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Afinitor®

(a-FIN-i-tor)

Afinitor® (Everolimus) is used to treat the following: o Hormone receptor–positive (HR+), human epidermal growth factor receptor-2 (HER-2)-negative breast cancer, in combination with the medication exemestane o Pancreatic cancer (i.e., pancreatic neuroendocrine tumor [PNET]) o Neuroendocrine tumo...

Afinitor® (Everolimus) is used to treat the following: o Hormone receptor–positive (HR+), human epidermal growth factor receptor-2 (HER-2)-negative breast cancer, in combination with the medication exemestane ...

ShowAll Page 1 EVEROLIMUS ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — everolimus eh-veh-ROH-lih-mus Brand name — Afinitor® a-FIN-i-tor Approved uses Everolimus is used to treat the following: o Hormone receptor–positive HR+ human epidermal growth factor receptor-2 HER-2 -negative breast cancer in combination with the medication exemestane o Pancreatic cancer i e pancreatic neuroendocrine tumor [PNET] o Neuroendocrine tumor NET of the stomach and intestine gastrointestinal or lung o Kidney cancer called renal cell carcinoma or angiomyolipoma and tuberous sclerosis complex o Brain tumor called subependymal giant cell astrocytoma SEGA Dose and schedule Taking everolimus as instructed is important to allow your treatment to be as effective as possible so here are some key points to remember o Your dose may vary but the usual dose of everolimus is 10 milligrams 10 mg to be taken by mouth at a scheduled time once a day o Your dose is based on many factors including your height and weight overall health and diagnosis o Everolimus can be taken with or without food Choose one with food or without food and take at the same time each day o Everolimus should be taken with a full glass of water o Everolimus is available as regular tablets and tablets used to make a suspension Afinitor® Disperz The regular tablets should be taken whole and not crushed cut or dissolved The tablets used to make a suspension should not be crushed or cut but can be dissolved in water If you are unable to swallow everolimus talk to your care provider or pharmacist for possible options o If you miss a dose of everolimus: Only take the missed dose if it has been less than six hours since you were supposed to take it Then take the next dose at the regularly scheduled time Do not take the missed dose if it has been more than six hours since you should have taken it Simply take the next dose at the regularly scheduled time Do not take two doses at one time Be sure to write down if you miss a dose and let your care provider know about any missed doses Storage and handling Handle everolimus with care Just like when chemotherapy is given into the vein this drug can be toxic and exposure of the drug to others should be limited o Store everolimus at room temperature 68°F–77°F in a dry location away from light o Keep everolimus out of reach of children and pets EVEROLIMUS ORAL CHEMOTHERAPY EDUCATION Page 2 o Leave everolimus in the provided packaging until it is ready to be taken o Whenever possible give everolimus to yourself and follow the steps below If a family member friend or caregiver needs to give everolimus to you they also need to follow these steps: 1 Wash hands with soap and water 2 Put on gloves to avoid touching the medication Gloves are not necessary if you give the drug to yourself 3 Gently transfer the everolimus from its package to a small medicine or other disposable cup 4 Administer the medicine immediately by mouth with water 5 Remove gloves and do not use them for anything else 6 Throw gloves and medicine cup in household trash 7 Wash hands with soap and water o A daily pill box or pill reminder is not recommended for use with everolimus o If you have any unused everolimus do not throw it in the trash and do not flush it down the sink or toilet Talk to your care provider or pharmacist about proper disposal of everolimus o If you are traveling put your everolimus in a sealed plastic bag Ask your pharmacist if any additional travel precautions are needed Handling body fluids and waste Everolimus remains in your body for several days after it is taken so some of the drug may be present in urine stool sweat or vomit Once you have started to take everolimus it is important to follow the instructions below every day for as long as your treatment lasts This will keep yourself loved ones and the environment as safe as possible o Pregnant women should avoid touching anything that may be soiled with body fluids from the patient o Toilet and septic systems You may use the same toilet septic tank and/or sewer that you usually use If you have a low-flow toilet close the lid and flush twice to ensure all waste has been discarded If the toilet or toilet seat becomes soiled with urine stool or vomit clean the surfaces before other people use the toilet Wash hands with soap and water after using the toilet o If you need a bedpan be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day o If you do not have good control of bladder or bowels use a disposable pad with a plastic back a diaper or a sheet to absorb body waste o Wash any skin that has been exposed to body waste or everolimus with soap and water o Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing If you do not have a washer place the soiled linens in a plastic bag until they can be washed o Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids EVEROLIMUS ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Everolimus The common side effects that have been known to happen in more than 30% of patients taking everolimus are listed in the left side of this table You MAY NOT experience these side effects Options to help manage any side effects that do occur are included on the right side of this table These should be discussed with your care provider If you experience any side effect you cannot manage or that is not listed here contact your care provider Possible Side Effect Management Decreased hemoglobin part of the red blood cells that carry iron and oxygen Your hemoglobin should be monitored by a simple blood test When your hemoglobin is low you may notice that you get tired or fatigued more easily Try to get 7–8 hours of sleep per night Avoid operating heavy machinery if you feel too tired Find a balance between work and rest Stay as active as possible but know that it is okay to rest as needed You might notice that you are more pale than usual Let your care provider know right away if you experience: Shortness of breath Dizziness Palpitations Changes in electrolyte and other laboratory values High glucose levels High prothrombin time levels High cholesterol levels High triglyceride levels High bicarbonate levels Low phosphate levels Low calcium levels Low albumin levels Changes in some lab values may occur and will be monitored by a simple blood test You may not feel any symptoms if the changes are mild and they usually are not a sign of a serious problem More severe changes may occur which can be a sign of a serious problem Notify your care provider if you have any of the following: Shortness of breath Chest discomfort Weakness or fatigue New aches and pains Headaches Dizziness Swelling of your legs or feet Red- or brown-colored urine Changes in liver function Your liver function will be checked periodically by a simple blood test Contact your care provider if you notice any of the following: Yellowing of the skin or whites of your eyes Dark or brown urine Unusual bleeding or bruising Continued on the next page EVEROLIMUS ORAL CHEMOTHERAPY EDUCATION Page 4 Possible Side Effect Management Mouth irritation or sores Practice good mouth care Rinse your mouth frequently Brush your teeth with a soft toothbrush or cotton swab after meals Use a mild nonalcohol mouth rinse at least four times a day after eating and at bedtime For example you can use a mixture of 1/8 teaspoon of salt and 1/4 teaspoon of baking soda in 8 ounces of warm not hot water If you have sores in your mouth avoid using tobacco products alcohol and mouthwashes that contain alcohol Call your care provider if you experience pain or sores in your mouth or throat Rash or itchy skin Keep your skin moisturized with creams and moisturizing lotions to decrease the risk of rash or itchiness and wear loose fitting clothing Avoid using perfumes and cologne as these products may increase rash symptoms Avoid being in the heat for long periods of time Your provider may recommend an over-the-counter antihistamine or a topical cream Sunlight can make symptoms worse Avoid sun exposure as much as possible to decrease the risk of sunburn The highest exposure to ultraviolet UV radiation occurs from 10 am–4 pm Wear long-sleeved clothing with UV protection if possible Wear broad-brimmed hats Apply broad-spectrum sunscreen UVA/UVB with at least SPF 30 as often as directed on the bottle If your rash or itching continues to worsen contact your care provider Decreased platelet count and increased risk of bleeding Your platelets should be monitored by a simple blood test When they are low you may bruise or bleed more easily than usual Use caution to avoid bruises cuts bleeding or burns Blow your nose gently and do not pick your nose Brush your teeth gently with a soft toothbrush and maintain good oral hygiene When shaving use an electronic razor instead of razor blades Use a nail file instead of nail clippers Call your care provider if you have bleeding that won’t stop Examples include: A bloody nose that bleeds for more than five minutes despite pressure A cut that continues to ooze despite pressure Gums that bleed excessively when you floss or brush Seek medical help immediately if you experience any severe headaches blood in your urine or stool coughing up blood or prolonged and uncontrollable bleeding You may need to take a break or “hold” your medication for medical or dental procedures Talk to your care provider or dentist before any scheduled procedures Continued on the next page EVEROLIMUS ORAL CHEMOTHERAPY EDUCATION Page 5 Possible Side Effect Management Changes in kidney function Your kidney renal function will be checked periodically by a simple blood test Contact your care provider if you notice either of the following: Decreased amount of urination Unusual swelling in your legs and feet Decreased white blood cells WBCs and increased risk for infection including respiratory tract infections Your WBCs should be monitored by a simple blood test When your WBCs are low you are at a greater risk of having an infection Take the following precautions to protect yourself from infection Wash your hands often especially before eating and after using the bathroom Avoid crowds and people with fevers flu or other infection Bathe regularly to keep good personal hygiene Contact your care provider if you experience any signs or symptoms of an infection such as: Fever temperature more than 100 4°F or 38°C Chills Sore throat Burning with urination Unusual tiredness A sore that becomes red is draining or does not heal Report symptoms of a respiratory infection like a cough sneezing runny nose fever and scratchy or sore throat to your provider Check with your care provider before taking any medicine for a fever or chills Diarrhea loose and/ or urgent bowel movements Monitor how many bowel movements you have each day Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake related to some other health problem Eat small frequent meals throughout the day rather than a few large meals Eat bland low-fiber foods e g bananas applesauce potatoes chicken rice toast Avoid high-fiber foods such as raw vegetables raw fruits and whole grains Avoid foods that cause gas such as broccoli and beans Avoid lactose-containing foods such as yogurt and milk Avoid spicy fried and greasy foods Contact your provider if any of the following occur: The number of bowel movements you have in a day increases by four or more You feel dizzy or lightheaded Your care provider may recommend an over-the-counter medication called loperamide Imodium® to help with your diarrhea but talk to your care provider before starting this medication Continued on the next page EVEROLIMUS ORAL CHEMOTHERAPY EDUCATION Page 6 Possible Side Effect Management Fatigue You may be more tired than usual or have less energy Stay as active as possible but know it is okay to rest as needed too Try to do some activity every day Plan your activities and do them at a time of day when you feel a bit more energetic Avoid operating heavy machinery if you feel too tired Fluid retention or swelling Do not stand for long periods of time Keep your legs elevated when sitting or lying down Avoid eating salty foods which can increase swelling Avoid wearing tight-fitting clothing and shoes Weigh yourself daily Contact your care provider if you notice any of the following: Swelling in the hands feet or legs Shortness of breath Weight gain of five pounds or more in a week Abdominal pain Abdominal pain or discomfort may occur Report any serious pain or symptoms to your care provider immediately Headache Ask your provider what you may use to ease headaches Contact your care provider immediately if your headache: Follows a head injury Is severe especially if it starts suddenly Does not go away after three days Is associated with vomiting visual disturbance neck stiffness drowsiness confusion made worse by coughing or lowering the head rash weakness in an arm or leg or numbness Muscle or joint pain or weakness Keep a diary of your pain including a description of when and where the pain is occurring what it feels like and how long it lasts Stay as active as possible but know that it is okay to rest as needed too Tell your care provider if pain interferes with your activity If the pain or weakness bothers you ask your provider how you may ease this discomfort Continued on the next page EVEROLIMUS ORAL CHEMOTHERAPY EDUCATION Page 7 Possible Side Effect Management Nausea or vomiting Eat and drink slowly Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake Eat small frequent meals throughout the day rather than a few large meals Eat bland foods; avoid spicy fried and greasy foods Avoid vigorous exercise immediately after eating Don’t lay down immediately after eating Avoid strong odors Let your provider know if you experience nausea or vomiting Your provider may prescribe medication that can help Cough or shortness of breath A cough that does not produce any mucous or congestion relief dry cough may occur while taking this medication If you experience any breathing problems or shortness of breath notify your care provider immediately This may be a serious side effect of the medication Decreased appetite or weight loss Talk to your provider if you notice a decrease in your weight while taking this medication When you don’t feel like eating try the following: Eat frequent meals instead of three large meals each day Keep snacks nearby so you can eat when you feel hungry Drink liquid nutritional supplements Drink 8–10 glasses of water or fluid each day especially if you are not eating unless your care provider has instructed you to limit your fluid intake Drug and food interactions o Everolimus has many drug interactions Inform your care providers of all prescription medications over-the-counter medications vitamins and herbal products that you are taking o Grapefruit or grapefruit juice may interact with everolimus; avoid eating or drinking these during treatment with everolimus o Talk with your care provider or pharmacist before taking new medications or supplements or receiving any vaccines o Avoid live vaccines during treatment with everolimus If you experience ANY uncontrolled side effect call your physician or healthcare center immediately: _ INSTITUTIONAL CONTACT INFO EVEROLIMUS ORAL CHEMOTHERAPY EDUCATION Page 8 Important notice: The Association of Community Cancer Centers ACCC Hematology/Oncology Pharmacy Association HOPA National Community Oncology Dispensing Association Inc NCODA and Oncology Nursing Society ONS have collaborated in gathering information for and developing this patient education guide This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources This guide does not cover all existing information related to the possible uses directions doses precautions warnings interactions adverse effects or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional Provision of this guide is for informational purposes only and does not constitute or imply endorsement recommendation or favoring of this medication by ACCC HOPA NCODA or ONS who assume no liability for and cannot ensure the accuracy of the information presented The collaborators are not making any representations with respect to the medications whatsoever and any and all decisions with respect to such medications are at the sole risk of the individual consuming the medication All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional Permission: Oral Chemotherapy Education OCE sheets are provided as a free educational resource for patients with cancer in need of concise easy-to-understand information about oral cancer drugs Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information However commercial reproduction or reuse as well as rebranding or reposting of any type are strictly prohibited without permission of the copyright holder Please email permission requests and licensing inquiries to Contact@NCODA org Copyright © 2017 by Hematology/Oncology Pharmacy Association All rights reserved Pregnancy sexual activity and contraception o Women should not become pregnant and men should not get a partner pregnant while taking everolimus Men and women of childbearing age and potential should use effective contraception during therapy and for a minimum of eight weeks after the last dose of everolimus o Do not breastfeed while taking everolimus and for two weeks after the last dose of everolimus o Inform your care provider if you become pregnant o It is safe to hug and kiss Special precautions may be needed for sexual activity while on everolimus and you are encouraged to ask your care provider Obtaining medication Talk with your care provider about how to obtain your everolimus PHARMACY OR SPECIALTY PHARMACY CONTACT INFO Additional resources Product website: www us afinitor com Product prescribing information: www pharma us novartis com/sites/www pharma us novartis com/files/afinitor pdf Product resources: www us afinitor com/sega-tuberous-sclerosis www us afinitor com/angiomyolipoma-tsc www us afinitor com/progressive-nonfunctional-gi-neuroendocrine-tumor www us afinitor com/lung-neuroendocrine-tumors www us afinitor com/advanced-pancreatic-neuroendocrine-tumors Updated – August 20 2017 EVEROLIMUS ORAL CHEMOTHERAPY EDUCATION Page 9 Additional instructions

Alecensa®

(A-leh-SEN-suh)

Alecensa® (Alectinib) is used to treat metastatic non-small cell lung cancer (NSCLC) that has a genetic mutation called anaplastic lymphoma kinase (ALK).

Alecensa® (Alectinib) is used to treat metastatic non-small cell lung cancer (NSCLC) that has a genetic mutation called anaplastic lymphoma kinase (ALK).

Page 1 ALECTINIB ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — alectinib uh-LEK-tih-nib Brand name — Alecensa® A-leh-SEN-suh Approved uses Alectinib is used to treat metastatic non-small cell lung cancer NSCLC that has a genetic mutation called anaplastic lymphoma kinase ALK . Dose and schedule Taking alectinib as instructed is important to allow your treatment to be as effective as possible, so here are some key points to remember. Your dose may vary, but the usual dose of alectinib is 600 milligrams 600 mg to be taken by mouth at a scheduled time, two times a day. Alectinib should be taken with food and at the same times each day. Alectinib should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow alectinib, talk to your care provider or pharmacist for possible options. If you miss a dose of alectinib, do not take an extra dose or two doses at one time. Simply take your next dose at the regularly scheduled time. Be sure to write down if you miss a dose and let your care provider know about any missed doses. Storage and handling Handle alectinib with care. Just like when chemotherapy is given into the vein, this drug can be toxic, and exposure of the drug to others should be limited. Store alectinib at room temperature 68°F–77°F in a dry location away from light. Keep alectinib out of reach of children and pets. Leave alectinib in the provided packaging until it is ready to be taken. Whenever possible, you should give alectinib to yourself and follow the steps below. If a family member, friend, or caregiver needs to give the alectinib to you, they also need to follow these steps: 1. Wash hands with soap and water. 2. Put on gloves to avoid touching the medication. Gloves are not necessary if you give the drug to yourself. 3. Gently transfer the alectinib from its package to a small medicine or other disposable cup. 4. Administer the medicine immediately by mouth with water. 5. Remove gloves and do not use them for anything else. 6. Throw gloves and medicine cup in household trash. 7. Wash hands with soap and water. ALECTINIB ORAL CHEMOTHERAPY EDUCATION Page 2 A daily pill box or pill reminder is not recommended to be used with alectinib. Keep alectinib in the original container until use. If you have any unused alectinib, do not throw it in the trash and do not flush it down the sink or toilet. Talk to your care provider or pharmacist about proper disposal of alectinib. If you are traveling, put your alectinib in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Since alectinib remains in your body for several days after it is taken, some of the drug may be present in urine, stool, sweat, or vomit. Once you have started to take alectinib, it is important to follow the instructions below every day for as long as your treatment lasts. This is to keep yourself, loved ones, and the environment as safe as possible. Pregnant women should avoid touching anything that may be soiled with body fluids from the patient. Toilet and septic systems You may use the same toilet, septic tank, and/or sewer that you usually use. If you have a low-flow toilet, close the lid and flush twice to ensure all waste has been discarded. If the toilet or toilet seat becomes soiled with urine, stool, or vomit, clean the surfaces before other people use the toilet. Wash hands with soap and water after using the toilet. If you need a bedpan, be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day. If you do not have good control of bladder or bowels, use a disposable pad with a plastic back, a diaper, or a sheet to absorb body waste. Wash any skin that has been exposed to body waste or alectinib with soap and water. Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing. If you do not have a washer, place the soiled linens in a plastic bag until they can be washed. Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids. Drug and food interactions Alectinib has many drug interactions. Please inform your care provider of all prescription medications, over-the-counter medications, vitamins, and herbal products. Alectinib should be taken with food. Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. ALECTINIB ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Alectinib The common side effects that have been known to happen in more than 30% of patients taking alectinib are listed in the left side of this table. You MAY NOT experience these side effects. Options to help manage any side effects that do occur are included on the right side of this table. These should be discussed with your care provider. If you experience any side effect you cannot manage or that is not listed here, contact your care provider. Possible Side Effect Management Decreased hemoglobin, part of the red blood cells that carry iron and oxygen Your hemoglobin should be monitored by a simple blood test. When your hemoglobin is low, you may notice that you get tired or fatigued more easily. Try to get 7–8 hours of sleep per night. Avoid operating heavy machinery if you feel too tired. Find a balance between work and rest. Stay as active as possible, but know that it is okay to rest as needed. You might notice that you are more pale than usual. Let your care provider know right away if you experience any of the following: Shortness of breath Dizziness Palpitations Changes in liver function Your liver function will be checked periodically by a simple blood test. Contact your care provider if you notice any of the following: Yellowing of the skin or whites of your eyes Dark or brown urine Bleeding or bruising Changes in electrolytes and other laboratory values High creatine phosphokinase levels High glucose levels Low calcium levels Changes in some lab values may occur and will be monitored by a simple blood test. You may not feel any symptoms if the changes are mild, and they usually are not a sign of a serious problem. More severe changes may occur, which can be a sign of a serious problem. Notify your care provider if you have any of the following: Shortness of breath Chest discomfort Weakness or fatigue New aches and pains Headaches Dizziness Swelling of your legs or feet Red- or brown-colored urine Continued on the next page ALECTINIB ORAL CHEMOTHERAPY EDUCATION Page 4 Possible Side Effect Management Fatigue You may be more tired than usual or have less energy. Stay as active as possible, but know it is okay to rest as needed. Try to do some activity every day. Plan your activities, and do them at a time of day when you feel a bit more energetic. Avoid operating heavy machinery if you feel too tired. Constipation Monitor how many bowel movements you have each day. Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake. Stay active and exercise, if possible. Eat foods high in fiber, like raw fruits and vegetables. Contact your care provider if you have not had a bowel movement in three or more days. Your care provider may recommend over-the-counter medications to help with your constipation. A daily stool softener, such as docusate Colace® , and/or a laxative, such as senna Senokot® , may be helpful. If these do not help within 48 hours, tell your provider. Fluid retention or swelling Do not stand for long periods of time. Keep your legs elevated when sitting or lying down. Avoid eating salty foods, which can increase swelling. Avoid wearing tight-fitting clothing and shoes. Weigh yourself daily. Contact your care provider if you notice: Swelling in the hands, feet, or legs If you experience ANY uncontrolled side effect, call your physician or healthcare center immediately: INSTITUTIONAL CONTACT INFO Pregnancy, sexual activity, and contraception Women should not become pregnant and men should not get a partner pregnant while taking alectinib. Females of childbearing age and potential should use effective contraception during therapy and for a minimum of one week after the last dose of alectinib. Males with female partners of childbearing age and potential should use effective contraception during therapy and for a minimum of three months after the last dose of alectinib. Do not breastfeed while taking alectinib and for one week after the last dose of alectinib. Please inform your care provider if you become pregnant. It is safe to hug and kiss. Special precautions may be needed for sexual activity while on oral chemotherapy, and you are encouraged to ask your care provider. ALECTINIB ORAL CHEMOTHERAPY EDUCATION Page 5 Obtaining medication Talk with your care provider about the process for obtaining your alectinib. PHARMACY OR SPECIALTY PHARMACY CONTACT INFO Additional resources Product website: www.alecensa.com Product prescribing information: www.gene.com/download/pdf/alecensa prescribing.pdf Product resources: www.alecensa.com/patient/patient-support/financial-and-other-resources.html Updated – November 6, 2017 Additional instructions Important notice: The Association of Community Cancer Centers ACCC , Hematology/Oncology Pharmacy Association HOPA , National Community Oncology Dispensing Association, Inc. NCODA , and Oncology Nursing Society ONS have collaborated in gathering information for and developing this patient education guide. This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this medication by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Oral Chemotherapy Education OCE sheets are provided as a free educational resource for patients with cancer in need of concise, easy-to-understand information about oral cancer drugs. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2017 by Hematology/Oncology Pharmacy Association. All rights reserved.

Alkeran®

(AL-keh-ran)

Alkeran® (Melphalan) is used to treat multiple myeloma (MM) and ovarian cancer.

Alkeran® (Melphalan) is used to treat multiple myeloma (MM) and ovarian cancer.

Page 1 MELPHALAN ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — melphalan MEL fuh lan Brand name — Alkeran® AL keh ran Approved uses Melphalan is used to treat multiple myeloma MM and ovarian cancer. Dose and schedule Taking melphalan as instructed is important to allow your treatment to be as effective as possible, so here are some key points to remember. Your dose is based on many factors, including your height and weight, overall health and diagnosis. Melphalan should be taken on an empty stomach at least 1 hour before or 2 hours after a meal or snack , but at the same time each day. Melphalan should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow melphalan, talk to your care provider or pharmacist for possible options. If you miss a dose of melphalan, do not take an extra dose or two doses at one time. Simply take your next dose at the regularly scheduled time. Be sure to write down if you miss a dose and let your care provider know about any missed doses. Storage and handling Handle melphalan with care. Just like when chemotherapy is given into the vein, this drug can be toxic, and exposure of the drug to others should be limited. Store melphalan in the refrigerator 36°F–46°F in a dry location protected from light. Keep melphalan out of reach of children and pets. Leave melphalan in the provided packaging until it is ready to be taken. Whenever possible, you should give melphalan to yourself and follow the steps below. If a family member, friend, or caregiver needs to give the melphalan to you, they also need to follow these steps: 1. Wash hands with soap and water. 2. Put on gloves to avoid touching the medication. Gloves are not necessary if you give the drug to yourself. 3. Gently transfer the melphalan from its package to a small medicine or other disposable cup. 4. Administer the medicine immediately by mouth with water. 5. Remove gloves and do not use them for anything else. 6. Throw gloves and medicine cup in household trash. 7. Wash hands with soap and water. A daily pill box or pill reminder is not recommended to be used with melphalan. If you have any unused melphalan, do not throw it in the trash and do not flush it down the sink or toilet. Talk to your care provider or pharmacist about proper disposal of melphalan. MELPHALAN ORAL CHEMOTHERAPY EDUCATION Page 2 If you are traveling, put your melphalan in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Since melphalan remains in your body for several days after it is taken, some of the drug may be present in urine, stool, sweat, or vomit. Once you have started to take melphalan, it is important to know the following instructions every day for as long as your treatment lasts. This is to keep yourself, loved ones, and the environment as safe as possible. Pregnant women should avoid touching anything that may be soiled with body fluids from the patient. Toilet and septic systems You may use the same toilet, septic tank, and/or sewer that you usually use. If you have a low flow toilet, close the lid and flush twice to ensure all waste has been discarded. If the toilet or toilet seat becomes soiled with urine, stool, or vomit, clean the surfaces before other people use the toilet. Wash hands with soap and water after using the toilet. If you need a bedpan, be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day. If you do not have good control of bladder or bowels, use a disposable pad with a plastic back, a diaper, or a sheet to absorb body waste. Wash any skin that has been exposed to body waste or melphalan with soap and water. Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing. If you do not have a washer, place the soiled linens in a plastic bag until they can be washed. Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids. Drug and food interactions Melphalan has many drug interactions, please inform your care providers of all prescription medications, over the counter medications, vitamins, and herbal products. Melphalan should be taken on an empty stomach at least 1 hour before or 2 hours after a meal or snack . Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. Avoid live vaccines during treatment with melphalan. Serious side effects of melphalan Bone marrow suppression is a decrease in the number of white blood cells, red blood cells, and platelets, and can be a severe side effect of melphalan. Speak to your care provider to know when you need to have laboratory tests done to monitor your blood cell counts. Secondary malignancy is the growth of a cancer months or years after treatment. This is a rare but possible side effect of treatment with melphalan. MELPHALAN ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Melphalan The common side effects that have been known to happen in more than 30% of patients taking melphalan are listed in the left side of this table. You MAY NOT experience these side effects. Options to help manage any side effects that do occur are included on the right side of this table. These should be discussed with your care provider. If you experience any side effect you cannot manage or that is not listed here, contact your care provider. Possible Side Effect Management Decreased white blood cells WBCs and increased risk for infection Your WBCs should be monitored by a simple blood test. When your WBCs are low, you are at a greater risk of having an infection. Take the following precautions to protect yourself from infection. Wash your hands often, especially before eating and after using the bathroom. Avoid crowds and people with fevers, flu, or other infection. Bathe regularly to keep good personal hygiene. Contact your care provider if you experience any signs or symptoms of an infection such as: Fever temperature more than 100.4°F or 38°C Chills Sore throat Burning with urination Unusual tiredness A sore that becomes red, is draining, or does not heal Check with your care provider before taking any medicine for a fever or chills. Decreased platelet count and increased risk of bleeding Your platelets should be monitored by a simple blood test. When they are low, you may bruise or bleed more easily than usual. Use caution to avoid bruises, cuts, or burns. Blow your nose gently, and do not pick your nose. Brush your teeth gently with a soft toothbrush, and maintain good oral hygiene. When shaving, use an electronic razor instead of razor blades. Use a nail file instead of nail clippers. Call your care provider if you have bleeding that won’t stop. Examples include: A bloody nose that bleeds for more than 5 minutes despite pressure A cut that continues to ooze despite pressure Gums that bleed excessively when you floss or brush Seek medical help immediately if you experience any severe headaches, observe blood in your urine or stool, cough up blood, or experience prolonged and uncontrollable bleeding. You may need to take a break or hold your medication for medical or dental procedures. Talk to your care provider or dentist before any scheduled procedures. Continued on the next page MELPHALAN ORAL CHEMOTHERAPY EDUCATION Page 4 Possible Side Effect Management Decreased hemoglobin, part of the red blood cells that carry iron and oxygen Your hemoglobin should be monitored by a simple blood test. When your hemoglobin is low, you may notice that you get tired or fatigued more easily. Try to get 7–8 hours of sleep per night. Avoid operating heavy machinery if you feel too tired. Find a balance between work and rest. Stay as active as possible, but know that it is okay to rest as needed. You might notice that you are more pale than usual. Let your care provider know right away if you experience: Shortness of breath Dizziness Palpitations Nausea or vomiting Eat and drink slowly. Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake. Eat small, frequent meals throughout the day rather than a few large meals. Eat bland foods. Avoid spicy, fried, and greasy foods. Avoid vigorous exercise immediately after eating. Don’t lie down immediately after eating. Avoid strong odors. Let your provider know if you experience nausea or vomiting. Your provider may prescribe medication to help with the nausea or vomiting. If you experience ANY uncontrolled side effect, call your physician or healthcare center immediately: INSTITUTIONAL CONTACT INFO Pregnancy, sexual activity, and contraception Women should not become pregnant and men should not get a partner pregnant while taking melphalan. Men and women of childbearing age and potential should use effective contraception during therapy and for a minimum of one month after the last dose of melphalan. Do not breastfeed while taking melphalan and for one month after the last dose of melphalan. Please inform your care provider if you become pregnant. It is safe to hug and kiss. Special precautions may be needed for sexual activity while on oral chemotherapy, and you are encouraged to ask your care provider. MELPHALAN ORAL CHEMOTHERAPY EDUCATION Page 5 Obtaining medication Talk with your care provider about the process for obtaining your melphalan. PHARMACY OR SPECIALTY PHARMACY CONTACT INFO Additional resources Product prescribing information: https://www.accessdata.fda.gov/drugsatfda docs/ label/2011/014691s029lbl.pdf Updated — March 14, 2018 Additional instructions Important notice: The Association of Community Cancer Centers ACCC , Hematology/Oncology Pharmacy Association HOPA , National Community Oncology Dispensing Association, Inc. NCODA , and Oncology Nursing Society ONS have collaborated in gathering information for and developing this patient education guide. This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this medication by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Oral Chemotherapy Education OCE sheets are provided as a free educational resource for patients with cancer in need of concise, easy to understand information about oral cancer drugs. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2018 by Hematology/Oncology Pharmacy Association. All rights reserved.

Arimidex®

(uh-RIH-mih-dex)

Arimidex® (Anastrozole) is used in postmenopausal women as: • A first-step treatment for breast cancer that has spread beyond the breast itself and is either hormone-dependent or has an uknown hormone status • Treatment for early-stage hormone-dependent breast cancer after surgery with ...

Arimidex® (Anastrozole) is used in postmenopausal women as: • A first-step treatment for breast cancer that has spread beyond the breast itself and is either hormone-dependent or has an uknown hormo...

Page 1 ANASTROZOLE ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — anastrozole an AS-troh-zole Brand name — Arimidex® uh-RIH-mih-dex Approved uses Anastrozole is used in postmenopausal women as: A first-step treatment for breast cancer that has spread beyond the breast itself and is either hormone-dependent or has an uknown hormone status Treatment for early-stage hormone-dependent breast cancer after surgery with or without radiation therapy Treatment for advanced stage breast cancer that has progressed after treatment with tamoxifen Nolvadex® Dose and schedule Taking anastrozole as instructed is important to allow your treatment to be as effective as possible, so here are some key points to remember. Your dose may vary, but the usual dose of anastrozole is 1 milligram 1 mg to be taken by mouth at a scheduled time once a day. Anastrozole can be taken with or without food but at the same time each day. Anastrozole should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow anastrozole, talk to your care provider or pharmacist for possible options. If you miss a dose of anastrozole, do not take an extra dose or two doses at one time. Simply take your next dose at the regularly scheduled time. Be sure to write down if you miss a dose and let your care provider know about any missed doses. Storage and handling Handle anastrozole with care. Just like when chemotherapy is given into the vein, this drug can be toxic, and exposure of the drug to others should be limited. Store anastrozole at room temperature 68°F–77°F in a dry location away from light. Keep anastrozole out of reach of children and pets. Leave anastrozole in the provided packaging until it is ready to be taken. Whenever possible, give anastrozole to yourself and follow the steps below. If a family member, friend, or caregiver needs to give anastrozole to you, they also need to follow these steps: 1. Wash hands with soap and water. 2. Put on gloves to avoid touching the medication. Gloves are not necessary if you give the drug to yourself. 3. Gently transfer the anastrozole from its package to a small medicine or other disposable cup. ANASTROZOLE ORAL CHEMOTHERAPY EDUCATION Page 2 4. Administer the medicine immediately by mouth with water. 5. Remove gloves and do not use them for anything else. 6. Throw gloves and medicine cup in household trash. 7. Wash hands with soap and water. If a daily pill box or pill reminder is used, a separate one should be used for anastrozole. Do not mix other medications into the box with anastrozole. The person filling the box or reminder should wear gloves. Gloves are not necessary if you are filling the box or reminder. When empty, the box or reminder should be washed with soap and water before refilling. Be sure to wash hands with soap and water after the task is complete, whether or not gloves are worn. If you have any unused anastrozole, do not throw it in the trash and do not flush it down the sink or toilet. Talk to your care provider or pharmacist about proper disposal of anastrozole. If you are traveling, put your anastrozole in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Anastrozole remains in your body for several days after it is taken, so some of the drug may be present in urine, stool, sweat, or vomit. Once you have started to take anastrozole, it is important to follow the instructions below every day for as long as your treatment lasts. This will keep yourself, loved ones, and the environment as safe as possible. Pregnant women should avoid touching anything that may be soiled with body fluids from the patient. Toilet and septic systems You may use the same toilet, septic tank, and/or sewer that you usually use. If you have a low-flow toilet, close the lid and flush twice to ensure all waste has been discarded. If the toilet or toilet seat becomes soiled with urine, stool, or vomit, clean the surfaces before other people use the toilet. Wash hands with soap and water after using the toilet. If you need a bedpan, be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day. If you do not have good control of bladder or bowels, use a disposable pad with a plastic back, a diaper, or a sheet to absorb body waste. Wash any skin that has been exposed to body waste or anastrozole with soap and water. Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing. If you do not have a washer, place the soiled linens in a plastic bag until they can be washed. Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids. ANASTROZOLE ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Anastrozole The common side effects that have been known to happen in more than 30% of patients taking anastrozole are listed in the left side of this table. You MAY NOT experience these side effects. Options to help manage any side effects that do occur are included on the right side of this table. These should be discussed with your care provider. If you experience any side effect you cannot manage or that is not listed here, contact your care provider. Possible Side Effect Management Hot flashes sudden sweating and feelings of warmth If hot flashes are bothersome: Mild, regular exercise may help. Consult first with your care provider. Try staying in a cool environment. Wear layers so that if you experience a hot flash, the outer layers may be removed. Avoid or limit caffeine, spicy food, alcohol, and stress, which may cause hot flashes to worsen. Inform your care provider if this side effect is bothersome as there may be medications that can help with hot flashes. Muscle or joint pain or weakness Keep a diary of your pain, including a description of when and where the pain is occurring, what it feels like, and how long it lasts. Stay as active as possible, but know that it is okay to rest as needed, too. Tell your care provider if pain interferes with your activity. If the pain or weakness bothers you, ask your provider what you may use to help with this discomfort. Take only pain medication that has been prescribed or recommended by your care provider. Drug and food interactions Anastrozole has many drug interactions. Inform your care providers of all prescription medications, over-the-counter medications, vitamins, and herbal products that you are taking. Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. If you experience ANY uncontrolled side effect, call your physician or healthcare center immediately: INSTITUTIONAL CONTACT INFO Pregnancy, sexual activity, and contraception Women should not become pregnant and men should not get a partner pregnant while taking anastrozole. Men and women of childbearing age and potential should use effective contraception during therapy and for a minimum of one month after the last dose of anastrozole. Inform your care provider if you become pregnant. Do not breastfeed while taking anastrozole and for one month after the last dose of anastrozole. It is safe to hug and kiss. Special precautions may be needed for sexual activity while on anastrozole, and you are encouraged to ask your care provider. ANASTROZOLE ORAL CHEMOTHERAPY EDUCATION Page 4 Obtaining medication Talk with your care provider about how to obtain your anastrozole. PHARMACY OR SPECIALTY PHARMACY CONTACT INFO Additional resources Anastrozole drug information: www.arimidex.com Product prescribing information: www.arimidex.com/prescribing-information.html Product resources: www.arimidex.com/support-breast-cancer.html Updated – August 24, 2017 Additional instructions Important notice: The Association of Community Cancer Centers ACCC , Hematology/Oncology Pharmacy Association HOPA , National Community Oncology Dispensing Association, Inc. NCODA , and Oncology Nursing Society ONS have collaborated in gathering information for and developing this patient education guide. This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this medication by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Oral Chemotherapy Education OCE sheets are provided as a free educational resource for patients with cancer in need of concise, easy-to-understand information about oral cancer drugs. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2017 by Hematology/Oncology Pharmacy Association. All rights reserved.

Aromasin®

(uh-ROH-muh-sin)

Aromasin® (Exemestane) is used in the treatment of certain types of hormone-dependent breast cancer in postmenopausal women.

Aromasin® (Exemestane) is used in the treatment of certain types of hormone-dependent breast cancer in postmenopausal women.

Page 1 EXEMESTANE ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — exemestane EK seh MEH stayn Brand name — Aromasin® uh ROH muh sin Approved uses Exemestane is used in the treatment of certain types of hormone dependent breast cancer in postmenopausal women Dose and schedule Taking exemestane as instructed is important to allow your treatment to be as effective as possible so here are some key points to remember o Your dose may vary but the usual dose of exemestane is 25 milligrams 25 mg to be taken by mouth at a scheduled time once a day o Exemestane should be taken with food at the same time each day o Exemestane should be taken whole and not crushed cut or dissolved If you are unable to swallow exemestane talk to your care provider or pharmacist for possible options o If you miss a dose of exemestane do not take an extra dose or two doses at one time Simply take your next dose at the regularly scheduled time Be sure to write down if you miss a dose and let your care provider know about any missed doses Storage and handling Handle exemestane with care Just like when chemotherapy is given into the vein this drug can be toxic and exposure of the drug to others should be limited o Store exemestane at room temperature 68°F–77°F in a dry location away from light o Keep exemestane out of reach of children and pets o Leave exemestane in the provided packaging until it is ready to be taken o Whenever possible give exemestane to yourself and follow the steps below If a family member friend or caregiver needs to give exemestane to you they also need to follow these steps 1 Wash hands with soap and water 2 Put on gloves to avoid touching the medication Gloves are not necessary if you give the drug to yourself 3 Gently transfer the exemestane from its package to a small medicine or other disposable cup 4 Administer the medicine immediately by mouth with water 5 Remove gloves and do not use them for anything else 6 Throw gloves and medicine cup in household trash 7 Wash hands with soap and water EXEMESTANE ORAL CHEMOTHERAPY EDUCATION Page 2 o If a daily pill box or pill reminder is used a separate one should be used for exemestane Do not mix other medications into the box with exemestane The person filling the box or reminder should wear gloves gloves are not necessary if you are filling the box or reminder When empty the box or reminder should be washed with soap and water before refilling Be sure to wash hands with soap and water after the task is complete whether or not gloves are worn o If you have any unused exemestane do not throw it in the trash and do not flush it down the sink or toilet Talk to your care provider or pharmacist about proper disposal of exemestane o If you are traveling put your exemestane in a sealed plastic bag Ask your pharmacist if any additional travel precautions are needed Handling body fluids and waste Because exemestane remains in your body for several days after it is taken some of the drug may be present in urine stool sweat or vomit Once you have started to take exemestane it is important to follow the instructions below every day for as long as your treatment lasts This is to keep yourself loved ones and the environment as safe as possible o Pregnant women should avoid touching anything that may be soiled with body fluids from the patient o Toilet and septic systems You may use the same toilet septic tank and/or sewer that you usually use If you have a low flow toilet close the lid and flush twice to ensure all waste has been discarded If the toilet or toilet seat becomes soiled with urine stool or vomit clean the surfaces before other people use the toilet Wash hands with soap and water after using the toilet o If you need a bedpan be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day o If you do not have good control of bladder or bowels use a disposable pad with a plastic back a diaper or a sheet to absorb body waste o Wash any skin that has been exposed to body waste or exemestane with soap and water o Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing If you do not have a washer place the soiled linens in a plastic bag until they can be washed o Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids Drug and food interactions o Exemestane has many drug interactions Inform your care providers of all prescription medications over the counter medications vitamins and herbal products o Exemestane should be taken with food o Talk with your care provider or pharmacist before taking new medications or supplements or receiving any vaccines EXEMESTANE ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Exemestane The common side effects that have been known to happen in more than 30% of patients taking exemestane are listed in the left side of this table You MAY NOT experience these side effects Options to help manage any side effects that do occur are included on the right side of this table These should be discussed with your care provider If you experience any side effect you cannot manage or that is not listed here contact your care provider Possible Side Effect Management Hot flashes sudden sweating and feelings of warmth If hot flashes are bothersome Mild regular exercise program may help Consult first with your care provider Try staying in a cool environment Wear layers so that you can remove outer layers when experiencing a hot flash Avoid or limit caffeine spicy food alcohol and stress which may worsen hot flashes Inform your care provider if your hot flashes are bothersome as there may be medications that can help If you experience ANY uncontrolled side effect call your physician or healthcare center immediately INSTITUTIONAL CONTACT INFO Pregnancy sexual activity and contraception o Women should not become pregnant and men should not get a partner pregnant while taking exemestane Men and women of childbearing age and potential should use effective contraception during therapy and for a minimum of one month after the last dose of exemestane o Do not breastfeed while taking exemestane and for one month after the last dose of exemestane o Inform your care provider if you become pregnant o It is safe to hug and kiss Special precautions may be needed for sexual activity while on oral chemotherapy and you are encouraged to ask your care provider Obtaining medication o Talk with your care provider about the process for obtaining your exemestane PHARMACY OR SPECIALTY PHARMACY CONTACT INFO EXEMESTANE ORAL CHEMOTHERAPY EDUCATION Page 4 Additional resources Product website www pfizer com/products/product detail/aromasin Product prescribing information http //labeling pfizer com/ShowLabeling aspx?id=523 Product resources www aromasin com/tools and resources Updated – September 3 2017 Additional instructions Important notice The Association of Community Cancer Centers ACCC Hematology/Oncology Pharmacy Association HOPA National Community Oncology Dispensing Association Inc NCODA and Oncology Nursing Society ONS have collaborated in gathering information for and developing this patient education guide This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources This guide does not cover all existing information related to the possible uses directions doses precautions warnings interactions adverse effects or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional Provision of this guide is for informational purposes only and does not constitute or imply endorsement recommendation or favoring of this medication by ACCC HOPA NCODA or ONS who assume no liability for and cannot ensure the accuracy of the information presented The collaborators are not making any representations with respect to the medications whatsoever and any and all decisions with respect to such medications are at the sole risk of the individual consuming the medication All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional Permission Oral Chemotherapy Education OCE sheets are provided as a free educational resource for patients with cancer in need of concise easy to understand information about oral cancer drugs Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information However commercial reproduction or reuse as well as rebranding or reposting of any type are strictly prohibited without permission of the copyright holder Please email permission requests and licensing inquiries to Contact@NCODA org Copyright © 2017 by Hematology/Oncology Pharmacy Association All rights reserved

Bosulif®

(BAH-soo-lif)

Bosulif® (Bosutinib) is used to treat adults with chronic myeloid leukemia (CML) that is Philadelphia chromosome–positive (Ph+).

Bosulif® (Bosutinib) is used to treat adults with chronic myeloid leukemia (CML) that is Philadelphia chromosome–positive (Ph+).

Page 1 BOSUTINIB ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — bosutinib bah SOO tih nib Brand name — Bosulif® BAH soo lif Approved uses Bosutinib is used to treat adults with chronic myeloid leukemia CML that is Philadelphia chromosome–positive Ph+ . Dose and schedule Taking bosutinib as instructed is important to allow your treatment to be as effective as possible, so here are some key points to remember. Your dose may vary, but the usual adult dose of bosutinib is 400 milligrams 400 mg to 500 milligrams 500 mg to be taken by mouth at a scheduled time once a day. Bosutinib should be taken with food at the same time each day. Bosutinib should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow bosutinib, talk to your care provider or pharmacist for possible options. If you miss a dose of bosutinib: Only take the missed dose if it has been less than 12 hours since you were supposed to take it. Then, take the next dose at the regularly scheduled time. Do not take the missed dose if it has been more than 12 hours since you should have taken it. Simply take your next dose at the regularly scheduled time. Do not take two doses at one time. Be sure to write down if you miss a dose, and let your care provider know about any missed doses. Storage and handling Handle bosutinib with care. Just like when chemotherapy is given into the vein, this drug can be toxic, and exposure of the drug to others should be limited. Store bosutinib at room temperature 68°F–77°F in a dry location away from light. Keep bosutinib out of reach of children and pets. Leave bosutinib in the provided packaging until it is ready to be taken. Whenever possible, give bosutinib to yourself and follow the steps below. If a family member, friend, or caregiver needs to give bosutinib to you, they also need to follow these steps. 1. Wash hands with soap and water. 2. Put on gloves to avoid touching the medication. Gloves are not necessary if you give the drug to yourself. 3. Gently transfer the bosutinib from its package to a small medicine or other disposable cup. 4. Administer the medicine immediately by mouth with water. 5. Remove gloves and do not use them for anything else. BOSUTINIB ORAL CHEMOTHERAPY EDUCATION Page 2 6. Throw gloves and medicine cup in household trash. 7. Wash hands with soap and water. If a daily pill box or pill reminder is used, a separate one should be used for bosutinib. Do not mix other medications into the box with bosutinib. The person filling the box or reminder should wear gloves. Gloves are not necessary if you are filling the box or reminder. When empty, the box or reminder should be washed with soap and water before refilling. Be sure to wash hands with soap and water after the task is complete, whether or not gloves are worn. If you have any unused bosutinib, do not throw it in the trash and do not flush it down the sink or toilet. Talk to your care provider or pharmacist about proper disposal of bosutinib. If you are traveling, put your bosutinib in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Since bosutinib remains in your body for several days after it is taken, some of the drug may be present in urine, stool, sweat, or vomit. Once you have started to take bosutinib, it is important to follow the instructions below every day for as long as your treatment lasts. This will keep yourself, loved ones, and the environment as safe as possible. Pregnant women should avoid touching anything that may be soiled with body fluids from the patient. Toilet and septic systems You may use the same toilet, septic tank, and/or sewer that you usually use. If you have a low flow toilet, close the lid and flush twice to ensure all waste has been discarded. If the toilet or toilet seat becomes soiled with urine, stool, or vomit, clean the surfaces before other people use the toilet. Wash hands with soap and water after using the toilet. If you need a bedpan, be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day. If you do not have good control of bladder or bowels, use a disposable pad with a plastic back, a diaper, or a sheet to absorb body waste. Wash any skin that has been exposed to body waste or bosutinib with soap and water. Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing. If you do not have a washer, place the soiled linens in a plastic bag until they can be washed. Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids. Drug and food interactions Bosutinib has many drug interactions, please inform your care providers of all prescription medications, over the counter medications, vitamins, and herbal products that you are taking. Bosutinib should be taken with food. Grapefruit or grapefruit juice may interact with bosutinib; avoid eating or drinking these during your treatment with bosutinib. Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. BOSUTINIB ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Bosutinib The common side effects that have been known to happen in more than 30% of patients taking bosutinib are listed in the left side of this table. You MAY NOT experience these side effects. Options to help manage any side effects that do occur are included on the right side of this table. These should be discussed with your care provider. If you experience any side effect you cannot manage or that is not listed here, contact your care provider. Possible Side Effect Management Diarrhea loose and/ or urgent bowel movements Monitor how many bowel movements you have each day. Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake. Eat small, frequent meals throughout the day rather than a few large meals. Eat bland, low fiber foods, such as bananas, applesauce, potatoes, chicken, rice, and toast. Avoid high fiber foods, such as raw vegetables, raw fruits, and whole grains. Avoid foods that cause gas, such as broccoli and beans. Avoid lactose containing foods, such as yogurt and milk. Avoid spicy, fried, and greasy foods. Contact your provider if any of the following occur: The number of bowel movements you have in a day increases by 4 or more. You feel dizzy or lightheaded. Your care provider may recommend an over the counter medication called loperamide Imodium® to help with your diarrhea, but talk to your care provider before starting this medication. Decreased platelet count and increased risk of bleeding Your platelets should be monitored by a simple blood test. When they are low, you may bruise or bleed more easily than usual. Use caution to avoid bruises, cuts, or burns. Blow your nose gently, and do not pick your nose. Brush your teeth gently with a soft toothbrush, and maintain good oral hygiene. When shaving, use an electronic razor instead of razor blades. Use a nail file instead of nail clippers. Call your care provider if you have bleeding that won’t stop. Examples include: A bloody nose that bleeds for more than 5 minutes despite pressure A cut that continues to ooze despite pressure Gums that bleed excessively when you floss or brush Seek medical help immediately if you experience any severe headaches, observe blood in your urine or stool, cough up blood, or experience prolonged and uncontrollable bleeding. You may need to take a break or hold your medication for medical or dental procedures. Talk to your care provider or dentist before any scheduled procedures. Continued on the next page BOSUTINIB ORAL CHEMOTHERAPY EDUCATION Page 4 Possible Side Effect Management Nausea or vomiting Eat and drink slowly. Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake. Eat small, frequent meals throughout the day rather than a few large meals. Eat bland foods; avoid spicy, fried, and greasy foods. Avoid vigorous exercise immediately after eating. Don’t lie down immediately after eating. Avoid strong odors. Let your provider know if you experience nausea or vomiting. Your provider may prescribe medication to help with the nausea or vomiting. Rash or itchy skin Keep your skin moisturized with creams and moisturizing lotions to decrease the risk of rash or itchiness, and wear loose fitting clothing. Avoid using perfumes and cologne as these products may increase rash symptoms. Avoid being in the heat for long periods of time. Your provider may recommend an over the counter antihistamine or a topical cream. Sunlight can make symptoms worse. Avoid sun exposure as much as possible to decrease the risk of sunburn. The highest exposure to ultraviolet UV radiation occurs from 10 am–4 pm. Wear long sleeved clothing, with UV protection if possible. Wear broad brimmed hats. Apply broad spectrum sunscreen UVA/UVB with at least SPF 30 as often as directed on the bottle. Use lip balm with at least SPF 30. If your rash or itching continues to worsen, contact your care provider. Abdominal pain Abdominal pain/discomfort may occur. Report any serious pain or symptoms to your care provider immediately. If these side effects occur with nausea and vomiting, you might have inflammation of your pancreas pancreatitis . Continued on the next page BOSUTINIB ORAL CHEMOTHERAPY EDUCATION Page 5 Possible Side Effect Management Decreased white blood cells WBCs and increased risk for infection Your WBCs should be monitored by a simple blood test. When your WBCs are low, you are at a greater risk of having an infection. Take the following precautions to protect yourself from infection. Wash your hands often, especially before eating and after using the bathroom. Avoid crowds and people with fevers, flu, or other infection. Bathe regularly to keep good personal hygiene. Contact your care provider if you experience any signs or symptoms of an infection such as: Fever temperature more than 100.4°F or 38°C Chills Sore throat Burning with urination Unusual tiredness A sore that becomes red, is draining, or does not heal Check with your care provider before taking any medicine for a fever or chills. Decreased hemoglobin, part of the red blood cells that carry iron and oxygen Your hemoglobin should be monitored by a simple blood test. When your hemoglobin is low, you may notice that you get tired or fatigued more easily. Try to get 7–8 hours of sleep per night. Avoid operating heavy machinery if you feel too tired. Find a balance between work and rest. Stay as active as possible, but know that it is okay to rest as needed. You might notice that you are more pale than usual. Let your care provider know right away if you experience: Shortness of breath Dizziness Palpitations Changes in liver function Your liver function should be checked periodically by a simple blood test. Contact your care provider if you notice any of the following: Yellowing of the skin or whites of your eyes Dark or brown urine Bleeding or bruising If you experience ANY uncontrolled side effect, call your physician or healthcare center immediately: INSTITUTIONAL CONTACT INFO BOSUTINIB ORAL CHEMOTHERAPY EDUCATION Page 6 Pregnancy, sexual activity, and contraception Women should not become pregnant and men should not get a partner pregnant while taking bosutinib. Men and women of childbearing age and potential should use effective contraception during therapy and for a minimum of one month after the last dose of bosutinib. Do not breastfeed while taking bosutinib and for one month after the last dose of bosutinib. Please inform your care provider if you become pregnant. It is safe to hug and kiss. Special precautions may be needed for sexual activity while on bosutinib, and you are encouraged to ask your care provider. Obtaining medication Talk with your care provider about the process for obtaining your bosutinib. PHARMACY OR SPECIALTY PHARMACY CONTACT INFO Additional resources Product website: www.bosulif.com Product prescribing information: www.accessdata.fda.gov/drugsatfda docs/label/2012/203341lbl.pdf Product resources: https://www.bosulif.com/resources Updated — March 6, 2018 Additional instructions Important notice: The Association of Community Cancer Centers ACCC , Hematology/Oncology Pharmacy Association HOPA , National Community Oncology Dispensing Association, Inc. NCODA , and Oncology Nursing Society ONS have collaborated in gathering information for and developing this patient education guide. This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this medication by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Oral Chemotherapy Education OCE sheets are provided as a free educational resource for patients with cancer in need of concise, easy to understand information about oral cancer drugs. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2018 by Hematology/Oncology Pharmacy Association. All rights reserved.

Cabometyx™

(ka-boe-MET-iks)

Cabometyx™ (Cabozantinib) is used to treat patients with advanced kidney cancer (renal cell carcinoma) and those with progressive, metastatic medullary thyroid cancer.

Cabometyx™ (Cabozantinib) is used to treat patients with advanced kidney cancer (renal cell carcinoma) and those with progressive, metastatic medullary thyroid cancer.

Page 1 CABOZANTINIB ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — cabozantinib KA boe ZAN ti nib Brand name — Cabometyx™ for kidney cancer; ka boe MET iks ; Cometriq® for thyroid cancer; CO met rik Approved uses Cabozantinib is used to treat patients with advanced kidney cancer renal cell carcinoma and those with progressive, metastatic medullary thyroid cancer. Dose and schedule Taking cabozantinib as instructed is important to allow your treatment to be as effective as possible, so here are some key points to remember. Your dose may vary, but the usual dose of cabozantinib is: 60 milligrams 60 mg to be taken by mouth at a scheduled time once a day for kidney cancer 140 milligrams 140 mg to be taken by mouth at a scheduled time once a day for thyroid cancer Cabozantinib should be taken on an empty stomach do not eat for at least 2 hours before and at least 1 hour after taking cabozantinib at the same time each day. Do not substitute cabozantinib tablets with cabozantinib capsules. Cabozantinib should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow cabozantinib, talk to your care provider or pharmacist for possible options. If you miss a dose of cabozantinib, Only take the missed dose if it has been less than 12 hours since you were supposed to take it. Then, take the next dose at the regularly scheduled time. Do not take the missed dose if it has been more than 12 hours since you should have taken it. Simply take the next dose at the regularly scheduled time. Do not take two doses at one time. Be sure to write down if you miss a dose and let your care provider know about any missed doses. If you need to have surgery, tell your care provider you are taking cabozantinib. Cabozantinib may need to be stopped until your wound heals after some surgeries. Storage and handling Handle cabozantinib with care. Just like when chemotherapy is given into the vein, this drug can be toxic, and exposure of the drug to others should be limited. Store cabozantinib at room temperature 68°F–77°F in a dry location away from light. Keep cabozantinib out of reach of children and pets. Leave cabozantinib in the provided packaging until it is ready to be taken. Whenever possible, give cabozantinib to yourself and follow the steps below. If a family member, friend, or caregiver needs to give cabozantinib to you, they also need to follow these steps: 1. Wash hands with soap and water. 2. Put on gloves to avoid touching the medication. Gloves are not necessary if you give the drug to yourself. CABOZANTINIB ORAL CHEMOTHERAPY EDUCATION Page 2 3. Gently transfer the cabozantinib from its package to a small medicine or other disposable cup. 4. Administer the medicine immediately by mouth with water. 5. Remove gloves and do not use them for anything else. 6. Throw gloves and medicine cup in household trash. 7. Wash hands with soap and water. If a daily pill box or pill reminder is used, a separate one should be used for cabozantinib. Do not mix other medications into the box with cabozantinib. The person filling the box or reminder should wear gloves gloves are not necessary if you are filling the box or reminder . When empty, the box or reminder should be washed with soap and water before refilling. Be sure to wash hands with soap and water after the task is complete, whether or not gloves are worn. If you have any unused cabozantinib, do not throw it in the trash and do not flush it down the sink or toilet. Talk to your care provider or pharmacist about proper disposal of cabozantinib. If you are traveling, put your cabozantinib in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Because cabozantinib remains in your body for several days after it is taken, some of the drug may be present in urine, stool, sweat, or vomit. Once you have started to take cabozantinib, it is important to follow the instructions below every day for as long as your treatment lasts. This is to keep yourself, loved ones, and the environment as safe as possible. Pregnant women should avoid touching anything that may be soiled with body fluids from the patient. Toilet and septic systems You may use the same toilet, septic tank, and/or sewer that you usually use. If you have a low flow toilet, close the lid and flush twice to ensure all waste has been discarded. If the toilet or toilet seat becomes soiled with urine, stool, or vomit, clean the surfaces before other people use the toilet. Wash hands with soap and water after using the toilet. If you need a bedpan, be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day. If you do not have good control of bladder or bowels, use a disposable pad with a plastic back, a diaper, or a sheet to absorb body waste. Wash any skin that has been exposed to body waste or cabozantinib with soap and water. Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing. If you do not have a washer, place the soiled linens in a plastic bag until they can be washed. Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids. CABOZANTINIB ORAL CHEMOTHERAPY EDUCATION Page 3 Drug and food interactions Cabozantinib has many drug interactions. Inform your care providers of all prescription medications, over the counter medications, vitamins, and herbal products. Cabozantinib should be taken without food do not eat for at least 2 hours before and at least 1 hour after taking cabozantinib . Grapefruit or grapefruit juice may interact with cabozantinib; avoid eating or drinking these during treatment with cabozantinib. Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. Serious side effects of cabozantinib Cabozantinib that is taken for thyroid cancer can increase your risk of developing gastrointestinal fistulas and perforations holes to occur. Cabozantinib that is taken for thyroid cancer can increase your risk of bleeding. Side Effects of Cabozantinib The common side effects that have been known to happen in more than 30% of patients taking cabozantinib are listed in the left side of this table. You MAY NOT experience these side effects. Options to help manage any side effects that do occur are included on the right side of this table. These should be discussed with your care provider. If you experience any side effect you cannot manage or that is not listed here, contact your care provider. Possible Side Effect Management Changes in liver function Your liver function will be checked periodically by a simple blood test. Contact your care provider if you notice any of the following: Yellowing of the skin or whites of your eyes Dark or brown urine Bleeding or bruising Continued on the next page CABOZANTINIB ORAL CHEMOTHERAPY EDUCATION Page 4 Possible Side Effect Management Diarrhea loose and/ or urgent bowel movements Monitor how many bowel movements you have each day. Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake. Eat small, frequent meals throughout the day rather than a few large meals. Eat bland, low fiber foods e.g., bananas, applesauce, potatoes, chicken, rice, toast . Avoid high fiber foods e.g., raw vegetables, raw fruits, whole grains . Avoid foods that cause gas e.g., broccoli, beans . Avoid lactose containing foods e.g., yogurt, milk . Avoid spicy, fried, and greasy foods. Contact your provider if any of the following occur: The number of bowel movements you have in a day increases by four or more. You feel dizzy or lightheaded. Your care provider may recommend an over the counter medication called loperamide Imodium® to help with your diarrhea, but talk to your care provider before starting this medication. Changes in kidney function Your kidney renal function will be checked periodically by a simple blood test. Contact your care provider if you notice any of the following: Decreased amount of urination Unusual swelling in your legs and feet Fatigue You may be more tired than usual or have less energy. Stay as active as possible, but know it is okay to rest as needed, too. Try to do some activity every day. Plan your activities, and do them at a time of day when you feel a bit more energetic. Avoid operating heavy machinery if you feel too tired. Changes in electrolytes and other laboratory values Low calcium levels High triglyceride levels Low phosphate levels High glucose levels Low albumin levels Low magnesium levels Low sodium levels Changes in some laboratory values may occur and should be monitored by a simple blood test. You may not feel any symptoms if the changes are mild, and they usually are not a sign of a serious problem. More severe changes may occur, which can be a sign of a serious problem. Notify your care provider if you have any of the following: Shortness of breath Chest discomfort Weakness or fatigue New aches and pains Headaches Dizziness Swelling of your legs or feet Red or brown colored urine Continued on the next page CABOZANTINIB ORAL CHEMOTHERAPY EDUCATION Page 5 Possible Side Effect Management Nausea or vomiting Eat and drink slowly. Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake. Eat small, frequent meals throughout the day rather than a few large meals. Eat bland foods; avoid spicy, fried, and greasy foods. Avoid vigorous exercise immediately after eating. Don’t lie down immediately after eating. Avoid strong odors. Let your provider know if you experience nausea or vomiting. Your provider may prescribe medication that can help. Pain or discomfort in hands and/or feet Hand foot skin reaction HFSR appears on the palms of the hands and soles of the feet. It can appear as a rash, callus, or peeling skin, and the area has increased sensitivity to heat or a “pins and needles” sensation. Let your care provider know right away if you experience this side effect. To prevent HFSR, you can do the following: Soak your feet in a water bath with Epsom salt and gently pumice any callused skin. Exfoliate and keep hands and feet moisturized. Avoid tight fitting shoes or socks. Use cushioning i.e., gloves when performing activities that increase pressure on the palms of your hands. Mouth irritation or sores Practice good mouth care. Rinse your mouth frequently. Brush your teeth with a soft toothbrush or cotton swab after meals. Use a mild nonalcohol mouth rinse at least 4 times a day after eating and at bedtime . One example is a mixture of 1/8 teaspoon of salt and 1/4 teaspoon of baking soda in 8 ounces of warm not hot water. If you have sores in your mouth, avoid using tobacco products, alcohol, and mouthwashes that contain alcohol. Call your care provider if you experience pain or sores in your mouth or throat. Continued on the next page CABOZANTINIB ORAL CHEMOTHERAPY EDUCATION Page 6 Possible Side Effect Management Decreased white blood cells WBCs and increased risk for infection Your WBCs should be monitored by a simple blood test. When your WBCs are low, you are at a greater risk of having an infection. Take the following precautions to protect yourself from infection. Wash your hands often, especially before eating and after using the bathroom. Avoid crowds and people with fevers, flu, or other infection. Bathe regularly to keep good personal hygiene. Contact your care provider if you experience any signs or symptoms of an infection: Fever temperature more than 100.4°F or 38°C Chills Sore throat Burning with urination Unusual tiredness A sore that becomes red, is draining, or does not heal Check with your care provider before taking any medicine for a fever or chills. Decreased appetite or weight loss Talk to your care provider if you notice a decrease in weight while taking this medication. When you do not feel like eating, try the following: Eat small frequent meals instead of three large meals each day. Keep snacks nearby so you can eat when you feel hungry. Take liquid nutritional supplements. Drink 8–10 glasses of water or fluid each day, especially if you are not eating, unless your care provider has instructed you to limit your fluid intake. Increased blood pressure Routinely take your blood pressure. Record your blood pressure in a journal/diary and report these to your physician. Contact your healthcare provider for high blood pressure or if the following symptoms occur: Headache Dizziness Chest pain Shortness of breath Fluid retention, weight gain, or swelling Continued on the next page CABOZANTINIB ORAL CHEMOTHERAPY EDUCATION Page 7 Possible Side Effect Management Decreased platelet count and increased risk of bleeding Your platelets should be monitored by a simple blood test. When they are low, you may bruise or bleed more easily than usual. Use caution to avoid bruises, cuts, or burns. Blow your nose gently, and do not pick your nose. Brush your teeth gently with a soft toothbrush, and maintain good oral hygiene. When shaving, use an electronic razor instead of razor blades. Use a nail file instead of nail clippers. Call your care provider if you have bleeding that won’t stop. Examples include the following: A bloody nose that bleeds for more than five minutes despite pressure A cut that continues to ooze despite pressure Gums that bleed excessively when you floss or brush Seek medical help immediately if you experience any severe headaches, observe blood in your urine or stool, cough up blood, or experience prolonged and uncontrollable bleeding. You may need to take a break or “hold” your medication for medical or dental procedures. Talk to your care provider or dentist before any scheduled procedures. Hair color changes Changes to your hair color may occur during treatment. The hair usually returns to normal after treatment, but for some, the change is permanent. Taste changes Some people experience a metallic or bitter taste in their mouth. To help with taste changes, try the following: Choose and prepare foods that look and smell good to you. Use plastic utensils if food tastes like metal. Flavor foods with spices to change taste. Suck on mints or chew gum to mask taste. Brush teeth with a soft bristle toothbrush before and after eating. Avoid smoking. Notify your doctor if you are having trouble eating or are losing weight. Decreased hemoglobin, part of the red blood cells that carry iron and oxygen Your hemoglobin should be monitored using a blood test. When your hemoglobin is low, you may notice that you get tired or fatigued more easily. Try to get 7–8 hours of sleep per night. Avoid operating heavy machinery if you feel too tired. Find a balance between work and rest. Stay as active as possible, but know that it is okay to rest as needed. You might notice that you are more pale than usual. Let your healthcare provider know right away if you experience any of the following: Shortness of breath Dizziness Palpitations CABOZANTINIB ORAL CHEMOTHERAPY EDUCATION Page 8 If you experience ANY uncontrolled side effect, call your physician or healthcare center immediately: INSTITUTIONAL CONTACT INFO Pregnancy, sexual activity, and contraception Women should not become pregnant and men should not get a partner pregnant while taking cabozantinib. Men and women of childbearing age and potential should use effective contraception during therapy and for a minimum of four months after the last dose of cabozantinib. Do not breastfeed while taking cabozantinib and for four months after the last dose of cabozantinib. Inform your care provider if you become pregnant. It is safe to hug and kiss. Special precautions may be needed for sexual activity while on oral chemotherapy, and you are encouraged to ask your care provider. Obtaining medication Talk with your care provider about the process for obtaining your cabozantinib. PHARMACY OR SPECIALTY PHARMACY CONTACT INFO Additional resources Product websites: www.cometriq.com and www.cabometyx.com Product prescribing information: www.cometriq.com/downloads/Cometriq Full Prescribing Information.pdf and www.cabometyx.com/downloads/CABOMETYXUSPI.pdf Product resources: www.cometriq.com/support and www.cabometyx.com/support Updated – October 1, 2017 CABOZANTINIB ORAL CHEMOTHERAPY EDUCATION Page 9 Important notice: The Association of Community Cancer Centers ACCC , Hematology/Oncology Pharmacy Association HOPA , National Community Oncology Dispensing Association, Inc. NCODA , and Oncology Nursing Society ONS have collaborated in gathering information for and developing this patient education guide. This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this medication by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Oral Chemotherapy Education OCE sheets are provided as a free educational resource for patients with cancer in need of concise, easy to understand information about oral cancer drugs. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2018 by Hematology/Oncology Pharmacy Association. All rights reserved. Additional instructions

Calquence®

(KAL-kwents)

Calquence® (Acalabrutinib) is used to treat patients with mantle cell lymphoma.

Calquence® (Acalabrutinib) is used to treat patients with mantle cell lymphoma.

Page 1 ACALABRUTINIB ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — acalabrutinib uh KA luh BROO tih nib Brand name — Calquence® KAL kwents Approved uses Acalabrutinib is used to treat patients with mantle cell lymphoma. Dose and schedule Taking acalabrutinib as instructed is important to allow your treatment to be as effective as possible, so here are some key points to remember. Your dose may vary, but the usual dose of acalabrutinib is 100 milligrams 100 mg to be taken by mouth every 12 hours. The dose may be adjusted by your care provider based upon your individual needs. Acalabrutinib can be taken with or without food, but at the same time each day. Acalabrutinib should be taken whole and not crushed, cut, opened, or dissolved. If you are unable to swallow acalabrutinib, talk to your care provider or pharmacist for possible options. If you miss a dose of acalabrutinib, follow these guidelines: Only take the missed dose if it has been less than three hours since you were supposed to take it. Then, take the next dose at the regularly scheduled time. Do not take the missed dose if it has been more than three hours since you should have taken it. Simply take the next dose at the regularly scheduled time. Do not take two doses at one time. Be sure to write down if you miss a dose and let your care provider know about any missed doses. Storage and handling Handle acalabrutinib with care. Just like when chemotherapy is given into the vein, this drug can be toxic, and exposure of the drug to others should be limited. Store acalabrutinib at room temperature 68°F–77°F in a dry location away from light. Keep acalabrutinib out of reach of children and pets. Leave acalabrutinib in the provided packaging until it is ready to be taken. Whenever possible, give acalabrutinib to yourself and follow the steps below. If a family member, friend, or caregiver needs to give the acalabrutinib to you, they also need to follow these steps: 1. Wash hands with soap and water. 2. Put on gloves to avoid touching the medication. Gloves are not necessary if you give the drug to yourself. 3. Gently transfer the acalabrutinib from its package to a small medicine or other disposable cup. 4. Administer the medicine immediately by mouth with water. 5. Remove gloves and do not use them for anything else. ACALABRUTINIB ORAL CHEMOTHERAPY EDUCATION Page 2 6. Throw gloves and medicine cup in household trash. 7. Wash hands with soap and water. If a daily pill box or pill reminder is used, a separate one should be used for acalabrutinib. Do not mix other medications into the box with acalabrutinib. The person filling the box or reminder should wear gloves. Gloves are not necessary if you are filling the box or reminder. When empty, the box or reminder should be washed with soap and water before refilling. Be sure to wash hands with soap and water after the task is complete, whether or not gloves are worn. If you have any unused acalabrutinib, do not throw it in the trash and do not flush it down the sink or toilet. Talk to your care provider or pharmacist about proper disposal of acalabrutinib. If you are traveling, put your acalabrutinib in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Acalabrutinib remains in your body for several days after it is taken, so some of the drug may be present in urine, stool, sweat, or vomit. Once you have started to take acalabrutinib, it is important to follow the instructions below every day for as long as your treatment lasts. This will keep yourself, loved ones, and the environment as safe as possible. Pregnant women should avoid touching anything that may be soiled with body fluids from the patient. Toilet and septic systems You may use the same toilet, septic tank, and/or sewer that you usually use. If you have a low flow toilet, close the lid and flush twice to ensure that all waste has been discarded. If the toilet or toilet seat becomes soiled with urine, stool, or vomit, clean the surfaces before other people use the toilet. Wash hands with soap and water after using the toilet. If you need a bedpan, be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day. If you do not have good control of bladder or bowels, use a disposable pad with a plastic back, a diaper, or a sheet to absorb body waste. Wash any skin that has been exposed to body waste or acalabrutinib with soap and water. Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing. If you do not have a washer, place the soiled linens in a plastic bag until they can be washed. Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids. Drug and food interactions Acalabrutinib has the potential for drug interactions. Inform your care providers of all prescription medications, over thecounter medications, vitamins, and herbal products that you are taking. Grapefruit or grapefruit juice may interact with acalabrutinib. Avoid eating or drinking these during your treatment with acalabrutinib. Acalabrutinib can be taken with or without food. Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. ACALABRUTINIB ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Acalabrutinib The common side effects that have been known to happen in more than 30% of patients taking acalabrutinib are listed in the left side of this table. You MAY NOT experience these side effects. Options to help manage any side effects that do occur are included on the right side of this table. These should be discussed with your care provider. If you experience any side effect you cannot manage or that is not listed here, contact your care provider. Possible Side Effect Management Decreased hemoglobin, part of the red blood cells that carry iron and oxygen Your hemoglobin should be monitored by a simple blood test. When your hemoglobin is low, you may notice that you get tired or fatigued more easily. Try to get 7–8 hours of sleep per night. Avoid operating heavy machinery if you feel too tired. Find a balance between work and rest. Stay as active as possible, but know that it is okay to rest as needed. You might notice that you are more pale than usual. Let your care provider know right away if you experience any of the following: Shortness of breath Dizziness Palpitations Decreased platelet count and increased risk of bleeding Your platelets should be monitored by a simple blood test. When they are low, you may bruise or bleed more easily than usual. Use caution to avoid bruises, cuts, or burns. Blow your nose gently, and do not pick your nose. Brush your teeth gently with a soft toothbrush, and maintain good oral hygiene. When shaving, use an electronic razor instead of razor blades. Use a nail file instead of nail clippers. Call your care provider if you have bleeding that won’t stop. Examples include the following: A bloody nose that bleeds for more than five minutes despite pressure A cut that continues to ooze despite pressure Gums that bleed excessively when you floss or brush Seek medical help immediately if you experience any severe headaches, observe blood in your urine or stool, cough up blood, or experience prolonged and uncontrollable bleeding. You may need to take a break or “hold” your medication for medical or dental procedures. Talk to your care provider or dentist before any scheduled procedures. Continued on the next page ACALABRUTINIB ORAL CHEMOTHERAPY EDUCATION Page 4 Possible Side Effect Management Headache Ask your provider what you may use to help with this discomfort. Contact your care provider right away if your headache has any of the following characteristics: Follows a head injury Is severe or starts suddenly Does not go away after three days Is associated with vomiting, visual disturbance, neck stiffness, drowsiness, confusion, rash, weakness in an arm or leg, or numbness Is made worse by coughing or lowering the head Decreased white blood cells WBCs and increased risk for infection Your WBCs should be monitored by a simple blood test. When your WBCs are low, you are at a greater risk of having an infection. Take the following precautions to protect yourself from infection. Wash your hands often, especially before eating and after using the bathroom. Avoid crowds and people with fevers, flu, or other infection. Bathe regularly to keep good personal hygiene. Contact your care provider if you experience any signs or symptoms of an infection: Fever temperature more than 100.4°F or 38°C Chills Sore throat Burning with urination Unusual tiredness A sore that becomes red, is draining, or does not heal Check with your care provider before taking any medicine for a fever or chills. Continued on the next page ACALABRUTINIB ORAL CHEMOTHERAPY EDUCATION Page 5 If you experience ANY uncontrolled side effect, call your physician or healthcare center immediately: INSTITUTIONAL CONTACT INFO Pregnancy, sexual activity, and contraception Women should not become pregnant and men should not get a partner pregnant while taking acalabrutinib. Women of childbearing age and potential should use effective contraception during therapy and for a minimum of four weeks after the last dose of acalabrutinib. Men of reproductive age and potential should use effective contraception during therapy and for a minimum of four weeks after the last dose of acalabrutinib. Do not breastfeed while taking acalabrutinib and for two weeks after the last dose of acalabrutinib. Please inform your care provider if you become pregnant. It is safe to hug and kiss. Special precautions may be needed for sexual activity while on oral chemotherapy, and you are encouraged to ask your care provider. Obtaining medication Talk with your care provider about the process for obtaining your acalabrutinib. PHARMACY OR SPECIALTY PHARMACY CONTACT INFO Possible Side Effect Management Diarrhea loose and/ or urgent bowel movements Monitor how many bowel movements you have each day. Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake due to some other health problem. Eat small, frequent meals throughout the day rather than a few large meals. Eat bland, low fiber foods, such as bananas, applesauce, potatoes, chicken, rice, and toast. Avoid high fiber foods, such as raw vegetables, raw fruits, and whole grains. Avoid foods that cause gas, such as broccoli and beans. Avoid lactose containing foods, such as yogurt and milk. Avoid spicy, fried, and greasy foods. Contact your provider if any of the following occur: The number of bowel movements you have in a day increases by four or more. You feel dizzy or lightheaded. Your care provider may recommend an over the counter medication called loperamide Imodium® to help with your diarrhea, but talk to your care provider before starting this medication. ACALABRUTINIB ORAL CHEMOTHERAPY EDUCATION Page 6 Important notice: The Association of Community Cancer Centers ACCC , Hematology/Oncology Pharmacy Association HOPA , National Community Oncology Dispensing Association, Inc. NCODA , and Oncology Nursing Society ONS have collaborated in gathering information for and developing this patient education guide. This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this medication by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Oral Chemotherapy Education OCE sheets are provided as a free educational resource for patients with cancer in need of concise, easy to understand information about oral cancer drugs. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2018 by Hematology/Oncology Pharmacy Association. All rights reserved. Additional resources Product website: www.calquence.com Product prescribing information: www.azpicentral.com/calquence/calquence.pdf#page=1 Product resources: www.calquence.com/patient/support for patients.html Updated – March 2, 2018 Additional instructions

Caprelsa®

(ka-PREL-suh)

Caprelsa® (Vandetanib) is used to treat thyroid cancer.

Caprelsa® (Vandetanib) is used to treat thyroid cancer.

Page 1 VANDETANIB ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — vandetanib van-DEH-tuh-nib Brand name — Caprelsa® ka-PREL-suh Approved uses Vandetanib is used to treat thyroid cancer. Dose and schedule Taking vandetanib as instructed is important to allow your treatment to be as effective as possible, so here are some key points to remember. Your dose may vary, but the usual dose of vandetanib is 300 milligrams 300 mg to be taken by mouth once daily. The dose may be adjusted by your care provider based on your individual needs. Vandetanib can be taken with or without food, but at the same time each day. Vandetanib should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow vandetanib, talk to your care provider or pharmacist for possible options. If you miss a dose of vandetanib, Only take the missed dose if it has been less than 12 hours since you were supposed to take it. Then take the next dose at the regularly scheduled time. Do not take the missed dose if it has been more than 12 hours since you should have taken it. Simply take the next dose at the regularly scheduled time. Do not take two doses at one time. Be sure to write down if you miss a dose and let your care provider know about any missed doses. Storage and handling Handle vandetanib with care. Just like when chemotherapy is given into the vein, this drug can be toxic, and exposure of the drug to others should be limited. Store vandetanib at room temperature 68°F–77°F in a dry location away from light. Keep vandetanib out of reach of children and pets. Leave vandetanib in the provided packaging until it is ready to be taken. Whenever possible, you should give vandetanib to yourself and follow the steps below. If a family member, friend, or caregiver needs to give the vandetanib to you, they also need to follow these steps: 1. Wash hands with soap and water. 2. Put on gloves to avoid touching the medication. Gloves are not necessary if you give the drug to yourself. 3. Gently transfer the vandetanib from its package to a small medicine or other disposable cup. 4. Administer the medicine immediately by mouth with water. 5. Remove gloves and do not use them for anything else. 6. Throw gloves and medicine cup in household trash. VANDETANIB ORAL CHEMOTHERAPY EDUCATION Page 2 7. Wash hands with soap and water. If a daily pill box or pill reminder is used, a separate one should be used for vandetanib. Do not mix other medications into the box with vandetanib. The person filling the box or reminder should wear gloves. Gloves are not necessary if you are filling the box or reminder. When empty, the box or reminder should be washed with soap and water before refilling. Be sure to wash hands with soap and water after the task is complete, whether or not gloves are worn. If you have any unused vandetanib, do not throw it in the trash and do not flush it down the sink or toilet. Talk to your care provider or pharmacist about proper disposal of vandetanib. If you are traveling, put your vandetanib in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Vandetanib remains in your body for several days after it is taken, so some of the drug may be present in urine, stool, sweat, or vomit. Once you have started to take vandetanib, it is important to follow the instructions below every day every day for as long as your treatment lasts. This is to keep yourself, loved ones, and the environment as safe as possible. Pregnant women should avoid touching anything that may be soiled with body fluids from the patient. Toilet and septic systems You may use the same toilet, septic tank, and/or sewer that you usually use. If you have a low-flow toilet, close the lid and flush twice to ensure all waste has been discarded. If the toilet or toilet seat becomes soiled with urine, stool, or vomit, clean the surfaces before other people use the toilet. Wash hands with soap and water after using the toilet. If you need a bedpan, be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day. If you do not have good control of bladder or bowels, use a disposable pad with a plastic back, a diaper, or a sheet to absorb body waste. Wash any skin that has been exposed to body waste or vandetanib with soap and water. Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing. If you do not have a washer, place the soiled linens in a plastic bag until they can be washed. Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids. Drug and food interactions Vandetanib has many drug interactions, please inform your care providers of all prescription medications, over-thecounter medications, vitamins, and herbal products. Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. Serious side effects Vandetanib can cause changes in the heart called QT prolongation. This can cause irregular heartbeats. Serious skin reactions have been reported, even up to four months after stopping treatment. Limit sun exposure, and report any serious skin reaction to your care provider. VANDETANIB ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Vandetanib The common side effects that have been known to happen in more than 30% of patients taking vandetanib are listed in the left side of this table. You MAY NOT experience these side effects. Options to help manage any side effects that do occur are included on the right side of this table. These should be discussed with your care provider. If you experience any side effect you cannot manage or that is not listed here, contact your care provider. Possible Side Effect Management Diarrhea loose and/ or urgent bowel movements Monitor how many bowel movements you have each day. Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake because of some other health problem. Eat small, frequent meals throughout the day rather than a few large meals. Eat bland, low-fiber foods e.g., bananas, applesauce, potatoes, chicken, rice, toast . Avoid high-fiber foods e.g., raw vegetables, raw fruits, whole grains . Avoid foods that cause gas e.g., broccoli, beans . Avoid lactose-containing foods e.g., yogurt, milk . Avoid spicy, fried, and greasy foods. Contact your provider if any of the following occur: The number of bowel movements you have in a day increases by four or more. You feel dizzy or lightheaded. Your care provider may recommend an over-the-counter medication called loperamide Imodium® to help with your diarrhea, but talk to your care provider before starting this medication. Nausea or vomiting Eat and drink slowly. Drink 8-10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake. Eat small, frequent meals throughout the day rather than a few large meals. Eat bland foods; avoid spicy, fried, and greasy foods. Avoid vigorous exercise immediately after eating. Don’t lie down immediately after eating. Avoid strong odors. Let your provider know if you experience nausea or vomiting. Your provider may prescribe medication to help with the nausea or vomiting. Changes in liver function Your liver function should be checked periodically by a simple blood test. Contact your care provider if you notice any of the following: Yellowing of the skin or whites of your eyes Dark or brown urine Unusual bleeding or bruising Continued on the next page VANDETANIB ORAL CHEMOTHERAPY EDUCATION Page 4 Possible Side Effect Management Increased blood pressure Routinely take your blood pressure. Record your blood pressure in a journal or diary and report this information to your physician. Contact your healthcare provider for high blood pressure or if symptoms such as the following occur: Headache Dizziness Chest pain Shortness of breath Fluid retention, weight gain, or swelling Acne-like rash or itchy skin A rash that looks like acne may appear on your face, chest, and upper back while taking this medication. Your doctor may prescribe medication to help prevent or manage the rash. If you do get a rash, keep the area around the rash clean and dry. Check with your care provider before using anything to treat it. Do not use over-the-counter acne treatments, such as benzoyl peroxide and salicylic acid, and soaps containing alcohol. Oatmeal baths and unscented moisturizers may help with itching. Sunlight can make symptoms worse. Avoid sun exposure as much as possible to decrease the risk of sunburn. The highest exposure to UV ultraviolet radiation occurs from 10 am–4 pm. Wear long-sleeved clothing, with UV protection if possible. Wear broad-brimmed hats. Apply broad-spectrum sunscreen UVA/UVB with at least SPF 30 as often as directed on the bottle. Use lip balm with at least SPF 30. Rash Keep your skin moisturized with creams and moisturizing lotions to decrease the risk of rash or itchiness, and wear loose-fitting clothing. Avoid using perfumes and cologne as these products may increase rash symptoms. Avoid being in the heat for long periods of time. Your provider may recommend an over-the-counter antihistamine or a topical cream. Sunlight can make symptoms worse. Avoid sun exposure as much as possible to decrease the risk of sunburn. The highest exposure to UV ultraviolet radiation occurs between 10 am–4 pm. Wear long-sleeved clothing, with UV protection if possible. Wear broad-brimmed hats. Apply broad-spectrum sunscreen UVA/UVB with at least SPF 30 as often as directed on the bottle. Use lip balm with at least SPF 30. If your rash or itching continues to worsen, contact your care provider. Continued on the next page VANDETANIB ORAL CHEMOTHERAPY EDUCATION Page 5 Possible Side Effect Management Changes in electrolytes and other laboratory values Low calcium levels Changes in some laboratory values may occur and should be monitored by a simple blood test. You may not feel any symptoms if the changes are mild, and they usually are not a sign of a serious problem. More severe changes may occur, which can be a sign of a serious problem. Notify your care provider if you have any of the following: Shortness of breath Chest discomfort Weakness or fatigue New aches and pains Headaches Dizziness Swelling of your legs or feet Red- or brown-colored urine If you experience ANY uncontrolled side effect, call your physician or healthcare center immediately: INSTITUTIONAL CONTACT INFO Pregnancy, sexual activity, and contraception Women should not become pregnant and men should not get a partner pregnant while taking vandetanib. Men and women of childbearing age and potential should use effective contraception during therapy and for a minimum of four months after the last dose of vandetanib. Do not breastfeed while taking vandetanib and for one month after the last dose of vandetanib. Inform your care provider if you become pregnant. It is safe to hug and kiss. Special precautions may be needed for sexual activity while on oral chemotherapy, and you are encouraged to ask your care provider. Obtaining medication Talk with your care provider about how to obtain your vandetanib. Vandetanib is only available through a Risk Evaluation and Mitigation Strategy REMS program, and prescribers and pharmacies must be certified with this REMS program. Only a 30-day supply of medication can be obtained from the pharmacy at one time. PHARMACY OR SPECIALTY PHARMACY CONTACT INFO VANDETANIB ORAL CHEMOTHERAPY EDUCATION Page 6 Additional resources Product website: www.caprelsa.com Product prescribing information: www.caprelsa.com/files/caprelsa-pi.pdf Product resources: www.caprelsa.com/pt resources and support.asp Updated – August 21, 2017 Additional instructions Important notice: The Association of Community Cancer Centers ACCC , Hematology/Oncology Pharmacy Association HOPA , National Community Oncology Dispensing Association, Inc. NCODA , and Oncology Nursing Society ONS have collaborated in gathering information for and developing this patient education guide. This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this medication by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Oral Chemotherapy Education OCE sheets are provided as a free educational resource for patients with cancer in need of concise, easy-to-understand information about oral cancer drugs. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2017 by Hematology/Oncology Pharmacy Association. All rights reserved.

Casodex®

(ka-soh-dex)

Casodex® (Bicalutamide) is used to treat prostate cancer.

Casodex® (Bicalutamide) is used to treat prostate cancer.

ShowAll Page1BICALUTAMIDE ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — bicalutamide bye-ka-LOO-ta-mide Brand name — Casodex® ka-soh-dex Approved uses Bicalutamide is used to treat prostate cancer Dose and schedule Taking bicalutamide as instructed is important to allow your treatment to be as effective as possible so here are some key points to remember o Your dose may vary but the usual dose of bicalutamide is 50 mg to be taken by mouth at a scheduled time once a day o Bicalutamide can be taken with or without food o Bicalutamide should be taken whole and not crushed cut or dissolved If you are unable to swallow bicalutamide talk to your care provider or pharmacist for possible options o If you miss a dose of bicalutamide do not take an extra dose or two doses at one time Simply take your next dose at the regularly scheduled time Be sure to write down if you miss a dose and let your care provider know about any missed doses Storage and handling Handle bicalutamide with care Just like when chemotherapy is given into the vein this drug can be toxic and exposure of the drug to others should be limited o Store bicalutamide at room temperature 68°F–77°F in a dry location away from light o Keep bicalutamide out of reach of children and pets o Leave bicalutamide in the provided packaging until it is ready to be taken o Whenever possible give bicalutamide to yourself and follow the steps below If a family member friend or caregiver needs to give bicalutamide to you they also need to follow these steps: 1 Wash hands with soap and water 2 Put on gloves to avoid touching the medication Gloves are not necessary if you give the drug to yourself 3 Gently transfer the bicalutamide from its package to a small medicine or other disposable cup 4 Administer the medicine immediately by mouth with water 5 Remove gloves and do not use them for anything else 6 Throw gloves and medicine cup in household trash 7 Wash hands with soap and water BICALUTAMIDE ORAL CHEMOTHERAPY EDUCATION Page 2 o If a daily pill box or pill reminder is used a separate one should be used for bicalutamide Do not mix other medications into the box with bicalutamide The person filling the box or reminder should wear gloves Gloves are not necessary if you are filling the box or reminder When empty the box or reminder should be washed with soap and water before refilling Be sure to wash hands with soap and water after the task is complete whether or not gloves are worn o If you have any unused bicalutamide do not throw it in the trash and do not flush it down the sink or toilet Talk to your care provider or pharmacist about proper disposal of bicalutamide o If you are traveling put your bicalutamide in a sealed plastic bag Ask your pharmacist if any additional travel precautions are needed Handling body fluids and waste Bicalutamide remains in your body for several days after it is taken so some of the drug may be present in urine stool sweat or vomit Once you have started to take bicalutamide it is important to follow the instructions below every day for as long as your treatment lasts This will keep yourself loved ones and the environment as safe as possible o Pregnant women should avoid touching anything that may be soiled with body fluids from the patient o Toilet and septic systems You may use the same toilet septic tank and/or sewer that you usually use If you have a low-flow toilet close the lid and flush twice to ensure all waste has been discarded If the toilet or toilet seat becomes soiled with urine stool or vomit clean the surfaces before other people use the toilet Wash hands with soap and water after using the toilet o If you need a bedpan be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day o If you do not have good control of bladder or bowels use a disposable pad with a plastic back a diaper or a sheet to absorb body waste o Wash any skin that has been exposed to body waste or bicalutamide with soap and water o Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing If you do not have a washer place the soiled linens in a plastic bag until they can be washed o Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids Drug and food interactions o Bicalutamide has many drug interactions Inform your care providers of all prescription medications over-the-counter medications vitamins and herbal products that you are taking o Talk with your care provider or pharmacist before taking new medications or supplements or receiving any vaccines BICALUTAMIDE ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Bicalutamide The common side effects that have been known to happen in more than 30% of patients taking bicalutamide are listed in the left side of this table You MAY NOT experience these side effects Options to help manage any side effects that do occur are included on the right side of this table These should be discussed with your care provider If you experience any side effect you cannot manage or that is not listed here contact your care provider Possible Side Effect Management Hot flashes sudden sweating and feelings of warmth If hot flashes are bothersome: Mild regular exercise may help Consult first with your care provider Try staying in a cool environment Wear layers so that if you experience a hot flash the outer layers may be removed Avoid or limit caffeine spicy food alcohol and stress which may cause hot flashes to worsen Inform your care provider if this side effect is bothersome as there may be medications that can help with hot flashes Pain Keep a diary of your pain including a description of when and where the pain is occurring what it feels like and how long it lasts Stay as active as possible but know that it is okay to rest as needed too Tell your care provider if pain interferes with your activity If the pain bothers you ask your provider what you may use to help with this discomfort Take only pain medication that has been prescribed or recommended by your care provider If you experience ANY uncontrolled side effect call your physician or healthcare center immediately: _ INSTITUTIONAL CONTACT INFO Pregnancy sexual activity and contraception o Women should not become pregnant and men should not get a partner pregnant while taking bicalutamide Men and women of childbearing age and potential should use effective contraception during therapy and for a minimum of one month after the last dose of bicalutamide o Inform your care provider if you become pregnant o It is safe to hug and kiss Special precautions may be needed for sexual activity while on bicalutamide and you are encouraged to ask your care provider Obtaining medication Talk with your care provider about how to obtain your bicalutamide PHARMACY OR SPECIALTY PHARMACY CONTACT INFO BICALUTAMIDE ORAL CHEMOTHERAPY EDUCATION Page 4 Additional resources Bicalutamide drug information: https://medlineplus gov/druginfo/meds/a697047 html Product prescribing information: www accessdata fda gov/drugsatfda_docs/label/2005/020498s016lbl pdf Updated – August 6 2017 Additional instructions Important notice: The Association of Community Cancer Centers ACCC Hematology/Oncology Pharmacy Association HOPA National Community Oncology Dispensing Association Inc NCODA and Oncology Nursing Society ONS have collaborated in gathering information for and developing this patient education guide This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources This guide does not cover all existing information related to the possible uses directions doses precautions warnings interactions adverse effects or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional Provision of this guide is for informational purposes only and does not constitute or imply endorsement recommendation or favoring of this medication by ACCC HOPA NCODA or ONS who assume no liability for and cannot ensure the accuracy of the information presented The collaborators are not making any representations with respect to the medications whatsoever and any and all decisions with respect to such medications are at the sole risk of the individual consuming the medication All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional Permission: Oral Chemotherapy Education OCE sheets are provided as a free educational resource for patients with cancer in need of concise easy-to-understand information about oral cancer drugs Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information However commercial reproduction or reuse as well as rebranding or reposting of any type are strictly prohibited without permission of the copyright holder Please email permission requests and licensing inquiries to Contact@NCODA org Copyright © 2017 by Hematology/Oncology Pharmacy Association All rights reserved

Cometriq®

(CO-met-rik)

Cometriq® (Cabozantinib) is used to treat patients with advanced kidney cancer (renal cell carcinoma) and those with progressive, metastatic medullary thyroid cancer.

Cometriq® (Cabozantinib) is used to treat patients with advanced kidney cancer (renal cell carcinoma) and those with progressive, metastatic medullary thyroid cancer.

Page 1 CABOZANTINIB ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — cabozantinib KA boe ZAN ti nib Brand name — Cabometyx™ for kidney cancer; ka boe MET iks ; Cometriq® for thyroid cancer; CO met rik Approved uses Cabozantinib is used to treat patients with advanced kidney cancer renal cell carcinoma and those with progressive, metastatic medullary thyroid cancer. Dose and schedule Taking cabozantinib as instructed is important to allow your treatment to be as effective as possible, so here are some key points to remember. Your dose may vary, but the usual dose of cabozantinib is: 60 milligrams 60 mg to be taken by mouth at a scheduled time once a day for kidney cancer 140 milligrams 140 mg to be taken by mouth at a scheduled time once a day for thyroid cancer Cabozantinib should be taken on an empty stomach do not eat for at least 2 hours before and at least 1 hour after taking cabozantinib at the same time each day. Do not substitute cabozantinib tablets with cabozantinib capsules. Cabozantinib should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow cabozantinib, talk to your care provider or pharmacist for possible options. If you miss a dose of cabozantinib, Only take the missed dose if it has been less than 12 hours since you were supposed to take it. Then, take the next dose at the regularly scheduled time. Do not take the missed dose if it has been more than 12 hours since you should have taken it. Simply take the next dose at the regularly scheduled time. Do not take two doses at one time. Be sure to write down if you miss a dose and let your care provider know about any missed doses. If you need to have surgery, tell your care provider you are taking cabozantinib. Cabozantinib may need to be stopped until your wound heals after some surgeries. Storage and handling Handle cabozantinib with care. Just like when chemotherapy is given into the vein, this drug can be toxic, and exposure of the drug to others should be limited. Store cabozantinib at room temperature 68°F–77°F in a dry location away from light. Keep cabozantinib out of reach of children and pets. Leave cabozantinib in the provided packaging until it is ready to be taken. Whenever possible, give cabozantinib to yourself and follow the steps below. If a family member, friend, or caregiver needs to give cabozantinib to you, they also need to follow these steps: 1. Wash hands with soap and water. 2. Put on gloves to avoid touching the medication. Gloves are not necessary if you give the drug to yourself. CABOZANTINIB ORAL CHEMOTHERAPY EDUCATION Page 2 3. Gently transfer the cabozantinib from its package to a small medicine or other disposable cup. 4. Administer the medicine immediately by mouth with water. 5. Remove gloves and do not use them for anything else. 6. Throw gloves and medicine cup in household trash. 7. Wash hands with soap and water. If a daily pill box or pill reminder is used, a separate one should be used for cabozantinib. Do not mix other medications into the box with cabozantinib. The person filling the box or reminder should wear gloves gloves are not necessary if you are filling the box or reminder . When empty, the box or reminder should be washed with soap and water before refilling. Be sure to wash hands with soap and water after the task is complete, whether or not gloves are worn. If you have any unused cabozantinib, do not throw it in the trash and do not flush it down the sink or toilet. Talk to your care provider or pharmacist about proper disposal of cabozantinib. If you are traveling, put your cabozantinib in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Because cabozantinib remains in your body for several days after it is taken, some of the drug may be present in urine, stool, sweat, or vomit. Once you have started to take cabozantinib, it is important to follow the instructions below every day for as long as your treatment lasts. This is to keep yourself, loved ones, and the environment as safe as possible. Pregnant women should avoid touching anything that may be soiled with body fluids from the patient. Toilet and septic systems You may use the same toilet, septic tank, and/or sewer that you usually use. If you have a low flow toilet, close the lid and flush twice to ensure all waste has been discarded. If the toilet or toilet seat becomes soiled with urine, stool, or vomit, clean the surfaces before other people use the toilet. Wash hands with soap and water after using the toilet. If you need a bedpan, be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day. If you do not have good control of bladder or bowels, use a disposable pad with a plastic back, a diaper, or a sheet to absorb body waste. Wash any skin that has been exposed to body waste or cabozantinib with soap and water. Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing. If you do not have a washer, place the soiled linens in a plastic bag until they can be washed. Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids. CABOZANTINIB ORAL CHEMOTHERAPY EDUCATION Page 3 Drug and food interactions Cabozantinib has many drug interactions. Inform your care providers of all prescription medications, over the counter medications, vitamins, and herbal products. Cabozantinib should be taken without food do not eat for at least 2 hours before and at least 1 hour after taking cabozantinib . Grapefruit or grapefruit juice may interact with cabozantinib; avoid eating or drinking these during treatment with cabozantinib. Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. Serious side effects of cabozantinib Cabozantinib that is taken for thyroid cancer can increase your risk of developing gastrointestinal fistulas and perforations holes to occur. Cabozantinib that is taken for thyroid cancer can increase your risk of bleeding. Side Effects of Cabozantinib The common side effects that have been known to happen in more than 30% of patients taking cabozantinib are listed in the left side of this table. You MAY NOT experience these side effects. Options to help manage any side effects that do occur are included on the right side of this table. These should be discussed with your care provider. If you experience any side effect you cannot manage or that is not listed here, contact your care provider. Possible Side Effect Management Changes in liver function Your liver function will be checked periodically by a simple blood test. Contact your care provider if you notice any of the following: Yellowing of the skin or whites of your eyes Dark or brown urine Bleeding or bruising Continued on the next page CABOZANTINIB ORAL CHEMOTHERAPY EDUCATION Page 4 Possible Side Effect Management Diarrhea loose and/ or urgent bowel movements Monitor how many bowel movements you have each day. Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake. Eat small, frequent meals throughout the day rather than a few large meals. Eat bland, low fiber foods e.g., bananas, applesauce, potatoes, chicken, rice, toast . Avoid high fiber foods e.g., raw vegetables, raw fruits, whole grains . Avoid foods that cause gas e.g., broccoli, beans . Avoid lactose containing foods e.g., yogurt, milk . Avoid spicy, fried, and greasy foods. Contact your provider if any of the following occur: The number of bowel movements you have in a day increases by four or more. You feel dizzy or lightheaded. Your care provider may recommend an over the counter medication called loperamide Imodium® to help with your diarrhea, but talk to your care provider before starting this medication. Changes in kidney function Your kidney renal function will be checked periodically by a simple blood test. Contact your care provider if you notice any of the following: Decreased amount of urination Unusual swelling in your legs and feet Fatigue You may be more tired than usual or have less energy. Stay as active as possible, but know it is okay to rest as needed, too. Try to do some activity every day. Plan your activities, and do them at a time of day when you feel a bit more energetic. Avoid operating heavy machinery if you feel too tired. Changes in electrolytes and other laboratory values Low calcium levels High triglyceride levels Low phosphate levels High glucose levels Low albumin levels Low magnesium levels Low sodium levels Changes in some laboratory values may occur and should be monitored by a simple blood test. You may not feel any symptoms if the changes are mild, and they usually are not a sign of a serious problem. More severe changes may occur, which can be a sign of a serious problem. Notify your care provider if you have any of the following: Shortness of breath Chest discomfort Weakness or fatigue New aches and pains Headaches Dizziness Swelling of your legs or feet Red or brown colored urine Continued on the next page CABOZANTINIB ORAL CHEMOTHERAPY EDUCATION Page 5 Possible Side Effect Management Nausea or vomiting Eat and drink slowly. Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake. Eat small, frequent meals throughout the day rather than a few large meals. Eat bland foods; avoid spicy, fried, and greasy foods. Avoid vigorous exercise immediately after eating. Don’t lie down immediately after eating. Avoid strong odors. Let your provider know if you experience nausea or vomiting. Your provider may prescribe medication that can help. Pain or discomfort in hands and/or feet Hand foot skin reaction HFSR appears on the palms of the hands and soles of the feet. It can appear as a rash, callus, or peeling skin, and the area has increased sensitivity to heat or a “pins and needles” sensation. Let your care provider know right away if you experience this side effect. To prevent HFSR, you can do the following: Soak your feet in a water bath with Epsom salt and gently pumice any callused skin. Exfoliate and keep hands and feet moisturized. Avoid tight fitting shoes or socks. Use cushioning i.e., gloves when performing activities that increase pressure on the palms of your hands. Mouth irritation or sores Practice good mouth care. Rinse your mouth frequently. Brush your teeth with a soft toothbrush or cotton swab after meals. Use a mild nonalcohol mouth rinse at least 4 times a day after eating and at bedtime . One example is a mixture of 1/8 teaspoon of salt and 1/4 teaspoon of baking soda in 8 ounces of warm not hot water. If you have sores in your mouth, avoid using tobacco products, alcohol, and mouthwashes that contain alcohol. Call your care provider if you experience pain or sores in your mouth or throat. Continued on the next page CABOZANTINIB ORAL CHEMOTHERAPY EDUCATION Page 6 Possible Side Effect Management Decreased white blood cells WBCs and increased risk for infection Your WBCs should be monitored by a simple blood test. When your WBCs are low, you are at a greater risk of having an infection. Take the following precautions to protect yourself from infection. Wash your hands often, especially before eating and after using the bathroom. Avoid crowds and people with fevers, flu, or other infection. Bathe regularly to keep good personal hygiene. Contact your care provider if you experience any signs or symptoms of an infection: Fever temperature more than 100.4°F or 38°C Chills Sore throat Burning with urination Unusual tiredness A sore that becomes red, is draining, or does not heal Check with your care provider before taking any medicine for a fever or chills. Decreased appetite or weight loss Talk to your care provider if you notice a decrease in weight while taking this medication. When you do not feel like eating, try the following: Eat small frequent meals instead of three large meals each day. Keep snacks nearby so you can eat when you feel hungry. Take liquid nutritional supplements. Drink 8–10 glasses of water or fluid each day, especially if you are not eating, unless your care provider has instructed you to limit your fluid intake. Increased blood pressure Routinely take your blood pressure. Record your blood pressure in a journal/diary and report these to your physician. Contact your healthcare provider for high blood pressure or if the following symptoms occur: Headache Dizziness Chest pain Shortness of breath Fluid retention, weight gain, or swelling Continued on the next page CABOZANTINIB ORAL CHEMOTHERAPY EDUCATION Page 7 Possible Side Effect Management Decreased platelet count and increased risk of bleeding Your platelets should be monitored by a simple blood test. When they are low, you may bruise or bleed more easily than usual. Use caution to avoid bruises, cuts, or burns. Blow your nose gently, and do not pick your nose. Brush your teeth gently with a soft toothbrush, and maintain good oral hygiene. When shaving, use an electronic razor instead of razor blades. Use a nail file instead of nail clippers. Call your care provider if you have bleeding that won’t stop. Examples include the following: A bloody nose that bleeds for more than five minutes despite pressure A cut that continues to ooze despite pressure Gums that bleed excessively when you floss or brush Seek medical help immediately if you experience any severe headaches, observe blood in your urine or stool, cough up blood, or experience prolonged and uncontrollable bleeding. You may need to take a break or “hold” your medication for medical or dental procedures. Talk to your care provider or dentist before any scheduled procedures. Hair color changes Changes to your hair color may occur during treatment. The hair usually returns to normal after treatment, but for some, the change is permanent. Taste changes Some people experience a metallic or bitter taste in their mouth. To help with taste changes, try the following: Choose and prepare foods that look and smell good to you. Use plastic utensils if food tastes like metal. Flavor foods with spices to change taste. Suck on mints or chew gum to mask taste. Brush teeth with a soft bristle toothbrush before and after eating. Avoid smoking. Notify your doctor if you are having trouble eating or are losing weight. Decreased hemoglobin, part of the red blood cells that carry iron and oxygen Your hemoglobin should be monitored using a blood test. When your hemoglobin is low, you may notice that you get tired or fatigued more easily. Try to get 7–8 hours of sleep per night. Avoid operating heavy machinery if you feel too tired. Find a balance between work and rest. Stay as active as possible, but know that it is okay to rest as needed. You might notice that you are more pale than usual. Let your healthcare provider know right away if you experience any of the following: Shortness of breath Dizziness Palpitations CABOZANTINIB ORAL CHEMOTHERAPY EDUCATION Page 8 If you experience ANY uncontrolled side effect, call your physician or healthcare center immediately: INSTITUTIONAL CONTACT INFO Pregnancy, sexual activity, and contraception Women should not become pregnant and men should not get a partner pregnant while taking cabozantinib. Men and women of childbearing age and potential should use effective contraception during therapy and for a minimum of four months after the last dose of cabozantinib. Do not breastfeed while taking cabozantinib and for four months after the last dose of cabozantinib. Inform your care provider if you become pregnant. It is safe to hug and kiss. Special precautions may be needed for sexual activity while on oral chemotherapy, and you are encouraged to ask your care provider. Obtaining medication Talk with your care provider about the process for obtaining your cabozantinib. PHARMACY OR SPECIALTY PHARMACY CONTACT INFO Additional resources Product websites: www.cometriq.com and www.cabometyx.com Product prescribing information: www.cometriq.com/downloads/Cometriq Full Prescribing Information.pdf and www.cabometyx.com/downloads/CABOMETYXUSPI.pdf Product resources: www.cometriq.com/support and www.cabometyx.com/support Updated – October 1, 2017 CABOZANTINIB ORAL CHEMOTHERAPY EDUCATION Page 9 Important notice: The Association of Community Cancer Centers ACCC , Hematology/Oncology Pharmacy Association HOPA , National Community Oncology Dispensing Association, Inc. NCODA , and Oncology Nursing Society ONS have collaborated in gathering information for and developing this patient education guide. This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this medication by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Oral Chemotherapy Education OCE sheets are provided as a free educational resource for patients with cancer in need of concise, easy to understand information about oral cancer drugs. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2018 by Hematology/Oncology Pharmacy Association. All rights reserved. Additional instructions

Cotellic®

(coh-TEL-lik)

Cotellic® (Cobimetinib) is used to treat patients with melanoma with a genetic mutation called BRAF V600 E or V600K, and is used in combination with another medication, vemurafenib.

Cotellic® (Cobimetinib) is used to treat patients with melanoma with a genetic mutation called BRAF V600 E or V600K, and is used in combination with another medication, vemurafenib.

ShowAll Page1COBIMETINIB ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — cobimetinib (KOH-bih-MEH-tih-nib) Brand name — Cotellic® (coh-TEL-lik) Approved uses Cobimetinib is used to treat patients with melanoma with a genetic mutation called BRAF V600 E or V600K and is used in combination with another medication vemurafenib Dose and schedule Taking cobimetinib as instructed is important to allow your treatment to be as effective as possible so here are some key points to remember o Your dose may vary but the usual dose of cobimetinib is 60 milligrams (60 mg) to be taken by mouth on days 1–21 of each 28-day treatment cycle The dose may be adjusted by your care provider based on your individual needs o Cobimetinib can be taken with or without food but at the same time each day o Cobimetinib should be taken whole and not crushed cut or dissolved If you are unable to swallow cobimetinib talk to your care provider or pharmacist for possible options o If you miss a dose of cobimetinib do not take an extra dose or two doses at one time Simply take your next dose at the regularly scheduled time Be sure to write down if you miss a dose and let your care provider know about any missed doses Storage and handling Handle cobimetinib with care Just like when chemotherapy is given into the vein this drug can be toxic and exposure of the drug to others should be limited o Store cobimetinib at room temperature (68°F–77°F) in a dry location away from light o Keep cobimetinib out of reach of children and pets o Leave cobimetinib in the provided packaging until it is ready to be taken o Whenever possible give cobimetinib to yourself and follow the steps below If a family member friend or caregiver needs to give cobimetinib to you they also need to follow these steps: 1 Wash hands with soap and water 2 Put on gloves to avoid touching the medication (Gloves are not necessary if you give the drug to yourself ) 3 Gently transfer the cobimetinib from its package to a small medicine or other disposable cup 4 Administer the medicine immediately by mouth with water 5 Remove gloves and do not use them for anything else 6 Throw gloves and medicine cup in household trash 7 Wash hands with soap and water COBIMETINIB ORAL CHEMOTHERAPY EDUCATION Page 2 o If a daily pill box or pill reminder is used a separate one should be used for cobimetinib Do not mix other medications into the box with cobimetinib The person filling the box or reminder should wear gloves (Gloves are not necessary if you are filling the box or reminder ) When empty the box or reminder should be washed with soap and water before refilling Be sure to wash hands with soap and water after the task is complete whether or not gloves are worn o If you have any unused cobimetinib do not throw it in the trash and do not flush it down the sink or toilet Talk to your care provider or pharmacist about proper disposal of cobimetinib o If you are traveling put your cobimetinib in a sealed plastic bag Ask your pharmacist if any additional travel precautions are needed Handling body fluids and waste Cobimetinib remains in your body for several days after it is taken so some of the drug may be present in urine stool sweat or vomit Once you have started to take cobimetinib it is important to follow the instructions below every day for as long as your treatment lasts This will keep yourself loved ones and the environment as safe as possible o Pregnant women should avoid touching anything that may be soiled with body fluids from the patient o Toilet and septic systems You may use the same toilet septic tank and/or sewer that you usually use If you have a low-flow toilet close the lid and flush twice to ensure all waste has been discarded If the toilet or toilet seat becomes soiled with urine stool or vomit clean the surfaces before other people use the toilet Wash hands with soap and water after using the toilet o If you need a bedpan be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day o If you do not have good control of bladder or bowels use a disposable pad with a plastic back a diaper or a sheet to absorb body waste o Wash any skin that has been exposed to body waste or cobimetinib with soap and water o Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing If you do not have a washer place the soiled linens in a plastic bag until they can be washed o Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids Drug and food interactions o Cobimetinib has many drug interactions Inform your care providers of all prescription medications over-the-counter medications vitamins and herbal products that you are taking o Grapefruit and grapefruit juice may interact with cobimetinib Avoid eating and drinking these during treatment with cobimetinib o Talk with your care provider or pharmacist before taking new medications or supplements or receiving any vaccines COBIMETINIB ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Cobimetinib The common side effects that have been known to happen in more than 30% of patients taking cobimetinib are listed in the left side of this table You MAY NOT experience these side effects Options to help manage any side effects that do occur are included on the right side of this table These should be discussed with your care provider If you experience any side effect you cannot manage or that is not listed here contact your care provider Possible Side Effect Management Changes in kidney function Your kidney (renal) function will be checked periodically by a simple blood test Contact your care provider if you notice either of the following: Decreased amount of urination Unusual swelling in your legs and feet Changes in electrolyte and other laboratory values High creatine phosphokinase levels Low albumin levels Low phosphate levels Low sodium levels Changes in some lab values may occur and will be monitored by a simple blood test You may not feel any symptoms if the changes are mild and they usually are not a sign of a serious problem More severe changes may occur which can be a sign of a serious problem Notify your care provider if you have any of the following: Shortness of breath Chest discomfort Weakness or fatigue New aches and pains Headaches Dizziness Swelling of your legs or feet Red- or brown-colored urine Decreased white blood cells (WBCs) and increased risk for infection Your WBCs should be monitored by a simple blood test When your WBCs are low you are at a greater risk of having an infection Take the following precautions to protect yourself from infection Wash your hands often especially before eating and after using the bathroom Avoid crowds and people with fevers flu or other infection Bathe regularly to keep good personal hygiene Contact your care provider if you experience any signs or symptoms of an infection such as: Fever (temperature more than 100 4°F or 38°C) Chills Sore throat Burning with urination Unusual tiredness A sore that becomes red is draining or does not heal Check with your care provider before taking any medicine for a fever or chills Continued on the next page COBIMETINIB ORAL CHEMOTHERAPY EDUCATION Page 4 Possible Side Effect Management Changes in liver function Your liver function will be checked periodically by a simple blood test Contact your care provider if you notice any of the following: Yellowing of the skin or whites of your eyes Dark or brown urine Unusual bleeding or bruising Decreased hemoglobin part of the red blood cells that carry iron and oxygen Your hemoglobin should be monitored by a simple blood test When your hemoglobin is low you may notice that you get tired or fatigued more easily Try to get 7–8 hours of sleep per night Avoid operating heavy machinery if you feel too tired Find a balance between work and rest Stay as active as possible but know that it is okay to rest as needed You might notice that you are more pale than usual Let your care provider know right away if you experience: Shortness of breath Dizziness Palpitations Diarrhea (loose and/ or urgent bowel movements) Monitor how many bowel movements you have each day Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake related to some other health problem Eat small frequent meals throughout the day rather than a few large meals Eat bland low-fiber foods (e g bananas applesauce potatoes chicken rice toast) Avoid high-fiber foods such as raw vegetables raw fruits and whole grains Avoid foods that cause gas such as broccoli and beans Avoid lactose-containing foods such as yogurt and milk Avoid spicy fried and greasy foods Contact your provider if any of the following occur: The number of bowel movements you have in a day increases by four or more You feel dizzy or lightheaded Your care provider may recommend an over-the-counter medication called loperamide (Imodium®) to help with your diarrhea but talk to your care provider before starting this medication Continued on the next page COBIMETINIB ORAL CHEMOTHERAPY EDUCATION Page 5 Possible Side Effect Management Sun sensitivity sunburn easily Avoid sun exposure as much as possible to decrease the risk of sunburn The highest exposure to ultraviolet (UV) radiation occurs from 10 am–4 pm Wear long-sleeved clothing with UV protection if possible Wear broad-brimmed hats Apply broad-spectrum sunscreen (UVA/UVB) with at least SPF 30 as often as directed on the bottle Use lip balm with at least SPF 30 Nausea or vomiting Eat and drink slowly Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake Eat small frequent meals throughout the day rather than a few large meals Eat bland foods; avoid spicy fried and greasy foods Avoid vigorous exercise immediately after eating Don’t lay down immediately after eating Avoid strong odors Let your provider know if you experience nausea or vomiting Your provider may prescribe medication that can help If you experience ANY uncontrolled side effect call your physician or healthcare center immediately: _ (INSTITUTIONAL CONTACT INFO) Pregnancy sexual activity and contraception o Women should not become pregnant and men should not get a partner pregnant while taking cobimetinib Men and women of childbearing age and potential should use effective contraception during therapy and for a minimum of two weeks after the last dose of cobimetinib o Do not breastfeed while taking cobimetinib for a minimum of two weeks after the last dose of cobimetinib o Inform your care provider if you become pregnant o It is safe to hug and kiss Special precautions may be needed for sexual activity while on cobimetinib and you are encouraged to ask your care provider Obtaining medication Talk with your care provider about how to obtain your bicalutamide (PHARMACY OR SPECIALTY PHARMACY CONTACT INFO) COBIMETINIB ORAL CHEMOTHERAPY EDUCATION Page 6 Additional resources Product website: www cotellic com Product prescribing information: www gene com/download/pdf/cotellic_prescribing pdf Product resources: www cotellic com/patient/support-resources/cotellic-melanoma-resources html Updated — August 6 2017 Additional instructions Important notice: The Association of Community Cancer Centers (ACCC) Hematology/Oncology Pharmacy Association (HOPA) National Community Oncology Dispensing Association Inc (NCODA) and Oncology Nursing Society (ONS) have collaborated in gathering information for and developing this patient education guide This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources This guide does not cover all existing information related to the possible uses directions doses precautions warnings interactions adverse effects or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional Provision of this guide is for informational purposes only and does not constitute or imply endorsement recommendation or favoring of this medication by ACCC HOPA NCODA or ONS who assume no liability for and cannot ensure the accuracy of the information presented The collaborators are not making any representations with respect to the medications whatsoever and any and all decisions with respect to such medications are at the sole risk of the individual consuming the medication All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional Permission: Oral Chemotherapy Education (OCE) sheets are provided as a free educational resource for patients with cancer in need of concise easy-to-understand information about oral cancer drugs Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information However commercial reproduction or reuse as well as rebranding or reposting of any type are strictly prohibited without permission of the copyright holder Please email permission requests and licensing inquiries to Contact@NCODA org Copyright © 2017 by Hematology/Oncology Pharmacy Association All rights reserved

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