Impact of CINV

IMPACT of CINV

Nurses

  • Do you recognize these patients?

    • Patients with previous break through symptoms3,a,b
      • Patients may experience a decrease in therapeutic effect when drug plasma levels are low4
      • Repeated administration of oral medication, such as antiemetics, over several days can give rise to peaks and troughs in plasma drug levels5,a
    • Patients who are forgetful6,7
      • Patients may experience forgetfulness or cognitive impairment due to their chemotherapy regimen6
      • Forgetting to take a daily oral antiemetic may result in breakthrough nausea and vomiting7,a
    • Patients taking polypharmacy8
      • Poor treatment adherence may result due to complex treatment regimens8
      • The rate of adherence to medications decreases as the dosing frequency increases8
    • Patients receiving multiday chemotherapy3
      • Multiday regimens, which are often highly emetogenic, may result in consecutive periods of acute CINV3

 

  • When to Consider Sancuso (granisetron transdermal system)

    • Oncology nurses are the primary and best resource for patients to manage chemotherapy-induced nausea and vomiting (CINV)—identify the patients who might be suitable for SANCUSO
      • Sancuso® (granisetron transdermal system) is indicated for the prevention of nausea and vomiting in adults receiving moderately and/or highly emetogenic chemotherapy regimens of up to 5 consecutive days.1
      • Due to its route of administration, SANCUSO may be an option for patients on chemotherapy who are unable to take or retain oral antiemetics2

 

  • How Sancuso may be able to help

    • Because SANCUSO is a patch that provides up to 5 days of prevention against CINV, your patients do not need to swallow antiemetic pills every day1
    • SANCUSO is absorbed through the skin, which bypasses the gastrointestinal tract and is not hindered by motility issues or blockages that may limit absorption of oral medications1,2
      • SANCUSO may be suitable for:
        • Sancuso can be considered for patients who have trouble swallowing
        • Patients who have difficulty swallowing
        • Patients may experience difficulty swallowing as a result of certain cancer types (e.g., head and neck), or treatment regimens9
          • Combination radiation and chemotherapy may increase oral mucositis and difficulty swallowing
          • Patients receiving combination radiation/chemotherapyb
    • Combination radiation/chemotherapy contributes to oral mucositis and difficulty swallowing10
    • Sancuso may help patients with limited gut motility or absorption
    • Patients with limited gut motility/absorption
    • Malignancy-associated delayed gastric emptying may lead to changes in the absorption of orally administered drugs such as antiemetics11
    • Combination radiation and chemotherapy may increase the risk of oral mucositis
    • Patients with oral mucositis
    • The risk of oral mucositis increases with certain chemotherapeutic agents or combination radiation/chemotherapy10,b,c
    • Nurse References

      • aSANCUSO is not a rescue medication or indicated for breakthrough symptoms.1

      • bSANCUSO is not indicated for radiation-induced nausea and vomiting.1

      • cPatients with cancer who are mechanically compromised include those with oral and/or gastrointestinal impairment associated with chemotherapy, with or without radiation, or tumor burden, who may be unable to take or retain oral antiemetics.9,10

      • Verify all references:
          • SANCUSO [package insert]. Bridgewater, NJ: Kyowa Kirin, Inc.; 2020. Schulmeister L. Granisetron transdermal system: a new option to help prevent chemotherapy-induced nausea and vomiting. Clin J Oncol Nurs. 2009;13(6):711-714. doi:10.1188/09.CJON.711-714. NCCN Clinical
            Practice Guidelines in Oncology (NCCN Guidelines®): Antiemesis. National Comprehensive Cancer Network. https://www.nccn.org/ professionals/physician_gls/pdf/antiemesis.pdf. Updated July 20, 2011. Accessed December 18, 2019. Mason JW, Moon TE. Use and cardiovascular safety of transdermal and other granisetron preparations in cancer management. Cancer Manag Res. 2013;5:179-185. doi:10.2147/CMAR.S34352. Boccia RV, Gordan LN, Clark G, Howell JD, Grunberg SM; on behalf of the SANCUSO Study Group. Efficacy and tolerability of transdermal granisetron for the control of chemotherapy-induced nausea and vomiting associated with moderately and highly emetogenic multi-day chemotherapy: a randomized, double-blind, phase III study. Support Care Cancer. 2011;19(10):1609-1617. doi:10.1007/ s00520-010-0990-y.

             

            Chemo brain. American Cancer Society website. 
            http://www.cancer.org/ treatment/treatments-and-side-effects/physical-side-effects/changes-in-mood-or-thinking/chemo-brain.html. Updated June 9, 2016. Accessed December 18, 2019. Fujii H, Iihara H, Ishihara M, Takahashi T, Yoshida K, Itoh Y. Improvement of adherence to guidelines for antiemetic medication enhances emetic control in patients with colorectal cancer receiving chemotherapy of moderate emetic risk. Anticancer Res.2013;33(12):5549-5556. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487-497. Raber-Durlacher JE, Brennan MT, Verdonck-de Leeuw IM, et al. Swallowing dysfunction in cancer patients. Support Care Cancer. 2012;20(3):433-443. doi:10.1007/ s00520-011-1342-2. Lalla RV, Bowen J, Barasch A, et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2014;120(10):1453-1461. doi:10.1002/ cncr.28592. Keller J, Layer P. Intestinal and anorectal motility and functional disorders. Best Pract Res Clin Gastroenterol. 2009;23(3):407-423. doi:10.1016/j.bpg.2009.02.012.

    INDICATIONS AND USAGE

    SANCUSO® (granisetron transdermal system) is indicated for the prevention of nausea and vomiting in adults receiving moderately and/or highly emetogenic chemotherapy regimens of up to 5 consecutive days.


    CONTRADICTIONS

    Sancuso is contraindicated in patients with known hypersensitivity to granisetron or to any of the components of the transdermal system.


    WARNINGS AND PRECAUTIONS
    • Progressive Ileus and Gastric Distention: Sancuso may mask a progressive ileus and/or gastric distention. This should be particularly considered before use of Sancuso in patients who have had recent abdominal surgery. Monitor for decreased bowel activity, particularly in patients with risk factors for gastrointestinal obstruction.
    • Serotonin Syndrome: The development of serotonin syndrome has been reported with 5-HT3 receptor antagonists. Patients should be monitored for the emergence of serotonin syndrome, especially with concomitant use of Sancuso and other serotonergic drugs.
    • If symptoms of serotonin syndrome occur, discontinue Sancuso and initiate supportive treatment. Patients should be informed of the increased risk of serotonin syndrome, especially if Sancuso is used concomitantly with other serotonergic drugs. Skin Reactions: In clinical trials with Sancuso, application site reactions were reported that were generally mild in intensity and did not lead to discontinuation of use. The incidence of reactions was comparable with placebo. If severe reactions, or a generalized skin reaction occur (e.g., allergic rash, including erythematous, macular, papular rash or pruritus), remove the Sancuso transdermal system.
    • Increased Drug Exposure with Use of External Heat Sources: Prolonged exposure to heat results in increasing plasma concentrations of granisetron during the period of heat exposure. Do not apply a heat pad or heat lamp over or in the vicinity of the Sancuso transdermal system and avoid extended exposure to heat.
    • Phototoxicity with Ultraviolet Light Exposure: Granisetron may be affected by direct natural or artificial sunlight, including sunlamps. An in vitro study using Chinese hamster ovary cells suggests that granisetron has the potential for photogenotoxicity. To avoid a potential skin reaction, advise patients to cover the application site of the transdermal system with clothing if there is a risk of exposure to direct natural or artificial sunlight throughout the period of wear and for 10 days following its removal.

    Adverse Reactions

    The most common adverse reaction (≥ 3%) is constipation.

    You are encouraged to report suspected adverse reactions to Cumberland Pharmaceuticals Inc. at 1-800-Sancuso or FDA at 1-800-FDA-1088 or www.fda.gov/ medwatch.

    See full Prescribing Information for SANCUSO.