Ixabepilone

INTRODUCTION

Indications

Combination use with capecitabine for the treatment of metastatic or locally advanced breast cancer currently resistant to a taxane and anthracycline or resistant to a taxane and cannot tolerate further anthracycline. May also be used as monotherapy for breast cancers that are not responding to anthracyclines, taxane, or capecitabine.

Action

Binds to β-tubulin subunits on microtubules; this action blocks cells in mitosis, leading to cell death. Also has antiangiogenic activity. Therapeutic Effects: Decreased spread of breast cancer.

Adverse Reactions/Side Effects

CNS: fatigue, weakness, dizziness, headache, insomnia. EENT: ↑ lacrimation. CV: chest pain, edema, myocardial ischemia, ventricular dysfunction. Resp: dyspnea. GI: abdominal pain, anorexia, constipation, diarrhea, mucositis, nausea, stomatitis, vomiting, altered taste. Derm: alopecia, hyperpigmentation, nail disorder, palmar-plantar erythrodysesthesia (combination therapy with capecitabine), exfoliation, pruritus, rash, hot flushes. Hemat: MYELOSUPPRESSION. MS: arthralgia, musculoskeletal pain, myalgia. Neuro: peripheral neuropathy. Misc: hypersensitivity reactions.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of bone marrow suppression (myelosuppression) as indicated by blood dyscrasias such as neutropenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or anemia (unusual weakness and fatigue, shortness of breath on exertion, pallor, cyanosis). Report these signs to the physician immediately.

• Monitor signs of hypersensitivity reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Monitor any chest pain or other signs of cardiac dysfunction (palpitations, fatigue upon exertion, altered heart rate). Notify physician if cardiac symptoms increase during exercise or limit functional ability.

• 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.

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

• Be alert for signs of peripheral neuropathy (numbness, tingling, decreased muscle strength). Establish baseline electroneuromyographic values using EMG and nerve conduction at the beginning of drug treatment whenever possible, and reexamine these values periodically to document drug-induced changes in peripheral nerve function.

• Assess dizziness and weakness 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.

Interventions

• For patients who are medically able to begin exercise, implement appropriate ...