Vorinostat

INTRODUCTION

Indications

Treatment of skin manifestations cutaneous T-cell lymphoma (CTCL) that has not responded to 2 systemic therapies.

Action

Acts as a histone deacetylase inhibitor which decreases gene transcription resulting in cell-cycle arrest. Therapeutic Effects: ↓ progression of CTCL.

Adverse Reactions/Side Effects

CNS: dizziness, headache. CV: PULMONARY EMBOLISM, deep vein thrombosis. Resp: cough. GI: anorexia, constipation, diarrhea, dry mouth, dysgeusia, nausea, vomiting. GU: proteinuria. Derm: alopecia, itching. Endo: hyperglycemia. Hemat: anemia, thrombocytopenia. Metab: weight loss. MS: muscle spasms. Misc: chills, fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of deep vein thrombosis (lower extremity swelling, warmth, erythema, tenderness) and pulmonary embolism (shortness of breath, chest pain, cough, bloody sputum). Notify physician immediately, and request objective tests (Doppler ultrasound, lung scan, others) if thrombosis is suspected.

• Monitor signs of thrombocytopenia (bruising, nose bleeds, bleeding gums) or unusual weakness and fatigue that might be due to anemia. Report these signs to the physician or nursing staff.

• Be alert for signs of hyperglycemia, including confusion, drowsiness, flushed/dry skin, fruit-like breath odor, rapid/deep breathing, polyuria, loss of appetite, and unusual thirst. Patients with diabetes mellitus should check blood glucose levels frequently.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). 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 spasms to rule out musculoskeletal pathology; that is, try to determine if spasms are drug induced rather than caused by anatomic or biomechanical problems.

• Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or unexplained weight loss or decreased body fat.

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.

Patient/Client-Related Instruction

• Advise patient about the likelihood of GI reactions such as nausea, vomiting, constipation, diarrhea, loss of appetite, dry mouth, and altered taste. Instruct patient to report severe or prolonged GI problems.

• Instruct patient to report other bothersome side effects such as severe or prolonged headache, cough, chills, fever, and skin reactions (rash, hair loss).

Pharmacokinetics

Absorption: Well absorbed following oral administration.

Distribution: Crosses the placenta.

Metabolism and Excretion: Mostly metabolized, <1% excreted unchanged in urine.

Half-life: 2 hr.