Table 4.
Information That Can Be Incorporated Into Decision-Making Regarding Which Drug to Initiate First in Patients With MTC Needing Systemic Therapy
| Cabozantinib is favored in patients with the following characteristics: | Vandetanib is favored in patients with the following characteristics: |
|---|---|
| • Inherited long QT syndrome, personal or family history of cardiac arrest, unexplained fainting or unexplained seizures | • Diverticulitis, Crohn disease, ulcerative colitis, history of gastrointestinal bleeding, fistulas of any kind |
| • Exposure to medications known to prolong the QT interval | • History of external beam radiation therapy to the neck and/or mediastinum |
| • Electrolyte abnormalities that are difficult to correct (e.g., persistent hypocalcemia, hypokalemia, hypomagnesemia, hypoparathyroidism) | • Tumor that invades the trachea, esophagus, or major vessels or encases major vessels |
| • Photosensitivity, inability to protect against sunlight exposure | • Low body mass index |
| • Treatment with a CYP3A4 inducera | • Treatment with a CYP3A4 inhibitora |
| • Rapidly progressive MTC | • Patients with jobs requiring use of the hands (e.g., musician, housekeeper, dishwasher) |
a
A list of CYP3A4 inhibitors and inducers can be found at www.medicine.iupui.edu/clinpharm/ddis/.