Tovorafenib (Ojemda™)

How to Take Tovorafenib

This medication comes in an immediate release tablet or an oral suspension (liquid). The dose depends on your size. It should be taken once a week around the same time, with or without food. The tablets should be taken whole with water, do not break, cut, crush, or chew them. The suspension comes as a powder in a bottle. You will need to add 14ml of room temperature water to the bottle. It should be given right away. If it is not given within 15 minutes of being mixed, it should not be used. Each ml contains a certain amount of medication. Your provider will tell you how much should be drawn up into the dosing syringe and given.

It is important to make sure you are taking the correct amount of medication every time. Before every dose, check that what you are taking matches what you have been prescribed.

 If you miss your dose by 3 days or less, take your dose as soon as possible and take your next dose on its scheduled day. If you miss it by more than 3 days, skip your missed dose and resume your schedule. If you throw up right after taking it, take another dose.

This medication can affect how hormonal contraception (birth control) works. A non-hormonal form of birth control should be used while taking this medication. The blood levels of this medication can be affected by certain medications, so they should be avoided. These may include: gemfibrozil, clopidogrel, rifampin, among others. Be sure to tell your healthcare provider about all medications and supplements you take.

Storage and Handling

Store your medication in the original, labeled container at room temperature and in a dry location (unless otherwise directed by your healthcare provider or pharmacist). The tablets come in a blister pack and should not be stored in a pillbox. The suspension comes in a glass bottle and is co-packaged with a bottle adaptor and an oral dosing syringe. Keep containers out of reach of children and pets.

If a caregiver prepares your dose for you, they should consider wearing gloves or pour the pills directly from their container into the cap, a small cup, or directly into your hand. The liquid can be given using a syringe directly into the mouth or a feeding tube. They should avoid touching the pills or liquid. They should always wash their hands before and after giving you the medication. Pregnant or nursing women should not prepare the dose for you. Ask your oncology team where to return any unused medication for disposal. Do not flush down the toilet or throw in the trash.

Where do I get this medication?

Certain cancer medications are only available through specialty pharmacies. If you need to get this medication through a specialty pharmacy, your provider will help you start this process. Where you can fill your prescriptions may also be influenced by your prescription drug coverage. Ask your healthcare provider or pharmacist for assistance in identifying where you can get this medication.

Insurance Information

This medication may be covered under your prescription drug plan. Patient assistance may be available to qualifying individuals depending upon prescription drug coverage. Co-pay cards, which reduce the patient co-pay responsibility for eligible commercially (non-government sponsored) insured patients, may also be available. Your care team can help you find these resources if they are available.

Possible Side Effects of Tovorafenib

There are a number of things you can do to manage the side effects of tovorafenib. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common or important side effects:

Skin and Hair Changes 

Some patients may develop a rash, very dry or itchy skin, acneiform rash, sun sensitivity, and redness and inflammation around your nails. Use an alcohol-free moisturizer on your skin and lips; avoid moisturizers with perfumes or scents. Your provider can recommend a medication you can put on the rash if needed. If your skin does crack or bleed, be sure to keep the area clean to avoid infection. Be sure to notify your healthcare provider of any changes in your skin and they can give you more tips on caring for your skin. You should wear sunscreen and clothing like long sleeves, long pants, hats, and sunglasses to protect your skin from the sun. This medication may also cause hair color changes.

Fever

Fever can be a serious side effect of this medication. If you develop a fever of 100.4°F/ 38°C or greater, call your oncology care team right away and before taking the next dose of medication.

Low Red Blood Cell Count (Anemia)

Your red blood cells are responsible for carrying oxygen to the tissues in your body. When the red cell count is low, you may feel tired or weak. You should let your oncology care team know if you experience any shortness of breath, difficulty breathing or pain in your chest. If the count gets too low, you may receive a blood transfusion.

Liver Toxicity

This medication can cause liver toxicity, which your oncology care team may monitor for using blood tests called liver function tests. Notify your healthcare provider if you notice yellowing of the skin or eyes, your urine appears dark or brown, or you have pain in your abdomen, as these can be signs of liver toxicity.

Low White Blood Cell Count (Leukopenia or Neutropenia)

This medication can cause fever and viral infections with or without a change in your white blood cell count. White blood cells (WBC) are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4°F or 38°C), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.

Tips to preventing infection:

• Washing hands, both yours and your visitors, is the best way to prevent the spread of infection.
• Avoid large crowds and people who are sick (i.e.: those who have a cold, fever or cough or live with someone with these symptoms).
• When working in your yard, wear protective clothing including long pants and gloves.
• Do not handle pet waste.
• Keep all cuts or scratches clean.
• Shower or bathe daily and perform frequent mouth care.
• Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
• Ask your oncology care team before scheduling dental appointments or procedures.
• Ask your oncology care team before you, or someone you live with has any vaccinations.

Electrolyte Abnormalities 

This medication can affect the normal levels of electrolytes (potassium, sodium, phosphate, etc.) in your body. Your levels will be monitored using blood tests. If your levels become too low, your care team may prescribe specific electrolytes to be given by IV or taken by mouth. Do not take any supplements without first consulting with your care team.

Fatigue

Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team for helpful tips on dealing with this side effect.

Nausea and/or Vomiting

Talk to your oncology care team so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy, or acidic foods (lemons, tomatoes, oranges). Try saltines, or ginger ale to lessen symptoms.

Call your oncology care team if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.

Headache

This medication can cause headaches. Ask your provider how they can be managed.

Hemorrhage (Bleeding)

Patients may have minor bleeding, such as a nosebleed, while on this medication. Serious bleeding has also occurred. You should contact your healthcare team right away if you have any new or worsening bleeding.

Constipation

There are several things you can do to prevent or relieve constipation. Include fiber in your diet (fruits and vegetables), drink 8-10 glasses of non-alcoholic fluids a day, and keep active. A stool softener once or twice a day may prevent constipation. If you do not have a bowel movement for 2-3 days, you should contact your healthcare team for suggestions to relieve the constipation.

Swelling (Edema)

Edema is swelling. The swelling can become uncomfortable. This can also be a sign of other problems, so be sure to notify your oncology care team if you are experiencing any new or worsening swelling.

Diarrhea

Your oncology team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice, products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses of non-alcoholic, un-caffeinated fluid a day to prevent dehydration.

Less common but important side effects can include:

•  Issues with Growth in Children: In rare cases, this medication can stunt a child's growth. This means they may have slower than normal growth during treatment with this medication. Their providers will monitor growth during and after treatment.

Sexual & Reproductive Concerns

This drug may affect your reproductive system, resulting in the menstrual cycle or sperm production becoming irregular or stopping permanently. In addition, the desire for sex may decrease during treatment.

Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. This medication can affect how hormonal birth control works. Non-hormonal methods of birth control (condoms, spermicide, diaphragm, Paraguard, IUD) are necessary during treatment and for at least 28 days after the last treatment for women and 2 weeks for men even if your menstrual cycle stops or you believe you are not producing sperm.

You may want to consider sperm banking or egg harvesting if you may wish to have a child in the future. Discuss these options with your oncology team. You should not breastfeed while taking this medication or for 2 weeks after your last dose.