Endometrial Cancer Drug Summary

• Respiratory effects (pulmonary embolism, dyspnea); Hormonal effects (gynecomastia, vaginal bleeding); CV effect (deep vein thrombophlebitis); Other effects (carpal tunnel syndrome, alopecia, weight gain, hyperglycemia, hearing loss) 

• Use with caution in patients with history of thromboembolic disease, diabetes mellitus, renal and hepatic impairment
• Avoid in patients with hypersensitivity 

• CV effects (edema, chest pain, flushing, hypertension); GI effects (nausea, weight loss, diarrhea, abdominal pain); CNS effects (fatigue, pain, dizziness, insomnia, depression); Dermatologic effects (rash, alopecia); Other effects (menstrual disorder, hot flushes, weakness, vaginal discharge, leukopenia, thrombocytopenia, hypercholesterolemia)

• Use with caution in patients with history of deep vein thrombosis or pulmonary embolism
• Associated with increased risk of uterine or endometrial cancer 

• GI effects (severe nausea/vomiting); Metabolic effects (hypomagnesemia, hypocalcemia, hyperuricemia); Neurologic effects (peripheral neuropathy, papilledema, optic neuritis, seizures, ototoxicity)
• Rarely, renal damage due to inadequate hydration during therapy, anaphylactoid reactions, cardiac abnormalities
• Very rarely, life-threatening myelosuppression

• Use with caution in patients with renal or hepatic impairment, myelosuppression
• Monitor renal, neurological and auditory function
• Perform blood counts regularly
• Maintain adequate hydration before and 24 hours after administration of therapy to minimize nephrotoxicity 

• Dermatologic effects (injection site reaction, alopecia, urticaria, rash); GI effects (nausea/vomiting, stomatitis, GI ulceration, diarrhea, loss of appetite); GU effects (urinary frequency, hematuria); Hematologic effects (leukopenia, anemia, thrombocytopenia); CV effects (transient ECG abnormalities, CHF); Other effects (discoloration of body fluids, hyperuricemia, infertility) 

• Avoid in patients with pre-existing bone marrow suppression and chronic heart failure
• Use with caution in patients with previous RT
• Baseline cardiac evaluation (ECG, LVEF) is advised especially in patients at high risk of cardiac toxicity

• GI upset, alopecia, reduction in blood count, cystitis, reversible encephalopathy, immunosuppression
• Rarely, renal, hepatic and cardiac dysfunction
• Increases risk of secondary malignancies

• Avoid in patients with severe bone marrow suppression, renal impairment, bilateral urinary flow obstruction, acute infections, acute hemorrhagic cystitis
• Use with caution in patients with brain metastases, infection or electrolyte imbalance and those who have undergone unilateral nephrectomy
• Patients of reproductive age should use contraceptives during therapy and for the following 6 months 

• GI effects (cholecystitis, cholangitis, bile duct necrosis); Dermatologic effects (alopecia, dermatitis, ulceration, cellulitis, injection site pain/erythema/blisters/ulceration) 
• Potentially fatal: Bone marrow depression, profound leukopenia and thrombocytopenia, renal damage, pulmonary toxicity, hemolytic-uremic syndrome

• Contraindicated in patients w/ platelet count <100,000/mm³, leucocyte count <4,000/mm³, serum creatinine conc >1.7 mg/dL, substantial prolongation of prothrombin time (PT) or bleeding time, coagulation disorders, increased bleeding tendency
• Use with caution in patients with hepatic or renal insufficiency, bone marrow depression, infections including varicella
• Monitor platelet and leucocyte count, PT, bleeding time, Hb determinations during therapy and for at least 7 weeks after discontinuation of treatment; LFTs and renal function test

• CNS effects (headache, dizziness); Endocrine/metabolic effects (breast discomfort, gynecomastia, changes in libido); GI effects (nausea/vomiting, weight changes); Dermatologic effect (hair loss or hirsutism); Other effects (fluid retention, thrombocytopenic purpura, cholestatic jaundice)

• 1 unit is effective for 5 years
• Avoid in pregnant patients, patients with undiagnosed vaginal bleeding, active hepatic disease, history of breast cancer, severe arterial disease 
• Use with caution in patients with DM, sex-steroid dependent cancer, history of ectopic pregnancy, CV or renal impairment, migraine, asthma, epilepsy, conditions aggravated by fluid retention 

• GI effects (GI disturbances, change in weight/ appetite); Breast changes (enlargement, secretion, discomfort); Androgenic effects (acne, mental depression, changes in libido, hair loss, hirsutism, irregular menstrual bleeding); Dermatologic effects (allergic rash, pruritus, erythema multiforme, erythema nodosum, urticaria); Other effects (asthenia, malaise, headache, migraine, change in vaginal secretions, fluid retention, edema, fatigue, alterations in lipid profile) 

• Avoid use in patients with unexplained vaginal bleeding, history or current high risk of arterial disease, severe hepatic impairment, breast or genital tract carcinoma unless progestogen is part of the management
• Use with caution in women with hypertension, cardiac or renal impairment, asthma, epilepsy, migraine, or other conditions aggravated by fluid retention, in patients with history of depression
  • High doses should be used with caution in patients at risk for thromboembolism

• 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)

• 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

Adverse Reactions

• Respiratory effects (cough, pneumonitis/radiation pneumonitis, upper resp tract infection, dyspnea); Other effect (rash)

Special Instructions

• Contraindicated in patients with severe or life-threatening immune-mediated diseases and infection
• Use with caution in patients with immune-mediated pneumonitis, elevated transaminase or total bilirubin levels, colitis, endocrinopathies, nephritis, dermatologic reactions

Adverse Reactions

• GI effects (N/V, constipation, diarrhea, decreased appetite); Hematologic effects (neutropenia, leukopenia, thrombocytopenia, anemia); Other effects (cough, alopecia, fatigue) 

Special Instructions

• Use with caution in patients at risk for severe, life-threatening, or fatal interstitial lung disease (ILD), severe neutropenia including febrile neutropenia, cardiac disorders
• Monitor CBC and assess LVEF prior to initiation and prior to each dose, and as clinically indicated 

Adverse Reactions

• GI effects (nausea, constipation, decreased appetite, diarrhea); Respiratory effects (cough, pneumonitis, dyspnea, pneumonia); Dermatologic effects (pruritus, rash, cellulitis); Other effects (fatigue, arthralgia, renal failure, pain)

Special Instructions

• Withhold treatment if any of the following occurs: Grade 2 pneumonitis, grade 2 or 3 colitis, symptomatic hypophysitis, grade 2 nephritis, grade 3 hyperthyroidism, AST or ALT >3-5x ULN or total bilirubin >1.5-3x ULN, or any other severe or grade 3 treatment-related adverse reaction
• Discontinue if life-threatening adverse events occur: Grade 3 or 4 pneumonitis, grade 3 or 4 nephritis, AST or ALT >5x ULN or total bilirubin >3x ULN, grade 3 or 4 infusion-related reactions, inability to reduce corticosteroid dose to ≤10 mg of Prednisone or equivalent per day within 12 weeks, persistent grade 2 or 3 adverse reactions (excluding endocrinopathies controlled with hormone replacement therapy) that do not recover to grade 0-1 within 12 weeks after last dose, or any severe or grade 3 treatment-related adverse reaction that recurs
• Use with caution in patients with hypothyroidism, type 1 DM, immune-mediated hepatitis/nephritis, renal failure 

Adverse Reactions

• GI effects (constipation, dysgeusia, diarrhea, nausea/vomiting); CNS effects (dizziness, cognitive impairment); Respiratory effects (dyspnea, cough); Musculoskeletal effects (myalgia, arthralgia); Other effects (fatigue, edema, dysesthesia, increased weight, pyrexia, vision disorders) 

Special Instructions

• Use with caution in patients with new or worsening CHF, myocarditis, QT prolongation, at risk for fractures, hyperuricemia
• Assess LVEF, serum uric acid levels prior to initiation of therapy
• Monitor liver tests, including ALT and AST, every 2 weeks during the first month of treatment, then monthly thereafter, and as clinically indicated
• Withhold treatment for new-onset or worsening CHF, new visual changes or changes that interfere with activities of daily living or presence of CNS effects (cognitive impairment, mood disorders, dizziness, sleep disturbances) 

• GI effects (nausea/vomiting, constipation, diarrhea); CNS effects (delirium, dysarthria, dizziness, gait disturbance, paresthesia, memory impairment); Other effects (increased AST/ALT, anemia, fatigue, cough) 

• Swallow capsules whole with water
• Use with caution in patients with hepatic impairment, women of childbearing potential
• Withhold or permanently discontinue if with neurologic adverse reactions

• GI effects (diarrhea, nausea/vomiting, stomatitis, abdominal pain, constipation); CV effect (hypertension); CNS effects (headache, decreased appetite); Respiratory effects (dyspnea, cough); Metabolic effects (hypothyroidism, hypomagnesemia); Dermatologic effect (rash); Other effects (fatigue, dysphonia, musculoskeletal pain, decreased weight, urinary tract infection, hemorrhagic events, palmar-plantar erythrodysesthesia) 

• Use with caution in patients with arterial thromboembolic event within the previous 6 months, posterior reversible encephalopathy syndrome/reversible posterior leukoencephalopathy syndrome
• Not recommended in patients with end-stage renal disease
• Monitor BP after 1 week of treatment then every 2 weeks for the first 2 months and monthly thereafter; urine protein, ECG, electrolytes, TSH levels regularly; for clinical symptoms or signs of cardiac decompensation; LFTs before initiation of treatment, then every 2 weeks for the first 2 months and monthly thereafter during treatment

• GI effects (dysgeusia, nausea/vomiting, diarrhea, dyspepsia, stomatitis, upper abdominal pain); Hematologic effects (anemia, neutropenia, lymphopenia, mean corpuscular volume elevation, thrombocytopenia); Other effects (increased creatinine, decreased appetite, headache, dizziness, fatigue)

• Should be taken on an empty stomach
• Start treatment not later than 8 weeks after completion of final dose of the platinum-containing regimen
• Interrupt treatment if severe hematological toxicity or blood transfusion dependence develops, or if new or worsening respiratory symptoms or a radiological abnormality occurs; discontinue treatment if pneumonitis is confirmed
• Use with caution in patients with myelodysplastic syndrome/acute myeloid leukemia, moderate to severe renal impairment, hepatic impairment
• Avoid co-administration with strong CYP3A inducers or inhibitors

• CNS effects (dizziness, peripheral neuropathy, cognitive impairment, ataxia, fatigue); GI effects (dysgeusia, constipation, nausea/vomiting); Hepatic effects (increased serum AST, ALT, alkaline phosphatase); Other effects (muscular weakness, dyspnea)

• Swallow capsule whole with water
• Determine NTRK gene fusion status prior to initiation of therapy
• Monitor LFTs and creatine phosphokinase (CPK) every 2 weeks during the first month of treatment and as clinically indicated thereafter, serum uric acid before initiation of treatment and periodically during treatment; monitor for signs and symptoms of CNS toxicity