olaratumab

General

Pronunciation:
oh-lar-at-ue-mab

Trade Name(s)

  • Lartruvo

Ther. Class.
antineoplastics

Pharm. Class.
monoclonal antibodies
temporary class platelet-derived growth factor receptor alpha blockers

Indications

Soft tissue sarcoma with a histologic subtype for which an anthracycline-containing regimen is appropriate and which is not amenable to curative treatment with radiotherapy or surgery (in combination with doxorubicin).

Action

Monoclonal antibody that binds to platelet-derived growth factor receptor alpha (PDGFR-α) which contributes to its antitumor activity in sarcomas.

Therapeutic Effect(s):

Improved survival.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.

Distribution: Minimally distributed to tissues.

Metabolism and Excretion: Unknown.

Half-life: 11 days.

TIME/ACTION PROFILE (plasma levels)

ROUTEONSETPEAKDURATION
IVunknownunknownunknown

Contraindication/Precautions

Contraindicated in:

  • OB: Pregnancy (may cause fetal harm);
  • Lactation: Avoid breast feeding.

Use Cautiously in:

  • Rep: Women of reproductive potential;
  • Pedi: Safety and effectiveness not established.

Adverse Reactions/Side Effects

CNS: anxiety, headache

Derm: alopecia

EENT: dry eyes

Endo: hyperglycemia

F and E: hypokalemia, hypomagnesemia, hypophosphatemia

GI: abdominal pain, ↓ appetite, diarrhea, ↑ alkaline phosphatase, mucositis, nausea, vomiting

GU: ↓ fertility (men)

Hemat: anemia, ↑ activated partial thromboplastin time (aPTT), lymphopenia, neutropenia, thrombocytopenia

MS: pain

Neuro: neuropathy

Misc: INFUSION REACTIONS, fatigue

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

None noted.

Route/Dosage

IV (Adults) 15 mg/kg on Days 1 and 8 of each 21–day cycle. Continue until unacceptable toxicity or disease progression.

Availability

Solution for IV infusion (must be diluted): 10 mg/mL

Assessment

  • Monitor for signs and symptoms of infusion-related reactions (flushing, shortness of breath, bronchospasm, fever/chills, severe hypotension, anaphylactic shock, cardiac arrest). If Grade 1 or 2 reactions occur, hold infusion until resolution. Restart infusion at 50% of initial infusion rate. If Grade 3 or 4 reactions occur, permanently discontinue olaratumab. Ensure resuscitation equipment is available.

Lab Test Considerations:

Monitor CBC with platelet count periodically during therapy. May cause neutropenia, thrombocytopenia, and lymphopenia. If neutropenic fever/infection or Grade 4 neutropenia lasting >1 week occurs, discontinue therapy until absolute neutrophil count is ≥1,000 cells/mm3, permanently reduce dose to 12 mg/kg.

  • May cause hyperglycemia, ↑ aPTT, ↑ alkaline phosphatase, hypokalemia, hypophosphatemia, and hypomagnesemia.

Potential Diagnoses

Implementation

IV Administration

  • Premedicate with diphenhydramine (25 to 50 mg IV) and dexamethasone (10 to 20 mg IV) prior to infusion on Day 1 of cycle 1.
  • Diluent: Dilute with 0.9% NaCl or a total volume of 250 mL. Do not mix with dextrose or other solutions. Solution is clear to slightly opalescent, and colorless to slightly yellow solution. Do not infuse solutions that are discolored or contain particulate matter. Gently invert to mix; do not shake or freeze. Solution is stable for 4 hrs at room temperature or 24 hrs if refrigerated, including infusion time.
  • Rate:Infuse over 1 hr. Do not administer as a bolus. Flush line with 0.9% NaCl following infusion.
  • Y-Site Incompatibility: Do not co-infuse electrolytes or other medications through same IV line.

Patient/Family Teaching

  • Explain purpose of olaratumab to patient.
  • Instruct patient to notify health care professional immediately if signs and symptoms of infusion-related reactions occurs.
  • Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications during therapy.
  • Rep: May be teratogenic. Advise female patient to use effective contraception and avoid breast feeding during and for at least 3 mo after last dose. Advise male patient that olaratumab may impair fertility.

Evaluation/Desired Outcomes

Improved survival.

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