Page 1 Name of your medication Generic name — adagrasib (a-DAH-GRA-sib) Brand name — KRAZATI® Common uses Adagrasib is used to treat patients with non-small cell lung cancer that have a genetic variant called KRAS G12C. Adagrasib may also be used for other treatments. Dose and schedule Taking adagrasib 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 adagrasib is 600 milligram (600 mg) to be taken by mouth at a scheduled time twice daily. o Adagrasib can be taken with or without food, but at the same time each day. o Adagrasib should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow adagrasib, talk to your care provider or pharmacist for possible options. o If you miss a dose of adagrasib: • Only take the missed dose if it has been less than 4 hours since you were supposed to take it. Then take the next dose at the regularly scheduled time. • Do not take two doses at one time. • Be sure to write down if you miss a dose and let your care provider know about any missed doses. Drug and food interactions o Adagrasib has many drug interactions, please inform your care providers of all prescription medications, over-the-counter medications, vitamins, and herbal products. o Grapefruit or grapefruit juice may interact with adagrasib; avoid eating or drinking these during treatment with adagrasib. o Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. ADAGRASIB ORAL CHEMOTHERAPY EDUCATION ADAGRASIB ORAL CHEMOTHERAPY EDUCATION Page 2 Storage and handling Handle adagrasib 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 adagrasib at room temperature (68°F to 77°F) in a dry location away from light. o Keep adagrasib out of reach of children and pets. o Leave adagrasib in the provided packaging until it is ready to be taken. o Whenever possible, you should give adagrasib to yourself and follow the steps below. If a family member, friend, or caregiver needs to give the adagrasib 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 adagrasib 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 to be used with adagrasib. o If you have any unused adagrasib, 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 adagrasib. o If you are traveling, put your adagrasib’s packaging in a separate sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. ADAGRASIB ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Adagrasib Below are common side effects that have been known to happen in about one-third or more of patients taking adagrasib; these are listed on the left side of this table. You MAY NOT experience these side effects. Options to help manage any side effects that do occur are included on the right side of this table. These should be discussed with your care provider. If you experience any side effect you cannot manage or that is not listed here, contact your care provider. Possible Side Effect Management Diarrhea Monitor how many bowel movements you have each day. • Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake. • Eat small, frequent meals throughout the day rather than a few large meals. • Eat bland, low-fiber foods (e.g., bananas, applesauce, potatoes, chicken, rice, toast). • Avoid high fiber foods, such as raw vegetables, raw fruits, and whole grains. • Avoid foods that cause gas, such as broccoli and beans. • Avoid lactose-containing foods, such as yogurt and milk. • Avoid spicy, fried, and greasy foods. Contact your provider if any of the following occur: • The number of bowel movements you have in a day increases by 4 or more. • You feel dizzy or lightheaded. Your care provider may recommend an over-the-counter medication called loperamide (Imodium®) to help with your diarrhea, but talk to your care provider before starting this medication. 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 to help with the nausea or vomiting. Continued on the next page ADAGRASIB 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 infections. • Bathe regularly to keep good personal hygiene. Contact your care provider if you experience any of the following 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. 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. • Stay as active as possible, but know that it is okay to rest as needed, too. • Avoid operating heavy machinery if you feel too tired. Changes in electrolytes and other laboratory values • Decreased sodium • Decreased albumin • Increased lipase 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 experience 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 ADAGRASIB ORAL CHEMOTHERAPY EDUCATION Page 5 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 to 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, too. • You might notice that you are more pale than usual. Let your care provider know right away if you experience the following symptoms: • Shortness of breath • Dizziness • Palpitations 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 OK 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. 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 symptoms: • Yellowing of the skin or whites of your eyes • Dark or brown urine • 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 symptoms: • Decreased amount of urination • Unusual swelling in your legs and feet Cough or shortness of breath A cough that does not produce any mucous or congestion relief (i.e., 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. Continued on the next page ADAGRASIB ORAL CHEMOTHERAPY EDUCATION Page 6 Possible Side Effect Management Fluid retention or swelling • Do not stand for long periods of time. • Keep your legs elevated when sitting or lying down. • Try to not eat salty foods, which can increase swelling. • Avoid 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 • You are short of breath • You have gained 5 pounds or more in one week Decreased appetite or weight loss Talk to your care provider if you notice a decrease in weight when taking this medication. When you do not feel like eating, try the following: • Eat small, frequent meals throughout the day rather than a few large meals. • Keep snacks nearby so you can eat when you feel hungry. • Use liquid nutritional supplements. • Drink 8–10 glasses of water or fluid each day, particularly if you are not eating, unless your care provider has instructed you to limit your fluid intake. Serious side effects o Adagrasib may cause your lung tissue to scar, which is called interstitial lung disease. Call your care team if you are feeling short of breath, have a fever, or have a lasting dry cough. o Adagrasib may cause a condition called QT or QTc prolongation, which is a heart rhythm that can cause fast, irregular heartbeats. These fast heartbeats may cause you to faint or have a seizure. In rare cases, this could be life-threatening. Tell your care team right away if you feel faint, lightheaded, dizzy, or if you feel your heart beating irregularly or fast, when taking adagrasib. If you experience ANY uncontrolled side effect, call your physician or healthcare center immediately: ADAGRASIB ORAL CHEMOTHERAPY EDUCATION Page 7 Handling body fluids and waste Because adagrasib 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 adagrasib, it is important to adhere to 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. 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 that all waste has been discarded. • If the toilet or toilet seat becomes soiled with urine, stool, or vomit, clean the surfaces before other people use the toilet. • Wash hands with soap and water after using the toilet. 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 adagrasib 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. Pregnancy, sexual activity, and contraception o Women should not become pregnant and men should not get a partner pregnant while taking adagrasib. Males and females of childbearing age and potential should use effective contraception during therapy and for a minimum of 1 month after the last dose of adagrasib. o Effective contraception could include one or more of the following: oral contraceptive, barrier methods, etc. o Do not breastfeed while taking adagrasib and for 1 week after the last dose of adagrasib. o Please inform your care provider if you become pregnant. o It is safe to hug and kiss. Special precautions may be needed for sexual activity while on oral chemotherapy, and you are encouraged to ask your care team for assistance. Obtaining medication o Talk with your care provider about the process for obtaining your adagrasib. ADAGRASIB ORAL CHEMOTHERAPY EDUCATION Page 8 Additional resources Product website: https://www.mirati.com Product prescribing information: https://www.mirati.com/krazati_uspi Product resources: https://www.mirati.com/responsibility/sponsorships-grants Updated – July 10, 2023 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 © 2023 by Hematology/Oncology Pharmacy Association. All rights reserved.

Page 1 LENVATINIB ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — lenvatinib len VA tih nib Brand name — Lenvima® len Vee muh Approved uses Lenvatinib is used to treat advanced thyroid cancer and renal cell carcinoma kidney cancer given in combination with another medication everolimus Afinitor® Dose and schedule Taking lenvatinib 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 lenvatinib is 24 milligrams 24 mg for thyroid cancer and 18 mg for kidney cancer to be taken by mouth at a scheduled time once daily o Lenvatinib can be taken with or without food but should be taken at the same time each day o Lenvatinib should be taken whole and not crushed cut or dissolved without proper instructions If you are unable to swallow lenvatinib talk to your care provider or pharmacist for possible options o If you miss a dose of lenvatinib Take the missed dose only if it has been less than 12 hours since you were supposed to take it Then take the next dose at the regularly scheduled time Do not take the missed dose if it has been more than 12 hours since you should have taken it Simply take your next dose at the regularly scheduled time Do not take two doses at one time Be sure to write down if you miss a dose and let your care provider know about any missed doses Storage and handling Handle lenvatinib 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 lenvatinib at room temperature 68°F–77°F in a dry location away from light o Keep lenvatinib out of reach of children and pets o Leave lenvatinib in the provided packaging until it is ready to be taken o Whenever possible give lenvatinib to yourself and follow the steps below If a family member friend or caregiver needs to give lenvatinib 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 lenvatinib from its package to a small medicine or other disposable cup 4 Administer the medicine immediately by mouth with water LENVATINIB 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 lenvatinib Do not mix other medications into the box with lenvatinib 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 lenvatinib 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 lenvatinib o If you are traveling put your lenvatinib in a sealed plastic bag Ask your pharmacist if any additional travel precautions are needed Handling body fluids and waste Lenvatinib 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 lenvatinib 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 lenvatinib 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 Lenvatinib has many drug interactions Inform your care providers of all prescription medications over the counter medications vitamins and herbal products that you are taking o Talk with your care provider or pharmacist before taking new medications or supplements or receiving any vaccines LENVATINIB ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Lenvatinib The common side effects that have been known to happen in more than 30% of patients taking lenvatinib 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 Increased blood pressure Routinely take your blood pressure Record your blood pressure readings in a journal/diary and report them to your physician Contact your healthcare provider for high blood pressure or if symptoms such as the following occur Headache Dizziness Chest pain Shortness of breath Fluid retention weight gain or swelling 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 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 LENVATINIB ORAL CHEMOTHERAPY EDUCATION Page 4 Possible Side Effect Management Muscle or joint pain or weakness Keep a diary of your pain including a description of when and where the pain is occurring what it feels like and how long it lasts Stay as active as possible but know that it is okay to rest as needed too Tell your care provider if pain interferes with your activity If the pain or weakness bothers you ask your provider how you may ease this discomfort Take only pain medication that has been prescribed or recommended by your care provider Nausea or vomiting Eat and drink slowly Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake Eat small frequent meals throughout the day rather than a few large meals Eat bland foods; avoid spicy fried and greasy foods Avoid vigorous exercise immediately after eating Don’t lie down immediately after eating Avoid strong odors Let your provider know if you experience nausea or vomiting Your provider may prescribe medication that can help 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 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 LENVATINIB ORAL CHEMOTHERAPY EDUCATION Page 5 Possible Side Effect Management 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 Abdominal pain Abdominal pain or discomfort may occur Report any serious pain or symptoms to your care provider immediately 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 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 Pain or discomfort in hands and/or feet Hand–foot skin reaction HFSR appears on the palms of the hands and soles of the feet It can appear as a rash callus peeling skin and increased sensitivity to heat or a “pins and needles” sensation Let your care provider know right away if you experience this side effect To prevent HFSR try the following Soak your feet in a water bath with Epsom salts and gently pumice any callused skin Exfoliate and moisturize hands and feet Avoid tight shoes or socks Use cushioning i e gloves when doing activities that increase pressure on the palms of your hands Kidney damage Your care provider will monitor your kidney function by checking the amount of protein in your urine LENVATINIB ORAL CHEMOTHERAPY EDUCATION Page 6 Pregnancy sexual activity and contraception o Women should not become pregnant and men should not get a partner pregnant while taking lenvatinib which could cause fetal harm 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 lenvatinib o Do not breastfeed while taking lenvatinib and for two weeks after the last dose of lenvatinib 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 lenvatinib and you are encouraged to ask your care provider Obtaining medication Talk with your care provider about how to obtain your lenvatinib PHARMACY OR SPECIALTY PHARMACY CONTACT INFO If you experience ANY uncontrolled side effect call your physician or healthcare center immediately INSTITUTIONAL CONTACT INFO Possible Side Effect Management Increased risk for bleeding You may be at higher risk for bleeding and 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 a 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 or uncontrolled bleeding Voice changes or hoarseness These changes are not permanent and should go away during the time you are not taking the medication ABIRATERONE ORAL CHEMOTHERAPY EDUCATION Page 7 LENVATINIB Page 7 Important notice The Association of Community Cancer Centers ACCC Hematology/Oncology Pharmacy Association HOPA National Community Oncology Dispensing Association Inc NCODA and Oncology Nursing Society ONS have collaborated in gathering information for and developing this patient education guide This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources This guide does not cover all existing information related to the possible uses directions doses precautions warnings interactions adverse effects or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional Provision of this guide is for informational purposes only and does not constitute or imply endorsement recommendation or favoring of this medication by ACCC HOPA NCODA or ONS who assume no liability for and cannot ensure the accuracy of the information presented The collaborators are not making any representations with respect to the medications whatsoever and any and all decisions with respect to such medications are at the sole risk of the individual consuming the medication All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional Permission Oral Chemotherapy Education OCE sheets are provided as a free educational resource for patients with cancer in need of concise easy to understand information about oral cancer drugs Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information However commercial reproduction or reuse as well as rebranding or reposting of any type are strictly prohibited without permission of the copyright holder Please email permission requests and licensing inquiries to Contact@NCODA org Copyright © 2017 by Hematology/Oncology Pharmacy Association All rights reserved Additional instructions Additional resources Product website http //www lenvima com Product prescribing information http //www lenvima com/pdfs/prescribing information pdf Product resources http //www lenvima com/RAI R differentiated thyroid cancer/resources Updated – August 27 2017

Page 1 CHLORAMBUCIL ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — chlorambucil klor AM byoo sil Brand name — Leukeran LOO keh run Approved uses Chlorambucil is used to treat adult patients with certain types of lymphomas and leukemias, specifically: Chronic lymphocytic leukemia Lymphosarcoma Giant follicular lymphoma Hodgkin’s disease Dose and schedule Taking chlorambucil 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. Chlorambucil should be taken on an empty stomach at least 1 hour before or 2 hours after a meal or snack , but at the same time each day. Chlorambucil should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow chlorambucil, talk to your care provider or pharmacist for possible options. If you miss a dose of chlorambucil, 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 chlorambucil 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 chlorambucil in the refrigerator 36°F–46°F in a dry location protected from light. Keep chlorambucil out of reach of children and pets. Leave chlorambucil in the provided packaging until it is ready to be taken. Whenever possible, you should give chlorambucil to yourself and follow the steps below. If a family member, friend, or caregiver needs to give the chlorambucil 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 chlorambucil 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. CHLORAMBUCIL ORAL CHEMOTHERAPY EDUCATION Page 2 If a daily pill box or pill reminder is used, a separate one should be used for chlorambucil. Do not mix other medications into the box with chlorambucil. 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 chlorambucil, 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 chlorambucil. If you are traveling, put your chlorambucil in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Since chlorambucil 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 chlorambucil, 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 chlorambucil 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 Chlorambucil has many drug interactions, please inform your care providers of all prescription medications, over the counter medications, vitamins, and herbal products. Chlorambucil should be taken on an empty stomach at least 1 hour before or 2 hours after a meal or snack . Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. Avoid live vaccines during treatment with chlorambucil. CHLORAMBUCIL ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Chlorambucil The common side effects that have been known to happen in more than 30% of patients taking chlorambucil are listed in the left side of this table. You MAY NOT experience these side effects. Options to help manage any side effects that do occur are included on the right side of this table. These should be discussed with your care provider. If you experience any side effect you cannot manage or that is not listed here, contact your care provider. Possible Side Effect Management Decreased white blood cells WBCs and increased risk for infection Your WBCs should be monitored by a simple blood test. When your WBCs are low, you are at a greater risk of having an infection. Take the following precautions to protect yourself from infection. Wash your hands often, especially before eating and after using the bathroom. Avoid crowds and people with fevers, flu, or other infection. Bathe regularly to keep good personal hygiene. Contact your care provider if you experience any signs or symptoms of an infection such as: Fever temperature more than 100.4°F or 38°C Chills Sore throat Burning with urination Unusual tiredness A sore that becomes red, is draining, or does not heal Check with your care provider before taking any medicine for a fever or chills. Continued on the next page Serious side effects of chlorambucil Bone marrow suppression is a decrease in the number of white blood cells, red blood cells, and platelets, and can be a severe side effect of chlorambucil. Speak to your care provider to know when you need to have laboratory tests done to monitor your blood cell counts. Secondary malignancy is the growth of a cancer months or years after treatment. This is a rare but possible side effect of treatment with chlorambucil. The use of chlorambucil may cause infertility the loss of the ability to reproduce and have children in both men and women. CHLORAMBUCIL ORAL CHEMOTHERAPY EDUCATION Page 4 Possible Side Effect Management Decreased platelet count and increased risk of bleeding Your platelets should be monitored by a simple blood test. When they are low, you may bruise or bleed more easily than usual. Use caution to avoid bruises, cuts, or burns. Blow your nose gently, and do not pick your nose. Brush your teeth gently with a soft toothbrush, and maintain good oral hygiene. When shaving, use an electronic razor instead of razor blades. Use a nail file instead of nail clippers. Call your care provider if you have bleeding that won’t stop. Examples include: A bloody nose that bleeds for more than five minutes despite pressure A cut that continues to ooze despite pressure Gums that bleed excessively when you floss or brush Seek medical help immediately if you experience any severe headaches, observe blood in your urine or stool, cough up blood, or experience prolonged and uncontrollable bleeding. You may need to take a break or hold your medication for medical or dental procedures. Talk to your care provider or dentist before any scheduled procedures. 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 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 chlorambucil. 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 chlorambucil. CHLORAMBUCIL ORAL CHEMOTHERAPY EDUCATION Page 5 Do not breastfeed while taking chlorambucil and for one month after the last dose of chlorambucil. 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 chlorambucil. PHARMACY OR SPECIALTY PHARMACY CONTACT INFO Additional resources Product prescribing information: https://www.accessdata.fda.gov/drugsatfda docs/ label/2011/010669s032lbl.pdf Updated — February 6, 2018 Additional instructions Important notice: The Association of Community Cancer Centers ACCC , Hematology/Oncology Pharmacy Association HOPA , National Community Oncology Dispensing Association, Inc. NCODA , and Oncology Nursing Society ONS have collaborated in gathering information for and developing this patient education guide. This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this medication by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Oral Chemotherapy Education OCE sheets are provided as a free educational resource for patients with cancer in need of concise, easy to understand information about oral cancer drugs. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2018 by Hematology/Oncology Pharmacy Association. All rights reserved.

Page 1 TRIFLURIDINE AND TIPIRACIL ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — trifluridine try FLOOR ih deen and tipiracil ty PEER uh sil Brand name — Lonsurf® LON serf Approved uses Trifluridine and tipiracil is a combination drug used to treat metastatic colorectal cancer. Dose and schedule Taking trifluridine and tipiracil 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. Trifluridine is taken by mouth twice daily on days 1–5 and days 8–12 of each 28 day cycle. You should not take this medication on other days of the cycle. The dose may be adjusted by your care provider based on your individual needs. Trifluridine and tipiracil should be taken within one hour after completion of the morning and evening meals, at the same time each day. Trifluridine and tipiracil should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow trifluridine and tipiracil, talk to your care provider or pharmacist for possible options. If you miss a dose of trifluridine and tipiracil, 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 trifluridine and tipiracil 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 trifluridine and tipiracil at room temperature 68°F–77°F in a dry location away from light. Keep trifluridine and tipiracil out of reach of children and pets. Leave trifluridine and tipiracil in the provided packaging until it is ready to be taken. Whenever possible, you should give trifluridine and tipiracil to yourself and follow the steps below. If a family member, friend, or caregiver needs to give the trifluridine and tipiracil 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 trifluridine and tipiracil 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. TRIFLURIDINE AND TIPIRACIL ORAL CHEMOTHERAPY EDUCATION Page 2 If a daily pill box or pill reminder is used, a separate one should be used for trifluridine and tipiracil. Do not mix other medications into the box with trifluridine and tipiracil. 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 trifluridine and tipiracil, 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 trifluridine and tipiracil. If you are traveling, put your trifluridine and tipiracil in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Since trifluridine and tipiracil 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 trifluridine and tipiracil, 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 trifluridine and tipiracil 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 Trifluridine and tipiracil has many drug interactions, please inform your care providers of all prescription medications, over the counter medications, vitamins, and herbal products. Trifluridine and tipiracil should be taken within one hour of completion of the morning and evening meals. Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. Page 3 TRIFLURIDINE AND TIPIRACIL ORAL CHEMOTHERAPY EDUCATION Side Effects of Trifluridine and Tipiracil The common side effects that have been known to happen in more than 30% of patients taking trifluridine and tipiracil 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 Decreased white blood cells WBCs and increased risk for infection Your WBCs should be monitored by a simple blood test. When your WBCs are low, you are at a greater risk of having an infection. Take the following precautions to protect yourself from infection. Wash your hands often, especially before eating and after using the bathroom. Avoid crowds and people with fevers, flu, or other infection. Bathe regularly to keep good personal hygiene. Contact your care provider if you experience any signs or symptoms of an infection such as: Fever temperature more than 100.4°F or 38°C Chills Sore throat Burning with urination Unusual tiredness A sore that becomes red, is draining, or does not heal Check with your care provider before taking any medicine for a fever or chills. Continued on the next page TRIFLURIDINE AND TIPIRACIL 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, 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. 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 and vomiting. Decreased platelet count and increased risk of bleeding Your platelets should be monitored by a simple blood test. When they are low, you may bruise or bleed more easily than usual. Use caution to avoid bruises, cuts, or burns. Blow your nose gently, and do not pick your nose. Brush your teeth gently with a soft toothbrush, and maintain good oral hygiene. When shaving, use an electronic razor instead of razor blades. Use a nail file instead of nail clippers. Call your care provider if you have bleeding that won’t stop. Examples include: A bloody nose that bleeds for more than five minutes despite pressure A cut that continues to ooze despite pressure Gums that bleed excessively when you floss or brush Seek medical help immediately if you experience any severe headaches, observe blood in your urine or stool, cough up blood, or experience prolonged and uncontrollable bleeding. You may need to take a break or hold your medication for medical or dental procedures. Talk to your care provider or dentist before any scheduled procedures. Continued on the next page Page 5 TRIFLURIDINE AND TIPIRACIL ORAL CHEMOTHERAPY EDUCATION Possible Side Effect Management Decreased appetite or weight loss Talk to your care provider if you notice a decrease in weight while taking this medication. When you do not feel like eating, try: Eat small, 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. Diarrhea loose and/ or urgent bowel movements Monitor how many bowel movements you have each day. Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake. Eat small, frequent meals throughout the day rather than a few large meals. Eat bland, low fiber foods, such as bananas, applesauce, potatoes, chicken, rice, and toast. Avoid high fiber foods, such as raw vegetables, raw fruits, and whole grains. Avoid foods that cause gas, such as broccoli and beans. Avoid lactose containing foods, such as yogurt and milk. Avoid spicy, fried, and greasy foods. Contact your provider if any of the following occur: The number of bowel movements you have in a day increases by 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. 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 trifluridine and tipiracil. Women of childbearing age and potential should use effective contraception during therapy and one day after the last dose of trifluridine and tipiracil. Men of childbearing age and potential should use effective contraception, including condoms, during therapy and for a minimum of three months after the last dose of trifluridine and tipiracil. Do not breastfeed while taking trifluridine and tipiracil and for one day after the last dose of trifluridine and tipiracil. 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 encouraged to ask your care provider. TRIFLURIDINE AND TIPIRACIL ORAL CHEMOTHERAPY EDUCATION Page 6 Important notice: The Association of Community Cancer Centers ACCC , Hematology/Oncology Pharmacy Association HOPA , National Community Oncology Dispensing Association, Inc. NCODA , and Oncology Nursing Society ONS have collaborated in gathering information for and developing this patient education guide. This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this medication by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Oral Chemotherapy Education OCE sheets are provided as a free educational resource for patients with cancer in need of concise, easy to understand information about oral cancer drugs. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2018 by Hematology/Oncology Pharmacy Association. All rights reserved. Obtaining medication Talk with your care provider about the process for obtaining your trifluridine and tipiracil. PHARMACY OR SPECIALTY PHARMACY CONTACT INFO Additional resources Product website: https://www.lonsurf.com Product prescribing information: https://www.taihooncology.com/us/prescribing information.pdf Product resources: https://www.lonsurf.com/patient resources/patient starter kit https://www.lonsurf.com/financial support/cost assistance https://www.lonsurf.com/taking lonsurf/potential treatment changes Updated — January 13, 2018 Additional instructions

Page 1 LORLATINIB ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name lorlatinib (lor LA tih nib) Brand name Lorbrena® (lor BREH nuh) Approved uses Lorlatinib is used to treat metastatic non small cell lung cancer that has a genetic mutation called anaplastic lymphoma kinase. Dose and schedule Taking lorlatinib 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 lorlatinib is 100 milligrams (100 mg) to be taken by mouth at a scheduled time, once daily. Lorlatinib can be taken with or without food, but at the same time each day. Lorlatinib should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow lorlatinib, talk to your care provider or pharmacist for possible options. If you miss a dose of lorlatinib, follow these guidelines: Take the missed dose unless the next dose is due within four hours. 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 lorlatinib 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 lorlatinib at room temperature (68°F–77°F) in a dry location away from light. Keep lorlatinib out of reach of children and pets. Leave lorlatinib in the provided packaging until it is ready to be taken. Whenever possible, you should give lorlatinib to yourself and follow the steps below. If a family member, friend, or caregiver needs to give the lorlatinib 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 lorlatinib 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. LORLATINIB ORAL CHEMOTHERAPY EDUCATION Page 2 If a daily pill box or pill reminder is used, a separate one should be used for lorlatinib. Do not mix other medications into the box with lorlatinib. 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 lorlatinib, 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 lorlatinib. If you are traveling, put your lorlatinib in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Since lorlatinib 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 lorlatinib, 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 lorlatinib 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 Lorlatinib has many drug interactions. Please inform your care providers of all prescription medications, over the counter medications, vitamins, and herbal products. Grapefruit or grapefruit juice may interact with lorlatinib; avoid eating or drinking this during treatment with lorlatinib. Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. LORLATINIB ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Lorlatinib The common side effects that have been known to happen in more than 30% of patients taking lorlatinib 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 cholesterol levels High triglyceride levels High glucose levels Low albumin 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 Fluid retention or swelling Do not stand for long periods of time. Keep your legs elevated when sitting or lying down. Try not to eat salty foods, which can increase swelling. Avoid tight fitting clothing and shoes. Weigh yourself daily. Contact your 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 one week Continued on the next page LORLATINIB 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 health care provider know right away if you experience any of the following: Shortness of breath Dizziness Palpitations Numbness or tingling in hands and feet Report changes in your sense of touch, such as a burning sensation, pain on the skin, or weakness. Changes in liver function Your liver function should be checked periodically by a simple blood test. Contact your care provider if you notice any of the following: Yellowing of the skin or whites of your eyes Dark or brown urine Bleeding or bruising Serious side effects Lorlatinib may cause changes to your heartbeats or heart rhythm. Your care provider should check your heart rhythm before starting lorlatinib and during treatment. Tell your care provider right away if you feel dizzy or faint, or if you have abnormal heartbeats. Lorlatinib can cause lung and breathing problems. Tell your healthcare provider right away if you have new or worsening cough, shortness of breath, chest pain, fever, difficulty breathing, or wheezing. Lorlatinib can cause brain problems. Report any changes in thinking, mood, speech, seeing, or hearing to your care provider. If you experience ANY uncontrolled side effect, call your physician or healthcare center immediately: (INSTITUTIONAL CONTACT INFO) Pregnancy, sexual activity, and contraception Women should not become pregnant and men should not get a partner pregnant while taking lorlatinib. Birth control pills (oral contraceptives) and other hormonal forms of birth control may not be effective with lorlatinib. Women of reproductive potential should use effective nonhormonal contraception during therapy and for a minimum of six months after the last dose of lorlatinib. LORLATINIB ORAL CHEMOTHERAPY EDUCATION Page 5 Do not breastfeed while taking lorlatinib and for seven days after the last dose of lorlatinib. 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 gilteritinib, and you are encouraged to ask your care provider. Obtaining medication Talk with your care provider about the process for obtaining your lorlatinib. (PHARMACY OR SPECIALTY PHARMACY CONTACT INFO) Additional resources Product website: https://www.lorbrena.com Product prescribing information: https://www.accessdata.fda.gov/drugsatfda docs/ label/2018/210868s000lbl.pdf Product resources: https://www.lorbrena.com/personalized support Updated – November 21, 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 © 2019 by Hematology/Oncology Pharmacy Association. All rights reserved.

Page 1 SOTORASIB ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — sotorasib (SOH toh RA sib) Brand name — Lumakras® (LOO muh kras) Approved uses Sotorasib is used to treat patients with non small cell lung cancer that have a genetic variant called KRAS G12C. Dose and schedule Taking sotorasib 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 sotorasib is 960 milligrams (960 mg) to be taken by mouth at a scheduled time each day. Sotorasib should be taken with or without food at the same time each day. Sotorasib should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow sotorasib, talk to your care provider or pharmacist for possible options. If you miss a dose of sotorasib, follow these guidelines: • 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 two doses at one time. • Be sure to write down if you miss a dose and let your care provider know about any missed doses. Drug and food interactions Sotorasib has many drug interactions. Inform your care providers of all prescription medications, over the counter medications, vitamins, and herbal products. Medications that decrease stomach acid decrease sotorasib concentrations. Avoid use with proton pump inhibitors (e.g., omeprazole [Prilosec®], esomeprazole [Nexium®]) and with histamine blockers (e.g., ranitidine [Zantac®], famotidine [Pepcid®]), if possible. If taken with an antacid, schedule your sotorasib 4 hours before or 10 hours after taking the antacid. Grapefruit or grapefruit juice may interact with sotorasib; avoid eating or drinking these during treatment with sotorasib. Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. Storage and handling Handle sotorasib 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 sotorasib at room temperature (68°F–77°F) in a dry location away from light. Keep out of reach of children and pets. Leave sotorasib in the provided packaging until it is ready to be taken. SOTORASIB ORAL CHEMOTHERAPY EDUCATION Page 2 Whenever possible, you should give sotorasib to yourself and follow the steps below. If a family member, friend, or caregiver needs to give it 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 sotorasib from its package to a small medicine or other disposable cup. 4. Administer the medicine immediately by mouth with water. 5. Remove gloves and do not use them for anything else. 6. Throw gloves and medicine cup in household trash. 7. Wash hands with soap and water. A daily pill box or reminder may be used for sotorasib. Contact your care team before using a daily pill box. • 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 sotorasib, 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 sotorasib. If you are traveling, put your sotorasib in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. SOTORASIB ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Sotorasib Below are common side effects that have been known to happen in about one third or more of patients taking sotorasib are listed on the left side of this table. You MAY NOT experience these side effects. Options to help manage any side effects that do occur are included on the right side of this table. These should be discussed with your care provider. If you experience any side effect you cannot manage or that is not listed here, contact your care provider. Possible Side Effect Management Decreased white blood cells (WBCs) and increased risk for infection Your WBCs should be monitored by a simple blood test. When your WBCs are low, you are at a greater risk of having an infection. Take the following precautions to protect yourself from infection. • Wash your hands often, especially before eating and after using the bathroom. • Avoid crowds and people with fevers, flu, or other infection. • Bathe regularly to keep good personal hygiene. Contact your care provider if you experience any signs or symptoms of an infection, such as the following: • Fever (temperature more than 100.4°F or 38°C) • Chills • Sore throat • Burning with urination • Unusual tiredness • A sore that becomes red, is draining, or does not heal Check with your care provider before taking any medicine for a fever or chills. Decreased hemoglobin, part of the red blood cells that carry iron and oxygen Your hemoglobin should be monitored by a simple blood test. When your hemoglobin is low, you may notice that you get tired or fatigued more easily. • Try to get 7–8 hours of sleep per night. • Avoid operating heavy machinery if you feel too tired. • Find a balance between work and rest. • Stay as active as possible, but know that it is OK 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 Continued on the next page SOTORASIB ORAL CHEMOTHERAPY EDUCATION Page 4 Possible Side Effect Management Diarrhea (loose and/ or urgent bowel movements) Monitor how many bowel movements you have each day. • Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake. • Eat small, frequent meals throughout the day rather than a few large meals. • Eat bland, low fiber foods (e.g., bananas, applesauce, potatoes, chicken, rice, toast). • Avoid high fiber foods (e.g., raw vegetables, raw fruits, whole grains). • Avoid foods that cause gas (e.g., broccoli, beans). • Avoid lactose containing foods (e.g., yogurt, milk). • Avoid spicy, fried, and greasy foods. Contact your provider if any of the following occur: • The number of bowel movements you have in a day increases by four or more. • You feel dizzy or lightheaded. Your care provider may recommend an over the counter medication called loperamide (Imodium®) to help with your diarrhea, but talk to your care provider before starting this medication. Changes in 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 Muscle or joint pain • Keep a diary of your pain, including a description of when and where the pain is occurring, what it feels like, and how long it lasts. • Stay as active as possible, but know that it is OK to rest as needed, too. • Tell your care provider if pain or a spasm interferes with your activity. • If the pain bothers you, ask your provider what you may use to help with this discomfort. Take only pain medication that has been prescribed or recommended by your care provider. Changes in electrolytes and other laboratory values • Low calcium • High alkaline phosphatase Changes in some laboratory 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 SOTORASIB ORAL CHEMOTHERAPY EDUCATION Page 5 Serious side effects Sotorasib may be harmful to your lungs. Inform your care provider of any new difficulty breathing, cough, or fever. Your provider may stop treatment with sotorasib if your lungs are affected. If you experience ANY uncontrolled side effect, call your physician or healthcare center immediately: (INSTITUTIONAL CONTACT INFO) Handling body fluids and waste Because sotorasib 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 sotorasib, 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 sotorasib with soap and water. Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing. If you do not have a washer, place the soiled linens in a plastic bag until they can be washed. Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids. Pregnancy, sexual activity, and contraception Women should not become pregnant and men should not get a partner pregnant while taking sotorasib. Males and females of childbearing age and potential should use effective contraception during therapy. Effective contraception could include one or more of the following: oral contraceptive, barrier methods, etc. Do not breastfeed while taking sotorasib and for at least one week after the last dose of sotorasib. 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. SOTORASIB 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 © 2021 by Hematology/Oncology Pharmacy Association. All rights reserved. Obtaining medication Talk with your care provider about the process for obtaining your sotorasib. (PHARMACY OR SPECIALTY PHARMACY CONTACT INFO) Additional resources Product website: www.lumakras.com Product prescribing information: www.pi.amgen.com/united states/lumakras/lumakras pi hcp english.pdf Product resources: www.lumakras.com/support Updated – July 16, 2021 Additional instructions

Page 1 OLAPARIB ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — olaparib (oh LA puh rib) Brand name — Lynparza® (lin PAR zuh) Approved uses Olaparib is used to treat ovarian, fallopian tube, or primary peritoneal cancer. Dose and schedule Taking olaparib 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 olaparib is 300 milligrams (300 mg) or 400 milligrams (400 mg) to be taken by mouth at a scheduled time two times a day. Olaparib comes as capsules and tablets. Capsules and tablets are not the same. If your care provider prescribes capsules for you, do not take tablets instead. If your care provider prescribes tablets, do not take capsules instead. Olaparib can be taken with or without food, but at the same time each day. Olaparib should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow olaparib, talk to your care provider or pharmacist for possible options. If you miss a dose of olaparib, 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 olaparib 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 olaparib at room temperature (68°F–77°F) in a dry location away from light. Keep olaparib out of reach of children and pets. Leave olaparib in the provided packaging until it is ready to be taken. Whenever possible, give olaparib to yourself and follow the steps below. If a family member, friend, or caregiver needs to give olaparib 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 olaparib 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. OLAPARIB ORAL CHEMOTHERAPY EDUCATION Page 2 If a daily pill box or pill reminder is used, a separate one should be used for olaparib. Do not mix other medications into the box with olaparib. 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 olaparib, 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 olaparib. If you are traveling, put your olaparib in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Olaparib 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 olaparib, 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 olaparib 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 Olaparib has many drug interactions. Inform your care providers of all prescription medications, over the counter medications, vitamins, and herbal products that you are taking. Grapefruit, grapefruit juice, and Seville oranges may interact with olaparib; avoid eating or drinking these during treatment with olaparib. Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. OLAPARIB ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Olaparib The common side effects that have been known to happen in more than 30% of patients taking olaparib 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 Nausea or vomiting Eat and drink slowly. Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake. Eat small, frequent meals throughout the day rather than a few large meals. Eat bland foods; avoid spicy, fried, and greasy foods. Avoid vigorous exercise immediately after eating. Don’t lie down immediately after eating. Avoid strong odors. Let your provider know if you experience nausea or vomiting. Your provider may prescribe medication that can help. 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 OLAPARIB 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. Abdominal pain Abdominal pain or discomfort may occur. Report any serious pain or symptoms to your care provider immediately. 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 OLAPARIB ORAL CHEMOTHERAPY EDUCATION Page 5 Possible Side Effect Management Muscle or joint pain or weakness Keep a diary of your pain, including a description of when and where the pain is occurring, what it feels like, and how long it lasts. Stay as active as possible, but know that it is okay to rest as needed, too. Tell your care provider if pain interferes with your activity. If the pain or weakness bothers you, ask your provider how you may ease this discomfort. Only take medication that has been prescribed or recommended by your care provider. 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 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 will not 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 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 If you experience ANY uncontrolled side effect call your physician or healthcare center immediately: (INSTITUTIONAL CONTACT INFO) OLAPARIB ORAL CHEMOTHERAPY EDUCATION Page 6 Pregnancy sexual activity and contraception Women should not become pregnant and men should not get a partner pregnant while taking olaparib Men and women of childbearing age and potential should use effective contraception during therapy and for a minimum of six months after the last dose of olaparib Do not breastfeed while taking olaparib and for one month after the last dose of olaparib 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 olaparib and you are encouraged to ask your care provider Obtaining medication Talk with your care provider about how to obtain your olaparib (PHARMACY OR SPECIALTY PHARMACY CONTACT INFO) Additional resources Product website: https://www lynparza com Product prescribing information: https://www azpicentral com/Lynparza/pi lynparza pdf#page=1 Product resources: https://www lynparza com/support for patients/support for patients html Updated – November 20 2017 OLAPARIB ORAL CHEMOTHERAPY EDUCATION Page 7 Important notice: The Association of Community Cancer Centers (ACCC) Hematology/Oncology Pharmacy Association (HOPA) National Community Oncology Dispensing Association Inc (NCODA) and Oncology Nursing Society (ONS) have collaborated in gathering information for and developing this patient education guide This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources This guide does not cover all existing information related to the possible uses directions doses precautions warnings interactions adverse effects or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional Provision of this guide is for informational purposes only and does not constitute or imply endorsement recommendation or favoring of this medication by ACCC HOPA NCODA or ONS who assume no liability for and cannot ensure the accuracy of the information presented The collaborators are not making any representations with respect to the medications whatsoever and any and all decisions with respect to such medications are at the sole risk of the individual consuming the medication All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional Permission: Oral Chemotherapy Education (OCE) sheets are provided as a free educational resource for patients with cancer in need of concise easy to understand information about oral cancer drugs Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information However commercial reproduction or reuse as well as rebranding or reposting of any type are strictly prohibited without permission of the copyright holder Please email permission requests and licensing inquiries to Contact@NCODA org Copyright © 2017 by Hematology/Oncology Pharmacy Association All rights reserved Additional instructions

Page 1 TER MITOTANE ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — mitotane MY toh tane Brand name — Lysodren™ Approved uses Mitotane is used to treat adrenal cortical carcinoma. Dose and schedule Taking mitotane 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 mitotane is between 2,000 milligrams 2,000 mg and 6,000 milligrams 6,000 mg per day to be divided into three or four doses. Mitotane can be taken with or without food at the same times each day. Mitotane should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow mitotane, talk to your care provider or pharmacist for possible options. If you miss a dose of mitotane, 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 mitotane 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 mitotane at room temperature 68°F–77°F in a dry location away from light. Keep mitotane out of reach of children and pets. Leave mitotane in the provided packaging until it is ready to be taken. Whenever possible, give mitotane to yourself and follow the steps below. If a family member, friend, or caregiver needs to give mitotane 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 mitotane 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. MITOTANE ORAL CHEMOTHERAPY EDUCATION Page 2 If a daily pill box or pill reminder is used, a separate one should be used for mitotane. Do not mix other medications into the box with mitotane. 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 mitotane, 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 mitotane. If you are traveling, put your mitotane in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Because mitotane 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 mitotane, 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 mitotane 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 Mitotane 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. Serious side effects Adrenal crisis may develop if shock or severe trauma occurs, which impairs your body’s response. Notify your provider of any planned surgeries. If you experience ANY uncontrolled side effect, call your physician or healthcare center immediately: INSTITUTIONAL CONTACT INFO MITOTANE ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Mitotane The common side effects that have been known to happen in more than 30% of patients taking mitotane 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 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. Decreased appetite or weight loss Talk to your care provider if you notice a decrease in weight while taking this medication. When you do not feel like eating, try the following: Eat small, frequent meals rather than 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. Diarrhea loose and/ or urgent bowel movements Monitor how many bowel movements you have each day. Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake. Eat small, frequent meals throughout the day rather than a few large meals. Eat bland, low fiber foods e.g., bananas, applesauce, potatoes, chicken, rice, toast . Avoid high fiber foods e.g., raw vegetables, raw fruits, whole grains . Avoid foods that cause gas e.g., broccoli, beans . Avoid lactose containing foods e.g., yogurt, milk . Avoid spicy, fried, and greasy foods. Contact your provider if either of the following occurs: The number of bowel movements you have in a day increases by 4 or more. You feel dizzy or lightheaded. Your care provider may recommend an over the counter medication called loperamide Imodium® to help with your diarrhea, but talk to your care provider before starting this medication. MITOTANE ORAL CHEMOTHERAPY EDUCATION Page 4 Pregnancy, sexual activity, and contraception Women should not become pregnant and men should not get a partner pregnant while taking mitotane. Men and women of childbearing age and potential should use effective contraception during therapy and for as long as mitotane levels are detectable. Do not breastfeed while taking mitotane and while mitotane levels are detectable. 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 mitotane, and you are encouraged to ask your care provider. Obtaining medication Talk with your care provider about the process for obtaining your mitotane. PHARMACY OR SPECIALTY PHARMACY CONTACT INFO Additional resource Product prescribing information: https://packageinserts.bms.com/pi/pi lysodren.pdf Updated — May 3, 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.

Page 1 FUTIBATINIB ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — futibatinib (FYOO-tih-BA-tih-nib) Brand name — Lytgobi® (lite-GOH-bee) Common uses Futibatinib is used to treat intrahepatic cholangiocarcinoma that has spread or cannot be removed by surgery and has a fibroblast growth factor receptor 2 (FGFR2) gene fusion or other rearrangement. Futibatinib may also be used for other treatments. Dose and schedule Taking futibatinib 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 futibatinib is 20 milligrams (20 mg) to be taken by mouth once daily. o Futibatinib can be taken with or without food, but at the same time each day. o Futibatinib should be taken whole and not crushed, chewed, cut, or dissolved. If you are unable to swallow futibatinib, talk to your care provider or pharmacist for possible options. o If you miss a dose of futibatinib: • Do not take the missed dose if it has been more than 12 hours since you should have taken it or if vomiting occurs. 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. Drug and food interactions o Futibatinib has many drug interactions, please inform your care providers of all prescription medications, over-the counter medications, vitamins, and herbal products. o Grapefruit or grapefruit juice may interact with futibatinib; avoid eating or drinking these during treatment with futibatinib. o Talk with your care provider or pharmacist before taking new medications or supplements or receiving any vaccines. Page 2 FUTIBATINIB ORAL CHEMOTHERAPY EDUCATION Storage and handling Handle futibatinib 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 futibatinib at room temperature (68 to 77 F) in a dry location away from light. o Keep futibatinib out of reach of children and pets. o Leave futibatinib in the provided packaging until it is ready to be taken. o Whenever possible, you should give futibatinib to yourself and follow the steps below. If a family member, friend, or caregiver needs to give the futibatinib 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 futibatinib 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 If a daily pill box or pill reminder will be used, contact your care team before using: • The person filling the box or reminder should wear gloves (gloves are not necessary if you are filling the box or reminder). • When empty, the box or reminder should be washed with soap and water before refilling. Be sure to wash hands with soap and water after the task is complete, whether or not gloves are worn. o If you have any unused futibatinib, 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 futibatinib. o If you are traveling, put your futibatinib’s packaging in a separate sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Page 3 FUTIBATINIB ORAL CHEMOTHERAPY EDUCATION Side Effects of Futibatinib Common side effects that have been known to happen in about one third or more of patients taking futibatinib are listed on the left side of this table. You MAY NOT experience these side effects. Options to help manage any side effects that do occur are included on the right side of this table. These should be discussed with your care provider. If you experience any side effect you cannot manage or that is not listed here, contact your care provider. Possible Side Effect Management Changes in electrolytes and other laboratory values • High or low phosphate level • High or low glucose level • High calcium level • Low sodium level 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 kidney function Your kidney (renal) function will be checked periodically by a simple blood test. Contact your care provider if you notice any of the following: • Decreased amount of urination • Unusual swelling in your legs and feet Changes in liver function Your liver function will be checked periodically by a simple blood test. Contact your care provider if you notice any of the following: • Yellowing of the skin or whites of your eyes • Dark or brown urine • Bleeding or bruising Continued on the next page Page 4 FUTIBATINIB ORAL CHEMOTHERAPY EDUCATION 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 to 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, too. • 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 Decreased white blood cells (WBCs) and increased risk for infection Your WBCs should be monitored by a simple blood test. When your WBCs are low, you are at a greater risk of having an infection. Take the following precautions to protect yourself from infection. • Wash your hands often, especially before eating and after using the bathroom. • Avoid crowds and people with fevers, flu, or other infection. • Bathe regularly to keep good personal hygiene. Contact your care provider if you experience any signs or symptoms of an infection such as: • Fever (temperature more than 100.4°F or 38°C) • Chills • Sore throat • Burning with urination • Unusual tiredness • A sore that becomes red, is draining, or does not heal Check with your care provider before taking any medicine for a fever or chills. Continued on the next page Page 5 FUTIBATINIB ORAL CHEMOTHERAPY EDUCATION Possible Side Effect Management Decreased platelet count and increased risk of bleeding Your platelets should be monitored by a simple blood test. When they are low, you may bruise or bleed more easily than usual. • Use caution to avoid bruises, cuts, or burns. • Blow your nose gently and do not pick your nose. • Brush your teeth gently with a soft toothbrush and maintain good oral hygiene. • When shaving use an electronic razor instead of razor blades. • Use a nail file instead of nail clippers. Call your care provider if you have bleeding that won’t stop. Examples include: • 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, 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. Nail changes Usually this change starts at the cuticle and may affect the skin around the nail. • Biting, chewing, or picking at your nails can increase the risk of getting an infection • Talk to your care provider if you notice any changes in your nails 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. Continued on the next page Page 6 FUTIBATINIB ORAL CHEMOTHERAPY EDUCATION Possible Side Effect Management Constipation 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. • 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 3 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 laxative such as senna (Senakot®) may be helpful. If these do not help within 48 hours, tell your provider. Diarrhea (loose and/ or urgent bowel movement) 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 4 or more. • You feel dizzy or lightheaded. Your care provider may recommend an over-the-counter medication called loperamide (Imodium®) to help with your diarrhea, but talk to your care provider before starting this medication. Continued on the next page Page 7 FUTIBATINIB ORAL CHEMOTHERAPY EDUCATION 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. o Plan your activities, and do them at a time of day when you feel a bit more energetic. o Avoid operating heavy machinery if you feel too tired. Hair loss (alopecia) Your hair will grow back after treatment is over. Some people choose to wear scarves, caps, or wigs. A short haircut prior to treatment may help with stress of hair loss. Dry mouth 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 non-alcohol mouth rinse at least 4 times a day (after eating and at bedtime). One example is a mixture of 1/8 teaspoon of salt and 1/4 teaspoon of baking soda in 8 ounces of warm (not hot) water. • If you have sores in your mouth, avoid using tobacco products, alcohol, and mouthwashes that contain alcohol. Call your care provider if you experience pain or sores in your mouth or throat. Abdominal pain Abdominal pain/discomfort may occur. Report any serious pain or symptoms to your care provider immediately. Serious side effects o Futibatinib may be harmful to your eyes. Call your care team if you have any issue with your vision, or if you have pain in your eyes. o Your phosphate levels may be higher while taking futibatinib. Your provider may prescribe a medication to lower your phosphate level. Speak to your care team to know when you need to have blood tests done to monitor your phosphate level. o Futibatinib can cause serious birth defects. Do not take futibatinib if you are pregnant or think you might be pregnant. If you experience ANY uncontrolled side effect, call your physician or healthcare center immediately: Handling body fluids and waste Since futibatinib 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 futibatinib, 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. o Pregnant women should avoid touching anything that may be soiled with body fluids from the patient. Page 8 FUTIBATINIB ORAL CHEMOTHERAPY EDUCATION 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 that all waste has been discarded. • If the toilet or toilet seat becomes soiled with urine, stool, or vomit, clean the surfaces before other people use the toilet. • Wash hands with soap and water after using the toilet. 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 futibatinib 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. Pregnancy, sexual activity, and contraception o Women should not become pregnant and men should not get a partner pregnant while taking futibatinib. Males and females of childbearing age and potential should use effective contraception during therapy and for a minimum of 1 week after the last dose of futibatinib. o Effective contraception could include 1 or more of the following: oral contraceptive, barrier methods, etc. o Do not breastfeed while taking futibatinib and 1 week after the last dose of futibatinib. o Please inform your care provider if you become pregnant. o It is safe to hug and kiss. Special precautions may be needed for sexual activity while on oral chemotherapy and you are encouraged to ask your care team for assistance. Obtaining medication o Talk with your care provider about the process for obtaining your futibatinib. Page 9 FUTIBATINIB ORAL CHEMOTHERAPY EDUCATION 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 © 2023 by Hematology/Oncology Pharmacy Association. All rights reserved. Additional resources Product website: www. lytgobi.com Product prescribing information: https://taihocorp-media-release.s3.us-west-2.amazonaws.com/documents/ LYTGOBI_Prescribing_Information.pdf Product resources: https://www.taihopatientsupport.com Updated – April 27, 2023 Additional instructions

Page 1 PROCARBAZINE ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — procarbazine proh KAR buh zeen Brand name — Matulane MA choo layn Approved uses Procarbazine is used to treat Hodgkin’s disease. Dose and schedule Taking procarbazine 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. Procarbazine can be taken with or without food, but at the same time each day. However, some foods may interact with procarbazine. Please see the “Drug and food interactions” section for more details. Procarbazine should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow procarbazine, talk to your care provider or pharmacist for possible options. If you miss a dose of procarbazine, 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 procarbazine 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 procarbazine at room temperature 68°F–77°F in a dry location away from light. Keep procarbazine out of reach of children and pets. Leave procarbazine in the provided packaging until it is ready to be taken. Whenever possible, you should give procarbazine to yourself and follow the steps below. If a family member, friend, or caregiver needs to give the procarbazine 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 procarbazine from its package to a small medicine or other disposable cup. 4. Administer the medicine immediately by mouth with water. 5. Remove gloves and do not use them for anything else. 6. Throw gloves and medicine cup in household trash. 7. Wash hands with soap and water. If a daily pill box or pill reminder is used, a separate one should be used for procarbazine. Do not mix other medications into the box with procarbazine. 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. PROCARBAZINE ORAL CHEMOTHERAPY EDUCATION Page 2 If you have any unused procarbazine, 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 procarbazine. If you are traveling, put your procarbazine in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Since procarbazine 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 procarbazine, 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 procarbazine 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 Procarbazine has many drug interactions, please inform your care providers of all prescription medications, over the counter medications, vitamins, and herbal products. Alcoholic beverages may interact with procarbazine; avoid drinking these during treatment with procarbazine. Foods with known high tyramine content, such as wine, yogurt, ripe cheese, and bananas, may interact with procarbazine; avoid eating these foods during treatment with procarbazine. Tobacco may interact with procarbazine; avoid tobacco products during treatment with procarbazine Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. PROCARBAZINE ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Procarbazine The common side effects that have been known to happen in more than 30% of patients taking procarbazine 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 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 and vomiting. Decreased white blood cells WBCs and increased risk for infection Your WBCs should be monitored by a simple blood test. When your WBCs are low, you are at a greater risk of having an infection. Take the following precautions to protect yourself from infection. Wash your hands often, especially before eating and after using the bathroom. Avoid crowds and people with fevers, flu, or other infection. Bathe regularly to keep good personal hygiene. Contact your care provider if you experience any signs or symptoms of an infection such as: Fever temperature more than 100.4°F or 38°C Chills Sore throat Burning with urination Unusual tiredness A sore that becomes red, is draining, or does not heal Check with your care provider before taking any medicine for a fever or chills. Continued on the next page PROCARBAZINE ORAL CHEMOTHERAPY EDUCATION Page 4 Possible Side Effect Management Decreased hemoglobin, part of the red blood cells that carry iron and oxygen Your hemoglobin should be monitored by a simple blood test. When your hemoglobin is low, you may notice that you get tired or fatigued more easily. Try to get 7–8 hours of sleep per night. Avoid operating heavy machinery if you feel too tired. Find a balance between work and rest. Stay as active as possible, but know that it is okay to rest as needed. You might notice that you are more pale than usual. Let your care provider know right away if you experience: Shortness of breath Dizziness Palpitations Decreased platelet count and increased risk of bleeding Your platelets should be monitored by a simple blood test. When they are low, you may bruise or bleed more easily than usual. Use caution to avoid bruises, cuts, or burns. Blow your nose gently, and do not pick your nose. Brush your teeth gently with a soft toothbrush, and maintain good oral hygiene. When shaving, use an electronic razor instead of razor blades. Use a nail file instead of nail clippers. Call your care provider if you have bleeding that won’t stop. Examples include: A bloody nose that bleeds for more than five minutes despite pressure A cut that continues to ooze despite pressure Gums that bleed excessively when you floss or brush Seek medical help immediately if you experience any severe headaches, observe blood in your urine or stool, cough up blood, or experience prolonged and uncontrollable bleeding. You may need to take a break or hold your medication for medical or dental procedures. Talk to your care provider or dentist before any scheduled procedures. 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 procarbazine. 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 procarbazine. Do not breastfeed while taking procarbazine and for one month after the last dose of procarbazine. PROCARBAZINE ORAL CHEMOTHERAPY EDUCATION Page 5 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 procarbazine. PHARMACY OR SPECIALTY PHARMACY CONTACT INFO Additional resources Product website: http://www.matulane.com Product prescribing information: http://www.matulane.com/pdf/prescribe info matulane 20140422164502 508945.pdf Updated — January 14, 2018 Additional instructions Important notice: The Association of Community Cancer Centers ACCC , Hematology/Oncology Pharmacy Association HOPA , National Community Oncology Dispensing Association, Inc. NCODA , and Oncology Nursing Society ONS have collaborated in gathering information for and developing this patient education guide. This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this medication by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Oral Chemotherapy Education OCE sheets are provided as a free educational resource for patients with cancer in need of concise, easy to understand information about oral cancer drugs. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2018 by Hematology/Oncology Pharmacy Association. All rights reserved.

ORAL CANCER TREATMENT EDUCATION TRAMETINIB Name of your medication Generic name — trametinib (truh-MEH-tih-nib) Brand name — Mekinist® (MEH-kih-nist) Common uses Trametinib is used to treat patients with the following: o Melanoma that has a genetic variant called BRAF V600E or V600K and may or may not be used in combination with dabrafenib. o Non-small cell lung cancer, anaplastic thyroid cancer, solid tumors, and low-grade glioma that has a genetic variant called BRAF V600E and is used in combination with dabrafenib. Trametinib may also be used for other treatments. Dose and schedule Taking trametinib 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 trametinib is 2 milligrams (2 mg) to be taken by mouth at a scheduled time once a day. o Trametinib should be taken on an empty stomach (one hour before and two hours after a meal or snack) and at the same time each day. o Trametinib should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow trametinib, talk to your care provider or pharmacist for possible options. o If you miss a dose of trametinib: • Take the missed dose only 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. Drug and food interactions o Trametinib 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 Trametinib should be taken on an empty stomach (one hour before and two hours after a meal or snack). o Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. Page 1 ORAL CANCER TREATMENT EDUCATION TRAMETINIB Storage and handling Handle trametinib 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 trametinib in the refrigerator (36°F–46°F) in a sealed plastic bag or closed container to prevent exposure to food and spills. Do not freeze. o Keep trametinib out of reach of children and pets. o Leave trametinib in the provided packaging until it is ready to be taken. o Whenever possible, give trametinib to yourself and follow the steps below. If a family member, friend, or caregiver needs to give trametinib 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 trametinib 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 to be used with trametinib. o If you have any unused trametinib, 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 trametinib. o If you are traveling, put your trametinib in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Page 2 ORAL CANCER TREATMENT EDUCATION TRAMETINIB Side Effects of Trametinib The common side effects that have been known to happen in more than 30% of patients taking trametinib as monotherapy are listed in the left side of this table. You MAY NOT experience these side effects. Additional side effects may occur if used in combination with other cancer treatments. 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 Rash or itchy skin Changes in liver function Management • Keep your skin moisturized with creams and moisturizing lotions to decrease the risk of rash or itchiness, and wear loose fitting clothing. • Avoid using perfumes and cologne as these products may increase rash symptoms. • Avoid being in the heat for long periods of time. • Your provider may recommend an over-the-counter antihistamine or a topical cream. Sunlight can make symptoms worse. • Avoid sun exposure as much as possible to decrease the risk of sunburn. The highest exposure to ultraviolet (UV) radiation occurs from 10 am–4 pm. • Wear long-sleeved clothing, with UV protection if possible. • Wear broad-brimmed hats. • Apply broad-spectrum sunscreen (UVA/UVB) with at least SPF 30 as often as directed on the bottle. • Use lip balm with at least SPF 30. If your rash or itching continues to worsen, contact your care provider. Your liver function will be checked periodically by a simple blood test. Contact your care provider if you notice any of the following: • Yellowing of the skin or whites of your eyes • Dark or brown urine • Bleeding or bruising Continued on the next page Page 3 ORAL CANCER TREATMENT EDUCATION TRAMETINIB Possible Side Effect Diarrhea (loose and/ or urgent bowel movements) Management Monitor how many bowel movements you have each day. • Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake. • Eat small, frequent meals throughout the day rather than a few large meals. • Eat bland, low-fiber foods, such as bananas, applesauce, potatoes, chicken, rice, and toast. • Avoid high-fiber foods, such as raw vegetables, raw fruits, and whole grains. • Avoid foods that cause gas, such as broccoli and beans. • Avoid lactose-containing foods, such as yogurt and milk. • Avoid spicy, fried, and greasy foods. Contact your provider if any of the following occur: • The number of bowel movements you have in a day increases by 4 or more. • You feel dizzy or lightheaded. Your care provider may recommend an over-the-counter medication called loperamide (Imodium®) to help with your diarrhea, but talk to your care provider before starting this medication. 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. Decreased hemoglobin, part of the red blood cells that carry iron and oxygen Changes in electrolytes and other laboratory values • Low albumin • Low sodium • Low calcium • Low magnesium • Low phosphate • High glucose • High alkaline phosphatase • 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 some laboratory values may occur and should be monitored by a simple blood test. • You may not feel any symptoms if the changes are mild, and they usually are not a sign of a serious problem. • More severe changes may occur, which can be a sign of a serious problem. Notify your care provider if you have any of the following: • Shortness of breath • Chest discomfort • Weakness or fatigue • New aches and pains • Headaches • Dizziness • Swelling of your legs or feet • Red- or brown-colored urine Continued on the next page Page 4 ORAL CANCER TREATMENT EDUCATION TRAMETINIB Possible Side Effect Fluid retention or swelling Serious side effects Management • Do not stand for long periods of time. • Keep your legs elevated when sitting or lying down. • Try not to eat salty foods, which can increase swelling. • Avoid 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 • You are short of breath • You have gained 5 pounds or more in one week o Trametinib may rarely cause a tear or hole in your intestine, called bowel perforation. Speak to your care team right away if you have a high fever, or nausea, vomiting, or severe stomach pain. o Trametinib may be harmful to your eyes. Call your care team if you have any issue with your vision, or if you have pain in your eyes. o Trametinib may cause your lung tissue to scar, which is called interstitial lung disease, or swelling of lung tissue, which is called pneumonitis. Call your care team if you are feeling short of breath, or have chest pain, a fever, or a lasting dry cough. o When trametinib is used in combination with dabrafenib: • You may be at a higher risk of bleeding. Contact your care team if you notice frequent nose bleeds, blood in your stool, bleeding that occurs by itself without injury, or bleeding that will not stop after 5 minutes of pressure. • You may be at an increased risk of having a blood clot. Seek immediate medical attention if you have sudden swelling in an arm or leg, chest pain, or trouble breathing. • Your heart may have to work harder to pump blood to the rest of your body. Notify your care team if you are having shortness of breath or chest pain. • There is a small risk of developing a second cancer years or months after treatment. Talk to your provider about this risk. • Your blood sugar levels may be higher. Your care provider may have you regularly check your blood sugar. Contact your care team if you are urinating more than normal, are very thirsty, are more tired than normal, or are having trouble keeping your blood sugar within a desired range. • Severe skin reactions can occur, including Stevens-Johnson syndrome, which can be life-threatening. Seek emergency care if you have a severe rash or a rash on your mouth, eyes, or genitals. If you experience ANY uncontrolled side effect, call your physician or healthcare center immediately: Page 5 ORAL CANCER TREATMENT EDUCATION TRAMETINIB Handling body fluids and waste Trametinib 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 trametinib, 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 trametinib 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. Pregnancy, sexual activity, and contraception o Women should not become pregnant and men should not get a partner pregnant while taking trametinib. Men and women of childbearing age and potential should use effective contraception during therapy and for a minimum of 4 months after the last dose of trametinib. o Do not breastfeed while taking trametinib and for 4 months after the last dose of trametinib. o Inform your care provider if you become pregnant. o It is safe to hug and kiss. Special precautions may be needed for sexual activity while on oral chemotherapy, and you are encouraged to ask your care provider. Obtaining medication Talk with your care provider about how to obtain your trametinib. Page 6 ORAL CANCER TREATMENT EDUCATION TRAMETINIB Additional resources Product website: https://www.us.tafinlarmekinist.com Product prescribing information: https://www.novartis.us/sites/www.novartis.us/files/mekinist.pdf Product resources: o https://www.us.tafinlarmekinist.com/metastatic-nsclc/patient-support/financial-cost-support/ Updated — January 24, 2024 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 Cancer Treatment 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 © 2024 by Hematology/Oncology Pharmacy Association. All rights reserved. Page 7

IV AND ORAL CANCER TREATMENT EDUCATION TAFASITAMAB-CXIX + LENALIDOMIDE Name of the regimen and anti-cancer drugs o Oral Treatment Generic name (pronunciation): lenalidomide (leh-nuh-LIH-doh-mide) Brand name: Revlimid® (REV-lih-mid) o Infusion Treatment Generic name (pronunciation): tafasitamab-cxix (TA-fuh-SIH-tuh-mab) Brand name: Monjuvi® (mon-JOO-vee) Common uses This regimen is most commonly used for adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL). Treatment dose and schedule The first part of your treatment, tafasitamab-cxix, will be given into your vein through an intravenous (IV) line. This may be into a short, flexible temporary catheter in your arm, or through a central venous catheter. A central venous catheter, or central line, is a long, flexible IV tube that empties into a very large vein next to the heart. Talk with your care team to see which will be best for you and your treatment. The second part of your treatment, lenalidomide, will be given orally. This medication will be ordered by your provider to take by mouth at home. Each tafasitamab-cxix and lenalidomide treatment is repeated every 28 days. This is known as one cycle. Your treatment may be given for a set number of cycles, or it will keep going until the drug, or drugs, stop working or you have side effects which stop you from continuing treatment. o Your tafasitamab-cxix is given through your veins (IV) as follows: • Cycle 1: Days 1, 4, 8, 15 and 22 of the 28-day cycle • Cycles 2 and 3: Days 1, 8, 15 and 22 of each 28-day cycle • Cycle 4 and beyond: Days 1 and 15 of each 28-day cycle o Your lenalidomide should be taken by mouth once daily on days 1-21 of each 28-day treatment cycle Taking lenalidomide 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 and schedule of lenalidomide will be determined by your overall health, diagnosis, and individual treatment needs. o Lenalidomide is to be taken by mouth one time per day. o Lenalidomide can be taken with or without food but at the same time each day. o Lenalidomide should be taken whole and not opened, crushed, cut, or dissolved. If you are unable to swallow lenalidomide, talk to your care provider or pharmacist for possible options. o If you miss a dose • 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. Page 1 Page 2 TAFASITAMAB-CXIX + LENALIDOMIDE IV AND ORAL CANCER TREATMENT EDUCATION Other medications Other medications may be ordered to prevent or treat certain side effects. These include: Possible drug interactions o Tafasitamab-cxix and lenalidomide may interact with other drugs you are taking. Please inform your care providers of all prescription medicine, over-the-counter medications, vitamins, and herbal products that you take. o Talk with your care provider or pharmacist before taking new medications, supplements, or receiving any vaccines. Instructions Medications to prevent allergic reactions You will receive medications to prevent infusion related reactions prior to starting your cancer treatment. Medications to prevent side effects You will receive your medications to prevent side effects just before your cancer treatment. You may get prescriptions for other medications to take at home, as below: IV AND ORAL CANCER TREATMENT EDUCATION TAFASITAMAB-CXIX + LENALIDOMIDE Common Side Effects of tafasitamab-cxix + lenalidomide Common side effects that have been known to happen in patients receiving TAFASITAMAB-CXIX + LENALIDOMIDE are listed in the left side of this table. In some instances, the side effects may be reported less often but are still important to discuss. This table does not list all the known side effects for this therapy, only the ones that are experienced most often. Not every patient experiences every known side effect of a drug; even if you are taking the same drug as another patient, you may experience different 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 Decreased white blood cells (WBCs) and increased risk for infection Decreased hemoglobin, part of the red blood cells that carry iron and oxygen Management 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 often for good personal hygiene. Contact your care team if you experience any signs or symptoms of an infection such as: • Fever (temperature more than 100.4oF or 38oC) • Chills • Sore throat • Burning when peeing • Tiredness that is worse than normal • A sore that becomes red, is draining, or does not heal Check with your care team before taking any medicine for a fever or chills. Your hemoglobin should be checked 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 to 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, too. • You might notice that you are more pale than usual. Let your care team know right away if you have: • Shortness of breath • Dizziness • Fast or abnormal heartbeat • Headache Continued on the next page Page 3 IV AND ORAL CANCER TREATMENT EDUCATION TAFASITAMAB-CXIX + LENALIDOMIDE Possible Side Effect Decreased platelet count and increased risk of bleeding Management 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 electric razor instead of razor blades. • Use a nail file instead of a nail clippers. Call your care team if you have bleeding that won’t stop. Examples include: • A bloody nose that bleeds for more than 5 minutes despite pressure. • A cut that continues to ooze despite pressure. • Gums that bleed a lot when you floss or brush. Seek medical help right away if you have any severe headaches, blood in your urine or stool, coughing up blood, or bleeding that you cannot stop or lasts a long time. You may need to take a break or “hold” your medication for medical or dental procedures. Talk to your care team or dentist before any scheduled procedures. Monitor how many bowel movements you have each day. If experiencing diarrhea, consider the following: • Drink 8-10 (8-ounce) glasses of water or fluid each day unless your care team has asked 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). Diarrhea (loose and/ or urgent bowel movements) • Avoid high fiber foods, such as raw vegetables and fruits and whole grains. • Avoid foods that cause gas, such as broccoli and beans. • Avoid foods with lactose, such as yogurt and milk. • Avoid spicy, fried, and greasy foods. Contact your care team if: • The number of bowel movements you have in a day increases by 4 or more. • You feel dizzy or lightheaded. Your care team may recommend an over-the-counter medication or prescribe something to help manage your symptoms. Continued on the next page Page 4 IV AND ORAL CANCER TREATMENT EDUCATION TAFASITAMAB-CXIX + LENALIDOMIDE Possible Side Effect Fluid retention or swelling (edema) Infusion reaction Management • Do not stand for long periods of time • Keep your legs elevated when sitting or lying down • Try to not eat salty foods, which can increase swelling • Avoid tight-fitting clothing and shoes • Weigh yourself daily • Take any medications as prescribed to decrease fluid retention Contact your care team if you notice: • Swelling in the hands, feet, or legs • You are short of breath • You have gained 5 pounds or more in one week During your treatment, let the nurse know right away if any of these symptoms happen: • Chills or shaking • Dizziness • Fever • Itchiness or rash • Flushing • Difficulty breathing • Wheezing • Throat irritation • Cough • Congestion • Sudden back pain • Feeling faint • 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. Rash or itchy skin o Avoid sun exposure as much as possible to decrease the risk of sunburn. The highest exposure to UV (ultra-violet) radiation occurs between the hours of 10am and 4pm. o Wear long-sleeved clothing, with UV protection if possible. o Wear broad-brimmed hats. o Apply broad-spectrum sunscreen (UVA/UVB) with at least SPF 30 as often as directed on the bottle. o Use lip balm with at least SPF 30. o Avoid tanning beds. If your rash or itching continues to worsen, contact your care team. Page 5 IV AND ORAL CANCER TREATMENT EDUCATION TAFASITAMAB-CXIX + LENALIDOMIDE Rare but serious side effects o If you experience ANY new, worsening, or uncontrolled side effects, call your care team immediately. o Tafasitamab-cxix can cause infections like pneumonia and urinary tract infections. Let your provider know if you experience a new or worsening cough, pain when urinating or increased urinary frequency, especially in combination with a fever. Always let your provider know if you experience a temperature more than 100.4oF or 38oC. o Lenalidomide may be harmful to your liver. Speak to your care provider to know when you need to have laboratory tests done to monitor your liver function. If your get this side effect, your doctor may change your dose or stop treatment for some time. o Some patients taking tafasitamab + lenalidomide have experienced a condition called tumor lysis syndrome when starting treatment. This results from the rapid destruction of cancer cells in the body during the initial cycles of treatment. Your care team may do blood tests to check for this side effect. o Lenalidomide can cause tumor flare reaction, which can cause a temporary worsening of symptoms related to the size or location of your cancer. o Severe allergic reactions are a rare but serious side effect of lenalidomide. Immediately seek medical attention if you notice difficulty breathing, swelling of the mouth or tongue, or a serious rash. o Lenalidomide can increase your risk of having a blood clot. Seek immediate medical attention if you have sudden swelling in an arm or leg, have chest pain, or have trouble breathing. o Lenalidomide can cause serious birth defects or death of a baby if taken while pregnant. To receive this medication, your doctor must help you sign up for the Risk Evaluation and Mitigation Strategies (REMS) program. The REMS program requires females who can get pregnant to use two forms of birth control. It also requires men to always use a condom during any sexual contact with females who can get pregnant. Let your doctor know if you are pregnant, or if you think you might be pregnant. Page 6 IV AND ORAL CANCER TREATMENT EDUCATION TAFASITAMAB-CXIX + LENALIDOMIDE Storage and handling of lenalidomide Handle lenalidomide with care. Just like when chemotherapy is given into the vein, this drug can be toxic, and exposure of the others to the drug should be limited. o Store lenalidomide at room temperature (68o F to 77oF) in a dry location away from light. o Keep lenalidomide out of reach of children and pets. o Leave lenalidomide in the provided packaging until it is ready to be taken. o Whenever possible, you should give lenalidomide to yourself and follow the steps below. If a family member, friend, or caregiver needs to give the lenalidomide to you, they also need to follow these steps: • Wash hands with soap and water. • Put on gloves to avoid touching the medication. (Gloves are not necessary if you give the drug to yourself.) • Gently transfer the lenalidomide from its package to a small medicine or other disposable cup. • Administer the medicine immediately by mouth with water. • Remove gloves and do not use them for anything else. • Throw gloves and medicine cup in household trash. • Wash hands with soap and water. o If a daily pill box or pill reminder will be used, contact your care team before using: • The person filling the box or reminder should wear gloves (gloves are not necessary if you are filling the box or reminder). • When empty, the box or reminder should be washed with soap and water before refilling. Be sure to wash hands with soap and water after the task is complete, whether or not gloves are worn. o If you have any unused lenalidomide, 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 lenalidomide. o If you are traveling, put your lenalidomide’s packaging in a separate sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Some of the drugs you receive may be present in urine, stool, sweat, or vomit for many days after treatment. Many cancer drugs are toxic, your bodily waste may also be toxic and can be dangerous to come into contact with. Once you have started TAFASITAMAB-CXIX + LENALIDOMIDE, follow the instructions below during your treatment. This is to keep you, your loved ones, and the environment as safe as possible. o Pregnant women should avoid touching anything that may be soiled with your body fluids. o Toilet and septic systems: • You may use the same toilet, septic tank, and/or sewer that you usually use. Close the lid and flush to ensure all waste has been discarded. If you have a low-flow toilet, close the lid and flush twice. Page 7 IV AND ORAL CANCER TREATMENT EDUCATION TAFASITAMAB-CXIX + LENALIDOMIDE o If the toilet or toilet seat is soiled with urine, stool, or vomit, clean the surface after every use before other people use the toilet. o Wash hands with soap and water for at least 20 seconds 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 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. Pregnancy, sexual activity, and contraception o Patients of reproductive ability should not become pregnant or get their partners pregnant while receiving TAFASITAMAB CXIX + LENALIDOMIDE. Patients of childbearing age and potential should use effective contraception during therapy and for a minimum of 3 months after the last dose of TAFASITAMAB-CXIX + LENALIDOMIDE. o Women of childbearing age and potential must have 2 negative pregnancy tests prior to starting lenalidomide and will need to repeat this test with each cycle or sooner. o Women of childbearing age and potential should go without having sex or use 2 forms of birth control beginning 4 weeks before starting treatment with lenalidomide, during treatment, and for at least 4 weeks after stopping treatment. • Effective contraception could include one or more of the following: barrier methods (e.g. condoms), hormone methods (e.g. birth control pills), or surgery. o Males must always use a latex or synthetic condom during any sexual contact with females of reproductive potential while taking lenalidomide, during treatment breaks, and for up to 4 weeks after discontinuing lenalidomide, even if they have undergone a successful vasectomy. o Do not donate sperm while taking lenalidomide, during treatment breaks, and for 4 weeks after stopping this medication. o Do not breastfeed while taking lenalidomide and for 4 weeks after the last dose of TAFASITAMAB-CXIX + LENALIDOMIDE o Please inform your care provider if you become pregnant. o Some treatments can influence the ability to have children, also known as fertility. If you’re interested in preserving fertility, talk to your care team before treatment. Ask your healthcare provider to determine when it is safe to become pregnant after your treatment. o It is safe to hug and kiss. Special precautions may be needed for sexual activity while on oral chemotherapy and you are encouraged to ask your care team for assistance. Page 8 Page 9 TAFASITAMAB-CXIX + LENALIDOMIDE IV AND ORAL CANCER TREATMENT EDUCATION Obtaining medication o Talk with your care provider about how to obtain your lenalidomide. o Lenalidomide is available only through a Risk Evaluation and Mitigation Strategy (REMS) program, and prescribers, patients, and pharmacies must be certified with this REMS program. oOnly a 28-day supply of medication can be obtained from the pharmacy at one time, and this medication is not eligible for automatic refills. Additional resources Product websites: Monjuvi®: https://www.monjuvi.com Revlimid®: https://www.revlimid.com/multiple-myeloma Prescribing information links: Tafasitamab-cxix: https://www.monjuvi.com/pi/monjuvi-pi.pdf Lenalidomide: https://packageinserts.bms.com/pi/pi_revlimid.pdf Product resources: Treatment calendar: https://www.monjuvi.com/treatment-tracker Lenalidomide REMS: https://www.lenalidomiderems.com/index.html Updated – February 6, 2024 Additional instructions IV AND ORAL CANCER TREATMENT EDUCATION TAFASITAMAB-CXIX + LENALIDOMIDE 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 © 2023 by Hematology/Oncology Pharmacy Association. All rights reserved. Page 10