Table 2.
Suggested modifications of vemurafenib and dabrafenib doses in response to adverse events other than dermatologic conditions and fever
| Grade and tolerability | Vemurafenib modification | Dabrafenib modification |
|---|---|---|
| Grade 1 or 2, tolerable (other than LFT abnormality) | No dose change (960 mg bid); manage adverse event medically | No dose change (150 mg bid); manage adverse event medically |
| Grade 2, intolerable or grade 2 LFT abnormality |
1st occurrence: interrupt treatment until grade 0 or 1, then resume at −1 dose level (720 mg bid) 2nd occurrence: interrupt treatment until grade 0 or 1, then resume −2 dose levels (480 mg bid) 3rd occurrence: discontinue treatment |
1st occurrence: interrupt treatment until grade 0 or 1, then resume at −1 dose level (100 mg bid) 2nd occurrence: interrupt treatment until grade 0 or 1, then resume −2 dose levels (75 mg bid) 3rd occurrence: consider discontinuing treatment or interrupting treatment until grade 0 or 1, then resume −3 dose levels (50 mg bid) |
| Grade 3 |
1st occurrence: interrupt treatment until grade 0 or 1, then resume at −1 dose level (720 mg bid) 2nd occurrence: interrupt treatment until grade 0 or 1, then resume −2 dose levels (480 mg bid) 3rd occurrence: discontinue treatment |
1st occurrence: interrupt treatment until grade 0 or 1, then resume at −1 dose level (100 mg bid) 2nd occurrence: interrupt treatment until grade 0or 1, then resume −2 dose levels (75 mg bid) 3rd occurrence: Consider discontinuing treatment or interrupting treatment until grade 0 or 1, then resume −3 dose levels (50 mg bid) |
| Grade 4 |
1st occurrence: consider discontinuing treatment. If toxicity is unlikely to recur, interrupt treatment until grade 0 or 1, then resume at −2 dose levels (480 mg bid) 2nd occurrence: discontinue treatment |
1st occurrence: consider discontinuing treatment. If toxicity is unlikely to recur, interrupt treatment until grade 0 or 1, then resume at −2 or −3 dose levels (75 mg bid or 50 mg bid, respectively) 2nd occurrence: discontinue treatment |
LFT liver function test, bid twice per day