Names and pronunciation
(pan-i-tue′moo-mab) Vectibix
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Drug reference
(pan-i-tue′moo-mab) Vectibix
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Func. class.: Antineoplastic—miscel- laneous
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Chem. class.: Multikinase inhibitor, signal transduction inhibitor
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ACTION: Decreases growth and survival of cancer cells by competitive inhibition of EGF receptor
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USES: EGFR expressing metastatic colorectal cancer; not beneficial with KRAS mutations in codon 12 or 13
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CONTRAINDICATIONS: Hyper sensitivity, RAS (KRAS and NRAS) mutant mCRC or if unknown, child <18 yr Precautions: Pregnancy, breastfeeding, children, hepatic disease, acute bron- chospasm, diarrhea, hamster protein allergy, hypomagnesemia, hypotension, pulmonary fibrosis, sepsis, KRAS mutations, soft tissue toxicities, infusion- related reactions
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Black Box Warning: Exfoliative dermatitis Black Box Warning: Serious skin dis- orders: fever, sore throat, fatigue, then lesions in mouth, lips; withhold product, notify prescriber • Serum electrolytes periodically (cal- cium, magnesium) • Infection: increased temperature • Assess for diarrhea Black Box Warning: Infusion reactions: bronchospasm, fever, chills, hypotension; may require discontinuation, have emer- gency equipment available • Ocular toxicity: ocular irritation, hy- peremia P • Pulmonary fibrosis: dyspnea, cough, wheezing; may require discon- tinuation • Pregnancy/breastfeeding: do not use in pregnancy/breastfeeding
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SIDE EFFECTS CNS: Fatigue CV: Peripheral edema EENT: Ocular irritation, ocular toxicity GI: Nausea, diarrhea, vomiting, anorexia, mouth ulceration, abdominal pain, constipation HEMA: Thrombophlebitis INTEG: Rash, pruritus, exfoliative der- matitis, skin fissure, angioedema, severe/ fatal infusion reactions META: Hypocalcemia, hypomagnesemia, antibody formation RESP: Bronchospasm, cough, dyspnea, hypoxia, pulmonary fibrosis/embolism, pneumonitis, wheezing, interstitial lung disease
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INTERACTIONS • Do not use in combination with other antineoplastics
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DOSAGE AND ROUTES • Adult: IV INFUSION 6 mg/kg over 60 min every 2 wk; doses >1000 mg over 90 min
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Available forms: Sol for inj 20 mg/mL (100 mg/5 mL, 400 mg/20 mL)
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Administer: Proactive skin treatment • Skin moisturizer, sunscreen (SPF >15 UVA and UVB, topical steroid cream (1% hydrocortisone), and an oral antibiotic (doxycycline) for possible skin toxicities; patients need to apply moisturizer and sunscreen to face, hands, feet, neck, back, and chest every AM during treatment, and apply topical steroid to face, hands, feet, neck, back, and chest every PM Intermittent IV INFUSION route • Assess for KRAS before use • Give in hospital or clinic setting with full resuscitation equipment • Only as IV infusion using controlled IV infusion pump; do not give IV push or bolus; use low–protein binding 0.2- or 0.22-micron in-line filter; flush line with 0.9% NaCl before and after administra- tion • Give over 60 min through a peripheral line or indwelling catheter; infuse doses of >1000 mg over 90 min • Dilute in 100 mL of 0.9% NaCl; dilute doses >1000 mg in 150 mL of 0.9% NaCl; mix by inverting; do not exceed 10 mg/mL; use within 6 hr if stored at room temperature; can be stored between 2°C and 8°C for up to 24 hr • Dosage adjustment for infusion/der- matologic reaction: Grade 1 or 2: reduce infusion by 50%; Grade 3 or 4: terminate, permanently discontinue depending on severity/resistance • Store unopened vials in refrigerator; do not shake; protect from direct sun- light; do not freeze
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Assess:
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Evaluate: • Therapeutic response: decrease in co- lon carcinoma progression
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report adverse reactions imme- diately: difficulty breathing, mouth sores, skin rash, ocular toxicity • About reason for treatment, expected results, adverse reactions • To use contraception while taking prod- uct, for 6 mo after treatment; not to breastfeed for ≥2 mo after stopping treat- ment; to enroll in Amgen Pregnancy Sur- veillance Program, 1-800-772-6436 • To avoid the sun, use sunscreen while taking product HIGH ALERT
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PHARMACOKINETICS Bioavailability 38%-49%; elimination half-life 7.5 days; peak 3 hr; high-fat meal decreases bioavailability; plasma protein binding 99.5%; metabolized in liver; oxidative metabolism by CYP3A4, glucuronidation by UGT1A9; 77% excreted in feces
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• Adult: IV INFUSION 6 mg/kg over 60 min every 2 wk; doses >1000 mg over 90 min
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