Table 4.
Summary of dose modification guidelines
| Adverse event (CTCAE v4.0) | Lapatinib | Capecitabine | Radiation |
|---|---|---|---|
| Hematology: neutrophils or platelets | |||
| Grade –2: | Continue | Hold 7 daysa | Continue |
| Grade ≥3: | Hold 7 daysa | Holdb | |
| Dermatology: rash | |||
| Grade –3: | Hold 7 daysa | Not applicable | |
| Dermatology: irradiated skin | |||
| Grade ≥3: | Not applicable | Holdb | |
| Dermatology: palmar-plantar erythrodysesthesia | |||
| Grade ≥2: | Not applicable | Hold 7 daysa | Not applicable |
| Gastroenteroloy: diarrhea | |||
| Grade ≥3: | Discontinue | Holda | Holdb |
| Respiratory: pneumonitis | |||
| Grade ≥3: | Discontinue | ||
| Cardiac dysfunction: | |||
| Asymptomatic LVEF decrease >20 % from baseline and absolute value below the LLN | Discontinue | Not applicable | |
| Grade –3 | |||
| Hepatotoxicity: | |||
| ALT > 3 × ULN AND ALT < 5 × ULN | Continue | Not applicable | |
| ALT > 3 × ULN AND ALT > 5 × ULN for ≥2 weeks | Discontinue | ||
| ALT > 3 × ULN AND ALT < 5 × ULN for > 4 weeks | |||
| ALT > 3 × ULN AND bilirubin > 2 × ULN (>35 % direct) | |||
| ALT > 3 × ULN AND ALT > 8 × ULN | |||
| ALT > 3 x ULN AND signs and symptoms of hepatitis or hypersensitivity | |||
aRechallenge if grade 0–1
bRestart if grade 0–2