Panitumumab

INTRODUCTION

Indications

Treatment of metastatic colorectal cancer that expresses EGFR (epidermal growth factor receptor) and has failed conventional treatments (to be used as monotherapy).

Action

Binds to EGFR resulting in inactivation of kinases that regulate proliferation and transformation. Therapeutic Effects: Decreased progression of colorectal cancer.

Adverse Reactions/Side Effects

CNS: fatigue. EENT: OCULAR TOXICITY, eyelash growth. Resp: PULMONARY FIBROSIS, cough. GI: abdominal pain, constipation, diarrhea, nausea, vomiting, stomatitis. Derm: DERMATOLOGIC TOXICITY, paronychia, photosensitivity. F and E: edema, hypocalcemia, hypomagnesemia. Misc: INFUSION REACTIONS.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess any breathing problems or signs of pulmonary fibrosis 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.

• Identify signs of skin toxicity such as rash, itching, scaling, redness, warmth, and rapid skin loss. Report these signs to the physician or nursing staff immediately.

• Report allergy-like responses (wheezing, laryngeal edema, urticaria, other skin reactions) that occur during and after administration (infusion related reactions).

• Monitor any vision disturbances, eye pain, or inflammation that might indicate ocular toxicity. Report vision problems to the physician or nursing staff immediately.

• 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 neuromuscular signs of electrolyte imbalances such as low calcium levels (headache, lethargy, weakness, cramping, muscle hyperexcitability and tetany) and low magnesium levels (irritability, insomnia, muscle tremors, confusion). Notify physician or nursing staff of these signs.

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, unusual fatigue) or displays other criteria for exercise termination (See Appendix L).

• Causes photosensitivity; use care if administering UV treatments. Advise patient to avoid direct sunlight and use sunscreens and protective clothing.

Patient/Client-Related Instruction

• Advise patient about the likelihood of GI reactions, including abdominal pain, constipation, diarrhea, nausea, vomiting, and inflammation in/around mouth. Instruct patient to report severe or prolonged GI problems.

• Instruct patient or family/caregivers to report other bothersome side effects such as severe or prolonged cough, fatigue, or ...