Toceranib

What it is used for

• Malignancies (Off-label)
• Patnaik grade II or III, recurrent, cutaneous mast cell tumors (Label Dose)
• Patnaik grade II or III, recurrent, cutaneous mast cell tumors (Clinical Experience Dose)
• Mast cell tumours and other malignancies

How it is given

Possible side effects

• Diarrhea (can be severe)
• Decreased or loss of appetite
• Lameness
• Weight loss
• Gastrointestinal bleeding (blood in stool, melena)
• Muscle cramping
• Neutropenia
• Hypoalbuminemia
• Thromboembolic disease (including pulmonary emboli)
• Vasculitis
• Pancreatitis
• Nasal depigmentation
• Change in coat or skin color
• Epistaxis

Cautions & contraindications

• Breeding, pregnant, or lactating bitches
• Dogs less than 24 months of age or weighing less than 5 kg (safe use not evaluated)
• Pregnant or lactating bitches
• Dogs < 2 years old
• Dogs < 5 kg
• Patients with any signs of gastrointestinal haemorrhage
• Known hypersensitivity to toceranib
• **Surgical Warning:** Because toceranib can cause vascular dysfunction leading to edema and thromboembolism, **wait at least 3 days** after stopping the drug before performing surgery. **Systemic Mastocytosis:** When used in the presence of systemic mast cell tumors, significant mast cell degranulation may occur, leading to severe adverse effects (e.g., anaphylaxis, GI ulceration). Attempt to rule out systemic mastocytosis prior to starting therapy. **Hazardous Drug Handling:** Use caution when handling this medication. Wear gloves and follow standard veterinary cytotoxic drug handling protocols. **Toxicity Mimicry:** Toceranib can cause clinical signs similar to those seen with aggressive mast cell tumors; if these occur, stop the drug and re-evaluate the patient.

Drug interactions

• NSAIDs (e.g., piroxicam, carprofen): Increased risk of gastrointestinal ulceration or perforation. Use with extreme caution; never give on the same day as toceranib to avoid exacerbating GI toxicity.
• CYP3A4 Inhibitors (e.g., ketoconazole, fluconazole, itraconazole, clarithromycin, verapamil, grapefruit juice): May theoretically increase toceranib plasma concentrations and toxicity. Use with caution.
• Corticosteroids: Increased risk of severe gastrointestinal toxicity and ulceration.
• NSAIDs: Increased risk of severe gastrointestinal toxicity and ulceration.
• Other chemotherapeutic agents: Potential for additive myelosuppression and systemic toxicity. Use with caution.

Frequently asked questions