Medical Information

Pazopanib, as a multi-target tyrosine kinase inhibitor, commonly has side effects including liver toxicity, hypertension, and hematological abnormalities. Regular monitoring and preventive measures are needed to reduce the risk. The following system explains its spectrum of side effects and corresponding management strategies, covering laboratory monitoring requirements, symptom intervention plans, and precautions for special populations.

1. Hematological toxicity

(1) Thrombocytopenia: The incidence rate is about 32%, and the use of sharp instruments should be avoided. Suspend administration when<50 × 10 ⁹/L, platelet transfusion is required when<25 × 10 ⁹/L.

(2) Neutropenia: incidence rate of 18%, G-CSF treatment is used when ANC<1.0 × 10 ⁹/L. Febrile neutropenia requires immediate hospitalization.

2. Cardiovascular system response

(1) Hypertension: The incidence rate is 41% 2 weeks before treatment, and baseline blood pressure should be<140/90mmHg. When grade 3 hypertension (≥ 160/100mmHg) occurs, medication should be suspended and combined with calcium channel blockers for treatment.

(2) QT interval prolongation: Correct hypokalemia before treatment and avoid combination with fluoroquinolones. Regularly monitor the electrocardiogram and permanently discontinue medication if QTc>500ms.

3. Liver toxicity management

(1) Elevated transaminase levels: ALT/AST should be reduced when the upper limit is greater than 3 times, and permanently discontinued when the upper limit is greater than 8 times. Monitor weekly until 12 weeks, then change to monthly.

(2) Elevated bilirubin: Direct bilirubin>2 times the upper limit should rule out biliary obstruction. Gilbert syndrome patients need to distinguish between non binding elevated levels.

4. Skin adverse reactions

(1) Hand foot syndrome: incidence rate of 29%, prevention with urea ointment. When grade 2 symptoms (affecting daily life) appear, the dosage is reduced by 50%.

(2) Photogenic response: During treatment, it is necessary to use SPF50+sunscreen and avoid direct sunlight from 10am to 3pm.

5. Medication for special populations

(1) Liver dysfunction: Child Pugh B dose reduced to 200mg/day, C grade is contraindicated. Bilirubin levels greater than 3 times ULN are absolutely contraindicated.

(2) Pregnancy period: Animals show embryo fetal toxicity, effective contraception is required during medication and 2 weeks after discontinuation. Medication is prohibited during lactation.