(vor-IN-o-stat)

Trade Name: Zolinza

Drug Type:

Vorinostat is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. Vorinostat is classified as a "Histone Deacetylase Inhibitor". For more detail, see How Vorinostat Works below.

What Vorinostat Is Used For:

Vorinostat is used to treat relapsed or refractory cutaneous T-cell lymphoma (CTCL).

Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.

How Vorinostat Is Given:

The amount of Vorinostat that you will receive depends on many factors, including your general health or other health problems, and the type of cancer or condition you have. Your doctor will determine your exact dosage and schedule.

Side Effects:

Important things to remember about the side effects of Vorinostat:

• Most people will not experience all of the Vorinostat side effects listed. 
• Vorinostat side effects are often predictable in terms of their onset, duration, and severity.
• Vorinostat side effects are almost always reversible and will go away after therapy is complete.
• There is no relationship between the presence or severity of Vorinostat side effects and the effectiveness of the medication.
• Vorinostat side effects may be quite manageable. There are many options to minimize or prevent them.

The following Vorinostat side effects are common (occurring in greater than 30%) for patients taking Vorinostat:

• Fatigue
• Diarrhea
• Nausea
• Taste changes
• Increased blood glucose level (hyperglycemia)
• Increased creatinine level (transient)
• Increased level of protein in the urine
• Low platelet count (thrombocytopenia)

These are less common side effects (occurring in about 10-29%) of patients receiving Vorinostat:

• Loss of appetite (anorexia)
• Weight loss
• Muscle spasms
• Hair loss (alopecia)
• Dry mouth
• Chills
• Fever
• Vomiting
• Dizziness
• Constipation
• Low red blood cell count (anemia)
• Headache
• Itching
• Swelling in hands or feet
• Cough
• Upper respiratory infection
• Dehydration
• Shortness of breath

A rare, but serious side effect of Vorinostat is blood clots, including deep vein thrombosis (DVT) and pulmonary embolus.  You should seek emergency help and notify your health care provider immediately if you develop sudden chest pain and shortness of breath.  Notify your health care provider within 24 hours if you notice that one leg is swollen, red, painful and/or warm to touch and the other is not.

This list includes common and less common side effects for those taking Vorinostat. Vorinostat side effects that are very rare -- occurring in less than about 10 percent of patients -- are not listed here. But you should always inform your health care provider if you experience any unusual symptoms.

When to contact your doctor or health care provider:

Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:

• Chest pain
• Sudden onset of shortness of breath
• Severe bleeding

The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following:

• Nausea (interferes with ability to eat and unrelieved with prescribed medication).
• Vomiting (vomiting more than 4-5 times in a 24 hour period).
• Diarrhea (4-6 episodes in a 24-hour period).
• Unusual bleeding or bruising
• Black or tarry stools, or blood in your stools.
• Blood in the urine.
• Pain or burning with urination.
• Extreme fatigue (unable to carry on self-care activities).
• Swelling, redness and/or pain in one leg or arm and not the other
• Unable to eat or drink for 24 hours or have signs of dehydration: tiredness, thirst, dry mouth, dark and decreased amount of urine, or dizziness (particularly with standing).

Always inform your health care provider if you experience any unusual symptoms.

Precautions:

• Before starting Vorinostat treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). Do not take aspirin, or products containing aspirin unless your doctor specifically permits this.
• Do not receive any kind of immunization or vaccination without your doctor’s approval while taking Vorinostat.
• Inform your health care professional if you are pregnant or may be pregnant prior to starting Vorinostat. Pregnancy category D (Vorinostat may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus.)
• For both men and women: Do not conceive a child (get pregnant) while taking Vorinostat.  Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
• Do not breast feed while taking Vorinostat.

Self-Care Tips:

• Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
• You may be at risk of infection so try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your health care provider.
• Wash your hands often.
• Use an electric razor and a soft toothbrush to minimize bleeding.
• Avoid contact sports or activities that could cause injury.
• To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.
• Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing.
• In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
• Get plenty of rest.
• Maintain good nutrition.
• If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.
• For flu-like symptoms, keep warm with blankets and drink plenty of liquids. There are medications that can help reduce the discomfort caused by chills.
• Acetaminophen or ibuprofen may help relieve discomfort from fever, headache and/or generalized aches and pains. However, be sure to talk with your doctor before taking it.

Monitoring and Testing:

You will be checked regularly by your doctor while you are taking Vorinostat, to monitor side effects and check your response to therapy. Periodic blood work will be obtained to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor.

How Vorinostat Works:

Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue.   "Normal" cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition.  Cancerous cells lose this ability.  Cancer cells no longer have the normal checks and balances in place that control and limit cell division.  The process of cell division, whether normal or cancerous cells, is through the cell cycle.  The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division).

The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division.  Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division.  If the cells are unable to divide, they die.  The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink.  They also induce cell suicide (self-death or apoptosis).

Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific.  Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific.  The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective.  This is why chemotherapy is typically given in cycles.

Chemotherapy is most effective at killing cells that are rapidly dividing.  Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The "normal" cells will grow back and be healthy but in the meantime, side effects occur.  The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss.  Different drugs may affect different parts of the body.

Vorinostat is a Histone Deacetylase (HDAC) Inhibitor.  Histone Deacetylase is an enzyme that is normally present in the cells.  In some cancer cells, there is an overexpression of HDACs.  It is believed that inhibition of the HDAC activity causes cell cycle arrest and cell death.  The exact mechanism of action has not been fully described.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

Chemocare.com is designed to provide the latest information about chemotherapy to patients and their families, caregivers and friends. For information about the 4th Angel Mentoring Program visit www.4thangel.org