Performance Comparison of Microfluidic and Immunomagnetic Platforms for Pancreatic CTC Enrichment
November 15, 2025
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Brand Name :
Caprelsa
(United States) [Available]Synonyms :
vandetanib
Class :
Anticancer & protein kinase inhibitors
Brand Name :
Caprelsa
(United States) [Available]Synonyms :
vandetanib
Class :
Anticancer & protein kinase inhibitors
Dosage Forms & Strengths
Tablet, Oral
100 mg
300 mg
Note: Not recommended for patients with recent surgery or suffering from major injury and blood loss. Do not begin treatment until OTcF < 450 msec. Maintain serum calcium and magnesium > 4 mEQ/L to avoid the risk of QT prolongation.
Advanced/metastatic Thyroid cancer:
300
mg
Orally
once a day
(continue the dose based on symptoms, stop if shows any unacceptable toxicity)
Dose Adjustments
Reduce the dose from 300 mg to 200 mg or further 100 if Cardiac: QTcF > 500 msec, Severe diarrhea, Recurrent toxicity grade-1 occurs
No safe and efficacious dosage is available
Refer to adult dosing
It may diminish the effect when combined with phenobarbital by affecting the intestinal/hepatic enzyme CYP3A4
When nafcillin combines with vandetanib, nafcillin will decrease the effect of action of vandetanib by affecting enzyme CYP3A4 metabolism.
may increase the QT-prolonging effect and enhance the risk of ventricular arrhythmias
may increase the QT-prolonging effect and enhance the risk of ventricular arrhythmias
may increase the QT-prolonging effect and enhance the risk of ventricular arrhythmias
may increase the QT-prolonging effect and enhance the risk of ventricular arrhythmias
may increase the QT-prolonging effect and enhance the risk of ventricular arrhythmias
may increase the QT-prolonging effect and enhance the risk of ventricular arrhythmias
may increase the QT-prolonging effect
may increase the QT-prolonging effect
may increase the QT-prolonging effect
may increase the QT-prolonging effect and enhance the risk of bradycardia, hypokalemia
may increase the QT-prolonging effect and enhance the risk of bradycardia, hypokalemia
may increase the QT-prolonging effect and enhance the risk of bradycardia, hypokalemia
may increase the QT-prolonging effect and enhance the risk of bradycardia, hypokalemia
may increase the QT-prolonging effect and enhance the risk of bradycardia, hypokalemia
may increase the QT-prolonging effect and enhance the risk of bradycardia, hypokalemia
may increase the QT-prolonging effect and enhance the risk of bradycardia, hypokalemia
may increase the QT-prolonging effect and enhance the risk of bradycardia, hypokalemia
may increase the QT-prolonging effect and enhance the risk of bradycardia, hypokalemia
may increase the QT-prolonging effect and enhance the risk of bradycardia, hypokalemia
may increase the QT-prolonging effect and enhance the risk of bradycardia, hypokalemia
may increase the QT-prolonging effect and enhance the risk of bradycardia, hypokalemia
may increase the QT-prolonging effect and enhance the risk of bradycardia, hypokalemia
may increase the QT-prolonging effect and enhance the risk of bradycardia, hypokalemia
may increase the QT-prolonging effect and enhance the risk of bradycardia, hypokalemia
may increase the QT-prolonging effect and enhance the risk of bradycardia, hypokalemia
may increase the QT-prolonging effect and enhance the risk of bradycardia, hypokalemia
QTc interval is increased both by lenvatinib and vandetanib
CYP3A enhancers (strong) may increase plasma concentrations of the active metabolite(s) of vandetanib and reduce the the bioavailability
when used together, entrectinib and vandetanib both increase the QTc interval
when used together, encorafenib and vandetanib both increase the QTc interval
the interaction may enhance the hypertensive effect
the interaction may increase the active metabolite serum concentration of artesunate
vandetanib may increase the cardiotoxic and hepatotoxic effects of avelumab
the interaction with vandetanib may enhance the risk of osteonecrosis
may increase the serum level of CYP3A4 substrates
vandetanib may enhance the serum concentration of digoxin
may reduce the serum levels of CYP3A4 substrates
may enhance the serum levels of CYP3A4 substrates
may increase the QT-prolonging effect
may enhance the serum levels of CYP3A4 substrates
may reduce the serum levels of CYP3A4 substrates
vandetanib may enhance the serum concentration of metformin
vandetanib may increase the hepatotoxic effects of pembrolizumab
may enhance the risk of ventricular arrhythmias
may increase the hypertension effects of solriamfetol
the effect of vandetanib is decreased by lorlatinib, by altering intestinal or hepatic CYP3A4 enzyme metabolism
Action and spectrum
Vandetanib (ZD-6474) is a potent and selective tyrosine kinase inhibitor that targets three key receptors involved in tumor growth and progression:
VEGFR (Vascular Endothelial Growth Factor Receptor): Inhibits angiogenesis, the formation of new blood vessels that supply tumors.
EGFR (Epidermal Growth Factor Receptor): Blocks pathways critical for tumor cell proliferation and survival.
RET (REarranged during Transfection): Inhibits RET-mediated signaling, which is especially important in certain thyroid cancers such as medullary thyroid carcinoma.
These targets are implicated in various cancers, including non-small cell lung cancer (NSCLC) and medullary thyroid cancer. Vandetanib’s multi-targeted inhibition contributes to its antitumor activity across tumors dependent on these signaling pathways.
Frequency defined:
>40-20%
Hypertension (33%)
Prolong QT interval on ECG (14%)
Acne vulgaris (35%)
Hypocalcemia rash (53%)
Abdominal pain
Abdominal appetite
Fatigue (24%)
Headache (26%)
>10%
Alopecia (8%)
Hypothyroidism (6%)
Cerebral ischemia
Muscle spasm
Blurred vision (9%)
Proteinuria
<1%:
Heart failure
Intestinal perforation
pancreatitis
Frequency not defined:
Melena
Cerebral hemorrhage
Retinal artery occlusion
Postmarketing:
Wound healing impairment
Arterial rupture
Vandetanib can prolong the QT interval, with reports of torsades de pointes and sudden death. It is contraindicated in patients with electrolyte imbalances (hypocalcemia, hypokalemia, hypomagnesemia) or long QT syndrome. Electrolytes must be corrected before starting treatment and monitored regularly. Avoid using other QT-prolonging drugs, or if unavoidable, increase ECG monitoring. Due to its long half-life (19 days), ECGs should be done at baseline, 2–4 weeks, 8–12 weeks, and every 3 months during treatment. QT monitoring should also be repeated after dose reductions or interruptions over 2 weeks, as adverse effects may persist.
Contraindication
Congenital long QT syndrome
Cautions
Vandetanib use should be carefully evaluated in patients with slow-growing or asymptomatic disease due to its potential risks. Caution is advised when co-administered with strong CYP3A4 inducers, which may reduce its effectiveness, though CYP3A4 inhibitors do not significantly impact drug levels.
Serious skin reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis, have occurred and warrant permanent discontinuation if severe. Photosensitivity can occur during treatment and up to 4 months afterward.
Interstitial lung disease (ILD), sometimes fatal, has been reported; any unexplained respiratory symptoms should prompt discontinuation if ILD is confirmed. Cerebrovascular ischemic events and serious bleeding episodes, including fatal cases, have also been observed treatment should be stopped in such instances, especially with a recent history of hemoptysis.
Vandetanib can cause fetal harm, so pregnancy must be avoided during and for 4 months post-treatment. Heart failure, which may not always reverse, has also been reported.
Diarrhea is a common side effect, and antidiarrheal treatment is recommended to prevent electrolyte imbalances that could heighten the risk of QT prolongation. Hypothyroidism can develop; TSH levels should be monitored regularly and managed with thyroid hormone replacement if needed.
Pregnancy consideration: vandetanib is assigned under pregnancy category C based on animal studies.
Lactation: No data available for excretion in breast milk, it should be avoided due to potential side effects.
Pregnancy category:
Vandetanib is a tyrosine kinase inhibitor used mainly for medullary thyroid cancer. It targets RET, VEGFR-2, and EGFR, disrupting pathways involved in tumor growth and blood vessel formation (angiogenesis).
Pharmacokinetics
Absorption
Peak plasma concentration occurs approximately 6 hours after dosing (range: 4–10 hours).
Reaches steady state in about 3 months, with approximately 8-fold accumulation upon repeated dosing.
Distribution
Plasma protein binding: ~90%
Volume of distribution (Vd): 7450 liters, indicating extensive tissue distribution.
Metabolism
Primarily metabolized by the CYP3A4 enzyme in the liver.
Elimination/Excretion
Half-life: Approximately 19 days, contributing to prolonged drug exposure.
Clearance: 13.2 L/hour
Feces: 44%
Urine: 25%
(Based on a 21-day collection period after a single dose)
Take orally with or without food. Swallow tablets whole with water—do not crush. If unable to swallow, disperse the tablet in 2 oz of water, stir for ~10 minutes, and swallow immediately; rinse with 4 oz water and swallow again. This dispersion can also be given via nasogastric or gastrostomy tubes.
Generic Name: vandetanib
Pronounced: van-DET-a-nib
Why do we use vandetanib?
Vandetanib is prescribed for the treatment of medullary thyroid cancer that is inoperable or has metastasized to other parts of the body. It is available exclusively through the Vandetanib REMS (Risk Evaluation and Mitigation Strategy) Program, a restricted distribution system designed to ensure safe use.
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