Sirolimus
|
Bone lytic lesions
Effusions
LM engorgement Pain
|
GLA
GSD
KLA
CCLA††
|
0.8mg/m2/dose PO every 12 hours*
Trough target level: 8-12ng/mL
|
Indefinite OR transition to other targeted therapy
|
Oral mucositis
High triglycerides
Immunosuppression
(consider PJP prophylaxis)
|
Oral mucositis
High triglycerides
Immunosuppression
(consider PJP prophylaxis)
|
Interferon alpha 2b
|
Bone lytic lesions
Effusions
|
GLA
GSD
KLA
|
Pegylated form: 1.5mcg/kg/dose subQ weekly
|
Indefinite (but may be limited due to complications)
|
Flu-like symptoms with administration
Hypothyroidism
|
|
Vincristine
|
Coagulopathy
Effusions
|
KLA
|
>10kg: 1.5mg/m2/dose IV weekly initially,
max 2mg/dose
≦10 kg: 0.05mg/kg/dose
|
Taper off as coagulopathy improves
|
Peripheral neuropathy
Constipation
Bone pain
SIADH
Extravasation risk
Hair loss
|
Peripheral neuropathy
Constipation
Bone pain
SIADH
Extravasation risk
Hair loss
|
Steroids
|
Coagulopathy
Effusions
|
KLA
|
Methylprednisone IV 1.6mg/kg/day
OR
Prednisolone PO 2mg/kg/day, initially
|
Taper off over 2-3 months if possible
|
Hyperglycemia
Increased appetite
Stomach/duodenal ulcers
Weight change
Mood/sleeping disturbances
|
Hyperglycemia
Increased appetite
Stomach/duodenal ulcers
Weight change
Mood/sleeping disturbances
|
Zoledronic acid
|
Bone lytic lesions
Pathogenic fractures
|
GLA
GSD
KLA
|
VAC: 0.05 mg/kg/dose IV every 6 months, max 4mg/dose
|
2 years max
|
Infusion reactions (including anaphylaxis)
Osteonecrosis of jaw
Electrolyte disturbances
Atypical femur fracture
|
Infusion reactions (including anaphylaxis)
Osteonecrosis of jaw
Electrolyte disturbances
Atypical femur fracture
|
|
|
|
HVMC: 4mg/m2/dose IV monthly x 3 doses, then every 3
months, max 4mg/dose
|
Reassess need after 10 doses
5 years max
|
|
|
Trametinib
|
Bone lytic lesions
Effusions
Coagulopathy (KLA)
|
KLA
CCLA††
|
0.025mg/kg/dose PO once daily, max 2mg/dose**
0.5mg, 1mg, 2mg tablets available only
|
Indefinite OR transition to other targeted therapy
|
Skin rash
Edema
Diarrhea
Increased liver enzymes
Hair lightening or loss
Oral mucositis
|
Skin rash
Edema
Diarrhea
Increased liver enzymes
Hair lightening or loss
Oral mucositis
|