Page 1 IMATINIB ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — imatinib ih MA tih nib Brand name — Gleevec® GLEE vek Approved uses Imatinib is used to treat adult and pediatric patients with chronic myeloid leukemia CML that is Philadelphia chromosome–positive Ph+ and acute lymphoblastic leukemia ALL that is Ph+. Other approved uses in adults include the following: Gastrointestinal stromal tumors GISTs that are Kit CD117 positive Myelodysplastic/myeloproliferative diseases MDS/MPD with platelet derived growth factor receptor PDGFR gene rearrangements Aggressive systemic mastocytosis ASM without the D816V c Kit mutation Hypereosinophilic syndrome and/or chronic eosinophilic leukemia CEL Dermatofibrosarcoma protuberans DFSP Dose and schedule Taking imatinib as instructed is important to allow your treatment to be as effective as possible, so here are some key points to remember. Your dose may vary, but the usual dose of imatinib is 100 milligrams 100 mg to 600 milligrams 600 mg to be taken by mouth at a scheduled time once a day. Imatinib should be taken with food at the same time each day. Imatinib should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow imatinib, talk to your care provider or pharmacist for possible options. If you miss a dose of imatinib, do not take an extra dose or two doses at one time. Simply take your next dose at the regularly scheduled time. Be sure to write down if you miss a dose, and let your care provider know about any missed doses. Storage and handling Handle imatinib with care. Just like when chemotherapy is given into the vein, this drug can be toxic, and exposure of the drug to others should be limited. Store imatinib at room temperature 68°F–77°F in a dry location away from light. Keep imatinib out of reach of children and pets. Leave imatinib in the provided packaging until it is ready to be taken. Whenever possible, give imatinib to yourself and follow the steps below. If a family member, friend, or caregiver needs to give imatinib to you, they may also need to follow these steps: 1. Wash hands with soap and water. 2. Put on gloves to avoid touching the medication. Gloves are not necessary if you give the drug to yourself. 3. Gently transfer the imatinib from its package to a small medicine or other disposable cup. 4. Administer the medicine immediately by mouth with water. IMATINIB ORAL CHEMOTHERAPY EDUCATION Page 2 5. Remove gloves and do not use them for anything else. 6. Throw gloves and medicine cup in household trash. 7. Wash hands with soap and water. A daily pill box or pill reminder is not recommended for use with imatinib. If you have any unused imatinib, do not throw it in the trash and do not flush it down the sink or toilet. Talk to your care provider or pharmacist about proper disposal of imatinib. If you are traveling, put your imatinib in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Since imatinib remains in your body for several days after it is taken, some of the drug may be present in urine, stool, sweat, or vomit. Once you have started to take imatinib, it is important to follow the instructions below every day for as long as your treatment lasts. This will keep yourself, loved ones, and the environment as safe as possible. Pregnant women should avoid touching anything that may be soiled with body fluids from the patient. Toilet and septic systems You may use the same toilet, septic tank, and/or sewer that you usually use. If you have a low flow toilet, close the lid and flush twice to ensure all waste has been discarded. If the toilet or toilet seat becomes soiled with urine, stool, or vomit, clean the surfaces before other people use the toilet. Wash hands with soap and water after using the toilet. If you need a bedpan, be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day. If you do not have good control of bladder or bowels, use a disposable pad with a plastic back, a diaper, or a sheet to absorb body waste. Wash any skin that has been exposed to body waste or imatinib with soap and water. Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing. If you do not have a washer, place the soiled linens in a plastic bag until they can be washed. Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids. Drug and food interactions Imatinib has many drug interactions. Inform your care providers of all prescription medications, over the counter medications, vitamins, and herbal products that you are taking. Imatinib should be taken with food. Grapefruit or grapefruit juice may interact with imatinib; avoid eating or drinking these during your treatment with imatinib. Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. IMATINIB ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Imatinib The common side effects that have been known to happen in more than 30% of patients taking imatinib are listed in the left side of this table. You MAY NOT experience these side effects. Options to help manage any side effects that do occur are included on the right side of this table. These should be discussed with your care provider. If you experience any side effect you cannot manage or that is not listed here, contact your care provider. Possible Side Effect Management Decreased white blood cells WBCs and increased risk for infection Your WBCs should be monitored by a simple blood test. When your WBCs are low, you are at a greater risk of having an infection. Take the following precautions to protect yourself from infection. Wash your hands often, especially before eating and after using the bathroom. Avoid crowds and people with fevers, flu, or other infection. Bathe regularly to keep good personal hygiene. Contact your care provider if you experience any signs or symptoms of an infection such as: Fever temperature more than 100.4°F or 38°C Chills Sore throat Burning with urination Unusual tiredness A sore that becomes red, is draining, or does not heal Check with your care provider before taking any medicine for a fever or chills. Decreased platelet count and increased risk of bleeding Your platelets should be monitored by a simple blood test. When they are low, you may bruise or bleed more easily than usual. Use caution to avoid bruises, cuts, or burns. Blow your nose gently, and do not pick your nose. Brush your teeth gently with a soft toothbrush, and maintain good oral hygiene. When shaving, use an electronic razor instead of razor blades. Use a nail file instead of nail clippers. Call your care provider if you have bleeding that won’t stop. Examples include: A bloody nose that bleeds for more than 5 minutes despite pressure A cut that continues to ooze despite pressure Gums that bleed excessively when you floss or brush Seek medical help immediately if you experience any severe headaches, observe blood in your urine or stool, cough up blood, or experience prolonged and uncontrollable bleeding. You may need to take a break or hold your medication for medical or dental procedures. Talk to your care provider or dentist before any scheduled procedures. Continued on the next page IMATINIB ORAL CHEMOTHERAPY EDUCATION Page 4 Possible Side Effect Management Decreased hemoglobin, part of the red blood cells that carry iron and oxygen Your hemoglobin should be monitored by a simple blood test. When your hemoglobin is low, you may notice that you get tired or fatigued more easily. Try to get 7–8 hours of sleep per night. Avoid operating heavy machinery if you feel too tired. Find a balance between work and rest. Stay as active as possible, but know that it is okay to rest as needed. You might notice that you are more pale than usual. Let your care provider know right away if you experience any of the following: Shortness of breath Dizziness Palpitations Fluid retention or swelling Do not stand for long periods of time. Keep your legs elevated when sitting or lying down. Avoid eating salty foods, which can increase swelling. Avoid wearing tight fitting clothing and shoes. Weigh yourself daily. Contact your care provider if you notice: Swelling in the hands, feet, or legs Shortness of breath Weight gain of 5 pounds or more in a week Nausea or vomiting Eat and drink slowly. Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake. Eat small, frequent meals throughout the day rather than a few large meals. Eat bland foods; avoid spicy, fried, and greasy foods. Avoid vigorous exercise immediately after eating. Don’t lie down immediately after eating. Avoid strong odors. Let your provider know if you experience nausea or vomiting. Your provider may prescribe medication to help with the nausea or vomiting. Muscle or joint pain or weakness Keep a diary of your pain, including a description of when and where the pain is occurring, what it feels like, and how long it lasts. Stay as active as possible, but know that it is okay to rest as needed. Tell your care provider if pain interferes with your activity. If the pain or weakness bothers you, ask your provider how you may ease this discomfort. Take only pain medication that has been prescribed or recommended by your care provider. Continued on the next page IMATINIB ORAL CHEMOTHERAPY EDUCATION Page 5 Possible Side Effect Management Diarrhea loose and/ or urgent bowel movements Monitor how many bowel movements you have each day. Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake. Eat small, frequent meals throughout the day rather than a few large meals. Eat bland, low fiber foods, such as bananas, applesauce, potatoes, chicken, rice, and toast. Avoid high fiber foods, such as raw vegetables, raw fruits, and whole grains. Avoid foods that cause gas, such as broccoli and beans. Avoid lactose containing foods, such as yogurt and milk. Avoid spicy, fried, and greasy foods. Contact your provider if any of the following occur: The number of bowel movements you have in a day increases by four or more. You feel dizzy or lightheaded. Your care provider may recommend an over the counter medication called loperamide Imodium® to help with diarrhea, but talk to your care provider before starting this medication. Changes in liver function Your liver function should be checked periodically by a simple blood test. Contact your care provider if you notice any of the following: Yellowing of the skin or whites of your eyes Dark or brown urine Bleeding or bruising Fatigue You may be more tired than usual or have less energy. Stay as active as possible, but know it is okay to rest as needed. Try to do some activity every day. Plan your activities, and do them at a time of day when you feel a bit more energetic. Avoid operating heavy machinery if you feel too tired. Rash or itchy skin Keep your skin moisturized with creams and moisturizing lotions to decrease the risk of rash or itchiness, and wear loose fitting clothing. Avoid using perfumes and cologne as these products may increase rash symptoms. Avoid being in the heat for long periods of time. Your provider may recommend an over the counter antihistamine or a topical cream. Sunlight can make symptoms worse. Avoid sun exposure as much as possible to decrease the risk of sunburn. The highest exposure to UV ultraviolet radiation occurs from 10 am–4 pm. Wear long sleeved clothing, with UV protection if possible. Wear broad brimmed hats. Apply broad spectrum sunscreen UVA/UVB with at least SPF 30 as often as directed. Use lip balm with at least SPF 30. If your rash or itching continues to worsen, contact your care provider. Continued on the next page IMATINIB ORAL CHEMOTHERAPY EDUCATION Page 6 Possible Side Effect Management Headache Ask your provider what you may use to help with this discomfort. Contact your care provider right away if your headache: Follows a head injury Is severe or starts suddenly Does not go away after 3 days Is associated with vomiting, visual disturbance, neck stiffness, drowsiness, confusion, rash, weakness in an arm or leg, or numbness; or is made worse by coughing or lowering the head. Abdominal pain Abdominal pain or discomfort may occur. Report any serious pain or symptoms to your care provider immediately. If these side effects occur with nausea and vomiting, you might have inflammation of the pancreas pancreatitis . Changes in electrolytes and other laboratory values Low potassium Changes in some laboratory values may occur and should be monitored by a simple blood test. You may not feel any symptoms if the changes are mild, and they usually are not a sign of a serious problem. More severe changes may occur, which can be a sign of a serious problem. Notify your care provider if you have any of the following: Shortness of breath Chest discomfort Weakness or fatigue New aches and pains Headaches Dizziness If you experience ANY uncontrolled side effect, call your physician or healthcare center immediately: INSTITUTIONAL CONTACT INFO Pregnancy, sexual activity, and contraception Women should not become pregnant and men should not get a partner pregnant while taking imatinib. Men and women of childbearing potential should use effective contraception during therapy and for a minimum of 14 days after the last dose of imatinib. Do not breastfeed while taking imatinib and for one month after the last dose of imatinib. Inform your care provider if you become pregnant. It is safe to hug and kiss. Special precautions may be needed for sexual activity while on imatinib, and you are encouraged to ask your care provider. IMATINIB ORAL CHEMOTHERAPY EDUCATION Page 7 Important notice: The Association of Community Cancer Centers ACCC , Hematology/Oncology Pharmacy Association HOPA , National Community Oncology Dispensing Association, Inc. NCODA , and Oncology Nursing Society ONS have collaborated in gathering information for and developing this patient education guide. This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this medication by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Oral Chemotherapy Education OCE sheets are provided as a free educational resource for patients with cancer in need of concise, easy to understand information about oral cancer drugs. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2018 by Hematology/Oncology Pharmacy Association. All rights reserved. Obtaining medication Talk with your care provider about the process for obtaining your imatinib. PHARMACY OR SPECIALTY PHARMACY CONTACT INFO Additional resources Product website: www.gleevec.com/index.jsp Product prescribing information: www.pharma.us.novartis.com/sites/www.pharma.us.novartis.com/files/ gleevec tabs.pdf Product resources: www.gleevec.com/patient/patient resource support.jsp Updated — March 6, 2018 Additional instructions

Page 1 IVOSIDENIB ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — ivosidenib (I voh SIH deh nib) Brand name — Tibsovo® (tib SOH voh) Approved uses Ivosidenib is used to treat patients with relapsed or refractory acute myeloid leukemia (AML) with an isocitrate dehydrogenase 1 (IDH 1) mutation. Ivosidenib is also used to treat patients with cholangiocarcinoma with an isocitrate dehydrogenase 1 (IDH 1) mutation. Dose and schedule Taking ivosidenib as instructed is important to allow your treatment to be as effective as possible, so here are some key points to remember. Your dose may vary, but the usual dose of ivosidenib is 500 milligrams (500 mg) to be taken by mouth at a scheduled time once a day. Ivosidenib can be taken with or without food but at the same time each day. Avoid consuming a high fat meal while taking a dose of ivosidenib. Ivosidenib should be swallowed whole. Do not crush, cut, or dissolve the tablet. If you are unable to swallow ivosidenib, talk to your care provider or pharmacist for possible options. If you vomit immediately after taking ivosidenib, do not take a replacement dose. Wait until the next scheduled dose. If a dose of ivosidenib is missed, take a dose as soon as possible, as long as it is at least 12 hours prior to the next scheduled dose. Be sure to write down if you miss a dose and let your care provider know about any missed doses. Storage and handling Handle ivosidenib with care. Just like when chemotherapy is given into the vein, this drug can be toxic, and exposure of the drug to others should be limited. Store ivosidenib at room temperature (68°F–77°F) in a dry location away from light. Keep ivosidenib out of reach of children and pets. Whenever possible, you should give ivosidenib to yourself and follow the steps below. If a family member, friend, or caregiver needs to give the ivosidenib to you, they also need to follow these steps. 1. Wash hands with soap and water. 2. Put on gloves to avoid touching the medication. (Gloves are not necessary if you give the drug to yourself.) 3. Gently transfer the ivosidenib from its package to a small medicine or other disposable cup. 4. Administer the medicine immediately by mouth with water. 5. Remove gloves and do not use them for anything else. 6. Throw gloves and medicine cup in household trash. 7. Wash hands with soap and water. IVOSIDENIB ORAL CHEMOTHERAPY EDUCATION Page 2 If a daily pill box or pill reminder is used, a separate one should be used for ivosidenib. Do not mix other medications into the box with ivosidenib. The person filling the box or reminder should wear gloves (gloves are not necessary if you are filling the box or reminder). When empty, the box or reminder should be washed with soap and water before refilling. Be sure to wash hands with soap and water after the task is complete, whether or not gloves are worn. If you have any unused ivosidenib, do not throw it in the trash and do not flush it down the sink or toilet. Talk to your care provider or pharmacist about proper disposal of ivosidenib. If you are traveling, put your ivosidenib in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Ivosidenib remains in your body for several days after it is taken, and some of the drug may be present in urine, stool, sweat, or vomit. Once you have started to take ivosidenib, it is important to know the following instructions every day for as long as your treatment lasts. This is to keep yourself, loved ones, and the environment as safe as possible. Pregnant women should avoid touching anything that may be soiled with body fluids from the patient. Toilet and septic systems • You may use the same toilet, septic tank, and/or sewer that you usually use. If you have a low flow toilet, close the lid and flush twice to ensure that all waste has been discarded. • If the toilet or toilet seat becomes soiled with urine, stool, or vomit, clean the surfaces before other people use the toilet. • Wash hands with soap and water after using the toilet. If you need a bedpan, be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day. If you do not have good control of bladder or bowels, use a disposable pad with a plastic back, a diaper, or a sheet to absorb body waste. Wash any skin that has been exposed to body waste or ivosidenib with soap and water. Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing. If you do not have a washer, place the soiled linens in a plastic bag until they can be washed. Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids. Drug and food interactions Ivosidenib has many drug interactions. Please inform your care providers of all prescription medications, over the counter medications, vitamins, and herbal products. Grapefruit or grapefruit juice may interact with ivosidenib; avoid eating or drinking these during treatment with ivosidenib. Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. Serious side effects Ivosidenib can cause differentiation syndrome, which is a condition that affects your blood cells and may be lifethreatening. Differentiation syndrome has happened as early as one day and up to three months after starting ivosidenib. Call your healthcare provider or go to the nearest emergency room right away if you develop any of the following symptoms of differentiation syndrome while taking ivosidenib: fever, cough, trouble breathing, rash, decreased urination, dizziness or lightheadness, rapid weight gain, and swelling of your arms or legs. IVOSIDENIB ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Ivosidenib The common side effects that have been known to happen in more than 30% of patients taking ivosidenib are listed in the left side of this table. You MAY NOT experience these side effects. Options to help manage any side effects that do occur are included on the right side of this table. These should be discussed with your care provider. If you experience any side effect you cannot manage or that is not listed here, contact your care provider. Possible Side Effect Management Changes in electrolytes and other laboratory values • Increased white blood cell count (leukocytosis) • Increased uric acid levels • Low magnesium levels • Low potassium levels • Low sodium levels Changes in some lab values may occur and will be monitored by a simple blood test. • You may not feel any symptoms if the changes are mild, and they usually are not a sign of a serious problem. • More severe changes may occur, which can be a sign of a serious problem. Notify your care provider if you have any of the following: • Shortness of breath • Chest discomfort • Weakness or fatigue • New aches and pains • Headaches • Dizziness • Swelling of your legs or feet • Red or brown colored urine Decreased hemoglobin, part of the red blood cells that carry iron and oxygen Your hemoglobin should be monitored by a simple blood test. When your hemoglobin is low, you may notice that you get tired or fatigued more easily. • Try to get 7–8 hours of sleep per night. • Avoid operating heavy machinery if you feel too tired. • Find a balance between work and rest. • Stay as active as possible, but know that it is okay to rest as needed. • You might notice that you are more pale than usual. Let your care provider know right away if you experience any of the following: • Shortness of breath • Dizziness • Palpitations Continued on the next page IVOSIDENIB ORAL CHEMOTHERAPY EDUCATION Page 4 Possible Side Effect Management Diarrhea (loose and/ or urgent bowel movements) Monitor how many bowel movements you have each day. • Drink 8–10 glasses of water/fluid each day unless your care provider has instructed you to limit your fluid intake. • Eat small, frequent meals throughout the day rather than a few large meals. • Eat bland, low fiber foods (such as bananas, applesauce, potatoes, chicken, rice, and toast). • Avoid high fiber foods, such as raw vegetables, raw fruits, and whole grains. • Avoid foods that cause gas, such as broccoli and beans. • Avoid lactose containing foods, such as yogurt and milk. • Avoid spicy, fried, and greasy foods. Contact your provider if any of the following occur: • The number of bowel movements you have in a day increases by four or more. • You feel dizzy or lightheaded. Your care provider may recommend an over the counter medication called loperamide (Imodium®) to help with your diarrhea, but talk to your care provider before starting this medication. Fatigue • You may be more tired than usual or have less energy. • Stay as active as possible, but know it is okay to rest as needed. • Try to do some activity every day. • Plan your activities, and do them at a time of day when you feel a bit more energetic. • Avoid operating heavy machinery if you feel too tired. Nausea or vomiting • Eat and drink slowly. • Drink 8 10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake. • Eat small, frequent meals throughout the day rather than a few large meals. • Eat bland foods; avoid spicy, fried, and greasy foods. • Avoid vigorous exercise immediately after eating. • Don’t lie down immediately after eating. • Avoid strong odors. Let your provider know if you experience nausea or vomiting. Your provider may prescribe medication to help with the nausea or vomiting. Continued on the next page IVOSIDENIB ORAL CHEMOTHERAPY EDUCATION Page 5 Possible Side Effect Management Fluid retention or swelling • Do not stand for long periods of time. • Keep your legs elevated when sitting or lying down. • Try not to eat salty foods, which can increase swelling. • Avoid tight fitting clothing and shoes. • Weigh yourself daily. Contact your provider if you notice any of the following: • Swelling in the hands, feet, or legs • Shortness of breath • Weight gain of five pounds or more in one week Muscle or joint pain or weakness • Keep a diary of your pain, including a description of when and where the pain is occurring, what it feels like, and how long it lasts. • Stay as active as possible, but know it is okay to rest as needed. • Tell your care provider if pain interferes with your activity. If the pain or weakness bothers you, ask your provider what you may use to help with this discomfort. Take only pain medication that has been prescribed or recommended by your care provider. If you experience ANY uncontrolled side effect, call your physician or healthcare center immediately: (INSTITUTIONAL CONTACT INFO) Pregnancy, sexual activity, and contraception Women should not become pregnant and men should not get a partner pregnant while taking ivosidenib. Women of childbearing age and potential should use effective contraception during therapy and for a minimum of one month after the last dose of ivosidenib. Men of reproductive age and potential should use effective contraception during therapy and for a minimum of one month after the last dose of ivosidenib. Do not breastfeed while taking ivosidenib and for one month after the last dose of ivosidenib. Please inform your care provider if you become pregnant. It is safe to hug and kiss. Special precautions may be needed for sexual activity while on oral chemotherapy, and you are encouraged to ask your care provider. IBRUTINIB ORAL CHEMOTHERAPY EDUCATION Page 6 IVOSIDENIB ORAL CHEMOTHERAPY EDUCATION Obtaining medication Talk with your care provider about the process for obtaining your ivosidenib. (PHARMACY OR SPECIALTY PHARMACY CONTACT INFO) Additional resources Product website: www.tibsovo.com Product prescribing information: www.tibsovo.com/pdf/prescribinginformation.pdf Product resources: 1 844 409 1141 Updated – July 31, 2018 Additional instructions Important notice: The Association of Community Cancer Centers (ACCC), Hematology/Oncology Pharmacy Association (HOPA), National Community Oncology Dispensing Association, Inc. (NCODA), and Oncology Nursing Society (ONS) have collaborated in gathering information for and developing this patient education guide. This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this medication by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Oral Chemotherapy Education (OCE) sheets are provided as a free educational resource for patients with cancer in need of concise, easy to understand information about oral cancer drugs. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2018 by Hematology/Oncology Pharmacy Association. All rights reserved.

Page 1 IXAZOMIB ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — ixazomib ik SA zoh mib Brand name — Ninlaro® nin LAR oh Approved uses Ixazomib is used to treat multiple myeloma MM in combination with lenalidomide and dexamethasone. Dose and schedule Taking ixazomib as instructed is important to allow your treatment to be as effective as possible, so here are some key points to remember. While capsules come in different strengths 4 mg, 3 mg, and 2.3 mg , the usual dose of ixazomib is 4 milligrams 4 mg to be taken by mouth at a scheduled time once weekly for 3 weeks, followed by a 1 week break i.e., on days 1, 8, and 15 of a 28 day cycle . Ixazomib should be taken on an empty stomach at least 1 hour before or 2 hours after a meal or snack , but at the same time of day. Ixazomib should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow ixazomib, talk to your care provider or pharmacist for possible options. If you miss a dose of ixazomib: Only take the missed dose if the next scheduled dose is at least 72 hours 3 days away. Then take the next dose at the regularly scheduled time. Do not take the missed dose if it is within 72 hours 3 days of the next scheduled dose. Simply take the next dose at the regularly scheduled time. Do not take two doses at one time. Be sure to write down if you miss a dose and let your care provider know about any missed doses. Storage and handling Handle ixazomib with care. Just like when chemotherapy is given into the vein, this drug can be toxic, and exposure of the drug to others should be limited. Store ixazomib at room temperature 68°F to 77°F in a dry location away from light. Keep ixazomib out of reach of children and pets. Leave ixazomib in the provided packaging until it is ready to be taken. Whenever possible, you should give ixazomib to yourself and follow the steps below. If a family member, friend, or caregiver needs to give the ixazomib to you, they also need to follow these steps. 1. Wash hands with soap and water. 2. Put on gloves to avoid touching the medication. Gloves are not necessary if you give the drug to yourself. 3. Gently transfer the ixazomib from its package to a small medicine or other disposable cup. IXAZOMIB ORAL CHEMOTHERAPY EDUCATION Page 2 4. Administer the medicine immediately by mouth with water. 5. Remove gloves and do not use them for anything else. 6. Throw gloves and medicine cup in household trash. 7. Wash hands with soap and water. A daily pill box is not recommended to be used with ixazomib. If you have any unused ixazomib, do not throw it in the trash and do not flush it down the sink or toilet. Talk to your care provider or pharmacist about proper disposal of ixazomib. If you are traveling, ask your pharmacist, nurse, or healthcare provider if any additional travel precautions are needed as capsules are to remain in the packaging. Handling body fluids and waste Since ixazomib remains in your body for several days after it is taken, some of the drug may be present in urine, stool, sweat, or vomit. Once you have started to take ixazomib, it is important to know the following instructions every day for as long as your treatment lasts. This is to keep yourself, loved ones, and the environment as safe as possible. Pregnant women should avoid touching anything that may be soiled with body fluids from the patient. Toilet and septic systems You may use the same toilet, septic tank, and/or sewer that you usually use. If you have a low flow toilet, close the lid and flush twice to ensure that all waste has been discarded. If the toilet or toilet seat becomes soiled with urine, stool, or vomit, clean the surfaces before other people use the toilet. Wash hands with soap and water after using the toilet. If you need a bedpan, be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day. If you do not have good control of bladder or bowels, use a disposable pad with a plastic back, a diaper, or a sheet to absorb body waste. Wash any skin that has been exposed to body waste or ixazomib with soap and water. Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing. If you do not have a washer, place the soiled linens in a plastic bag until they can be washed. Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids. Drug and food interactions Ixazomib has many drug interactions, please inform your care providers of all prescription medications, over the counter medications, vitamins, and herbal products. Ixazomib should be taken on an empty stomach at least 1 hour before or 2 hours after a meal or snack . Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. IXAZOMIB ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Ixazomib The common side effects that have been known to happen in more than 30% of patients taking ixazomib are listed in the left side of this table. You MAY NOT experience these side effects. Options to help manage any side effects that do occur are included on the right side of this table. These should be discussed with your care provider. If you experience any side effect you cannot manage or that is not listed here, contact your care provider. Possible Side Effect Management Decreased platelet count and increased risk of bleeding Your platelets should be monitored by a simple blood test. When they are low, you may bruise or bleed more easily than usual. Use caution to avoid bruises, cuts, or burns. Blow your nose gently, and do not pick your nose. Brush your teeth gently with a soft toothbrush, and maintain good oral hygiene. When shaving, use an electronic razor instead of razor blades. Use a nail file instead of nail clippers. Call your care provider if you have bleeding that won’t stop. Examples include: A bloody nose that bleeds for more than 5 minutes despite pressure A cut that continues to ooze despite pressure Gums that bleed excessively when you floss or brush Seek medical help immediately if you experience any severe headaches, notice blood in your urine or stool, cough up blood, or have prolonged and uncontrollable bleeding. You may need to take a break or hold your medication for medical or dental procedures. Talk to your care provider or dentist before any scheduled procedures. Decreased white blood cells WBCs and increased risk for infection Your WBCs should be monitored by a simple blood test. When your WBCs are low, you are at a greater risk of having an infection. Take the following precautions to protect yourself from infection. Wash your hands often, especially before eating and after using the bathroom. Avoid crowds and people with fevers, flu, or other infection. Bathe regularly to keep good personal hygiene. Contact your care provider if you experience any signs or symptoms of an infection such as: Fever temperature more than 100.4°F or 38°C Chills Sore throat Burning with urination Unusual tiredness A sore that becomes red, is draining, or does not heal Check with your care provider before taking any medicine for a fever or chills. IXAZOMIB ORAL CHEMOTHERAPY EDUCATION Page 4 If you experience ANY uncontrolled side effect, call your physician or healthcare center immediately: INSTITUTIONAL CONTACT INFO Pregnancy, sexual activity, and contraception Women should not become pregnant and men should not get a partner pregnant while taking ixazomib. Men and women of childbearing age and potential should use effective contraception during therapy and for a minimum of 90 days after the last dose of ixazomib. Women using hormonal contraceptives should also use a barrier method of contraception. Do not breastfeed while taking ixazomib and for 90 days after the last dose of ixazomib. Possible Side Effect Management Diarrhea loose and/ or urgent bowel movements Monitor how many bowel movements you have each day. Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake. Eat small, frequent meals throughout the day rather than a few large meals. Eat bland, low fiber foods, such as bananas, applesauce, potatoes, chicken, rice, and toast. Avoid high fiber foods, such as raw vegetables, raw fruits, and whole grains. Avoid foods that cause gas, such as broccoli and beans. Avoid lactose containing foods, such as yogurt and milk. Avoid spicy, fried, and greasy foods. Contact your provider if either of the following occurs: The number of bowel movements you have in a day increases by 4 or more. You feel dizzy or lightheaded. Your care provider may recommend an over the counter medication called loperamide Imodium® to help with your diarrhea, but talk to your care provider before starting this medication. Constipation Monitor how many bowel movements you have each day. Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake. Stay active and exercise, if possible. Eat foods high in fiber like raw fruits and vegetables. Contact your care provider if you have not had a bowel movement in 3 or more days. A daily stool softener, such as docusate Colace® , and/or laxative, such as senna Senakot® , may be helpful. If these do not help within 48 hours, tell your provider. IXAZOMIB ORAL CHEMOTHERAPY EDUCATION Page 5 Page 5 Important notice: The Association of Community Cancer Centers ACCC , Hematology/Oncology Pharmacy Association HOPA , National Community Oncology Dispensing Association, Inc. NCODA , and Oncology Nursing Society ONS have collaborated in gathering information for and developing this patient education guide. This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this medication by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Oral Chemotherapy Education OCE sheets are provided as a free educational resource for patients with cancer in need of concise, easy to understand information about oral cancer drugs. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2018 by Hematology/Oncology Pharmacy Association. All rights reserved. Please inform your care provider if you become pregnant. It is safe to hug and kiss. Special precautions may be needed for sexual activity while on oral chemotherapy, and you are encouraged to ask your care provider. Obtaining medication Talk with your care provider about the process for obtaining your ixazomib. PHARMACY OR SPECIALTY PHARMACY CONTACT INFO Additional resources Product website: www.ninlaro.com Product prescribing information: https://www.ninlaro.com/prescribing information.pdf Product resources: https://www.ninlaro.com/financial resources Updated – March 14, 2018 Additional instructions

Page 1 LAPATINIB ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — lapatinib luh PA tih nib Brand name — Tykerb® TY kerb Approved uses Lapatinib is used in combination to treat advanced or metastatic breast cancer that overexpresses human epidermal growth factor receptor 2 HER2 receptor. It is used in combination with capecitabine or letrozole. Dose and schedule Taking lapatinib as instructed is important to allow your treatment to be as effective as possible, so here are some key points to remember. Your dose may vary, but the usual dose of lapatinib is from 1,250 milligrams 1,250 mg to 1,500 milligrams 1,500 mg to be taken by mouth at a scheduled time once a day. Lapatinib should be taken on an empty stomach at least 1 hour before or 1 hour after a meal or snack at the same time each day. Lapatinib should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow lapatinib, talk to your care provider or pharmacist for possible options. If you miss a dose of lapatinib, do not take an extra dose or two doses at one time. Simply take your next dose at the regularly scheduled time. Be sure to write down if you miss a dose and let your care provider know about any missed doses. Storage and handling Handle lapatinib with care. Just like when chemotherapy is given into the vein, this drug can be toxic, and exposure of the drug to others should be limited. Store lapatinib at room temperature 68°F–77°F in a dry location away from light. Keep lapatinib out of reach of children and pets. Leave lapatinib in the provided packaging until it is ready to be taken. Whenever possible, you should give lapatinib to yourself and follow the steps below. If a family member, friend, or caregiver needs to give the lapatinib to you, they also need to follow these steps: 1. Wash hands with soap and water. 2. Put on gloves to avoid touching the medication. Gloves are not necessary if you give the drug to yourself. 3. Gently transfer the lapatinib from its package to a small medicine or other disposable cup. 4. Administer the medicine immediately by mouth with water. 5. Remove gloves and do not use them for anything else. 6. Throw gloves and medicine cup in household trash. 7. Wash hands with soap and water. LAPATINIB ORAL CHEMOTHERAPY EDUCATION Page 2 If a daily pill box or pill reminder is used, a separate one should be used for lapatinib. Do not mix other medications into the box with lapatinib. The person filling the box or reminder should wear gloves. Gloves are not necessary if you are filling the box or reminder. When empty, the box or reminder should be washed with soap and water before refilling. Be sure to wash hands with soap and water after the task is complete, whether or not gloves are worn. If you have any unused lapatinib, do not throw it in the trash and do not flush it down the sink or toilet. Talk to your care provider or pharmacist about proper disposal of lapatinib. If you are traveling, put your lapatinib in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Lapatinib remains in your body for several days after it is taken, so some of the drug may be present in urine, stool, sweat, or vomit. Once you have started to take lapatinib, it is important to follow the instructions below every day for as long as your treatment lasts. This will keep yourself, loved ones, and the environment as safe as possible. Pregnant women should avoid touching anything that may be soiled with body fluids from the patient. Toilet and septic systems You may use the same toilet, septic tank, and/or sewer that you usually use. If you have a low flow toilet, close the lid and flush twice to ensure all waste has been discarded. If the toilet or toilet seat becomes soiled with urine, stool, or vomit, clean the surfaces before other people use the toilet. Wash hands with soap and water after using the toilet. If you need a bedpan, be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day. If you do not have good control of bladder or bowels, use a disposable pad with a plastic back, a diaper, or a sheet to absorb body waste. Wash any skin that has been exposed to body waste or lapatinib with soap and water. Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing. If you do not have a washer, place the soiled linens in a plastic bag until they can be washed. Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids. Drug and food interactions Lapatinib has many drug interactions. Inform your care providers of all prescription medications, over the counter medications, vitamins, and herbal products. Lapatinib should be taken on an empty stomach at least 1 hour before or 1 hour after a meal or snack . Grapefruit or grapefruit juice may interact with lapatinib, so avoid eating or drinking these during treatment with lapatinib. Talk with your care provider or pharmacist before taking new medications or supplements or receiving any vaccines. Serious side effects Lapatinib can cause liver toxicity. Liver toxicity can be severe and deaths have been reported. LAPATINIB ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Lapatinib The common side effects that have been known to happen in more than 30% of patients taking lapatinib are listed in the left side of this table. You MAY NOT experience these side effects. Options to help manage any side effects that do occur are included on the right side of this table. These should be discussed with your care provider. If you experience any side effect you cannot manage or that is not listed here, contact your care provider. Possible Side Effect Management Diarrhea loose and/ or urgent bowel movements Monitor how many bowel movements you have each day. Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake. Eat small, frequent meals throughout the day rather than a few large meals. Eat bland, low fiber foods e.g., bananas, applesauce, potatoes, chicken, rice, toast . Avoid high fiber foods e.g., raw vegetables, raw fruits, whole grains . Avoid foods that cause gas e.g., broccoli, beans . Avoid lactose containing foods e.g., yogurt, milk . Avoid spicy, fried, and greasy foods. Contact your provider if any of the following occur: The number of bowel movements you have in a day increases by 4 or more. You feel dizzy or lightheaded. Your care provider may recommend an over the counter medication called loperamide Imodium® to help with your diarrhea, but talk to your care provider before starting this medication. Decreased hemoglobin, part of the red blood cells that carry iron and oxygen Your hemoglobin should be monitored by a simple blood test. When your hemoglobin is low, you may notice that you get tired or fatigued more easily. Try to get 7–8 hours of sleep per night. Avoid operating heavy machinery if you feel too tired. Find a balance between work and rest. Stay as active as possible, but know that it is okay to rest, too. You might notice that you are more pale than usual. Let your healthcare provider know right away if you experience any of the following: Shortness of breath Dizziness Palpitations Changes in liver function Your liver function will be checked periodically by a simple blood test. Contact your care provider if you notice any of the following: Yellowing of the skin or whites of your eyes Dark or brown urine Bleeding or bruising Continued on the next page LAPATINIB ORAL CHEMOTHERAPY EDUCATION Page 4 Possible Side Effect Management Pain or discomfort on hands and/or feet Hand and foot syndrome HFS is a skin reaction that appears on the palms of the hands and soles of the feet. It can appear as a rash, peeling skin, or a “pins and needles” sensation. Let your care provider know right away if you experience this side effect. To prevent HFS, you can: Keep hands and feet moisturized. Avoid hot showers or baths that may dry out the skin. Avoid tight fitting shoes or socks. Rash or itchy skin Keep your skin moisturized with creams and moisturizing lotions to decrease the risk of rash or itchiness, and wear loose fitting clothing. Avoid using perfumes and cologne as these products may increase rash symptoms. Avoid being in the heat for long periods of time. Your provider may recommend an over the counter antihistamine or a topical cream. Sunlight can make symptoms worse. – Avoid sun exposure as much as possible to decrease the risk of sunburn. The highest exposure to UV ultraviolet radiation occurs from 10 am to 4 pm. – Wear long sleeved clothing, with UV protection if possible. – Wear broad brimmed hats. – Apply broad spectrum sunscreen UVA/UVB with at least SPF 30 as often as directed on the bottle. – Use lip balm that has at least SPF 30. If your rash or itching continues to worsen, contact your care provider. Nausea or vomiting Eat and drink slowly. Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake. Eat small, frequent meals throughout the day rather than a few large meals. Eat bland foods. Avoid spicy, fried, and greasy foods. Avoid vigorous exercise immediately after eating. Don’t lay down immediately after eating. Avoid strong odors. Let your provider know if you experience nausea or vomiting. Your provider may prescribe medication to help with the nausea or vomiting. If you experience ANY uncontrolled side effect, call your physician or healthcare center immediately: INSTITUTIONAL CONTACT INFO LAPATINIB ORAL CHEMOTHERAPY EDUCATION Page 5 Pregnancy, sexual activity, and contraception Women should not become pregnant and men should not get a partner pregnant while taking lapatinib. Men and women of childbearing age and potential should use effective contraception during therapy and for a month after the last dose of lapatinib. Do not breastfeed while taking lapatinib and for one month after the last dose of lapatinib. Inform your care provider if you become pregnant. It is safe to hug and kiss, but special precautions may be needed for sexual activity while on oral chemotherapy. You are encouraged to talk to your care provider. Obtaining medication Talk with your care provider about how to obtain your lapatinib. PHARMACY OR SPECIALTY PHARMACY CONTACT INFO Additional resources Product website: www.hcp.novartis.com/products/tykerb/ Product prescribing information: www.pharma.us.novartis.com/sites/www.pharma.us.novartis.com/files/tykerb.pdf Product resources: www.hcp.novartis.com/products/tykerb/her2 abc mbc/patient resources/ Updated – January 7, 2018 Additional instructions Important notice: The Association of Community Cancer Centers ACCC , Hematology/Oncology Pharmacy Association HOPA , National Community Oncology Dispensing Association, Inc. NCODA , and Oncology Nursing Society ONS have collaborated in gathering information for and developing this patient education guide. This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this medication by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Oral Chemotherapy Education OCE sheets are provided as a free educational resource for patients with cancer in need of concise, easy to understand information about oral cancer drugs. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2018 by Hematology/Oncology Pharmacy Association. All rights reserved

Page 1 LAROTRECTINIB ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name larotrectinib (LAYR oh TREK tih nib) Brand name Vitrakvi® (vi trak vee) Approved uses Larotrectinib is used to treat adults and children with solid tumors that are caused by a certain abnormal neurotrophic receptor tyrosine kinase (NTRK) gene. Dose and schedule Taking larotrectinib as instructed is important to allow your treatment to be as effective as possible, so here are some key points to remember. Your dose may vary, but the usual dose of larotrectinib is 100 milligrams (100 mg) by mouth twice a day. Your dose is based on many factors, including your height and weight, overall health, and diagnosis. Larotrectinib can be taken with or without food, but at the same time each day. Larotrectinib should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow larotrectinib, talk to your care provider or pharmacist for possible options. If you miss a dose of larotrectinib, follow these guidelines: Take it as soon as you remember, unless your next scheduled dose is due within six hours. Take the next dose at your regular time. Do not take two doses at one time. Be sure to write down if you miss a dose, and let your care provider know about any missed doses. Storage and handling Handle larotrectinib with care. Just like when chemotherapy is given into the vein, this drug can be toxic, and exposure of the drug to others should be limited. Store larotrectinib capsules at room temperature (68°F–77°F) in a dry location away from light. Store larotrectinib oral solution in the refrigerator (36°F– 46°F). Do not freeze. Keep larotrectinib out of reach of children and pets. Leave larotrectinib in the provided packaging until it is ready to be taken. Whenever possible, you should give larotrectinib to yourself and follow the steps below. If a family member, friend, or caregiver needs to give the larotrectinib to you, they also need to follow these steps. 1. Wash hands with soap and water. 2. Put on gloves to avoid touching the medication. (Gloves are not necessary if you give the drug to yourself.) 3. Gently transfer the larotrectinib from its package to a small medicine or other disposable cup. 4. Administer the medicine immediately by mouth with water. 5. Remove gloves and do not use them for anything else. LAROTRECTINIB ORAL CHEMOTHERAPY EDUCATION Page 2 6. Throw gloves and medicine cup in household trash. 7. Wash hands with soap and water. If a daily pill box or pill reminder is used, a separate one should be used for larotrectinib capsules. Do not mix other medications into the box with larotrectinib capsules. The person filling the box or reminder should wear gloves. (Gloves are not necessary if you are filling the box or reminder.) When empty, the box or reminder should be washed with soap and water before refilling. Be sure to wash hands with soap and water after the task is complete, whether or not gloves are worn. If you have any unused larotrectinib, do not throw it in the trash and do not flush it down the sink or toilet. Talk to your care provider or pharmacist about proper disposal of larotrectinib. If you are traveling, put your larotrectinib in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Since larotrectinib remains in your body for several days after it is taken, some of the drug may be present in urine, stool, sweat, or vomit. Once you have started to take larotrectinib, it is important to know the following instructions every day for as long as your treatment lasts. This is to keep yourself, loved ones, and the environment as safe as possible. Pregnant women should avoid touching anything that may be soiled with body fluids from the patient. Toilet and septic systems You may use the same toilet, septic tank, and/or sewer that you usually use. If you have a low flow toilet, close the lid and flush twice to ensure all waste has been discarded. If the toilet or toilet seat becomes soiled with urine, stool, or vomit, clean the surfaces before other people use the toilet. Wash hands with soap and water after using the toilet. If you need a bedpan, be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day. If you do not have good control of bladder or bowels, use a disposable pad with a plastic back, a diaper, or a sheet to absorb body waste. Wash any skin that has been exposed to body waste or larotrectinib with soap and water. Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing. If you do not have a washer, place the soiled linens in a plastic bag until they can be washed. Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids. Drug and food interactions Larotrectinib has many drug interactions. Please inform your care providers of all prescription medications, over thecounter medications, vitamins, and herbal products. Grapefruit or grapefruit juice may interact with larotrectinib; avoid eating or drinking this during treatment with larotrectinib. Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. LAROTRECTINIB ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Larotrectinib The common side effects that have been known to happen in more than 30% of patients taking larotrectinib are listed in the left side of this table. You MAY NOT experience these side effects. Options to help manage any side effects that do occur are included on the right side of this table. These should be discussed with your care provider. If you experience any side effect you cannot manage or that is not listed here, contact your care provider. Possible Side Effect Management Changes in liver function Your liver function should be checked periodically by a simple blood test. Contact your care provider if you notice any of the following: Yellowing of the skin or whites of your eyes Dark or brown urine Bleeding or bruising Decreased hemoglobin, part of the red blood cells that carry iron and oxygen Your hemoglobin should be monitored by a simple blood test. When your hemoglobin is low, you may notice that you get tired or fatigued more easily. Try to get seven to eight hours of sleep per night. Avoid operating heavy machinery if you feel too tired. Find a balance between work and rest. Stay as active as possible, but know that it is okay to rest as needed. You might notice that you are more pale than usual. Let your care provider know right away if you experience any of the following: Shortness of breath Dizziness Palpitations Fatigue You may be more tired than usual or have less energy. Stay as active as possible, but know it is okay to rest as needed. Try to do some activity every day. Plan your activities, and do them at a time of day when you feel a bit more energetic. Avoid operating heavy machinery if you feel too tired. Continued on the next page LAROTRECTINIB ORAL CHEMOTHERAPY EDUCATION Page 4 Possible Side Effect Management Changes in laboratory values Low albumin levels Changes in some lab values may occur and will be monitored by a simple blood test. You may not feel any symptoms if the changes are mild, and they usually are not a sign of a serious problem. More severe changes may occur, which can be a sign of a serious problem. Notify your care provider if you have any of the following: Shortness of breath Chest discomfort Weakness or fatigue New aches and pains Headaches Dizziness Swelling of legs or feet Red or brown colored urine Serious side effects Larotrectinib can cause serious neurologic adverse effects. Do not drive or operate hazardous machinery if experiencing neurologic adverse effects. Neurologic adverse effects may include confusion, slurred or slowed speech, dizziness, tremor, memory impairment, or a tingling sensation. If you experience ANY uncontrolled side effect, call your physician or healthcare center immediately: (INSTITUTIONAL CONTACT INFO) Pregnancy, sexual activity, and contraception Women should not become pregnant and men should not get a partner pregnant while taking larotrectinib. Men and women of childbearing age and potential should use effective contraception during therapy and for a minimum of one week after the last dose of larotrectinib. Do not breastfeed while taking larotrectinib and for one week after the last dose of larotrectinib. Please inform your care provider if you become pregnant. It is safe to hug and kiss. Special precautions may be needed for sexual activity while on oral chemotherapy, and you are encouraged to ask your care provider. Obtaining medication Talk with your care provider about the process for obtaining your larotrectinib. (PHARMACY OR SPECIALTY PHARMACY CONTACT INFO) LAROTRECTINIB ORAL CHEMOTHERAPY EDUCATION Page 5 Additional resources Product website: www.vitrakvi.com Product prescribing information: https://www.accessdata.fda.gov/drugsatfda docs/ label/2018/210861s000lbl.pdf Product resources: https://www.hcp.vitrakvi us.com/access and reimbursement Updated – December 11, 2018 Additional instructions Important notice: The Association of Community Cancer Centers (ACCC), Hematology/Oncology Pharmacy Association (HOPA), National Community Oncology Dispensing Association, Inc. (NCODA), and Oncology Nursing Society (ONS) have collaborated in gathering information for and developing this patient education guide. This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this medication by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Oral Chemotherapy Education (OCE) sheets are provided as a free educational resource for patients with cancer in need of concise, easy to understand information about oral cancer drugs. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2019 by Hematology/Oncology Pharmacy Association. All rights reserved.

Page 1 LENALIDOMIDE ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — lenalidomide leh nuh LIH doh mide Brand name — Revlimid® REV lih mid Approved uses Lenalidomide is used to treat adult patients with certain types of blood cancers, including mantle cell lymphoma, multiple myeloma, and myelodysplastic syndrome. It may be used in combination with another medication, dexamethasone. Dose and schedule Taking lenalidomide as instructed is important to allow your treatment to be as effective as possible, so here are some key points to remember. Your dose of lenalidomide will be determined by your overall health, diagnosis, and individual treatment needs. Lenalidomide is to be taken by mouth one time per day. Lenalidomide can be taken with or without food but at the same time each day. Lenalidomide should be taken whole and not opened, crushed, cut, or dissolved. If you are unable to swallow lenalidomide, talk to your care provider or pharmacist for possible options. If you miss a dose of lenalidomide: Only take the missed dose if it has been less than 12 hours since you were supposed to take it. Then, take the next dose at the regularly scheduled time. Do not take the missed dose if it has been more than 12 hours since you should have taken it. Simply take the next dose at the regularly scheduled time. Do not take two doses at one time. Be sure to write down if you miss a dose and let your care provider know about any missed doses. Storage and handling Handle lenalidomide with care. Just like when chemotherapy is given into the vein, this drug can be toxic, and exposure of the drug to others should be limited. Store lenalidomide at room temperature 68°F–77°F in a dry location away from light. Keep lenalidomide out of reach of children and pets. Leave lenalidomide in the provided packaging until it is ready to be taken. Whenever possible, give lenalidomide to yourself and follow the steps below. If a family member, friend, or caregiver needs to give lenalidomide to you, they also need to follow these steps: 1. Wash hands with soap and water. 2. Put on gloves to avoid touching the medication. Gloves are not necessary if you give the drug to yourself. 3. Gently transfer the lenalidomide from its package to a small medicine or other disposable cup. 4. Administer the medicine immediately by mouth with water. LENALIDOMIDE ORAL CHEMOTHERAPY EDUCATION Page 2 5. Remove gloves and do not use them for anything else. 6. Throw gloves and medicine cup in household trash. 7. Wash hands with soap and water. If a daily pill box or pill reminder is used, a separate one should be used for lenalidomide. Do not mix other medications into the box with lenalidomide. The person filling the box or reminder should wear gloves. Gloves are not necessary if you are filling the box or reminder. When empty, the box or reminder should be washed with soap and water before refilling. Be sure to wash hands with soap and water after the task is complete, whether or not gloves are worn. If you have any unused lenalidomide, do not throw it in the trash and do not flush it down the sink or toilet. Talk to your care provider or pharmacist about proper disposal of lenalidomide. If you are traveling, put your lenalidomide in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Since lenalidomide remains in your body for several days after it is taken, some of the drug may be present in urine, stool, sweat, or vomit. Once you have started to take lenalidomide, it is important to follow the instructions below every day for as long as your treatment lasts. This will keep yourself, loved ones, and the environment as safe as possible. Pregnant women should avoid touching anything that may be soiled with body fluids from the patient. Toilet and septic systems You may use the same toilet, septic tank, and/or sewer that you usually use. If you have a low flow toilet, close the lid and flush twice to ensure all waste has been discarded. If the toilet or toilet seat becomes soiled with urine, stool, or vomit, clean the surfaces before other people use the toilet. Wash hands with soap and water after using the toilet. If you need a bedpan, be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day. If you do not have good control of bladder or bowels, use a disposable pad with a plastic back, a diaper, or a sheet to absorb body waste. Wash any skin that has been exposed to body waste or lenalidomide with soap and water. Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing. If you do not have a washer, place the soiled linens in a plastic bag until they can be washed. Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids. Drug and food interactions Lenalidomide has many drug interactions. Inform your care providers of all prescription medications, over the counter medications, vitamins, and herbal products that you are taking. Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. LENALIDOMIDE ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Lenalidomide The common side effects that have been known to happen in more than 30% of patients taking lenalidomide are listed in the left side of this table. You MAY NOT experience these side effects. Options to help manage any side effects that do occur are included on the right side of this table. These should be discussed with your care provider. If you experience any side effect you cannot manage or that is not listed here, contact your care provider. Possible Side Effect Management Decreased white blood cells WBCs and increased risk of infection Your WBCs should be monitored by a simple blood test. When your WBCs are low, you are at a greater risk for having an infection. Take the following precautions to protect yourself from infection. Wash your hands often, especially before eating and after using the bathroom. Avoid crowds and people with fevers, flu, or other infection. Bathe regularly to keep good personal hygiene. Contact your care provider if you experience any signs or symptoms of an infection such as: Fever temperature more than 100.4°F or 38°C Chills Sore throat Burning with urination Unusual tiredness A sore that becomes red, is draining, or does not heal Check with your care provider before taking any medicine for fever or chills. Continued on the next page Serious side effects Lenalidomide can cause serious birth defects. Do not take lenalidomide if you are pregnant or think you might be pregnant. Lenalidomide can lower your white blood cells and your platelets, increasing your risk of infection and bleeding. Lenalidomide can increase your risk for a blood clot. LENALIDOMIDE ORAL CHEMOTHERAPY EDUCATION Page 4 Possible Side Effect Management Decreased platelet count and increased risk of bleeding Your platelets should be monitored by a simple blood test. When they are low, you may bruise or bleed more easily than usual. Use caution to avoid bruises, cuts, or burns. Blow your nose gently, and do not pick your nose. Brush your teeth gently with a soft toothbrush, and maintain good oral hygiene. When shaving, use an electronic razor instead of razor blades. Use a nail file instead of nail clippers. Call your care provider if you have bleeding that won’t stop. Examples include the following: A bloody nose that bleeds for more than five minutes despite pressure A cut that continues to ooze despite pressure Gums that bleed excessively when you floss or brush Seek medical help immediately if you experience any severe headaches, observe blood in your urine or stool, cough up blood, or experience prolonged and uncontrollable bleeding. You may need to take a break or “hold” your medication for medical or dental procedures. Talk to your care provider or dentist before any scheduled procedures. Diarrhea loose and/ or urgent bowel movements Monitor how many bowel movements you have each day. Drink 8–10 glasses of water/fluid each day unless your care provider has instructed you to limit your fluid intake. Eat small, frequent meals throughout the day rather than a few large meals. Eat bland, low fiber foods, such as bananas, applesauce, potatoes, chicken, rice, and toast. Avoid high fiber foods, such as raw vegetables, raw fruits, and whole grains. Avoid foods that cause gas, such as broccoli and beans. Avoid lactose containing foods, such as yogurt and milk. Avoid spicy, fried, and greasy foods. Contact your provider if any of the following occur: The number of bowel movements you have in a day increases by four or more. You feel dizzy or lightheaded. Your care provider may recommend an over the counter medication called loperamide Imodium® to help with your diarrhea, but talk to your care provider before starting this medication. Continued on the next page LENALIDOMIDE ORAL CHEMOTHERAPY EDUCATION Page 5 Possible Side Effect Management Decreased hemoglobin, part of the red blood cells that carry iron and oxygen Your hemoglobin should be monitored using a blood test. When your hemoglobin is low, you may notice that you get tired or fatigued more easily. Try to get 7–8 hours of sleep per night. Avoid operating heavy machinery if you feel too tired. Find a balance between work and rest. Stay as active as possible, but know that it is okay to rest as needed. You might notice that you are more pale than usual. Let your healthcare provider know right away if you experience any of the following: Shortness of breath Dizziness Palpitations Fatigue You may be more tired than usual or have less energy. Stay as active as possible, but know it is okay to rest as needed. Try to do some activity every day. Plan your activities, and do them at a time of day when you feel a bit more energetic. Avoid operating heavy machinery if you feel too tired. Constipation Monitor how many bowel movements you have each day. Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake. Stay active and exercise, if possible. Eat foods high in fiber like raw fruits and vegetables. Contact your care provider if you have not had a bowel movement in three or more days. Your care provider may recommend over the counter medications to help with your constipation. A daily stool softener such as docusate Colace® and/or laxative such as senna Senakot® may be helpful. If these do not help within 48 hours, tell your provider. Continued on the next page LENALIDOMIDE ORAL CHEMOTHERAPY EDUCATION Page 6 If you experience ANY uncontrolled side effect, call your physician or healthcare center immediately: INSTITUTIONAL CONTACT INFO Possible Side Effect Management Rash or itchy skin Keep your skin moisturized with creams and moisturizing lotions to decrease the risk of rash or itchiness, and wear loose fitting clothing. Avoid using perfumes and cologne because these products may increase rash symptoms. Avoid being in the heat for long periods of time. Your provider may recommend an over the counter antihistamine or a topical cream. Sunlight can make symptoms worse. Avoid sun exposure as much as possible to decrease the risk of sunburn. The highest exposure to ultraviolet UV radiation occurs from 10 am–4 pm. Wear long sleeved clothing, with UV protection if possible. Wear broad brimmed hats. Apply broad spectrum sunscreen UVA/UVB with at least SPF 30 as often as directed on the bottle. Use lip balm with at least SPF 30. If your rash or itching continues to worsen, contact your care provider. Back pain and muscle pain or spasms Keep a diary of your pain or spasms, including a description of when and where the pain is occurring, what it feels like, and how long it lasts. Stay as active as possible, but know that it is okay to rest as needed, too. Tell your care provider if pain or spasms interfere with your activity. If the pain or spasms bother you, ask your provider what you may use to help with this discomfort. Take pain medication only that has been prescribed or recommended by your care provider. Nausea or vomiting Eat and drink slowly. Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake. Eat small, frequent meals throughout the day rather than a few large meals. Eat bland foods; avoid spicy, fried, and greasy foods. Avoid vigorous exercise immediately after eating. Don’t lie down immediately after eating. Avoid strong odors. Let your provider know if you experience nausea or vomiting. Your provider may prescribe medication that can help. LENALIDOMIDE ORAL CHEMOTHERAPY EDUCATION Page 7 Pregnancy, sexual activity, and contraception Women should not become pregnant and men should not get a partner pregnant while taking lenalidomide, during any treatment breaks, and for at least four weeks after stopping this medication. Do not take lenalidomide if you are pregnant or think you might be pregnant. Lenalidomide can cause serious birth defects. If you think you might be pregnant, notify your care provider right away. Women of childbearing age and potential must have two negative pregnancy tests prior to starting lenalidomide and will need to repeat this test with each cycle or sooner. Women of childbearing age and potential should use two forms of birth control or go without having sex during treatment with lenalidomide and for at least four weeks after stopping treatment. Men who are taking lenalidomide must always wear a latex or synthetic condom during sex, during treatment breaks, and for at least four weeks after stopping lenalidomide because the drug can be found in sperm. Notify your care provider if you have unprotected sex with a woman. Do not donate sperm while taking lenalidomide, during treatment breaks, and for four weeks after stopping this medication. Do not breastfeed while taking lenalidomide and for four weeks after the last dose of lenalidomide. It is safe to hug and kiss, but the special precautions described above are required before sexual activity. Blood product donation It is recommended that you do not donate blood or blood products such as platelets while receiving lenalidomide and for at least four weeks after your last dose of lenalidomide. Obtaining medication Talk with your care provider about how to obtain your lenalidomide. Lenalidomide is available only through a Risk Evaluation and Mitigation Strategy REMS program, and prescribers, patients, and pharmacies must be certified with this REMS program. Only a 28 day supply of medication can be obtained from the pharmacy at one time, and this medication is not eligible for automatic refills. PHARMACY OR SPECIALTY PHARMACY CONTACT INFO Additional resources Product website: www.revlimid.com Product prescribing information: www.celgene.com/content/uploads/revlimid pi.pdf Product resources: www.celgenepatientsupport.com Updated — September 8, 2017 LENALIDOMIDE ORAL CHEMOTHERAPY EDUCATION Page 8 Important notice: The Association of Community Cancer Centers ACCC , Hematology/Oncology Pharmacy Association HOPA , National Community Oncology Dispensing Association, Inc. NCODA , and Oncology Nursing Society ONS have collaborated in gathering information for and developing this patient education guide. This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this medication by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Oral Chemotherapy Education OCE sheets are provided as a free educational resource for patients with cancer in need of concise, easy to understand information about oral cancer drugs. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2017 by Hematology/Oncology Pharmacy Association. All rights reserved. Additional instructions

Page 1 LENVATINIB ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — lenvatinib len VA tih nib Brand name — Lenvima® len Vee muh Approved uses Lenvatinib is used to treat advanced thyroid cancer and renal cell carcinoma kidney cancer given in combination with another medication everolimus Afinitor® Dose and schedule Taking lenvatinib as instructed is important to allow your treatment to be as effective as possible so here are some key points to remember o Your dose may vary but the usual dose of lenvatinib is 24 milligrams 24 mg for thyroid cancer and 18 mg for kidney cancer to be taken by mouth at a scheduled time once daily o Lenvatinib can be taken with or without food but should be taken at the same time each day o Lenvatinib should be taken whole and not crushed cut or dissolved without proper instructions If you are unable to swallow lenvatinib talk to your care provider or pharmacist for possible options o If you miss a dose of lenvatinib Take the missed dose only if it has been less than 12 hours since you were supposed to take it Then take the next dose at the regularly scheduled time Do not take the missed dose if it has been more than 12 hours since you should have taken it Simply take your next dose at the regularly scheduled time Do not take two doses at one time Be sure to write down if you miss a dose and let your care provider know about any missed doses Storage and handling Handle lenvatinib with care Just like when chemotherapy is given into the vein this drug can be toxic and exposure of the drug to others should be limited o Store lenvatinib at room temperature 68°F–77°F in a dry location away from light o Keep lenvatinib out of reach of children and pets o Leave lenvatinib in the provided packaging until it is ready to be taken o Whenever possible give lenvatinib to yourself and follow the steps below If a family member friend or caregiver needs to give lenvatinib to you they also need to follow these steps 1 Wash hands with soap and water 2 Put on gloves to avoid touching the medication Gloves are not necessary if you give the drug to yourself 3 Gently transfer the lenvatinib from its package to a small medicine or other disposable cup 4 Administer the medicine immediately by mouth with water LENVATINIB ORAL CHEMOTHERAPY EDUCATION Page 2 5 Remove gloves and do not use them for anything else 6 Throw gloves and medicine cup in household trash 7 Wash hands with soap and water o If a daily pill box or pill reminder is used a separate one should be used for lenvatinib Do not mix other medications into the box with lenvatinib The person filling the box or reminder should wear gloves Gloves are not necessary if you are filling the box or reminder When empty the box or reminder should be washed with soap and water before refilling Be sure to wash hands with soap and water after the task is complete whether or not gloves are worn o If you have any unused lenvatinib do not throw it in the trash and do not flush it down the sink or toilet Talk to your care provider or pharmacist about proper disposal of lenvatinib o If you are traveling put your lenvatinib in a sealed plastic bag Ask your pharmacist if any additional travel precautions are needed Handling body fluids and waste Lenvatinib remains in your body for several days after it is taken so some of the drug may be present in urine stool sweat or vomit Once you have started to take lenvatinib it is important to follow the instructions below every day for as long as your treatment lasts This will keep yourself loved ones and the environment as safe as possible o Pregnant women should avoid touching anything that may be soiled with body fluids from the patient o Toilet and septic systems You may use the same toilet septic tank and/or sewer that you usually use If you have a low flow toilet close the lid and flush twice to ensure all waste has been discarded If the toilet or toilet seat becomes soiled with urine stool or vomit clean the surfaces before other people use the toilet Wash hands with soap and water after using the toilet o If you need a bedpan be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day o If you do not have good control of bladder or bowels use a disposable pad with a plastic back a diaper or a sheet to absorb body waste o Wash any skin that has been exposed to body waste or lenvatinib with soap and water o Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing If you do not have a washer place the soiled linens in a plastic bag until they can be washed o Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids Drug and food interactions o Lenvatinib has many drug interactions Inform your care providers of all prescription medications over the counter medications vitamins and herbal products that you are taking o Talk with your care provider or pharmacist before taking new medications or supplements or receiving any vaccines LENVATINIB ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Lenvatinib The common side effects that have been known to happen in more than 30% of patients taking lenvatinib are listed in the left side of this table You MAY NOT experience these side effects Options to help manage any side effects that do occur are included on the right side of this table These should be discussed with your care provider If you experience any side effect you cannot manage or that is not listed here contact your care provider Possible Side Effect Management Increased blood pressure Routinely take your blood pressure Record your blood pressure readings in a journal/diary and report them to your physician Contact your healthcare provider for high blood pressure or if symptoms such as the following occur Headache Dizziness Chest pain Shortness of breath Fluid retention weight gain or swelling Diarrhea loose and/or urgent bowel movements Monitor how many bowel movements you have each day Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake related to some other health problem Eat small frequent meals throughout the day rather than a few large meals Eat bland low fiber foods e g bananas applesauce potatoes chicken rice toast Avoid high fiber foods such as raw vegetables raw fruits and whole grains Avoid foods that cause gas such as broccoli and beans Avoid lactose containing foods such as yogurt and milk Avoid spicy fried and greasy foods Contact your provider if any of the following occur The number of bowel movements you have in a day increases by four or more You feel dizzy or lightheaded Your care provider may recommend an over the counter medication called loperamide Imodium® to help with your diarrhea but talk to your care provider before starting this medication Fatigue You may be more tired than usual or have less energy Stay as active as possible but know it is okay to rest as needed Try to do some activity every day Plan your activities and do them at a time of day when you feel a bit more energetic Avoid operating heavy machinery if you feel too tired LENVATINIB ORAL CHEMOTHERAPY EDUCATION Page 4 Possible Side Effect Management Muscle or joint pain or weakness Keep a diary of your pain including a description of when and where the pain is occurring what it feels like and how long it lasts Stay as active as possible but know that it is okay to rest as needed too Tell your care provider if pain interferes with your activity If the pain or weakness bothers you ask your provider how you may ease this discomfort Take only pain medication that has been prescribed or recommended by your care provider Nausea or vomiting Eat and drink slowly Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake Eat small frequent meals throughout the day rather than a few large meals Eat bland foods; avoid spicy fried and greasy foods Avoid vigorous exercise immediately after eating Don’t lie down immediately after eating Avoid strong odors Let your provider know if you experience nausea or vomiting Your provider may prescribe medication that can help Decreased appetite or weight loss Talk to your provider if you notice a decrease in your weight while taking this medication When you don’t feel like eating try the following Eat frequent meals instead of three large meals each day Keep snacks nearby so you can eat when you feel hungry Drink liquid nutritional supplements Drink 8–10 glasses of water or fluid each day especially if you are not eating unless your care provider has instructed you to limit your fluid intake Mouth irritation or sores Practice good mouth care Rinse your mouth frequently Brush your teeth with a soft toothbrush or cotton swab after meals Use a mild nonalcohol mouth rinse at least four times a day after eating and at bedtime For example you can use a mixture of 1/8 teaspoon of salt and 1/4 teaspoon of baking soda in 8 ounces of warm not hot water If you have sores in your mouth avoid using tobacco products alcohol and mouthwashes that contain alcohol Call your care provider if you experience pain or sores in your mouth or throat LENVATINIB ORAL CHEMOTHERAPY EDUCATION Page 5 Possible Side Effect Management Headache Ask your provider what you may use to ease headaches Contact your care provider immediately if your headache Follows a head injury Is severe especially if it starts suddenly Does not go away after three days Is associated with vomiting visual disturbance neck stiffness drowsiness confusion made worse by coughing or lowering the head rash weakness in an arm or leg or numbness Abdominal pain Abdominal pain or discomfort may occur Report any serious pain or symptoms to your care provider immediately Fluid retention or swelling Do not stand for long periods of time Keep your legs elevated when sitting or lying down Avoid eating salty foods which can increase swelling Avoid wearing tight fitting clothing and shoes Weigh yourself daily Contact your care provider if you notice any of the following Swelling in the hands feet or legs Shortness of breath Weight gain of five pounds or more in a week Cough or shortness of breath A cough that does not produce any mucous or congestion relief dry cough may occur while taking this medication If you experience any breathing problems or shortness of breath notify your care provider immediately This may be a serious side effect of the medication Pain or discomfort in hands and/or feet Hand–foot skin reaction HFSR appears on the palms of the hands and soles of the feet It can appear as a rash callus peeling skin and increased sensitivity to heat or a “pins and needles” sensation Let your care provider know right away if you experience this side effect To prevent HFSR try the following Soak your feet in a water bath with Epsom salts and gently pumice any callused skin Exfoliate and moisturize hands and feet Avoid tight shoes or socks Use cushioning i e gloves when doing activities that increase pressure on the palms of your hands Kidney damage Your care provider will monitor your kidney function by checking the amount of protein in your urine LENVATINIB ORAL CHEMOTHERAPY EDUCATION Page 6 Pregnancy sexual activity and contraception o Women should not become pregnant and men should not get a partner pregnant while taking lenvatinib which could cause fetal harm Men and women of childbearing age and potential should use effective contraception during therapy and for a minimum of two weeks after the last dose of lenvatinib o Do not breastfeed while taking lenvatinib and for two weeks after the last dose of lenvatinib o Inform your care provider if you become pregnant o It is safe to hug and kiss Special precautions may be needed for sexual activity while on lenvatinib and you are encouraged to ask your care provider Obtaining medication Talk with your care provider about how to obtain your lenvatinib PHARMACY OR SPECIALTY PHARMACY CONTACT INFO If you experience ANY uncontrolled side effect call your physician or healthcare center immediately INSTITUTIONAL CONTACT INFO Possible Side Effect Management Increased risk for bleeding You may be at higher risk for bleeding and may bruise or bleed more easily than usual Use caution to avoid bruises cuts or burns Blow your nose gently and do not pick your nose Brush your teeth gently with a soft toothbrush and maintain good oral hygiene When shaving use an electronic razor instead of razor blades Use a nail file instead of a nail clippers Call your care provider if you have bleeding that won’t stop Examples include A bloody nose that bleeds for more than five minutes despite pressure A cut that continues to ooze despite pressure Gums that bleed excessively when you floss or brush Seek medical help immediately if you experience any severe headaches blood in your urine or stool coughing up blood or prolonged or uncontrolled bleeding Voice changes or hoarseness These changes are not permanent and should go away during the time you are not taking the medication ABIRATERONE ORAL CHEMOTHERAPY EDUCATION Page 7 LENVATINIB Page 7 Important notice The Association of Community Cancer Centers ACCC Hematology/Oncology Pharmacy Association HOPA National Community Oncology Dispensing Association Inc NCODA and Oncology Nursing Society ONS have collaborated in gathering information for and developing this patient education guide This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources This guide does not cover all existing information related to the possible uses directions doses precautions warnings interactions adverse effects or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional Provision of this guide is for informational purposes only and does not constitute or imply endorsement recommendation or favoring of this medication by ACCC HOPA NCODA or ONS who assume no liability for and cannot ensure the accuracy of the information presented The collaborators are not making any representations with respect to the medications whatsoever and any and all decisions with respect to such medications are at the sole risk of the individual consuming the medication All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional Permission Oral Chemotherapy Education OCE sheets are provided as a free educational resource for patients with cancer in need of concise easy to understand information about oral cancer drugs Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information However commercial reproduction or reuse as well as rebranding or reposting of any type are strictly prohibited without permission of the copyright holder Please email permission requests and licensing inquiries to Contact@NCODA org Copyright © 2017 by Hematology/Oncology Pharmacy Association All rights reserved Additional instructions Additional resources Product website http //www lenvima com Product prescribing information http //www lenvima com/pdfs/prescribing information pdf Product resources http //www lenvima com/RAI R differentiated thyroid cancer/resources Updated – August 27 2017

Page 1 LETROZOLE ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — letrozole LEH truh zole Brand name — Femara® FEH muh ruh Approved uses Letrozole is used in the treatment of certain types of hormone dependent breast cancer in postmenopausal women Dose and schedule Taking letrozole as instructed is important to allow your treatment to be as effective as possible so here are some key points to remember o Your dose may vary but the usual dose of letrozole is 2 5 milligrams 2 5 mg to be taken by mouth at a scheduled time once a day o Letrozole can be taken with or without food but at the same time each day o Letrozole should be taken whole and not crushed cut or dissolved If you are unable to swallow letrozole talk to your care provider or pharmacist for possible options o If you miss a dose of letrozole do not take an extra dose or two doses at one time Simply take your next dose at the regularly scheduled time Be sure to write down if you miss a dose and let your care provider know about any missed doses Storage and handling Handle letrozole with care Just like when chemotherapy is given into the vein this drug can be toxic and exposure of the drug to others should be limited o Store letrozole at room temperature 68°F–77°F in a dry location away from light o Keep letrozole out of reach of children and pets o Leave letrozole in the provided packaging until it is ready to be taken o Whenever possible give letrozole to yourself and follow the steps below If a family member friend or caregiver needs to give letrozole to you they also need to follow these steps 1 Wash hands with soap and water 2 Put on gloves to avoid touching the medication Gloves are not necessary if you give the drug to yourself 3 Gently transfer the letrozole from its package to a small medicine or other disposable cup 4 Administer the medicine immediately by mouth with water 5 Remove gloves and do not use them for anything else 6 Throw gloves and medicine cup in household trash 7 Wash hands with soap and water LETROZOLE ORAL CHEMOTHERAPY EDUCATION Page 2 o If a daily pill box or pill reminder is used a separate one should be used for letrozole Do not mix other medications into the box with letrozole The person filling the box or reminder should wear gloves gloves are not necessary if you are filling the box or reminder When empty the box or reminder should be washed with soap and water before refilling Be sure to wash hands with soap and water after the task is complete whether or not gloves are worn o If you have any unused letrozole do not throw it in the trash and do not flush it down the sink or toilet Talk to your care provider or pharmacist about proper disposal of letrozole o If you are traveling put your letrozole in a sealed plastic bag Ask your pharmacist if any additional travel precautions are needed Handling body fluids and waste Because letrozole remains in your body for several days after it is taken some of the drug may be present in urine stool sweat or vomit Once you have started to take letrozole it is important to follow the instructions below every day for as long as your treatment lasts This is to keep yourself loved ones and the environment as safe as possible o Pregnant women should avoid touching anything that may be soiled with body fluids from the patient o Toilet and septic systems You may use the same toilet septic tank and/or sewer that you usually use If you have a low flow toilet close the lid and flush twice to ensure all waste has been discarded If the toilet or toilet seat becomes soiled with urine stool or vomit clean the surfaces before other people use the toilet Wash hands with soap and water after using the toilet o If you need a bedpan be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day o If you do not have good control of bladder or bowels use a disposable pad with a plastic back a diaper or a sheet to absorb body waste o Wash any skin that has been exposed to body waste or letrozole with soap and water o Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing If you do not have a washer place the soiled linens in a plastic bag until they can be washed o Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids Drug and food interactions o Letrozole has many drug interactions Inform your care providers of all prescription medications over the counter medications vitamins and herbal products o Talk with your care provider or pharmacist before taking new medications or supplements or receiving any vaccines LETROZOLE ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Letrozole The common side effects that have been known to happen in more than 30% of patients taking letrozole are listed in the left side of this table You MAY NOT experience these side effects Options to help manage any side effects that do occur are included on the right side of this table These should be discussed with your care provider If you experience any side effect you cannot manage or that is not listed here contact your care provider Possible Side Effect Management Changes in electrolytes and other laboratory values High cholesterol levels Changes in some laboratory values may occur and will be monitored by a simple blood test You may not feel any symptoms if the changes are mild and they usually are not a sign of a serious problem More severe changes may occur which can be a sign of a serious problem Notify your care provider if you have any of the following Shortness of breath Chest discomfort Weakness or fatigue New aches and pains Headaches Dizziness Swelling of your legs or feet Red or brown colored urine Hot flashes sudden sweating and feelings of warmth If hot flashes are bothersome Mild regular exercise program may help Consult first with your care provider Try staying in a cool environment Wear layers so that you can remove outer layers when experiencing a hot flash Avoid or limit caffeine spicy food alcohol and stress which may worsen hot flashes Inform your care provider if your hot flashes are bothersome as there may be medications that can help Muscle or joint pain or weakness Keep a diary of your pain including a description of when and where the pain is occurring what it feels like and how long it lasts Stay as active as possible but know that it is okay to rest as needed too Tell your care provider if pain interferes with your activity If the pain or weakness bothers you ask your provider how you may ease this discomfort Take only pain medication that has been prescribed or recommended by your care provider LETROZOLE ORAL CHEMOTHERAPY EDUCATION Page 4 If you experience ANY uncontrolled side effect call your physician or healthcare center immediately INSTITUTIONAL CONTACT INFO Pregnancy sexual activity and contraception o Women should not become pregnant and men should not get a partner pregnant while taking letrozole Men and women of childbearing age and potential should use effective contraception during therapy and for a minimum of one month after the last dose of letrozole o Do not breastfeed while taking letrozole and for one month after the last dose of letrozole o Inform your care provider if you become pregnant o It is safe to hug and kiss Special precautions may be needed for sexual activity while on oral chemotherapy and you are encouraged to ask your care provider Obtaining medication o Talk with your care provider about the process for obtaining your letrozole PHARMACY OR SPECIALTY PHARMACY CONTACT INFO Additional resources Product website www femara com Product prescribing information www pharma us novartis com/sites/www pharma us novartis com/files/ Femara pdf Updated – September 3 2017 LETROZOLE ORAL CHEMOTHERAPY EDUCATION Page 5 Additional instructions Important notice The Association of Community Cancer Centers ACCC Hematology/Oncology Pharmacy Association HOPA National Community Oncology Dispensing Association Inc NCODA and Oncology Nursing Society ONS have collaborated in gathering information for and developing this patient education guide This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources This guide does not cover all existing information related to the possible uses directions doses precautions warnings interactions adverse effects or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional Provision of this guide is for informational purposes only and does not constitute or imply endorsement recommendation or favoring of this medication by ACCC HOPA NCODA or ONS who assume no liability for and cannot ensure the accuracy of the information presented The collaborators are not making any representations with respect to the medications whatsoever and any and all decisions with respect to such medications are at the sole risk of the individual consuming the medication All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional Permission Oral Chemotherapy Education OCE sheets are provided as a free educational resource for patients with cancer in need of concise easy to understand information about oral cancer drugs Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information However commercial reproduction or reuse as well as rebranding or reposting of any type are strictly prohibited without permission of the copyright holder Please email permission requests and licensing inquiries to Contact@NCODA org Copyright © 2017 by Hematology/Oncology Pharmacy Association All rights reserved

Page 1 LOMUSTINE ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name lomustine (loh MUS teen) Brand name Gleostine® (GLEE oh steen) Approved uses Lomustine is used to treat people with the following conditions: Brain tumors, primary and metastatic, following appropriate surgical and radiation therapy Hodgkin lymphoma in combination with other chemotherapies, following treatment with initial chemotherapy Dose and schedule Taking lomustine as instructed is important to allow your treatment to be as effective as possible, so here are some key points to remember. Your dose of lomustine is based on many factors, including your height and weight, overall health, and diagnosis. Lomustine is taken by mouth as a single dose once every six weeks. Lomustine can be taken with or without food, but at the same time each day. Taking lomustine on an empty stomach may decrease the amount of nausea you have. Lomustine should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow lomustine, talk to your care provider or pharmacist for possible options. Lomustine should only be administered once every six weeks. If you forget to take your scheduled dose of lomustine, contact your healthcare provider. Storage and handling Handle lomustine with care. Just like when chemotherapy is given into the vein, this drug can be toxic, and exposure of the drug to others should be limited. Store lomustine at room temperature (68°F–77°F) in a dry location away from light. Keep lomustine out of reach of children and pets. Leave lomustine in the provided packaging until it is ready to be taken. Whenever possible, you should give lomustine to yourself and follow the steps below. If a family member, friend, or caregiver needs to give the lomustine to you, they also need to follow these steps: 1. Wash hands with soap and water. 2. Put on gloves to avoid touching the medication. (Gloves are not necessary if you give the drug to yourself.) 3. Gently transfer the lomustine from its package to a small medicine or other disposable cup. 4. Administer the medicine immediately by mouth with water. 5. Remove gloves and do not use them for anything else. 6. Throw gloves and medicine cup in household trash. 7. Wash hands with soap and water. LOMUSTINE ORAL CHEMOTHERAPY EDUCATION Page 2 If you have any unused lomustine, do not throw it in the trash and do not flush it down the sink or toilet. Talk to your care provider or pharmacist about proper disposal of lomustine. If you are traveling, put your lomustine in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Since lomustine remains in your body for several days after it is taken, some of the drug may be present in urine, stool, sweat, or vomit. Once you have started to take lomustine, it is important to follow the instructions below every day for as long as your treatment lasts. This is to keep yourself, loved ones, and the environment as safe as possible. Pregnant women should avoid touching anything that may be soiled with body fluids from the patient. Toilet and septic systems You may use the same toilet, septic tank, and/or sewer that you usually use. If you have a low flow toilet, close the lid and flush twice to ensure all waste has been discarded. If the toilet or toilet seat becomes soiled with urine, stool, or vomit, clean the surfaces before other people use the toilet. Wash hands with soap and water after using the toilet. If you need a bedpan, be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day. If you do not have good control of bladder or bowels, use a disposable pad with a plastic back, a diaper, or a sheet to absorb body waste. Wash any skin that has been exposed to body waste or lomustine with soap and water. Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing. If you do not have a washer, place the soiled linens in a plastic bag until they can be washed. Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids. Drug and food interactions Lomustine has many drug interactions. Please inform your care providers of all prescription medications, over the counter medications, vitamins, and herbal products. Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. LOMUSTINE ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Lomustine The common side effects that have been known to happen in more than 30% of patients taking lomustine are listed in the left side of this table. You MAY NOT experience these side effects. Options to help manage any side effects that do occur are included on the right side of this table. These should be discussed with your care provider. If you experience any side effect you cannot manage or that is not listed here, contact your care provider. Possible Side Effect Management Decreased white blood cells (WBCs) and increased risk for infection Your WBCs should be monitored by a simple blood test. When your WBCs are low, you are at a greater risk of having an infection. Take the following precautions to protect yourself from infection. Wash your hands often, especially before eating and after using the bathroom. Avoid crowds and people with fevers, flu, or other infection. Bathe regularly to keep good personal hygiene. Contact your care provider if you experience any signs or symptoms of an infection: Fever (temperature more than 100.4°F or 38°C) Chills Sore throat Burning with urination Unusual tiredness A sore that becomes red, is draining, or does not heal Check with your care provider before taking any medicine for a fever or chills. Decreased platelet count and increased risk of bleeding Your platelets should be monitored by a simple blood test. When they are low, you may bruise or bleed more easily than usual. Use caution to avoid bruises, cuts, or burns. Blow your nose gently, and do not pick your nose. Brush your teeth gently with a soft toothbrush, and maintain good oral hygiene. When shaving, use an electronic razor instead of razor blades. Use a nail file instead of nail clippers. Call your care provider if you have bleeding that won’t stop. Examples include the following: A bloody nose that bleeds for more than five minutes despite pressure A cut that continues to ooze despite pressure Gums that bleed excessively when you floss or brush Seek medical help immediately if you experience any severe headaches, observe blood in your urine or stool, cough up blood, or experience prolonged and uncontrollable bleeding. You may need to take a break or “hold” your medication for medical or dental procedures. Talk to your care provider or dentist before any scheduled procedures. Continued on the next page LOMUSTINE ORAL CHEMOTHERAPY EDUCATION Page 4 Possible Side Effect Management Nausea or vomiting Eat and drink slowly. Drink 8 10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake. Eat small, frequent meals throughout the day rather than a few large meals. Eat bland foods; avoid spicy, fried, and greasy foods. Avoid vigorous exercise immediately after eating. Don’t lie down immediately after eating. Avoid strong odors. Let your provider know if you experience nausea or vomiting. Your provider may prescribe medication to help with the nausea or vomiting. Serious side effects Lomustine can be fatal if taken more frequently than prescribed. Lomustine may be harmful to your lungs. Inform your care provider of any new difficulty breathing, cough, or fever. Lomustine may rarely cause a secondary cancer called myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML). Symptoms of low blood counts are common during treatment but can be a sign of MDS or AML. Lomustine may be harmful to your liver and kidneys. Speak to your care provider to determine when you need to have laboratory tests done to monitor your liver and kidney function. If you experience ANY uncontrolled side effect, call your physician or healthcare center immediately: (INSTITUTIONAL CONTACT INFO) Pregnancy, sexual activity, and contraception Women should not become pregnant and men should not get a partner pregnant while taking lomustine. Women of childbearing age and potential should use effective contraception during therapy and for a minimum of two weeks after the last dose of lomustine. Men of childbearing age and potential should use effective contraception during therapy and for a minimum of three and a half months after the last dose of lomustine. Do not breastfeed while taking lomustine and for two weeks after the last dose of lomustine. Please inform your care provider if you become pregnant. It is safe to hug and kiss. Special precautions may be needed for sexual activity while on oral chemotherapy, and you are encouraged to ask your care provider. LOMUSTINE ORAL CHEMOTHERAPY EDUCATION Page 5 Obtaining medication Talk with your care provider about the process for obtaining your lomustine. (PHARMACY OR SPECIALTY PHARMACY CONTACT INFO) Additional resources Product website: http://gleostine.com Product prescribing information: www.accessdata.fda.gov/drugsatfda docs/label/2016/017588s042lbl.pdf Product resources: http://gleostine.com/nextsource cares Updated – October 19, 2018 Additional instructions Important notice: The Association of Community Cancer Centers (ACCC), Hematology/Oncology Pharmacy Association (HOPA), National Community Oncology Dispensing Association, Inc. (NCODA), and Oncology Nursing Society (ONS) have collaborated in gathering information for and developing this patient education guide. This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this medication by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Oral Chemotherapy Education (OCE) sheets are provided as a free educational resource for patients with cancer in need of concise, easy to understand information about oral cancer drugs. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2019 by Hematology/Oncology Pharmacy Association. All rights reserved.

Page 1 LORLATINIB ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name lorlatinib (lor LA tih nib) Brand name Lorbrena® (lor BREH nuh) Approved uses Lorlatinib is used to treat metastatic non small cell lung cancer that has a genetic mutation called anaplastic lymphoma kinase. Dose and schedule Taking lorlatinib as instructed is important to allow your treatment to be as effective as possible, so here are some key points to remember. Your dose may vary, but the usual dose of lorlatinib is 100 milligrams (100 mg) to be taken by mouth at a scheduled time, once daily. Lorlatinib can be taken with or without food, but at the same time each day. Lorlatinib should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow lorlatinib, talk to your care provider or pharmacist for possible options. If you miss a dose of lorlatinib, follow these guidelines: Take the missed dose unless the next dose is due within four hours. Do not take two doses at one time. Be sure to write down if you miss a dose, and let your care provider know about any missed doses. Storage and handling Handle lorlatinib with care. Just like when chemotherapy is given into the vein, this drug can be toxic, and exposure of the drug to others should be limited. Store lorlatinib at room temperature (68°F–77°F) in a dry location away from light. Keep lorlatinib out of reach of children and pets. Leave lorlatinib in the provided packaging until it is ready to be taken. Whenever possible, you should give lorlatinib to yourself and follow the steps below. If a family member, friend, or caregiver needs to give the lorlatinib to you, they also need to follow these steps. 1. Wash hands with soap and water. 2. Put on gloves to avoid touching the medication. (Gloves are not necessary if you give the drug to yourself.) 3. Gently transfer the lorlatinib from its package to a small medicine or other disposable cup. 4. Administer the medicine immediately by mouth with water. 5. Remove gloves and do not use them for anything else. 6. Throw gloves and medicine cup in household trash. 7. Wash hands with soap and water. LORLATINIB ORAL CHEMOTHERAPY EDUCATION Page 2 If a daily pill box or pill reminder is used, a separate one should be used for lorlatinib. Do not mix other medications into the box with lorlatinib. The person filling the box or reminder should wear gloves. (Gloves are not necessary if you are filling the box or reminder). When empty, the box or reminder should be washed with soap and water before refilling. Be sure to wash hands with soap and water after the task is complete, whether or not gloves are worn. If you have any unused lorlatinib, do not throw it in the trash and do not flush it down the sink or toilet. Talk to your care provider or pharmacist about proper disposal of lorlatinib. If you are traveling, put your lorlatinib in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Since lorlatinib remains in your body for several days after it is taken, some of the drug may be present in urine, stool, sweat, or vomit. Once you have started to take lorlatinib, it is important to know the following instructions every day for as long as your treatment lasts. This is to keep yourself, loved ones, and the environment as safe as possible. Pregnant women should avoid touching anything that may be soiled with body fluids from the patient. Toilet and septic systems You may use the same toilet, septic tank, and/or sewer that you usually use. If you have a low flow toilet, close the lid and flush twice to ensure all waste has been discarded. If the toilet or toilet seat becomes soiled with urine, stool, or vomit, clean the surfaces before other people use the toilet. Wash hands with soap and water after using the toilet. If you need a bedpan, be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day. If you do not have good control of bladder or bowels, use a disposable pad with a plastic back, a diaper, or a sheet to absorb body waste. Wash any skin that has been exposed to body waste or lorlatinib with soap and water. Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing. If you do not have a washer, place the soiled linens in a plastic bag until they can be washed. Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids. Drug and food interactions Lorlatinib has many drug interactions. Please inform your care providers of all prescription medications, over the counter medications, vitamins, and herbal products. Grapefruit or grapefruit juice may interact with lorlatinib; avoid eating or drinking this during treatment with lorlatinib. Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. LORLATINIB ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Lorlatinib The common side effects that have been known to happen in more than 30% of patients taking lorlatinib are listed in the left side of this table. You MAY NOT experience these side effects. Options to help manage any side effects that do occur are included on the right side of this table. These should be discussed with your care provider. If you experience any side effect you cannot manage or that is not listed here, contact your care provider. Possible Side Effect Management Changes in electrolytes and other laboratory values High cholesterol levels High triglyceride levels High glucose levels Low albumin Changes in some lab values may occur and will be monitored by a simple blood test. You may not feel any symptoms if the changes are mild, and they usually are not a sign of a serious problem. More severe changes may occur, which can be a sign of a serious problem. Notify your care provider if you have any of the following: Shortness of breath Chest discomfort Weakness or fatigue New aches and pains Headaches Dizziness Swelling of your legs or feet Red or brown colored urine Fluid retention or swelling Do not stand for long periods of time. Keep your legs elevated when sitting or lying down. Try not to eat salty foods, which can increase swelling. Avoid tight fitting clothing and shoes. Weigh yourself daily. Contact your provider if you notice any of the following: Swelling in the hands, feet, or legs Shortness of breath Weight gain of five pounds or more in one week Continued on the next page LORLATINIB ORAL CHEMOTHERAPY EDUCATION Page 4 Possible Side Effect Management Decreased hemoglobin, part of the red blood cells that carry iron and oxygen Your hemoglobin should be monitored using a blood test. When your hemoglobin is low, you may notice that you get tired or fatigued more easily. Try to get 7–8 hours of sleep per night. Avoid operating heavy machinery if you feel too tired. Find a balance between work and rest. Stay as active as possible, but know that it is okay to rest as needed. You might notice that you are more pale than usual. Let your health care provider know right away if you experience any of the following: Shortness of breath Dizziness Palpitations Numbness or tingling in hands and feet Report changes in your sense of touch, such as a burning sensation, pain on the skin, or weakness. Changes in liver function Your liver function should be checked periodically by a simple blood test. Contact your care provider if you notice any of the following: Yellowing of the skin or whites of your eyes Dark or brown urine Bleeding or bruising Serious side effects Lorlatinib may cause changes to your heartbeats or heart rhythm. Your care provider should check your heart rhythm before starting lorlatinib and during treatment. Tell your care provider right away if you feel dizzy or faint, or if you have abnormal heartbeats. Lorlatinib can cause lung and breathing problems. Tell your healthcare provider right away if you have new or worsening cough, shortness of breath, chest pain, fever, difficulty breathing, or wheezing. Lorlatinib can cause brain problems. Report any changes in thinking, mood, speech, seeing, or hearing to your care provider. If you experience ANY uncontrolled side effect, call your physician or healthcare center immediately: (INSTITUTIONAL CONTACT INFO) Pregnancy, sexual activity, and contraception Women should not become pregnant and men should not get a partner pregnant while taking lorlatinib. Birth control pills (oral contraceptives) and other hormonal forms of birth control may not be effective with lorlatinib. Women of reproductive potential should use effective nonhormonal contraception during therapy and for a minimum of six months after the last dose of lorlatinib. LORLATINIB ORAL CHEMOTHERAPY EDUCATION Page 5 Do not breastfeed while taking lorlatinib and for seven days after the last dose of lorlatinib. Please inform your care provider if you become pregnant. It is safe to hug and kiss. Special precautions may be needed for sexual activity while on gilteritinib, and you are encouraged to ask your care provider. Obtaining medication Talk with your care provider about the process for obtaining your lorlatinib. (PHARMACY OR SPECIALTY PHARMACY CONTACT INFO) Additional resources Product website: https://www.lorbrena.com Product prescribing information: https://www.accessdata.fda.gov/drugsatfda docs/ label/2018/210868s000lbl.pdf Product resources: https://www.lorbrena.com/personalized support Updated – November 21, 2018 Additional instructions Important notice: The Association of Community Cancer Centers (ACCC), Hematology/Oncology Pharmacy Association (HOPA), National Community Oncology Dispensing Association, Inc. (NCODA), and Oncology Nursing Society (ONS) have collaborated in gathering information for and developing this patient education guide. This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this medication by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Oral Chemotherapy Education (OCE) sheets are provided as a free educational resource for patients with cancer in need of concise, easy to understand information about oral cancer drugs. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2019 by Hematology/Oncology Pharmacy Association. All rights reserved.

Page 1 MELPHALAN ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — melphalan MEL fuh lan Brand name — Alkeran® AL keh ran Approved uses Melphalan is used to treat multiple myeloma MM and ovarian cancer. Dose and schedule Taking melphalan as instructed is important to allow your treatment to be as effective as possible, so here are some key points to remember. Your dose is based on many factors, including your height and weight, overall health and diagnosis. Melphalan should be taken on an empty stomach at least 1 hour before or 2 hours after a meal or snack , but at the same time each day. Melphalan should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow melphalan, talk to your care provider or pharmacist for possible options. If you miss a dose of melphalan, do not take an extra dose or two doses at one time. Simply take your next dose at the regularly scheduled time. Be sure to write down if you miss a dose and let your care provider know about any missed doses. Storage and handling Handle melphalan with care. Just like when chemotherapy is given into the vein, this drug can be toxic, and exposure of the drug to others should be limited. Store melphalan in the refrigerator 36°F–46°F in a dry location protected from light. Keep melphalan out of reach of children and pets. Leave melphalan in the provided packaging until it is ready to be taken. Whenever possible, you should give melphalan to yourself and follow the steps below. If a family member, friend, or caregiver needs to give the melphalan to you, they also need to follow these steps: 1. Wash hands with soap and water. 2. Put on gloves to avoid touching the medication. Gloves are not necessary if you give the drug to yourself. 3. Gently transfer the melphalan from its package to a small medicine or other disposable cup. 4. Administer the medicine immediately by mouth with water. 5. Remove gloves and do not use them for anything else. 6. Throw gloves and medicine cup in household trash. 7. Wash hands with soap and water. A daily pill box or pill reminder is not recommended to be used with melphalan. If you have any unused melphalan, do not throw it in the trash and do not flush it down the sink or toilet. Talk to your care provider or pharmacist about proper disposal of melphalan. MELPHALAN ORAL CHEMOTHERAPY EDUCATION Page 2 If you are traveling, put your melphalan in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Since melphalan remains in your body for several days after it is taken, some of the drug may be present in urine, stool, sweat, or vomit. Once you have started to take melphalan, it is important to know the following instructions every day for as long as your treatment lasts. This is to keep yourself, loved ones, and the environment as safe as possible. Pregnant women should avoid touching anything that may be soiled with body fluids from the patient. Toilet and septic systems You may use the same toilet, septic tank, and/or sewer that you usually use. If you have a low flow toilet, close the lid and flush twice to ensure all waste has been discarded. If the toilet or toilet seat becomes soiled with urine, stool, or vomit, clean the surfaces before other people use the toilet. Wash hands with soap and water after using the toilet. If you need a bedpan, be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day. If you do not have good control of bladder or bowels, use a disposable pad with a plastic back, a diaper, or a sheet to absorb body waste. Wash any skin that has been exposed to body waste or melphalan with soap and water. Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing. If you do not have a washer, place the soiled linens in a plastic bag until they can be washed. Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids. Drug and food interactions Melphalan has many drug interactions, please inform your care providers of all prescription medications, over the counter medications, vitamins, and herbal products. Melphalan should be taken on an empty stomach at least 1 hour before or 2 hours after a meal or snack . Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. Avoid live vaccines during treatment with melphalan. Serious side effects of melphalan Bone marrow suppression is a decrease in the number of white blood cells, red blood cells, and platelets, and can be a severe side effect of melphalan. Speak to your care provider to know when you need to have laboratory tests done to monitor your blood cell counts. Secondary malignancy is the growth of a cancer months or years after treatment. This is a rare but possible side effect of treatment with melphalan. MELPHALAN ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Melphalan The common side effects that have been known to happen in more than 30% of patients taking melphalan are listed in the left side of this table. You MAY NOT experience these side effects. Options to help manage any side effects that do occur are included on the right side of this table. These should be discussed with your care provider. If you experience any side effect you cannot manage or that is not listed here, contact your care provider. Possible Side Effect Management Decreased white blood cells WBCs and increased risk for infection Your WBCs should be monitored by a simple blood test. When your WBCs are low, you are at a greater risk of having an infection. Take the following precautions to protect yourself from infection. Wash your hands often, especially before eating and after using the bathroom. Avoid crowds and people with fevers, flu, or other infection. Bathe regularly to keep good personal hygiene. Contact your care provider if you experience any signs or symptoms of an infection such as: Fever temperature more than 100.4°F or 38°C Chills Sore throat Burning with urination Unusual tiredness A sore that becomes red, is draining, or does not heal Check with your care provider before taking any medicine for a fever or chills. Decreased platelet count and increased risk of bleeding Your platelets should be monitored by a simple blood test. When they are low, you may bruise or bleed more easily than usual. Use caution to avoid bruises, cuts, or burns. Blow your nose gently, and do not pick your nose. Brush your teeth gently with a soft toothbrush, and maintain good oral hygiene. When shaving, use an electronic razor instead of razor blades. Use a nail file instead of nail clippers. Call your care provider if you have bleeding that won’t stop. Examples include: A bloody nose that bleeds for more than 5 minutes despite pressure A cut that continues to ooze despite pressure Gums that bleed excessively when you floss or brush Seek medical help immediately if you experience any severe headaches, observe blood in your urine or stool, cough up blood, or experience prolonged and uncontrollable bleeding. You may need to take a break or hold your medication for medical or dental procedures. Talk to your care provider or dentist before any scheduled procedures. Continued on the next page MELPHALAN ORAL CHEMOTHERAPY EDUCATION Page 4 Possible Side Effect Management Decreased hemoglobin, part of the red blood cells that carry iron and oxygen Your hemoglobin should be monitored by a simple blood test. When your hemoglobin is low, you may notice that you get tired or fatigued more easily. Try to get 7–8 hours of sleep per night. Avoid operating heavy machinery if you feel too tired. Find a balance between work and rest. Stay as active as possible, but know that it is okay to rest as needed. You might notice that you are more pale than usual. Let your care provider know right away if you experience: Shortness of breath Dizziness Palpitations Nausea or vomiting Eat and drink slowly. Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake. Eat small, frequent meals throughout the day rather than a few large meals. Eat bland foods. Avoid spicy, fried, and greasy foods. Avoid vigorous exercise immediately after eating. Don’t lie down immediately after eating. Avoid strong odors. Let your provider know if you experience nausea or vomiting. Your provider may prescribe medication to help with the nausea or vomiting. If you experience ANY uncontrolled side effect, call your physician or healthcare center immediately: INSTITUTIONAL CONTACT INFO Pregnancy, sexual activity, and contraception Women should not become pregnant and men should not get a partner pregnant while taking melphalan. Men and women of childbearing age and potential should use effective contraception during therapy and for a minimum of one month after the last dose of melphalan. Do not breastfeed while taking melphalan and for one month after the last dose of melphalan. Please inform your care provider if you become pregnant. It is safe to hug and kiss. Special precautions may be needed for sexual activity while on oral chemotherapy, and you are encouraged to ask your care provider. MELPHALAN ORAL CHEMOTHERAPY EDUCATION Page 5 Obtaining medication Talk with your care provider about the process for obtaining your melphalan. PHARMACY OR SPECIALTY PHARMACY CONTACT INFO Additional resources Product prescribing information: https://www.accessdata.fda.gov/drugsatfda docs/ label/2011/014691s029lbl.pdf Updated — March 14, 2018 Additional instructions Important notice: The Association of Community Cancer Centers ACCC , Hematology/Oncology Pharmacy Association HOPA , National Community Oncology Dispensing Association, Inc. NCODA , and Oncology Nursing Society ONS have collaborated in gathering information for and developing this patient education guide. This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this medication by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Oral Chemotherapy Education OCE sheets are provided as a free educational resource for patients with cancer in need of concise, easy to understand information about oral cancer drugs. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2018 by Hematology/Oncology Pharmacy Association. All rights reserved.

Page 1 MERCAPTOPURINE ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — mercaptopurine mer KAP toh PYOOR een Brand name — Purinethol® pyoor IN eh thol ; Purixan® PYOOR ee zan Other names — 6 mercaptopurine and 6 MP Approved uses Mercaptopurine is used to treat adult and pediatric patients with acute lymphoblastic leukemia ALL . Dose and schedule Taking mercaptopurine as instructed is important to allow your treatment to be as effective as possible, so here are some key points to remember. Your dose is based on many factors, including your height and weight, overall health, and diagnosis. Mercaptopurine can be taken with or without food but at the same time each day. Mercaptopurine tablets should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow mercaptopurine, talk to your care provider or pharmacist for possible options. Mercaptopurine suspension should be shaken vigorously for at least 30 seconds prior to taking. If you miss a dose of mercaptopurine, do not take an extra dose or two doses at one time. Simply take your next dose at the regularly scheduled time. Be sure to write down if you miss a dose and let your care provider know about any missed doses. Storage and handling Handle mercaptopurine with care. Just like when chemotherapy is given into the vein, this drug can be toxic, and exposure of the drug to others should be limited. Store mercaptopurine at room temperature 68°F–77°F in a dry location away from light. Keep mercaptopurine out of reach of children and pets. Leave mercaptopurine in the provided packaging until it is ready to be taken. Once opened, mercaptopurine suspension should be used within 8 weeks. Whenever possible, give mercaptopurine to yourself and follow the steps below. If a family member, friend, or caregiver needs to give mercaptopurine to you, they also need to follow these steps: 1. Wash hands with soap and water. 2. Put on gloves to avoid touching the medication. Gloves are not necessary if you give the drug to yourself. 3. Gently transfer the mercaptopurine from its package to a small medicine or other disposable cup. 4. Administer the medicine immediately by mouth with water. 5. Remove gloves and do not use them for anything else. 6. Throw gloves and medicine cup in household trash. 7. Wash hands with soap and water. MERCAPTOPURINE ORAL CHEMOTHERAPY EDUCATION Page 2 If a daily pill box or pill reminder is used, a separate one should be used for mercaptopurine. Do not mix other medications into the box with mercaptopurine. The person filling the box or reminder should wear gloves gloves are not necessary if you are filling the box or reminder . When empty, the box or reminder should be washed with soap and water before refilling. Be sure to wash hands with soap and water after the task is complete, whether or not gloves are worn. If you have any unused mercaptopurine, do not throw it in the trash and do not flush it down the sink or toilet. Talk to your care provider or pharmacist about proper disposal of mercaptopurine. If you are traveling, put your mercaptopurine in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Because mercaptopurine remains in your body for several days after it is taken, some of the drug may be present in urine, stool, sweat, or vomit. Once you have started to take mercaptopurine, it is important to follow the instructions below every day for as long as your treatment lasts. This is to keep yourself, loved ones, and the environment as safe as possible. Pregnant women should avoid touching anything that may be soiled with body fluids from the patient. Toilet and septic systems You may use the same toilet, septic tank, and/or sewer that you usually use. If you have a low flow toilet, close the lid and flush twice to ensure all waste has been discarded. If the toilet or toilet seat becomes soiled with urine, stool, or vomit, clean the surfaces before other people use the toilet. Wash hands with soap and water after using the toilet. If you need a bedpan, be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day. If you do not have good control of bladder or bowels, use a disposable pad with a plastic back, a diaper, or a sheet to absorb body waste. Wash any skin that has been exposed to body waste or mercaptopurine with soap and water. Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing. If you do not have a washer, place the soiled linens in a plastic bag until they can be washed. Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids. Drug and food interactions Mercaptopurine has many drug interactions. Inform your care providers of all prescription medications, over the counter medications, vitamins, and herbal products. Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. MERCAPTOPURINE ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Mercaptopurine The common side effects that have been known to happen in more than 30% of patients taking mercaptopurine are listed in the left side of this table. You MAY NOT experience these side effects. Options to help manage any side effects that do occur are included on the right side of this table. These should be discussed with your care provider. If you experience any side effect you cannot manage or that is not listed here, contact your care provider. Possible Side Effect Management Decreased white blood cells WBCs and increased risk for infection Your WBCs should be monitored by a simple blood test. When your WBCs are low, you are at greater risk of having an infection. Take the following precautions to protect yourself from infection. Wash your hands often, especially before eating and after using the bathroom. Avoid crowds and people with fevers, flu, or other infection. Bathe regularly to keep good personal hygiene. Contact your care provider if you experience any signs or symptoms of an infection: Fever temperature more than 100.4°F or 38°C Chills Sore throat Burning with urination Unusual tiredness A sore that becomes red, is draining, or does not heal Check with your care provider before taking any medicine for a fever or chills. Decreased platelet count and increased risk of bleeding Your platelets should be monitored by a simple blood test. When they are low, you may bruise or bleed more easily than usual. Use caution to avoid bruises, cuts, or burns. Blow your nose gently, and do not pick your nose. Brush your teeth gently with a soft toothbrush, and maintain good oral hygiene. When shaving, use an electronic razor instead of razor blades. Use a nail file instead of nail clippers. Call your care provider if you have bleeding that won’t stop. Examples include the following: A bloody nose that bleeds for more than 5 minutes despite pressure A cut that continues to ooze despite pressure Gums that bleed excessively when you floss or brush Seek medical help immediately if you experience any severe headaches, observe blood in your urine or stool, cough up blood, or experience prolonged and uncontrollable bleeding. You may need to take a break or “hold” your medication for medical or dental procedures. Talk to your care provider or dentist before any scheduled procedures. Continued on the next page MERCAPTOPURINE ORAL CHEMOTHERAPY EDUCATION Page 4 Possible Side Effect Management Decreased hemoglobin, part of the red blood cells that carry iron and oxygen Your hemoglobin should be monitored using a blood test. When your hemoglobin is low, you may notice that you get tired or fatigued more easily. Try to get 7–8 hours of sleep per night. Avoid operating heavy machinery if you feel too tired. Find a balance between work and rest. Stay as active as possible, but know that it is okay to rest as needed. You might notice that you are more pale than usual. Let your healthcare provider know right away if you experience any of the following: Shortness of breath Dizziness Palpitations Changes in liver function Your liver function will be checked periodically by a simple blood test. Contact your care provider if you notice any of the following: Yellowing of the skin or whites of your eyes Dark or brown urine Bleeding or bruising If you experience ANY uncontrolled side effect, call your physician or healthcare center immediately: INSTITUTIONAL CONTACT INFO Pregnancy, sexual activity, and contraception Women should not become pregnant and men should not get a partner pregnant while taking mercaptopurine. Men and women of childbearing age and potential should use effective contraception during therapy and for a minimum of one month after the last dose of mercaptopurine. Do not breastfeed while taking mercaptopurine and for one month after the last dose of mercaptopurine. Inform your care provider if you become pregnant. It is safe to hug and kiss. Special precautions may be needed for sexual activity while on oral chemotherapy, and you are encouraged to ask your care provider. Obtaining medication Talk with your care provider about the process for obtaining your mercaptopurine. PHARMACY OR SPECIALTY PHARMACY CONTACT INFO MERCAPTOPURINE ORAL CHEMOTHERAPY EDUCATION Page 5 Additional resources Product website: www.purixan us.com Product prescribing information: www.accessdata.fda.gov/drugsatfda docs/label/2011/009053s032lbl.pdf; www.purixan us.com/resources/Package Insert.pdf Product resources: www.purixan us.com/information instructions/#info Updated – February 5, 2018 Additional instructions Important notice: The Association of Community Cancer Centers ACCC , Hematology/Oncology Pharmacy Association HOPA , National Community Oncology Dispensing Association, Inc. NCODA , and Oncology Nursing Society ONS have collaborated in gathering information for and developing this patient education guide. This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this medication by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Oral Chemotherapy Education OCE sheets are provided as a free educational resource for patients with cancer in need of concise, easy to understand information about oral cancer drugs. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2018 by Hematology/Oncology Pharmacy Association. All rights reserved.