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Lonsurf®

(LON-serf)

Lonsurf® (Trifluridine and Tipiracil) is a combination drug used to treat metastatic colorectal cancer.

Lonsurf® (Trifluridine and Tipiracil) is a combination drug used to treat metastatic colorectal cancer.

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

Lorbrena®

(lor-BREH-nuh)

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

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

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.

Lorlatinib

(lor-LA-tih-nib)

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

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

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.

Lumakras®

(LOO-muh-kras)

Lumakras® (Sotorasib) is used to treat patients with non-small cell lung cancer that have a genetic variant called KRAS G12C.

Lumakras® (Sotorasib) is used to treat patients with non-small cell lung cancer that have a genetic variant called KRAS G12C.

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

Lynparza®

((lin PAR zuh))

Lynparza® (Olaparib) is used to treat ovarian, fallopian tube, or primary peritoneal cancer.

Lynparza® (Olaparib) is used to treat ovarian, fallopian tube, or primary peritoneal cancer.

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

Lysodren™

()

Lysodren™ (Mitotane) is used to treat adrenal cortical carcinoma.

Lysodren™ (Mitotane) is used to treat adrenal cortical carcinoma.

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.

Lytgobi

(lite-GOH-bee)

Lytgobi 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. Lytgobi may also be used for other treatments.

Lytgobi 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. Lytgobi may also be used for other treatments.

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

Matulane®

(MA-choo-layn)

Matulane® (Procarbazine) is used to treat Hodgkin’s disease.

Matulane® (Procarbazine) is used to treat Hodgkin’s disease.

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.

Mekinist®

(MEH-kih-nist)

Trametinib (Mekinist®) is used to treat patients with: • Melanoma that has a genetic mutation called BRAF V600E or V600K and may be used in combination with dabrafenib. • 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 (Mekinist®) is used to treat patients with: • Melanoma that has a genetic mutation called BRAF V600E or V600K and may be used in combination with dabrafenib. • 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

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

Melphalan

(MEL-fuh-lan)

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

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

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

Mercaptopurine - 6-MP / 6-Mercaptopurine

(mer-KAP-toh-PYOOR-een)

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

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

Page 1 MERCAPTOPURINE ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — mercaptopurine mer KAP toh PYOOR een Brand name — Purinethol® pyoor IN eh thol ; Purixan® PYOOR ee zan Other names — 6 mercaptopurine and 6 MP Approved uses Mercaptopurine is used to treat adult and pediatric patients with acute lymphoblastic leukemia ALL . Dose and schedule Taking mercaptopurine as instructed is important to allow your treatment to be as effective as possible, so here are some key points to remember. Your dose is based on many factors, including your height and weight, overall health, and diagnosis. Mercaptopurine can be taken with or without food but at the same time each day. Mercaptopurine tablets should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow mercaptopurine, talk to your care provider or pharmacist for possible options. Mercaptopurine suspension should be shaken vigorously for at least 30 seconds prior to taking. If you miss a dose of mercaptopurine, do not take an extra dose or two doses at one time. Simply take your next dose at the regularly scheduled time. Be sure to write down if you miss a dose and let your care provider know about any missed doses. Storage and handling Handle mercaptopurine with care. Just like when chemotherapy is given into the vein, this drug can be toxic, and exposure of the drug to others should be limited. Store mercaptopurine at room temperature 68°F–77°F in a dry location away from light. Keep mercaptopurine out of reach of children and pets. Leave mercaptopurine in the provided packaging until it is ready to be taken. Once opened, mercaptopurine suspension should be used within 8 weeks. Whenever possible, give mercaptopurine to yourself and follow the steps below. If a family member, friend, or caregiver needs to give mercaptopurine to you, they also need to follow these steps: 1. Wash hands with soap and water. 2. Put on gloves to avoid touching the medication. Gloves are not necessary if you give the drug to yourself. 3. Gently transfer the mercaptopurine from its package to a small medicine or other disposable cup. 4. Administer the medicine immediately by mouth with water. 5. Remove gloves and do not use them for anything else. 6. Throw gloves and medicine cup in household trash. 7. Wash hands with soap and water. MERCAPTOPURINE ORAL CHEMOTHERAPY EDUCATION Page 2 If a daily pill box or pill reminder is used, a separate one should be used for mercaptopurine. Do not mix other medications into the box with mercaptopurine. The person filling the box or reminder should wear gloves gloves are not necessary if you are filling the box or reminder . When empty, the box or reminder should be washed with soap and water before refilling. Be sure to wash hands with soap and water after the task is complete, whether or not gloves are worn. If you have any unused mercaptopurine, do not throw it in the trash and do not flush it down the sink or toilet. Talk to your care provider or pharmacist about proper disposal of mercaptopurine. If you are traveling, put your mercaptopurine in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Because mercaptopurine remains in your body for several days after it is taken, some of the drug may be present in urine, stool, sweat, or vomit. Once you have started to take mercaptopurine, it is important to follow the instructions below every day for as long as your treatment lasts. This is to keep yourself, loved ones, and the environment as safe as possible. Pregnant women should avoid touching anything that may be soiled with body fluids from the patient. Toilet and septic systems You may use the same toilet, septic tank, and/or sewer that you usually use. If you have a low flow toilet, close the lid and flush twice to ensure all waste has been discarded. If the toilet or toilet seat becomes soiled with urine, stool, or vomit, clean the surfaces before other people use the toilet. Wash hands with soap and water after using the toilet. If you need a bedpan, be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day. If you do not have good control of bladder or bowels, use a disposable pad with a plastic back, a diaper, or a sheet to absorb body waste. Wash any skin that has been exposed to body waste or mercaptopurine with soap and water. Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing. If you do not have a washer, place the soiled linens in a plastic bag until they can be washed. Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids. Drug and food interactions Mercaptopurine has many drug interactions. Inform your care providers of all prescription medications, over the counter medications, vitamins, and herbal products. Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. MERCAPTOPURINE ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Mercaptopurine The common side effects that have been known to happen in more than 30% of patients taking mercaptopurine are listed in the left side of this table. You MAY NOT experience these side effects. Options to help manage any side effects that do occur are included on the right side of this table. These should be discussed with your care provider. If you experience any side effect you cannot manage or that is not listed here, contact your care provider. Possible Side Effect Management Decreased white blood cells WBCs and increased risk for infection Your WBCs should be monitored by a simple blood test. When your WBCs are low, you are at greater risk of having an infection. Take the following precautions to protect yourself from infection. Wash your hands often, especially before eating and after using the bathroom. Avoid crowds and people with fevers, flu, or other infection. Bathe regularly to keep good personal hygiene. Contact your care provider if you experience any signs or symptoms of an infection: Fever temperature more than 100.4°F or 38°C Chills Sore throat Burning with urination Unusual tiredness A sore that becomes red, is draining, or does not heal Check with your care provider before taking any medicine for a fever or chills. Decreased platelet count and increased risk of bleeding Your platelets should be monitored by a simple blood test. When they are low, you may bruise or bleed more easily than usual. Use caution to avoid bruises, cuts, or burns. Blow your nose gently, and do not pick your nose. Brush your teeth gently with a soft toothbrush, and maintain good oral hygiene. When shaving, use an electronic razor instead of razor blades. Use a nail file instead of nail clippers. Call your care provider if you have bleeding that won’t stop. Examples include the following: A bloody nose that bleeds for more than 5 minutes despite pressure A cut that continues to ooze despite pressure Gums that bleed excessively when you floss or brush Seek medical help immediately if you experience any severe headaches, observe blood in your urine or stool, cough up blood, or experience prolonged and uncontrollable bleeding. You may need to take a break or “hold” your medication for medical or dental procedures. Talk to your care provider or dentist before any scheduled procedures. Continued on the next page MERCAPTOPURINE ORAL CHEMOTHERAPY EDUCATION Page 4 Possible Side Effect Management Decreased hemoglobin, part of the red blood cells that carry iron and oxygen Your hemoglobin should be monitored using a blood test. When your hemoglobin is low, you may notice that you get tired or fatigued more easily. Try to get 7–8 hours of sleep per night. Avoid operating heavy machinery if you feel too tired. Find a balance between work and rest. Stay as active as possible, but know that it is okay to rest as needed. You might notice that you are more pale than usual. Let your healthcare provider know right away if you experience any of the following: Shortness of breath Dizziness Palpitations Changes in liver function Your liver function will be checked periodically by a simple blood test. Contact your care provider if you notice any of the following: Yellowing of the skin or whites of your eyes Dark or brown urine Bleeding or bruising If you experience ANY uncontrolled side effect, call your physician or healthcare center immediately: INSTITUTIONAL CONTACT INFO Pregnancy, sexual activity, and contraception Women should not become pregnant and men should not get a partner pregnant while taking mercaptopurine. Men and women of childbearing age and potential should use effective contraception during therapy and for a minimum of one month after the last dose of mercaptopurine. Do not breastfeed while taking mercaptopurine and for one month after the last dose of mercaptopurine. Inform your care provider if you become pregnant. It is safe to hug and kiss. Special precautions may be needed for sexual activity while on oral chemotherapy, and you are encouraged to ask your care provider. Obtaining medication Talk with your care provider about the process for obtaining your mercaptopurine. PHARMACY OR SPECIALTY PHARMACY CONTACT INFO MERCAPTOPURINE ORAL CHEMOTHERAPY EDUCATION Page 5 Additional resources Product website: www.purixan us.com Product prescribing information: www.accessdata.fda.gov/drugsatfda docs/label/2011/009053s032lbl.pdf; www.purixan us.com/resources/Package Insert.pdf Product resources: www.purixan us.com/information instructions/#info Updated – February 5, 2018 Additional instructions Important notice: The Association of Community Cancer Centers ACCC , Hematology/Oncology Pharmacy Association HOPA , National Community Oncology Dispensing Association, Inc. NCODA , and Oncology Nursing Society ONS have collaborated in gathering information for and developing this patient education guide. This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this medication by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Oral Chemotherapy Education OCE sheets are provided as a free educational resource for patients with cancer in need of concise, easy to understand information about oral cancer drugs. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2018 by Hematology/Oncology Pharmacy Association. All rights reserved.

Methotrexate

(meh-thuh-TREK-sayt)

Methotrexate is used alone or in combination with other anticancer agents to treat many cancers, including breast cancer, head and neck cancer, cutaneous T-cell lymphoma, lung cancer, and non-Hodgkin lymphoma. Methotrexate may be used in treating noncancerous conditions and autoimmune dise...

Methotrexate () is used alone or in combination with other anticancer agents to treat many cancers, including breast cancer, head and neck cancer, cutaneous T-cell lymphoma, lung cancer, and non-Hodgkin ...

Page 1 METHOTREXATE ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name methotrexate (meh thuh TREK sayt) Approved uses Methotrexate is used alone or in combination with other anticancer agents to treat many cancers, including breast cancer, head and neck cancer, cutaneous T cell lymphoma, lung cancer, and non Hodgkin lymphoma. Methotrexate may be used in treating noncancerous conditions and autoimmune diseases. Dose and schedule Taking methotrexate 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. Methotrexate can be taken with or without food, but at the same time each week. Methotrexate should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow methotrexate, talk to your care provider or pharmacist for possible options. If you miss a dose of methotrexate, do not take an extra dose or two doses at one time. Simply take your next dose at the regularly scheduled time. If you miss a dose of this medication, contact your care team for further information. Storage and handling Handle methotrexate 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 methotrexate at room temperature (68°F–77°F) in a dry location away from light. Keep methotrexate out of reach of children and pets. Leave methotrexate in the provided packaging until it is ready to be taken. Whenever possible, you should give methotrexate to yourself and follow the steps below. If a family member, friend, or caregiver needs to give the methotrexate 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 methotrexate 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. METHOTREXATE ORAL CHEMOTHERAPY EDUCATION Page 2 If a daily pill box or pill reminder is used, a separate one should be used for methotrexate. Do not mix other medications into the box with methotrexate. 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 methotrexate, 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 methotrexate. If you are traveling, put your methotrexate in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Since methotrexate 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 methotrexate, 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 methotrexate 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 Methotrexate has many drug interactions. Please inform your care providers of all prescription medications, over thecounter medications, vitamins, and herbal products. Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. Avoid live vaccines during treatment with methotrexate. METHOTREXATE ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Methotrexate The common side effects that have been known to happen in more than 30% of patients taking methotrexate 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: 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. Serious side effects Methotrexate can cause serious side effects that can be life threatening. Your doctor may do tests regularly to check how methotrexate is affecting your body. It is important that you remain in your doctor’s care while taking methotrexate. Liver problems can occur. Contact your healthcare team if you notice yellowing of the skin or whites of your eyes, dark or brown urine, or unusual bleeding or bruising. Your kidney function will be checked periodically with a blood test. Contact your care team if you notice decreased urination or unusual swelling in your legs and feet. Lung problems can occur. Report any shortness of breath or difficulty breathing. Severe skin reactions can occur. Report any new rashes. Methotrexate can cause diarrhea and mouth sores. Contact your care team if you experience these. Infertility can occur. METHOTREXATE ORAL CHEMOTHERAPY EDUCATION Page 4 If you experience ANY uncontrolled side effect, call your physician or healthcare center immediately: (INSTITUTIONAL CONTACT INFO) Pregnancy, sexual activity, and contraception Women should not become pregnant and men should not get a partner pregnant while taking methotrexate. Men and women of childbearing age and potential should use effective contraception during therapy and for a minimum of three months after the last dose of methotrexate. Do not breastfeed while taking methotrexate and for three months after the last dose of methotrexate. Please inform your care provider if you become pregnant or plan to have a baby after taking methotrexate. 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 methotrexate. (PHARMACY OR SPECIALTY PHARMACY CONTACT INFO) Additional resources Product prescribing information: https://www.accessdata.fda.gov/drugsatfda docs/ label/2016/008085s066lbl.pdf Updated – October 19, 2018 Additional instructions METHOTREXATE ORAL CHEMOTHERAPY EDUCATION Page 5 Important notice: The Association of Community Cancer Centers (ACCC), Hematology/Oncology Pharmacy Association (HOPA), National Community Oncology Dispensing Association, Inc. (NCODA), and Oncology Nursing Society (ONS) have collaborated in gathering information for and developing this patient education guide. This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this medication by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Oral Chemotherapy Education (OCE) sheets are provided as a free educational resource for patients with cancer in need of concise, easy to understand information about oral cancer drugs. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2019 by Hematology/Oncology Pharmacy Association. All rights reserved.