Congress Abstracts 2004

83

THE NURSING ROLE IN THE MANAGEMENT OF THE NOVEL PROTEASOME INHIBITOR BORTEZOMIB (VELCADE [™] FOR INJECTION, FORMERLY PS-341) RELATED GASTROINTESTINAL (GI) ADVERSE EVENTS (AES) IN PATIENTS WITH MULTIPLE MYELOMA (MM). Kathryn Lilleby, RN, Fred Hutchinson Cancer Research Center, Seattle, WA.

The nursing role in bortezomib-related gastrointestinal AE management in patients with MM is critical.

Bortezomib was recently approved for the treatment of MM patients who have received >= 2 therapies and have demonstrated disease progression on last therapy. GI events were generally manageable with standard antiemetics/antidiarrheals, but led to 5% discontinuations. Nausea, vomiting, and diarrhea (N/V/D) are dehydration risk factors, with potentially harmful sequelae in MM. This case study illustrates effective assessment and risk management. BC, a 77-year old female with advanced MM and a history of paroxysmal hypertension for which she received atenolol at study entry, received bortezomib 1.3 mg/m2 2x/wk x2 q3wk. She experienced diarrhea, nausea, and anorexia starting at cycle 1. Food/fluid intake was low, and during cycle 2, she exhibited poor skin turgor and BP decreased to 124/86, which later increased. Transient G3 neutropenia was observed. No peripheral neuropathy was observed.

N/V/D was assessed by patient reporting, with follow-up questioning prn. Hypertension was monitored by routine BP measurements including orthostatic and patient self-measurement. Symptom management included loperamide (diarrhea, resolved after approximately 8 hours) and use of 250 CC saline flush with drug administration and encouragement to drink more fluids. Nausea was mild and not treated. Neutropenia was determined by blood counts and appeared to resolve by dose withholding. Atenolol was not held/decreased due to the hypertension’s paroxysmal nature.

Three cycles have been administered, with 3 doses withheld (neutropenia). GI symptoms resolved during rest periods without continuation of antiemetics/antidiarrheals.

Fluid loss/diminished intake due to GI distress, the most likely basis for the dehydration, should be corrected through increased fluid intake. The change from baseline BP, while potentially related to the GI effects and dehydration, could result from other causes, including concomitant medications or comorbidities. Nurses should assess the patient’s pretreatment-hydration status and need for supplemental fluids and prophylactic antiemetics. They should be aware of the degree, frequency, and duration of symptoms, the response to symptom-management medication, and concomitant medications, and be prepared to instruct patients on antidiarrheal agents, encourage patients to proactively increase fluid intake, and review prior therapies and previously experienced toxicities.