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LORBRENA®Adverse Reactions (lorlatinib)

6 ADVERSE REACTIONS

The following adverse reactions are described elsewhere in the labeling:

6.1 Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

The pooled safety population described in the Warnings and Precautions section reflects exposure to LORBRENA in 476 patients who received 100 mg LORBRENA once daily in Study B7461001 (N=327) and Study B7461006 (N=149). Among 476 patients who received LORBRENA, 75% were exposed for 6 months or longer and 61% were exposed for greater than 1 year. In this pooled safety population, the most frequent adverse reactions in ≥ 20% of 476 patients who received LORBRENA were edema (56%), peripheral neuropathy (44%), weight gain (31%), cognitive effects (28%), fatigue (27%), dyspnea (27%), arthralgia (24%), diarrhea (23%), mood effects (21%), and cough (21%). The most frequent Grade 3–4 laboratory abnormalities in ≥ 20% of 476 patients who received LORBRENA were hypercholesterolemia (21%) and hypertriglyceridemia (21%).

Previously Untreated ALK-Positive Metastatic NSCLC (CROWN Study)

The safety of LORBRENA was evaluated in 149 patients with ALK-positive NSCLC in a randomized, open-label, active-controlled trial for the treatment of patients with ALK-positive, locally advanced or metastatic, NSCLC who had not received previous systemic treatment for advanced disease [see Clinical Studies (14)]. The median duration of exposure to LORBRENA was 16.7 months (4 days to 34.3 months) and 76% received LORBRENA for at least 12 months.

Serious adverse reactions occurred in 34% of patients treated with LORBRENA; the most frequently reported serious adverse reactions were pneumonia (4.7%), dyspnea (2.7%), respiratory failure (2.7%), cognitive effects (2.0%), and pyrexia (2.0%). Fatal adverse reactions occurred in 3.4% of patients treated with LORBRENA and included pneumonia (0.7%), respiratory failure (0.7%), cardiac failure acute (0.7%), pulmonary embolism (0.7%), and sudden death (0.7%).

Permanent discontinuation of LORBRENA due to adverse reactions occurred in 6.7% of patients. The most frequent adverse reaction that led to permanent discontinuation of LORBRENA was cognitive effects (1.3%). Adverse reactions leading to dose interruptions occurred in 49% of patients treated with LORBRENA. The most frequent adverse reactions that led to dose interruptions of LORBRENA were hypertriglyceridemia (7%), edema (5%), pneumonia (4.7%) cognitive effects (4.0%), mood effects (4.0%), and hypercholesterolemia (3.4%). Adverse reactions leading to dose reductions occurred in 21% of patients treated with LORBRENA. The most frequent adverse reactions that led to dose reductions were edema (5%), hypertriglyceridemia (4.0%), and peripheral neuropathy (3.4%).

Tables 2 and 3 summarize most frequent adverse reactions and laboratory abnormalities, respectively, in patients treated with LORBRENA in Study B7461006.

Table 2 Adverse Reactions (≥10% for all NCI CTCAE Grades or ≥2% for Grades 3–4) in Patients Treated with LORBRENA in Study B7461006*
Adverse ReactionLORBRENA
N=149
Crizotinib
N=142
All Grades
(%)
Grade 3 or 4
(%)
All Grades
(%)
Grade 3 or 4
(%)
Abbreviations: NCI CTCAE=National Cancer Institute Common Terminology Criteria for Adverse Events; SOC=System organ class.
*
Adverse reactions were graded using NCI CTCAE version 4.03.
Mood effects (including affective disorder, affect lability, agitation, anger, anxiety, bipolar I disorder, depressed mood, depression, depressive symptom, euphoric mood, intentional self-injury, irritability, mood altered, mood swings, stress).
Peripheral neuropathy (including dysesthesia, gait disturbance, hypoesthesia, motor dysfunction, muscular weakness, neuralgia, neuropathy peripheral, paresthesia, peripheral motor neuropathy, peripheral sensory neuropathy).
§
Cognitive effects (including events from SOC Nervous system disorders: amnesia, cognitive disorder, disturbance in attention, memory impairment, mental impairment; and also including events from SOC Psychiatric disorders: confusional state, delirium, disorientation).
Sleep effects (including insomnia, nightmare, sleep disorder, somnambulism).
#
Vision disorder (including diplopia, photophobia, photopsia, vision blurred, visual acuity reduced, visual impairment, vitreous floaters).
Þ
Myalgia (including musculoskeletal pain, myalgia).
ß
Edema (including edema, edema peripheral, eyelid edema, face edema, generalized edema, localized edema, periorbital edema, peripheral swelling, swelling).
à
Fatigue (including asthenia, fatigue).
è
Upper respiratory tract infection (including upper respiratory infection).
ð
Rash (including dermatitis acneiform, maculopapular rash, rash).
Psychiatric
  Mood effects16250
Nervous system
  Peripheral neuropathy342150.7
  Cognitive effects§21260
  Headache170180.7
  Dizziness110140
  Sleep effects111.3100
Respiratory
  Dyspnea202.7162.1
  Cough160180
  Respiratory failure2.7200
Vascular disorders
  Hypertension18102.10
Ocular
  Vision disorder#180390.7
Gastrointestinal
  Diarrhea211.3520.7
  Nausea150.7522.1
  Constipation170300.7
  Vomiting130.7391.4
Musculoskeletal and connective tissue
  Arthralgia190.7110
  MyalgiaÞ150.770
  Back pain150.7110
  Pain in extremity17080
General
  Edemaß564401.4
  Weight gain3817132.1
  Fatigueà191.3322.8
  Pyrexia171.3131.4
  Chest pain111.3140.7
Infections
  Upper respiratory tract infectionè110.77.71.4
  Pneumonia7.428.53.5
  Bronchitis6.722.10
Skin
  Rashð1108.50

Additional clinically significant adverse reactions occurring at an incidence between 1% and 10% were speech effects (6.7%) and psychotic effects (3.4%).

Table 3 Laboratory Abnormalities Worsening from Baseline in ≥20% of Patients in Study B7461006
Laboratory AbnormalityLORBRENA
N=149
Crizotinib
N=142
All Grades
(%)
Grade 3 or 4
(%)
All Grades
(%)
Grade 3 or 4
(%)
Abbreviations: ALT=alanine aminotransferase; AST=aspartate aminotransferase; CPK=creatine phosphokinase; GGT=gamma glutamyl transferase; NCI CTCAE=National Cancer Institute Common Terminology Criteria for Adverse Events; PTT=partial thromboplastin time.
N=number of patients who had at least one on-study assessment for the parameter of interest.
*
N=149 (LORBRENA).
N=141 (crizotinib).
N=148 (LORBRENA).
§
N=138 (LORBRENA).
N=135 (crizotinib).
Chemistry
  Hypertriglyceridemia*,9522270
  Hypercholesterolemia*,9119120
  Increased creatinine*,810.7992.1
  Increased GGT*,526416
  Increased AST*,482753.5
  Hyperglycemia*,487272.1
  Increased ALT*,442.7754.3
  Increased CPK*,392645
  Hypoalbuminemia*,360.7616
  Increased lipase*,287345
  Increased alkaline phosphatase*,230500.7
  Hyperkalemia*,211.3272.1
  Increased amylase,201.4321.4
Hematology
  Anemia*,482382.8
  Activated PTT§,250140
  Lymphopenia*,232.7436
  Thrombocytopenia*,23070.7

Previously Treated ALK-Positive Metastatic NSCLC

The data described below reflect exposure to LORBRENA in 295 patients with ALK-positive or ROS1-positive metastatic NSCLC who received LORBRENA 100 mg orally once daily in Study B7461001, a multi-cohort, non-comparative trial [see Clinical Studies (14)]. The median duration of exposure to LORBRENA was 12.5 months (1 day to 35 months) and 52% received LORBRENA for ≥12 months. Patient characteristics were: median age of 53 years (19 to 85 years), age ≥65 years (18%), female (58%), White (49%), Asian (37%), and ECOG performance status 0 or 1 (96%).

The most frequent (≥20%) adverse reactions were edema, peripheral neuropathy, cognitive effects, dyspnea, fatigue, weight gain, arthralgia, mood effects, and diarrhea. Of the worsening laboratory values occurring in ≥20% of patients, the most frequent were hypercholesterolemia, hypertriglyceridemia, anemia, hyperglycemia, increased AST, hypoalbuminemia, increased ALT, increased lipase, and increased alkaline phosphatase.

Serious adverse reactions occurred in 32% of the 295 patients; the most frequently reported serious adverse reactions were pneumonia (3.4%), dyspnea (2.7%), pyrexia (2%), mental status changes (1.4%), and respiratory failure (1.4%). Fatal adverse reactions occurred in 2.7% of patients and included pneumonia (0.7%), myocardial infarction (0.7%), acute pulmonary edema (0.3%), embolism (0.3%), peripheral artery occlusion (0.3%), and respiratory distress (0.3%). Permanent discontinuation of LORBRENA for adverse reactions occurred in 8% of patients.

The most frequent adverse reactions that led to permanent discontinuation were respiratory failure (1.4%), dyspnea (0.7%), myocardial infarction (0.7%), cognitive effects (0.7%) and mood effects (0.7%). Approximately 48% of patients required dose interruption. The most frequent adverse reactions that led to dose interruptions were edema (7%), hypertriglyceridemia (6%), peripheral neuropathy (5%), cognitive effects (4.4%), increased lipase (3.7%), hypercholesterolemia (3.4%), mood effects (3.1%), dyspnea (2.7%), pneumonia (2.7%), and hypertension (2.0%). Approximately 24% of patients required at least 1 dose reduction for adverse reactions. The most frequent adverse reactions that led to dose reductions were edema (6%), peripheral neuropathy (4.7%), cognitive effects (4.1%), and mood effects (3.1%).

Tables 4 and 5 summarize most frequent adverse reactions and laboratory abnormalities, respectively, in patients treated with LORBRENA in Study B7461001.

Table 4 Adverse Reactions Occurring in ≥10% of Patients in Study B7461001*
Adverse ReactionLORBRENA
(N=295)
All Grades
(%)
Grade 3 or 4
(%)
Abbreviations: NCI CTCAE=National Cancer Institute Common Terminology Criteria for Adverse Events; SOC=System organ class.
*
Adverse reactions were graded using NCI CTCAE version 4.03.
Mood effects (including affective disorder, affect lability, aggression, agitation, anxiety, depressed mood, depression, euphoric mood, irritability, mania, mood altered, mood swings, personality change, stress, suicidal ideation).
Peripheral neuropathy (including burning sensation, carpal tunnel syndrome, dysesthesia, formication, gait disturbance, hypoesthesia, muscular weakness, neuralgia, neuropathy peripheral, neurotoxicity, paresthesia, peripheral sensory neuropathy, sensory disturbance).
§
Cognitive effects (including events from SOC Nervous system disorders: amnesia, cognitive disorder, dementia, disturbance in attention, memory impairment, mental impairment; and also including events from SOC Psychiatric disorders: attention deficit/hyperactivity disorder, confusional state, delirium, disorientation, reading disorder).
Speech effects (including aphasia, dysarthria, slow speech, speech disorder)
#
Sleep effects (including abnormal dreams, insomnia, nightmare, sleep disorder, sleep talking, somnambulism)
Þ
Vision disorder (including blindness, diplopia, photophobia, photopsia, vision blurred, visual acuity reduced, visual impairment, vitreous floaters).
ß
Myalgia (including musculoskeletal pain, myalgia).
à
Edema (including edema, edema peripheral, eyelid edema, face edema, generalized edema, localized edema, periorbital edema, peripheral swelling, swelling).
è
Fatigue (including asthenia, fatigue).
ð
Upper respiratory infection (including fungal upper respiratory infection, upper respiratory infection, viral upper respiratory infection).
ø
Rash (including dermatitis acneiform, maculopapular rash, pruritic rash, rash).
Psychiatric
  Mood effects231.7
Nervous system
  Peripheral neuropathy472.7
  Cognitive effects§272
  Headache180.7
  Dizziness160.7
  Speech effects120.3
  Sleep effects#100
Respiratory
  Dyspnea275
  Cough180
Ocular
  Vision disorderÞ150.3
Gastrointestinal
  Diarrhea220.7
  Nausea180.7
  Constipation150
  Vomiting121
Musculoskeletal and connective tissue
  Arthralgia230.7
  Myalgiaß170
  Back pain130.7
  Pain in extremity130.3
General
  Edemaà573.1
  Fatigueè260.3
  Weight gain244.4
  Pyrexia120.7
Infections
  Upper respiratory tract infectionð120
Skin
  Rashø140.3

Additional clinically significant adverse reactions occurring at an incidence between 1% and 10% were psychotic effects (7%).

Table 5 Worsening Laboratory Values Occurring in ≥20% of Patients in Study B7461001*
Laboratory AbnormalityLORBRENA
All Grades
(%)
Grade 3 or 4
(%)
Abbreviations: ALT=alanine aminotransferase; AST=aspartate aminotransferase; NCI CTCAE=National Cancer Institute Common Terminology Criteria for Adverse Events.
N=number of patients who had at least one on-study assessment for the parameter of interest.
*
Grades using NCI CTCAE version 4.03.
N=292.
N=293.
§
N=291.
N=290.
#
N=284.
Chemistry
  Hypercholesterolemia9618
  Hypertriglyceridemia9018
  Hyperglycemia525
  Increased AST372.1
  Hypoalbuminemia§331
  Increased ALT282.1
  Increased lipase2410
  Increased alkaline phosphatase241
  Increased amylase#223.9
  Hypophosphatemia214.8
  Hyperkalemia211
  Hypomagnesemia210
Hematology
  Anemia524.8
  Thrombocytopenia230.3
  Lymphopenia223.4
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