All About Farydak (Panobinostat)

[Music] so panavenostat is an hdac inhibitor so which is a unique mechanism in action to be able to offer to patients an hdac inhibitor works specifically on histones or uses epigenetic changes to be able to modify cancer cells importantly this is a novel class of therapies that's offered for patients panabinostat is offered in combination with dexamethasone in combination with bortessamid panambinistat is approved after patients have received either a protease inhibitor or an image class of drugs so this combination of panabenistat which is a pill with in combination with porteza mib which is a subcutaneous shot that's injected is also given with steroids pandemic status given on days one and three in in addition to dexamethasone and bortisomib that is given on a typical bortesma schedule on 1 4 8 and 11. these are typically 21-day cycles that can be adjusted for patients based upon tolerance in addition to other side effects that can be managed such as hematologic toxicities checking at things on blood counts to make sure that the patient is able to tolerate it panabenistat is an oral therapy so a pill therapy that is offered for patients and it's approved in combination with vortezumib and dexamethasone there can be changes with hematologic toxicities and what that means is it can have changes to your blood counts which include a low white blood cell count anemia and a low platelet count this can put patients at risk for having infections they sometimes may require growth factors or neupogen to be able to stimulate white blood cell count recovery and or blood transfusions or platelet transfusions importantly when we talk about panamino's debt it also can have other non-hematologic toxicities that are that can be significant some of the non-non-hematologic toxicities include diarrhea and nausea and vomiting these side effects can be significant as well as it can contribute to significant electrolyte disturbances when someone is having a significant amount of either nausea they're not eating very well and also having diarrhea you can lose a lot of critical electrolytes which also can contribute to having heart arrhythmias or heart changes that will that can be significant because of this when we're talking about access to therapy and understanding the side effect profiles for some of these novel agents um one of the significant things that we identified with use of panda benestat with amongst our patients is the diarrhea that patients experience can be significant we have become more savvy in terms of managing some of the side effect profiles with diarrhea specifically being able to provide medications to help with some of those symptom management but it does make it often times difficult to tolerate especially if someone is losing weight or has already nausea related to where they're at within their clinical course and so it's an important aspect when we're talking about treatment options to make sure that quality of life is addressed for patients as well and that's a particularly important aspect of their care at ohio state um taking care of older adults specifically with multiple myeloma is that we want these therapies to be effective and for these therapies to work in controlling their cancer but we always have to be cognizant to make sure that we're balancing the toxicities of the therapy with the benefits of the therapy and that's particularly important in a patient population that i take care of and relevant to aging adults with multiple myeloma when we talk about many of these different side effects and the many therapeutic options that are available we have to think about the patient in terms of what their pre-existing medical factors are they've also previously often had prior myeloma therapy and so we need to make sure that they haven't experienced side effects from those therapies so we're able to design a treatment plan that is unique for the patient panambinistat is required for patients to participate in the rems program the rem stands for the risk evaluation and mitigation strategy this is a program that is required by the fda to make sure that both the patient and provider are aware of these significant toxicities that can be associated with this drug in particular and so patients are required to acknowledge and fill out a survey through the rem system as well as the physician who's prescribing this drug because of these toxicities oftentimes patients and will who experience significant nausea vomiting or diarrhea we'll also at the time of prescribing this therapy prescribe anti-diarrhea medications or even schedule patients to receive fluids and anti-nausea medications as part of the the care for that for this therapy but it is an important therapy because it offers a different mechanism of action that which is different than mechanisms of action from prior therapies that most patients would have received you