 Dabrafenib

Nursing Responsibilities
1. Monitor for signs and symptoms of ocular toxicities (change in vision, photophobia, eye pain). May
require steroid and mydriatic ophthalmic drops. (INDEPENDENT)
2. Perform skin examinations prior to starting therapy and every 2 months during and for 6 months after
completion of therapy. If intolerable Grade 2 skin toxicity, Grade 3 or Grade 4 occurs, hold dabrafenib
for up to 3 weeks. If improved, resume at a lower dose and if not improved, permanently discontinue as
prescribed by the physician. (DEPENDENT)
3. Monitor for signs and symptoms of venous thromboembolism (shortness of breath, chest pain, arm or
leg swelling, cool or pale arm or leg) during therapy. If uncomplicated deep vein thrombosis (DVT) or
pulmonary embolus (PE) occurs, do not modify dabrafenib dose. Withhold trametinib for up to 3 weeks.
If improved to Grade 0-1, resume at lower dose. If not improved, permanently discontinue. If life
threatening PE occurs, permanently discontinue dabrafenib. (INTERDEPENDENT)
(URL: https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Drug-Guide/109867/all/dabrafenib)
 Pembrolizumab
Nursing Responsibilities
1. Monitor for signs and symptoms of immune-mediate pneumonitis (shortness of breath, chest pain, new
or worse cough) periodically during therapy. (INDEPENDENT) (URL:
https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Drug-
Guide/110182/all/pebrolizumab#:~:text=Monitor%20for%20signs%20and%20symptoms,mediated
%20pneumonitis%20occurs%2C%20hold%20pembrolizumab.)
2. Instruct patient to take as directed. If patient vomits after taking, do not replace dose; notify health care
professional. Do not take missed doses; take next scheduled dose and notify health care professional. If
any capsules are broken or leaking, do not touch with bare hands; dispose of capsules and wash hands
with soap and water. Patient should be instructed to read the Patient Information guide prior to first dose
and with each refill; new information may be available. (DEPENDENT)
3. Monitor CBC with differential and platelet count prior to administration and frequently during therapy.
Baseline neutrophil count of ≥1500 cells/mm3 and platelet count of ≥100,000 cells/mm3 are required
before first dose. The nadir of neutropenia occurs in 11 days, with a duration of 7 days. The nadir of
thrombocytopenia occurs in 15 days, with a duration of 5 days. The nadir of anemia occurs in 15 days.
Subsequent doses should not be administered until neutrophils recover to >1000 cells/mm3, platelets
recover to >100,000 cells/mm3, and hemoglobin levels recover to 9.0 mg/dL. If severe neutropenia
occurs during any course, subsequent doses should be reduced by 0.25 mg/m2 or filgrastim may be
administered following the subsequent course of therapy starting on day 6, 24 hours after the completion
of topotecan. (INTERDEPENDENT)
(URL: https://davisplus.fadavis.com/3976/meddeck/pdf/topotecan.pdf)
 Ipilimumab
Nursing Responsibilities
1. Inform patient of the risk of immune-mediated reactions due to T-cell activation and proliferation.
Advise patients these may be severe and fatal. Instruct patient to notify health care professional
immediately if signs and symptoms occur. (INDEPENDENT)
2. Assess for signs and symptoms of hepatotoxicity (yellowing of skin or whites of eyes, unusual
darkening of urine, unusual tiredness, pain in right upper stomach) before each dose. If hepatotoxicity
occurs, rule out infectious or malignant causes. Permanently discontinue ipilimumab if Grade 3–5
hepatotoxicity occurs and start systemic corticosteroids at a dose of 1–2 mg/kg/day of prednisone or
equivalent. When liver function tests show sustained improvement or return to baseline, start
corticosteroid taper over 1 mo. May administer mycophenolate in patients with persistent severe
hepatitis despite high-dose corticosteroids. Withhold ipilimumab in patients with Grade 2
hepatotoxicity. (DEPENDENT)
3. Monitor liver function tests (AST, ALT, bilirubin) prior to each dose of ipilimumab; high frequency of
monitoring if levels high. Withhold ipilimumab in patients with Grade 2 hepatotoxicity. With complete
or partial resolution (Grade 0–1), and patient receiving <7.5 mg prednisone, resume at a dose of 3 mg/kg
every 3 weeks until administration of all 4 planned doses or 16 weeks from first dose, whichever occurs
earlier. Discontinue ipilimumab permanently with Grade 3–5 hepatotoxicity and administer systemic
corticosteroids at a dose of 1 to 2 mg/kg/day of prednisone or equivalent. Initiate corticosteroid taper
when liver function tests show sustained improvement or return to baseline; continue to taper over 1 mo.
(INTERDEPENDENT)
(URL: https://davisplus.fadavis.com/3976/meddeck/pdf/ipilimumab.pdf)
Generic name: aldesleukin
Brand name: proleukin
Drug classification: antineoplastics/interleukins
Mechanism of action: Increases cellular immunity (noted as lymphocytosis and eosinophilia), increases the production
of cytokines (including tumor necrosis factor, interleukin-1, and gamma interferon), and inhibits tumor growth.

Desired effect: this drug is given to the patient to skin cancer. This medication is the same as a substance that
your body normally makes (interleukin-2). In the body, this drug is thought to work by affecting the body's
natural defenses (immune system). This effect slows or stops cancer cell growth. (URL:
https://www.webmd.com/drugs/2/drug-11667/aldesleukin-intravenous/details#:~:text=Aldesleukin%20is
%20used%20to%20treat,or%20stops%20cancer%20cell%20growth.)
Nursing responsibilities

1. Assess patient for the development of capillary leak syndrome (hypotension, hypovolemia, edema, ascites,
pleural effusions). This initially manifests as a drop in arterial BP beginning 2–12 hours from start of
administration. If BP decreases to <90 mmHg, constant ECG monitoring, hourly vital signs, and CVP monitoring
are recommended. (INDEPENDENT)
2. Monitor ECG continuously during infusion. Cardiac function, including thallium stress testing, should be
determined prior to initiation of therapy. Supraventricular arrhythmias may respond to digoxin or verapamil and
usually resolve after completion of therapy. (DEPENDENT)
3. : Monitor CBC, differential, platelet count, blood chemistries including electrolytes, and renal and hepatic
function prior to and daily throughout therapy. May cause elevated bilirubin, BUN, serum creatinine,
transaminase, and alkaline phosphatase levels. May cause anemia, thrombocytopenia, hypomagnesemia,
acidosis, hypocalcemia, hypophosphatemia, hypokalemia, hyperuricemia, hypoalbuminemia, and
hypoproteinemia. (INTERDEPENDENT)

(URL: https://davisplus.fadavis.com/3976/meddeck/pdf/aldesleukin.pdf)
 Nursing Central. (2020). Davis’s Drug Guide.
https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Drug-Guide/109867/all/dabrafenib#12
Medscape. (2020). Pembrolizumab. https://reference.medscape.com/drug/keytruda-pembrolizumab-
999962#5
 Becze BA, ELS., E. (2019). Patient Education Is Critical to Managing irAEs for Immune Checkpoint
Inhibitors. https://voice.ons.org/news-and-views/patient-education-is-critical-to-managing-iraes-for-immune-
checkpoint-inhibitors#:~:text=Patient%20Education%20Is%20Critical%20to%20Managing%20irAEs%20for
%20Immune%20Checkpoint%20Inhibitors,-October%2008%2C%202019&text=By%20rebalancing%20the
%20immune%20system,fight%20their%20cancers%20for%20them.
Beynon, B. (2020). Adverse Event Management for BRAF/MEK Inhibitors in Melanoma.
https://www.oncnursingnews.com/conference-coverage/sono-2020/adverse-event-management-for-brafmek-
inhibitors-in-melanoma