Efficacy of Solubilized Vemurafenib Administered via Nasogastric Tube

Khimani, Farhad; Hoban, Christina; Williams, Vicky; Mavromatis, Blanche H.; Auber, Miklos; Abraham, Jame; Higa, Gerald M.

doi:10.2217/fon.13.187

Cited by 8 publications

(5 citation statements)

References 3 publications

(4 reference statements)

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“…In both cases, patients had a partial response and a significant benefit of short duration. 6,7 Compared to our patients, there was no difference in efficacy and tolerance of this altered administration of treatment. Even if the efficacy of treatment was short-lived, patients and family appreciated our having tried to provide the best care.…”

Section: Discussioncontrasting

confidence: 66%

Alternative use of BRAF inhibitors in patients with metastatic melanoma unable to swallow pills

Fleury

Regnault

Cales

et al. 2020

J Oncol Pharm Pract

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Introduction BRAF and MEK inhibitors have been approved for use in metastatic melanoma therapies. All of them are administered as oral capsules or pills. We report two cases treated applying an alternative method of vemurafenib or debrafenib-trametinib administration in patients unable to swallow. Case Report The first case involved a 38-year-old man who was referred to a dermatologist for dysphagia and anorexia. After a computerized tomography (CT) scan it was concluded that the dysphagia was due to compression by mediastinal metastasis in a context of metastatic BRAF mutant melanoma. The second case involved a 35-year-old man who was diagnosed in March 2017 with melanoma of the back of the hand. Several months later a positron emission tomography (PET)/CT scan was performed. It revealed multiple disseminated metastasis. Management & Outcome: The first patient presented total dysphagia and was unable to swallow pills. It was decided to dissolve vemurafenib in order to facilitate administration. Dysphagia was improved 48 hours later, and oral feeding was reintroduced. Due to severe tablet phobia, the second patient was unable to swallow pills. Dabrafenib capsules were emptied and trametinib pills were grinded. One month later, we noted improved health associated with reduction of the metastases. Discussion Our study highlights the possibility of crushing or dissolving BRAF and MEK inhibitors in metastatic melanoma patients for whom it is impossible to swallow pills, eliciting a response and achieving significant if temporary clinical benefit.

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Section: Discussioncontrasting

confidence: 66%

Alternative use of BRAF inhibitors in patients with metastatic melanoma unable to swallow pills

Fleury

Regnault

Cales

et al. 2020

J Oncol Pharm Pract

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“…A further illustration of alternate delivery methods involving the dispersal of vemurafenib has been published. 14 The technique described involves dissolving each vemurafenib capsule in 15 mL of water before administering it via nasogastric tube or feeding tube and then flushing the tube with 30 mL of water per capsule. The technique described would not have been applicable here as the capsule formulation is not available in Australia.…”

Section: Discussionmentioning

confidence: 99%

Use of vemurafenib in a patient unable to swallow whole

Janson

Whittle

Witney

et al. 2016

J Oncol Pharm Pract

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The treatment landscape for metastatic melanoma has increased dramatically in the past five years, with the pivotal discovery of activating BRAF mutations in half of all melanomas spurring the development for effective treatments that target mitogen-activated protein kinase (RAS/RAF/MEK/ERK) pathway. Vemurafenib, a selective mutant BRAF Val600 inhibitor, results in striking tumour responses and a survival advantage over conventional chemotherapy. We present here the case of a 38-year-old woman with metastatic BRAFV600E mutant melanoma and a severe tablet phobia, who was found to have been crushing and/or chewing her vemurafenib tablets. In this case, she attained a partial response and significant clinical benefit, albeit temporarily.

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“…Review of agents found 36 (31%) with guidance for alternative routes of administration readily available in tertiary resources or commercial liquid formulations, 38 (33%) with off‐label manufacturer information or case reports describing manipulation of solid dosage formulations, and 42 (36%) with no data or insight limited to pharmacokinetic studies. Findings are detailed in Table 3 10‐196 . Unique administration instructions (ie, with or without foo...…”

Section: Resultsmentioning

confidence: 99%

Medication use process and assessment of extemporaneous compounding and alternative routes of administration of oral oncology drugs: Guidance for clinical and oncology pharmacists

Cohen

Lee

Markham

et al. 2022

J Am Coll Clin Pharm

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Cancer treatment is evolving. Oral formulations offer potentially more convenient, effective alternatives to conventional chemotherapy for many cancers. An appealing aspect of oral antineoplastic agents is their relative ease of administration; unfortunately, patients may have difficulty swallowing the tablets or capsules. This shift towards oral administration and the accompanying issues around oral medication adherence highlights the need to assess the safety and feasibility of delivery methods for patients unable to swallow solid dosage forms. A new medication‐use process (MUP) was created to facilitate extemporaneous compounding of oral oncology drugs (OOD). Systematic review consisting of tertiary resources, drug manufacturers, and primary literature was performed to identify information related to extemporaneous compounding or alternative routes of administration for a predetermined list of OODs. A single‐center retrospective review was conducted of patients receiving liquid formulations of OODs to characterize institutional experience. Overall, 116 OODs were reviewed. The majority of OODs had information describing extemporaneous compounding or alternative routes of administration (31% with commercial liquid formulations available or information in tertiary resources; 33% with off‐label manufacturer information or case reports) while 36% had no data. The MUP included three compounding workflows to account for available solid dosage formulations (tablet, hard capsule, gelatin capsule) and creation of an electronic health record order template. Retrospective review identified 41 patients who received compounded liquid formulations of 14 OODs for 13 indications. Liquid OODs were used for a median of 3‐5 days. None of the 41 patients experienced discernable safety or overt effectiveness concerns readily attributed to use of liquid OODs. Implementation of a novel MUP and systematic review of OODs aids the pharmacist in standardizing institutional practice and mitigates risks associated with extemporaneous liquid formulations of OODs facilitating medication delivery of new agents to patients unable to swallow solid dosage forms.

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Efficacy of Solubilized Vemurafenib Administered via Nasogastric Tube

Cited by 8 publications

References 3 publications

Alternative use of BRAF inhibitors in patients with metastatic melanoma unable to swallow pills

Alternative use of BRAF inhibitors in patients with metastatic melanoma unable to swallow pills

Use of vemurafenib in a patient unable to swallow whole

Medication use process and assessment of extemporaneous compounding and alternative routes of administration of oral oncology drugs: Guidance for clinical and oncology pharmacists

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