Ovarian Cancer Drug Summary

Last updated: 01 August 2025
Reviewed by

Cancer Hormone Therapy


Drug Dosage1 Remarks
Tamoxifen 20 mg PO 12 hourly
Max dose: 40 mg/day
Adjuvant therapy is continued for up to
5 years
 Adverse Reactions
  • CV effects (edema, chest pain, flushing, hypertension); GI effects (nausea, weight loss, diarrhea, abdominal pain); CNS effects (fatigue, pain, dizziness, insomnia, depression); Dermatologic effects (rash, alopecia); Other effects (menstrual disorder, hot flushes, weakness, vaginal discharge, leukopenia, thrombocytopenia, hypercholesterolemia)
Special Instructions
  • Use with caution in patients with history of deep vein thrombosis or pulmonary embolism
  • Associated with increased risk of uterine or endometrial cancer
1Various dosage recommendations are available. Please refer to specialist for specific treatment option.

Cytotoxic Chemotherapy


Drug Dosage1 Remarks
Altretamine 260 mg/m2/day PO in 4 divided doses for 14 or 21 consecutive days out of a 28-day cycle, up to 12 cycles Adverse Reactions
  • Hematologic effects (bone marrow depression, manifested by leukopenia, thrombocytopenia, anemia); GI effects (nausea/vomiting, hepatotoxicity); Neurologic effects (central neurotoxicity, peripheral neuropathy); Other effects (alopecia, rashes, pruritus)
Special Instructions
  • Should be taken with food
  • If WBC count is <2,000/mm3, granulocyte count is <1,000/mm3, platelet count is <75,000/mm3, or if neurotoxicity or intolerable GI symptoms occur, therapy should be temporarily discontinued for ≥14 days prior to restarting at 200 mg/m2/day
  • Use with caution in patients previously treated with other myelosuppressive agents
  • Contraindicated in patients with pre-existing severe bone marrow depression, severe neurologic toxicity, currently being treated with antidepressants of the MAOI class
  • Perform peripheral blood counts at least monthly, prior to initiation of each course of therapy and as clinically indicated; monitor neurologic function regularly
Carboplatin Monotherapy
Previously untreated: 400 mg/m2 IV as a single dose administered in 15-60 minutes
Previously treated: 360 mg/m2
Combination therapy
Carboplatin: 300 mg/m2
and
Cyclophosphamide: 600 mg/m2
To be administered as IV infusion over 15-60 minutes on day 1 every 4 weeks for 6 cycles		 Adverse Reactions
  • Hematologic effects (thrombocytopenia, neutropenia, leukopenia, anemia); Metabolic effects (elevation of blood urea and bilirubin levels, electrolyte disturbances); GI effects (nausea/vomiting, hepatic impairment); CNS effects (central neurotoxicity, peripheral neuropathies, ototoxicity); CV effects (cardiac failure, embolism and cerebrovascular accidents may occur); Other effects (alopecia, asthenia, pain, mucositis)
  • Potentially fatal: Bone marrow suppression, anaphylactic reactions
Special Instructions
  • Both regimens are not to be repeated until neutrophil count is ≥2,000 cells/mm3 and platelet count is ≥100,000/mm3
  • Use with caution in patients with impaired hepatic and renal function
Chlorambucil Monotherapy
0.2 mg/kg/day PO for 4-6 weeks
Maintenance dose: 0.2 mg/kg/day PO for 2-4 weeks with 2-6 weeks intervals between each course 		Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, hepatotoxicity); Other effects (acute secondary hematologic malignancies; rarely irreversible bone marrow failure, allergic reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis, seizures, peripheral neuropathy, interstitial pulmonary fibrosis or pneumonia)
Special Instructions
  • Avoid in first trimester of pregnancy 
  • Use with caution in patients with renal or hepatic impairment, seizure disorder, patients immunized with live vaccine
  • Monitor blood counts closely
Cisplatin Monotherapy: 50-120 mg/m2 IV per cycle, given as a single dose once every 3-4 weeks
or
15-20 mg/m2 IV 24 hourly for 5 days every 3-4 weeks
Combination therapy with Cyclophosphamide: 75-100 mg/m2 IV on day 1 of every 4-week cycle		 Adverse Reactions
  • GI effects (severe nausea/vomiting); Metabolic effects (hypomagnesemia, hypocalcemia, hyperuricemia); CNS effects (peripheral neuropathy, papilledema, optic neuritis, seizures, ototoxicity)
  • Rarely, renal damage due to inadequate hydration during therapy, anaphylactoid reactions, cardiac abnormalities
  • Very rarely, life-threatening myelosuppression
Special Instructions
  • Use with caution in patients with renal or hepatic impairment, myelosuppression
  • Monitor renal, neurological and auditory function
  • Perform blood counts regularly
  • Maintain adequate hydration before and 24 hours after administration of therapy to minimize nephrotoxicity
Cyclophosphamide Low-dose regimen: 2-6 mg/kg PO weekly in divided doses
May also be given as a single IV dose
Moderate-dose regimen: 10-15 mg/kg IV weekly
High-dose regimen: 20-40 mg/kg IV every 10-20 days
Dosage may vary depending on the disease state, patient’s condition, state of the bone marrow and whether it is used as a single agent or in combination regimens 		Adverse Reactions
  • GI effects (nausea/vomiting, anorexia, mucositis); CNS effect (headache); GU effect (acute hemorrhagic cystitis or urinary fibrosis); Dermatologic effects (alopecia, rash); Hematologic effect (leukopenia); Respiratory effects (rhinorrhea, nasal congestion); Other effects (fertility impairment, renal tubular necrosis, syndrome of inappropriate secretion of diuretic hormone may occur with doses >50 mg/kg)
Special Instructions
  • Use with caution in patients with blood disorders, elderly or debilitated patients, diabetic patients, those with renal or hepatic impairment or who have undergone adrenalectomy, and those previously treated with X-ray or cytotoxic agents
  • Monitor hematological profile and presence of RBC in urine regularly
  • Maintain adequate hydration and frequent micturition to reduce the risk of cystitis
Cytarabine  0.2-0.8 mg/kg IV infusion 1-2x for 1 week   Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, anorexia, abdominal pain, ileus, stomatitis); Hematologic effects (leukopenia, thrombocytopenia, hemorrhage, anemia, megaloblastosis); Other effects (fever, malaise, rash, headache)
Special Instructions
  • Use with caution in patients with hepatic or renal impairment, bone marrow suppression and complicated infections
  • Monitor renal, hepatic and bone marrow function regularly
Dactinomycin  500 mcg IV 24 hourly for max 5 days
A second course may be given after at least 3 weeks if all signs of toxicity have disappeared
 Adverse Reactions
  • GI effects (nausea/vomiting); Hematologic effects (anemia, leukopenia, thrombocytopenia); Other effects (alopecia, phlebitis at injection site)
Special Instructions
  • Use with caution in patients with hepatic or renal impairment, bone marrow suppression and complicated infections
  • Monitor renal, hepatic and bone marrow function regularly
Docetaxel
 100 mg/m2 IV infusion over 1 hour once every 3 weeks
Combination therapy with Carboplatin:
75 mg/m2 IV infusion over 1 hour every 3 weeks
Adverse Reactions
  • Ophthalmologic effect (epiphora with canalicular stenosis); CNS effects (paresthesia, dysesthesia, pain); Dermatologic effects (alopecia, rash, erythema, desquamation, anaphylaxis); GI effects (nausea/vomiting, stomatitis, diarrhea); CV effects (hypotension, edema); Hematologic effects (neutropenia, leukopenia, anemia, thrombocytopenia); Other effects (weakness, bronchospasm, increased transaminases)
Special Instructions
  • Contraindicated in patients with pre-existing bone marrow suppression with neutrophil count of <1,500 cells/mm3, and patients with severe hepatic impairment
Doxorubicin hydrochloride
(pegylated liposomal) 		 50 mg/m2 IV every 4 weeks for as long as the disease does not progress and patient continues to tolerate treatment
Adverse Reactions
  • Dermatologic effects (injection site reaction, alopecia, urticaria, rash); GI effects (nausea/vomiting, stomatitis, GI ulceration, diarrhea, loss of appetite); GU effects (urinary frequency, hematuria); Hematologic effects (leukopenia, anemia, thrombocytopenia); CV effects (transient ECG abnormalities, CHF); Other effects (discoloration of body fluids, hyperuricemia, infertility)
Special Instructions
  • Avoid in patients with pre-existing bone marrow suppression and chronic heart failure
  • Use with caution in patients with previous RT
  • Baseline cardiac evaluation (ECG, left ventricular ejection fraction [LVEF]) is advised especially in patients at high risk of cardiac toxicity
Epirubicin  60-90 mg/m2 as single IV over 3-5 minutes every 3 weeks 
Adverse Reactions
  • CNS effects (changes in sensorium, fever); Dermatologic effects (injection site reaction, alopecia, anaphylaxis, rash); GI effects (nausea/vomiting, diarrhea, loss of appetite); Hematologic effects (leukopenia, anemia, thrombocytopenia); Other effects (menstrual dysfunction, hot flushes)
Special Instructions
  • Avoid in patients with cardiac disease (severe myocardial insufficiency, severe arrhythmias and recent MI), severe hepatic impairment and in patients with baseline neutrophil count 1,500 cells/mm3
  • Use with caution in patients with pre-existing cardiac disease, hepatic and renal dysfunction and in patients who have previously received anthracyclines
  • May cause secondary leukemia
Etoposide
 Usual dose: 50-120 mg/m2 IV 24 hourly for 5 days or
50 mg/m2 PO 24 hourly for 21 days every 4 weeks until disease progression or unacceptable toxicity
 Adverse Reactions
  • GI effects (nausea/vomiting, anorexia, diarrhea, stomatitis); CNS effect (peripheral neuropathy); Local effects (irritation, thrombophlebitis); Other effects (anaphylactic reactions, hypotension with IV injection, reversible alopecia)
  • Rarely, disturbances of liver function
  • Potentially fatal: Severe myelosuppression, characterized by leukopenia and thrombocytopenia, cardiotoxicity, anaphylaxis
Special Instructions
  • Avoid direct contact with skin
  • Avoid use in patients with severe myelosuppression and severe hepatic or renal impairment
  • Use with caution in patients with renal or hepatic disease or with low serum albumin
  • Monitor CBC before, during and after therapy
Fluorouracil (5-Fluorouracil, 5-FU) 15 mg/kg (600 mg/m2) IV infusion over 2-4 hours 24 hourly
or
12 mg/kg/day (480 mg/m2) slow IV injection x 3 consecutive days
May give 6 mg/kg on the fifth, seventh and ninth days if there are no signs of toxicity
Max IV infusion dose: 1 g/day
Maintenance dose: 5-10 mg/kg (200-400 mg/m2) IV injection once weekly 		 Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea); Hematologic effects (leukopenia, thrombocytopenia, anemia); CV effects (precordial pain, transient change in ECG); Dermatologic effects (alopecia, maculopapular rash)
Special Instructions
  • Contraindicated in patients with severe changes in blood count, bone marrow depression, hemorrhage, malabsorption, severe liver and renal impairment, severe infections, herpes zoster, varicella, stomatitis, ulcerations of the oral cavity and GIT, pseudomembranous enteritis, extensive liver metastasis
  • Use with caution in patients after high-dose pelvic irradiation, after therapy with alkylating substances and in severe bone metastasis
  • Monitor blood count, liver and renal functions regularly
Gemcitabine
 Monotherapy:
800-1,250 mg IV infusion over 30 minutes on days 1, 8 and 15 of each 28-day cycle
Combination with Carboplatin:
1,000 mg/m2 IV infusion over 30 minutes on days 1 and 8 of each 21-day cycle, combined with Carboplatin on day 1 following Gemcitabine consistent with AUC 4 mg/mL/min
 Adverse Reactions
  • CV effect (edema); CNS effects (pain, fever, headache); GI effects (diarrhea, paralytic ileus, nausea/vomiting); Dermatologic effects (rash, alopecia, pruritus); Hepatic effects (elevated liver enzymes and total bilirubin level); Other effects (bone marrow suppression, hemolytic uremic syndrome)
Special Instructions
  • Use with caution in patients with hepatic metastasis, hepatic or renal impairment, with concurrent RT
Hydroxyurea
(Hydroxycarbamide)
 Intermittent therapy:
80 mg/kg body weight PO as a single dose every third day
Continuous therapy:
20-30 mg/kg body weight PO single dose 24 hourly
Concomitant therapy with irradiation:
80 mg/kg PO as a single dose every third day  		 Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, anorexia); Other effects (decreased blood counts, alopecia, headache)
Special Instructions
  • May be taken with or without food
  • Use with caution in the elderly
  • Monitor blood counts 
  • Use with caution in patients with bone marrow depression, severe anemia, renal dysfunction, prior chemotherapy or radiation therapy
  • Contraindicated in pregnancy and lactation, hypersensitivity to Hydroxyurea, marked bone marrow depression
Ifosfamide
 8-12 g/m2 IV divided over3-5 days or
5-6 g/m2, up to max of 10 g, as single 24-hour IV infusion
Repeat at 2-4 weeks interval depending on blood count
 Adverse Reactions
  • GI upset, alopecia, reduction in blood count, cystitis, reversible encephalopathy, immunosuppression
  • Rarely, renal, hepatic and cardiac dysfunction
  • Increases risk of secondary malignancies

Special Instructions

  • Patients of reproductive age should use contraceptives during therapy and for the following 6 months
  • Use with caution in patients with brain metastases, infection or electrolyte imbalance and those who have undergone unilateral nephrectomy
Irinotecan  Combination with Cisplatin:
65 mg/m2 IV and Cisplatin 30 mg/m2 IV in repeated 6-week cycles, comprising weekly treatment for 4 weeks followed by a 2-week rest 		 Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, abdominal pain); CNS effects (insomnia, dizziness, asthenia); Other effects (bone marrow suppression, pulmonary toxicity, alopecia, skin rash, fever)
Special Instructions
  • Use with caution in patients with renal and hepatic impairment, history of bleeding disorder; carcinogenicity, mutagenicity, fertility impairment
Melphalan  0.2 mg/kg body wt/day PO for 5 days every 4-8 weeks or 1 mg/kg body wt IV given at 4-weeks intervals
Combination therapy: 0.3-0.4 mg/kg body wt IV given at 4-6 weeks intervals 		 Adverse Reactions
  • Dermatologic effects (rashes, hypersensitivity, skin ulceration, necrosis, alopecia); GI disturbances, pulmonary fibrosis, hemolytic anemia, bone marrow depression, myalgia, flu-like symptoms
Special Instructions
  • Use with caution in pregnancy, in patients with renal impairment, and in those who have just received radiotherapy or cytotoxic agents
  • Monitor blood counts
  • Contraindicated in lactating women
Mitoxantrone  14 mg/m2 BSA slow IV initially for the first cycle
May be repeated after 21 days 		 Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, abdominal pain, anorexia, constipation); CV effects (asymptomatic decrease in LVEF, transient ECG changes, arrhythmia); CNS effects (somnolence, neuritis, confusion, cramps, anxiety, paresthesia); Hematologic effects (transient leukopenia, thrombocytopenia, anemia); Other effects (allergic reactions, bluish discoloration of sclerae, urine, or skin and nails)
Special Instructions
  • Use with caution in patients with history of anthracycline therapy, changes in cardiac function, severe hepatic or renal insufficiency
  • Monitor blood count and liver function before and during treatment
  • Avoid in patients with severe bone marrow suppression
Paclitaxel
 Primary therapy:
135 mg/m2 IV infusion over 24 hours followed by Cisplatin at 3-week interval or
175 mg/m2 IV infusion over 3 hours followed by Cisplatin every 3 weeks
Secondary therapy:
135 mg/m2 IV or 175 mg/m2 IV infusion over 3 hours once every 3 weeks
Adverse Reactions
  • Albumin bound: CV effects (ECG abnormality, edema, hypotension); GI effects (nausea/vomiting); Hematologic effects (neutropenia, anemia); Hepatic effect (elevated liver enzymes); Other effects (candidiasis infection, vision disturbances, sensory neuropathy)
  • Conventional: Dermatologic effects (rash, alopecia, injection site reaction, hypersensitivity reaction); CV effects (edema, flushing); GI effects (nausea/vomiting, stomatitis, mucositis, diarrhea); Hematologic effects (neutropenia, leukopenia); Hepatic effect (elevated liver enzymes); Other effect (peripheral neuropathy)
Special Instructions
  • Albumin bound: Contraindicated in patients with baseline neutrophil count of <1,500 cells/mm3; use with caution in patients with renal or hepatic dysfunction
  • Conventional: Use with caution in patients with hepatic dysfunction
Topotecan hydrochloride  1.5 mg/m2/day IV infusion over 30 minutes on days 1-5 of a 21-day cycle
Minimum: 4 cycles
Severe neutropenia (<25,000 cells/mm3): Reduce dose to 1.25 mg/m2 		 Adverse Reactions
  • Hematologic effects (anemia, febrile neutropenia, leukopenia, neutropenia, thrombocytopenia); GI effects (nausea/vomiting, diarrhea, abdominal pain, constipation, stomatitis); Other effects (fatigue, pyrexia, anorexia, asthenia, alopecia, infection)
Special Instructions
  • Perform peripheral blood cell count frequently
  • Contraindicated in patients with severe bone marrow depression, baseline neutrophil count <1,500 cells/mm3 or platelet count <100,000/mm3
  • Contraindicated in pregnancy and lactation
Trabectedin
 Combination with pegylated liposomal Doxorubicin:
1.1 mg/m2 3-hour IV infusion every 3 weeks after pegylated liposomal Doxorubicin
30 mg/ m2 90-minutes IV infusion 		 Adverse Reactions
  • Injection site reaction; GI effects (nausea/vomiting, constipation, anorexia, diarrhea, abdominal pain); CNS effects (headache, dizziness, fatigue, asthenia, arthralgia); Other effects (decreased blood cell counts and blood albumin, increased blood creatine phosphokinase, ALT and AST, hyperbilirubinemia, dyspnea, cough, hypotension, edema, alopecia)
Special Instructions
  • Use with caution in patients with hepatic or renal impairment, neutropenia and thrombocytopenia, nausea/vomiting, rhabdomyolysis, severe CPK elevations, concomitant use with CYP3A4 inhibitors; live attenuated vaccines
  • Avoid in patients with active serious/uncontrolled infection
Vinorelbine tartrate
 25 mg/m2 IV weekly or 30 mg/m2 IV on days 1 and 8 of a 21-day treatment cycle until
disease progression or unacceptable toxicity 		 Adverse Reactions
  • CNS effects (peripheral paresthesia, neurotoxicity, loss of deep tendon reflexes, fatigue); GI effects (constipation, paralytic ileus, nausea/vomiting); Hematologic effects (bone marrow suppression, severe granulocytopenia, leukopenia); Hepatic effects (elevated AST and total bilirubin level); Other effects (alopecia, injection site reaction, weakness)
Special Instructions
  • Use with caution in patients with ulcerated skin or cachexia
  • Only used for IV infusion
1Various dosage recommendations are available. Please refer to specialist for specific treatment option.

Targeted Cancer Therapy


Drug Dosage1 Remarks
Monoclonal Antibodies
Bevacizumab Combination therapy:
15 mg/kg IV infusion over 30-90 minutes once every 3 weeks in addition to Carboplatin and Paclitaxel for up to 6 cycles, then as monotherapy for 15 months or until disease progression
Recurrent disease:
Platinum-sensitive: 15 mg/kg IV infusion once every 3 weeks in combination with Carboplatin and Paclitaxel for 6 cycles and up to 8 cycles or alternatively, 15 mg/kg every 3 weeks in combination with Carboplatin and Gemcitabine for 6 cycles and up to 10 cycles, followed by monotherapy until disease progression
Platinum-resistant:
10 mg/kg IV infusion once every 2 weeks in combination with one of the following agents: Paclitaxel, Topotecan (given weekly) or pegylated liposomal Doxorubicin. Alternatively, 15 mg/kg every 3 weeks in combination with Topotecan on days 1-5 every 3 weeks		 Adverse Reactions
  • Hematologic effects (febrile neutropenia, leukopenia, neutropenia, thrombocytopenia); Metabolic effects (hyponatremia, hypomagnesemia); CNS effects (peripheral sensory neuropathy, headache, anorexia); GI effects (GI perforation, diarrhea, abdominal pain, nausea/vomiting); Respiratory effects (pulmonary hemorrhage/hemoptysis); CV effects (arterial thromboembolism, hypertension); Other effects (fatigue, asthenia)
Special Instructions
  • Discontinue in patients who develop GI perforation, grade 3 or 4 bleeding, arterial thromboembolic events (including CVA, TIA, MI), uncontrolled hypertension
  • Should not be used in patients with recent pulmonary hemorrhage/hemoptysis
  • Monitor BP; pre-existing hypertension should be adequately controlled prior to initiating therapy with Bevacizumab
Dostarlimab-gxly
 MSI-H/dMMR recurrent or advanced solid tumors:
500 mg IV infusion over 30 minutes every 3 weeks x 4 cycles followed by 1,000 mg every 6 weeks until disease progression or unacceptable toxicity

Adverse Reactions

  • GI effects (nausea/vomiting, diarrhea, colitis, pancreatitis); Hematologic effects (anemia, decreased lymphocytes); Metabolic effects (decreased sodium, increased alkaline phosphatase, decreased albumin, increased transaminases, hypothyroidism); Musculoskeletal effects (arthralgia, myalgia); Other effects (pneumonitis,fatigue, asthenia, rash, pruritus, pyrexia, chills)

Special Instructions

  • Use with caution in patients with history of allogeneic hematopoietic stem cell transplantation (HSCT)
  • Monitor for signs and symptoms of immune-mediated adverse reactions (pneumonitis, colitis, hepatitis, endocrinopathies, nephritis, rash, arthralgia)
  • Evaluate clinical chemistries, including liver enzymes, creatinine, and thyroid function at baseline and periodically during treatment
Fam-trastuzumab deruxtecan-nxki (Trastuzumab deruxtecan) HER2-positive tumors (IHC 3+ or 2+) solid tumors:
5.4 mg/kg IV infusion once every 3 weeks until disease progression or unacceptable toxicity

Adverse Reactions

  • GI effects (nausea/vomiting, constipation, diarrhea, decreased appetite); Hematologic effects (neutropenia, leukopenia, thrombocytopenia, anemia); Other effects (cough, alopecia, fatigue)

Special Instructions

  • Use with caution in patients at risk for severe life-threatening or fatal interstitial lung disease (ILD), severe neutropenia including febrile neutropenia, cardiac disorders
  • Monitor CBC and assess LVEF prior to initiation and prior to each dose and as clinically indicated
Mirvetuximab soravtansine Platinum-resistant FRα-positive tumors:
6 mg/kg adjusted ideal body wt IV infusion 24 hourly every 3 weeks until disease progression or unacceptable toxicity

Adverse Reactions

  • Endocrine/metabolic effects (decreased serum albumin, bicarbonate, potassium and/or sodium, increased serum calcium); GI effects (abdominal distension, abdominal pain, constipation, decreased appetite, diarrhea, nausea/vomiting); Hematologic effects (decreased hemoglobin, neutrophils and/or platelet count, leukopenia, lymphocytopenia); CNS effects (fatigue, headache, peripheral neuropathy, hypoesthesia, neurotoxicity, paresthesia); Musculoskeletal effects (arthralgia, myalgia); Hepatic effects (increased ALT, AST and/or alkaline phosphatase); Ophthalmologic effects (cataract, corneal disease, dry eye syndrome, photophobia, visual impairment); Other effects (increased serum creatinine, dyspnea)

Special Instructions

  • Administer prophylactic artificial tears and ophthalmic steroid drops
  • Avoid use in patients with moderate to severe hepatic impairment
  • Withhold treatment in the presence of persistent or recurrent grade 2 pneumonitis
  • Perform ophthalmic exam including visual acuity and slit lamp before initiation of treatment and every other cycle for the first 8 cycles and as clinically indicated
  • Monitor for signs and symptoms of pneumonitis and neuropathy
Pembrolizumab
 Recurrent locally advanced, metastatic or MSI-H:
200 mg IV infusion over 30 minutes every 3 weeks or
400 mg IV infusion over 30 minutes every 6 weeks
Continue treatment until disease progression or unacceptable toxicity
Max duration: 2 years
Adverse Reactions
  • GI effects (diarrhea, nausea, stomatitis, mucosal inflammation, constipation); Respiratory effects (dysphonia, cough); Dermatologic effects (palmar-plantar erythrodysesthesia syndrome, rash); Other effects (hypertension, fatigue, asthenia, hypothyroidism, decreased appetite, hepatotoxicity)
Special Instructions
  • Use with caution in patients with hypothyroidism, type 1 DM, immune-mediated pneumonitis/colitis/hepatitis/nephritis/endocrinopathies/skin adverse reactions, renal failure
  • Withhold treatment if any of the following occurs: Grade2 pneumonitis, grade 2 or 3 colitis, symptomatic hypophysitis, grade 2 nephritis, grade 3 hyperthyroidism, AST or ALT >3-5x upper limit of normal (ULN) or total bilirubin >1.5-3x ULN, or any other severe or grade 3 treatment-related adverse reaction
  • Discontinue if life-threatening adverse events occur: Grade 3 or 4 pneumonitis, grade 3 or 4 nephritis, AST or ALT >5x ULN or total bilirubin >3x ULN, grade 3 or 4 infusion-related reactions, inability to reduce corticosteroid dose to ≤10 mg of Prednisone or equivalent per day within 12 weeks, persistent grade 2 or 3 adverse reactions (excluding endocrinopathies controlled with hormone replacement therapy) that do not recover to grade 0-1 within 12 weeks after last dose, or any severe or grade 3 treatment-related adverse reaction that recurs
Protein Kinase Inhibitors
Avutometinib/Defactinib In combination with Defactinib:
KRAS gene fusion-positive solid tumors: 
Avutometinib given at 3.2 mg PO twice weekly (day 1 and 4) and Defactinib given at 200 mg PO 12 hourly on weeks 1-3 of a 4-week cycle

Adverse Reactions

  • Dermatologic effects (rash, dermatitis acneiform, pruritus,dry skin); GI effects (nausea/vomiting, diarrhea, abdominal pain,dyspepsia, stomatitis, constipation); Hematologic effects (decreased hemoglobin, decreased lymphocyte count, decreased neutrophil count, decreased platelet count); Metabolic effects (increased creatine phosphokinase, aspartate aminotransferase, alanine aminotransferase,triglycerides, alkaline phosphatase, blood bilirubin); Musculoskeletal effect (musculoskeletal pain); Ophthalmologic effects (vitreoretinal disorders, visual impairment); Respiratory effects (dyspnea, cough); Other effects (fatigue, edema, urinary tract infection)

Special Instructions

  • Use with caution in patients at risk for ocular toxicities including visual impairment and vitreoretinal disorders, serious skin toxicities, hepatotoxicity, rhabdomyolysis
  • Perform comprehensive ophthalmologic evaluation at baseline, prior to cycle 2, every 3 cycles thereafter, and as clinically indicated
  • Monitor LFTs and creatine phosphokinase prior to each cycle, on day 15 of the first 4 cycles, and as clinically indicated
Dabrafenib BRAF V600E mutation-positive solid tumors:
150 mg PO 12 hourly in combination with Trametinib until disease progression or unacceptable toxicity

Adverse Reactions

  • CV effects (cardiomyopathy, decreased LVEF, hypertension); Dermatologic effects (dermatitis, rash, erythema); Respiratory effects (pneumonitis, ILD); Other effects (granulomatous nephritis, hepatic events, hemorrhage, pancreatitis, hyperglycemia, malignancy, ocular toxicity, serious febrile reactions)

Special Instructions

  • Should be taken on an empty stomach
  • Use with caution in patients with DM or hyperglycemia, moderate to severe hepatic impairment, severe renal impairment
Entrectinib NTRK gene fusion-positive solid tumors:
600 mg PO 24 hourly until disease progression or unacceptable toxicity

Adverse Reactions

  • GI effects (nausea/vomiting, diarrhea, constipation, dysgeusia); CNS effects (dizziness, cognitive impairment; dysesthesia); Respiratory effects (cough, dyspnea); Musculoskeletal effects (myalgia, arthralgia); Other effects (fatigue, edema, increased weight, pyrexia, vision disorders)

Special Instructions

  • Assess LV ejection fraction before initiation
  • Use with caution in patients with CHF, severe renal impairment and moderate-severe hepatic impairment
  • Monitor LFTs every 2 weeks during first month of treatment then monthly or as clinically indicated thereafter
  • Monitor serum uric acid levels before and periodically during treatment
  • Monitor for signs and symptoms of CHF, hyperuricemia
Larotrectinib NTRK genefusion-positive solid tumors:
100 mg PO12 hourly until disease progression or unacceptable toxicity

Adverse Reactions

  • GI effects (nausea/vomiting, diarrhea, constipation); Other effects (fatigue, dizziness, anemia, increased ALT and AST, cough)

Special Instructions

  • May impair ability to drive or operate machinery
  • Monitor LFTs every 2 weeks during first month of treatment then monthly or as clinically indicated thereafter
Niraparib
 300 mg PO 24 hourly
First-line maintenance
treatment of advanced ovarian cancer:
<77 kg or platelet count <150,000/μL:
200 mg PO 24 hourly
≥77 kg or platelet count ≥150,000/μL:
300 mg PO 24 hourly 		 Adverse Reactions
  • GI effects (nausea/vomiting, constipation, abdominal pain, diarrhea); CNS effects (insomnia, headache, dizziness); Respiratory effects (dyspnea, cough); Hematologic effects (thrombocytopenia, anemia, neutropenia, leukopenia); GU effects (acute kidney injury, urinary tract infection); Other effects (fatigue, musculoskeletal pain, decreased appetite, rash, hypertension, hypomagnesemia)
Special Instructions
  • Use with caution in patients with prior multiple platinum-containing chemotherapy, DNA damaging agent, radiotherapy, bone marrow dysplasia history, hypertension, severe hepatic and/or renal impairment, end-stage renal disease undergoing hemodialysis, ECOG performance status 2-4, galactose intolerance, Lapp lactase deficiency, glucose-galactose malabsorption, advanced age (≥75 years old)
  • Monitor full blood count weekly for first month, monthly for next 10 months, periodically after), BP, heart rate (weekly for first 2 months, monthly for first year, periodically after)
Olaparib  300 mg (two 150-mg tab) PO 12 hourly
First-line maintenance treatment of HRD-positive ovarian cancer:
300 mg PO 12 hourly in combination with Bevacizumab 15 mg/kg IV infusion every 3 weeks
Adverse Reactions
  • GI effects (dysgeusia, nausea/vomiting, diarrhea, dyspepsia, stomatitis, upper abdominal pain); Hematologic effects (anemia, neutropenia, lymphopenia, mean corpuscular vol elevation, thrombocytopenia); Other effects (increased creatinine, decreased appetite, headache, dizziness, fatigue)
Special Instructions
  • Start treatment not later than 8 weeks after completion of final dose of the platinum-containing regimen
  • Interrupt treatment if severe hematological toxicity or blood transfusion dependence develops, or if new or worsening respiratory symptoms or a radiological abnormality occurs; discontinue treatment if pneumonitis is confirmed
  • Use with caution in patients with myelodysplastic syndrome/acute myeloid leukemia, moderate to severe renal impairment, hepatic impairment
  • Avoid co-administration with strong CYP3A inducers or inhibitors
  • Women of childbearing potential must use effective contraception during therapy
Repotrectinib
 NTRK gene fusion positive solid tumors:
160 mg PO 24 hourly x 14 days then increased to 160 mg PO 12 hourly until disease progression or unacceptable toxicity 		 Adverse Reactions
  • GI effects (nausea/vomiting, constipation, dysgeusia, diarrhea, decreased appetite); CV effect (edema); Endocrine/metabolic effects (decreased/increased serum glucose, increased serum potassium and/or sodium, weight gain); Hematologic effects (decreased neutrophils and/or hemoglobin, increased INR, prolonged prothrombin time, lymphocytopenia); Hepatic effects (increased AST, ALT and/or alkaline phosphatase); CNS effects (ataxia, cognitive dysfunction, anemia, aphasia, confusion, delirium, delusion, hallucination, impaired consciousness, dizziness, peripheral neuropathy, drowsiness, hypersomnia, insomnia, fatigue, headache); Respiratory effects (cough, dyspnea, pneumonia); Other effects (visual disturbance, myalgia)
Special Instructions
  • Monitor LFTs and creatine phosphokinase every 2 weeks during the first month of therapy then monthly thereafter and as clinically indicated; monitor serum uric acid before initiation then periodically during treatment
  • Monitor for signs and symptoms of CNS toxicity and new or worsening pulmonary symptoms indicative of interstitial lung disease
Rucaparib
 600 mg PO 12 hourly until disease progression or unacceptable toxicity  Adverse Reactions
  • GI effects (nausea/vomiting, abdominal distension, abdominal pain, constipation, dysgeusia, diarrhea); CNS effects (fatigue, dizziness, headache, insomnia, depression); Hematologic effects (decreased WBC, anemia, decreased absolute lymphocyte count, thrombocytopenia, neutropenia); Dermatologic effect (rash); Metabolic effect (dyslipidemia); Other effects (weakness, increased serum creatinine, increased ALT, AST and alkaline phosphatase)
Special Instructions
  • Contraindicated in patients with leukemia, myelodysplastic syndrome
Selpercatinib
 RET fusion-positive tumors
<50 kg: 120 mg PO 12 hourly
≥50 kg: 160 mg PO 12 hourly
Continue until disease
progression or unacceptable toxicity 		 Adverse Reactions
  • CV effects (edema, hypertension, prolonged QT interval); GI effects (nausea, dry mouth, abdominal pain, constipation); CNS effects (fatigue, headache); Other effects (rash, increased AST/ALT)
Special Instructions
  • Contraindicated in patients with uncontrolled hypertension
  • Use with caution in patients with risk factors for QT prolongation, severe hepatic impairment
  • Monitor ALT and AST prior to initiation, every 2 weeks during the first 3 months of therapy then monthly thereafter; monitor QT interval, electrolytes and TSH at baseline and regularly during treatment
Trametinib  BRAF V600E mutation-positive solid tumors:
2 mg PO 24 hourly in combination with Dabrafenib until disease progression or unacceptable toxicity 		 Adverse Reactions
  • CV effects (heart failure, LV dysfunction, decreased LVEF, hypotension/hypertension); Dermatologic effects (rash, dermatitis, erythema); Respiratory effects (pneumonitis, ILD); Other effects (fever, chills, dehydration, elevated LFT, rhabdomyolysis)
Special Instructions
  • Should be taken on an empty stomach and swallowed whole
  • Use with caution in patients with DM or hyperglycemia, impaired LV function, hypertension, suspected ILD, moderate to severe hepatic impairment, severe renal impairment
1Various dosage recommendations are available. Please refer to specialist for specific treatment option.

Disclaimer

All dosage recommendations are for non-elderly adults with normal renal and hepatic function unless otherwise stated.   
Not all products are available or approved for above use in all countries.  
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.   
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.  

Related MIMS Drugs