Vandetanib
CAPRELSA
What it isOral multikinase inhibitor of RET, VEGFR, and EGFR for symptomatic or progressive unresectable locally advanced or metastatic medullary thyroid cancer.
Why this oneTargets RET-driven signaling and can produce durable disease control with once-daily oral dosing.
What limits itA roughly 19-day half-life makes QT toxicity slow to emerge and slow to resolve; correct electrolytes, avoid QT-prolonging drugs, and perform serial ECGs.
FDA-approved for
- medullary thyroid cancer (2011)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Medullary thyroid cancer (unresectable, locally advanced or metastatic) | Adults | 300 mg QD until progression or unacceptable toxicity | 300 mg QD | 300 mg QD |
Renal Moderate impairment (CrCl ≥30 to <50 mL/min): start 200 mg QD; monitor QT.
Hepatic Not recommended in moderate or severe hepatic impairment.
Do not take a missed dose within 12 hours of the next dose.
Instructions
- With or without food
- Do not take a missed dose within 12 hours of the next dose
- Do not crush; tablets may be dispersed in water (stir ~10 min) and given by NG/gastrostomy tube
Contraindications
- Congenital long QT syndrome
Cautions
- QT prolongation/torsades/sudden death (monitor ECG, K/Ca/Mg, TSH)
- Severe skin reactions (SJS/TEN)
- Interstitial lung disease
- Ischemic cerebrovascular events, hemorrhage, heart failure
- Diarrhea, hypertension
- Reversible posterior leukoencephalopathy syndrome
- Impaired wound healing
- Embryo-fetal toxicity
- Osteonecrosis (including jaw)
Adverse reactions
- Diarrhea/colitis
- Rash
- Acneiform dermatitis
- Hypertension
- Nausea
- Headache
- Upper respiratory tract infection
- Decreased appetite
- Abdominal pain
Pregnancy Can cause fetal harm (embryotoxic, fetotoxic, teratogenic in animals).
Lactation Do not breastfeed during treatment and for 4 months after the last dose.
⚠ BOXED WARNING
- QT prolongation can cause torsades and sudden death; avoid long-QT states, correct calcium/potassium/magnesium, avoid QT-prolonging drugs, and monitor ECGs and electrolytes
Cost, est. cash$5,000–$30,000+/month or cycle
Generic entry2028 est.
Classes and tags
Clinical profile
Legacy pregnancy categoryD
Defining liabilityMyelosuppression and agent-specific hepatic, cardiac, pulmonary, neurologic or reproductive toxicity require oncology monitoring.
Mechanism of action: Vandetanib ballicule
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Memory aids: mascots and interaction avatars
