Gefitinib

INTRODUCTION

Indications

Patients who are currently benefiting from or have benefited from gefitinib in the past for treatment of non–small cell lung cancer.

Action

Inhibits activation of kinases found in transmembrane cell surface receptors, including epidermal growth factor receptor (EGFR-TK). Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones.

Adverse Reactions/Side Effects

CNS: weakness. EENT: aberrant eyelash, conjunctivitis, corneal erosion/ulcer, eye pain, ↓ vision. CV: peripheral edema. Resp: PULMONARY TOXICITY, dyspnea. GI: diarrhea, nausea, vomiting, anorexia, hepatotoxicity, mouth ulceration. Derm: acne, dry skin, rash, pruritus. Metab: weight loss. Misc: ALLERGIC REACTIONS, INCLUDING ANGIOEDEMA.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of allergic reactions and angioedema, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rashes, raised patches of red or white skin, burning/itching skin, swelling in the face). Notify physician or nursing staff immediately if these reactions occur.

• Assess any other breathing problems or signs of pulmonary toxicity such as dry cough, wheezing, chest pain, shortness of breath, and difficult or labored breathing. Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Monitor any vision disturbances or eye pain and inflammation. Report these signs to the physician.

• Monitor body weight and report any severe or sudden weight loss.

Interventions

• For patients who are medically able to begin exercise, implement appropriate resistive exercises and aerobic training to maintain muscle strength and aerobic capacity during cancer chemotherapy or to help restore function after chemotherapy.

• Use caution during aerobic exercise and endurance conditioning because of potential pulmonary toxicity. Terminate exercise if patient exhibits untoward symptoms (chest pain, shortness of breath, etc.) or displays other criteria for exercise termination (See Appendix L).

Patient/Client-Related Instruction

• Advise patient and family/caregivers that fatigue and weakness are likely and may be severe. Functional abilities may be limited, and patient may need to use assistive devices during ambulation.

• Advise patient about the likelihood of GI reactions such as diarrhea, nausea, vomiting, loss of appetite, and inflammation in/around mouth. Instruct patient to report severe or prolonged GI problems, or signs of hepatotoxicity including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising.

• Advise patient ...