Interactions between Durvalumab and Matulane

Durvalumab has a moderate potential interaction with Adrenal Insufficiency.

Durvalumab can cause immune-mediated adrenal insufficiency. Adrenal function should be monitored in patients with adrenal insufficiency or with borderline adrenal function and in patients with prolonged periods of stress due to major surgery, intensive care, etc. It is recommended to monitor patients for clinical signs and symptoms of adrenal insufficiency and to institute appropriate measures as necessary. Monitor as clinically indicated prior to and periodically during treatment and withhold, reduce dose, or discontinue therapy with durvalumab as necessary.

Durvalumab has a moderate potential interaction with Autoimmune Disorders.

Programmed death receptor-1/ligand-1 (PD-1/PD-L1) blocking antibodies can cause immune-mediated adverse reactions, which may be severe or fatal. Immune-mediated adverse reactions can occur in any organ system or tissue at any time after starting therapy. This may be considered when using PD-1/PD-L1 blocking antibodies in patients with immune system disorders (e.g., ulcerative colitis, Crohn's disease, lupus) or with conditions affecting the nervous system (e.g., myasthenia gravis, Guillain-Barre syndrome). It is recommended to monitor patients closely for signs/symptoms that may be clinical manifestations of underlying immune-mediated adverse reactions.

The procarbazine in Matulane has a major potential interaction with Bleeding Disorder.

Procarbazine induces myelosuppression, including thrombocytopenia. Bleeding tendencies have included petechiae, purpura, epistaxis, hemoptysis, hematuria, and melena. Therapy with procarbazine should be administered cautiously in patients with bleeding tendencies. Patients should be instructed to immediately report any signs or symptoms of bleeding. Procarbazine should be withheld and/or discontinued if bleeding occurs. Therapy should be withheld if white blood cell counts fall below 4000/mm3 and/or platelet counts fall below 100,000/mm3. Clinical monitoring of hematopoietic function is recommended.

The procarbazine in Matulane has a major potential interaction with Bone Marrow Depression/Low Blood Counts.

Procarbazine induces myelosuppression. Leukopenia, thrombocytopenia, and anemia have been reported during procarbazine therapy. Therapy with procarbazine is contraindicated in patients with inadequate bone marrow reserve as demonstrated by bone marrow aspiration, and should be administered after cautious consideration in patients whose bone marrow reserve may be severely depressed by prior irradiation or chemotherapy or whose marrow function is recovering from previous cytotoxic therapy. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, local infection, or bleeding. Therapy should be withheld if leukocyte counts fall below 4000/mm3 and/or platelet counts fall below 100,000/mm3. Close monitoring of hematopoietic function is recommended.

Durvalumab has a moderate potential interaction with Bone Marrow Transplantation.

Fatal and other serious complications can occur in patients who receive allogeneic hematopoietic stem cell transplantation (HSCT) before or after being treated with a programmed death receptor-1/ligand-1 (PD-1/PD-L1) blocking antibody. Transplant-related complications include hyperacute graft-versus-host disease (GVHD), acute GVHD, chronic GVHD, hepatic veno-occlusive disease after reduced intensity conditioning, and steroid-requiring febrile syndrome (without an identified infectious cause). These complications may occur despite intervening therapy between PD-1/PD-L1 blockade and allogeneic HSCT. It is recommended to follow patients closely for evidence of transplant-related complications and intervene promptly. The benefit versus risks of treatment with a PD-1/PD-L1 blocking antibody before or after an allogeneic HSCT should be considered.

Durvalumab has a moderate potential interaction with Diabetes Mellitus.

Durvalumab can cause type 1 diabetes mellitus. Monitor for hyperglycemia or other signs and symptoms of diabetes. Withhold treatment in cases of severe hyperglycemia until metabolic control is achieved. Permanently discontinue durvalumab for life-threatening hyperglycemia. If appropriate interrupt treatment according to manufacturer recommendations. Care should be exercised when using durvalumab in diabetic patients.

Durvalumab has a moderate potential interaction with Diarrhea.

Immune-mediated colitis has been reported with the use of durvalumab. Monitor patients for signs and symptoms of diarrhea or colitis. It is recommended to administer corticosteroids at a dose of 1 to 2 mg/kg/day prednisone equivalents followed by corticosteroid taper for severe or life-threatening colitis. It is recommended to interrupt or to permanently discontinue durvalumab for life-threatening or for recurrent colitis. Care should be taken when using durvalumab in patients with inflammatory bowel disease.

The procarbazine in Matulane has a major potential interaction with Fever.

Procarbazine induces myelosuppression. Leukopenia, thrombocytopenia, and anemia have been reported during procarbazine therapy. Therapy with procarbazine is contraindicated in patients with inadequate bone marrow reserve as demonstrated by bone marrow aspiration, and should be administered after cautious consideration in patients whose bone marrow reserve may be severely depressed by prior irradiation or chemotherapy or whose marrow function is recovering from previous cytotoxic therapy. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, local infection, or bleeding. Therapy should be withheld if leukocyte counts fall below 4000/mm3 and/or platelet counts fall below 100,000/mm3. Close monitoring of hematopoietic function is recommended.

The procarbazine in Matulane has a major potential interaction with Infection.

Because of their cytotoxic effects on rapidly proliferating tissues, antineoplastic agents frequently can, to varying extent, induce myelosuppression. The use of these drugs may be contraindicated in patients with known infectious diseases. All patients should be instructed to immediately report any signs or symptoms suggesting infection such as fever, sore throat, or local infection during antineoplastic therapy. Close clinical monitoring of hematopoietic function is recommended.

Durvalumab has a moderate potential interaction with Infection.

Durvalumab may alter the normal immune response and increase susceptibility to infections. Monitor patients for signs and symptoms of infection and withhold durvalumab treatment for Grade 3 or higher infections, particularly in patients with urinary tract infections. Resume once clinically stable.

Durvalumab has a moderate potential interaction with Inflammatory Bowel Disease.

Immune-mediated colitis has been reported with the use of durvalumab. Monitor patients for signs and symptoms of diarrhea or colitis. It is recommended to administer corticosteroids at a dose of 1 to 2 mg/kg/day prednisone equivalents followed by corticosteroid taper for severe or life-threatening colitis. It is recommended to interrupt or to permanently discontinue durvalumab for life-threatening or for recurrent colitis. Care should be taken when using durvalumab in patients with inflammatory bowel disease.

Durvalumab has a moderate potential interaction with Liver Disease.

Durvalumab can cause immune-mediated hepatitis. Caution is recommended when using durvalumab in patients with moderate or severe hepatic impairment as this agent has not been studied in these patients. Monitor patients for signs and symptoms of hepatitis during and after treatment discontinuation. Periodic hepatic function test should be performed according to medical practices. Administer corticosteroids as appropriate according to manufacturer recommendations. It is recommended to interrupt or permanently discontinue treatment with durvalumab for severe or life-threatening transaminase or total bilirubin elevation. Care should be taken when using durvalumab in patients with liver disease.

The procarbazine in Matulane has a moderate potential interaction with Liver Disease.

Procarbazine is metabolized by liver and kidney. Patients with hepatic impairment may be at increased risk for toxicity from procarbazine therapy at recommended dosages. Therapy with procarbazine should be administered cautiously in patients with compromised hepatic function.

Durvalumab has a moderate potential interaction with Organ Transplant.

Solid organ transplant rejection and other transplant (including corneal graft) rejection have been reported with the use of programmed death receptor-1/ligand-1 (PD-1/PD-L1) blocking antibodies. This may be considered when using PD-1/PD-L1 blocking antibodies in patients who have received a solid organ or other transplant.

Durvalumab has a moderate potential interaction with Pleuropulmonary Infection.

Durvalumab can cause immune-mediated pneumonitis. Monitor patients for signs and symptoms of pneumonitis. Evaluate patients with suspected pneumonitis with radiographic imaging. It is recommended to administer corticosteroids at a dose of 1 to 2 mg/kg/day prednisone equivalents for moderate pneumonitis or 1 to 4 mg per kg per day or equivalent corticosteroid for more severe pneumonitis, followed by a taper. It is recommended to interrupt or permanently discontinue durvalumab based on the severity of symptoms. Care should be exercised when using this agent in patients with suspected pneumonitis.

Durvalumab has a moderate potential interaction with Renal Dysfunction.

Durvalumab can cause immune-mediated nephritis. Monitor patients for abnormal renal function tests prior to and periodically during treatment. It is recommended to administer corticosteroids at a dose of 1 to 2 mg/kg/day prednisone equivalents followed by corticosteroid taper for life-threatening increased serum creatinine. Withhold or permanently discontinue durvalumab based on severity. If appropriate modify the dose according to manufacturer recommendations. Care should be taken when using durvalumab in patients with renal dysfunction.

The procarbazine in Matulane has a moderate potential interaction with Renal Dysfunction.

Procarbazine is metabolized by the liver and kidney. Approximately 70 % of procarbazine is excreted in the urine. Patients with renal impairment may be at increased risk for toxicity from procarbazine therapy at recommended dosages. Therapy with procarbazine should be administered cautiously in patients with compromised renal function.

Durvalumab has a moderate potential interaction with Thyroid Disease.

Durvalumab can cause immune-mediated thyroid disorders. Monitor thyroid function prior to and periodically during treatment. Administer hormone-replacement therapy for hypothyroidism or initiate medical management for control of hyperthyroidism. Continue durvalumab for hypothyroidism and interrupt for hyperthyroidism based on the manufacturer recommendation. Care should be taken when using this agent in patients with thyroid disease.