Medication: Toceranib

Your cat has been prescribed toceranib to shrink or reduce the growth rate of tumors. It is licensed in the dog for treating mast cell tumors.

Key points: 
• Targeted therapy that inhibits Tyrosine kinase and reduces the growth of blood vessels in tumors.
• Do not handle toceranib if you are pregnant, breastfeeding, under 18, immunosuppressed or receiving chemotherapy or immunosuppressive drugs.
• Aways wear gloves to handle the tablets/capsules and wash your hands afterwards.
• Never crush or split tablets or open capsules.
• Cats will excrete toxic products for up to 7 days after administration so precautions must be followed to reduce exposure to other people and pets.
• Dosage: the frequency of dosing varies and should be clearly stated on the packaging provided by your veterinarian.
* STOP the drug if your pet experiences side-effects or the feces become black or you notice fresh blood in them. 

This information sheet is designed to help answer commonly asked questions and help you give the medication safely and effectively to your pet. It does not contain all available information for this medication. If you have other questions or need more information, contact your veterinarian or pharmacist. Always follow the dosing instructions provided by your veterinarian.

Name

• Toceranib phosphate (to-cera-nib).

Brand name

• Palladia ®.

Class of drug

• A tyrosine kinase (TK) inhibitor.

Storage

• Store at controlled room temperature 20°-25° C (68°-77° F).

Toceranib is licensed for the treatment of mast cell tumors in dogs. It is also used in cats to treat mast cell tumors and a variety of other tumors off license as it can reduce cancer cell growth and reduce the blood vessels in a tumor.

Toceranib is given orally as film-coated tablets that are quite large. Cats will usually be treated with a small (10 mg) or medium (15 mg) tablet. The tablets must never be crushed or split but must be given whole directly into the mouth.

Handling toceranib

• Do not handle toceranib if you are pregnant, breastfeeding, under 18, immunosuppressed or receiving chemotherapy or immunosuppressive drugs.
• Aways wear gloves to handle the tablets and wash your hands afterwards.
• Never crush or split tablets as it can result in dust which could be dangerous to those around.
• Keep your cat’s drugs in the container supplied. This should be a child proof container.
• Store them in a safe place and always out of the reach of children and pets.
• Toceranib tablets are large and need to be given whole. Therefore they should be given directly into the mouth. Make sure you wash them down with some food or water by syringe afterwards to prevent them getting stuck.
• If you find a tablet on the floor after administering it to your cat. Wear gloves to pick it up and bag it. Do not give another dose until you have spoken to your veterinarian.
• If you are unable to give oral medication to your cat, please contact your veterinarian for advice.

The following adverse reactions have been noted:

• Gastrointestinal symptoms (rare): not eating, nausea, vomiting, diarrhea.
• Changes in feces: Dark or tarry feces or fresh blood in the feces.
• Low white blood cell count (leukopenia or neutropenia) – regular blood tests will monitor the white blood cell counts.
• Low platelet counts (thrombocytopenia) (uncommon).
• Low red blood cell counts (anemia) (rare).
• Increased liver parameters on blood tests.
• Increased protein in the urine.

Stop treatment and contact your veterinarian if you notice any of the following changes in your cat:

• Refusal to eat
• Vomiting or watery stools (diarrhea), especially if more frequent than twice in 24 hours
• Black tarry stools
• Bright red blood in vomit or stools
• Unexplained bruising or bleeding.

Drug interactions

Some drugs may interact with toceranib. If your cat is taking other medications or supplements, please check these with your veterinarian before starting treatment.

If NSAIDs are given alongside toceranib, there is an increased risk of gastrointestinal ulceration or perforation. NSAIDs should therefore only be given on the days when toceranib is NOT given.

The duration of treatment depends on the cat’s response to the medication and the type of tumor involved.

All unused toceranib should be returned to your veterinary practice for disposal and must not be placed in household waste.

If you miss a dose, give the dose as soon as possible but do not give a double dose.

Contact your veterinarian immediately if you have given your cat an overdose of toceranib. It can be highly toxic if an overdose is administered.

If your pet is unwell, contact your veterinarian for advice.

Toceranib should only be given to the cat that it has been prescribed for. If accidentally given to other pets, contact your veterinarian for advice.

Care must be taken to handle this medication safely:

• Keep in a secure storage area out of reach of children.
• Keep children away from feces, urine, or vomit of treated cats.
• As toceranib will be present in feces, urine and vomit of cats under treatment, protective gloves must be worn when cleaning up after the treated pet and any feces, urine or vomit and any disposable towels used in the clean up should be disposed in a sealed plastic bag.

If accidentally consumed by a human, speak to your primary care physician or poison control center.

Handling your cat

Your cat will excrete products from the chemotherapy drug after each toceranib tablet has been given. This period is referred to as the “barrier” period. As there is a small risk of you absorbing these toxic products, there are some sensible precautions that you should take to reduce your exposure during this time. These precautions should be taken throughout treatment and for 7 days after the last tablet is given.

• Wear gloves when handling any urine, feces, vomit or saliva from your cat.
• Always wash your hands after handling your cat and before eating or drinking.
• The following people should minimize direct contact with your cat:
  • Pregnant or breastfeeding women
  • Young children who do not understand the need for hand washing after contact
  • Immunosuppressed or receiving chemotherapy or immunosuppressive drugs.
• Cat litter trays should be lined with plastic litter tray liners and filled with clumping cat litter. This is to prevent contaminated dust.
• Wear gloves when handling the litter tray contents.
• Empty the tray by lifting all the litter out with the liner as soon as possible after soiling to prevent your cat from scratching around in their dirty tray. It may be sensible to use a smaller amount of litter when you refill it during this time. Covered litter trays will restrict the amount of dust that can be spread into the air.
• If your cat has an accident in the house or has soiled itself, you should wear gloves to clean the area as quickly as possible using copious amounts of soapy water. Use disposable paper towels to dry the area and dispose of these in a plastic bag in an outside bin.
• Your cat’s bedding should be washed regularly as some toxic products may end up on your cat’s coat when they lick themselves.
• There is no risk to other pets in the home from sharing water bowls or toileting in the same litter tray.

Your pet will require blood and urine tests to be checked regularly throughout treatment. The frequency will vary depending on the treatment protocol your pet is receiving. Your veterinarian will want to monitor your pet to make sure that treatment is working and to monitor any side-effects. Blood tests will need to be performed prior to starting treatment and then at 2 weeks, 4 weeks, 8 weeks and 12 weeks after starting treatment and then every 3 months thereafter. The results of blood tests and any adverse effects may mean that toceranib is temporarily stopped (drug holiday) and/or the dose is adjusted. Bloods will need to be checked 2 weeks after any dose change.

Further information 

If you have any concerns, further information on toceranib can be found on the package insert and the following websites:

Europe & UK

• European Medicines Agency Palladia®. Website: www.ema.europa.eu/en/documents/product-information/palladia-epar-product-information_en.pdf 

US

• Zoetis (US) Palladia®. Website: www.zoetisus.com/content/_assets/docs/Petcare/Palladia-Client-Information-Form-2022.pdf

Always follow the recommended dosage and contact your veterinary team or pharmacist if you have any questions regarding your cat’s medication.