Vandetanib is manufactured in tablet form and should be taken on a daily basis with or without food. The drug is administered orally to inhibit tumor cell proliferation and tumor angiogenesis for a range of tumor types. The drug is used as an alternative to local therapies for both disseminated and unresectable diseases. Since Vandetanib prolongs the Q-T interval, it is contraindicated for use in patients with a history of cardiac conditions such as congenital QT syndrome and uncompensated heart failure.
Vandetanib is administered to patients whose cancer cannot be removed via surgery or that has spread to other parts of the body. The drug works by blocking the action of a protein that triggers multiplication of cancer cells. The use of Vandetanib in patients with asymptomatic, indolent or slowly advancing disease should be carefully considered because of treatment related risks associated with the drug.
This medication comes in tablet form and is usually taken once daily, with or without food.
Vandetanib is a targeted therapy that isolates and binds to the tyrosine kinase reporters to inhibit Epidermal Growth Factor Receptor (EGFR), Rearranged During Transfection (RET), Vascular Endothelial Growth Factor (VEGF), EPH kinase receptors, TIE2, protein tyrosine kinase 6 (BRK), and SRC kinase receptors on the cell’s surface. By binding to these receptors, Vandetanib blocks the pathway that promotes cell division and the spread of cancer.
Like with any other medication, it is important that you read your Medication Guide as provided by the pharmacist before you start using Vandetanib and every time you get a refill. Ask your doctor or pharmacist the questions you might have as concerns the medication.
Vandetanib should be taken orally with or without food as directed by your doctor. The drug should be taken once per day. It is recommended that you swallow the tablet whole. However, if this is a challenge, place the tablet in a glass of non-carbonated water (about 2 ounces) and stir until the tablet has broken apart. Swallow the solution right away.
Do not crush or break the tablets. Also, do not touch the powder or dust from this drug. Since the drug can be absorbed via the lungs and skin, and may harm an unborn baby, expectant women are advised not to handle or breath dust from the tablets. Vandetanib dosage is strictly based on the patient’s medical condition and response to treatment. Patients are advised to take the medication regularly to get the most benefits from it.
Vandetanib 100-mg tabs are white, round, film-coated and biconcave. They are plain on one side with the inscription “Z-100” on the reverse side.
Vandetanib 300-mg tabs, on the other hand, are white, biconcave, oval and film-coated. The carry the inscription “Z-300’ on one side and are plain on the reverse side.
Mild renal impairment (CrCl 50 mL/min or greater): No need for dose adjustment. However, for moderate to severe renal impairment (CrCl less than 50 mL/min), the patient may take an initial dose of 200 mg per day.
The US Food and Drug Administration recommends a Risk Evaluation and Mitigation Strategy (REMS) for Vandetanib. This includes medication guide, assurance for safe use, communication plan, and a system of implementation. Refer to www.fda.gov/REMS for additional information.
A total of 355 drugs (both brand and generic names) have been reported to interact with Vandetanib.
Hypertension, including hypertensive crisis, has been reported in patients on Vandetanib medication. Monitoring the patient for hypertension and dose interruption or reduction may be considered. In cases where hypertension cannot be controlled, the patient should not resume Vandetinab.
The use of Vandetanib has been associated with pulmonary infections. Severe cases of Interstitial Lung Disease (ILD), including fatalities as a result of pulmonary fibrosis or interstitial pneumonitis have been reported in patients who are on Vandetanib medication. Caution is recommended when prescribing this medication to patients with a history of pulmonary fibrosis or interstitial pneumonitis, or patients who exhibit severe onset of new or progressive unexplained pulmonary symptoms like persistent cough, dyspnea and fever. The medication should be permanently discontinued if ILD is confirmed.
Cardiovascular failures, including fatalities have been reported in patients on Vandetanib treatment. It is important to be on the look for signs and symptoms of heart failures with immediate discontinuation on patients with these symptoms.
Serious bleeding cases, including fatalities, have occurred in patients on Vandetanib treatment. The drug is not recommended for patients with a recent history of hemoptysis that is equal to or greater than 0.5 teaspoon of red blood. Medication should be discontinued in patients with severe hemorrhage.
Vandetanib medication is not recommended for patients with moderate to severe hepatic impairment, or other liver diseases, as the safety and efficacy of this medication is yet to be established.
Hypertension, including hypertensive crisis, have been reported in patients on Vandetanib medication. The patient should be monitored for blood pressure changes and dose reduction or termination effected based on severity of the hypertension. In cases where hypertension cannot be controlled, the patient should not resume Vandetanib treatment.
Increased thyroid replacement therapy is recommended in patients with a history of thyroidectomy. It is thus recommended to administer Thyroid-stimulating hormone (TSH) at baseline during Vandetanib treatment and thereafter as directed by your doctor. If symptoms of hypothyroidism persist, the patient’s thyroid hormone levels should be examined, and thyroid replacement therapy adjusted accordingly during Vandetanib treatment.
Episodes of Ischemic cerebrovascular attacks, including fatalities, have occurred in patients on Vandetanib therapy. The safety of resuming Vandetanib treatment after resolving an ischemic cerebrovascular episode has not yet been fully studied. Thus, care should be taken when prescribing this medication to a patient who has experienced ischemic cerebrovascular event.
Studies have shown that Vandetanib can prolong the QT interval. In addition, its use is contraindicated in patients with congenital long QT syndrome. Patients with hypokalemia, hypocalcemia, hypomagnesemia and long QT syndrome should never use Vandetanib. It is recommended to correct these conditions before administering this medication to patients. Additionally, caution should be exercised when prescribing this medication for patients with recent myocardial infarction or arrhythmias.
Increased exposure to Vandetanib have been linked to renal dysfunction. Patients with moderate to severe renal impairment are advised to reduce Vandetanib’s starting dose and monitor their QT levels closely. Currently, there is no information on how patients with advanced renal infection, or those dialysis, can use Vandetanib.
Reversible Posterior Leukoencephalopathy Syndrome (RPLS), a subcortical vasogenic edema condition that is detected by an MRI of the brain, has been reported in patients who are Vandetanib treatment. The syndrome is characterized by headache, seizures, visual impairment, altered mental function and general confusion. Vandetanib therapy should be discontinued as soon as these symptoms are detected.
Severe skin reactions, including Stevens-Johnson Syndrome, some leading to fatalities, have been reported in patients who are on Vandetanib medication. Treatment for severe skin reactions may include the use of corticosteroids followed by a permanent discontinuation from Vandetanib. Mild to moderate skin reactions (rashes, dry skin, acne, dermatitis and pruritis) may be treated using systemic antibiotics, oral antihistamines, topical or systemic corticosteroids. In case there is CTCAE grade 3 or greater skin reactions, the patient may need to discontinue Vandetanib treatment for until there is improvement upon which they may resume with treatment at a reduced dose.
It is important that you inform your doctor if you are expectant or planning to conceive before starting Vandetanib treatment. This is because Vandetanib have been documented to affect unborn babies. Do not conceive for at least four months from your last Vandetanib dose.
Be sure to inform your doctor if you are breastfeeding before taking this medication. While it is not clear if Vandetanib can pass on to your breast milk, it is not recommended that you use this medication while breastfeeding.
Some are known to interact with Vandetanib. It is important that you disclose to your doctor all the medications you are currently before starting Vandetanib therapy. Some of the drugs that interact with Vandetanib include:
Due to the risk of QT prolongation, sudden fatality, and Torsades de pointes, Vandetanib is only available via a restricted distribution program called the REMS Program. Thus, only pharmacies and prescribers certified with the REMS program are allowed to prescribe and dispense this medication.
Here is an overview of the requirements for pharmacies and prescribers:
There is no specific Vandetanib overdose treatment. In addition, possible overdose symptoms are not yet very clear. Since the drug has 19-day half-life, severe reactions may take longer to resolve. That said, call the poisons control department, or 911 immediately when the patient exhibits serious symptoms like difficulty in breathing and passing out.
It is advisable that you store this medication in the container it came with. Close the bottle tightly and keep out of children’s reach. Store the medication at room temperature and away from excess moisture and heat. Do not keep the medication in your bathroom.
Dispose of all unused medication to ensure that pets, children and other members of your household do not reach and use them. That said, do not flush the medication down the toilet. Instead, use the medicine take-back program. You may learn about this from your pharmacist or from the local garbage collection and recycling department in your community. Visit the FDA’s Safe Disposal of Medicines web page for more information on how you can dispose of Vandetanib. Do not store Vandetanib medication alongside other medications like creams, eye drops and inhalers. To prevent accidental use by children, or other members of your household, always keep this medication under lock and key in a safe location.
Points to remember:
Developed by AstraZeneca, Vandetanib (trade name Caprelsa) is an anti-cancer medication that is used for treating certain tumors of the thyroid gland. It works by acting as a kinase inhibitor on certain cell receptors, mainly the Epidermal Growth Factor Receptor (EGFR), Vascular Endothelial Growth Factor Receptor (VEGFR), and the RET-tyrosine kinase. In addition, the drug stops endothelial cell migration, proliferation, growth and formation of new blood vessels in in vitro models of angiogenesis. This reduces tumor vessel permeability thus helps slow down or stop the spread of cancer cells altogether.
Vandetanib is administered to treat a type of thyroid cancer that cannot be treated via surgical procedures or that has spread to other parts of the body. Vandetanib belongs to a class of medications called kinase inhibitors.
During treatment, it is important that you keep all your appointment with the doctor and laboratory. Your doctor will recommend laboratory tests from time to time to check how your body is responding to the medication. Your doctor will also monitor your blood pressure from time to time during the treatment period.
Since Vandetanib interacts with most medications, it is important that you inform your doctor of all the prescription as well as non-prescriptions you are on before starting this therapy. Finally, always look out for Vandetinab side effects and discuss them with your doctor as soon they manifest for urgent action.