GeftiNat (gefitinib) by Natco is generic version of  Iressa.

GeftiNat  (IRESSA - Gefitinib)

Generic Name : Gefitinib 

Brand Names : IRESSA

it comes in Pack of 30 tablets 250mg (Gefitinib Tablets)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DRUG DESCRIPTION

GeftiNat (Iressa or Gefitinib) is a cancer chemotherapy medication. GeftiNat (Iressa or Gefitinib) interferes with the growth of cancer cells and slows their growth and spread in the body. Gefitinib is used in the treatment of non-small cell lung cancer. Iressa tablets contain 250 mg of gefitinib and are available as brown film-coated tablets for daily oral administration

Gefitinib is an anilinoquinazoline with the chemical name 4-Quinazolinamine, N-(3-chloro-4-fluorophenyl)-7-methoxy-6-[3-4-morpholin) propoxy] and the following structural formula:

It has the molecular formula C22H24ClFN4O3, a relative molecular mass of 446.9 and is a white-colored powder. Gefitinib is a free base. The molecule has pKas of 5.4 and 7.2 and therefore ionizes progressively in solution as the pH falls. Gefitinib can be defined as sparingly soluble at pH 1, but is practically insoluble above pH 7, with the solubility dropping sharply between pH 4 and pH 6. In non-aqueous solvents, gefitinib is freely soluble in glacial acetic acid and dimethylsulphoxide, soluble in pyridine, sparingly soluble in tetrahydrofuran, and slightly soluble in methanol, ethanol (99.5%), ethyl acetate, propan-2-ol and acetonitrile.

The inactive ingredients of GEFTINAT tablets are: Tablet core: Lactose monohydrate, microcrystalline cellulose, croscarmellose sodium, povidone, sodium lauryl sulfate and magnesium stearate. Coating: Hypromellose, polyethylene glycol 300, titanium dioxide, red ferric oxide and yellow ferric oxide

GEFTINAT is indicated as monotherapy for the continued treatment of patients with locally advanced or metastatic non-small cell lung cancer after failure of both platinum-based and docetaxel chemotherapies who are benefiting or have benefited from GEFTINAT.

In light of positive survival data with other agents including another oral EGFR inhibitor, physicians should use other treatment options in advanced non-small cell lung cancer patient populations who have received one or two prior chemotherapy regimens and are refractory or intolerant to their most recent regimen.

The effectiveness of GEFTINAT was initially based on objective response rates (see CLINICAL PHARMACOLOGY - Clinical Studies section). Subsequent studies intended to demonstrate an increase in survival have been unsuccessful. Specifically, results from a large placebo-controlled randomized trial in patients with advanced NSCLC who progressed while receiving or within 90 days of the last dose of chemotherapy or were intolerant to the most recent prior chemotherapy regimen, did not show an improvement in survival (see CLINICAL PHARMACOLOGY - Clinical Studies section).

Results from two large, controlled, randomized trials in first-line treatment of non-small cell lung cancer showed no benefit from adding GEFTINAT to doublet, platinum-based chemotherapy.

Indications

GeftiNat (Iressa or Gefitinib) is indicated as monotherapy for the continued treatment of patients with locally advanced or metastatic non-small cell lung cancer after failure of both platinum-based and docetaxel chemotherapies who are benefiting or have benefited from Gefitinib. GeftiNat (Iressa or Gefitinib) may also be used for purposes other than those listed in this drug information guide.

DOSAGE AND ADMINISTRATION

The recommended daily dose of GEFTINAT is one 250 mg tablet with or without food. Higher doses do not give a better response and cause increased toxicity.

For Patients who have Difficulty Swallowing Solids

GEFTINAT tablets can also be dispersed in half a glass of drinking water (noncarbonated). No other liquids should be used. Drop the tablet in the water, without crushing it, stir until the tablet is dispersed (approximately 10 minutes) and drink the liquid immediately. Rinse the glass with half a glass of water and drink. The liquid can also be administered through a naso-gastric tube.

Dosage Adjustment

Patients with poorly tolerated diarrhea (sometimes associated with dehydration) or skin adverse drug reactions may be successfully managed by providing a brief (up to 14 days) therapy interruption followed by reinstatement of the 250 mg daily dose.

In the event of acute onset or worsening of pulmonary symptoms (dyspnea,cough, fever), GEFTINAT therapy should be interrupted and a prompt investigation of these symptoms should occur and appropriate treatment initiated. If interstitial lung disease is confirmed, GEFTINAT should be discontinued and the patient treated appropriately (see WARNINGS - Pulmonary Toxicity, PRECAUTIONS - INFORMATION FOR PATIENTS and ADVERSE REACTIONS sections).

Patients who develop onset of new eye symptoms such as pain should be medically evaluated and managed appropriately, including GEFTINAT therapy interruption and removal of an aberrant eyelash if present. After symptoms and eye changes have resolved, the decision should be made concerning reinstatement of the 250 mg daily dose (see PRECAUTIONS - INFORMATION FOR PATIENTS and ADVERSE REACTIONS sections).

In patients receiving a potent CYP3A4 inducer such as rifampicin or phenytoin, a dose increase to 500 mg daily should be considered in the absence of severeadverse drug reaction, and clinical response and adverse events should be carefully monitored (see CLINICAL PHARMACOLOGY - Pharmacokinetics-Drug-Drug Interactions and PRECAUTIONS - DRUG INTERACTIONSsections).

No dosage adjustment is required on the basis of patient age, body weight, gender, ethnicity, or renal function; or in patients with moderate to severe hepatic impairment due to liver metastases (see CLINICAL PHARMACOLOGY - Pharmacokinetics-Special Populations section).

HOW SUPPLIED

GEFTINAT tablets are supplied as round, biconvex, brown film-coated tablets intagliated with “GEFTINAT 250” on one side and plain on the other side, each containing 250 mg of gefitinib.

Bottles of 30 Tablets (NDC 0310-0482-30)

Storage

Store at controlled room temperature 20-25°C (68-77°F) [see USP].

 

 

SIDE EFFECTS

Serious side effects have been reported with the use of Iressa including: allergic reactions (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives); lung problems; liver problems; eye problems; severe nausea, vomiting, loss of appetite, or diarrhea; and others.

The safety database includes 941 patients from clinical trials and approximately 23,000 patients in the Expanded Access Program.

Table 3 includes drug-related adverse events with an incidence of ≥ 5% for the 216 patients who received either 250 mg or 500 mg of GEFTINAT monotherapy for treatment of NSCLC. The most common adverse events reported at the recommended 250 mg daily dose were diarrhea, rash, acne, dry skin, nausea, and vomiting (see PRECAUTIONS - INFORMATION FOR PATIENTS andDOSAGE AND ADMINISTRATION – Dosage Adjustment sections). The 500 mg dose showed a higher rate for most of these adverse events.

Table 4 provides drug-related adverse events with an incidence of ≥ 5% by CTC grade for the patients who received the 250 mg/day dose of GEFTINAT monotherapy for treatment of NSCLC. Only 2% of patients stopped therapy due to an adverse drug reaction (ADR). The onset of these ADRs occurred within the first month of therapy.

Table 3 - Drug-Related Adverse Events With an Incidence of ≥ 5% in either 250 mg or 500 mg Dose Group

Drug-related adverse eventa

Number (%) of Patients

250 mg/day
(N=102)
%

500 mg/day
(N=114)
%

Diarrhea

49 (48)

76 (67)

Rash

44 (43)

61 (54)

Acne

25 (25)

37 (33)

Dry skin

13 (13)

30 (26)

Nausea

13 (13)

20 (18)

Vomiting

12 (12)

10 (9)

Pruritus

8 (8)

10 (9)

Anorexia

7 (7)

11 (10)

Asthenia

6 (6)

5 (4)

Weight loss

3 (3)

6 (5)

a A patient may have had more than 1 drug-related adverse event.

Table 4 - Drug Related Adverse Events ≥ 5% at 250 mg dose by Worst CTC Grade (n=102)

Adverse Event

% of Patients

All
Grades

CTC
Grade 1

CTC
Grade 2

CTC
Grade 3

CTC
Grade 4

Diarrhea

48

41

6

1

0

Rash

43

39

4

0

0

Acne

25

19

6

0

0

Dry Skin

13

12

1

0

0

Nausea

13

7

5

1

0

Vomiting

12

9

2

1

0

Pruritus

8

7

1

0

0

Anorexia

7

3

4

0

0

Asthenia

6

2

2

1

1

Other adverse events reported at an incidence of <5% in patients who received either 250 mg or 500 mg as monotherapy for treatment of NSCLC (along with their frequency at the 250 mg recommended dose) include the following: peripheral edema (2%), amblyopia (2%), dyspnea (2%), conjunctivitis (1%), vesiculobullous rash (1%), and mouth ulceration (1%).

Interstitial Lung Disease

Cases of interstitial lung disease (ILD) have been observed in patients receiving GEFTINAT at an overall incidence of about 1%. Approximately 1/3 of the cases have been fatal. The reported incidence of ILD was about 2% in the Japanese post-marketing experience, about 0.3% in approximately 23,000 patients treated with GEFTINAT in a US expanded access program and about 1% in the studies of first-line use in NSCLC (but with similar rates in both treatment and placebo groups). Reports have described the adverse event as interstitial pneumonia, pneumonitis and alveolitis. Patients often present with the acute onset of dyspnea, sometimes associated with cough or low-grade fever, often becoming severe within a short time and requiring hospitalization. ILD has occurred in patients who have received prior radiation therapy (31% of reported cases), prior chemotherapy (57% of reported patients), and no previous therapy (12% of reported cases). Patients with concurrent idiopathic pulmonary fibrosis whose condition worsens while receiving GEFTINAT have been observed to have an increased mortality compared to those without concurrent idiopathic pulmonary fibrosis.

In the event of acute onset or worsening of pulmonary symptoms (dyspnea, cough, fever), GEFTINAT therapy should be interrupted and a prompt investigation of these symptoms should occur. If interstitial lung disease is confirmed, GEFTINAT should be discontinued and the patient treated appropriately (seeWARNINGS - Pulmonary Toxicity, PRECAUTIONS - INFORMATION FOR PATIENTS and DOSAGE AND ADMINISTRATION - Dosage Adjustmentsections).

In patients receiving GEFTINAT therapy, there were reports of eye pain and corneal erosion/ulcer, sometimes in association with aberrant eyelash growth (seePRECAUTIONS - INFORMATION FOR PATIENTS section). Hemorrhage, such as epistaxis and hematuria have been reported in patients receiving GEFTINAT. There were also rare reports of pancreatitis and very rare reports of corneal membrane sloughing, ocular ischemia/hemorrhage, toxic epidermal necrolysis,erythema multiforme, and allergic reactions, including angioedema and urticaria.

International Normalized Ratio (INR) elevations and/or bleeding events have been reported in some patients taking warfarin while on GEFTINAT therapy. Patients taking warfarin should be monitored regularly for changes in prothrombin time or INR (see CLINICAL PHARMACOLOGY - Drug-Drug Interactions andPRECAUTIONS - DRUG INTERACTIONS sections).

Data from non-clinical (in vitro and in vivo) studies indicate that gefitinib has the potential to inhibit the cardiac action potential repolarization process (eg, QT interval). The clinical relevance of these findings is unknown.

DRUG INTERACTIONS

Substances that are inducers of CYP3A4 activity increase the metabolism of gefitinib and decrease its plasma concentrations. In patients receiving a potent CYP3A4 inducer such as rifampicin or phenytoin, a dose increase to 500 mg daily should be considered in the absence of severe adverse drug reaction, and clinical response and adverse events should be carefully monitored (see CLINICAL PHARMACOLOGY - Pharmacokinetics-Drug-Drug Interactions and DOSAGE AND ADMINISTRATION - Dosage Adjustment sections).

International Normalized Ratio (INR) elevations and/or bleeding events have been reported in some patients taking warfarin while on GEFTINAT therapy. Patients taking warfarin should be monitored regularly for changes in prothrombin time or INR (see CLINICAL PHARMACOLOGY - Pharmacokinetics-Drug-Drug Interactions and ADVERSE REACTIONS sections).

Substances that are potent inhibitors of CYP3A4 activity (eg, ketoconazole and itraconazole) decrease gefitinib metabolism and increase gefitinib plasma concentrations. This increase may be clinically relevant as adverse experiences are related to dose and exposure; therefore, caution should be used when administering CYP3A4 inhibitors with GEFTINAT (see CLINICAL PHARMACOLOGY - Pharmacokinetics-Drug-Drug Interactions andADVERSE REACTIONS sections).

Drugs that cause significant sustained elevation in gastric pH (histamine H2-receptor antagonists such as ranitidine or cimetidine) may reduce plasma concentrations of GEFTINAT and therefore potentially may reduce efficacy (seeCLINICAL PHARMACOLOGY - Drug-Drug Interactions section).

Phase II clinical trial data, where GEFTINAT and vinorelbine have been used concomitantly, indicate that GEFTINAT may exacerbate the neutropenic effect of vinorelbine.

Warnings & Precautions

WARNINGS

Pulmonary Toxicity

Cases of interstitial lung disease (ILD) have been observed in patients receiving GEFTINAT at an overall incidence of about 1%. Approximately 1/3 of the cases have been fatal. The reported incidence of ILD was about 2% in the Japanese post-marketing experience, about 0.3% in approximately 23,000 patients treated with GEFTINAT in a US expanded access program and about 1% in the studies of first-line use in NSCLC (but with similar rates in both treatment and placebo groups). Reports have described the adverse event as interstitial pneumonia, pneumonitis and alveolitis. Patients often present with the acute onset ofdyspnea, sometimes associated with cough or low-grade fever, often becoming severe within a short time and requiring hospitalization. ILD has occurred in patients who have received prior radiation therapy (31% of reported cases), prior chemotherapy (57% of reported patients), and no previous therapy (12% of reported cases). Patients with concurrent idiopathic pulmonary fibrosis whose condition worsens while receiving GEFTINAT have been observed to have an increased mortality compared to those without concurrent idiopathic pulmonary fibrosis.

In the event of acute onset or worsening of pulmonary symptoms (dyspnea, cough, fever), GEFTINAT therapy should be interrupted and a prompt investigation of these symptoms should occur. If interstitial lung disease is confirmed, GEFTINAT should be discontinued and the patient treated appropriately (seePRECAUTIONS - INFORMATION FOR PATIENTS, ADVERSE REACTIONSand DOSAGE AND ADMINISTRATION - Dosage Adjustment sections).

Pregnancy Category D

GEFTINAT may cause fetal harm when administered to a pregnant woman. A single dose study in rats showed that gefitinib crosses the placenta after an oral dose of 5mg/kg (30 mg/m², about 1/5 the recommended human dose on a mg/m²basis). When pregnant rats were treated with 5 mg/kg from the beginning of organogenesis to the end of weaning gave birth, there was a reduction in the number of offspring born alive. This effect was more severe at 20 mg/kg and was accompanied by high neonatal mortality soon after parturition. In this study a dose of 1 mg/kg caused no adverse effects.

In rabbits, a dose of 20 mg/kg/day (240 mg/m², about twice the recommended dose in humans on a mg/m²basis) caused reduced fetal weight.

There are no adequate and well-controlled studies in pregnant women using GEFTINAT. If GEFTINAT is used during pregnancy or if the patient becomes pregnant while receiving this drug, she should be apprised of the potential hazard to the fetus or potential risk for loss of the pregnancy.

 

 

 

PRECAUTIONS

Hepatotoxicity

Asymptomatic increases in liver transaminases have been observed in GEFTINAT-treated patients; therefore, periodic liver function (transaminases, bilirubin, andalkaline phosphatase) testing should be considered. Discontinuation of GEFTINAT should be considered if changes are severe.

Patients with Hepatic Impairment

In vitroand in vivo evidence suggest that gefitinib is cleared primarily by the liver. Therefore, gefitinib exposure may be increased in patients with hepatic dysfunction. In patients with liver metastases and moderately to severely elevated biochemical liver abnormalities, however, gefitinib pharmacokinetics were similar to the pharmacoki-netics of individuals without liver abnormalities (see CLINICAL PHARMACOLOGY - Pharmacokinetics-Special Populationssection). The influence of non-cancer related hepatic impairment on the pharmacokinetics of gefitinib has not been evaluated.

Carcinogenesis, Mutagenesis, Impairment of Fertility

Gefitinib has been tested for genotoxicity in a series of in vitro (bacterialmutation, mouse lymphoma, and human lymphocyte) assays and an in vivo rat micronucleus test. Under the conditions of these assays, gefitinib did not cause genetic damage.

Carcinogenicity studies have not been conducted with gefitinib.

Pregnancy

Pregnancy Category D (see WARNINGS and PRECAUTIONS -INFORMATION FOR PATIENTS sections).

Nursing Mothers

It is not known whether GEFTINAT is excreted in human milk. Following oral administration of carbon-14 labeled gefitinib to rats 14 days postpartum, concentrations of radioactivity in milk were higher than in blood. Levels of gefitinib and its metabolites were 11-to-19-fold higher in milk than in blood, after oral exposure of lactating rats to a dose of 5 mg/kg. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants, women should be advised against breast-feeding while receiving GEFTINAT therapy.

Pediatric Use

GEFTINAT is not indicated for use in pediatric patients, as safety and effectiveness have not been established. In clinical trials of GEFTINAT alone or with radiation in pediatric patients with primary Central Nervous System (CNS) tumors, cases of CNS hemor-rhageand death have been reported. There are insufficient data in pediatric patients to establish a causal relationship. There is no evidence to suggest increased risk of cerebral hemorrhage in adult patients with NSCLC receiving GEFTINAT.

Geriatric Use

Of the total number of patients participating in trials of second- and third-line GEFTINAT treatment of NSCLC, 65% were aged 64 years or less, 30.5% were aged 65 to 74years, and 5% of patients were aged 75 years or older. No differences in safety or efficacy were observed between younger and older patients.

Patients with Severe Renal Impairment

The effect of severe renal impairment on the pharmacokinetics of gefitinib is not known. Patients with severe renal impairment should be treated with caution when given GEFTINAT.

 

 

Overdosage & Contraindications

There is no specific treatment for an GEFTINAT overdose and possible symptoms of overdose are not established. However, in Phase 1 clinical trials, a limited number of patients were treated with daily doses of up to 1000 mg. An increase in frequency and severity of some adverse reactions was observed, mainlydiarrhea and skin rash. Adverse reactions associated with overdose should be treated symptomatically; in particular, severe diarrhea should be managed appropriately.

CONTRAINDICATIONS

GEFTINAT is contraindicated in patients with severe hypersensitivity to gefitinib or to any other component of GEFTINAT.

 

Geftinat

Clinical Pharmacology

CLINICAL PHARMACOLOGY

Mechanism of Action

The mechanism of the clinical antitumor action of gefitinib is not fully characterized. Gefitinib inhibits the intracellular phosphorylation of numerous tyrosine kinases associated with transmembrane cell surface receptors, including the tyrosine kinases associated with the epidermal growth factor receptor (EGFR-TK). EGFR is expressed on the cell surface of many normal cells and cancer cells. No clinical studies have been performed that demonstrate a correlation between EGFR receptor expression and response to gefitinib.

Pharmacokinetics

Gefitinib is absorbed slowly after oral administration with mean bioavailability of 60%. Elimination is by metabolism (primarily CYP3A4) and excretion in feces. The elimination half-life is about 48 hours. Daily oral administration of gefitinib to cancer patients resulted in a 2-fold accumulation compared to single dose administration. Steady state plasma concentrations are achieved within 10 days.

Absorption and Distribution

Gefitinib is slowly absorbed, with peak plasma levels occurring 3-7 hours after dosing and mean oral bioavailability of 60%. Bioavailability is not significantly altered by food. Gefitinib is extensively distributed throughout the body with a mean steady state volume of distribution of 1400 L following intravenous administration. In vitro binding of gefitinib to human plasma proteins (serum albumin and α1-acid glyco-protein) is 90% and is independent of drug concentrations.

Metabolism and Elimination

Gefitinib undergoes extensive hepatic metabolism in humans, predominantly by CYP3A4. Three sites of biotransformation have been identified: metabolism of the N-propoxymorpholino-group, demethylation of the methoxy-substituent on the quinazoline, and oxidative defluorination of the halogenated phenyl group.

Five metabolites were identified in human plasma. Only O-desmethyl gefitinib has exposure comparable to gefitinib. Although this metabolite has similar EGFR-TK activity to gefitinib in the isolated enzyme assay, it had only 1/14 of the potency of gefitinib in one of the cell-based assays.

Gefitinib is cleared primarily by the liver, with total plasma clearance and elimination half-life values of 595 mL/min and 48 hours, respectively, after intravenous administration. Excretion is predominantly via the feces (86%), with renal elimination of drug and metabolites accounting for less than 4% of the administered dose.

Special Populations

In population based data analyses, no relationships were identified between predicted steady state trough concentration and patient age, body weight, gender, ethnicity or creatinine clearance.

Pediatric: There are no pharmacokinetic data in pediatric patients.

Hepatic Impairment

The influence of hepatic metastases with elevation of serum aspartate aminotrans-ferase (AST/SGOT), alkaline phosphatase, and bilirubin has been evaluated in patients with normal (14 patients), moderately elevated (13 patients) and severely elevated (4 patients) levels of one or more of these biochemical parameters. Patients with moderately and severely elevated biochemical liver abnormalities had gefitinib pharmacokinetics similar to individuals without liver abnormalities (see PRECAUTIONS section).

Renal Impairment

No clinical studies were conducted with GEFTINAT in patients with severely compromised renal function (see PRECAUTIONS section). Gefitinib and its metabolites are not significantly excreted via the kidney (<4%).

Drug-Drug Interactions

In human liver microsome studies, gefitinib had no inhibitory effect on CYP1A2, CYP2C9, and CYP3A4 activities at concentrations ranging from 2-5000 ng/mL. At the highest concentration studied (5000 ng/mL), gefitinib inhibited CYP2C19 by 24% and CYP2D6 by 43%. Exposure to metoprolol, a substrate of CYP2D6, was increased by 30% when it was given in combination with gefitinib (500 mg daily for 28 days) in patients with solid tumors.

Rifampicin, an inducer of CYP3A4, reduced mean AUC of gefitinib by 85% in healthy male volunteers (see PRECAUTIONS - DRUG INTERACTIONS andDOSAGE AND ADMINISTRATION -Dosage Adjustment sections).

Concomitant administration of itraconazole (200 mg QD for 12 days), an inhibitor of CYP3A4, with gefitinib (250 mg single dose) to healthy male volunteers, increased mean gefitinib AUC by 88% (see PRECAUTIONS - DRUG INTERACTIONS section).

Co-administration of high doses of ranitidine with sodium bicarbonate (to maintain the gastric pH above pH 5.0) reduced mean gefitinib AUC by 44% (seePRECAUTIONS - DRUG INTERACTIONS section).

International Normalized Ratio (INR) elevations and/or bleeding events have been reported in some patients taking warfarin while on GEFTINAT therapy. Patients taking warfarin should be monitored regularly for changes in prothrombin time or INR (see PRECAUTIONS - DRUG INTERACTIONS and ADVERSE REACTIONSsections).

Clinical Studies

Non-Small Cell Lung Cancer (NSCLC): Refractory Disease Tumor Response Study – A multicenter clinical trial in the United States evaluated the tumor response rate of GEFTINAT 250 and 500 mg/day in patients with advanced non-small cell lung cancer whose disease had progressed after at least two prior chemotherapy regimens including a platinum drug and docetaxel. GEFTINAT was taken once daily at approximately the same time each day.

Two hundred and sixteen patients received GEFTINAT, 102 (47%) and 114 (53%) receiving 250 mg and 500 mg daily doses, respectively. Study patient demographics and disease characteristics are summarized in Table 1. Forty-one percent of the patients had received two prior treatment regimens, 33% three prior treatment regimens, and 25% four or more prior treatment regimens. Effectiveness of GEFTINAT as third line therapy was determined in the 142 evaluable patients with documented disease progression on platinum and docetaxel therapies or who had had unacceptable toxicity on these agents.

Table 1: Demographic and Disease Characteristics

Characteristic

GEFTINAT Dose

250 mg/day
N=66 (%)

500 mg/day
N=76 (%)

Age Group

  18-64 years

43 (65)

43 (57)

  64-74 years

19 (29)

30 (39)

  75 years and above

4 (6)

3 (4)

Sex

  Male

38 (58)

41 (54)

  Female

28 (42)

35 (46)

Race

  White

61 (92)

68 (89)

  Black

1 (2)

2 (3)

  Asian/Oriental

1 (2)

2 (3)

  Hispanic

0 (0)

3 (4)

  Other

3 (5)

1 (1)

Smoking History

  Yes (Previous or current smoker)

45 (68)

62 (82)

  No (Never smoked)

21 (32)

14 (18)

Baseline WHO Performance Status

  0

14 (21)

9 (12)

  1

36 (55)

53 (70)

  2

15 (23)

14 (18)

  Not Recorded

1 (2)

0 (0)

Tumor Histology

  Squamous

9 (14)

11 (14)

  Adenocarcinoma

47 (71)

50 (66)

  Undifferentiated

6 (9)

4 (5)

  Large Cell

1 (2)

2 (3)

  Squamous and Adenocarcinoma

3 (5)

7 (9)

  Not Recorded

0 (0)

2 (3)

Current Disease Status

  Locally Advanced

11 (17)

5 (7)

  Metastatic

55 (83)

71 (93)

Table 2 shows tumor response rates and response duration. The overall response rate for the 250 and 500 mg doses combined was 10.6% (95% CI: 6%, 16.8%). Response rates appeared to be highly variable in subgroups of the treated population: 5.1% (4/79) in males, 17.5% (11/63) in females, 4.6% (5/108) in previous or current smokers, 29.4% (10/34) in nonsmokers, 12.4% (12/97) with adenocar-cinoma histology, and 6.7% (3/45) with other NSCLC histologies. Similar differences in response were seen in a multinational study in patients who had received 1 or 2 prior chemotherapy regimens, at least 1 of which was platinum-based. In responders, the median time from diagnosis to study randomization was 16.7 months (range 8 to 34 months).

Table 2 - Efficacy Results

 

Efficacy Population

250 mg
(N=66)

500 mg
(N=76)

Combined
(N=142)

Objective Tumor Response Rate (%)

13.6

7.9

10.6

95% CI (%)

6.4 - 24.3

3.0 - 16.4

6.0 - 16.8

Median Duration of Objective Response (months)

8.9

4.5

7.0

Range (months)

4.6 - 18.6+

4.4 - 7.6

4.4 - 18.6+

+ = data are ongoing

Non-Small Cell Lung Cancer (NSCLC): Refractory Disease Survival Study—A double-blind, placebo-controlled parallel-group trial randomized 1692 patients with advanced NSCLC to receive either GEFTINAT 250 mg daily plus Best Supportive Care or placebo plus Best Supportive Care. Patients had received 1 or 2 prior chemotherapy regimens and had progressed while receiving or within 90 days of the last dose of chemotherapy or were intolerant to the most recent prior chemotherapy regimen. The two treatment arms were well-balanced for demographic and disease-related patient characteristics. The primary endpoint of the study was survival. GEFTINAT did not significantly prolong survival (stratified log rank HR 0.89, P=0.11, Median 5.6 vs 5.1 months for GEFTINAT and placebo, respectively).

Non-Small Cell Lung Cancer (NSCLC); Studies of First-line Treatment in Combination with Chemotherapy— Two large trials were conducted in chemotherapy-naïve patients with stage III and IV non-small cell lung cancer. Two thousand one hundred thirty patients were randomized to receive GEFTINAT 250 mg daily, GEFTINAT 500 mg daily, or placebo in combination with platinum-based chemotherapy regimens. The chemotherapies given in these first-line trials were gemcitabine and cis-platinum (N=1093) or carboplatin and paclitaxel (N=1037). The addition of GEFTINAT did not demonstrate any increase, or trend toward such an increase, in tumor response rates, time to progression, or overall survival.

Patient Information

PATIENT INFORMATION

Patients should be advised to seek medical advice promptly if they develop 1) severe or persistent diarrhea, nausea, anorexia, or vomiting, as these have sometimes been associated with dehydration; 2) an onset or worsening ofpulmonary symptoms, ie, shortness of breath or cough; 3) an eye irritation; or, 4) any other new symptom (see WARNINGS - Pulmonary Toxicity, ADVERSE REACTIONS and DOSAGE AND ADMINISTRATION - Dosage Adjustmentsections).

Women of childbearing potential must be advised to avoid becoming pregnant(see WARNINGS - Pregnancy Category D).

IMPORTANT NOTE:This is a summary and does not contain all possible information about this product. For complete information about this product or your specific health needs, ask your health care professional. Always seek the advice of your health care professional if you have any questions about this product or your medical condition. This information is not intended as individual medical advice and does not substitute for the knowledge and judgment of your health care professional. This information does not contain any assurances that this product is safe, effective, or appropriate for you.

GEFITINIB - ORAL

(geh-FIT-ih-nib)

COMMON BRAND NAME(S): Geftinat , Iressa

USES:This medication is used alone to treat lung cancer after other cancer chemotherapy treatments have not been successful. It is a cancer chemotherapy drug which works by blocking a certain protein (an enzyme called tyrosine kinase) which may help cancer grow and spread.

HOW TO USE:Take gefitinib by mouth once daily, with or without food, or as directed.

Medications which reduce or completely block stomach acid (e.g., proton pump inhibitors/PPIs, H2 blockers, antacids) may decrease the absorption of gefitinib. This could decrease the effectiveness of gefitinib. Consult your doctor or pharmacist if you are taking any of these medications.

Use this medication regularly in order to get the most benefit from it. To help you remember, use it at the same time each day.

CONSUMER (CONTINUED)

SIDE EFFECTS:Diarrhea, rash, acne, nausea, vomiting, loss of appetite or unusual weakness may occur. If any of these effects persist or worsen, notify your doctor or pharmacist immediately.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor immediately if any of these unlikely but serious side effects occur: eye irritation/pain, swelling of the ankles/feet.

Tell your doctor immediately if any of these highly unlikely but very serious side effects occur: unusual bleeding (coughing up blood, blood in urine), stomach/abdominal pain, extreme fatigue, dark urine, yellowing eyes/skin.

Gefitinib may cause rare (possibly fatal) lung disease (interstitial lung disease-ILD). Tell your doctor immediately if you develop trouble breathing, cough or fever.

If you have persistent diarrhea or skin rashes contact your doctor. Your doctor may temporarily stop gefitinib (for up to 14 days) which may help reverse those side effects. Treatment is then resumed with the same dosage.

An allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of an allergic reaction include: severe rash, itching, swelling, dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

Contact your doctor for medical advice about side effects.

PRECAUTIONS:Before using this medication, tell your doctor or pharmacist your medical history, especially of: lung disease (e.g., pulmonary fibrosis), severe kidney disease, any allergies.

Gefitinib is not recommended for use during pregnancy. It may cause harm to an unborn baby. Consult your doctor for more details.

It is not known whether this drug passes into breast milk. Due to the potential risk to the infant, breast-feeding while using gefitinib is not recommended.

DRUG INTERACTIONS:Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with them first.

Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription products you may use, especially of: "blood thinners" (warfarin), drugs which reduce stomach acid (e.g., ranitidine, cimetidine, famotidine, omeprazole, lansoprazole, rabeprazole), certain liver enzyme inhibitors (CYP 3A4 inhibitors such as ketoconazole, itraconazole, erythromycin, clarithromycin), vinorelbine.

Some liver enzyme inducer medications such as rifamycins (e.g., rifampin, rifabutin), St. John's wort or phenytoin will stimulate certain liver enzymes (CYP 3A4). Your dosage of gefitinib may need to be increased if you are using such medications. Consult your doctor or pharmacist for more details.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

OVERDOSE:If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of overdose may include: severe/persistent diarrhea, severe skin rash.

NOTES: Do not share this medication with others.

Laboratory and/or medical tests (e.g., liver function tests) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

MISSED DOSE:If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

STORAGE:Store at room temperature between 68 and 77 degrees F (20-25 degrees C) away from light and moisture. Do not store in the bathroom. Keep all medicines away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.