Pregnancy Category: X
Oral—Treatment of cutaneous T-cell lymphoma (cutaneous manifestations) in patients who have failed at least one previous systemic therapy.Topical—Treatment of cutaneous T-cell lymphoma (cutaneous manifestations) in Stage IA or IB patients who have refractory/persistent lesions and have not responded to or tolerated other treatments.
Binds and inactivates selected retinoid X receptors (RXRs) that are ultimately responsible for cellular differentiation and proliferation. Inhibits growth of some tumor cell lines including lines of hematopoetic and squamous cell origin.
Decreased spread of cutaneous T-cell lymphoma.
Absorption: Well absorbed following oral administration, absorption is enhance by a fat-containing meal. Some systemic absorption follows topical application.
Protein Binding: >99%.
Metabolism and Excretion: Mostly metabolized by the liver, mainly by the CYP3A4 enzyme system; some metabolites may be pharmacologically active. Excreted almost entirely via hepatobiliary elimination, <1% excreted in urine.
Half-life: 7 hr.
Time/action profile (improvement in lesions)
|PO, Top||within 4 wk†||unknown||unknown|
Contraindicated in: Hypersensitivity; Concurrent use of gemfibrozil; Obstetric: Pregnancy (may cause fetal harm); Lactation: Avoid breastfeeding.
Use Cautiously in: Hepatic impairment (may ↓ elimination); Renal impairment (may alter protein binding); Diabetic patients (concurrent use with some antidiabetics may increase the risk of hypoglycemia); Patients with child-bearing potential/male patients with partners who have child-bearing potential; Geriatric: Elderly patients may be more sensitive to drug effects; Pediatric: Safe and effective use in pediatric patients has not been established.
Adverse Reactions/Side EffectsOral
Central nervous system
- headache (most frequent)
- weakness (most frequent)
Ear, Eye, Nose, Throat
- new/worsening cataracts (most frequent)
- peripheral edema (most frequent)
- pancreatitis (life-threatening)
- abdominal pain (most frequent)
- nausea (most frequent)
- liver function abnormalities
- dry skin (most frequent)
- rash (most frequent)
- exfoliative dermatitis
- hyperlipidemia (most frequent)
- hypothyroidism (most frequent)
- anemia (most frequent)
- leukopenia (most frequent)
- flu-like syndrome
Central nervous system
- headache (most frequent)
- pain (most frequent)
- pruritus (most frequent)
- skin disorder (most frequent)
- rash (most frequent)
Drug-Drug interactionInteractions are noted for oral use, but may occur with topical use especially with high dose/prolonged treatment.↑ levels and risk of toxicity with gemfibrozil ; concurrent use not recommended.Combination regimen of paclitaxel and carboplatin ↑ levels.May act as an inducer of the CYP3A4 enzyme system; may ↓ levels and effectiveness of substrates of the CYP3A4 system including atorvastatin, tamoxifen, paclitaxel, and hormonal contraceptives.Vitamin A may ↑ risk of toxicity (limit supplementation to <15,000 IU/day).Concurrent use of insulin, sulfonylureas, or thiazolidinediones in diabetic patients may ↑ risk of hypoglycemia.Topical—Concurrent use with DEET (N,N-diethyl-m-toluamide)-containing insect repellents may ↑ risk of DEET toxicity and should be avoided.
Oral (Adults) 300 mg/m2 once daily; dosage to be adjusted based on tolerance/toxicity.
Topical (Adults) Apply once every other day for 1 wk, increase at weekly interval to once daily, then twice daily, then 3 times daily and finally four times daily as tolerated, continued as long as benefit is derived.
Capsules: 75 mg
Topical gel: 1.0% (contains dehydrated alcohol and propylene glycol in 60 gram tubes
- Monitor for signs and symptoms of pancreatitis.
- Assess for visual difficulties. May cause cataracts.
- Lab Test Considerations: Monitor fasting blood lipid levels prior to therapy, weekly until lipid response is established (usually 2–4 wks), every 8 wks thereafter. May cause hyperlipemia and hypercholesterolemia. Maintain triglyceride levels <400 mg/dL during therapy. If fasting triglyceride levels are elevated or become elevated during therapy, institute antilipemic therapy. May require ↓ dose or stopping bexarotene.
- Monitor liver function tests prior to therapy and after 1, 2, and 4 wks of therapy. If stable, monitor every 8 wks thereafter. May cause ↑AST, ALT, and serum bilirubin. May require interruption or discontinuation of therapy if levels are > 3 times the upper limit of normal.
- Monitor thyroid function tests at baseline and periodically during therapy. Consider thyroid replacement if levels ↓.
- Monitor WBC with differential at baseline and periodically during therapy. May cause leukopenia in the range of 1000 to <3000 WBC/mm3. Onset is usually 4–8 wks. Usually resolves within 30 days with dose ↓ or discontinuation of therapy.
- Obtain a pregnancy test with a sensitivity of at least 50 mIU/L within 1 wk of starting bexarotene and monthly during therapy.
Potential Nursing DiagnosesImpaired skin integrity (Indications)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)
- Triglycerides should be normal or normalized with medication prior to starting bexarotene.
- Oral: Administer all capsules at once, once a day with or immediately following a meal. Swallow capsules whole; do not chew or dissolve in liquid or in mouth.
- Topical: Initiate therapy with gel on second or third day of a normal menstrual period. Apply generous amount of gel to cover entire lesion. Allow gel to dry for 5–10 min before covering with clothing. If applied after shower or bath, wait 20 min before application. Do not apply gel to normal skin or mucosal surfaces. Do not cover with occlusive dressings. Wash hands following application. Do not use gel after the expiration date.
- Instruct patient to take or apply bexarotene as directed. Take missed doses as soon as remembered unless close to time for next dose; do not double doses.
- Advise patient to avoid touching broken or leaking capsules and notify pharmacist. If contents get on skin, immediately wash area with soap and water and notify health care professional. Do not use capsules after expiration date.
- Advise patient to notify health care professional immediately if signs and symptoms of pancreatitis (persistent nausea, vomiting and abdominal or back pain) occur.
- Caution patient to wear protective clothing and avoid sunlight and artificial ultraviolet light to prevent phototoxocity reactions.
- Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications, especially vitamin A.
- Caution patient that bexarotene is teratogenic and should be avoided during pregnancy. Pregnancy tests will be taken before starting and monthly during therapy. Effective contraception must be used 1 mo before beginning therapy, during, and 1 mo following therapy. Two forms of contraception are recommended with at least 1 being condom, diaphragm, cervical cap, IUD, or spermacide. Patients should not breastfeed during therapy. Male patients whose partner is pregnant or capable of becoming pregnant should discuss precautions with health care professional.
- Explain need for regular blood tests to patient.
- Topical: Advise patient to avoid showering, bathing, or swimming for at least 3 hrs after application. Avoid insect repellent containing DEET or other products containing DEET during therapy. Keep gel away from flame; contains alcohol.
- Inform patient that redness, itching, burning, irritation, and scaling at application area may occur; notify health care professional if they become troublesome.
- Decrease in lesions of cutaneous T-cell lymphoma.
A novel synthetic retinoid analog that binds to members of the RXR subclass of receptors; of low toxicity, it induces apoptosis in a variety of tumor cell types.
bexaroteneA retinoid that binds to retinoid X receptors, upregulating their activity by either removing negative transcription control or by facilitating transcription. It is FDA-approved for treating cutaneous T cell lymphoma, and has been used off label for lung and breast cancer, and Kaposi sarcoma.
Adverse effects Similar to hypervitaminosis A—headache, nausea, vomiting, lip inflammation, mucous-membrane dryness, joint pain, scaly skin, hyperlipidaemia