Reference
1. Wells SA Jr, Gosnell JE, Gagel RF, et al. Vandetanib for the treatment of patients with locally advanced or metastatic hereditary medullary thyroid cancer. J Clin Oncol 2010;28:767–772.
What’s new, what’s important
Jame Abraham, MD, Editor
Vandetanib (Caprelsa), an oral kinase inhibitor, was approved in April 2011 by the US Food and Drug Administration for the treatment of symptomatic or progressive medullary thyroid cancer in patients with unresectable locally advanced or metastatic disease.
The recommended dose of vandetanib is 300 mg/day PO; in patients with renal impairment, it should be reduced to 200 mg/day. Treatment should be continued until disease progression or intolerable side effects occur.
Vandetanib can prolong the QT interval, and cases of torsades de pointes and sudden death were reported in clinical trials. Because of this risk, vandetanib is only available through a Risk Evaluation and Mitigation Strategy (REMS) program.
Because of the risk of QT prolongation, electrocardiograms and serum levels of potassium, calcium, magnesium, and thyroid stimulating hormone should be monitored at baseline, 2–4 weeks, and 8–12 weeks after starting treatment and every 3 months thereafter or following dose adjustments. The most common (> 20%) adverse drug reactions observed with vandetanib are diarrhea (57%), rash (53%), acne (35%), nausea (33%), hypertension (33%), headache (26%), fatigue (24%), decreased appetite (21%), and abdominal pain (21%). The most common (> 20%) laboratory abnormalities are decreases in serum calcium (57%) and glucose (24%) levels and increases in alanine aminotransferase levels (51%).
Vandetanib is a promising drug for patients with inoperable advanced or metastatic medullary thyroid cancer.