Panitumumab monotherapy for metastatic, RAS/BRAF wildtype colorectal cancer^[1]

Panitumumab monotherapy for metastatic, RAS/BRAF wildtype colorectal cancer^[1]

Cycle length: 2 weeks. Duration: Continue until disease progression or unacceptable toxicity.
Drug	Dose and route	Administration	Given on days
Panitumumab	6 mg/kg IV	Dilute to total volume 100 mL with NS.*^¶ Administer over 60 minutes^Δ using a low-protein-binding 0.2 micron or 0.22 micron in-line filter.	Day 1
Pretreatment considerations:
Emesis risk	LOW. Refer to UpToDate topics on prevention of chemotherapy-induced nausea and vomiting in adults.
Prophylaxis for infusion reactions	Routine premedication not indicated. Refer to UpToDate topics on infusion-related reactions to therapeutic monoclonal antibodies used for cancer therapy.
Monitoring parameters:
Assess basic metabolic panel (including creatinine, magnesium, calcium, and potassium) prior to each dose. Monitor calcium, magnesium and potassium levels weekly for eight weeks after completion of therapy and institute appropriate treatment as needed.^[2]
Monitor for skin rash and for evidence of keratitis or ulcerative keratitis.
Monitor for diarrhea.
Assess for signs/symptoms of pulmonary toxicity.
Suggested dose modifications for toxicity:
Ocular toxicities	Interrupt or discontinue panitumumab for acute or worsening keratitis.^[2]
Infusion reactions	Reduce infusion rate by 50% for mild or moderate (grade 1 and 2) reactions and terminate the infusion for severe infusion reactions. Depending on the severity and/or persistence of the reaction, permanently discontinue panitumumab.^[2] Refer to UpToDate topics on infusion-related reactions to therapeutic monoclonal antibodies used for cancer therapy.
Dermatologic toxicity	Withhold therapy for severe or intolerable toxicity; may resume at 50% of dose if toxicity improves and escalate dose as tolerated for subsequent infusions.^[2] Refer to UpToDate topics on acneiform eruption secondary to epidermal growth factor receptor (EGFR) and MEK inhibitors.
Pulmonary toxicity	Permanently discontinue panitumumab in patients developing pulmonary fibrosis/interstitial lung disease.^[2]
If there is a change in body weight of at least 10%, doses should be recalculated.

This table is provided as an example of how to administer this regimen; there may be other acceptable methods. This regimen must be administered by a clinician trained in the use of chemotherapy, who should use independent medical judgment in the context of individual circumstances to make adjustments, as necessary.

IV: intravenous; NS: normal saline.
* Doses higher than 1000 mg should be diluted to 150 mL with NS^¶ and administered over 90 rather than 60 minutes.
¶ Diluent solutions should not be modified without consulting a detailed reference due to potential incompatibilities.
Δ If initial dose is well tolerated, subsequent doses can be administered over 30 minutes.

References:

Van Cutsem E, et al. J Clin Oncol 2007; 25:1658.
Panitumumab injection. United States Prescribing Information. US National Library of Medicine. (Available online at dailymed.nlm.nih.gov, accessed on June 8, 2012).

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Panitumumab monotherapy for metastatic, RAS/BRAF wildtype colorectal cancer[1]

Panitumumab monotherapy for metastatic, RAS/BRAF wildtype colorectal cancer^[1]