Lung Cancer Drug Summary

• GI effects (nausea/vomiting, stomatitis, constipation); Respiratory effects (cough, dyspnea); Dermatologic effects (rash, paronychia); Metabolic effects (decreased albumin, phosphate, potassium, and sodium, increased alkaline phosphatase, glucose, and gamma-glutamyl transferase); Hematologic effect (decreased lymphocytes); Other effects (infusion-related reactions, musculoskeletal pain, edema)

• GI effects (nausea, constipation, decreased appetite, diarrhea); Respiratory effects (cough, dyspnea); Dermatologic effects (pruritus, rash, cellulitis); Other effects (fatigue, musculoskeletal pain)

Bevacizumab

• CV effects (hypertension, arterial thromboembolism); Hematologic effects (hemorrhage, neutropenia, leukopenia); CNS effects (reversible posterior leukoencephalopathy syndrome, headache); Dermatologic effects (alopecia, exfoliative dermatitis); GI effects (GI perforation, hemorrhage, nausea/vomiting, constipation, diarrhea); Other effects (pain, infection, proteinuria, hypokalemia)

• CNS effects (neurotoxicity, loss of vision with high dose); Endocrine effects (hyponatremia, hypomagnesemia, hypocalcemia, hypokalemia); GI effects (nausea/vomiting, abdominal pain); Hematologic effects (leukopenia, anemia, thrombocytopenia, neutropenia); Hepatic effect (increased liver enzymes); Neuromuscular effect (weakness); Other effects (pain, nephrotoxicity, allergy)

• GI effect (diarrhea); Hematologic effects (lymphopenia, hyponatremia, hypophosphatemia, anemia); Metabolic effects (increased AST, hyperkalemia); Other effects (musculoskeletal pain, fatigue, rash)

• CNS effect (neurotoxicity); GI effects (nausea/vomiting); Hematologic effect (myelosuppression); Hepatic effect (increased enzyme levels); Renal effect (nephrotoxicity); Otic effect (ototoxicity); Other effect (rarely anaphylaxis)

• CNS effects (headache, dizziness); GI effects (abdominal pain, constipation, diarrhea, nausea/vomiting); Dermatologic effects (dry skin, pruritus, rash, erythema); Hepatic effect (increased liver enzymes); Musculoskeletal effects (arthralgia, myalgia, muscle spasms); Other effects (fatigue, chills, asthenia, peripheral edema, infection)

• CV effect (fluid retention); CNS effects (neuropathy, fever, neuromotor effects); Dermatologic effects (alopecia, cutaneous events, nail disorder); GI effects (stomatitis, diarrhea, nausea/vomiting); Hematologic effects (neutropenia, leukopenia, anemia, thrombocytopenia, febrile neutropenia); Neuromuscular effects (weakness, myalgia); Respiratory effect (pulmonary events); Other effects (infection, hypersensitivity)

• CNS effects (fatigue, anorexia); GI effects (diarrhea, nausea/vomiting, stomatitis, abdominal pain, GI perforation); Hepatic effects (increased hepatic enzyme levels and bilirubin); Dermatologic effects (rash, pruritus, dry skin, keratitis); Respiratory effects (dyspnea, cough); Other effects (conjunctivitis, keratoconjunctivitis sicca, infection)

• Dermatologic effect (alopecia); Endocrine effect (ovarian failure); GI effects (nausea/vomiting, anorexia, diarrhea, mucositis); Hematologic effects (leukopenia, thrombocytopenia, anemia); Other effect (rarely anaphylaxis)

• CV effects (peripheral edema, edema); CNS effects (pain, fever, somnolence); Dermatologic effects (rash, alopecia, pruritus); GI effects (nausea/vomiting, constipation, diarrhea, stomatitis); Hematologic effects (anemia, leukopenia, neutropenia, thrombocytopenia, hemorrhage, myelosuppression); Hepatic effect (increased liver enzymes); Renal effects (proteinuria, hematuria, increased BUN); Respiratory effect (dyspnea); Other effect (infection)

• GI effects (diarrhea, colitis, hepatitis); Dermatologic effects (rash, pruritus, toxic epidermal necrolysis); Other effects (fatigue, blurred vision, neuropathy, hypopituitarism, adrenal insufficiency)

• Dermatologic effects (rash, nail toxicity, dry skin, pruritus); GI effects (diarrhea, constipation, nausea, stomatitis); Metabolic effects (decreased albumin, sodium, potassium, hemoglobin, increased ALT, AST, GGT, magnesium); Other effects (musculoskeletal pain, edema, VTE, paresthesia, fatigue, COVID-19, hemorrhage, decreased appetite, ocular toxicity)

• GI effects (decreased weight, decreased appetite, vomiting, increased hepatic enzymes [ALT, AST, GGT])

• GI effects (abdominal pain, constipation, nausea); Respiratory effects (cough, dyspnea); Other effects (hyponatremia, increased AST/lipase, rash, fatigue, musculoskeletal pain)

• GI effects (diarrhea, stomatitis); Dermatologic effects (dry skin, pruritus, paronychia); Respiratory effect (ILD); Other effects (decreased platelet, neutrophil and leukocyte counts)

• CV effects (ECG abnormality, edema, hypotension); GI effects (nausea/vomiting); Hematologic effects (neutropenia, anemia); Hepatic effect (elevated liver enzymes); Other effects (candidiasis infection, vision disturbances, sensory neuropathy)

• CV effects (flushing, edema, hypotension, ECG abnormality); Dermatologic effects (alopecia, rash); GI effects (nausea/vomiting, diarrhea, mucositis); Hematologic effects (neutropenia, leukopenia, anemia, bleeding, thrombocytopenia); Hepatic effect (increased alkaline phosphatase & AST); Local effects (injection site erythema, tenderness and swelling); Neuromuscular effects (peripheral neuropathy, arthralgia, weakness); Renal effect (increased creatinine); Other effect (hypersensitivity)

• 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)

• CV effects (chest pain, edema); CNS effects (fatigue, fever, depression); Dermatologic effects (rash, desquamation); GI effects (anorexia, nausea/vomiting, constipation, diarrhea, stomatitis); Respiratory effects (dyspnea, pharyngitis); Hematologic effects (neutropenia, leukopenia, anemia); Other effects (renal failure, infection)

• Hematologic effects (neutropenia, thrombocytopenia, leukopenia); GI effects (GI hemorrhage, stomatitis, diarrhea, abdominal pain); CV effect (hypertension); Other effects (asthenia, fatigue, proteinuria, peripheral edema, epistaxis, palmar-plantar erythrodysesthesia, mucosal inflammation, hypoalbuminemia)

Tislezimumab

• GI effects (nausea, diarrhea, stomatitis); Respiratory effects (cough, pneumonia, pneumonitis, dyspnea); Hematologic effects (anemia, neutropenia, thrombocytopenia, lymphopenia); Metabolic effects (increased AST, ALT, blood bilirubin, blood alkaline phosphatase, blood creatinine, hyponatremia, hypokalemia, hyperglycemia); Endocrine effects (hypothyroidism, hyperthyroidism, thyroiditis); CV effects (hypertension, myocarditis); Dermatologic effects (rash, pruritus); Musculoskeletal effects (arthralgia, myalgia); Other effects (fatigue, hepatitis, decreased appetite)

Trametinib

• CNS effects (headache, dizziness); GI effects (abdominal pain, constipation, diarrhea, nausea/vomiting); Dermatologic effects (dry skin, pruritus, rash, erythema); Hepatic effect (increased liver enzymes); Musculoskeletal effects (arthralgia, myalgia, muscle spasms); Other effects (fatigue, chills, asthenia, peripheral edema, infection)

• CNS effect (fatigue); Hematologic effects (granulocytopenia, anemia); GI effects (constipation, nausea/vomiting); Respiratory effects (dyspnea, bronchospasm); Dermatologic effect (alopecia); Hepatic effect (increased liver enzyme); Other effects (lower limb weakness, jaw pain, phlebitis)

• Monitor for new or worsening symptoms indicative of interstitial lung disease (ILD) or pneumonitis

• Withhold treatment if any of the following occurs: Moderate pneumonitis, moderate or severe immune-mediated colitis, moderate-severe hypophysitis, severe hyperglycemia, moderate immune-mediated nephritis, symptomatic thyroid disease, severe ocular inflammatory toxicity, severe or life-threatening infection
• Discontinue if life-threatening adverse events of pneumonitis, colitis, hypophysitis, hyperthyroidism, nephritis, infusion reactions, severe liver enzyme elevations, myasthenic syndrome or myasthenia gravis, Guillain-Barre, meningoencephalitis, pancreatitis occur

• Use with caution in patients with hypertension; monitor BP closely
• Should not be given within 28 days of major surgery and only after complete healing of incision
• Discontinue 28 days prior to elective surgery, in patients with nephrotic syndrome and with arterial thromboembolic events

Carboplatin

• Taxane derivatives should be administered before platinum-based agents
• Use with caution in patients with renal impairment

• Contraindicated in patients with severe or life-threatening immune-mediated diseases and infection
• Use with caution in patients with immune-mediated pneumonitis, colitis, hepatitis, endocrinopathies, nephritis, dermatologic reaction
• Monitor patients for signs and symptoms of immune-related and infusion-related adverse reactions
• Evaluate liver enzymes, creatinine, and thyroid function at baseline and periodically during treatment

• Taxane derivatives should be administered before platinum-based agents
• Hydrate patient with 1-2 L of IV fluid before and 24 hours after therapy

• Take at least 1 hour before or 2 hours after meals
• Use with caution in patients with severe renal impairment, moderate to severe hepatic impairment, risk for new malignancies, hemorrhage, ophthalmologic reactions, decreased left ventricular ejection fraction/left ventricular dysfunction, renal failure, hepatic adverse events, hypertension, pneumonitis or ILD, rash, rhabdomyolysis, pancreatitis, pulmonary embolism or DVT, colitis, GI perforation

• Premedicate with corticosteroid prior and up to 5 days after therapy
• Contraindicated in patients with ANC <1,500 cells/mm³, AST >1.5 x upper normal limit (UNL), ALP >2.5 x UNL and bilirubin >UNL

• Administer 1 hour before and 2 hours after meal
• Use with caution in patients on anticoagulant medication, elevated INR, and bleeding tendency

• Discontinue treatment if platelet count is <50,000/mm³, or ANC <500 cells/mm³
• Use with caution in patients with hepatic and renal impairment

• Use with caution in patients with renal and hepatic impairment

• Monitor for signs and symptoms of immune-mediated reactions
• Treatment with Ipilimumab may be temporarily stopped and steroid therapy started if moderate reactions occur; however, treatment should be permanently stopped if moderate disease persists or severe reactions occur
• Check liver and thyroid function tests at baseline and prior each treatment

• Prophylactic anticoagulation is recommended for the first 4 months of treatment
• Use with caution in patients at risk for interstitial lung disease/pneumonitis and VTE
• Encourage patients to limit sun exposure during and for 2 months after treatment

• Use with caution in patients who may develop QTc prolongation, with severe renal impairment (<30 mL/min CrCl), moderate (Child-Pugh B) and severe (Child-Pugh C) hepatic impairment, and higher CV risk including known CAD
• Contraindicated in patients with allergy to soya and peanuts
• Monitor plasma levels of electrolytes (if relevant GI adverse effects occur), systemic blood pressure (BP), changes in prothrombin time, INR or clinical bleeding episodes
• Consider treatment interruption in patients who develop signs or symptoms of acute myocardial ischemia
• Discontinue in patients with life-threatening VTE reactions, who develop GI perforation and if nausea/vomiting occurs

• Monitor liver enzymes, serum creatinine and thyroid function

• Use with caution in patients with known hepatic or renal impairment, QTc prolongation, women of childbearing potential
• Male and female patients should be advised to use an effective contraception
• Prior to the initiation of treatment, the EGFR T790M mutation status should be determined

• Contraindicated in patients with baseline neutrophil count of <1,500 cells/mm³
• Use with caution in patients with renal or hepatic dysfunction

• Contraindicated in patients with ANC <1,500 cells/mm³
• Premedicate with Dexamethasone (20 mg PO or IV at 12 and 6 hours or 14 and 7 hours prior), Diphenhydramine (50 mg IV 30-60 minutes prior) and IV H_₂ antagonist (30-60 minutes prior)

• Withhold treatment if any of the following occurs: Moderate pneumonitis, moderate or severe immune-mediated colitis, moderate hypophysitis, severe hyperglycemia, moderate immune-mediated nephritis
• Discontinue if life-threatening adverse events of pneumonitis, colitis, hypophysitis, hyperthyroidism, nephritis, infusion reactions, severe liver enzyme elevations occur
• Monitor liver enzymes, serum creatinine, and thyroid and renal function

• Pretreatment with Dexamethasone 4 mg PO 12 hourly 1 day before, during and 1 day after therapy is recommended
• Folic acid supplementation at 350-1,000 mcg/day 1 week before, during and 21 days after therapy is required
• Vitamin B₁₂ supplementation 1,000 mcg IM, 1 dose 1 week before treatment and every 3 cycles thereafter is also required

• Discontinue use with GI perforation, fistula formation, grade 3 or 4 bleeding, severe arterial thromboembolic events, urine protein level >3 g/24 hours
• Use with caution in cases of hypertension, severe liver cirrhosis
• Monitor blood counts and coagulation parameters
• Should be temporarily suspended for at least 4 weeks prior to elective surgery

Tislezimumab

• Use with caution in patients at risk for severe, life-threatening, or fatal 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

Trametinib

• Should be taken at the same time each day with either the morning dose or the evening dose of Dabrafenib
• Take at least 1 hour before or 2 hours after meals

• Follow IV dose with 75-125 mL saline or D5W

• CV effect (fluid retention); CNS effects (neuropathy, fever, neuromotor effects); Dermatologic effects (alopecia, cutaneous events, nail disorder); GI effects (stomatitis, diarrhea, nausea/vomiting); Hematologic effects (neutropenia, leukopenia, anemia, thrombocytopenia, febrile neutropenia); Neuromuscular effects (weakness, myalgia); Respiratory effect (pulmonary events); Other effects (infection, hypersensitivity)

• Premedicate with corticosteroid prior and up to 5 days after therapy
• Contraindicated in patients with ANC <1,500 cells/mm³, AST >1.5 x upper normal limit (UNL), ALP >2.5 x UNL and bilirubin >UNL

Adverse Reactions

• CV effects (peripheral edema, edema); CNS effects (pain, fever, somnolence); Dermatologic effects (rash, alopecia, pruritus); GI effects (nausea/vomiting, constipation, diarrhea, stomatitis); Hematologic effects (anemia, leukopenia, neutropenia, thrombocytopenia, hemorrhage, myelosuppression); Hepatic effect (increased liver enzymes); Renal effects (proteinuria, hematuria, increased BUN); Respiratory effect (dyspnea); Other effect (infection)

Special Instructions

• Use with caution in patients with renal and hepatic impairment

Adverse Reactions

• CV effects (flushing, edema, hypotension, ECG abnormality); Dermatologic effects (alopecia, rash); GI effects (nausea/vomiting, diarrhea, mucositis); Hematologic effects (neutropenia, leukopenia, anemia, bleeding, thrombocytopenia); Hepatic effect (increased alkaline phosphatase & AST); Local effects (injection site erythema, tenderness and swelling); Neuromuscular effects (peripheral neuropathy, arthralgia, weakness); Renal effect (increased creatinine); Other effect (hypersensitivity)

Special Instructions

• Contraindicated in patients with ANC <1,500 cells/mm³
• Premedicate with Dexamethasone (20 mg PO or IV at 12 and 6 hours or 14 and 7 hours prior), Diphenhydramine (50 mg IV 30-60 minutes prior) and IV H_₂ antagonist (30-60 minutes prior)

Adverse Reactions

• CV effects (chest pain, edema); CNS effects (fatigue, fever, depression); Dermatologic effects (rash, desquamation); GI effects (anorexia, nausea/vomiting, constipation, diarrhea, stomatitis); Respiratory effects (dyspnea, pharyngitis); Hematologic effects (neutropenia, leukopenia, anemia); Other effects (renal failure, infection)

Special Instructions

• Pretreatment with Dexamethasone 4 mg PO 12 hourly 1 day before, during and 1 day after therapy is recommended
• Folic acid supplementation at 350-1,000 mcg/day 1 week before, during and 21 days after therapy is required
• Vitamin B₁₂ supplementation 1,000 mcg IM, 1 dose 1 week before treatment and every 3 cycles thereafter is also required

• CNS effect (fatigue); Hematologic effects (granulocytopenia, anemia); GI effects (constipation, nausea/vomiting); Respiratory effects (dyspnea, bronchospasm); Dermatologic effect (alopecia); Hepatic effect (increased liver enzyme); Other effects (lower limb weakness, jaw pain, phlebitis)

• Follow IV dose with 75-125 mL saline or D5W

Adverse Reactions

• GI effects (nausea/vomiting, stomatitis, constipation); Respiratory effects (cough, dyspnea); Dermatologic effects (rash, paronychia); Metabolic effects (decreased albumin, phosphate, potassium, and sodium, increased alkaline phosphatase, glucose, and gamma-glutamyl transferase); Hematologic effect (decreased lymphocytes); Other effects (infusion-related reactions, musculoskeletal pain, edema)

Special Instructions

• Monitor for new or worsening symptoms indicative of interstitial lung disease (ILD) or pneumonitis
• No dosage adjustment is needed in the elderly

• GI effects (nausea, constipation, decreased appetite, diarrhea); Respiratory effects (cough, dyspnea); Dermatologic effects (pruritus, rash, cellulitis); Other effects (fatigue, musculoskeletal pain)

• Withhold treatment if any of the following occurs: Moderate pneumonitis, moderate or severe immune-mediated colitis, moderate-severe hypophysitis, severe hyperglycemia, moderate immune-mediated nephritis, symptomatic thyroid disease, severe ocular inflammatory toxicity, severe or life-threatening infection
• Discontinue if life-threatening adverse events of pneumonitis, colitis, hypophysitis, hyperthyroidism, nephritis, infusion reactions, severe liver enzyme elevations, myasthenic syndrome or myasthenia gravis, Guillain-Barre, meningoencephalitis, pancreatitis occur

• CV effects (hypertension, arterial thromboembolism); Hematologic effects (hemorrhage, neutropenia, leukopenia); CNS effects (reversible posterior leukoencephalopathy syndrome, headache); Dermatologic effects (alopecia, exfoliative dermatitis); GI effects (GI perforation, hemorrhage, nausea/vomiting, constipation, diarrhea); Other effects (pain, infection, proteinuria, hypokalemia)

• Use with caution in patients with hypertension; monitor BP closely
• Should not be given within 28 days of major surgery and only after complete healing of incision
• Discontinue 28 days prior to elective surgery, in patients with nephrotic syndrome and with arterial thromboembolic events

• GI effect (diarrhea); Hematologic effects (lymphopenia, hyponatremia, hypophosphatemia, anemia); Metabolic effects (increased AST, hyperkalemia); Other effects (musculoskeletal pain, fatigue, rash)

• Contraindicated in patients with severe or life-threatening immune-mediated diseases and infection
• Use with caution in patients with immune-mediated pneumonitis, colitis, hepatitis, endocrinopathies, nephritis, dermatologic reaction
• Monitor patients for signs and symptoms of immune-related and infusion-related adverse reactions
• Evaluate liver enzymes, creatinine, and thyroid function at baseline and periodically during treatment

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

• 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

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

• Use with caution in patients at risk for severe, life-threatening, or fatal 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

• GI effects (abdominal pain, constipation, nausea); Respiratory effects (cough, dyspnea); Other effects (hyponatremia, increased AST/lipase, rash, fatigue, musculoskeletal pain)

• Monitor liver enzymes, serum creatinine and thyroid function

• 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)

• Withhold treatment if any of the following occurs: Moderate pneumonitis, moderate or severe immune-mediated colitis, moderate hypophysitis, severe hyperglycemia, moderate immune-mediated nephritis
• Discontinue if life-threatening adverse events of pneumonitis, colitis, hypophysitis, hyperthyroidism, nephritis, infusion reactions, severe liver enzyme elevations occur
• Monitor liver enzymes, serum creatinine, and thyroid and renal function

• GI effect (decreased appetite); Hematologic effects (increased glucose and glutamyl transferase, decreased phosphorus, sodium and calcium); Other effects (peripheral neuropathy, peripheral edema, fatigue, decreased appetite)

• Withhold or discontinue treatment if ILD or pneumonitis occurs
• Monitor patients for signs or symptoms of ocular surface disorders, including vision changes, and infusion-related reactions
  • Withhold or permanently discontinue treatment based on the severity

• GI effects (nausea, diarrhea, stomatitis); Respiratory effects (cough, pneumonia, pneumonitis, dyspnea); Hematologic effects (anemia, neutropenia, thrombocytopenia, lymphopenia); Metabolic effects (increased AST, ALT, blood bilirubin, blood alkaline phosphatase, blood creatinine, hyponatremia, hypokalemia, hyperglycemia); Endocrine effects (hypothyroidism, hyperthyroidism, thyroiditis); CV effects (hypertension, myocarditis); Dermatologic effects (rash, pruritus); Musculoskeletal effects (arthralgia, myalgia); Other effects (fatigue, hepatitis, decreased appetite)

• Use with caution in patients at risk for severe, life-threatening, or fatal 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

• GI effects (nausea, diarrhea); Other effects (fatigue, musculoskeletal pain, decreased appetite, rash)

• Monitor liver enzymes, serum creatinine, adrenocorticotropic hormone level and thyroid function at baseline and before each dose

• GI effect (diarrhea, nausea/vomiting, abdominal pain, constipation, increased LFT and alkaline phosphatase); Respiratory effect (dyspnea); Other effects (musculoskeletal pain, fatigue, edema)

• Withhold or discontinue treatment if ILD, pneumonitis or CHF occurs
• Assess for left ventricular dysfunction before initiating treatment and at regular intervals during treatment as clinically indicated

Adverse Reactions

• GI effects (nausea/vomiting, diarrhea, hepatotoxicity); Respiratory effect (dyspnea); Hematologic effects (decreased lymphocytes, hemoglobin, leukocytes and neutrophils); Metabolic effects (increased ALT and AST, lipase, alkaline phosphatase, hypokalemia, hyponatremia); Other effects (fatigue, musculoskeletal pain, renal impairment, edema, decreased appetite)

Special Instructions

• May be taken with or without food
• Use with caution in patients with ILD, pneumonitis, hepatic impairment
• Monitor ECG and electrolytes in patients at risk, and in patients taking medications known to prolong QT interval, LFTs, for diarrhea, nausea/vomiting, new or worsening respiratory symptoms

• GI effects (diarrhea, decreased appetite); Dermatologic effects (dry skin, pruritus, dermatitis acneiform, rash, paronychia); Respiratory effect (pneumonitis); Other effect (epistaxis)

• Contraindicated in patients with galactose intolerance, Lapp lactase deficiency, or glucose-galactose malabsorption
• Use with caution in patients with renal/hepatic impairment, ILD, history of keratitis, ulcerative keratitis or severe dry eyes
• Monitor left ventricular function in patients with cardiac risk factors
• Take at least 3 hours before or 1 hour after meals

• GI effect (intestinal perforation, vomiting); Hepatic effects (increased ALT and AST levels, CPK, hyperbilirubinemia); Respiratory effects (dyspnea, pulmonary embolism); Other effects (hemorrhage, endocarditis)

• Monitor CPK levels and LFTs including ALT, AST and total bilirubin every 2 weeks during the first 2 month of treatment, then periodically during treatment, with more frequent testing in patients who develop transaminase and bilirubin elevations; heart rate and BP regularly
• Promptly investigate for ILD/pneumonitis (eg dyspnea, cough and fever)
• Report any unexplained muscle pain, tenderness or weakness

• GI effects (nausea/vomiting, diarrhea, constipation, abdominal pain); Respiratory effects (cough, dyspnea, pneumonitis); CNS effects (headache, peripheral neuropathy); Musculoskeletal effects (muscle spasms, back pain, myalgia, arthralgia); Other effects (decreased appetite, visual disturbance, fatigue, pyrexia)

• Discontinue if patient is unable to tolerate the 60 mg/day dose
• Assess fasting serum glucose prior to initiation of therapy
• Monitor CPK levels, lipase and amylase levels, BP, heart rate and vision regularly

• GI effects (nausea/vomiting); Respiratory effect (dyspnea); Other effects (peripheral edema, decreased appetite, fatigue)

• May be taken with or without food
• Use with caution in patients with ILD, pneumonitis, hepatic impairment
• Monitor LFTs

• GI effects (nausea/vomiting, decreased appetite, diarrhea, abdominal pain, constipation, esophageal disorder); Hematologic effect (anemia); Other effects (rash, fatigue)

• To be taken with a low-fat meal; dose to be increased to 750 mg if to be taken during fasting
• Use with caution in patients with hepatotoxicity, ILD/pneumonitis, QT interval prolongation, bradycardia, GI toxicity, hyperglycemia

• GI effects (diarrhea, nausea/vomiting, constipation); Respiratory effects (pneumonia, pulmonary embolism, dyspnea); Other effects (vision disorder, edema, fatigue, decreased appetite, neuropathy, dizziness, dysgeusia, increased ALT and neutropenia)

• Assess for ALK positive NSCLC
• Contraindicated in patients with hepatic impairment

• GI effects (diarrhea, stomatitis, nausea, constipation, mouth ulceration); Dermatologic effects (rashes, paronychia, dry skin, alopecia, pruritus); Respiratory effects (cough, dyspnea, infection); Other effects (decreased appetite, decreased weight, asthenia, conjunctivitis, insomnia, musculoskeletal pain)

• May be taken with or without food
• Use with caution in patients with ILD, diarrhea, dermatologic disease

• CNS effects (headache, dizziness); GI effects (abdominal pain, constipation, diarrhea, nausea/vomiting); Dermatologic effects (dry skin, pruritus, rash, erythema); Hepatic effect (increased liver enzymes); Musculoskeletal effects (arthralgia, myalgia, muscle spasms); Other effects (fatigue, chills, asthenia, peripheral edema, infection)

• Take at least 1 hour before or 2 hours after meals
• Use with caution in patients with severe renal impairment, moderate to severe hepatic impairment, risk for new malignancies, hemorrhage, ophthalmologic reactions, decreased left ventricular ejection fraction/left ventricular dysfunction, renal failure, hepatic adverse events, hypertension, pneumonitis or ILD, rash, rhabdomyolysis, pancreatitis, pulmonary embolism or DVT, colitis, GI perforation

• GI effects (constipation, nausea/vomiting); Respiratory effect (cough); Dermatologic effects (rash, pruritus); Other effects (fever, fatigue, musculoskeletal pain, edema)

• Evaluate LFTs and fasting blood glucose prior to therapy
• Discontinue treatment if ILD or pneumonitis occurs
• Withhold or discontinue treatment (based on severity) if hepatotoxicity, bradycardia, hyperglycemia, visual disturbances, hyperuricemia or increased CPK occurs
• Monitor LFTs, heart rate, blood glucose, CPK and uric acid periodically
• Advise patients to report any visual symptoms during treatment

• 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)

• Use with caution in patients with new or worsening congestive heart failure, myocarditis, QT prolongation, at risk for fractures, hyperuricemia
• Assess left ventricular ejection fraction, serum uric acid levels prior to initiation of therapy
• Monitor LFTs, 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)

• CNS effects (fatigue, anorexia); GI effects (diarrhea, nausea/vomiting, stomatitis, abdominal pain, GI perforation); Hepatic effects (increased hepatic enzyme levels and bilirubin); Dermatologic effects (rash, pruritus, dry skin, keratitis); Respiratory effects (dyspnea, cough); Other effects (conjunctivitis, keratoconjunctivitis sicca, infection)

• Administer 1 hour before and 2 hours after meal
• Use with caution in patients on anticoagulant medication, elevated INR, and bleeding tendency

• CNS effect (anorexia); Dermatologic effects (rash, pruritus, skin dryness, nail disorder, alopecia); GI effects (diarrhea, nausea/vomiting, stomatitis); Other effects (conjunctivitis, dyspnea); Respiratory effect (pneumonitis); Hepatic and renal toxicity

• Assess for EGFR mutation prior to initiation of therapy; not to be used in preference to doublet chemotherapy in mutation-negative patients

• 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

• Metabolic effects (hypercholesterolemia, hypertriglyceridemia, increased lipase and amylase); CNS effects (peripheral neuropathy, headache, vision disorder); GI effects (diarrhea, nausea, constipation); Musculoskeletal effects (arthralgia, myalgia); Psychiatric effects (mental status changes, mood and cognitive effects); Other effects (speech effects, increased weight, rash, edema, fatigue, pneumonitis, anemia)

• Take at the same time each day
• Use with caution in patients with hyperlipidemia, AV block, decreased left ventricular ejection fraction (LVEF), increased lipase and amylase, pneumonitis, hypertension, hyperglycemia, severe renal impairment, moderate to severe hepatic impairment
• Monitor serum cholesterol, fasting serum glucose and triglycerides prior to initiation; 2, 4 and 8 weeks after initiating and periodically thereafter; cardiac monitoring including LVEF assessment at baseline and during treatment; lipase and amylase elevations prior to therapy and regularly thereafter

• GI effects (diarrhea, stomatitis); Dermatologic effects (dry skin, pruritus, paronychia); Respiratory effect (ILD); Other effects (decreased platelet, neutrophil and leukocyte counts)

• Use with caution in patients with known hepatic or renal impairment, QTc prolongation, women of childbearing potential
• Male and female patients should be advised to use an effective contraception
• Prior to the initiation of treatment, the EGFR T790M mutation status should be determined

• GI effect (constipation); Hematologic effects (decreased lymphocytes, neutrophils, hemoglobin); Metabolic effects (decreased phosphate, sodium and calcium, increased ALT); Other effects (fatigue, musculoskeletal pain, hypertension)

• To be taken on an empty stomach; no food intake for at least 2 hours before and at least 1 hour after dose
• Contraindicated in patients with uncontrolled hypertension, recurrent ILD or pneumonitis, life-threatening hemorrhage
• Monitor ALT and AST prior to initiating treatment, every 2 weeks during the first 3 months, then monthly thereafter and as clinically indicated

• CNS effects (dizziness, ataxia, cognitive disorders, peripheral neuropathy); GI effects (constipation, dysgeusia); Respiratory effect (dyspnea); Other effects (fatigue, muscular weakness)

• Monitor patients for new or worsening pulmonary symptoms indicative of 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

• 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)

• 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

• GI effects (nausea, diarrhea); Hematologic effects (decreased lymphocytes, decreased hemoglobin); Respiratory effect (cough); Metabolic effects (increased AST/ALT, alkaline phosphatase, decreased sodium, calcium); Other effects (increased urine protein, musculoskeletal pain, fatigue, hepatotoxicity)

• Contraindicated in patients with ILD or pneumonitis
• Monitor LFTs every 3 weeks for the first 3 months of treatment then once monthly as clinically indicated

• GI effects (nausea, diarrhea); Hematologic effects (decreased lymphocytes, neutrophils, phosphate, hemoglobin, sodium and calcium, increased ALT); Other effects (edema, fatigue, musculoskeletal pain, dyspnea)

• To be taken with food
• Contraindicated in patients with ILD or pneumonitis
• Monitor LFTs

• GI effects (nausea, constipation, decreased appetite, diarrhea); Respiratory effects (cough, dyspnea); Dermatologic effects (pruritus, rash, cellulitis); Other effects (fatigue, musculoskeletal pain)

• CNS effects (neurotoxicity, loss of vision with high dose); Endocrine effects (hyponatremia, hypomagnesemia, hypocalcemia, hypokalemia); GI effects (nausea/vomiting, abdominal pain); Hematologic effects (leukopenia, anemia, thrombocytopenia, neutropenia); Hepatic effect (increased liver enzymes); Neuromuscular effect (weakness); Other effects (pain, nephrotoxicity, allergy)

• CNS effect (neurotoxicity); GI effects (nausea/vomiting); Hematologic effect (myelosuppression); Hepatic effect (increased enzyme levels); Renal effect (nephrotoxicity); Otic effect (ototoxicity); Other effect (rarely anaphylaxis)

• Dermatologic effect (alopecia); Endocrine effects (amenorrhea, sterility); GI effects (nausea/vomiting, anorexia, diarrhea); GU effect (acute hemorrhagic cystitis); Hematologic effect (leukopenia)

• CV effects (AV block, bradycardia, ECG abnormality); Dermatologic effect (alopecia); GI effects (nausea/vomiting, mucositis, GI ulcers, anorexia, diarrhea); GU effect (red discoloration of urine); Hematologic effects (leukopenia, thrombocytopenia, anemia); Endocrine effects (amenorrhea, hyperuricemia)

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

• Dermatologic effect (alopecia); Endocrine effect (ovarian failure); GI effects (nausea/vomiting, anorexia, diarrhea, mucositis); Hematologic effects (leukopenia, thrombocytopenia, anemia); Other effect (rarely anaphylaxis)

• GI effects (nausea/vomiting which can be severe, diarrhea which may become prolonged and severe >24 hours after a dose, abdominal pain, anorexia, constipation, mucositis, weight loss); Hematologic effects (neutropenia, leukopenia, thrombocytopenia); CNS effects (pain, dizziness, insomnia, headache); Other effects (fever, rash, malaise, reversible alopecia, weakness)

• Dermatologic effect (alopecia); CV effects (orthostatic hypotension or hypertension); CNS effects (depression, headache, insomnia, fever); GI effects (anorexia, bloating, paralytic ileus)

• Withhold treatment if any of the following occurs: Moderate pneumonitis, moderate or severe immune-mediated colitis, moderate-severe hypophysitis, severe hyperglycemia, moderate immune-mediated nephritis, symptomatic thyroid disease, severe ocular inflammatory toxicity, severe or life-threatening infection
• Discontinue if life-threatening adverse events of pneumonitis, colitis, hypophysitis, hyperthyroidism, nephritis, infusion reactions, severe liver enzyme elevations, myasthenic syndrome or myasthenia gravis, Guillain-Barre, meningoencephalitis, pancreatitis occur

Carboplatin

• Taxane derivatives should be administered before platinum-based agents
• Use with caution in patients with renal impairment

• Taxane derivatives should be administered before platinum-based agents
• Hydrate patient with 1-2 L of IV fluid before and 24 hours after therapy

• Increase fluid intake (2 L/day) during and 1-2 days after therapy
• Use with caution in patients with hepatic and renal impairment

• Flush with 5-10 mL of IV solution before and after giving drug
• Contraindicated in patients with recent MI, severe myocardial insufficiency, severe arrhythmia, baseline neutrophil count <1,500/mm³, severe hepatic impairment

• 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

• Discontinue treatment if platelet count is <50,000/mm³, or ANC <500 cells/mm³
• Use with caution in patients with hepatic and renal impairment

• Use with caution in patients with increased risk of diarrhea, those with previous abdominal/pelvic radiotherapy, those with renal or hepatic impairment; may impair ability to drive or operate machinery
• CBC should be monitored weekly during treatment
• LFTs should be measured at baseline and prior to each cycle
• Treatment should be delayed for 1-2 weeks to allow recovery from treatment-related toxicities. If patient has not recovered after the 2-week delay, consider discontinuing Irinotecan
• Reduce initial/starting dose in patients with prior history of pelvic radiation or those with performance status of 2

• Give prophylaxis for constipation
• Use with caution in patients with hepatic impairment and pre-existing neuromuscular disease

• Dermatologic effect (alopecia); Endocrine effect (ovarian failure); GI effects (nausea/vomiting, anorexia, diarrhea, mucositis); Hematologic effects (leukopenia, thrombocytopenia, anemia); Other effect (rarely anaphylaxis)

• Discontinue treatment if platelet count is <50,000/mm³, or ANC <500 cells/mm³
• Use with caution in patients with hepatic and renal impairment

Adverse Reactions

• GI effects (nausea/vomiting which can be severe, diarrhea which may become prolonged and severe >24 hours after a dose, abdominal pain, anorexia, constipation, mucositis, weight loss); Hematologic effects (neutropenia, leukopenia, thrombocytopenia); CNS effects (pain, dizziness, insomnia, headache); Other effects (fever, rash, malaise, reversible alopecia, weakness)

Special Instructions

• Use with caution in patients with increased risk of diarrhea, those with previous abdominal/pelvic radiotherapy, those with renal or hepatic impairment; may impair ability to drive or operate machinery
• CBC should be monitored weekly during treatment
• LFTs should be measured at baseline and prior to each cycle
• Treatment should be delayed for 1-2 weeks to allow recovery from treatment-related toxicities. If patient has not recovered after the 2-week delay, consider discontinuing Irinotecan
• Reduce initial/starting dose in patients with prior history of pelvic radiation or those with performance status of 2

Adverse Reactions

• GI effects (nausea/vomiting, constipation, diarrhea); Hematologic effects (leukopenia, lymphopenia, thrombocytopenia, neutropenia, anemia); Metabolic effects (increased creatinine, ALT/AST, and glucose, decreased albumin, sodium, and magnesium); Respiratory effects (dyspnea, cough); Other effects (fatigue, musculoskeletal pain, decreased appetite)

Special Instructions

• Use with caution in patients with myelosuppression, hepatic impairment
• Monitor LFTs prior to initiating treatment, periodically during treatment and as clinically indicated
• Obtain baseline CBC and monitor prior to each administration

Adverse Reactions

• GI effects (abdominal pain, constipation, nausea); Respiratory effects (cough, dyspnea); Other effects (hyponatremia, increased AST/lipase, rash, fatigue, musculoskeletal pain)

Special Instructions

• Monitor liver enzymes, serum creatinine and thyroid function

• GI effects (constipation, nausea, dysgeusia); Hematologic effects (anemia, decreased lymphocytes, total neutrophils, hemoglobin, WBC, platelets, increased activated partial thromboplastin time); Metabolic effects (decreased sodium, potassium, increased ALT/AST, uric acid); Other effects (cytokine release syndrome, fatigue, pyrexia, decreased appetite, musculoskeletal pain)

• Monitor patients as follows:
  • Cycle 1: From the start of the infusion for 22-24 hours on days 1 and 8; on day 15, for 6-8 hours post-infusion
  • Cycle 2: For 6-8 hours post-infusion
  • Cycles 3 and 4: For 3-4 hours post-infusion
  • Cycle 5 and subsequent infusions: For 2 hours post-infusion
• Monitor CBC prior to treatment, before each dose, and as clinically indicated for signs and symptoms of infection and hypersensitivity, liver enzymes, and bilirubin

Adverse Reactions

• CNS effects (fatigue, fever, headache); Dermatologic effects (alopecia, rash); GI effects (nausea/vomiting, diarrhea, constipation, abdominal pain, anorexia, stomatitis); Hematologic effects (neutropenia, leukopenia, anemia, thrombocytopenia); Respiratory effect (dyspnea)

Special Instructions

• Baseline neutrophil count >1,500/mm³, re-treatment neutrophil count >1,500/mm³ baseline and re-treatment platelet count >100,000/mm³
• Do not give replacement dose if patient vomits after therapy