Nilotinib

INTRODUCTION

Indications

Chronic or accelerated phase Philadelphia chromosome–positive chronic myelogenous leukemia which has not responded to other treatment, including imatinib.

Action

Inhibits kinases which may be produced by malignant cell lines. Therapeutic Effects: Inhibits production of malignant cells lines with decreased proliferation of leukemic cells.

Adverse Reactions/Side Effects

CNS: fatigue, headache, dizziness. EENT: vertigo. CV: ARRHYTHMIAS, hypertension, palpitations, QT prolongation. GI: constipation, diarrhea, nausea, vomiting, abdominal discomfort, anorexia, dyspepsia, flatulence, hepatotoxicity. Derm: pruritus, rash, alopecia, flushing. F and E: hyperkalemia, hypocalcemia, hypokalemia, hyponatremia, hypophosphatemia. Hemat: MYELOSUPRESSION. Metab: ↑ lipase, hyperglycemia. MS: musculoskeletal pain. Neuro: paresthesia. Misc: fever, night sweats.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of myelosuppression, including fatigue, dizziness, fever, chills, sore throat, shortness of breath, chest pain, pallor, and unusual bruising or bleeding. Report these signs to the physician or nursing staff immediately.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report a sustained increase in BP (hypertension).

• Be alert for vertigo that might affect gait, balance, and other functional activities. Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

• Assess any muscle or joint pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Assess signs of paresthesia (numbness, tingling) or muscle twitching. Perform objective tests, including electroneuromyography and sensory testing to document any drug-related neuropathic changes.

• Monitor neuromuscular signs of electrolyte imbalances (hypocalcemia, hyperkalemia, hypokalemia, others), including headache, lethargy, weakness, cramping, and muscle hyperexcitability and tetany. Notify physician or nursing staff if these signs occur.

• Monitor signs of hyperglycemia, including confusion, drowsiness, skin flushing, dry skin, fruit-like breath odor, rapid breathing, polyuria, loss of appetite, and unusual thirst. Insulin dosages may need to be adjusted to prevent repeated episodes of hyperglycemia.

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.

• Because of the risk of serious arrhythmias, use caution during aerobic exercise and endurance conditioning. Terminate exercise if patient exhibits untoward symptoms (chest pain, shortness of breath, unusual fatigue) or displays other criteria for exercise termination (See Appendix L).