

Special Instructions
  • Should be taken on an empty stomach and swallowed whole
  • Doses may have to be reduced or withheld if toxicity occurs, but treatment is continued until disease progresses or intolerable toxicity occurs
  • Contraindicated in pregnancy; advise contraception during and 4 weeks following treatment
Dostarlimab
(Dostarlimab-gxly)		 dMMR recurrent or advanced solid tumors: 
500 mg IV infusion over 30 minutes every 3 weeks x 4 cycles followed by 1,000 mg every 6 weeks until disease progression or unacceptable toxicity		 Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, colitis, pancreatitis); Hematologic effects (anemia, decreased lymphocytes); Metabolic effects (decreased sodium, increased alkaline phosphatase, decreased albumin, increased transaminases, hypothyroidism); Musculoskeletal effects (arthralgia, myalgia); Other effects (pneumonitis, fatigue, asthenia, rash, pruritus, pyrexia, chills) 

Special Instructions
  • Use with caution in patients with history of allogeneic hematopoietic stem cell transplantation (HSCT)
  • Monitor for signs and symptoms of immune-mediated adverse reactions (pneumonitis, colitis, hepatitis, endocrinopathies, nephritis, rash, arthralgia)
  • Evaluate clinical chemistries, including liver enzymes, creatinine, and thyroid function at baseline and periodically during treatment
Entrectinib NTRK gene fusion-positive solid tumors:
600 mg PO 24 hourly until
disease progression or
unacceptable toxicity		 Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, constipation, dysgeusia); CNS effects (dizziness, cognitive impairment; dysesthesia); Respiratory effects (cough, dyspnea); Musculoskeletal effects (myalgia, arthralgia); Other effects (fatigue, edema, increased weight, pyrexia, vision disorders)

Special Instructions
  • Use with caution in patients with CHF, severe renal impairment and moderate-severe hepatic impairment
  • Assess LV ejection fraction before initiation
  • Monitor LFTs every 2 weeks during first month of treatment then monthly or as clinically indicated thereafter
  • Monitor serum uric acid levels before and periodically during treatment
  • Monitor for signs and symptoms of CHF, hyperuricemia
Larotrectinib NTRK gene fusion-positive solid tumors:
100 mg PO 12 hourly until
disease progression or
unacceptable toxicity		 Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, constipation); Other effects (fatigue, dizziness, anemia, increased ALT and AST, cough) 

Special Instructions
  • May impair ability to drive or operate machinery
  • Monitor LFTs every 2 weeks during first month of treatment then monthly or as clinically indicated thereafter
Nivolumab In combination with fluoropyrimidine- and platinum-containing therapy for advanced or metastatic disease:
240 mg IV infusion over 30 minutes 2 weekly or
360 mg IV infusion over 30 minutes 3 weekly 
Continue treatment until disease progression or unacceptable toxicity 
Max duration: 2 years		 Adverse Reactions
  • Endocrine effects (adrenal insufficiency, type 1 diabetes mellitus, diabetic ketoacidosis); CV effects (edema, hypertension); GI effects (abdominal pain, nausea/vomiting, diarrhea); Respiratory effects (cough, upper respiratory tract infection, dyspnea); Metabolic effects (hyponatremia, hyperkalemia, hypocalcemia, hypomagnesemia, decreased appetite); Hepatic effects (increased ALT, AST, alkaline phosphatase, bilirubin); CNS effects (peripheral neuropathy, headache, dizziness, fatigue); Dermatologic effects (pruritus, rash, erythema, vitiligo); Musculoskeletal effects (musculoskeletal pain, asthenia, arthralgia); Other effects (immune-mediated nephritis, hypophysitis, fever)

Special Instructions
  • Use with caution in patients with moderate or severe hepatic impairment 
  • Monitor liver enzymes, serum creatinine and thyroid function
Pembrolizumab Recurrent locally advanced, metastatic or MSI-H:
200 mg IV infusion over 30 minutes 3 weekly or
400 mg IV infusion over 30 minutes 6 weekly 
Continue treatment until disease progression or unacceptable toxicity
Max duration: 2 years		 Adverse Reactions
  • Immune-mediated reactions (colitis, DM, hepatitis, hypothyroidism or hyperthyroidism, hypophysitis, nephritis, pneumonitis); Other effects (diarrhea, pyrexia, arthralgia, back pain, cough, vitiligo, abdominal pain, rash, pruritus, hyponatremia)

Special Instructions
  • Use with caution in patients with autoimmune disorders, recipient of allogeneic hematopoietic stem cell transplant (HSCT) or solid organ transplant
  • Monitor for signs and symptoms of immune-mediated adverse reactions such as pneumonitis, colitis, hepatitis, endocrinopathies, nephritis
  • Withhold use if with moderate grade 2 pneumonitis, grade 2-3 colitis, grade 2 nephritis or hypophysitis, AST/ALT >3 to 5x ULN or total bilirubin >1.5 to 3x ULN; discontinue permanently if with grade 3-4 pneumonitis, grade 4 colitis, grade 3-4 nephritis or hypophysitis, AST/ALT >5x ULN or total bilirubin >3x ULN 
Ramucirumab Monotherapy:
8 mg/kg IV body weight IV infusion over 60 minutes 2 weekly 
Max infusion rate:
25 mg/min
Combination with Paclitaxel: 
8 mg/kg body weight IV infusion over 60 minutes on days 1 and 15 of a 28-day cycle 
To be given prior to Paclitaxel infusion 		 Adverse Reactions
  • CV effects (MI, cardiac arrest, hypertension, arterial thromboembolic events); CNS effects (CVA, cerebral ischemia, headache); GI effects (perforation, hemorrhage, liver function disturbance, GI upset, stomatitis, intestinal obstruction); Metabolic effects (hyponatremia, hypokalemia, hypoalbuminemia); Hematologic effects (myelosuppression, leukopenia; neutropenia; thrombocytopenia); Other effects (fatigue, asthenia, peripheral edema, proteinuria, impaired wound healing)

Special Instructions
  • Use with caution in patients with uncontrolled hypertension, serious/non-healing wound, severe renal impairment, hepatorenal syndrome, cirrhosis with hepatic encephalopathy, children <18 years old
Repotrectinib NTRK gene fusion-
positive solid tumors in patients ≥12 years old:
160 mg PO 24 hourly x 14 days
May increase to 160 mg PO 12 hourly		 Adverse Reactions
  • CNS effects (dizziness, ataxia, cognitive disorders, peripheral neuropathy); GI effects (constipation, dysgeusia); Respiratory effect (dyspnea); Other effects (fatigue, muscular weakness)

Special Instructions
  • Monitor patients for new or worsening pulmonary symptoms indicative of interstitial lung disease (ILD)/pneumonitis, LFTs every 2 weeks during the first month of treatment and as clinically indicated thereafter, serum CPK levels during treatment in patients reporting unexplained muscle pain, tenderness or weakness, serum uric acid levels prior to initiating and periodically during treatment
  • Immediately withhold in patients with suspected ILD or pneumonitis and permanently discontinue once confirmed
  • Withhold treatment and resume at same or reduced dose, or permanently discontinue in the presence of CNS, LFT, CPK or serum uric acid level abnormalities
Selpercatinib RET gene fusion-positive
tumors:
2-<12 years old, 0.33-0.65 m2 BSA:
40 mg PO 8 hourly
2-<12 years old, 0.66-1.08 m2 BSA:
80 mg PO 12 hourly
2-<12 years old, 1.09-1.52 m2 BSA:
120 mg PO 12 hourly
2-<12 years old, ≥1.53 m2 BSA:
160 mg PO 12 hourly
2-<12 years old, ≥50 kg:
160 mg PO 12 hourly
≥12 years old, <50 kg:
120 mg PO 12 hourly
≥12 years old, ≥50 kg:
160 mg PO 12 hourly		 Adverse Reactions
  • Metabolic effects (increased AST/ALT, glucose, creatinine, alkaline phosphatase, and total cholesterol, decreased albumin, calcium, and sodium); Hematologic effects (decreased leukocytes, platelets); GI effects (dry mouth, diarrhea, constipation); Other effects (hypertension, fatigue, edema, rash)

Special Instructions
  • Use with caution in patients with significant risk of developing QTc prolongation
  • Contraindicated in patients with uncontrolled hypertension
  • Monitor AST/ALT prior to initiation of therapy, every 2 weeks during the first 3 months, then monthly; monitor BP 1 week after treatment initiation, then at least monthly thereafter
Tislelizumab Monotherapy: 200 mg IV infusion over 1 hour 3 weekly 
Combination therapy: 200 mg IV infusion over 1 hour 3 weekly
Subsequent doses may be administered as 30-minute IV infusion 		 Adverse Reactions
  • Hematologic effects (anemia, neutropenia, thrombocytopenia); GI effects (nausea, diarrhea, decreased appetite); Other effects (fatigue, increased AST/ALT, rash) 

Special Instructions
  • Establish PD-L1 status prior to treatment
  • Should not be administered as IV push or single bolus injection and must not be mixed or co-administered with other medications through the same infusion line
  • Avoid use of systemic corticosteroids and other immunosuppressants at baseline before initiation of treatment
  • Use with caution in patients at risk for immune-related reactions (eg pneumonitis, hepatitis, rash, suspected severe cutaneous adverse reactions [SCARS], colitis, hyperthyroidism, myositis, adrenal insufficiency, hypophysitis, myocarditis, type 1 DM associated with hypoglycemia or associated with ketoacidosis, nephritis with renal dysfunction, neurological toxicities, pancreatitis, or serum amylase or lipase levels)
  • Monitor hepatic, kidney and thyroid functions at baseline and periodically during therapy
Trametinib Unresectable or metastatic solid tumors with BRAF V600E mutation:
2 mg PO 24 hourly		 Adverse Reactions
  • Dermatologic effects (rash, pruritus, dry skin, severe skin toxicity); CV effects (hypertension, cardiomyopathy); Other effects (diarrhea, lymphedema, hemorrhage, interstitial lung disease, retinal vein occlusion and retinal pigment epithelial detachment)

Special Instructions
  • Should be taken on an empty stomach and swallowed whole
  • Doses may have to be reduced or withheld if toxicity occurs, but treatment is continued until disease progresses or intolerable toxicity occurs
  • Contraindicated in pregnancy; advise contraception during and 4 weeks following treatment
Trastuzumab Loading dose: 4 mg/kg body wt IV infusion over 90 minutes
Subsequent dosing:
Weekly dose: 2 mg/kg body weight IV infusion over 30 minutes 
Alternative 3- weekly schedule:
Initial dose:  8 mg/kg body weight IV infusion over 90 minutes
After 3 weeks: 6 mg/kg IV infusion over 30 minutes at 3-weekly intervals		 Adverse Reactions
  • GI effects (diarrhea, nausea/vomiting, stomatitis, constipation, abdominal pain); Hematologic effects (neutropenia, anemia, thrombocytopenia, leukopenia); Dermatologic effects (hand-foot syndrome, alopecia); CV effects (decreased ejection fraction, CHF, hypotension); CNS effects (dizziness, headache); Other effects (fatigue, asthenia, pyrexia, mucosal inflammation, anorexia, hiccups)

Special Instructions
  • Establish HER2 status prior to treatment
  • Use with caution in patients w/ pre-existing cardiac dysfunction especially in combination with anthracycline and Cyclophosphamide, pre-existing pulmonary disease
  • Patients should be observed for fever and chills or other infusion-associated symptoms
  • Monitor cardiac function before and during treatment
Trastuzumab
deruxtecan
(Fam-trastuzumab
deruxtecan-nxki)		 6.4 mg/kg body weight IV infusion over 90 minutes (initial dose) every 3 weeks until disease progression or unacceptable toxicity 
Subsequent doses may be administered as 30-minute IV infusion		 Adverse Reactions
  • Hematologic effects (neutropenia, anemia, leukopenia, lymphopenia, thrombocytopenia); GI effects (diarrhea, nausea/vomiting, stomatitis, constipation, abdominal pain; decreased appetite); Respiratory effects (upper respiratory tract infection, ILD, cough, epistaxis); Dermatologic effects (alopecia, rash); Hepatic effect (increased AST and ALT); Other effects (pyrexia, peripheral edema, fatigue, hypokalemia) 

Special Instructions
  • Establish HER2 status prior to treatment 
  • Use with caution in patients with moderate to severe hepatic impairment
  • Monitor CBC prior to and after each dose
  • Monitor LVEF at baseline and regularly during treatment
  • Monitor for signs and symptoms of ILD or pneumonitis
Zolbetuximab CLDN18.2-positive tumors
in combination with
chemotherapy:
Loading dose: 800 mg/m2 IV infusion over ≤2 hours on day 1 of cycle 1 
Maintenance dose: 600 mg/m2
IV infusion over ≤2 hours every 3 weeks or 400 mg/m2 IV infusion over ≤2 hours every 2 weeks		 Adverse Reactions
  • GI effects (nausea/vomiting, upper abdominal pain, salivary hypersecretion); Other effects (hypoalbuminemia, decreased appetite, weight loss, infusion-related reaction, peripheral edema, malaise)

Special Instructions
  • Must not be administered as an IV push or bolus injection
  • Each infusion should be started at a slower rate than the initially calculated rate for the entire infusion, and gradually increased as tolerated during the course of the infusion
  • Monitor patients for signs and symptoms of infusion-related reaction

Disclaimer

All dosage recommendations are for non-pregnant and non-breastfeeding women, and non-elderly adults with normal renal and hepatic function unless otherwise stated.  
Not all products are available or approved for above use in all countries.  
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.   
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.  

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