Vandetanib (Caprelsa®)

Vandetanib is a type of targeted therapy called a tyrosine kinase inhibitor. A kinase is an enzyme that promotes cell growth. This means it works by targeting receptors present on the cancer cells. Vandetanib targets epidermal growth factor (EGFR) and vascular endothelial growth factor receptors (VEGF). It blocks tumor growth and angiogenesis (the development of a blood supply to the tumor).

How to Take Vandetanib

Vandetanib is a tablet, taken by mouth, with or without food. This medication should be swallowed whole with water. If you miss a dose and your next dose is in less than 12 hours, take your next dose at the scheduled normal time. Do not make up for the missed dose. If you are more than 12 hours away from your next scheduled dose, take the missed dose as soon as you remember and the next scheduled dose at your normal time.

It is important to make sure you are taking the correct amount of medication every time. Before every dose, check that what you are taking matches what you have been prescribed.

If you cannot swallow the tablet whole, you can place it in 2 ounces of non-carbonated water, stir and allow it to break down for about 10 minutes, or until the tablets have become very small pieces (they will not dissolve completely). Drink the mixture right away. If residue remains in the glass, add additional noncarbonated water and drink. Use caution to avoid direct skin contact with the medication.

The blood levels of this medication can be affected by certain foods and medications, so they should be avoided. These include: grapefruit, grapefruit juice, carbamazepine verapamil, ketoconazole, rifampin, phenytoin, phenobarbital, rifabutin, rifapentine, St. John’s wort, modafinil, amiodarone, citalopram, dofetilide, fluoxetine, procainamide, quetiapine, quinidine, quinine, and sotalol. Extra caution and/or monitoring may need to be taken if you are also on metformin and digoxin. Be sure to tell your healthcare provider about all medications and supplements you take.

Storage and Handling

Store your medication in the original, labeled container at room temperature and in a dry location (unless otherwise directed by your healthcare provider or pharmacist). This medication should not be stored in a pillbox. Keep containers out of reach of children and pets.

If a caregiver prepares your dose for you, they should consider wearing gloves or pour the pills directly from their container into the cap, a small cup, or directly into your hand. They should avoid touching the pills. They should always wash their hands before and after giving you the medication. Pregnant or nursing women should not prepare the dose for you. Ask your oncology team where to return any unused medication for disposal. Do not flush down the toilet or throw in the trash.

Where do I get this medication?

Vandetanib is available through select specialty pharmacies. Your oncology team will work with your prescription drug plan to identify an in-network specialty pharmacy for distribution of this medication and shipment directly to your home.

Insurance Information

This medication may be covered under your prescription drug plan. Patient assistance may be available to qualifying individuals without prescription drug coverage. Co-pay cards, which reduce the patient co-pay responsibility for eligible commercially (non-government sponsored) insured patients, may also be available. Your care team can help you find these resources, if they are available.

Possible Side Effects of Vandetanib

There are a number of things you can do to manage the side effects of vandetanib. Talk to your care team about these recommendations. They can help you decide what will work best for you. These are some of the most common or important side effects:

Heart Problems

This medication can cause a change in the electrical activity of the heart called QT prolongation. Symptoms include: irregular or abnormal heartbeat, feeling faint or lightheaded. Your oncology team will regularly monitor blood levels of potassium, magnesium, calcium and TSH, as well as the electrical activity of your heart with regular electrocardiograms (ECG). This medication can also lead to heart failure. Contact your care team if you experience shortness of breath, swollen ankles or legs, weight gain or pain in the chest.

Diarrhea

Diarrhea is a potentially dangerous side effect because it can lead to serious dehydration. Notify your healthcare team if you develop diarrhea so they can help you manage this side effect.

Your oncology team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice, products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses of non-alcoholic, un-caffeinated fluid a day to prevent dehydration.

Skin Reactions

Severe (and rarely, life-threatening) skin reactions, which can range from mild to very severe, can develop while taking this medication. These include rash, acne, blisters, dry, peeling and itchy skin or redness, and swelling of hands and/or feet. Notify your healthcare provider if you develop any skin reactions so they can determine the seriousness of the reaction.

High Blood Pressure

This medication can cause high blood pressure (hypertension). Patients should have their blood pressure checked regularly during therapy. If you experience any symptoms of high blood pressure, including headache, dizziness or lightheadedness, nose bleed or ringing in the ears, report this to your healthcare provider immediately. Any hypertension should be treated appropriately.

Nausea and/or Vomiting

Talk to your doctor or nurse so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms.

Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.

Fatigue

Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team for helpful tips on dealing with this side effect.

Sun Sensitivity

This medication can make your skin more sensitive to the sun, which can result in severe sunburn or rash. Sun sensitivity can last even after chemotherapy is completed. Avoid the sun between 10-2pm, when it is strongest. Wear sunscreen (at least SPF 30) everyday; wear sunglasses, a hat and long sleeves/pants to protect your skin and seek out shade whenever possible. This medication remains in your system for several weeks and this sensitivity can last for up to 4 months after stopping therapy.

Thyroid Hormone Level Changes

You can have changes in your thyroid hormone levels while taking vandetanib. You may need to take thyroid replacement therapy medication. Your healthcare provider will check your TSH (thyroid stimulating hormone) level prior to starting the medication, at 2 to 4 and 8 to 12 weeks after starting, and every 3 months thereafter.

Less common, but important side effect can include:

• Lung Problems: This medication can cause interstitial lung disease. Symptoms include a new cough, shortness of breath and difficulty breathing. Call your care team if you experience these symptoms.
• Stroke: Symptoms include: numbness or weakness of the face, arm or leg, sudden confusion, trouble speaking or understanding, vision changes, trouble walking or with balance or coordination or severe headache. Call your care team if you experience these symptoms.
• Bleeding: Unexplained bleeding has occurred in clinical trials of this medication. Notify your healthcare provider if you have any bleeding.
• Posterior Reversible Encephalopathy Syndrome (PRES): In rare cases this medication has caused a neurological disorder called posterior reversible encephalopathy syndrome (PRES), also called reversible posterior leukoencephalopathy (RPLS). Symptoms of PRES/RPLS include headache, seizure, lethargy, confusion, blindness and other visual and neurological disturbances. Report any of these symptoms to your healthcare team immediately.
• Wound healing: This medication can lead to slower or incomplete wound healing, such as a surgical wound not healing or staying closed. Be sure to inform the team performing the surgical procedure that you are taking vandetanib. You should also inform your oncology team that a surgical procedure is planned. It is recommended that this medication be discontinued one month prior to any surgery. In addition, any surgical incision should be adequately healed prior to starting or restarting the medication. If you have a surgical wound that has not healed or begins to have signs of infection (redness, swelling, warmth), report this to your healthcare team.
• Kidney Problems: This medication can cause a decrease in kidney function or damage to the kidney. For this reason, your healthcare team will monitor your kidney function with blood tests. Some patients will need to stop the medication due to kidney function changes. Notify your provider if you notice any blood in your urine, decrease in urination or darkening of the urine.

Reproductive Concerns

Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment and for at least 4 months after treatment. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. You should not breastfeed while receiving this medication and for at least 4 months after your last dose.