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nursing guidelines for continuing treatment of afinitor everolimus afinitor everolimus is a tablet that contains either 5 or 10 mg of everolimus everolimus belongs to a class of drugs called mtor inhinitors this drug is used for the treatment of metastatic clear cell renal cell cancer that has progressed while on or after vegf-targeted therapy sutent or sorafenib overview of afinitor treatment schedule · baseline full panel blood work must be completed to ensure treatment may be initiated safely · following initiation of treatment patients will be assessed in clinic in 2 weeks with blood work done to assess for treatment related toxicities · patients must have cbc/diff liver function test and creatinine completed at least monthly while on afinitor · for patients stable on treatment scanning and restaging should be performed in clinic every 2-3 months · patients will inform rn if experiencing any signs and symptoms of treatment toxicity · rn will contact patient if discontinuation/dose reduction is required based on results of blood work · summary of important dates clinic visit+blood work to assess for treatment related toxicities clinic visit+blood work as part of routine monitoring scanning and restaging to assess treatment efficacy 2 weeks post initiation of everolimus monthly every 2-3 months guidelines for afinitor treatment patient must be monitored for signs and symptoms of toxicity from treatment signs and symptoms of toxicity include · febrile episode · diarrhea · stomatitis · pneumonitis shortness of breath/cough · rash patients must not be experiencing any new disease related symptoms monitoring guidelines to assess treatment safety refer to ctc criteria at the end of the document when needed bloodwork monitoring guideline hemoglobin-no significant drop neutrophils-greater than or equal to 1.5 creatinine-no increase greater than 30 from baseline platelets-greater than or equal to 90 with no significant drop bloodwork completed

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assess patient for common side effects from treatment diarrhea-resolved or grade 1 stomatitis-resolved or grade 1 fatigue -causing inability to perform adl shortness of breath-less than grade 2 rash-resolved or grade 1 adl=activities of daily living assess patient for treatment induced pneumonitis/infections shortness of breath-less then grade 2 newonset cough-absent fever or chills-absent pain in lungs or surrounding muscles upon deep breathing-absent management of metabolic abnormalities hyperlipidemia patient being monitored by family md for cholesterol assessment completed assessment completed assessment completed hyperglycemia patients with previously documented diabetes continue to be followed by family md for glucose control blood sugars are within normal range all patients random glucose blood reading less than or equal to 13 mmol/l other concerns if patient is experiencing other possible drug-related side effects document on flowsheet · onset · duration · interventions attempted assessment completed

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ctc criteria 3.0 stomatitis grading scale grade 0 patient is experiencing no oral discomfort grade 1 painless ulcers redness or mild soreness in the absence of lesions patient can maintain normal diet grade 2 painful redness swelling or ulcers but can eat or swallow patient can eat and swallow a modified diet grade 3 painful erythema edema or ulcers requiring iv hydration patient us unable to hydrate orally grade 4 severe ulceration or requires parenteral or enteral nutritional support or prophylactic intubation diarrhea grading scale grade 0 patient is experiencing no increase in number of stools from baseline grade 1 increase of less than 4 stools per day over baseline grade 2 increase of 4 ­ 6 stools per day over baseline iv fluids indicated for less than 24hrs not interfering with activities of daily living grade 3 increase of 7 stools or more per day over baseline incontinence iv fluids for 24 hrs or more requires hospitalization interfering with activities of daily living grade 4 life-threatening consequences e.g hemodynamic collapse ctc 2.0 dyspnea shortness of breath grading scale grade 0 normal grade 1 grade 2 dyspnea on exertion grade 3 dyspnea at normal level of activity grade 4 dyspnea at rest or requiring ventilator support

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