Drug Guide
Dostarlimab-gxly
Classification
Therapeutic: Cancer immunotherapy
Pharmacological: PD-1 inhibitor
FDA Approved Indications
- Mismatch repair-deficient (dMMR) recurrent or advanced endometrial cancer
Mechanism of Action
Dostarlimab-gxly is a monoclonal antibody that blocks PD-1, a receptor on T-cells, enhancing immune response against tumor cells.
Dosage and Administration
Adult: Administer 500 mg intravenously every 3 weeks for 4 doses, then 1000 mg every 6 weeks. Dosing may vary based on specific circumstances.
Pediatric: Not approved for pediatric use.
Geriatric: No specific dosage adjustment recommended, but monitor for immune-related adverse events.
Renal Impairment: No specific dose adjustment recommended.
Hepatic Impairment: No specific dose adjustment recommended.
Pharmacokinetics
Absorption: Not applicable (intravenous administration)
Distribution: Widely distributed; volume of distribution approximately 7 L
Metabolism: Metabolized via proteolytic pathways, typical for monoclonal antibodies
Excretion: Primarily via catabolic pathways; not cleared renally
Half Life: Approximately 25 days
Contraindications
- Hypersensitivity to dostarlimab or its excipients
Precautions
- Immune-related adverse events affecting multiple organs, including pneumonitis, colitis, hepatitis, endocrinopathies, and neurologic conditions. Caution in patients with pre-existing autoimmune diseases.
Adverse Reactions - Common
- Fatigue (Often)
- Nausea (Often)
- Rash (Often)
Adverse Reactions - Serious
- Immune-mediated pneumonitis (Less common)
- Colitis (Less common)
- Hepatitis (Less common)
- Endocrinopathies, such as hypophysitis or thyroiditis (Less common)
Drug-Drug Interactions
- Potential increased risk of immune-related adverse events when combined with other immunotherapies or immune-modulating agents.
Drug-Food Interactions
- No significant interactions identified.
Drug-Herb Interactions
- Limited data; precaution advised with herbal supplements that modulate immune system.
Nursing Implications
Assessment: Monitor for signs of immune-related adverse events: respiratory symptoms, gastrointestinal symptoms, hepatic function, thyroid function, neurological status.
Diagnoses:
- Risk for immune system disorders
- Impaired skin integrity
Implementation: Administer IV as scheduled, monitor infusion reactions, assess organ function regularly.
Evaluation: Assess for resolution or reduction of tumor size, and for adverse events.
Patient/Family Teaching
- Report any new or worsening symptoms immediately.
- Do not receive live vaccines during treatment.
- Follow-up appointments are essential for monitoring.
Special Considerations
Black Box Warnings:
- Immune-mediated adverse reactions can be severe or life-threatening, including pneumonitis, colitis, hepatitis, endocrinopathies, and neurologic toxicities.
Genetic Factors: N/A
Lab Test Interference: Potential for altered lab results related to immune function or inflammation.
Overdose Management
Signs/Symptoms: Allergic reactions, severe immune-mediated adverse events.
Treatment: Discontinue Dostarlimab and provide supportive care. Corticosteroids or other immunosuppressants may be administered for immune-related adverse events.
Storage and Handling
Storage: Store vials in a refrigerator at 2°C to 8°C (36°F to 46°F). Protect from light.
Stability: Stability remains for the duration specified in the product's package insert when stored properly.