Vandetanib (CAPRELSA)

Thyroid cancer

Thyroid cancer

• Oral: 300 mg once daily continuously until disease progression or unacceptable toxicity

Available as 100 mg and 300 mg tablets. Tablets can be dissolved for patients unable to swallow them, please discuss with your pharmacy team. Store at room temperature.

Multi-targeted TKI (tyrosine kinase inhibitor) which includes action as a VEGF (vascular endothelial growth factor) inhibitor

Take with or without food

If a dose is missed, patients should be instructed to take it as soon as they can if it is within 12 hours of the missed dose. If it is over 12 hours since the missed dose, patients should skip the missed dose and resume with the next scheduled dose.

Common: Diarrhea/colitis, Nausea, Fatigue, Dermatologic toxicities (ex. rash), Hypertension.

Less Common: QT prolongation, Hand-foot skin reaction, Pruritus.

The adverse effects listed above are not exhaustive. Please refer to the relevant product monograph for full details.

Baseline before treatment: CBC & differential, creatinine, potassium, calcium, magnesium, CEA, calcitonin, TSH, bilirubin, ALT, alkaline phosphatase, ECG, blood pressure.

Two weeks after starting treatment, after any dose change, and prior to each clinic visit during treatment: CBC & differential, creatinine, potassium, calcium, magnesium, CEA, calcitonin, TSH, bilirubin, ALT, alkaline phosphatase, ECG, blood pressure.

• This drug can impact or be impacted by metabolic enzymes for absorption and excretion. Many drugs can also affect or be affected by these enzymes, so please consult with pharmacy to assess for interactions.
• May increase the risk for QT interval prolongation. Avoid concurrent therapy with drugs associated with QTc prolongation and/or Torsades de pointes, if possible. If unavoidable, monitor for QT prolongation or cardiac arrhythmias.
• Avoid grapefruit, grapefruit juice, Seville oranges, or Seville orange juice.
• Current drug interaction databases should be consulted for more information.

• Avoid in pregnancy and lactation.
• Hypertension is common with VEGF inhibitors. Monitor blood pressure closely and manage with antihypertensives and dose hold/reductions. Hypertension should be well controlled prior to starting vandetanib.
• Thyroid dysfunction in particular hypothyroidism may occur with this treatment. Monitor for signs and symptoms of thyroid dysfunction and manage as clinically appropriate.
• Patients taking vandetanib have a potential for photosensitivity upon sun exposure. Patients should wear protective clothing and/or sunblock during vandetanib treatment and for 4 months after the last dose.
• Diarrhea is a common side effect of Vandetanib. Routine antidiarrheal agents are recommended for the treatment of diarrhea. Monitor electrolytes and ECGs more frequently in patients who experience diarrhea. If severe diarrhea develops, vandetanib should be stopped until diarrhea improves.
• Impaired wound healing is associated with VEGF inhibitors, drug may need to be held and restarted if patient requires surgery, discuss with team.

BC Cancer. BC Cancer Drug Manual. Vandetanib. Vancouver, British Columbia: BC Cancer Agency. Available at http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Vandetanib_monograph.pdf. Updated December 1, 2018. Accessed 22 Jan 2024.

Lexicomp. Vandetanib Monograph. In: Lexi-Drugs. Hudson, Ohio: Lexi-Comp, Inc. Available at:https://online-lexi-com.qe2a-proxy.mun.ca/lco/action/doc/retrieve/docid/patch_f/3414382?cesid=12ToLMDWvZj&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dvandetanib%26t%3Dname%26acs%3Dtrue%26acq%3Dvandet. Updated January 24, 2024. Accessed January 25, 2024.

Cancer Care Ontario. Vandetanib Monograph. Drug Formulary. Toronto, Ontario: Cancer Care Ontario. Available at: https://www.cancercareontario.ca/en/drugformulary/drugs/monograph/44261. Updated July 2022. Accessed January 22, 2024.

Sanofi Genzyme. CAPRELSA® Product Monograph. Mississauga, Ontario: Sanofi Genzyme; December 8, 2016.