Drug Action
Vandetanib is a tyrosine kinase inhibitor.
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Drug reference
Vandetanib is a tyrosine kinase inhibitor.
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Treatment of aggressive and symptomatic medullary thyroid cancer in patients with unresectable locally advanced or metastatic disease ▶BY MOUTH ▶Adult: 300 mg once daily, for dose adjustment due to side effects—consult product literature
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Congenital long QT syndrome. QT interval greater than 480 milliseconds
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Brain metastases (intracranial haemorrhage reported). electrolyte disturbances. history of torsades de pointes. hypertension. phototoxicity reactions reported (wear protective clothing and/or sunscreen). susceptibility to QT-prolongation
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NICE decisions ▶Vandetanib for treating medullary thyroid cancer (December 2018) NICE TA550 Vandetanib (Caprelsa ®) is not recommended, within its marketing authorisation, for treating aggressive and symptomatic medullary thyroid cancer in adults with unresectable, locally advanced or metastatic disease. Patients whose treatment was started within the NHS before this guidance was published should have the option to continue treatment, without change to their funding arrangements, until they and their NHS clinician consider it appropriate to stop. www.nice.org.uk/guidance/ta550
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RISKS OF INCORRECT DOSING OF ORAL ANTI-CANCER MEDICINES See Cytotoxic drugs p. 938.
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→Appendix 1: vandetanib
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▶Common or very common Alopecia. anxiety. appetite decreased. asthenia. cerebral ischaemia. cholelithiasis. constipation. corneal deposits. cystitis. dehydration. depression. diarrhoea. dizziness. dry eye. dry mouth. dysphagia. electrolyte imbalance. eye disorders. eye inflammation. fever. gastrointestinal discomfort. gastrointestinal disorders. glaucoma. haemorrhage. headache. hyperglycaemia. hypertension. hypothyroidism. increased risk of infection. insomnia. lethargy. loss of consciousness. movement disorders. nail disorder. nausea. nephrolithiasis. oedema. pain. photosensitivity reaction. proteinuria. QT interval prolongation. renal impairment. respiratory disorders. sensation abnormal. sepsis. skin reactions. stomatitis. taste altered. tremor. urinary disorders. vision disorders. vomiting. weight decreased ▶Uncommon Arrhythmias. brain oedema. cardiac arrest. cardiac conduction disorder. cataract. healing impaired. heart failure. malnutrition. pancreatitis. posterior reversible encephalopathy syndrome (PRES). seizure. urine discolouration ▶Frequency not known Aneurysm. artery dissection. Stevens-Johnson syndrome
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Effective contraception required during and for at least 4 months after treatment.
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Manufacturer advises avoid unless potential benefit outweighs risk. Most cytotoxic drugs are teratogenic and should not be administered during pregnancy, especially during the first trimester. Considerable caution is necessary if a pregnant woman presents with cancer requiring chemotherapy, and specialist advice should always be sought.
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Avoid—no information available.
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Manufacturer advises avoid if liver function tests exceed specific limits—consult product literature.
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Avoid if creatinine clearance less than 30 mL/minute. Dose adjustments Reduce dose to 200 mg if creatinine clearance 30–49 mL/minute.
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Monitor ECG, serum potassium, calcium, magnesium and thyroid stimulating hormone before treatment, then 1, 3, 6 and 12 weeks after starting treatment and following dose adjustment or interruption, then every 3 months for at least 1 year.
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Tablets may be dispersed in half a glass of water by stirring until dispersed (approximately 10 minutes), immediately before drinking (do not crush). After solution has been swallowed, any residue must be re-dispersed in the same volume of water and swallowed. The solution can also be administered via nasogastric or gastrostomy tubes.
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There can be variation in the licensing of different medicines containing the same drug. Tablet ▶Caprelsa (Genzyme Therapeutics Ltd) A Vandetanib 100 mg Caprelsa 100mg tablets | 30 tablet P £2,500.00 Immune system and malignant disease Vandetanib 300 mg Caprelsa 300mg tablets | 30 tablet P £5,000.00
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Patients or carers should be given advice on how to administer vandetanib tablets. Phototoxicity reactions Patients should be advised to wear protective clothing and/or sunscreen. Alert card An alert card should be provided.
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300 mg once daily, for dose adjustment due to
First-line fragment. Read the complete Indications and Dose section above.
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