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OP RSH PRO00041680 ABDELRAHIM HCC 23-116 SAFETY LEAD- IN	

Types:      Research Oncology Treatment
Synonyms:  ABDELRAHIM, HCC 23-116, SAFETY LEAD- IN, PRO00041680

Cycle 1	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1			Research tolerance: -0/+0 days	Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:     HCC 23-116_Abdelrahim
		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for Zanzalintinib (XL-092) Treatment: Refer to Section 7.2.1.2  Protocol Access Hyperlink:    HCC 23-116_Abdelrahim
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Eligibility Review
			Nursing Orders
  	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Medical History
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Review Medications
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	ECOG Performance Status.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
		  	ONC NURSING COMMUNICATION 9	Interval: --	Occurrences: --	Comments:	Adverse Events assessment
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Physical exam.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
			Nursing Orders
  	ONC NURSING COMMUNICATION 53	Interval: --	Occurrences: --	Comments:	PRO Evaluations.FACT-Hep questionnaire
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Window for hematology tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Clinical Chemistry. NOTE regarding serum chemistries during treatment: Only in cases where pneumonitis (ILD) is suspected during study treatment, per PI discretion, also do C-Reactive Protein (CRP) testing. Window for tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --			Labs
  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --			Labs
  	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	T3	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	T4, FREE	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --			Labs
  	ONC NURSING COMMUNICATION 37	Interval: --	Occurrences: --	Comments:	Infectious disease tests. As clinically Indicated
			Labs
  	URINALYSIS	Interval: --	Occurrences: --		  	URINE PROTEIN/CREATININE RATIO, RANDOM	Interval: --	Occurrences: --			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	For women of child-bearing potential.
		☐	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	Within 1 hour before first study treatment on Cycle 1 Day 1 (single). If abnormal, including a QTcF value > 470 ms, proceed immediately with 2 additional ECGs to provide a triplicate.Cycle 2 Day 1 (single). If abnormal, including a QTcF value > 470 ms, proceed immediately with 2 additional ECGs to provide a triplicate.
			Chemotherapy
  	ONC NURSING COMMUNICATION 54	Interval: --	Occurrences: --	Comments:	Zanzalintinib XL-092. Daily. XL092 tablets will be administered orally at assigned daily dose levels. Subjects will take study medication orally once daily (qd). Subjects should be instructed to fast (nothing to eat except water) for at least 2 hours before and at least 1 hour after taking XL092.Paper Rx order will be submitted to IDS for prescription dispensing of Zanzlintinib.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Drug Diary Review
				Day 8	Perform every 1 day x1			Research tolerance: -0/+0 days	Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:     HCC 23-116_Abdelrahim
		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for Zanzalintinib (XL-092) Treatment: Refer to Section 7.2.1.2  Protocol Access Hyperlink:    HCC 23-116_Abdelrahim
			Nursing Orders
  	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Medical History
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Review Medications
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	ECOG Performance Status.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
		  	ONC NURSING COMMUNICATION 9	Interval: --	Occurrences: --	Comments:	Adverse Events assessment
		  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Monitoring of Durvalumab/Tremelimumab dose administration - On the first infusion day (cycle 1 day 1 (cohort B) and cycle 2 day 1 (cohort A), participants will be monitored, and vital signs collected/recorded in eCRF prior to, during and after infusion(s) described below.
I. BP and pulse will be collected from participants before, during, and after each infusion(s) at the following times:
1. Prior to the beginning of the infusion(s), measured once from between approximately 30 to 0 minutes [i.e., the start of the infusion(s)])
2. Approximately halfway through each infusion(s),
3. At the end of the infusions approximately 120 ± 15 minutes
a. If the infusion(s) takes longer than expected minutes, then BP and pulse measurements should follow the principles as described above or be taken more frequently if clinically indicated. A 1-hour observation period is recommended after the first infusion of durvalumab.
4. Subsequent durvalumab infusions - BP, pulse and other vital signs should be measured, collected/recorded in eCRF prior to the start of the infusion. Patients should be carefully monitored, and BP and other vital signs should be measured during and post infusion as per institution standard and as clinically indicated.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Physical exam.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Window for hematology tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Clinical Chemistry. NOTE regarding serum chemistries during treatment: Only in cases where pneumonitis (ILD) is suspected during study treatment, per PI discretion, also do C-Reactive Protein (CRP) testing. Window for tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --			Labs
  	ONC NURSING COMMUNICATION 37	Interval: --	Occurrences: --	Comments:	Infectious disease tests. As clinically Indicated
			Chemotherapy
  	ONC NURSING COMMUNICATION 54	Interval: --	Occurrences: --	Comments:	Zanzalintinib XL-092. Daily. XL092 tablets will be administered orally at assigned daily dose levels. Subjects will take study medication orally once daily (qd). Subjects should be instructed to fast (nothing to eat except water) for at least 2 hours before and at least 1 hour after taking XL092.Paper Rx order will be submitted to IDS for prescription dispensing of Zanzlintinib.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Drug Diary Review
				Day 15	Perform every 1 day x1			Research tolerance: -0/+0 days	Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:     HCC 23-116_Abdelrahim
		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for Zanzalintinib (XL-092) Treatment: Refer to Section 7.2.1.2  Protocol Access Hyperlink:    HCC 23-116_Abdelrahim
			Nursing Orders
  	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Medical History
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Review Medications
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	ECOG Performance Status.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
		  	ONC NURSING COMMUNICATION 9	Interval: --	Occurrences: --	Comments:	Adverse Events assessment
		  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Monitoring of Durvalumab/Tremelimumab dose administration - On the first infusion day (cycle 1 day 1 (cohort B) and cycle 2 day 1 (cohort A), participants will be monitored, and vital signs collected/recorded in eCRF prior to, during and after infusion(s) described below.
I. BP and pulse will be collected from participants before, during, and after each infusion(s) at the following times:
1. Prior to the beginning of the infusion(s), measured once from between approximately 30 to 0 minutes [i.e., the start of the infusion(s)])
2. Approximately halfway through each infusion(s),
3. At the end of the infusions approximately 120 ± 15 minutes
a. If the infusion(s) takes longer than expected minutes, then BP and pulse measurements should follow the principles as described above or be taken more frequently if clinically indicated. A 1-hour observation period is recommended after the first infusion of durvalumab.
4. Subsequent durvalumab infusions - BP, pulse and other vital signs should be measured, collected/recorded in eCRF prior to the start of the infusion. Patients should be carefully monitored, and BP and other vital signs should be measured during and post infusion as per institution standard and as clinically indicated.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Physical exam.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Window for hematology tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Clinical Chemistry. NOTE regarding serum chemistries during treatment: Only in cases where pneumonitis (ILD) is suspected during study treatment, per PI discretion, also do C-Reactive Protein (CRP) testing. Window for tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --			Labs
  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --			Labs
  	URINALYSIS	Interval: --	Occurrences: --		  	URINE PROTEIN/CREATININE RATIO, RANDOM	Interval: --	Occurrences: --			Labs
  	ONC NURSING COMMUNICATION 37	Interval: --	Occurrences: --	Comments:	Infectious disease tests. As clinically Indicated
			Chemotherapy
  	ONC NURSING COMMUNICATION 54	Interval: --	Occurrences: --	Comments:	Zanzalintinib XL-092. Daily. XL092 tablets will be administered orally at assigned daily dose levels. Subjects will take study medication orally once daily (qd). Subjects should be instructed to fast (nothing to eat except water) for at least 2 hours before and at least 1 hour after taking XL092.Paper Rx order will be submitted to IDS for prescription dispensing of Zanzlintinib.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Drug Diary Review
				Day 22	Perform every 1 day x1			Research tolerance: -0/+0 days	Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:     HCC 23-116_Abdelrahim
		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for Zanzalintinib (XL-092) Treatment: Refer to Section 7.2.1.2  Protocol Access Hyperlink:    HCC 23-116_Abdelrahim
			Nursing Orders
  	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Medical History
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Review Medications
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	ECOG Performance Status.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
		  	ONC NURSING COMMUNICATION 9	Interval: --	Occurrences: --	Comments:	Adverse Events assessment
		  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Monitoring of Durvalumab/Tremelimumab dose administration - On the first infusion day (cycle 1 day 1 (cohort B) and cycle 2 day 1 (cohort A), participants will be monitored, and vital signs collected/recorded in eCRF prior to, during and after infusion(s) described below.
I. BP and pulse will be collected from participants before, during, and after each infusion(s) at the following times:
1. Prior to the beginning of the infusion(s), measured once from between approximately 30 to 0 minutes [i.e., the start of the infusion(s)])
2. Approximately halfway through each infusion(s),
3. At the end of the infusions approximately 120 ± 15 minutes
a. If the infusion(s) takes longer than expected minutes, then BP and pulse measurements should follow the principles as described above or be taken more frequently if clinically indicated. A 1-hour observation period is recommended after the first infusion of durvalumab.
4. Subsequent durvalumab infusions - BP, pulse and other vital signs should be measured, collected/recorded in eCRF prior to the start of the infusion. Patients should be carefully monitored, and BP and other vital signs should be measured during and post infusion as per institution standard and as clinically indicated.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Physical exam.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Window for hematology tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Clinical Chemistry. NOTE regarding serum chemistries during treatment: Only in cases where pneumonitis (ILD) is suspected during study treatment, per PI discretion, also do C-Reactive Protein (CRP) testing. Window for tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --			Labs
  	ONC NURSING COMMUNICATION 37	Interval: --	Occurrences: --	Comments:	Infectious disease tests. As clinically Indicated
			Chemotherapy
  	ONC NURSING COMMUNICATION 54	Interval: --	Occurrences: --	Comments:	Zanzalintinib XL-092. Daily. XL092 tablets will be administered orally at assigned daily dose levels. Subjects will take study medication orally once daily (qd). Subjects should be instructed to fast (nothing to eat except water) for at least 2 hours before and at least 1 hour after taking XL092.Paper Rx order will be submitted to IDS for prescription dispensing of Zanzlintinib.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Drug Diary Review
					
Cycle 2	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1			Research tolerance: -0/+0 days	Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:     HCC 23-116_Abdelrahim
		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for Zanzalintinib (XL-092) Treatment: Refer to Section 7.2.1.2  Protocol Access Hyperlink:    HCC 23-116_Abdelrahim
			Nursing Orders
  	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Medical History
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Review Medications
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	ECOG Performance Status.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
		  	ONC NURSING COMMUNICATION 9	Interval: --	Occurrences: --	Comments:	Adverse Events assessment
		  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Monitoring of Durvalumab/Tremelimumab dose administration - On the first infusion day (cycle 1 day 1 (cohort B) and cycle 2 day 1 (cohort A), participants will be monitored, and vital signs collected/recorded in eCRF prior to, during and after infusion(s) described below.
I. BP and pulse will be collected from participants before, during, and after each infusion(s) at the following times:
1. Prior to the beginning of the infusion(s), measured once from between approximately 30 to 0 minutes [i.e., the start of the infusion(s)])
2. Approximately halfway through each infusion(s),
3. At the end of the infusions approximately 120 ± 15 minutes
a. If the infusion(s) takes longer than expected minutes, then BP and pulse measurements should follow the principles as described above or be taken more frequently if clinically indicated. A 1-hour observation period is recommended after the first infusion of durvalumab.
4. Subsequent durvalumab infusions - BP, pulse and other vital signs should be measured, collected/recorded in eCRF prior to the start of the infusion. Patients should be carefully monitored, and BP and other vital signs should be measured during and post infusion as per institution standard and as clinically indicated.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Physical exam.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
			Nursing Orders
  	ONC NURSING COMMUNICATION 53	Interval: --	Occurrences: --	Comments:	PRO Evaluations.FACT-Hep questionnaire
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Window for hematology tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Clinical Chemistry. NOTE regarding serum chemistries during treatment: Only in cases where pneumonitis (ILD) is suspected during study treatment, per PI discretion, also do C-Reactive Protein (CRP) testing. Window for tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --			Labs
  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --			Labs
  	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	T3	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	T4, FREE	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --			Labs
  	URINALYSIS	Interval: --	Occurrences: --		  	URINE PROTEIN/CREATININE RATIO, RANDOM	Interval: --	Occurrences: --			Labs
  	ONC NURSING COMMUNICATION 37	Interval: --	Occurrences: --	Comments:	Infectious disease tests. As clinically Indicated
			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	For women of child-bearing potential.
		☐	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Blood sample collection for future research
			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	Within 1 hour before first study treatment on Cycle 1 Day 1 (single). If abnormal, including a QTcF value > 470 ms, proceed immediately with 2 additional ECGs to provide a triplicate.Cycle 2 Day 1 (single). If abnormal, including a QTcF value > 470 ms, proceed immediately with 2 additional ECGs to provide a triplicate.
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS 7	Interval: --	Occurrences: --	Comments:	HOLD and notify provider if 
o ANC LESS than 1000; 
o Platelets LESS than 100,000.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold and notify provider for
o AST or ALT GREATER than 3 x ULN or Total Bilirubin GREATER than 1.5 x ULN; 
o SCr GREATER than 1.5 x ULN or 1.5 from baseline.
			Nursing Orders
  	TREATMENT CONDITIONS 12	Interval: --	Occurrences: --	Comments:	Notify physician IF
o TSH GREATER than 10 and free T4 LESS than 0.9 or T3 LESS than 80; 
o TSH LESS than 0.27 AND free T4 GREATER than 1.7 or T3 GREATER than 200.
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	ONC NURSING COMMUNICATION 54	Interval: --	Occurrences: --	Comments:	Zanzalintinib XL-092. Daily. XL092 tablets will be administered orally at assigned daily dose levels. Subjects will take study medication orally once daily (qd). Subjects should be instructed to fast (nothing to eat except water) for at least 2 hours before and at least 1 hour after taking XL092.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Administer tremelimumab first and observe patient for 60 minutes following completion of tremelimumab infusion, then administer durvalumab as a separate infusion over 60 minutes on the same day.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Drug Diary Review
		  	tremelimumab (IMJUDO) chemo IVPB (RESTRICTED) 300 mg	Dose: 300 mg	Route: intravenous	once for 1 dose	Start: S			Instructions:	Administer intravenously over 60 minutes through an IV line containing a sterile, low-protein binding 0.2 or 0.22 micron filter.  
HAZARDOUS - Handle with care / Protect from light. 
Do not freeze and Do not tube/shake.Observe patient for 60 minutes after tremelimumab infusion before giving durvalumab.		  	durvalumab (IMFINZI) 1,500 mg in sodium chloride 0.9% 250 mL (6 mg/mL) IVPB (RESTRICTED)	Dose: 1,500 mg	Route: intravenous	once over 60 Minutes for 1 dose			Offset: 2 Hours	Instructions:	o Administer first dose of durvalumab over 60 min.  If tolerated, all subsequent doses of durvalumab can be administered over 30 minutes. 
o If not administered immediately, may be stored (from the time of preparation to the completion of infusion) for up to 28 days refrigerated at 2°C to 8°C (36°F to 46°F). 
o Administer intravenously via a 0.2 to 0.22 micron low protein binding in-line filter. 
o Do not coadminister with other drugs through the same IV line. 
o Flush line with Normal Saline once completed. Do not shake.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION	Medications	1,500 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	220 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once PRN	Start: S				  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 8	Perform every 1 day x1			Research tolerance: -0/+0 days	Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:     HCC 23-116_Abdelrahim
		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for Zanzalintinib (XL-092) Treatment: Refer to Section 7.2.1.2  Protocol Access Hyperlink:    HCC 23-116_Abdelrahim
			Nursing Orders
  	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Medical History
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Review Medications
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	ECOG Performance Status.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
		  	ONC NURSING COMMUNICATION 9	Interval: --	Occurrences: --	Comments:	Adverse Events assessment
		  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Monitoring of Durvalumab/Tremelimumab dose administration - On the first infusion day (cycle 1 day 1 (cohort B) and cycle 2 day 1 (cohort A), participants will be monitored, and vital signs collected/recorded in eCRF prior to, during and after infusion(s) described below.
I. BP and pulse will be collected from participants before, during, and after each infusion(s) at the following times:
1. Prior to the beginning of the infusion(s), measured once from between approximately 30 to 0 minutes [i.e., the start of the infusion(s)])
2. Approximately halfway through each infusion(s),
3. At the end of the infusions approximately 120 ± 15 minutes
a. If the infusion(s) takes longer than expected minutes, then BP and pulse measurements should follow the principles as described above or be taken more frequently if clinically indicated. A 1-hour observation period is recommended after the first infusion of durvalumab.
4. Subsequent durvalumab infusions - BP, pulse and other vital signs should be measured, collected/recorded in eCRF prior to the start of the infusion. Patients should be carefully monitored, and BP and other vital signs should be measured during and post infusion as per institution standard and as clinically indicated.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Physical exam.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Window for hematology tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Clinical Chemistry. NOTE regarding serum chemistries during treatment: Only in cases where pneumonitis (ILD) is suspected during study treatment, per PI discretion, also do C-Reactive Protein (CRP) testing. Window for tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --			Labs
  	ONC NURSING COMMUNICATION 37	Interval: --	Occurrences: --	Comments:	Infectious disease tests. As clinically Indicated
			Chemotherapy
  	ONC NURSING COMMUNICATION 54	Interval: --	Occurrences: --	Comments:	Zanzalintinib XL-092. Daily. XL092 tablets will be administered orally at assigned daily dose levels. Subjects will take study medication orally once daily (qd). Subjects should be instructed to fast (nothing to eat except water) for at least 2 hours before and at least 1 hour after taking XL092.Paper Rx order will be submitted to IDS for prescription dispensing of Zanzlintinib.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Drug Diary Review
				Day 15	Perform every 1 day x1			Research tolerance: -0/+0 days	Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:     HCC 23-116_Abdelrahim
		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for Zanzalintinib (XL-092) Treatment: Refer to Section 7.2.1.2  Protocol Access Hyperlink:    HCC 23-116_Abdelrahim
			Nursing Orders
  	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Medical History
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Review Medications
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	ECOG Performance Status.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
		  	ONC NURSING COMMUNICATION 9	Interval: --	Occurrences: --	Comments:	Adverse Events assessment
		  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Monitoring of Durvalumab/Tremelimumab dose administration - On the first infusion day (cycle 1 day 1 (cohort B) and cycle 2 day 1 (cohort A), participants will be monitored, and vital signs collected/recorded in eCRF prior to, during and after infusion(s) described below.
I. BP and pulse will be collected from participants before, during, and after each infusion(s) at the following times:
1. Prior to the beginning of the infusion(s), measured once from between approximately 30 to 0 minutes [i.e., the start of the infusion(s)])
2. Approximately halfway through each infusion(s),
3. At the end of the infusions approximately 120 ± 15 minutes
a. If the infusion(s) takes longer than expected minutes, then BP and pulse measurements should follow the principles as described above or be taken more frequently if clinically indicated. A 1-hour observation period is recommended after the first infusion of durvalumab.
4. Subsequent durvalumab infusions - BP, pulse and other vital signs should be measured, collected/recorded in eCRF prior to the start of the infusion. Patients should be carefully monitored, and BP and other vital signs should be measured during and post infusion as per institution standard and as clinically indicated.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Physical exam.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Window for hematology tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Clinical Chemistry. NOTE regarding serum chemistries during treatment: Only in cases where pneumonitis (ILD) is suspected during study treatment, per PI discretion, also do C-Reactive Protein (CRP) testing. Window for tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --			Labs
  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --			Labs
  	ONC NURSING COMMUNICATION 37	Interval: --	Occurrences: --	Comments:	Infectious disease tests. As clinically Indicated
			Labs
  	URINALYSIS	Interval: --	Occurrences: --		  	URINE PROTEIN/CREATININE RATIO, RANDOM	Interval: --	Occurrences: --			Chemotherapy
  	ONC NURSING COMMUNICATION 54	Interval: --	Occurrences: --	Comments:	Zanzalintinib XL-092. Daily. XL092 tablets will be administered orally at assigned daily dose levels. Subjects will take study medication orally once daily (qd). Subjects should be instructed to fast (nothing to eat except water) for at least 2 hours before and at least 1 hour after taking XL092.Paper Rx order will be submitted to IDS for prescription dispensing of Zanzlintinib.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Drug Diary Review
				Day 22	Perform every 1 day x1			Research tolerance: -0/+0 days	Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:     HCC 23-116_Abdelrahim
		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for Zanzalintinib (XL-092) Treatment: Refer to Section 7.2.1.2  Protocol Access Hyperlink:    HCC 23-116_Abdelrahim
			Nursing Orders
  	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Medical History
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Review Medications
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	ECOG Performance Status.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
		  	ONC NURSING COMMUNICATION 9	Interval: --	Occurrences: --	Comments:	Adverse Events assessment
		  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Monitoring of Durvalumab/Tremelimumab dose administration - On the first infusion day (cycle 1 day 1 (cohort B) and cycle 2 day 1 (cohort A), participants will be monitored, and vital signs collected/recorded in eCRF prior to, during and after infusion(s) described below.
I. BP and pulse will be collected from participants before, during, and after each infusion(s) at the following times:
1. Prior to the beginning of the infusion(s), measured once from between approximately 30 to 0 minutes [i.e., the start of the infusion(s)])
2. Approximately halfway through each infusion(s),
3. At the end of the infusions approximately 120 ± 15 minutes
a. If the infusion(s) takes longer than expected minutes, then BP and pulse measurements should follow the principles as described above or be taken more frequently if clinically indicated. A 1-hour observation period is recommended after the first infusion of durvalumab.
4. Subsequent durvalumab infusions - BP, pulse and other vital signs should be measured, collected/recorded in eCRF prior to the start of the infusion. Patients should be carefully monitored, and BP and other vital signs should be measured during and post infusion as per institution standard and as clinically indicated.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Physical exam.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Window for hematology tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Clinical Chemistry. NOTE regarding serum chemistries during treatment: Only in cases where pneumonitis (ILD) is suspected during study treatment, per PI discretion, also do C-Reactive Protein (CRP) testing. Window for tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --			Labs
  	ONC NURSING COMMUNICATION 37	Interval: --	Occurrences: --	Comments:	Infectious disease tests. As clinically Indicated
			Chemotherapy
  	ONC NURSING COMMUNICATION 54	Interval: --	Occurrences: --	Comments:	Zanzalintinib XL-092. Daily. XL092 tablets will be administered orally at assigned daily dose levels. Subjects will take study medication orally once daily (qd). Subjects should be instructed to fast (nothing to eat except water) for at least 2 hours before and at least 1 hour after taking XL092.Paper Rx order will be submitted to IDS for prescription dispensing of Zanzlintinib.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Drug Diary Review
				Day 28	Perform every 1 day x1			Research tolerance: -0/+0 days	Imaging
☑	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	C2D28,C4D28,C6D28,C8D28,C10D28, and subsequent even cycles.

Imaging - Chest, Abdomen and Pelvis (RECIST and imRECIST assessment). CT is preferred modality; MRI can be used if CT is contraindicated or at investigator discretion. Contrast should be used for all imaging per institutional practice unless contraindicated.
I. The same type of imaging used at screening must continue to be used throughout the study. (WINDOW: ± 4 DAYS).
		☑	CT CHEST W WO CONTRAST ABDOMEN W WO CONTRAST PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	CT CHEST W CONTRAST ABDOMEN W CONTRAST PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	CT CHEST WO CONTRAST ABDOMEN WO CONTRAST PELVIS WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	MRI CHEST W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI CHEST W CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI CHEST WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI ABDOMEN W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI ABDOMEN WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
					
Cycle 3	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1			Research tolerance: -0/+0 days	Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:     HCC 23-116_Abdelrahim
		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for Zanzalintinib (XL-092) Treatment: Refer to Section 7.2.1.2  Protocol Access Hyperlink:    HCC 23-116_Abdelrahim
			Nursing Orders
  	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Medical History
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Review Medications
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	ECOG Performance Status.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
		  	ONC NURSING COMMUNICATION 9	Interval: --	Occurrences: --	Comments:	Adverse Events assessment
		  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Monitoring of Durvalumab/Tremelimumab dose administration - On the first infusion day (cycle 1 day 1 (cohort B) and cycle 2 day 1 (cohort A), participants will be monitored, and vital signs collected/recorded in eCRF prior to, during and after infusion(s) described below.
I. BP and pulse will be collected from participants before, during, and after each infusion(s) at the following times:
1. Prior to the beginning of the infusion(s), measured once from between approximately 30 to 0 minutes [i.e., the start of the infusion(s)])
2. Approximately halfway through each infusion(s),
3. At the end of the infusions approximately 120 ± 15 minutes
a. If the infusion(s) takes longer than expected minutes, then BP and pulse measurements should follow the principles as described above or be taken more frequently if clinically indicated. A 1-hour observation period is recommended after the first infusion of durvalumab.
4. Subsequent durvalumab infusions - BP, pulse and other vital signs should be measured, collected/recorded in eCRF prior to the start of the infusion. Patients should be carefully monitored, and BP and other vital signs should be measured during and post infusion as per institution standard and as clinically indicated.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Physical exam.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
			Nursing Orders
  	ONC NURSING COMMUNICATION 53	Interval: --	Occurrences: --	Comments:	PRO Evaluations.FACT-Hep questionnaire
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Window for hematology tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Clinical Chemistry. NOTE regarding serum chemistries during treatment: Only in cases where pneumonitis (ILD) is suspected during study treatment, per PI discretion, also do C-Reactive Protein (CRP) testing. Window for tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --			Labs
  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --			Labs
  	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	T3	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	T4, FREE	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --			Labs
  	URINALYSIS	Interval: --	Occurrences: --		  	URINE PROTEIN/CREATININE RATIO, RANDOM	Interval: --	Occurrences: --			Labs
  	ONC NURSING COMMUNICATION 37	Interval: --	Occurrences: --	Comments:	Infectious disease tests. As clinically Indicated
			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	For women of child-bearing potential.
		☐	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Blood sample collection for future research
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS 7	Interval: --	Occurrences: --	Comments:	HOLD and notify provider if 
o ANC LESS than 1000; 
o Platelets LESS than 100,000.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold and notify provider for
o AST or ALT GREATER than 3 x ULN or Total Bilirubin GREATER than 1.5 x ULN; 
o SCr GREATER than 1.5 x ULN or 1.5 from baseline.
			Nursing Orders
  	TREATMENT CONDITIONS 12	Interval: --	Occurrences: --	Comments:	Notify physician IF
o TSH GREATER than 10 and free T4 LESS than 0.9 or T3 LESS than 80; 
o TSH LESS than 0.27 AND free T4 GREATER than 1.7 or T3 GREATER than 200.
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	ONC NURSING COMMUNICATION 54	Interval: --	Occurrences: --	Comments:	Zanzalintinib XL-092. Daily. XL092 tablets will be administered orally at assigned daily dose levels. Subjects will take study medication orally once daily (qd). Subjects should be instructed to fast (nothing to eat except water) for at least 2 hours before and at least 1 hour after taking XL092.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Drug Diary Review
		  	durvalumab (IMFINZI) 1,500 mg in sodium chloride 0.9% 250 mL (6 mg/mL) IVPB (RESTRICTED)	Dose: 1,500 mg	Route: intravenous	once over 60 Minutes for 1 dose				Instructions:	o Administer first dose of durvalumab over 60 min.  If tolerated, all subsequent doses of durvalumab can be administered over 30 minutes. 
o If not administered immediately, may be stored (from the time of preparation to the completion of infusion) for up to 28 days refrigerated at 2°C to 8°C (36°F to 46°F). 
o Administer intravenously via a 0.2 to 0.22 micron low protein binding in-line filter. 
o Do not coadminister with other drugs through the same IV line. 
o Flush line with Normal Saline once completed. Do not shake.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION	Medications	1,500 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	220 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once PRN	Start: S				  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 15	Perform every 1 day x1			Research tolerance: -0/+0 days	Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:     HCC 23-116_Abdelrahim
		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for Zanzalintinib (XL-092) Treatment: Refer to Section 7.2.1.2  Protocol Access Hyperlink:    HCC 23-116_Abdelrahim
			Nursing Orders
  	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Medical History
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Review Medications
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	ECOG Performance Status.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
		  	ONC NURSING COMMUNICATION 9	Interval: --	Occurrences: --	Comments:	Adverse Events assessment
		  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Monitoring of Durvalumab/Tremelimumab dose administration - On the first infusion day (cycle 1 day 1 (cohort B) and cycle 2 day 1 (cohort A), participants will be monitored, and vital signs collected/recorded in eCRF prior to, during and after infusion(s) described below.
I. BP and pulse will be collected from participants before, during, and after each infusion(s) at the following times:
1. Prior to the beginning of the infusion(s), measured once from between approximately 30 to 0 minutes [i.e., the start of the infusion(s)])
2. Approximately halfway through each infusion(s),
3. At the end of the infusions approximately 120 ± 15 minutes
a. If the infusion(s) takes longer than expected minutes, then BP and pulse measurements should follow the principles as described above or be taken more frequently if clinically indicated. A 1-hour observation period is recommended after the first infusion of durvalumab.
4. Subsequent durvalumab infusions - BP, pulse and other vital signs should be measured, collected/recorded in eCRF prior to the start of the infusion. Patients should be carefully monitored, and BP and other vital signs should be measured during and post infusion as per institution standard and as clinically indicated.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Physical exam.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
			Labs
  	ONC NURSING COMMUNICATION 37	Interval: --	Occurrences: --	Comments:	Infectious disease tests. As clinically Indicated
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Window for hematology tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Clinical Chemistry. NOTE regarding serum chemistries during treatment: Only in cases where pneumonitis (ILD) is suspected during study treatment, per PI discretion, also do C-Reactive Protein (CRP) testing. Window for tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --			Labs
  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --			Chemotherapy
  	ONC NURSING COMMUNICATION 54	Interval: --	Occurrences: --	Comments:	Zanzalintinib XL-092. Daily. XL092 tablets will be administered orally at assigned daily dose levels. Subjects will take study medication orally once daily (qd). Subjects should be instructed to fast (nothing to eat except water) for at least 2 hours before and at least 1 hour after taking XL092.Paper Rx order will be submitted to IDS for prescription dispensing of Zanzlintinib.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Drug Diary Review
					
Cycle 4	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1			Research tolerance: -0/+0 days	Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:     HCC 23-116_Abdelrahim
		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for Zanzalintinib (XL-092) Treatment: Refer to Section 7.2.1.2  Protocol Access Hyperlink:    HCC 23-116_Abdelrahim
			Nursing Orders
  	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Medical History
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Review Medications
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	ECOG Performance Status.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
		  	ONC NURSING COMMUNICATION 9	Interval: --	Occurrences: --	Comments:	Adverse Events assessment
		  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Monitoring of Durvalumab/Tremelimumab dose administration - On the first infusion day (cycle 1 day 1 (cohort B) and cycle 2 day 1 (cohort A), participants will be monitored, and vital signs collected/recorded in eCRF prior to, during and after infusion(s) described below.
I. BP and pulse will be collected from participants before, during, and after each infusion(s) at the following times:
1. Prior to the beginning of the infusion(s), measured once from between approximately 30 to 0 minutes [i.e., the start of the infusion(s)])
2. Approximately halfway through each infusion(s),
3. At the end of the infusions approximately 120 ± 15 minutes
a. If the infusion(s) takes longer than expected minutes, then BP and pulse measurements should follow the principles as described above or be taken more frequently if clinically indicated. A 1-hour observation period is recommended after the first infusion of durvalumab.
4. Subsequent durvalumab infusions - BP, pulse and other vital signs should be measured, collected/recorded in eCRF prior to the start of the infusion. Patients should be carefully monitored, and BP and other vital signs should be measured during and post infusion as per institution standard and as clinically indicated.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Physical exam.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
			Nursing Orders
  	ONC NURSING COMMUNICATION 53	Interval: --	Occurrences: --	Comments:	PRO Evaluations.FACT-Hep questionnaire
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Window for hematology tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Clinical Chemistry. NOTE regarding serum chemistries during treatment: Only in cases where pneumonitis (ILD) is suspected during study treatment, per PI discretion, also do C-Reactive Protein (CRP) testing. Window for tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --			Labs
  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --			Labs
  	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	T3	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	T4, FREE	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --			Labs
  	ONC NURSING COMMUNICATION 37	Interval: --	Occurrences: --	Comments:	Infectious disease tests. As clinically Indicated
			Labs
  	URINALYSIS	Interval: --	Occurrences: --		  	URINE PROTEIN/CREATININE RATIO, RANDOM	Interval: --	Occurrences: --			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	For women of child-bearing potential.
		☐	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS 7	Interval: --	Occurrences: --	Comments:	HOLD and notify provider if 
o ANC LESS than 1000; 
o Platelets LESS than 100,000.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold and notify provider for
o AST or ALT GREATER than 3 x ULN or Total Bilirubin GREATER than 1.5 x ULN; 
o SCr GREATER than 1.5 x ULN or 1.5 from baseline.
			Nursing Orders
  	TREATMENT CONDITIONS 12	Interval: --	Occurrences: --	Comments:	Notify physician IF
o TSH GREATER than 10 and free T4 LESS than 0.9 or T3 LESS than 80; 
o TSH LESS than 0.27 AND free T4 GREATER than 1.7 or T3 GREATER than 200.
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	ONC NURSING COMMUNICATION 54	Interval: --	Occurrences: --	Comments:	Zanzalintinib XL-092. Daily. XL092 tablets will be administered orally at assigned daily dose levels. Subjects will take study medication orally once daily (qd). Subjects should be instructed to fast (nothing to eat except water) for at least 2 hours before and at least 1 hour after taking XL092.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Drug Diary Review
		  	durvalumab (IMFINZI) 1,500 mg in sodium chloride 0.9% 250 mL (6 mg/mL) IVPB (RESTRICTED)	Dose: 1,500 mg	Route: intravenous	once over 60 Minutes for 1 dose				Instructions:	o Administer first dose of durvalumab over 60 min.  If tolerated, all subsequent doses of durvalumab can be administered over 30 minutes. 
o If not administered immediately, may be stored (from the time of preparation to the completion of infusion) for up to 28 days refrigerated at 2°C to 8°C (36°F to 46°F). 
o Administer intravenously via a 0.2 to 0.22 micron low protein binding in-line filter. 
o Do not coadminister with other drugs through the same IV line. 
o Flush line with Normal Saline once completed. Do not shake.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION	Medications	1,500 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	220 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once PRN	Start: S				  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 15	Perform every 1 day x1			Research tolerance: -0/+0 days	Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:     HCC 23-116_Abdelrahim
		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for Zanzalintinib (XL-092) Treatment: Refer to Section 7.2.1.2  Protocol Access Hyperlink:    HCC 23-116_Abdelrahim
			Nursing Orders
  	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Medical History
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Review Medications
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	ECOG Performance Status.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
		  	ONC NURSING COMMUNICATION 9	Interval: --	Occurrences: --	Comments:	Adverse Events assessment
		  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Monitoring of Durvalumab/Tremelimumab dose administration - On the first infusion day (cycle 1 day 1 (cohort B) and cycle 2 day 1 (cohort A), participants will be monitored, and vital signs collected/recorded in eCRF prior to, during and after infusion(s) described below.
I. BP and pulse will be collected from participants before, during, and after each infusion(s) at the following times:
1. Prior to the beginning of the infusion(s), measured once from between approximately 30 to 0 minutes [i.e., the start of the infusion(s)])
2. Approximately halfway through each infusion(s),
3. At the end of the infusions approximately 120 ± 15 minutes
a. If the infusion(s) takes longer than expected minutes, then BP and pulse measurements should follow the principles as described above or be taken more frequently if clinically indicated. A 1-hour observation period is recommended after the first infusion of durvalumab.
4. Subsequent durvalumab infusions - BP, pulse and other vital signs should be measured, collected/recorded in eCRF prior to the start of the infusion. Patients should be carefully monitored, and BP and other vital signs should be measured during and post infusion as per institution standard and as clinically indicated.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Physical exam.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
			Labs
  	ONC NURSING COMMUNICATION 37	Interval: --	Occurrences: --	Comments:	Infectious disease tests. As clinically Indicated
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Window for hematology tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Clinical Chemistry. NOTE regarding serum chemistries during treatment: Only in cases where pneumonitis (ILD) is suspected during study treatment, per PI discretion, also do C-Reactive Protein (CRP) testing. Window for tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --			Labs
  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --			Chemotherapy
  	ONC NURSING COMMUNICATION 54	Interval: --	Occurrences: --	Comments:	Zanzalintinib XL-092. Daily. XL092 tablets will be administered orally at assigned daily dose levels. Subjects will take study medication orally once daily (qd). Subjects should be instructed to fast (nothing to eat except water) for at least 2 hours before and at least 1 hour after taking XL092.Paper Rx order will be submitted to IDS for prescription dispensing of Zanzlintinib.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Drug Diary Review
				Day 28	Perform every 1 day x1			Research tolerance: -0/+0 days	Imaging
☑	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	C2D28,C4D28,C6D28,C8D28,C10D28, and subsequent even cycles.

Imaging - Chest, Abdomen and Pelvis (RECIST and imRECIST assessment). CT is preferred modality; MRI can be used if CT is contraindicated or at investigator discretion. Contrast should be used for all imaging per institutional practice unless contraindicated.
I. The same type of imaging used at screening must continue to be used throughout the study. (WINDOW: ± 4 DAYS).
		☑	CT CHEST W WO CONTRAST ABDOMEN W WO CONTRAST PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	CT CHEST W CONTRAST ABDOMEN W CONTRAST PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	CT CHEST WO CONTRAST ABDOMEN WO CONTRAST PELVIS WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	MRI CHEST W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI CHEST W CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI CHEST WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI ABDOMEN W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI ABDOMEN WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
					
Cycle 5	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1			Research tolerance: -0/+0 days	Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:     HCC 23-116_Abdelrahim
		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for Zanzalintinib (XL-092) Treatment: Refer to Section 7.2.1.2  Protocol Access Hyperlink:    HCC 23-116_Abdelrahim
			Nursing Orders
  	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Medical History
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Review Medications
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	ECOG Performance Status.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
		  	ONC NURSING COMMUNICATION 9	Interval: --	Occurrences: --	Comments:	Adverse Events assessment
		  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Monitoring of Durvalumab/Tremelimumab dose administration - On the first infusion day (cycle 1 day 1 (cohort B) and cycle 2 day 1 (cohort A), participants will be monitored, and vital signs collected/recorded in eCRF prior to, during and after infusion(s) described below.
I. BP and pulse will be collected from participants before, during, and after each infusion(s) at the following times:
1. Prior to the beginning of the infusion(s), measured once from between approximately 30 to 0 minutes [i.e., the start of the infusion(s)])
2. Approximately halfway through each infusion(s),
3. At the end of the infusions approximately 120 ± 15 minutes
a. If the infusion(s) takes longer than expected minutes, then BP and pulse measurements should follow the principles as described above or be taken more frequently if clinically indicated. A 1-hour observation period is recommended after the first infusion of durvalumab.
4. Subsequent durvalumab infusions - BP, pulse and other vital signs should be measured, collected/recorded in eCRF prior to the start of the infusion. Patients should be carefully monitored, and BP and other vital signs should be measured during and post infusion as per institution standard and as clinically indicated.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Physical exam.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
			Nursing Orders
  	ONC NURSING COMMUNICATION 53	Interval: --	Occurrences: --	Comments:	PRO Evaluations.FACT-Hep questionnaire
			Labs
  	ONC NURSING COMMUNICATION 37	Interval: --	Occurrences: --	Comments:	Infectious disease tests. As clinically Indicated
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Window for hematology tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Clinical Chemistry. NOTE regarding serum chemistries during treatment: Only in cases where pneumonitis (ILD) is suspected during study treatment, per PI discretion, also do C-Reactive Protein (CRP) testing. Window for tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --			Labs
  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --			Labs
  	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	T3	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	T4, FREE	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --			Labs
  	URINALYSIS	Interval: --	Occurrences: --		  	URINE PROTEIN/CREATININE RATIO, RANDOM	Interval: --	Occurrences: --			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	For women of child-bearing potential.
		☐	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS 7	Interval: --	Occurrences: --	Comments:	HOLD and notify provider if 
o ANC LESS than 1000; 
o Platelets LESS than 100,000.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold and notify provider for
o AST or ALT GREATER than 3 x ULN or Total Bilirubin GREATER than 1.5 x ULN; 
o SCr GREATER than 1.5 x ULN or 1.5 from baseline.
			Nursing Orders
  	TREATMENT CONDITIONS 12	Interval: --	Occurrences: --	Comments:	Notify physician IF
o TSH GREATER than 10 and free T4 LESS than 0.9 or T3 LESS than 80; 
o TSH LESS than 0.27 AND free T4 GREATER than 1.7 or T3 GREATER than 200.
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	ONC NURSING COMMUNICATION 54	Interval: --	Occurrences: --	Comments:	Zanzalintinib XL-092. Daily. XL092 tablets will be administered orally at assigned daily dose levels. Subjects will take study medication orally once daily (qd). Subjects should be instructed to fast (nothing to eat except water) for at least 2 hours before and at least 1 hour after taking XL092.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Drug Diary Review
		  	durvalumab (IMFINZI) 1,500 mg in sodium chloride 0.9% 250 mL (6 mg/mL) IVPB (RESTRICTED)	Dose: 1,500 mg	Route: intravenous	once over 60 Minutes for 1 dose				Instructions:	o Administer first dose of durvalumab over 60 min.  If tolerated, all subsequent doses of durvalumab can be administered over 30 minutes. 
o If not administered immediately, may be stored (from the time of preparation to the completion of infusion) for up to 28 days refrigerated at 2°C to 8°C (36°F to 46°F). 
o Administer intravenously via a 0.2 to 0.22 micron low protein binding in-line filter. 
o Do not coadminister with other drugs through the same IV line. 
o Flush line with Normal Saline once completed. Do not shake.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION	Medications	1,500 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	220 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once PRN	Start: S				  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 15	Perform every 1 day x1			Research tolerance: -0/+0 days	Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:     HCC 23-116_Abdelrahim
		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for Zanzalintinib (XL-092) Treatment: Refer to Section 7.2.1.2  Protocol Access Hyperlink:    HCC 23-116_Abdelrahim
			Nursing Orders
  	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Medical History
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Review Medications
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	ECOG Performance Status.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
		  	ONC NURSING COMMUNICATION 9	Interval: --	Occurrences: --	Comments:	Adverse Events assessment
		  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Monitoring of Durvalumab/Tremelimumab dose administration - On the first infusion day (cycle 1 day 1 (cohort B) and cycle 2 day 1 (cohort A), participants will be monitored, and vital signs collected/recorded in eCRF prior to, during and after infusion(s) described below.
I. BP and pulse will be collected from participants before, during, and after each infusion(s) at the following times:
1. Prior to the beginning of the infusion(s), measured once from between approximately 30 to 0 minutes [i.e., the start of the infusion(s)])
2. Approximately halfway through each infusion(s),
3. At the end of the infusions approximately 120 ± 15 minutes
a. If the infusion(s) takes longer than expected minutes, then BP and pulse measurements should follow the principles as described above or be taken more frequently if clinically indicated. A 1-hour observation period is recommended after the first infusion of durvalumab.
4. Subsequent durvalumab infusions - BP, pulse and other vital signs should be measured, collected/recorded in eCRF prior to the start of the infusion. Patients should be carefully monitored, and BP and other vital signs should be measured during and post infusion as per institution standard and as clinically indicated.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Physical exam.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
			Labs
  	ONC NURSING COMMUNICATION 37	Interval: --	Occurrences: --	Comments:	Infectious disease tests. As clinically Indicated
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Window for hematology tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Clinical Chemistry. NOTE regarding serum chemistries during treatment: Only in cases where pneumonitis (ILD) is suspected during study treatment, per PI discretion, also do C-Reactive Protein (CRP) testing. Window for tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --			Labs
  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --			Chemotherapy
  	ONC NURSING COMMUNICATION 54	Interval: --	Occurrences: --	Comments:	Zanzalintinib XL-092. Daily. XL092 tablets will be administered orally at assigned daily dose levels. Subjects will take study medication orally once daily (qd). Subjects should be instructed to fast (nothing to eat except water) for at least 2 hours before and at least 1 hour after taking XL092.Paper Rx order will be submitted to IDS for prescription dispensing of Zanzlintinib.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Drug Diary Review
					
Cycle 6	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1			Research tolerance: -0/+0 days	Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:     HCC 23-116_Abdelrahim
		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for Zanzalintinib (XL-092) Treatment: Refer to Section 7.2.1.2  Protocol Access Hyperlink:    HCC 23-116_Abdelrahim
			Nursing Orders
  	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Medical History
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Review Medications
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	ECOG Performance Status.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
		  	ONC NURSING COMMUNICATION 9	Interval: --	Occurrences: --	Comments:	Adverse Events assessment
		  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Monitoring of Durvalumab/Tremelimumab dose administration - On the first infusion day (cycle 1 day 1 (cohort B) and cycle 2 day 1 (cohort A), participants will be monitored, and vital signs collected/recorded in eCRF prior to, during and after infusion(s) described below.
I. BP and pulse will be collected from participants before, during, and after each infusion(s) at the following times:
1. Prior to the beginning of the infusion(s), measured once from between approximately 30 to 0 minutes [i.e., the start of the infusion(s)])
2. Approximately halfway through each infusion(s),
3. At the end of the infusions approximately 120 ± 15 minutes
a. If the infusion(s) takes longer than expected minutes, then BP and pulse measurements should follow the principles as described above or be taken more frequently if clinically indicated. A 1-hour observation period is recommended after the first infusion of durvalumab.
4. Subsequent durvalumab infusions - BP, pulse and other vital signs should be measured, collected/recorded in eCRF prior to the start of the infusion. Patients should be carefully monitored, and BP and other vital signs should be measured during and post infusion as per institution standard and as clinically indicated.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Physical exam.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
			Nursing Orders
  	ONC NURSING COMMUNICATION 53	Interval: --	Occurrences: --	Comments:	PRO Evaluations.FACT-Hep questionnaire
			Labs
  	ONC NURSING COMMUNICATION 37	Interval: --	Occurrences: --	Comments:	Infectious disease tests. As clinically Indicated
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Window for hematology tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Clinical Chemistry. NOTE regarding serum chemistries during treatment: Only in cases where pneumonitis (ILD) is suspected during study treatment, per PI discretion, also do C-Reactive Protein (CRP) testing. Window for tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --			Labs
  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --			Labs
  	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	T3	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	T4, FREE	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --			Labs
  	URINALYSIS	Interval: --	Occurrences: --		  	URINE PROTEIN/CREATININE RATIO, RANDOM	Interval: --	Occurrences: --			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	For women of child-bearing potential.
		☐	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS 7	Interval: --	Occurrences: --	Comments:	HOLD and notify provider if 
o ANC LESS than 1000; 
o Platelets LESS than 100,000.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold and notify provider for
o AST or ALT GREATER than 3 x ULN or Total Bilirubin GREATER than 1.5 x ULN; 
o SCr GREATER than 1.5 x ULN or 1.5 from baseline.
			Nursing Orders
  	TREATMENT CONDITIONS 12	Interval: --	Occurrences: --	Comments:	Notify physician IF
o TSH GREATER than 10 and free T4 LESS than 0.9 or T3 LESS than 80; 
o TSH LESS than 0.27 AND free T4 GREATER than 1.7 or T3 GREATER than 200.
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	ONC NURSING COMMUNICATION 54	Interval: --	Occurrences: --	Comments:	Zanzalintinib XL-092. Daily. XL092 tablets will be administered orally at assigned daily dose levels. Subjects will take study medication orally once daily (qd). Subjects should be instructed to fast (nothing to eat except water) for at least 2 hours before and at least 1 hour after taking XL092.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Drug Diary Review
		  	durvalumab (IMFINZI) 1,500 mg in sodium chloride 0.9% 250 mL (6 mg/mL) IVPB (RESTRICTED)	Dose: 1,500 mg	Route: intravenous	once over 60 Minutes for 1 dose				Instructions:	o Administer first dose of durvalumab over 60 min.  If tolerated, all subsequent doses of durvalumab can be administered over 30 minutes. 
o If not administered immediately, may be stored (from the time of preparation to the completion of infusion) for up to 28 days refrigerated at 2°C to 8°C (36°F to 46°F). 
o Administer intravenously via a 0.2 to 0.22 micron low protein binding in-line filter. 
o Do not coadminister with other drugs through the same IV line. 
o Flush line with Normal Saline once completed. Do not shake.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION	Medications	1,500 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	220 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once PRN	Start: S				  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 15	Perform every 1 day x1			Research tolerance: -0/+0 days	Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:     HCC 23-116_Abdelrahim
		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for Zanzalintinib (XL-092) Treatment: Refer to Section 7.2.1.2  Protocol Access Hyperlink:    HCC 23-116_Abdelrahim
			Nursing Orders
  	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Medical History
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Review Medications
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	ECOG Performance Status.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
		  	ONC NURSING COMMUNICATION 9	Interval: --	Occurrences: --	Comments:	Adverse Events assessment
		  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Monitoring of Durvalumab/Tremelimumab dose administration - On the first infusion day (cycle 1 day 1 (cohort B) and cycle 2 day 1 (cohort A), participants will be monitored, and vital signs collected/recorded in eCRF prior to, during and after infusion(s) described below.
I. BP and pulse will be collected from participants before, during, and after each infusion(s) at the following times:
1. Prior to the beginning of the infusion(s), measured once from between approximately 30 to 0 minutes [i.e., the start of the infusion(s)])
2. Approximately halfway through each infusion(s),
3. At the end of the infusions approximately 120 ± 15 minutes
a. If the infusion(s) takes longer than expected minutes, then BP and pulse measurements should follow the principles as described above or be taken more frequently if clinically indicated. A 1-hour observation period is recommended after the first infusion of durvalumab.
4. Subsequent durvalumab infusions - BP, pulse and other vital signs should be measured, collected/recorded in eCRF prior to the start of the infusion. Patients should be carefully monitored, and BP and other vital signs should be measured during and post infusion as per institution standard and as clinically indicated.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Physical exam.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
			Labs
  	ONC NURSING COMMUNICATION 37	Interval: --	Occurrences: --	Comments:	Infectious disease tests. As clinically Indicated
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Window for hematology tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Clinical Chemistry. NOTE regarding serum chemistries during treatment: Only in cases where pneumonitis (ILD) is suspected during study treatment, per PI discretion, also do C-Reactive Protein (CRP) testing. Window for tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --			Labs
  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --			Chemotherapy
  	ONC NURSING COMMUNICATION 54	Interval: --	Occurrences: --	Comments:	Zanzalintinib XL-092. Daily. XL092 tablets will be administered orally at assigned daily dose levels. Subjects will take study medication orally once daily (qd). Subjects should be instructed to fast (nothing to eat except water) for at least 2 hours before and at least 1 hour after taking XL092.Paper Rx order will be submitted to IDS for prescription dispensing of Zanzlintinib.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Drug Diary Review
				Day 28	Perform every 1 day x1			Research tolerance: -0/+0 days	Imaging
☑	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	C2D28,C4D28,C6D28,C8D28,C10D28, and subsequent even cycles.

Imaging - Chest, Abdomen and Pelvis (RECIST and imRECIST assessment). CT is preferred modality; MRI can be used if CT is contraindicated or at investigator discretion. Contrast should be used for all imaging per institutional practice unless contraindicated.
I. The same type of imaging used at screening must continue to be used throughout the study. (WINDOW: ± 4 DAYS).
		☑	CT CHEST W WO CONTRAST ABDOMEN W WO CONTRAST PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	CT CHEST W CONTRAST ABDOMEN W CONTRAST PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	CT CHEST WO CONTRAST ABDOMEN WO CONTRAST PELVIS WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	MRI CHEST W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI CHEST W CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI CHEST WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI ABDOMEN W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI ABDOMEN WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
					
Cycle 7	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1			Research tolerance: -0/+0 days	Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:     HCC 23-116_Abdelrahim
		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for Zanzalintinib (XL-092) Treatment: Refer to Section 7.2.1.2  Protocol Access Hyperlink:    HCC 23-116_Abdelrahim
			Nursing Orders
  	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Medical History
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Review Medications
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	ECOG Performance Status.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
		  	ONC NURSING COMMUNICATION 9	Interval: --	Occurrences: --	Comments:	Adverse Events assessment
		  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Monitoring of Durvalumab/Tremelimumab dose administration - On the first infusion day (cycle 1 day 1 (cohort B) and cycle 2 day 1 (cohort A), participants will be monitored, and vital signs collected/recorded in eCRF prior to, during and after infusion(s) described below.
I. BP and pulse will be collected from participants before, during, and after each infusion(s) at the following times:
1. Prior to the beginning of the infusion(s), measured once from between approximately 30 to 0 minutes [i.e., the start of the infusion(s)])
2. Approximately halfway through each infusion(s),
3. At the end of the infusions approximately 120 ± 15 minutes
a. If the infusion(s) takes longer than expected minutes, then BP and pulse measurements should follow the principles as described above or be taken more frequently if clinically indicated. A 1-hour observation period is recommended after the first infusion of durvalumab.
4. Subsequent durvalumab infusions - BP, pulse and other vital signs should be measured, collected/recorded in eCRF prior to the start of the infusion. Patients should be carefully monitored, and BP and other vital signs should be measured during and post infusion as per institution standard and as clinically indicated.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Physical exam.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
			Nursing Orders
  	ONC NURSING COMMUNICATION 53	Interval: --	Occurrences: --	Comments:	PRO Evaluations.FACT-Hep questionnaire
			Labs
  	ONC NURSING COMMUNICATION 37	Interval: --	Occurrences: --	Comments:	Infectious disease tests. As clinically Indicated
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Window for hematology tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Clinical Chemistry. NOTE regarding serum chemistries during treatment: Only in cases where pneumonitis (ILD) is suspected during study treatment, per PI discretion, also do C-Reactive Protein (CRP) testing. Window for tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --			Labs
  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --			Labs
  	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	T3	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	T4, FREE	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --			Labs
  	URINALYSIS	Interval: --	Occurrences: --		  	URINE PROTEIN/CREATININE RATIO, RANDOM	Interval: --	Occurrences: --			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	For women of child-bearing potential.
		☐	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS 7	Interval: --	Occurrences: --	Comments:	HOLD and notify provider if 
o ANC LESS than 1000; 
o Platelets LESS than 100,000.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold and notify provider for
o AST or ALT GREATER than 3 x ULN or Total Bilirubin GREATER than 1.5 x ULN; 
o SCr GREATER than 1.5 x ULN or 1.5 from baseline.
			Nursing Orders
  	TREATMENT CONDITIONS 12	Interval: --	Occurrences: --	Comments:	Notify physician IF
o TSH GREATER than 10 and free T4 LESS than 0.9 or T3 LESS than 80; 
o TSH LESS than 0.27 AND free T4 GREATER than 1.7 or T3 GREATER than 200.
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	ONC NURSING COMMUNICATION 54	Interval: --	Occurrences: --	Comments:	Zanzalintinib XL-092. Daily. XL092 tablets will be administered orally at assigned daily dose levels. Subjects will take study medication orally once daily (qd). Subjects should be instructed to fast (nothing to eat except water) for at least 2 hours before and at least 1 hour after taking XL092.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Drug Diary Review
		  	durvalumab (IMFINZI) 1,500 mg in sodium chloride 0.9% 250 mL (6 mg/mL) IVPB (RESTRICTED)	Dose: 1,500 mg	Route: intravenous	once over 60 Minutes for 1 dose				Instructions:	o Administer first dose of durvalumab over 60 min.  If tolerated, all subsequent doses of durvalumab can be administered over 30 minutes. 
o If not administered immediately, may be stored (from the time of preparation to the completion of infusion) for up to 28 days refrigerated at 2°C to 8°C (36°F to 46°F). 
o Administer intravenously via a 0.2 to 0.22 micron low protein binding in-line filter. 
o Do not coadminister with other drugs through the same IV line. 
o Flush line with Normal Saline once completed. Do not shake.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION	Medications	1,500 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	220 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once PRN	Start: S				  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 15	Perform every 1 day x1			Research tolerance: -0/+0 days	Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:     HCC 23-116_Abdelrahim
		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for Zanzalintinib (XL-092) Treatment: Refer to Section 7.2.1.2  Protocol Access Hyperlink:    HCC 23-116_Abdelrahim
			Nursing Orders
  	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Medical History
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Review Medications
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	ECOG Performance Status.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
		  	ONC NURSING COMMUNICATION 9	Interval: --	Occurrences: --	Comments:	Adverse Events assessment
		  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Monitoring of Durvalumab/Tremelimumab dose administration - On the first infusion day (cycle 1 day 1 (cohort B) and cycle 2 day 1 (cohort A), participants will be monitored, and vital signs collected/recorded in eCRF prior to, during and after infusion(s) described below.
I. BP and pulse will be collected from participants before, during, and after each infusion(s) at the following times:
1. Prior to the beginning of the infusion(s), measured once from between approximately 30 to 0 minutes [i.e., the start of the infusion(s)])
2. Approximately halfway through each infusion(s),
3. At the end of the infusions approximately 120 ± 15 minutes
a. If the infusion(s) takes longer than expected minutes, then BP and pulse measurements should follow the principles as described above or be taken more frequently if clinically indicated. A 1-hour observation period is recommended after the first infusion of durvalumab.
4. Subsequent durvalumab infusions - BP, pulse and other vital signs should be measured, collected/recorded in eCRF prior to the start of the infusion. Patients should be carefully monitored, and BP and other vital signs should be measured during and post infusion as per institution standard and as clinically indicated.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Physical exam.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
			Labs
  	ONC NURSING COMMUNICATION 37	Interval: --	Occurrences: --	Comments:	Infectious disease tests. As clinically Indicated
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Window for hematology tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Clinical Chemistry. NOTE regarding serum chemistries during treatment: Only in cases where pneumonitis (ILD) is suspected during study treatment, per PI discretion, also do C-Reactive Protein (CRP) testing. Window for tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --			Labs
  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --			Chemotherapy
  	ONC NURSING COMMUNICATION 54	Interval: --	Occurrences: --	Comments:	Zanzalintinib XL-092. Daily. XL092 tablets will be administered orally at assigned daily dose levels. Subjects will take study medication orally once daily (qd). Subjects should be instructed to fast (nothing to eat except water) for at least 2 hours before and at least 1 hour after taking XL092.Paper Rx order will be submitted to IDS for prescription dispensing of Zanzlintinib.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Drug Diary Review
					
Cycle 8	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1			Research tolerance: -0/+0 days	Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:     HCC 23-116_Abdelrahim
		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for Zanzalintinib (XL-092) Treatment: Refer to Section 7.2.1.2  Protocol Access Hyperlink:    HCC 23-116_Abdelrahim
			Nursing Orders
  	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Medical History
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Review Medications
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	ECOG Performance Status.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
		  	ONC NURSING COMMUNICATION 9	Interval: --	Occurrences: --	Comments:	Adverse Events assessment
		  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Monitoring of Durvalumab/Tremelimumab dose administration - On the first infusion day (cycle 1 day 1 (cohort B) and cycle 2 day 1 (cohort A), participants will be monitored, and vital signs collected/recorded in eCRF prior to, during and after infusion(s) described below.
I. BP and pulse will be collected from participants before, during, and after each infusion(s) at the following times:
1. Prior to the beginning of the infusion(s), measured once from between approximately 30 to 0 minutes [i.e., the start of the infusion(s)])
2. Approximately halfway through each infusion(s),
3. At the end of the infusions approximately 120 ± 15 minutes
a. If the infusion(s) takes longer than expected minutes, then BP and pulse measurements should follow the principles as described above or be taken more frequently if clinically indicated. A 1-hour observation period is recommended after the first infusion of durvalumab.
4. Subsequent durvalumab infusions - BP, pulse and other vital signs should be measured, collected/recorded in eCRF prior to the start of the infusion. Patients should be carefully monitored, and BP and other vital signs should be measured during and post infusion as per institution standard and as clinically indicated.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Physical exam.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
			Nursing Orders
  	ONC NURSING COMMUNICATION 53	Interval: --	Occurrences: --	Comments:	PRO Evaluations.FACT-Hep questionnaire
			Labs
  	ONC NURSING COMMUNICATION 37	Interval: --	Occurrences: --	Comments:	Infectious disease tests. As clinically Indicated
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Window for hematology tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Clinical Chemistry. NOTE regarding serum chemistries during treatment: Only in cases where pneumonitis (ILD) is suspected during study treatment, per PI discretion, also do C-Reactive Protein (CRP) testing. Window for tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --			Labs
  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --			Labs
  	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	T3	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	T4, FREE	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --			Labs
  	URINALYSIS	Interval: --	Occurrences: --		  	URINE PROTEIN/CREATININE RATIO, RANDOM	Interval: --	Occurrences: --			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	For women of child-bearing potential.
		☐	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS 7	Interval: --	Occurrences: --	Comments:	HOLD and notify provider if 
o ANC LESS than 1000; 
o Platelets LESS than 100,000.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold and notify provider for
o AST or ALT GREATER than 3 x ULN or Total Bilirubin GREATER than 1.5 x ULN; 
o SCr GREATER than 1.5 x ULN or 1.5 from baseline.
			Nursing Orders
  	TREATMENT CONDITIONS 12	Interval: --	Occurrences: --	Comments:	Notify physician IF
o TSH GREATER than 10 and free T4 LESS than 0.9 or T3 LESS than 80; 
o TSH LESS than 0.27 AND free T4 GREATER than 1.7 or T3 GREATER than 200.
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	ONC NURSING COMMUNICATION 54	Interval: --	Occurrences: --	Comments:	Zanzalintinib XL-092. Daily. XL092 tablets will be administered orally at assigned daily dose levels. Subjects will take study medication orally once daily (qd). Subjects should be instructed to fast (nothing to eat except water) for at least 2 hours before and at least 1 hour after taking XL092.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Drug Diary Review
		  	durvalumab (IMFINZI) 1,500 mg in sodium chloride 0.9% 250 mL (6 mg/mL) IVPB (RESTRICTED)	Dose: 1,500 mg	Route: intravenous	once over 60 Minutes for 1 dose				Instructions:	o Administer first dose of durvalumab over 60 min.  If tolerated, all subsequent doses of durvalumab can be administered over 30 minutes. 
o If not administered immediately, may be stored (from the time of preparation to the completion of infusion) for up to 28 days refrigerated at 2°C to 8°C (36°F to 46°F). 
o Administer intravenously via a 0.2 to 0.22 micron low protein binding in-line filter. 
o Do not coadminister with other drugs through the same IV line. 
o Flush line with Normal Saline once completed. Do not shake.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION	Medications	1,500 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	220 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once PRN	Start: S				  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 15	Perform every 1 day x1			Research tolerance: -0/+0 days	Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:     HCC 23-116_Abdelrahim
		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for Zanzalintinib (XL-092) Treatment: Refer to Section 7.2.1.2  Protocol Access Hyperlink:    HCC 23-116_Abdelrahim
			Nursing Orders
  	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Medical History
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Review Medications
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	ECOG Performance Status.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
		  	ONC NURSING COMMUNICATION 9	Interval: --	Occurrences: --	Comments:	Adverse Events assessment
		  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Monitoring of Durvalumab/Tremelimumab dose administration - On the first infusion day (cycle 1 day 1 (cohort B) and cycle 2 day 1 (cohort A), participants will be monitored, and vital signs collected/recorded in eCRF prior to, during and after infusion(s) described below.
I. BP and pulse will be collected from participants before, during, and after each infusion(s) at the following times:
1. Prior to the beginning of the infusion(s), measured once from between approximately 30 to 0 minutes [i.e., the start of the infusion(s)])
2. Approximately halfway through each infusion(s),
3. At the end of the infusions approximately 120 ± 15 minutes
a. If the infusion(s) takes longer than expected minutes, then BP and pulse measurements should follow the principles as described above or be taken more frequently if clinically indicated. A 1-hour observation period is recommended after the first infusion of durvalumab.
4. Subsequent durvalumab infusions - BP, pulse and other vital signs should be measured, collected/recorded in eCRF prior to the start of the infusion. Patients should be carefully monitored, and BP and other vital signs should be measured during and post infusion as per institution standard and as clinically indicated.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Physical exam.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
			Labs
  	ONC NURSING COMMUNICATION 37	Interval: --	Occurrences: --	Comments:	Infectious disease tests. As clinically Indicated
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Window for hematology tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Clinical Chemistry. NOTE regarding serum chemistries during treatment: Only in cases where pneumonitis (ILD) is suspected during study treatment, per PI discretion, also do C-Reactive Protein (CRP) testing. Window for tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --			Labs
  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --			Chemotherapy
  	ONC NURSING COMMUNICATION 54	Interval: --	Occurrences: --	Comments:	Zanzalintinib XL-092. Daily. XL092 tablets will be administered orally at assigned daily dose levels. Subjects will take study medication orally once daily (qd). Subjects should be instructed to fast (nothing to eat except water) for at least 2 hours before and at least 1 hour after taking XL092.Paper Rx order will be submitted to IDS for prescription dispensing of Zanzlintinib.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Drug Diary Review
				Day 28	Perform every 1 day x1			Research tolerance: -0/+0 days	Imaging
☑	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	C2D28,C4D28,C6D28,C8D28,C10D28, and subsequent even cycles.

Imaging - Chest, Abdomen and Pelvis (RECIST and imRECIST assessment). CT is preferred modality; MRI can be used if CT is contraindicated or at investigator discretion. Contrast should be used for all imaging per institutional practice unless contraindicated.
I. The same type of imaging used at screening must continue to be used throughout the study. (WINDOW: ± 4 DAYS).
		☑	CT CHEST W WO CONTRAST ABDOMEN W WO CONTRAST PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	CT CHEST W CONTRAST ABDOMEN W CONTRAST PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	CT CHEST WO CONTRAST ABDOMEN WO CONTRAST PELVIS WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	MRI CHEST W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI CHEST W CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI CHEST WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI ABDOMEN W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI ABDOMEN WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
					
Cycle 9	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1			Research tolerance: -0/+0 days	Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:     HCC 23-116_Abdelrahim
		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for Zanzalintinib (XL-092) Treatment: Refer to Section 7.2.1.2  Protocol Access Hyperlink:    HCC 23-116_Abdelrahim
			Nursing Orders
  	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Medical History
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Review Medications
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	ECOG Performance Status.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
		  	ONC NURSING COMMUNICATION 9	Interval: --	Occurrences: --	Comments:	Adverse Events assessment
		  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Monitoring of Durvalumab/Tremelimumab dose administration - On the first infusion day (cycle 1 day 1 (cohort B) and cycle 2 day 1 (cohort A), participants will be monitored, and vital signs collected/recorded in eCRF prior to, during and after infusion(s) described below.
I. BP and pulse will be collected from participants before, during, and after each infusion(s) at the following times:
1. Prior to the beginning of the infusion(s), measured once from between approximately 30 to 0 minutes [i.e., the start of the infusion(s)])
2. Approximately halfway through each infusion(s),
3. At the end of the infusions approximately 120 ± 15 minutes
a. If the infusion(s) takes longer than expected minutes, then BP and pulse measurements should follow the principles as described above or be taken more frequently if clinically indicated. A 1-hour observation period is recommended after the first infusion of durvalumab.
4. Subsequent durvalumab infusions - BP, pulse and other vital signs should be measured, collected/recorded in eCRF prior to the start of the infusion. Patients should be carefully monitored, and BP and other vital signs should be measured during and post infusion as per institution standard and as clinically indicated.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Physical exam.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
			Nursing Orders
  	ONC NURSING COMMUNICATION 53	Interval: --	Occurrences: --	Comments:	PRO Evaluations.FACT-Hep questionnaire
			Labs
  	ONC NURSING COMMUNICATION 37	Interval: --	Occurrences: --	Comments:	Infectious disease tests. As clinically Indicated
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Window for hematology tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Clinical Chemistry. NOTE regarding serum chemistries during treatment: Only in cases where pneumonitis (ILD) is suspected during study treatment, per PI discretion, also do C-Reactive Protein (CRP) testing. Window for tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --			Labs
  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --			Labs
  	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	T3	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	T4, FREE	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --			Labs
  	URINALYSIS	Interval: --	Occurrences: --		  	URINE PROTEIN/CREATININE RATIO, RANDOM	Interval: --	Occurrences: --			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	For women of child-bearing potential.
		☐	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS 7	Interval: --	Occurrences: --	Comments:	HOLD and notify provider if 
o ANC LESS than 1000; 
o Platelets LESS than 100,000.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold and notify provider for
o AST or ALT GREATER than 3 x ULN or Total Bilirubin GREATER than 1.5 x ULN; 
o SCr GREATER than 1.5 x ULN or 1.5 from baseline.
			Nursing Orders
  	TREATMENT CONDITIONS 12	Interval: --	Occurrences: --	Comments:	Notify physician IF
o TSH GREATER than 10 and free T4 LESS than 0.9 or T3 LESS than 80; 
o TSH LESS than 0.27 AND free T4 GREATER than 1.7 or T3 GREATER than 200.
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	ONC NURSING COMMUNICATION 54	Interval: --	Occurrences: --	Comments:	Zanzalintinib XL-092. Daily. XL092 tablets will be administered orally at assigned daily dose levels. Subjects will take study medication orally once daily (qd). Subjects should be instructed to fast (nothing to eat except water) for at least 2 hours before and at least 1 hour after taking XL092.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Drug Diary Review
		  	durvalumab (IMFINZI) 1,500 mg in sodium chloride 0.9% 250 mL (6 mg/mL) IVPB (RESTRICTED)	Dose: 1,500 mg	Route: intravenous	once over 60 Minutes for 1 dose				Instructions:	o Administer first dose of durvalumab over 60 min.  If tolerated, all subsequent doses of durvalumab can be administered over 30 minutes. 
o If not administered immediately, may be stored (from the time of preparation to the completion of infusion) for up to 28 days refrigerated at 2°C to 8°C (36°F to 46°F). 
o Administer intravenously via a 0.2 to 0.22 micron low protein binding in-line filter. 
o Do not coadminister with other drugs through the same IV line. 
o Flush line with Normal Saline once completed. Do not shake.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION	Medications	1,500 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	220 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once PRN	Start: S				  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 15	Perform every 1 day x1			Research tolerance: -0/+0 days	Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:     HCC 23-116_Abdelrahim
		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for Zanzalintinib (XL-092) Treatment: Refer to Section 7.2.1.2  Protocol Access Hyperlink:    HCC 23-116_Abdelrahim
			Nursing Orders
  	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Medical History
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Review Medications
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	ECOG Performance Status.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
		  	ONC NURSING COMMUNICATION 9	Interval: --	Occurrences: --	Comments:	Adverse Events assessment
		  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Monitoring of Durvalumab/Tremelimumab dose administration - On the first infusion day (cycle 1 day 1 (cohort B) and cycle 2 day 1 (cohort A), participants will be monitored, and vital signs collected/recorded in eCRF prior to, during and after infusion(s) described below.
I. BP and pulse will be collected from participants before, during, and after each infusion(s) at the following times:
1. Prior to the beginning of the infusion(s), measured once from between approximately 30 to 0 minutes [i.e., the start of the infusion(s)])
2. Approximately halfway through each infusion(s),
3. At the end of the infusions approximately 120 ± 15 minutes
a. If the infusion(s) takes longer than expected minutes, then BP and pulse measurements should follow the principles as described above or be taken more frequently if clinically indicated. A 1-hour observation period is recommended after the first infusion of durvalumab.
4. Subsequent durvalumab infusions - BP, pulse and other vital signs should be measured, collected/recorded in eCRF prior to the start of the infusion. Patients should be carefully monitored, and BP and other vital signs should be measured during and post infusion as per institution standard and as clinically indicated.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Physical exam.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
			Labs
  	ONC NURSING COMMUNICATION 37	Interval: --	Occurrences: --	Comments:	Infectious disease tests. As clinically Indicated
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Window for hematology tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Clinical Chemistry. NOTE regarding serum chemistries during treatment: Only in cases where pneumonitis (ILD) is suspected during study treatment, per PI discretion, also do C-Reactive Protein (CRP) testing. Window for tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --			Labs
  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --			Chemotherapy
  	ONC NURSING COMMUNICATION 54	Interval: --	Occurrences: --	Comments:	Zanzalintinib XL-092. Daily. XL092 tablets will be administered orally at assigned daily dose levels. Subjects will take study medication orally once daily (qd). Subjects should be instructed to fast (nothing to eat except water) for at least 2 hours before and at least 1 hour after taking XL092.Paper Rx order will be submitted to IDS for prescription dispensing of Zanzlintinib.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Drug Diary Review
					
Cycle 10	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1			Research tolerance: -0/+0 days	Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:     HCC 23-116_Abdelrahim
		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for Zanzalintinib (XL-092) Treatment: Refer to Section 7.2.1.2  Protocol Access Hyperlink:    HCC 23-116_Abdelrahim
			Nursing Orders
  	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Medical History
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Review Medications
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	ECOG Performance Status.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
		  	ONC NURSING COMMUNICATION 9	Interval: --	Occurrences: --	Comments:	Adverse Events assessment
		  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Monitoring of Durvalumab/Tremelimumab dose administration - On the first infusion day (cycle 1 day 1 (cohort B) and cycle 2 day 1 (cohort A), participants will be monitored, and vital signs collected/recorded in eCRF prior to, during and after infusion(s) described below.
I. BP and pulse will be collected from participants before, during, and after each infusion(s) at the following times:
1. Prior to the beginning of the infusion(s), measured once from between approximately 30 to 0 minutes [i.e., the start of the infusion(s)])
2. Approximately halfway through each infusion(s),
3. At the end of the infusions approximately 120 ± 15 minutes
a. If the infusion(s) takes longer than expected minutes, then BP and pulse measurements should follow the principles as described above or be taken more frequently if clinically indicated. A 1-hour observation period is recommended after the first infusion of durvalumab.
4. Subsequent durvalumab infusions - BP, pulse and other vital signs should be measured, collected/recorded in eCRF prior to the start of the infusion. Patients should be carefully monitored, and BP and other vital signs should be measured during and post infusion as per institution standard and as clinically indicated.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Physical exam.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
			Labs
  	ONC NURSING COMMUNICATION 37	Interval: --	Occurrences: --	Comments:	Infectious disease tests. As clinically Indicated
			Nursing Orders
  	ONC NURSING COMMUNICATION 53	Interval: --	Occurrences: --	Comments:	PRO Evaluations.FACT-Hep questionnaire
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Window for hematology tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Clinical Chemistry. NOTE regarding serum chemistries during treatment: Only in cases where pneumonitis (ILD) is suspected during study treatment, per PI discretion, also do C-Reactive Protein (CRP) testing. Window for tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --			Labs
  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --			Labs
  	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	T3	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	T4, FREE	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --			Labs
  	URINALYSIS	Interval: --	Occurrences: --		  	URINE PROTEIN/CREATININE RATIO, RANDOM	Interval: --	Occurrences: --			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	For women of child-bearing potential.
		☐	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --			Imaging
☑	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	C2D28,C4D28,C6D28,C8D28,C10D28, and subsequent even cycles.

Imaging - Chest, Abdomen and Pelvis (RECIST and imRECIST assessment). CT is preferred modality; MRI can be used if CT is contraindicated or at investigator discretion. Contrast should be used for all imaging per institutional practice unless contraindicated.
I. The same type of imaging used at screening must continue to be used throughout the study. (WINDOW: ± 4 DAYS).
		☑	CT CHEST W WO CONTRAST ABDOMEN W WO CONTRAST PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	CT CHEST W CONTRAST ABDOMEN W CONTRAST PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	CT CHEST WO CONTRAST ABDOMEN WO CONTRAST PELVIS WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	MRI CHEST W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI CHEST W CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI CHEST WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI ABDOMEN W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI ABDOMEN WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS 7	Interval: --	Occurrences: --	Comments:	HOLD and notify provider if 
o ANC LESS than 1000; 
o Platelets LESS than 100,000.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold and notify provider for
o AST or ALT GREATER than 3 x ULN or Total Bilirubin GREATER than 1.5 x ULN; 
o SCr GREATER than 1.5 x ULN or 1.5 from baseline.
			Nursing Orders
  	TREATMENT CONDITIONS 12	Interval: --	Occurrences: --	Comments:	Notify physician IF
o TSH GREATER than 10 and free T4 LESS than 0.9 or T3 LESS than 80; 
o TSH LESS than 0.27 AND free T4 GREATER than 1.7 or T3 GREATER than 200.
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	ONC NURSING COMMUNICATION 54	Interval: --	Occurrences: --	Comments:	Zanzalintinib XL-092. Daily. XL092 tablets will be administered orally at assigned daily dose levels. Subjects will take study medication orally once daily (qd). Subjects should be instructed to fast (nothing to eat except water) for at least 2 hours before and at least 1 hour after taking XL092.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Drug Diary Review
		  	durvalumab (IMFINZI) 1,500 mg in sodium chloride 0.9% 250 mL (6 mg/mL) IVPB (RESTRICTED)	Dose: 1,500 mg	Route: intravenous	once over 60 Minutes for 1 dose				Instructions:	o Administer first dose of durvalumab over 60 min.  If tolerated, all subsequent doses of durvalumab can be administered over 30 minutes. 
o If not administered immediately, may be stored (from the time of preparation to the completion of infusion) for up to 28 days refrigerated at 2°C to 8°C (36°F to 46°F). 
o Administer intravenously via a 0.2 to 0.22 micron low protein binding in-line filter. 
o Do not coadminister with other drugs through the same IV line. 
o Flush line with Normal Saline once completed. Do not shake.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION	Medications	1,500 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	220 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once PRN	Start: S				  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 15	Perform every 1 day x1			Research tolerance: -0/+0 days	Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:     HCC 23-116_Abdelrahim
		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for Zanzalintinib (XL-092) Treatment: Refer to Section 7.2.1.2  Protocol Access Hyperlink:    HCC 23-116_Abdelrahim
			Nursing Orders
  	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Medical History
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Review Medications
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	ECOG Performance Status.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
		  	ONC NURSING COMMUNICATION 9	Interval: --	Occurrences: --	Comments:	Adverse Events assessment
		  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Monitoring of Durvalumab/Tremelimumab dose administration - On the first infusion day (cycle 1 day 1 (cohort B) and cycle 2 day 1 (cohort A), participants will be monitored, and vital signs collected/recorded in eCRF prior to, during and after infusion(s) described below.
I. BP and pulse will be collected from participants before, during, and after each infusion(s) at the following times:
1. Prior to the beginning of the infusion(s), measured once from between approximately 30 to 0 minutes [i.e., the start of the infusion(s)])
2. Approximately halfway through each infusion(s),
3. At the end of the infusions approximately 120 ± 15 minutes
a. If the infusion(s) takes longer than expected minutes, then BP and pulse measurements should follow the principles as described above or be taken more frequently if clinically indicated. A 1-hour observation period is recommended after the first infusion of durvalumab.
4. Subsequent durvalumab infusions - BP, pulse and other vital signs should be measured, collected/recorded in eCRF prior to the start of the infusion. Patients should be carefully monitored, and BP and other vital signs should be measured during and post infusion as per institution standard and as clinically indicated.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Physical exam.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
			Labs
  	ONC NURSING COMMUNICATION 37	Interval: --	Occurrences: --	Comments:	Infectious disease tests. As clinically Indicated
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Window for hematology tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Clinical Chemistry. NOTE regarding serum chemistries during treatment: Only in cases where pneumonitis (ILD) is suspected during study treatment, per PI discretion, also do C-Reactive Protein (CRP) testing. Window for tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --			Labs
  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --			Chemotherapy
  	ONC NURSING COMMUNICATION 54	Interval: --	Occurrences: --	Comments:	Zanzalintinib XL-092. Daily. XL092 tablets will be administered orally at assigned daily dose levels. Subjects will take study medication orally once daily (qd). Subjects should be instructed to fast (nothing to eat except water) for at least 2 hours before and at least 1 hour after taking XL092.Paper Rx order will be submitted to IDS for prescription dispensing of Zanzlintinib.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Drug Diary Review
				Day 28	Perform every 1 day x1			Research tolerance: -0/+0 days	Imaging
☑	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	C2D28,C4D28,C6D28,C8D28,C10D28, and subsequent even cycles.

Imaging - Chest, Abdomen and Pelvis (RECIST and imRECIST assessment). CT is preferred modality; MRI can be used if CT is contraindicated or at investigator discretion. Contrast should be used for all imaging per institutional practice unless contraindicated.
I. The same type of imaging used at screening must continue to be used throughout the study. (WINDOW: ± 4 DAYS).
		☑	CT CHEST W WO CONTRAST ABDOMEN W WO CONTRAST PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	CT CHEST W CONTRAST ABDOMEN W CONTRAST PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	CT CHEST WO CONTRAST ABDOMEN WO CONTRAST PELVIS WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	MRI CHEST W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI CHEST W CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI CHEST WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI ABDOMEN W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI ABDOMEN WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
					
End of Treatment (EOT)	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1			Research tolerance: -0/+0 days	Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:     HCC 23-116_Abdelrahim
		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for Zanzalintinib (XL-092) Treatment: Refer to Section 7.2.1.2  Protocol Access Hyperlink:    HCC 23-116_Abdelrahim
			Nursing Orders
  	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Medical History
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Review Medications
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	ECOG Performance Status.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
		  	ONC NURSING COMMUNICATION 9	Interval: --	Occurrences: --	Comments:	Adverse Events assessment
		  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Monitoring of Durvalumab/Tremelimumab dose administration - On the first infusion day (cycle 1 day 1 (cohort B) and cycle 2 day 1 (cohort A), participants will be monitored, and vital signs collected/recorded in eCRF prior to, during and after infusion(s) described below.
I. BP and pulse will be collected from participants before, during, and after each infusion(s) at the following times:
1. Prior to the beginning of the infusion(s), measured once from between approximately 30 to 0 minutes [i.e., the start of the infusion(s)])
2. Approximately halfway through each infusion(s),
3. At the end of the infusions approximately 120 ± 15 minutes
a. If the infusion(s) takes longer than expected minutes, then BP and pulse measurements should follow the principles as described above or be taken more frequently if clinically indicated. A 1-hour observation period is recommended after the first infusion of durvalumab.
4. Subsequent durvalumab infusions - BP, pulse and other vital signs should be measured, collected/recorded in eCRF prior to the start of the infusion. Patients should be carefully monitored, and BP and other vital signs should be measured during and post infusion as per institution standard and as clinically indicated.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Physical exam.Screening procedures performed within 7 days of Cycle 1 Day 1 (C1D1) do not need to be repeated on C1D1
			Labs
  	ONC NURSING COMMUNICATION 37	Interval: --	Occurrences: --	Comments:	Infectious disease tests. As clinically Indicated
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Window for hematology tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Clinical Chemistry. NOTE regarding serum chemistries during treatment: Only in cases where pneumonitis (ILD) is suspected during study treatment, per PI discretion, also do C-Reactive Protein (CRP) testing. Window for tests is ± 7 days for Day 1 of all treatment cycles; ±3 days for days 8, 15, and 22 in Cycles 1 & 2 and day 15 of all the subsequent cycles; and ±7 days for EOT evaluations
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --			Labs
  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --			Labs
  	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	T3	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	T4, FREE	Interval: --	Occurrences: --	Comments:	TSH, Free T3 and Free T4 required at screening. Perform Free T3 and Free T4 only if TSH is abnormal at subsequent timepoints.
		  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Blood sample collection for future research
			Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	Within 1 hour before first study treatment on Cycle 1 Day 1 (single). If abnormal, including a QTcF value > 470 ms, proceed immediately with 2 additional ECGs to provide a triplicate.Cycle 2 Day 1 (single). If abnormal, including a QTcF value > 470 ms, proceed immediately with 2 additional ECGs to provide a triplicate.
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS 7	Interval: --	Occurrences: --	Comments:	HOLD and notify provider if 
o ANC LESS than 1000; 
o Platelets LESS than 100,000.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold and notify provider for
o AST or ALT GREATER than 3 x ULN or Total Bilirubin GREATER than 1.5 x ULN; 
o SCr GREATER than 1.5 x ULN or 1.5 from baseline.
			Nursing Orders
  	TREATMENT CONDITIONS 12	Interval: --	Occurrences: --	Comments:	Notify physician IF
o TSH GREATER than 10 and free T4 LESS than 0.9 or T3 LESS than 80; 
o TSH LESS than 0.27 AND free T4 GREATER than 1.7 or T3 GREATER than 200.
			Chemotherapy
  	ONC NURSING COMMUNICATION 54	Interval: --	Occurrences: --	Comments:	Zanzalintinib XL-092. Daily. XL092 tablets will be administered orally at assigned daily dose levels. Subjects will take study medication orally once daily (qd). Subjects should be instructed to fast (nothing to eat except water) for at least 2 hours before and at least 1 hour after taking XL092.Paper Rx order will be submitted to IDS for prescription dispensing of Zanzlintinib.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Drug Diary Review
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	ONC NURSING COMMUNICATION 54	Interval: --	Occurrences: --	Comments:	Zanzalintinib XL-092. Daily. XL092 tablets will be administered orally at assigned daily dose levels. Subjects will take study medication orally once daily (qd). Subjects should be instructed to fast (nothing to eat except water) for at least 2 hours before and at least 1 hour after taking XL092.
		  	ONC NURSING COMMUNICATION 67	Interval: --	Occurrences: --	Comments:	Drug Diary Review
		  	durvalumab (IMFINZI) 1,500 mg in sodium chloride 0.9% 250 mL (6 mg/mL) IVPB (RESTRICTED)	Dose: 1,500 mg	Route: intravenous	once over 60 Minutes for 1 dose				Instructions:	o Administer first dose of durvalumab over 60 min.  If tolerated, all subsequent doses of durvalumab can be administered over 30 minutes. 
o If not administered immediately, may be stored (from the time of preparation to the completion of infusion) for up to 28 days refrigerated at 2°C to 8°C (36°F to 46°F). 
o Administer intravenously via a 0.2 to 0.22 micron low protein binding in-line filter. 
o Do not coadminister with other drugs through the same IV line. 
o Flush line with Normal Saline once completed. Do not shake.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION	Medications	1,500 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	220 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once PRN	Start: S				  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
Follow Up (Day 30 , 60 and 90)	Repeat 1 time	Cycle length: 1 day	Day 1	Perform every 1 day x1			Research tolerance: -0/+0 days			
Survival Follow Up (Monthly)	Repeat 1 time	Cycle length: 1 day	Day 1	Perform every 1 day x1			Research tolerance: -0/+0 days	Imaging
  	ONC NURSING COMMUNICATION 53	Interval: --	Occurrences: --	Comments:	Survival Follow up. Monthly