Drug Action
Lapatinib is a tyrosine kinase inhibitor.
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Drug reference
Lapatinib is a tyrosine kinase inhibitor.
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Treatment of advanced or metastatic breast cancer in patients with tumours that overexpress human epidermal growth factor receptor-2 (HER2) with hormone-receptor-negative disease who have had previous treatment with trastuzumab in combination with chemotherapy (in combination with trastuzumab) ▶BY MOUTH ▶Adult: 1 g once daily Treatment of advanced or metastatic breast cancer in patients with tumours that overexpress human epidermal growth factor receptor-2 (HER2), for patients who have had previous treatment with an anthracycline, a taxane, and trastuzumab (in combination with capecitabine) ▶BY MOUTH ▶Adult: 1.25 g once daily Treatment of advanced or metastatic breast cancer with tumours that overexpress human epidermal growth factor receptor-2 (HER2), for postmenopausal women with hormone-receptor-positive disease (in combination with an aromatase inhibitor) ▶BY MOUTH ▶Adult: 1.5 g once daily
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Diarrhoea—withhold treatment if severe (consult product literature). low gastric pH (reduced absorption). susceptibility to QT-interval prolongation (including electrolyte disturbances)
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NICE decisions ▶Lapatinib or trastuzumab in combination with an aromatase inhibitor for the first-line treatment of metastatic hormone- receptor-positive breast cancer that overexpresses HER2 (June 2012) NICE TA257 Lapatinib (Tyverb ®) or trastuzumab in combination with an aromatase inhibitor is not recommended for first-line treatment in postmenopausal women of metastatic hormone-receptor-positive breast cancer that overexpresses human epidermal growth factor receptor 2 (HER2). Postmenopausal women currently receiving lapatinib or trastuzumab in combination with an aromatase inhibitor for this indication should have the option to continue treatment until they and their clinician consider it appropriate to stop. www.nice.org.uk/guidance/ta257
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RISKS OF INCORRECT DOSING OF ORAL ANTI-CANCER MEDICINES See Cytotoxic drugs p. 938.
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→Appendix 1: lapatinib
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▶Common or very common Alopecia. appetite decreased. arthralgia. asthenia. constipation. cough. dehydration. diarrhoea (treat promptly). dyspnoea. epistaxis. gastrointestinal discomfort. headache. hepatotoxicity (discontinue permanently if severe). hot flush. hyperbilirubinaemia. insomnia. mucositis. nail disorder. nausea. pain. paronychia. skin reactions. stomatitis. vomiting ▶Uncommon Respiratory disorders ▶Frequency not known Severe cutaneous adverse reactions (SCARs)
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Contraceptive advice required, see Pregnancy and reproductive function in Cytotoxic drugs p. 938.
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Avoid unless potential benefit outweighs risk—toxicity in animal studies. See also Pregnancy and reproductive function in Cytotoxic drugs p. 938.
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Discontinue breast-feeding.
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Manufacturer advises caution in moderate to severe impairment—increased exposure (limited information available).
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Caution in severe impairment—no information available.
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▶Monitor left ventricular function. ▶Monitor for pulmonary toxicity. Immune system and malignant disease ▶Monitor liver function before treatment and at monthly intervals.
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Always take at the same time in relation to food: either one hour before or one hour after food.
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There can be variation in the licensing of different medicines containing the same drug. Tablet ▶Tyverb (Novartis Pharmaceuticals UK Ltd) Lapatinib (as Lapatinib ditosylate monohydrate) 250 mg Tyverb 250mg tablets | 84 tablet P £965.16 | 105 tablet P £1,206.45
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Counselling advised (administration). Patients should be advised to report any unexpected changes in bowel habit.
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1 g once daily
First-line fragment. Read the complete Indications and Dose section above.
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1.25 g once daily
First-line fragment. Read the complete Indications and Dose section above.
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1.5 g once daily
First-line fragment. Read the complete Indications and Dose section above.
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