Drug Detail:Tagrisso (Osimertinib [ oh-sim-er-ti-nib ])
Generic Name: OSIMERTINIB 40mg
Dosage Form: tablet, film coated
Drug Class: EGFR inhibitors
Patient Selection
Select patients with resectable tumors for the adjuvant treatment of NSCLC with TAGRISSO based on the presence of EGFR exon 19 deletions or exon 21 L858R mutations in tumor specimens [see Clinical Studies (14)].
Select patients for the first-line treatment of metastatic EGFR-positive NSCLC with TAGRISSO based on the presence of EGFR exon 19 deletions or exon 21 L858R mutations in tumor or plasma specimens [see Clinical Studies (14)]. If these mutations are not detected in a plasma specimen, test tumor tissue if feasible.
Select patients for the treatment of metastatic EGFR T790M mutation-positive NSCLC with TAGRISSO following progression on or after EGFR TKI therapy based on the presence of an EGFR T790M mutation in tumor or plasma specimens [see Clinical Studies (14)]. Testing for the presence of the T790M mutation in plasma specimens is recommended only in patients for whom a tumor biopsy cannot be obtained. If this mutation is not detected in a plasma specimen, re-evaluate the feasibility of biopsy for tumor tissue testing.
Information on FDA-approved tests for the detection of EGFR mutations is available at http://www.fda.gov/companiondiagnostics.
Recommended Dosage Regimen
The recommended dosage of TAGRISSO is 80 mg tablet once a day. TAGRISSO can be taken with or without food.
If a dose of TAGRISSO is missed, do not make up the missed dose and take the next dose as scheduled.
Treat patients in the adjuvant setting until disease recurrence, or unacceptable toxicity, or for up to 3 years.
Treat patients with metastatic lung cancer until disease progression or unacceptable toxicity.
Administration to Patients Who Have Difficulty Swallowing Solids
Disperse tablet in 60 mL (2 ounces) of non-carbonated water only. Stir until tablet is dispersed into small pieces (the tablet will not completely dissolve) and swallow immediately. Do not crush, heat, or ultrasonicate during preparation. Rinse the container with 120 mL to 240 mL (4 to 8 ounces) of water and immediately drink.
If administration via nasogastric tube is required, disperse the tablet as above in 15 mL of non-carbonated water, and then use an additional 15 mL of water to transfer any residues to the syringe. The resulting 30 mL liquid should be administered as per the nasogastric tube instructions with appropriate water flushes (approximately 30 mL).
Dosage Modifications
Adverse Reactions
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Target Organ |
Adverse Reaction* |
Dosage Modification |
Pulmonary [see Warnings and Precautions (5.1)] |
Interstitial lung disease (ILD)/Pneumonitis |
Permanently discontinue TAGRISSO. |
Cardiac [see Warnings and Precautions (5.2, 5.3)] |
QTc† interval greater than 500 msec on at least 2 separate ECGs‡ |
Withhold TAGRISSO until QTc interval is less than 481 msec or recovery to baseline if baseline QTc is greater than or equal to 481 msec, then resume at 40 mg dose. |
QTc interval prolongation with signs/symptoms of life-threatening arrhythmia |
Permanently discontinue TAGRISSO. |
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Symptomatic congestive heart failure |
Permanently discontinue TAGRISSO. |
|
Cutaneous [see Warnings and Precautions (5.5)] |
Erythema Multiforme Major (EMM), Stevens-Johnson syndrome (SJS), and Toxic Epidermal Necrolysis (TEN) |
Withhold TAGRISSO if suspected and permanently discontinue if confirmed. |
Blood and bone marrow [see Warnings and Precautions (5.7)] |
Aplastic anemia |
Withhold TAGRISSO if aplastic anemia is suspected and permanently discontinue if confirmed. |
Other [see Adverse Reactions (6.1)] |
Adverse reaction of Grade 3 or greater severity |
Withhold TAGRISSO for up to 3 weeks. |
If improvement to Grade 0-2 within 3 weeks |
Resume at 80 mg or 40 mg daily. |
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If no improvement within 3 weeks |
Permanently discontinue TAGRISSO. |
Drug Interactions
Strong CYP3A4 Inducers
If concurrent use is unavoidable, increase TAGRISSO dosage to 160 mg daily when co-administering with a strong CYP3A inducer. Resume TAGRISSO at 80 mg 3 weeks after discontinuation of the strong CYP3A4 inducer [see Drug Interactions (7) and Clinical Pharmacology (12.3)].