• Oral — Treatment of cutaneous T-cell lymphoma (cutaneous manifestations) in patients who have failed at least one previous systemic therapy.
• Topical — Treatment of cutaneous T-cell lymphoma (cutaneous manifestations) in Stage IA or IB patients who have refractory/persistent lesions and have not responded to or tolerated other treatments.

Contraindicated in:

• Hypersensitivity
• Concurrent use of gemfibrozil
• OB: Pregnancy (may cause fetal harm)
• Lactation: Avoid breastfeeding.

Use Cautiously in:

• Hepatic impairment (may ↓ elimination)
• Renal impairment (may alter protein binding)
• Diabetic patients (concurrent use with some antidiabetics may increase the risk of hypoglycemia)
• Patients with child-bearing potential/male patients with partners who have child-bearing potential
• Geri: Elderly patients may be more sensitive to drug effects
• Pedi: Safe and effective use in pediatric patients has not been established.

Oral

EENT: new/worsening cataracts.

CV: peripheral edema.

GI: PANCREATITIS, abdominal pain, nausea, anorexia, diarrhea, liver function abnormalities, vomiting.

Derm: dry skin, rash, alopecia, exfoliative dermatitis, photosensitivity.

Endo: hyperlipidemia, hypercholesterolemia, hypothyroidism.

Hemat: anemia, leukopenia.

Neuro: headache, weakness, insomnia , headache.
Misc: flu-like syndrome.

Topical

CV: edema.

Derm: pain, pruritus, skin disorder, rash.

Endo: hyperlipidemia.

Hemat: leukopenia.
Misc: lymphadenopathy.

Drug-Drug:

• Interactions are noted for oral use, but may occur with topical use especially with high dose/prolonged treatment.
• ↑levels and risk of toxicity with gemfibrozil; concurrent use not recommended.
• Combination regimen of paclitaxel and carboplatin↑ levels.
• May act as an inducer of the CYP3A4 enzyme system; may ↓ levels and effectiveness of substrates of the CYP3A4 system including atorvastatin, tamoxifen, paclitaxel, and hormonal contraceptives.
• Vitamin A may ↑ risk of toxicity (limit supplementation to <15,000 IU/day).
• Concurrent use of insulin, sulfonylureas, or thiazolidinediones in diabetic patients may ↑ risk of hypoglycemia.
• Topical — Concurrent use with DEET (N,N-diethyl-m-toluamide)-containing insect repellents may ↑ risk of DEET toxicity and should be avoided.

(Generic available)

• Capsules: 75 mg;
• Topical gel: 1% (contains dehydrated alcohol and propylene glycol);

• PO (Adults): 300 mg/m² once daily; dosage to be adjusted based on tolerance/toxicity.
• Topical (Adults): Apply once every other day for 1 wk, increase at weekly interval to once daily, then twice daily, then 3 times daily and finally four times daily as tolerated, continued as long as benefit is derived.

Targretin

• Binds and inactivates selected retinoid X receptors (RXRs) that are ultimately responsible for cellular differentiation and proliferation. Inhibits growth of some tumor cell lines including lines of hematopoetic and squamous cell origin.

• Decreased spread of cutaneous T-cell lymphoma.

Therapeutic Classification: antineoplastics

Pharmacologic Classification: retinoids

Absorption: Well absorbed following oral administration, absorption is enhance by a fat-containing meal. Some systemic absorption follows topical application.

Distribution: Unknown.

Protein Binding: >99%.

Metabolism/Excretion: Mostly metabolized by the liver, mainly by the CYP3A4 enzyme system; some metabolites may be pharmacologically active. Excreted almost entirely via hepatobiliary elimination, <1% excreted in urine.

Half-life: 7 hr.

(improvement in lesions)

† Some responses took longer.

• Instruct patient to take or apply bexarotene as directed. Take missed doses as soon as remembered unless close to time for next dose; do not double doses.
• Advise patient to avoid touching broken or leaking capsules and notify pharmacist. If contents get on skin, immediately wash area with soap and water and notify health care professional. Do not use capsules after expiration date.
• Advise patient to notify health care professional immediately if signs and symptoms of pancreatitis (persistent nausea, vomiting and abdominal or back pain) occur.
• Caution patient to wear protective clothing and avoid sunlight and artificial ultraviolet light to prevent phototoxocity reactions.
• Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications, especially vitamin A.
• Caution patient that bexarotene is teratogenic and should be avoided during pregnancy. Pregnancy tests will be taken before starting and monthly during therapy. Effective contraception must be used 1 mo before beginning therapy, during, and 1 mo following therapy. Two forms of contraception are recommended with at least 1 being condom, diaphragm, cervical cap, IUD, or spermacide. Patients should not breastfeed during therapy. Male patients whose partner is pregnant or capable of becoming pregnant must use a condom during and for at least 1 mo after completion of therapy and should discuss precautions with health care professional.
• Explain need for regular blood tests to patient.
• Topical: Advise patient to avoid showering, bathing, or swimming for at least 3 hrs after application. Avoid insect repellent containing DEET or other products containing DEET during therapy. Keep gel away from flame; contains alcohol.
• Inform patient that redness, itching, burning, irritation, and scaling at application area may occur; notify health care professional if they become troublesome.

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