Tevimbra (tislelizumab-jsgr)
Drug Overview
Tevimbra is an immune checkpoint inhibitor (PD-1 blocker) used to treat unresectable or metastatic esophageal squamous cell carcinoma (ESCC) after prior systemic chemotherapy without PD-(L)1 inhibitors [1][4][6].
Mechanism of Action:
Blocks PD-1 on T-cells, preventing cancer cells from evading immune detection [1].
Enhances T-cell-mediated tumor destruction [4].
Dosage & Administration:
200 mg IV infusion every 3 weeks until disease progression or intolerable toxicity [4][6].
First infusion: Administer over 60 minutes [6].
Subsequent infusions (if tolerated): May reduce to 30 minutes [4][6].
Patient Education Before Administration
Pre-Infusion Assessment:
Verify allergies, medical history (autoimmune disorders, organ transplants, pregnancy) [1][5].
Confirm pregnancy status (avoid pregnancy for ≥4 months post-treatment) [1][5].
Review concurrent medications (risk of immune-mediated interactions) [1][5].
Infusion Preparation:
Inspect solution: Should be clear to slightly opalescent, colorless to pale yellow [6].
Patient Instructions:
Wear comfortable clothing (easy IV access) [2].
Hydrate well before the appointment [2].
Arrange transportation (fatigue/dizziness may occur post-infusion) [2][5].
Administration Guidelines
IV Setup:
Use 0.9% NaCl or 5% dextrose as diluent if needed [6].
Administer via IV line with a 0.2–5 micron filter [6].
Infusion Monitoring:
First dose: Monitor for hypersensitivity reactions (flushing, dyspnea, rash) [6].
Vital signs: Check before, during, and after infusion [6].
Rate Adjustments:
If mild reaction (Grade 1-2): Pause infusion, manage symptoms, resume at slower rate [6].
If severe reaction (Grade 3-4): Stop infusion permanently [6].
Managing Side Effects & Reactions
Common Side Effects:
Fatigue, rash, diarrhea, immune-mediated reactions (colitis, pneumonitis, hepatitis) [1][6].
Severe Immune-Mediated Reactions:
Pneumonitis: Monitor for dyspnea, hypoxia. Withhold Tevimbra if Grade 3, discontinue if Grade 4 [6].
Hepatitis: Check LFTs (AST/ALT elevation). Hold for Grade 3, discontinue for Grade 4 [6].
Colitis: Assess for diarrhea, abdominal pain. Requires corticosteroids if severe [6].
Infusion-Related Reactions (IRRs):
Symptoms: Fever, chills, hypotension, flushing [6].
Management:
Mild IRR: Slow infusion rate, administer antihistamines/steroids[6].
Severe IRR: Stop infusion, initiate emergency protocols (epinephrine if anaphylaxis) [6].
Post-Infusion Monitoring & Education
Follow-Up:
Lab monitoring: CBC, LFTs, thyroid function (immune-mediated effects) [1][6].
Symptom tracking: Report persistent fever, diarrhea, or neurological changes [5].
Patient Discharge Instructions:
Avoid live vaccines during treatment [1][5].
Watch for delayed immune reactions (may occur weeks later) [6].
Seek emergency care for severe symptoms (chest pain, difficulty breathing) [5].
Nursing Documentation:
Record infusion start/stop time, vital signs, adverse reactions, and patient tolerance [3][6].
For full prescribing details, refer to the FDA label [6] or institutional protocols.
Citations:
[1] https://www.drugs.com/tevimbra.html
[2] https://www.tevimbra.com/escc/tevimbra-first-infusion/
[3] https://wtcs.pressbooks.pub/nursingskills/chapter/15-2-basic-concepts-of-administering-medications/
[4] https://www.msho.org/aws/MSHO/pt/sd/news_article/574548/_blank/layout_details/false
[5] https://medsafe.govt.nz/Consumers/CMI/t/TevimbraInj.pdf
[6] https://www.ncbi.nlm.nih.gov/books/NBK560654/
[7] https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/761232Orig1s000lbl.pdf
[8] https://www.rxlist.com/tevimbra-drug.htm
[9] https://www.ema.europa.eu/en/medicines/human/EPAR/tevimbra
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