Page 1 DABRAFENIB ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — dabrafenib (duh BRA feh nib) Brand name — Tafinlar® (TA fin lar) Approved uses Dabrafenib is used to treat patients with the following: Melanoma that has a genetic mutation called BRAF V600E or V600K and may be used in combination with trametinib Non small cell lung cancer that has a genetic mutation called BRAF V600E and may be used in combination with trametinib Anaplastic thyroid cancer that has a genetic mutation called BRAF V600E and may be used in combination with trametinib Dose and schedule Taking dabrafenib 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 dabrafenib is 150 milligrams (mg) to be taken by mouth at a scheduled time twice a day. Dabrafenib should be taken twice daily and trametinib should be taken once daily at the same time every day. Both dabrafenib and trametinib should be taken on an empty stomach (one hour before or two hours after a meal or snack) and at the same time each day. Dabrafenib should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow dabrafenib, talk to your care provider or pharmacist for possible options. If you miss a dose of dabrafenib: • Take the missed dose only 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 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. Drug and food interactions Dabrafenib has many drug interactions. Inform your care providers of all prescription medications, over the counter medications, vitamins, and herbal products that you are taking. Grapefruit or grapefruit juice may interact with dabrafenib. Avoid eating or drinking these during treatment with dabrafenib. Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. DABRAFENIB ORAL CHEMOTHERAPY EDUCATION Page 2 Storage and handling Handle dabrafenib 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 dabrafenib at room temperature (68°F–77°F) in a dry location away from light. Keep dabrafenib out of reach of children and pets. Leave dabrafenib in the provided packaging until it is ready to be taken. Whenever possible, give dabrafenib to yourself and follow the steps below. If a family member, friend, or caregiver needs to give dabrafenib 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 dabrafenib 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 will be used, contact your care team before using: • 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 dabrafenib, 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 dabrafenib. If you are traveling, put your dabrafenib’s packaging in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed.DABRAFENIB ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Dabrafenib Below are common side effects that have been known to happen in about one third or more of patients taking dabrafenib are listed on 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. Thickening of the skin (hyperkeratosis) Ask your care provider for management strategies if this bothers you. 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. Continued on the next pageDABRAFENIB ORAL CHEMOTHERAPY EDUCATION Page 4 Possible Side Effect Management Changes in electrolyte and other laboratory values • High glucose 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 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 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, or 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 Fever You may feel hot, cold and shivery, achy, or dizzy. This usually starts during the first month of therapy but could happen at any time. • Call your doctor immediately if you have a fever (temperature more than 100.4°F or 38°C). • Ask your doctor if you can take medicine to help with the fever. Continued on the next pageDABRAFENIB ORAL CHEMOTHERAPY EDUCATION Page 5 Possible Side Effect Management 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. Take pain medication only that has been prescribed or recommended by your care provider. 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. Serious side effects of dabrafenib Secondary malignancy is the growth of a cancer months or years after treatment. This is a rare but possible side effect of treatment with dabrafenib. You may be at a higher risk of bleeding while taking dabrafenib. Be sure to seek medical attention right away if you have any majore bleeding. Also be sure to check for any signs of bleeding in your stool. Dabrafenib can make your heart work harder to pump blood to the rest of your body. Notify your healthcare provider if you experience shortness of breath or chest pain. Dabrafenib may be harmful to your eyes. Be sure to inform your care provider of any issue you have with your vision, or pain in your eyes. Your provider may stop treatment with dabrafenib if your eyes are affected. Serious fevers can occur when dabrafenib is used with trametinib. If you have a G6PD deficiency, dabrafenib can increase risk for hemolytic anemia. Call your care team if you experience weakness, dizziness, yellowing of the skin or whites of your eyes, or dark or brown urine. Rarely, dabrafenib can cause severe skin reactions, including Stevens Johnson syndrome, which can be life threatening. Seek emergency care if you have a severe rash or a rash on your mouth, eyes, or genitals. If you experience ANY uncontrolled side effect, call your physician or healthcare center immediately: (INSTITUTIONAL CONTACT INFO)DABRAFENIB ORAL CHEMOTHERAPY EDUCATION Page 6 Handling body fluids and waste Dabrafenib 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 dabrafenib, 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 dabrafenib 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. Pregnancy, sexual activity, and contraception Men and women of childbearing age and potential should use effective nonhormonal contraception during therapy and for a minimum of two weeks after the last dose of dabrafenib. Dabrafenib can cause hormonal contraceptive to be ineffective. o Do not breastfeed while taking dabrafenib and for two weeks after the last dose of dabrafenib. 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 dabrafenib, and you are encouraged to ask your care provider. Obtaining medication Talk with your care provider about how to obtain your dabrafenib. (PHARMACY OR SPECIALTY PHARMACY CONTACT INFO)DABRAFENIB ORAL CHEMOTHERAPY EDUCATION Page 7 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 © 2021 by Hematology/Oncology Pharmacy Association. All rights reserved. Additional resources Product website: https://www.us.tafinlarmekinist.com Product prescribing information: https://www.pharma.us.novartis.com/sites/www.pharma.us.novartis.com/ files/tafinlar.pdf Product resources: Melanoma: https://www.us.tafinlarmekinist.com/advanced melanoma/patient support/patient resources Lung cancer: https://www.us.tafinlarmekinist.com/globalassets/products37.com/tafinlarmekinist/lung/tafinlarmekinist patient medication guide.pdf Updated — May 28, 2021 Additional instructions