Patient and Healthcare Provider Resource

Patient and Healthcare Providers Resource

OralChemoEdSheets.com, Patient + Healthcare Providers Resource

OralChemoEdSheets.com, the Patient and Healthcare Providers Resource

Mercaptopurine / 6-MP / 6-Mercaptopurine

(mer-KAP-toh-PYOOR-een)

Mercaptopurine / 6-MP / 6-Mercaptopurine (Purinethol® / Purixan®) is used to treat adult and pediatric patients with acute lymphoblastic leukemia (ALL).

Additional Perscribing info

Mercaptopurine / 6-MP / 6-Mercaptopurine (Purinethol® / Purixan®) is used to treat adult and pediatric patients with acute lymphoblastic leukemia (ALL).

Additional Pers...

Page 1 MERCAPTOPURINE ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — mercaptopurine mer KAP toh PYOOR een Brand name — Purinethol® pyoor IN eh thol ; Purixan® PYOOR ee zan Other names — 6 mercaptopurine and 6 MP Approved uses Mercaptopurine is used to treat adult and pediatric patients with acute lymphoblastic leukemia ALL . Dose and schedule Taking mercaptopurine 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. Mercaptopurine can be taken with or without food but at the same time each day. Mercaptopurine tablets should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow mercaptopurine, talk to your care provider or pharmacist for possible options. Mercaptopurine suspension should be shaken vigorously for at least 30 seconds prior to taking. If you miss a dose of mercaptopurine, 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 mercaptopurine 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 mercaptopurine at room temperature 68°F–77°F in a dry location away from light. Keep mercaptopurine out of reach of children and pets. Leave mercaptopurine in the provided packaging until it is ready to be taken. Once opened, mercaptopurine suspension should be used within 8 weeks. Whenever possible, give mercaptopurine to yourself and follow the steps below. If a family member, friend, or caregiver needs to give mercaptopurine 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 mercaptopurine 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. MERCAPTOPURINE ORAL CHEMOTHERAPY EDUCATION Page 2 If a daily pill box or pill reminder is used, a separate one should be used for mercaptopurine. Do not mix other medications into the box with mercaptopurine. 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 mercaptopurine, 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 mercaptopurine. If you are traveling, put your mercaptopurine in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Because mercaptopurine 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 mercaptopurine, 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 mercaptopurine 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 Mercaptopurine has many drug interactions. Inform your care providers of all prescription medications, over the counter medications, vitamins, and herbal products. Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. MERCAPTOPURINE ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Mercaptopurine The common side effects that have been known to happen in more than 30% of patients taking mercaptopurine 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 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 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 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 MERCAPTOPURINE 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 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 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 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 mercaptopurine. 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 mercaptopurine. Do not breastfeed while taking mercaptopurine and for one month after the last dose of mercaptopurine. 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 mercaptopurine. PHARMACY OR SPECIALTY PHARMACY CONTACT INFO MERCAPTOPURINE ORAL CHEMOTHERAPY EDUCATION Page 5 Additional resources Product website: www.purixan us.com Product prescribing information: www.accessdata.fda.gov/drugsatfda docs/label/2011/009053s032lbl.pdf; www.purixan us.com/resources/Package Insert.pdf Product resources: www.purixan us.com/information instructions/#info Updated – February 5, 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.

Abemaciclib

()

Abemaciclib (VERZENIO) is a drug for the treatment of advanced or metastatic breast cancers.

Abemaciclib (VERZENIO) is a drug for the treatment of advanced or metastatic breast cancers.

Abiraterone Acetate

(A-bih-RA-the-rone A-seh-tayt)

Abiraterone Acetate (Zytiga®) is used in combination with prednisone to treat men with prostate cancer.

Abiraterone Acetate (Zytiga®) is used in combination with prednisone to treat men with prostate cancer.

ShowAll Page1ABIRATERONE ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — abiraterone acetate (A-bih-RA-the-rone A-seh-tayt) Brand name — Zytiga® (zye-Tee-ga) Approved uses Abiraterone acetate is used in combination with prednisone to treat men with prostate cancer. Dose and schedule Taking abiraterone acetate 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 abiraterone acetate is 1,000 milligrams (1,000 mg) to be taken by mouth at a scheduled time once a day. o Abiraterone acetate must be taken without food (at least one hour before or two hours after a meal or snack) at the same time each day. o Abiraterone acetate should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow abiraterone acetate, talk to your care provider or pharmacist for possible options. o Prednisone is recommended to be dosed at 5 mg by mouth twice daily, with food. For example, if you take prednisone with your breakfast at 8 am, you may want to take abiraterone at 7 am or one hour before breakfast on an empty stomach. o If you miss a dose of abiraterone acetate or prednisone, 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 abiraterone acetate 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 abiraterone acetate at room temperature (68°F–77°F) in a dry location away from light. o Keep abiraterone acetate out of reach of children and pets. o Leave abiraterone acetate in the provided packaging until it is ready to be taken. o Whenever possible, give abiraterone acetate to yourself and follow the steps below. If a family member, friend, or caregiver needs to give abiraterone acetate 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 abiraterone acetate 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. ABIRATERONE ORAL CHEMOTHERAPY EDUCATION Page 2 o If a daily pill box or pill reminder is used, a separate one should be used for abiraterone acetate. Do not mix other medications into the box with abiraterone acetate. 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 abiraterone acetate, 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 abiraterone acetate. o If you are traveling, put your abiraterone acetate in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Abiraterone acetate 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 abiraterone acetate, 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 abiraterone acetate 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 Abiraterone acetate has many drug interactions. Inform your care providers of all prescription medications, over-thecounter medications, vitamins, and herbal products that you are taking. o Abiraterone acetate should be taken without food. o Grapefruit or grapefruit juice may interact with abiraterone acetate; avoid eating or drinking these during treatment with abiraterone acetate. o Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. ABIRATERONE ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Abiraterone Acetate The common side effects that have been known to happen in more than 30% of patients taking abiraterone acetate 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 electrolytes and other laboratory values High trigylceride levels Low glucose 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 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. Continued on the next page ABIRATERONE ORAL CHEMOTHERAPY EDUCATION Page 4 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 abiraterone acetate. Men and women of childbearing age and potential should use effective contraception during therapy and for a minimum of one week after the last dose of abiraterone acetate. 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 abiraterone acetate, and you are encouraged to ask your care provider. Obtaining medication Talk with your care provider about how to obtain your abiraterone acetate (PHARMACY OR SPECIALTY PHARMACY CONTACT INFO) Additional resources Product website: www.zytiga.com Product prescribing information: www.zytiga.com/shared/product/zytiga/zytiga-prescribing-information.pdf Product resources: www.zytiga.com/patient-and-caregiver-resources/zytiga-stories Updated – August 20, 2017 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. ABIRATERONE ORAL CHEMOTHERAPY EDUCATION Page 5 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. Additional instructions

Acalabrutinib

()

Acalabrutinib (CALQUENCE®) is a novel experimental anti-cancer drug and a 2nd generation Bruton's tyrosine kinase inhibitor developed by Acerta Pharma. It is more potent and selective than ibrutinib, the first-in-class BTK inhibitor.

Acalabrutinib (CALQUENCE®) is a novel experimental anti-cancer drug and a 2nd generation Bruton's tyrosine kinase inhibitor developed by Acerta Pharma. It is more potent and selective than ibrutinib, the first-in-...

Afatinib

(ay-FA-tih-nib)

Afatinib (Gilotrif®) is used to treat people with non-small cell lung cancer (NSCLC) with an epidermal growth factor receptor (EGFR) genetic mutation or a squamous cell type of NSCLC.

Afatinib (Gilotrif®) is used to treat people with non-small cell lung cancer (NSCLC) with an epidermal growth factor receptor (EGFR) genetic mutation or a squamous cell type of NSCLC.

Page 1 AFATINIB ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — afatinib ay-FA-tih-nib Brand name — Gilotrif® JEE-loh-trif Approved uses Afatinib is used to treat people with non-small cell lung cancer NSCLC with an epidermal growth factor receptor EGFR genetic mutation or a squamous cell type of NSCLC. Dose and schedule Taking afatinib 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 afatinib is 40 milligrams 40 mg to be taken by mouth once daily. The dose may be adjusted by your care provider based on your individual needs. o Afatinib must be taken without food at least one hour before or two hours after a meal or snack at the same time each day. o Afatinib should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow afatinib, talk to your care provider or pharmacist for possible options. o If you miss a dose of afatinib: 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 afatinib 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 afatinib at room temperature 68°F–77°F in a dry location away from light. o Keep afatinib out of reach of children and pets. o Leave afatinib in the provided packaging until it is ready to be taken. o Whenever possible, give afatinib to yourself and follow the steps below. If a family member, friend, or caregiver needs to give afatinib 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 afatinib from its package to a small medicine or other disposable cup. 4. Administer the medicine immediately by mouth with water. AFATINIB ORAL CHEMOTHERAPY EDUCATION Page 2 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 If a daily pill box or pill reminder is used, a separate one should be used for afatinib. Do not mix other medications into the box with afatinib. 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 afatinib, 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 afatinib. o If you are traveling, put your afatinib in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Afatinib 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 afatinib, 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 afatinib 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 Afatinib 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 Afatinib should be taken without food. o Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. AFATINIB ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Afatinib The common side effects that have been known to happen in more than 30% of patients taking afatinib 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 electrolytes and other laboratory values Low potassium 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 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. Nail changes Usually changes start at the cuticle and may affect the skin around the nail. Biting, chewing, or picking at your nails can increase the risk for infection. Talk to your care provider if you notice any changes in your nails. Continued on the next page AFATINIB ORAL CHEMOTHERAPY EDUCATION Page 4 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. 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. Continued on the next page AFATINIB ORAL CHEMOTHERAPY EDUCATION Page 5 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 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 Acne-like rash 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 get a rash, keep the area around it 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 or 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 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 you experience ANY uncontrolled side effect, call your physician or healthcare center immediately: INSTITUTIONAL CONTACT INFO AFATINIB 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 © 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 afatinib. 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 afatinib. o Do not breastfeed while taking afatinib and for two weeks after the last dose of afatinib. 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 afatinib, and you are encouraged to ask your care provider. Obtaining medication Talk with your care provider about how to obtain your afatinib. PHARMACY OR SPECIALTY PHARMACY CONTACT INFO Additional resources Product website: http://www.gilotrif.com Product prescribing information: http://www.gilotrifhcp.com/dosing-prescribing Product resources: http://www.gilotrif.com/patient-resources/patient-resources.html Updated – August 22, 2017 Additional instructions

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.

Alectinib

(uh-LEK-tih-nib)

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

Alectinib (Alecensa®) 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

(N/A)

Alkeran (Melphalan) is approved for palliative treatment of Multiple myeloma, Ovarian epithelial cancer that cannot be removed by surgery. Melphalan is also being studied in the treatment of other types of cancer.

Alkeran (Melphalan) is approved for palliative treatment of Multiple myeloma, Ovarian epithelial cancer that cannot be removed by surgery. Melphalan is also being studied in the treatment of other types of ...

Alunbrig®

(uh-LUN-brig)

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

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

Page 1 BRIGATINIB ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — brigatinib brih GA tih nib Brand name — Alunbrig® uh LUN brig Approved uses Brigatinib 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 brigatinib 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 brigatinib is 90 milligrams 90 mg to be taken by mouth at a scheduled time, once a day for the first seven days. Then, the dose may increase to 180 milligrams 180 mg to be taken by mouth at a scheduled time, once a day. Brigatinib can be taken with or without food, but at the same time each day. Brigatinib should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow brigatinib, talk to your care provider or pharmacist for possible options. If you miss a dose of brigatinib, 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 brigatinib 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 brigatinib at room temperature 68°F–77°F in a dry location away from light. Keep brigatinib out of reach of children and pets. Leave brigatinib in the provided packaging until it is ready to be taken. Whenever possible, you should give brigatinib to yourself and follow the steps below. If a family member, friend, or caregiver needs to give the brigatinib 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 brigatinib 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. BRIGATINIB ORAL CHEMOTHERAPY EDUCATION Page 2 If a daily pill box or pill reminder is used, a separate one should be used for brigatinib. Do not mix other medications into the box with brigatinib. 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 brigatinib, 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 brigatinib. If you are traveling, put your brigatinib in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Since brigatinib 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 brigatinib, 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 brigatinib 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 Brigatinib has many drug interactions. Inform your care providers of all prescription medications, over the counter medications, vitamins, and herbal products. Grapefruit or grapefruit juice may interact with brigatinib; avoid eating or drinking these during treatment with brigatinib. Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. BRIGATINIB ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Brigatinib The common side effects that have been known to happen in more than 30% of patients taking brigatinib 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 Unusual bleeding or bruising Changes in electrolytes and other laboratory values High glucose levels High creatine phosphokinase levels High lipase levels High amylase 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 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. Continued on the next page BRIGATINIB 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 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 care provider know right away if you experience any of the following: Shortness of breath Dizziness Palpitations Diarrhea lose and/ or urgent bowel movements Monitor how many bowel movements you have each day. Drink 8–10 glasses of water/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 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. 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. 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. BRIGATINIB 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 brigatinib. Women of childbearing age and potential should use effective contraception during therapy and for a minimum of four months after the last dose of brigatinib. Men 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 brigatinib. Do not breastfeed while taking brigatinib and for one week after the last dose of brigatinib. 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 brigatinib. PHARMACY OR SPECIALTY PHARMACY CONTACT INFO Additional resources Product website: www.alunbrig.com Product prescribing information: www.alunbrig.com/assets/pi.pdf Product resources: www.ariadpass.com/patient alunbrig.html Updated – November 6, 2017 Additional instructions BRIGATINIB 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 © 2017 by Hematology/Oncology Pharmacy Association. All rights reserved.

Anastrozole

(an AS-troh-zole)

Anastrozole (Arimidex®) 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 ...

Anastrozole (Arimidex®) 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.

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.