Temsirolimus

INTRODUCTION

Indications

Advanced renal cell carcinoma.

Action

Binds to an intracellular protein. The resultant complex inhibits an enzyme, mTOR (mammalian target of rapamycin). Inhibition of this enzyme arrests cell growth in the G1 phase. Therapeutic Effects: Decreased spread of renal cell carcinoma.

Adverse Reactions/Side Effects

CNS: weakness. EENT: conjunctivitis. CV: hypertension, venous thromboembolism. Resp: INTERSTITIAL LUNG DISEASE. GI: BOWEL PERFORATION, anorexia, ↑ liver enzymes, mucositis, nausea. GU: RENAL FAILURE. Derm: rash, abnormal wound healing. Endo: hyperglycemia. F and E: edema, hypophosphatemia. Hemat: anemia, leukopenia, lymphopenia, thrombocytopenia. Metab: hyperlipidemia, hypertriglyceridemia. Misc: hypersensitivity reactions, including anaphylaxis, ↑ risk of infections.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess any breathing problems or signs of interstitial lung disease 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.

• Monitor signs of kidney failure, including decreased urine output, increased blood pressure (BP), muscle cramps/twitching, edema/weight gain from fluid retention, yellowish brown skin, and confusion that progresses to seizures and coma. Report these signs to the physician or nursing staff immediately.

• Be alert for signs of bowel perforation, including sudden severe abdominal pain accompanied by nausea, vomiting, chills, and fever. Report these signs to the physician or nursing staff immediately.

• Monitor signs of hypersensitivity reactions or anaphylaxis, 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 signs of venous thrombosis (lower extremity swelling, warmth, erythema, tenderness) and thromboembolism (shortness of breath, chest pain, cough, bloody sputum). Notify physician immediately, and request objective tests (Doppler ultrasound, lung scan, others) if thrombosis is suspected.

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

• 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.

• Be alert for signs of leukopenia (fever, sore throat, other signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or unusual weakness and fatigue that might be due to anemia or other blood dyscrasias. Report these signs to the physician or nursing staff immediately.

• 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.

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