October 3, 2017 at 6:50 pm #4188
How long do the fevers last?October 3, 2017 at 7:04 pm #4194Expert NurseJane Thompson
During the clinical trials, fevers with BRAK/MEK inhibitor therapy occurred in about 54% of patients. Fevers usually start after about 30 days of treatment, lasting 2-3 days, and typically improving after 6 months. Your patient must contact the oncology team if they begin to experience fevers. For low-grade fevers of 99-101°F, they can take antipyretics as directed by the provider. Also make sure your patient is drinking plenty of water. For a fever higher than 101°F, the oncology team member most likely will hold the BRAF inhibitor, and if the patient’s temperature is higher than 104°F, he/she will hold both medications and see the patient in clinic. The patient might need supportive care such as IV hydration and to begin low dose prednisone as recommended by the prescribing information. Some patients might need a dose holiday and dose reduction until fevers resolve. Keeping well hydrated is very important, especially with higher temperatures, to avoid dehydration.October 22, 2018 at 2:58 am #4906
Its really interested blog post because they talking about fever which is really bad disease if its more the 104 degree then die a person because its too much fever level. Its good to share bestessay essay writing with friends also who not know about this post.October 22, 2018 at 8:04 am #4907Expert NurseKathleen Madden
In my practice I have had patients experience fevers of up to 105, that is not the norm though, most patients experienced fevers up to 101-103. We try to prevent such high fevers by having patients notify the treating office at the onset of any adverse events.
However, the newer braf/ mek combination encorafenib & binimetinib during clinical trials demonstrated and 18% rate of pyrexia, lower incidence than other braf mek combinations. This may be a good alterantive to another combination, if pyrexia is a dose or treatment limiting side effect.
Thank you for your input and questions, Morgan.
KathyOctober 22, 2018 at 8:44 am #4908Expert NurseSuzanne McGettigan
I do agree with Kathy that the majority of fevers from dabrafenib/trametinib do tend be in the 101-103 range–luckily not too many over 104, but these certainly are possible.
There was a publication recently from the Australian Melanoma group which delineates their management strategies for pyrexia. This management guide is definitely more in line with my practice.
I will include a link to it here: https://doi.org/10.1111/ajco.12656
In this guideline, patients would hold both dabrafenib and trametinib with onset of fever > 100.5 degrees Farenheit. They would initiate anti-pyretic agents (acetominophen, NSAIDs) as well other supportive care measures (adequate hydration). They could resume both agents once fever free and asymptomatic for at least 24-48 hours. However, if symptoms do not improve within 24 hours, they would be instructed to initiate corticosteroid (i.e. prednisone 10-25 mg daily) as an anti-inflammatory to reduce fever and to continue as prophylaxis against pyrexia/pyrexia syndrome with resumption of dabrafenib/trametinib. The corticosteroid dose could be tapered after approximately one month if the patient remained fever-free.
I would certainly be interested in how you all manage these as well.
suzanneOctober 28, 2018 at 8:59 am #4909Expert NurseKathleen Madden
Thanks you Suzanne, this is a great reference to share!
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