Iclusig

— THERAPEUTIC CATEGORIES —
  • Leukemias, lymphomas, and other hematologic cancers

Iclusig Generic Name & Formulations

General Description

Ponatinib 10mg, 15mg, 30mg, 45mg; tabs; contains lactose.

Pharmacological Class

Kinase inhibitor.

How Supplied

Tabs 15mg—30, 60; 10mg, 30mg, 45mg—30

Generic Availability

NO

Mechanism of Action

Ponatinib inhibits the in vitro tyrosine kinase activity of ABL and T315I mutant ABL with IC50 concentrations of 0.4nM and 2.0nM, respectively. Ponatinib also inhibits the activity of additional kinases with IC50 concentrations between 0.1–20nM, including members of the VEGFR, PDGFR, FGFR, EPH receptors and SRC families of kinases, and KIT, RET, TIE2, and FLT3. Ponatinib inhibited the in vitro viability of cells expressing native or mutant BCR-ABL, including T315I.

Iclusig Indications

Indications

In combination with chemotherapy for adults with newly diagnosed Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL). As monotherapy for adults with Ph+ ALL for whome no other kinase inhibitors are indicated or T315I-positive Ph+ ALL. In adults with chronic phase (CP) chronic myeloid leukemia (CML) with resistance or intolerance to at least 2 prior kinase inhibitors. In adults with accelerated phase (AP) or blast phase (BP) CML for whom no other kinase inhibitors are indicated. In adults with T315I-positive CML (chronic, accelerated, or blast phase).

Limitations of Use

Not for treating patients with newly diagnosed CP-CML.

Iclusig Dosage and Administration

Adult

Swallow whole. ≥18yrs: (Newly diagnosed Ph+ ALL): initially 30mg once daily with a reduction to 15mg upon achieving MRD-negative (≤0.01% BCR::ABL1/ABL1) CR at the end of induction; continue in combination with chemotherapy for up to 20 cycles. (Monotherapy Ph+ ALL): initially 45mg once daily; consider discontinuing if no response occurred by 3 months. (CP-CML): initially 45mg once daily with a reduction to 15mg upon achieving ≤1% BCR-ABL1IS; if loss of response occurs, may re-escalate to previously tolerated dosage of 30mg or 45mg. (AP-CML, BP-CML): initially 45mg once daily; consider reducing dose in AP-CML if major cytogenetic response achieved; consider discontinuing if no response occurred by 3 months. For all: continue until loss of response or unacceptable toxicity. Concomitant strong CYP3A inhibitors (if unavoidable): reduce Iclusig dose (see full labeling). Concomitant hepatic impairment: reduce to 30mg once daily. Moderate to severe hepatic impairment (newly diagnosed Ph+ ALL): monitor closely and modify dose. Dose modifications for adverse reactions: see full labeling.

Children

<18yrs: not established.

Administration

Swallow whole. Do not take two doses at the same time to make up for a missed dose.

Nursing Considerations

Swallow whole. Do not take two doses at the same time to make up for a missed dose.

Iclusig Contraindications

Not Applicable

Iclusig Boxed Warnings

Boxed Warning

Arterial occlusive events. Venous thromboembolic events. Heart failure. Hepatotoxicity.

Iclusig Warnings/Precautions

Warnings/Precautions

Risk of venous thromboembolic and arterial occlusive events (including fatal MI, stroke, stenosis of arterial vessels of the brain, severe peripheral vascular disease, and the need for urgent revascularization procedures) in patients with or without CV risk factors (including ≤50yrs old, or increasing age, history of ischemia, HTN, diabetes, hypercholesterolemia); monitor and interrupt or discontinue based on recurrence/severity. Monitor for heart failure; interrupt or discontinue if new or worsening condition occurs. Monitor LFTs at baseline, then at least monthly or as needed; interrupt or discontinue based on recurrence/severity. Monitor BP at baseline, as clinically needed and manage appropriately; interrupt, reduce dose or discontinue if not controlled. Evaluate for renal artery stenosis if significant worsening, labile or treatment-resistant hypertension occurs. Risk of pancreatitis; check serum lipase every 2 weeks for the first 2 months and then monthly thereafter or as clinically indicated; interrupt, resume, or discontinue based on severity. Increased toxicity in newly diagnosed chronic phase CML: not recommended. Conduct eye exams at baseline and periodically during treatment. Monitor for symptoms of neuropathy, hemorrhage, cardiac arrhythmias, or fluid retention and manage as clinically indicated; interrupt, resume at same or reduced dose, or discontinue based on recurrence/severity. Obtain CBCs every 2 weeks for the first 3 months, then monthly or as indicated; if ANC <1×109/L or platelets <50×109/L, interrupt until ANC ≥1.5×109/L and platelets ≥75×109/L, then resume at same or reduced dose. Tumor lysis syndrome: ensure adequate hydration and treat uric levels prior to therapy. Impaired wound healing: withhold for ≥1 week prior to elective surgery; do not give for ≥2 weeks after major surgery and until adequate healing. Permanently discontinue if GI perforation occurs. Interrupt therapy if reversible posterior leukoencephalopathy syndrome occurs. Hepatic impairment. Elderly. Embryo-fetal toxicity. Advise females of reproductive potential to use effective contraception during and for 3 weeks after the last dose. Pregnancy: exclude status prior to initiation. Nursing mothers: not recommended (during and for 1 week after the last dose).

Iclusig Pharmacokinetics

Absorption

Peak concentration observed within 6 hours.

Distribution

Steady-state volume of distribution: 1223 L. >99% protein bound.

Metabolism

Hepatic (CYP3A4, 2C8, 2D6, 3A5).

Elimination

Fecal (~87%), renal (~5%). Half-life: ~24 hours (range: 12–66 hours).

Iclusig Interactions

Interactions

Avoid concomitant strong CYP3A inhibitors (eg, ketoconazole); if unavoidable, reduce Iclusig dose. Avoid concomitant strong CYP3A inducers unless the benefit outweighs the risk (eg, rifampin). May inhibit P-gp, BCRP and BSEP substrates.

Iclusig Adverse Reactions

Adverse Reactions

Rash and related conditions, arthralgia, abdominal pain, headache, constipation, dry skin, hypertension, fatigue, fluid retention and edema, pyrexia, nausea, pancreatitis/lipase elevation, hemorrhage, anemia, hepatic dysfunction, arterial occlusive events, decreased platelet count, decreased neutrophil cell count, decreased white blood cell.

Iclusig Clinical Trials

See Literature

Iclusig Note

Not Applicable

Iclusig Patient Counseling

See Literature

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