Panobinostat is a histone deacetylase (HDAC) inhibitor. It is used in combination with bortezomib and dexamethasone to treat patients with multiple myeloma who have received at least 2 prior treatment regimens (including bortezomib and immunomodulatory agents).

Precautions for Panobinostat Administration

Pre-Administration Assessment

Cardiac Function Assessment: A baseline electrocardiogram (ECG) is required to confirm that the QTcF interval is < 450 milliseconds.

Hematological Assessment: Ensure baseline platelet count ≥ 100×10⁹/L and absolute neutrophil count (ANC) ≥ 1.5×10⁹/L.

Liver Function Assessment: Patients with mild to moderate hepatic impairment need adjustment of the starting dose, while patients with severe hepatic impairment should avoid using the drug.

Drug Interaction Assessment: Avoid concurrent use with strong CYP3A4 inhibitors or inducers, and avoid use with drugs that prolong the QT interval.

Dosage and Administration Regimen

Starting Dose: 20mg, taken orally every other day, 3 times a week (on Days 1, 3, 5, 8, 10, and 12).

Treatment Cycle: A 21-day cycle, with combination use of bortezomib and dexamethasone in the first 8 cycles.

Treatment Extension: For patients who achieve clinical benefits and have no unresolved severe toxicity, an extension of 8 cycles may be considered (total treatment duration not exceeding 16 cycles).

Patients with Hepatic Impairment

Mild hepatic impairment: Reduce the dose to 15mg.

Moderate hepatic impairment: Reduce the dose to 10mg.

Severe hepatic impairment: Avoid use.

Management of Drug Interactions

Strong CYP3A4 Inhibitors: Such as ketoconazole, clarithromycin, etc. The dose of panobinostat needs to be reduced to 10mg.

Strong CYP3A4 Inducers: Such as rifampicin, carbamazepine, etc. Concurrent use should be avoided.

Sensitive CYP2D6 Substrates: Such as metoprolol, desipramine, etc. Concurrent use should be avoided.

Drugs That Prolong QT Interval: Such as amiodarone, chloroquine, etc. Concurrent use is not recommended.

Panobinostat Administration Monitoring

Cardiotoxicity Monitoring

ECG Monitoring: ECG examination is required before treatment and before each cycle.

Electrolyte Monitoring: Regularly monitor serum potassium and magnesium levels, and correct electrolyte abnormalities.

Symptom Monitoring: Pay attention to cardiac symptoms such as chest pain, palpitations, and syncope.

Management Measures: If QTcF ≥ 480 milliseconds, suspend drug administration and correct electrolyte abnormalities.

Diarrhea Monitoring

The incidence of diarrhea is 68%, of which 25% is severe.

When abdominal cramps or loose stools occur, anti-diarrheal treatment (such as loperamide) should be initiated immediately.

For moderate to severe diarrhea, drug administration needs to be suspended or the dose reduced.

Nausea and Vomiting Management: Consider prophylactic use of antiemetics.

Liver Function Monitoring

Monitoring Indicators: ALT, AST, total bilirubin, etc.

Monitoring Frequency: Regular monitoring before and during treatment.

Management Measures: When hepatotoxicity occurs, adjust the dose until liver function recovers.