Scemblix Drug Information
Generic name: ASCIMINIB
Uses of Scemblix
is indicated for the treatment of adult patients with: Newly diagnosed Philadelphia chromosome-positive chronic myeloid leukemia (Ph+ CML) in chronic phase (CP). This indication is approved under accelerated approval based on major molecular response rate . Continued approval for this indication may be contingent upon verification of clinical benefit in a confirmatory trial(s). Previously treated Ph+ CML in CP. Ph+ CML in CP with the T315I mutation. SCEMBLIX is a kinase inhibitor indicated for the treatment of adult patients with: Newly diagnosed Philadelphia chromosome-positive chronic myeloid leukemia (Ph+ CML) in chronic phase (CP). This indication is approved under accelerated approval based on major molecular response rate. Continued approval for this indication may be contingent upon verification of clinical benefit in a confirmatory trial(s). Previously treated Ph+ CML in CP. Ph+ CML in CP with the T315I mutation.
Dosage & Administration of Scemblix
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| Subsequent reduction | Permanently discontinue SCEMBLIX in patients unable to tolerate 40 mg once daily OR 20 mg twice daily. |
Side Effects of Scemblix
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 reflect exposure to SCEMBLIX at 10 mg to 200 mg orally twice daily (between 0.25 to 5 times the recommended dosage for the 80 mg daily dosage and between 0.05 times and up to the recommended dosage for the 200 mg twice daily dosage) in 556 patients enrolled in one of three clinical trials, including patients with Ph+ CML in CP receiving SCEMBLIX as monotherapy: study CABL001J12301 (ASC4FIRST), study CABL001A2301 (ASCEMBL) and study CABL001X2101 . Among the 556 patients receiving SCEMBLIX, the median duration of exposure to SCEMBLIX was 123 weeks (range, 0.1 to 439 weeks), with 79% of patients exposed for at least 48 weeks and 71% of patients exposed for at least 96 weeks, respectively. The most common (≥ 20%) adverse reactions in patients who received SCEMBLIX were musculoskeletal pain, rash, fatigue, upper respiratory tract infection, headache, abdominal pain, arthralgia, and diarrhea.
Adverse Reactions in Patients with Newly Diagnosed Ph+ CML-CP The ASC4FIRST clinical trial randomized 405 patients with newly diagnosed Ph+ CML-CP to receive SCEMBLIX 80 mg once daily or investigator selected tyrosine kinase inhibitors (IS-TKIs). IS-TKIs included imatinib (400 mg once daily), nilotinib (300 mg twice daily), dasatinib (100 mg once daily), or bosutinib (400 mg once daily) . The safety population (received at least 1 dose of SCEMBLIX) included 200 patients with newly diagnosed Ph+ CML-CP. Among patients who received SCEMBLIX, 84% were exposed for 96 weeks or longer . Serious adverse reactions occurred in 15% of patients who received SCEMBLIX. Serious adverse reactions in ≥ 1% included pancreatitis (1%), musculoskeletal pain (1%), and peripheral neuropathy (1%). Permanent discontinuation due to an adverse reaction occurred in 5% of patients receiving SCEMBLIX. Adverse reactions which resulted in permanent discontinuation of SCEMBLIX in ≥ 1% of patients included pancreatic enzymes increased (1.5%), cardiovascular toxicity (1%), and thrombocytopenia (1%). Dosage interruptions of SCEMBLIX due to an adverse reaction occurred in 33% of patients. Adverse reactions which required dosage interruption in > 5% of patients included thrombocytopenia (13%) and neutropenia (10%). Dose reductions of SCEMBLIX due to an adverse reaction occurred in 6% of patients. Adverse reactions which required dose reductions in > 1% of patients included thrombocytopenia (2.5%) and neutropenia (1.5%). The most common (≥ 20%) adverse reactions in patients who received SCEMBLIX were musculoskeletal pain and rash.
The most common select laboratory abnormalities that worsened from baseline in ≥ 20% of patients who received SCEMBLIX were lymphocyte count decreased, leukocyte count decreased, platelet count decreased, neutrophil count decreased, calcium corrected decreased, lipase increased, cholesterol increased, uric acid increased, alanine aminotransferase (ALT) increased, alkaline phosphatase (ALP) increased, hemoglobin decreased, and triglycerides increased. Table 3 summarizes the adverse reactions in ASC4FIRST. Table 3: Adverse Reactions (≥ 10%) in Patients with Newly Diagnosed Ph+ CML in CP, Who Received SCEMBLIX in ASC4FIRST Abbreviations: Ph+ CML in CP, Philadelphia chromosome-positive chronic myeloid leukemia (Ph+ CML) in chronic phase (CP); IS-TKIs, investigator selected tyrosine kinase inhibitors. a Musculoskeletal pain includes: musculoskeletal pain, myalgia, pain in extremity, back pain, non-cardiac chest pain, bone pain, neck pain, musculoskeletal stiffness, musculoskeletal discomfort, musculoskeletal chest pain, arthritis, and spinal pain. b Rash includes: rash, rash maculo-papular, rash pustular, rash macular, dermatitis exfoliative, drug eruption, dermatitis acneiform, eczema, rash pruritic and rash vesicular. c Fatigue includes: fatigue and asthenia. d Diarrhea includes: diarrhea, colitis and enteritis. e Abdominal pain includes: abdominal pain, abdominal pain upper, abdominal discomfort, abdominal pain lower and gastrointestinal pain. f Upper respiratory tract infection includes: upper respiratory tract infection, nasopharyngitis, pharyngitis, rhinitis and respiratory tract infection. g Dyslipidemia includes: dyslipidemia, hypertriglyceridemia, blood cholesterol increased, hypercholesterolemia, hyperlipidemia and blood triglycerides increased. h Headache contains: headache and migraine. i Hypertension contains: blood pressure increased, blood pressure systolic increased, diastolic hypertension, and hypertension. SCEMBLIX N = 200 IS-TKIs N = 201 Adverse Reaction All Grades % Grade 3 or 4 % All Grades % Grade 3 or 4 % Musculoskeletal and connective tissue disorders Musculoskeletal pain a 29 1.5 34
Arthralgia 13 2 10 0.5 Skin and subcutaneous tissue disorders Rash b
20 0 27 2 General disorders and administration site conditions Fatigue c 19 1 22 1 Gastrointestinal disorders Diarrhea d 18 0 28
Abdominal pain e 17 0.5 12 0.5 Constipation 10 0 9 0.5
Infections and infestations Upper respiratory tract infection f 18 0 20
Metabolism and nutrition disorders Dyslipidemia g 19 1 11 0.5 Nervous system
disorders Headache h 17 0.5 17 0 Vascular disorders Hypertension i 11 6 6 4 Clinically relevant adverse reactions in < 10% of patients treated with SCEMBLIX in ASC4FIRST included: nausea, cough, pruritus, dry eye, pyrexia, vomiting, dizziness, edema, lower respiratory tract infection, decreased appetite, hypothyroidism, urticaria, arrhythmia, influenza, neuropathy peripheral, hemorrhage, urinary tract infection, pneumonia, dyspnea, pancreatitis, vision blurred, febrile neutropenia, and palpitations. Table 4 summarizes the laboratory abnormalities in ASC4FIRST. Table 4: Select Laboratory Abnormalities (≥ 20%) That Worsened From Baseline in Patients with Newly Diagnosed Ph+ CML in CP, Who Received SCEMBLIX in ASC4FIRST a The denominator used to calculate the rate for SCEMBLIX and IS TKIs varied from 198 to 200 and 201, respectively, based on the number of patients with a baseline value and at least one post-treatment value. b Worst post-baseline laboratory abnormalities based on normal ranges. CTCAE version
SCEMBLIX a IS-TKIs a Laboratory Abnormality All Grades % Grade 3 or
4 % All Grades % Grade 3 or 4 % Hematologic parameters Lymphocyte count decreased 72 3.5 84 11 Leukocyte count decreased 55 5 68 13 Platelet count decreased 48 13 56 11 Neutrophil count decreased 47 12 63 21 Hemoglobin decreased 25 3 51 5 Biochemical parameters Calcium corrected decreased 46 0.5 76 2 Lipase increased 39 12 50 12 Cholesterol increased 40 0 34 0 Uric acid increased b 37 - 22 - Alanine aminotransferase (ALT) increased 33 2.5 45 6 Alkaline phosphatase (ALP) increased 26 0.5 36 0 Triglycerides increased 25 1 20
Adverse Reactions in Patients with Ph+
CML-CP, Previously Treated with Two or More TKIs The clinical trial randomized and treated 232 patients with Ph+ CML-CP, previously treated with two or more TKIs to receive SCEMBLIX 40 mg twice daily or bosutinib 500 mg once daily (ASCEMBL) . The safety population (received at least 1 dose of SCEMBLIX) included 156 patients with Ph+ CML-CP, previously treated with two or more TKIs. Among patients who received SCEMBLIX, 83% were exposed for 24 weeks or longer and 56% were exposed for 96 weeks or longer. Serious adverse reactions occurred in 18% of patients who received SCEMBLIX. Serious adverse reactions in ≥ 1% included cardiac failure congestive (1.9%), pyrexia (1.9%), urinary tract infection (1.9%), headache (1.3%), and thrombocytopenia (1.3%). Two patients (1.3%) had a fatal adverse reaction, one each for mesenteric artery thrombosis and ischemic stroke.
Permanent discontinuation of SCEMBLIX due to an adverse reaction occurred in 8% of patients. Adverse reactions which resulted in permanent discontinuation of SCEMBLIX in > 2% of patients included thrombocytopenia (3.2%) and neutropenia (2.6%). Dosage interruptions of SCEMBLIX due to an adverse reaction occurred in 41% of patients. Adverse reactions which required dosage interruption in > 5% of patients included thrombocytopenia (19%) and neutropenia (18%). Dose reductions of SCEMBLIX due to an adverse reaction occurred in 6% of patients.
Adverse reactions which required dose reductions in > 1% of patients included thrombocytopenia (4.5%) and neutropenia (1.3%). The most common (≥ 20%) adverse reactions in patients who received SCEMBLIX were upper respiratory tract infections, musculoskeletal pain, headache, and fatigue. The most common select laboratory abnormalities that worsened from baseline in ≥ 20% of patients who received SCEMBLIX were platelet count decreased, triglycerides increased, neutrophil count decreased, hemoglobin decreased, creatine kinase increased, alanine aminotransferase (ALT) increased, aspartate aminotransferase (AST) increased, uric acid increased, and lymphocyte count decreased. Table 5 summarizes the adverse reactions in ASCEMBL. Table 5: Adverse Reactions (≥ 10%) in Patients with Ph+ CML in CP, Previously Treated with Two or More TKIs Who Received SCEMBLIX in ASCEMBL Abbreviations: Ph+ CML in CP, Philadelphia chromosome-positive chronic myeloid leukemia (Ph+ CML) in chronic phase (CP); TKIs, tyrosine kinase inhibitors. a Upper respiratory tract infection includes: nasopharyngitis, upper respiratory tract infection, rhinitis, pharyngitis, respiratory tract infection, and pharyngotonsillitis. b Musculoskeletal pain includes: pain in extremity, back pain, myalgia, non-cardiac chest pain, neck pain, bone pain, spinal pain, arthritis, musculoskeletal pain, and musculoskeletal chest pain. c Headache includes: headache and post-traumatic headache. d Fatigue includes: fatigue and asthenia. e Rash includes: rash, rash maculopapular, dermatitis acneiform, rash pustular, eczema, dermatitis, skin exfoliation, dermatitis exfoliative generalized, rash morbilliform, drug eruption, erythema multiforme, and rash erythematous. f Hypertension includes: hypertension and hypertensive crisis. g Diarrhea includes: diarrhea and colitis. h Abdominal pain includes: abdominal pain, abdominal pain upper, abdominal discomfort, abdominal pain lower, abdominal tenderness, and epigastric discomfort.
SCEMBLIX N = 156 Bosutinib N = 76 Adverse Reaction All Grades % Grade 3 or 4 % All Grades % Grade 3 or 4 % Infections and infestations Upper respiratory tract infection a 26 0.6 12
Musculoskeletal and connective tissue disorders Musculoskeletal pain b 24 2.6 17 1.3
Arthralgia 13 0.6 3.9 0 Nervous system disorders Headache c 21 1.9 16 0 General disorders and administration-site conditions Fatigue d 20 0.6 11
Skin and subcutaneous tissue disorders Rash e 18 0.6 30 8 Vascular
disorders Hypertension f 14 7 5
Gastrointestinal disorders Diarrhea g 13 0 72 11 Nausea 12 0.6 46
0 Abdominal pain h 14 0 24
Clinically relevant adverse reactions in < 10% of patients treated with
SCEMBLIX in ASCEMBL included: cough, dyspnea, pleural effusion, dizziness, neuropathy peripheral, edema, pyrexia, vomiting, constipation, dyslipidemia, decreased appetite, pruritus, urticaria, lower respiratory tract infection, influenza, urinary tract infection, pneumonia, hemorrhage, arrhythmia (including electrocardiogram QT prolonged), palpitations, cardiac failure congestive, vision blurred, dry eye, hypothyroidism, and febrile neutropenia. Table 6 summarizes the laboratory abnormalities in ASCEMBL. Table 6: Select Laboratory Abnormalities (≥ 10%) That Worsened From Baseline in Patients with Ph+ CML in CP, Previously Treated with Two or More TKIs Who Received SCEMBLIX in ASCEMBL a The denominator used to calculate the rate for SCEMBLIX and bosutinib varied from 152 to 156 and 75 to 76, respectively, based on the number of patients with a baseline value and at least one post-treatment value. CTCAE version 4.03. SCEMBLIX a Bosutinib a Laboratory Abnormality All Grades % Grade 3 or 4 % All Grades % Grade 3 or 4 % Hematologic parameters Platelet count decreased 46 24 36 12 Neutrophil count decreased 43 22 33 15 Hemoglobin decreased 37 2 54 5 Lymphocyte count decreased 20 3.3 34
Biochemical parameters Triglycerides increased 44 5 30 2.6 Creatine kinase increased 30
2.6 24 5 Alanine aminotransferase (ALT) increased 26 0.6 50 16 Aspartate aminotransferase (AST) increased 21 1.9 46 7 Uric acid increased 21 6 18
Phosphate decreased 18 6 20 7 Corrected calcium decreased 16 0.6 22
0 Lipase increased 15 4.5 18 7 Creatinine increased 15 0 26 0 Amylase increased 13 1.3 13 0 Alkaline phosphatase (ALP) increased 13 0 12 0 Bilirubin increased 12 0 3.9 0 Cholesterol increased 12 0 8 0 Potassium decreased 11 0 9 0 Adverse Reactions in Patients with Ph+ CML-CP with the T315I Mutation The single-arm clinical trial enrolled patients with Ph+ CML-CP with the T315I mutation . The safety population (received at least 1 dose of SCEMBLIX) included 48 patients with Ph+ CML-CP with the T315I mutation who received 200 mg of SCEMBLIX twice daily. Among these patients, 83% were exposed for 24 weeks or longer, and 75% were exposed for 48 weeks or longer. Serious adverse reactions occurred in 23% of patients who received SCEMBLIX. Serious adverse reactions in > 1% included abdominal pain (4.2%), vomiting (4.2%), pneumonia (4.2%), musculoskeletal pain (2.1%), headache (2.1%), hemorrhage (2.1%), constipation (2.1%), arrhythmia (2.1%), and pleural effusion (2.1%). Permanent discontinuation of SCEMBLIX due to an adverse reaction occurred in 10% of patients.
Adverse reactions which resulted in permanent discontinuation of SCEMBLIX in > 2% of patients included pancreatic enzymes increased (2.1%). Dosage interruptions of SCEMBLIX due to an adverse reaction occurred in 31% of patients. Adverse reactions which required dosage interruption in > 5% of patients included pancreatic enzymes increased (17%) and thrombocytopenia (8%). Dose reductions of SCEMBLIX due to an adverse reaction occurred in 23% of patients. Adverse reactions which required dose reductions in > 1% of patients included pancreatic enzymes increased (10%), abdominal pain (4.2%), anemia (2.1%), blood bilirubin increased (2.1%), dizziness (2.1%), fatigue (2.1%), hepatic enzymes increased (2.1%), musculoskeletal pain (2.1%), nausea (2.1%), neutropenia (2.1%), pruritus (2.1%), and thrombocytopenia (2.1%). The most common (≥ 20%) adverse reactions in patients who received SCEMBLIX were musculoskeletal pain, fatigue, nausea, rash, and diarrhea.
The most common select laboratory abnormalities that worsened from baseline in ≥ 20% of patients who received SCEMBLIX were alanine aminotransferase (ALT) increased, lipase increased, triglycerides increased, hemoglobin decreased, neutrophil count decreased, lymphocyte count decreased, phosphate decreased, aspartate aminotransferase (AST) increased, amylase increased, platelet count decreased, and bilirubin increased. Table 7 summarizes adverse reactions in study X2101. Table 7: Adverse Reactions (≥ 10%) in Patients with Ph+ CML in CP with the T315I Mutation Who Received SCEMBLIX in X2101 a Musculoskeletal pain includes: pain in extremity, back pain, myalgia, musculoskeletal pain, non-cardiac chest pain, bone pain, arthritis, and musculoskeletal chest pain. b Fatigue includes: fatigue and asthenia. c Abdominal pain includes: abdominal pain and hepatic pain. d Rash includes: rash, rash maculopapular, dermatitis acneiform, eczema, rash papular, skin exfoliation, and dyshidrotic eczema. e Headache includes: headache and migraine. f Cough includes: cough and productive cough. g Hemorrhage includes: epistaxis, ear hemorrhage, mouth hemorrhage, post procedural hemorrhage, skin hemorrhage, and vaginal hemorrhage. h Hypertension includes: hypertension and hypertensive crisis. i Upper respiratory tract infection includes: upper respiratory tract infection, nasopharyngitis, rhinitis, and pharyngitis. SCEMBLIX 200 mg twice daily N = 48 Adverse Reaction All Grades % Grade 3 or 4 % Musculoskeletal and connective tissue disorders Musculoskeletal pain a 42
Arthralgia 17 0 General disorders and administration-site conditions Fatigue b 31 2.1
Edema 10
Gastrointestinal disorders Nausea 27 0 Diarrhea 21 2.1 Vomiting 19 6 Abdominal
pain c 17 8 Skin and subcutaneous tissue disorders Rash d 27 0 Pruritus 13 0 Nervous system disorders Headache e 19
Respiratory, thoracic, and mediastinal disorders Cough f 15 0 Vascular disorders Hemorrhage
g 15
Hypertension h 13 8 Infections and infestations Upper respiratory tract infection i
13 0 Clinically relevant adverse reactions in < 10% of patients treated with SCEMBLIX in X2101 included: constipation, pancreatitis, pyrexia, dizziness, neuropathy peripheral, pneumonia, lower respiratory tract infection, dyspnea, pleural effusion, dry eye, vision blurred, arrhythmia, palpitations, cardiac failure congestive, decreased appetite, dyslipidemia, hypersensitivity, and urticaria. Table 8 summarizes laboratory abnormalities in X2101. Table 8: Select Laboratory Abnormalities (≥ 10%) That Worsened From Baseline in Patients with Ph+ CML in CP with the T315I Mutation in X2101 a The denominator used to calculate the rate was 48 based on the number of patients with a baseline value and at least one post-treatment value. CTCAE version 4.03. SCEMBLIX a 200 mg twice daily Laboratory Abnormality All Grades % Grade 3-4 % Hematologic parameters Hemoglobin decreased 44
Neutrophil count decreased 44 15 Lymphocyte count decreased 42 4.2 Platelet count
decreased 25 15 Biochemical parameters Alanine aminotransferase (ALT) increased 48 6 Potassium increased 48
Triglycerides increased 46 2.1 Lipase increased 46 21 Phosphate decreased 40 6
Uric acid increased 40
Aspartate aminotransferase (AST) increased 35 2.1 Calcium corrected decreased 33 0 Creatinine
increased 31 0 Amylase increased 29 10 Bilirubin increased 23 0 Cholesterol increased 15 0 Alkaline phosphatase (ALP) increased 13 0
Warnings & Cautions for Scemblix
Myelosuppression Thrombocytopenia, neutropenia, and anemia have occurred in patients receiving
SCEMBLIX. Thrombocytopenia occurred in 156 of 556 (28%) patients receiving SCEMBLIX, with Grade 3 or 4 thrombocytopenia reported in 39 (7%) and 53 (10%) of patients, respectively. Among the patients with Grade 3 or 4 thrombocytopenia, median time to first occurrence of events was 6 weeks (range, 0.1 to 64 weeks). SCEMBLIX was permanently discontinued in 11 (2%) patients, while it was temporarily withheld in 70 (13%) patients due to thrombocytopenia. Neutropenia occurred in 121 (22%) patients receiving SCEMBLIX, with Grade 3 and 4 neutropenia reported in 42 (8%) and 35 (6%) patients, respectively.
Among the patients with Grade 3 or 4 neutropenia, median time to first occurrence of events was 7 weeks (range, 0.1 to 180 weeks). SCEMBLIX was permanently discontinued in 7 (1.3%) patients, while it was temporarily withheld in 52 (9%) patients due to neutropenia. Anemia occurred in 72 (13%) patients receiving SCEMBLIX, with Grade 3 anemia occurring in 23 (4%) patients. Among the patients with Grade 3 or 4 anemia, median time to first occurrence of events was 24 weeks (range, 0.1 to 207 weeks). SCEMBLIX was temporarily withheld in 3 (0.5%) patients due to anemia . Perform complete blood counts every two weeks for the first 3 months of treatment and monthly thereafter or as clinically indicated.
Monitor patients for signs and symptoms of myelosuppression. Based on the severity of thrombocytopenia and/or neutropenia, reduce dose, temporarily withhold, or permanently discontinue SCEMBLIX .
Pancreatic Toxicity Pancreatitis occurred in 11 of 556 (2%) patients receiving
SCEMBLIX, with Grade 3 pancreatitis occurring in 6 (1.1%) patients. SCEMBLIX was permanently discontinued in three (0.5%) patients, while it was temporarily withheld in 6 (1.1%) patients due to pancreatitis. Elevation of serum lipase and amylase occurred in 110 of 556 (20%) patients receiving SCEMBLIX, with Grade 3 and Grade 4 pancreatic enzyme elevations occurring in 41 (7%) and 11 (2%) patients, respectively.
SCEMBLIX was permanently discontinued in 11 (2%) patients due to the elevation of serum lipase and amylase . Assess serum lipase and amylase levels monthly during treatment with SCEMBLIX, or as clinically indicated. Monitor patients for signs and symptoms of pancreatic toxicity. Perform more frequent monitoring in patients with a history of pancreatitis.
If lipase and amylase elevation are accompanied by abdominal symptoms, temporarily withhold SCEMBLIX and consider appropriate diagnostic tests to exclude pancreatitis . Based on the severity of lipase and amylase elevation, reduce dose, temporarily withhold, or permanently discontinue SCEMBLIX .
Hypertension Hypertension occurred in 98 of 556 (18%) patients receiving
SCEMBLIX, with Grade 3 or 4 hypertension reported in 53 (10%) and 1 (0.2%) patients, respectively. Among the patients with Grade 3 or 4 hypertension, median time to first occurrence was 45 weeks (range, 0.1 to 365 weeks). SCEMBLIX was temporarily withheld in 5 (0.9%) patients due to hypertension . Monitor and manage hypertension using standard antihypertensive therapy during treatment with SCEMBLIX as clinically indicated; for Grade 3 or higher hypertension, temporarily withhold, reduce dose, or permanently discontinue SCEMBLIX depending on persistence of hypertension .
Hypersensitivity Hypersensitivity occurred in 172 of 556 (31%) patients receiving
SCEMBLIX, with Grade 3 or 4 hypersensitivity reported in 6 (1.1%) patients . Reactions included rash, edema, and bronchospasm. Monitor patients for signs and symptoms of hypersensitivity and initiate appropriate treatment as clinically indicated; for Grade 3 or higher hypersensitivity, temporarily withhold, reduce dose, or permanently discontinue SCEMBLIX depending on persistence of hypersensitivity .
Cardiovascular Toxicity Cardiovascular toxicity (including ischemic cardiac and
CNS conditions, arterial thrombotic and embolic conditions) and cardiac failure occurred in 65 (12%) and in 13 (2.3%) of 556 patients receiving SCEMBLIX, respectively . Grade 3 cardiovascular toxicity was reported in 14 (2.5%) patients, while Grade 3 cardiac failure was observed in 5 (0.9%) patients. Grade 4 cardiovascular toxicity occurred in 4 (0.7%) patients, with fatalities occurring in 5 (0.9%) patients. Grade 4 cardiac failure was reported in 1 (0.2%) patient with fatality occurring in 1 (0.2%) patient.
Permanent discontinuation of SCEMBLIX occurred in 4 (0.7%) patients due to cardiovascular toxicity and in 1 (0.2%) patient due to cardiac failure, respectively. In the majority of patients, cardiovascular toxicity occurred in patients with preexisting cardiovascular conditions or risk factors, and/or prior exposure to multiple TKIs. Arrhythmia, including QTc prolongation, occurred in 35 of 556 (6%) patients receiving SCEMBLIX, with Grade 3 or 4 arrhythmia reported in 10 (1.8%) and 2 (0.4%) patients, respectively.
QTc prolongation occurred in 5 of 556 (0.9%) patients receiving SCEMBLIX, with Grade 3 QTc prolongation reported in 2 (0.4%) patients . Monitor patients with history of cardiovascular risk factors for cardiovascular signs and symptoms. Initiate appropriate treatment as clinically indicated; for Grade 3 or higher cardiovascular toxicity, temporarily withhold, reduce dose, or permanently discontinue SCEMBLIX depending on persistence of cardiovascular toxicity .
Embryo-Fetal Toxicity
Based on findings from animal studies and its mechanism of action, SCEMBLIX can cause fetal harm when administered to a pregnant woman. In animal reproduction studies, administration of asciminib to pregnant rats and rabbits during the period organogenesis caused adverse developmental outcomes, including embryo-fetal mortality and malformations at maternal exposures (AUC) equivalent to or less than those in patients at the recommended doses. Advise pregnant women and females of reproductive potential of the potential risk to a fetus if SCEMBLIX is used during pregnancy or if the patient becomes pregnant while taking SCEMBLIX. Verify the pregnancy status of females of reproductive potential prior to starting treatment with SCEMBLIX. Females of reproductive potential should use effective contraception during treatment with SCEMBLIX and for 1 week after the last dose .
Drug Interactions with Scemblix
Effect of Other Drugs on
SCEMBLIX Strong CYP3A4 Inhibitors Asciminib is a CYP3A4 substrate. Concomitant use of SCEMBLIX with a strong CYP3A4 inhibitor increases both the asciminib C max and AUC, which may increase the risk of adverse reactions . Closely monitor for adverse reactions in patients treated with SCEMBLIX at 200 mg twice daily with concomitant use of strong CYP3A4 inhibitors. Itraconazole Oral Solution Containing Hydroxypropyl-β-cyclodextrin Concomitant use of SCEMBLIX with itraconazole oral solution containing hydroxypropyl-β-cyclodextrin decreases asciminib C max and AUC, which may reduce SCEMBLIX efficacy . Avoid coadministration of SCEMBLIX at all recommended doses with itraconazole oral solution containing hydroxypropyl-β-cyclodextrin.
Strong CYP3A4 Inducers Concomitant use of SCEMBLIX with strong CYP3A4 inducers decreases both the asciminib C max and AUC .
Effect of
SCEMBLIX on Other Drugs Certain CYP3A4 Substrates Asciminib is a CYP3A4 inhibitor. Concomitant use of SCEMBLIX increases the C max and AUC of CYP3A4 substrates, which may increase the risk of adverse reactions of these substrates . Closely monitor for adverse reactions in patients treated with SCEMBLIX at 80 mg total daily dose with concomitant use of certain CYP3A4 substrates, where minimal concentration changes may lead to serious adverse reactions. Avoid coadministration of SCEMBLIX at 200 mg twice daily with certain CYP3A4 substrates, where minimal concentration changes may lead to serious adverse reactions.
CYP2C9 Substrates Asciminib is a CYP2C9 inhibitor. Concomitant use of SCEMBLIX increases the C max and AUC of CYP2C9 substrates, which may increase the risk of adverse reactions of these substrates . Avoid coadministration of SCEMBLIX at 80 mg total daily dose with certain CYP2C9 substrates, where minimal concentration changes may lead to serious adverse reactions. If coadministration is unavoidable, reduce the CYP2C9 substrate dosage as recommended in its prescribing information.
Avoid coadministration of SCEMBLIX at 200 mg twice daily with sensitive CYP2C9 substrates and certain CYP2C9 substrates, where minimal concentration changes may lead to serious adverse reactions. If coadministration is unavoidable, consider alternative therapy with a non-CYP2C9 substrate. Certain P-gp Substrates Asciminib is a P-gp inhibitor.
Concomitant use of SCEMBLIX increases the plasma concentrations of P-gp substrates, which may increase the risk of adverse reactions of these substrates . Closely monitor for adverse reactions in patients treated with SCEMBLIX at all recommended doses with concomitant use of P-gp substrates, where minimal concentration changes may lead to serious toxicities. Substrates of BCRP Asciminib is a BCRP inhibitor. Concomitant use of SCEMBLIX may increase the plasma concentration of BCRP substrates , which may increase the risk of adverse reactions associated with these substrates.
Avoid coadministration of SCEMBLIX at all recommended doses with rosuvastatin. Closely monitor for adverse reactions in patients treated with SCEMBLIX at all recommended doses with concomitant use of other BCRP substrates. Reduce the dosage of the other BCRP substrates as recommended in their Prescribing Information when used concomitantly with SCEMBLIX at all recommended doses.
Pregnancy Safety for Scemblix
Pregnancy Risk Summary Based on findings from animal studies and the mechanism of action, SCEMBLIX can cause embryo-fetal harm when administered to a pregnant woman . There are no available data on SCEMBLIX use in pregnant women to evaluate a drug-associated risk. Animal reproduction studies in pregnant rats and rabbits demonstrated that oral administration of asciminib during organogenesis induced structural abnormalities, embryo-fetal mortality, and alterations to growth ( see Data ). Advise pregnant women and females of reproductive potential of the potential risk to a fetus. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively.
Data Animal Data In embryo-fetal development studies, pregnant animals received oral doses of asciminib at 25, 150, and 600 mg/kg/day in rats and at 15, 50, and 300 mg/kg/day in rabbits during the period of organogenesis. In rats, maternal toxicity at the asciminib dose of 600 mg/kg/day resulted in the early termination of the dose group; a complete embryo-fetal examination was not conducted for this group. Adverse embryo-fetal findings were observed at 25 and 150 mg/kg; these doses did not cause maternal toxicities.
Increases in fetal weights at 25 and 150 mg/kg/day were observed, which may be related to increased ossification (i.e., increased rate of development). Malformations were evident at 150 mg/kg and included cleft palate, anasarca (edema), and cardiac abnormalities. Additional fetal findings included urinary tract and skeletal variations, observed primarily at 150 mg/kg/day. At the dose of 25 mg/kg/day, the area under the curve (AUC) exposures were equivalent to or below those achieved in patients at the 40 mg twice daily or 80 mg once daily doses, respectively.
At the dose of 25 mg/kg/day, the AUC exposures were below those achieved in patients at the 200 mg twice daily dose. In rabbits, maternal toxicities at the asciminib dose of 300 mg/kg/day resulted in the early termination of the dose group; a complete embryo-fetal examination was not conducted for this group. Adverse embryo-fetal findings were observed at 50 mg/kg; this dose did not cause maternal toxicities.
Findings at the 50 mg/kg dose included increases in early resorptions and post-implantation loss, decreases in the number of live fetuses, and cardiac malformations. At the dose of 50 mg/kg/day, the AUC exposures were 4-fold those achieved in patients at the 40 mg twice daily or 80 mg once daily doses. At the dose of 50 mg/kg/day, the AUC exposures were below those achieved in patients at the 200 mg twice daily dose.
Pediatric Use of Scemblix
Pediatric Use The safety and efficacy of SCEMBLIX in pediatric patients have not been established.
Clinical Studies of Scemblix
Newly Diagnosed Ph+
CML-CP The efficacy of SCEMBLIX in the treatment of patients with newly diagnosed Ph+ CML in chronic phase (Ph+ CML-CP) was evaluated in the multi-center, randomized, active-controlled, and open-label study ASC4FIRST (NCT04971226). In this study, a total of 405 patients were randomized in a 1:1 ratio to receive either SCEMBLIX or investigator selected tyrosine kinase inhibitors (IS-TKIs). Prior to randomization, the investigator selected the TKI (imatinib, nilotinib, dasatinib, or bosutinib) to be used in the event of randomization to the comparator arm, based on patient characteristics and comorbidities. Patients were stratified according to EUTOS long-term survival (ELTS) risk group (low, intermediate, high), and pre-randomization selection of TKI (imatinib or other TKIs stratum composed of nilotinib, dasatinib, and bosutinib). Patients received either SCEMBLIX or IS-TKIs, and continued treatment until unacceptable toxicity or treatment failure occurred. Patients were 37% female and 63% male with median age 51 years (range, 18 to 86 years). Of the 405 patients, 24% were 65 years or older, while 6% were 75 years or older.
Patients were White (54%), Asian (44%), Black or African American (1%), and 1% unknown. Of the 405 patients, 200 received SCEMBLIX, while 201 received IS-TKIs. Of the 201 patients receiving IS-TKIs, 99 received imatinib, 49 received nilotinib, 42 received dasatinib, and 11 received bosutinib.
Four patients did not receive any treatment. The median duration of treatment was 27 months (range, 0.2 to 36 months) for patients receiving SCEMBLIX, and 25 months (range, 0.3 to 35 months) for patients receiving IS-TKIs. With a minimum of 96 weeks of follow-up, 82% of patients on SCEMBLIX, and 60% of patients on IS-TKIs were still receiving treatment.
The main efficacy outcome was major molecular response rate (MMR) at 48 weeks. Efficacy was established based on SCEMBLIX compared to IS-TKIs and SCEMBLIX compared to IS-TKIs within the imatinib stratum. The key secondary objective evaluated MMR at 96 weeks for SCEMBLIX compared both to IS-TKIs and to IS-TKIs within the imatinib stratum.
Secondary objectives evaluated MMR at 48 and 96 weeks for SCEMBLIX compared to IS-TKIs within the other TKIs stratum. The main efficacy outcomes from ASC4FIRST are summarized in Table 10. Table 10: Efficacy Results in Patients with Newly Diagnosed Ph+ CML-CP (ASC4FIRST) Abbreviations: MMR, major molecular response ( BCR::ABL1 IS ≤ 0.1%); IS-TKIs, investigator selected tyrosine kinase inhibitors. a IS-TKIs include imatinib (400 mg once daily) and other TKIs of nilotinib (300 mg twice daily), dasatinib (100 mg once daily) or bosutinib (400 mg once daily). b Estimated using a common risk difference stratified by PRS-TKI and baseline ELTS risk groups. c Adjusted p-value using a Cochran-Mantel-Haenszel 1-sided test stratified by PRS-TKI and baseline ELTS risk groups. d Adjusted p-value using a Cochran-Mantel-Haenszel 1-sided test stratified by baseline ELTS risk groups. Response SCEMBLIX 80 mg once daily All patients (N = 201) IS-TKIs a All patients (N = 204) Difference (95% CI) b p-value MMR at 48 weeks MMR (%) (95% CI) 68 49 19 < 0.001 c MMR at 96 weeks MMR (%) (95% CI) 74 52 22 < 0.001 c Response SCEMBLIX 80 mg once daily Imatinib stratum (N = 101) IS-TKIs a Imatinib stratum (N = 102) Difference (95% CI) b p-value MMR at 48 weeks MMR (%) (95% CI) 69 40 30 < 0.001 d MMR at 96 weeks MMR (%) (95% CI) 76 47 30 < 0.001 d MMR rates at 96 weeks in patients receiving SCEMBLIX and IS-TKIs within the other TKIs stratum were 72% (95% CI: 62%, 81%) and 57% (95% CI: 47%, 67%), respectively.
Median time to MMR in patients receiving SCEMBLIX, IS-TKIs, and IS-TKIs within the imatinib stratum were: 24 weeks (95% CI: 24 to 25 weeks), 36 weeks (95% CI: 36 to 49 weeks), and 49 weeks (95% CI: 36 to 60 weeks), respectively.
Ph+
CML-CP, Previously Treated with Two or More TKIs The efficacy of SCEMBLIX in the treatment of patients with Ph+ CML-CP, previously treated with two or more TKIs was evaluated in the multi-center, randomized, active-controlled, and open-label study ASCEMBL (NCT03106779). In this study, a total of 233 patients were randomized in a 2:1 ratio and stratified according to major cytogenetic response (MCyR) status to receive either SCEMBLIX 40 mg twice daily (N = 157) or bosutinib 500 mg once daily (N = 76). Patients continued treatment until unacceptable toxicity or treatment failure occurred. Patients were 52% female and 48% male with a median age of 52 years (range, 19 to 83 years). Of the 233 patients, 19% were 65 years or older, while 2.6% were 75 years or older. Patients were White (75%), Asian (14%), and Black or African American (4.3%). Of the 233 patients, 81% and 18% had Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1, respectively.
Patients who had previously received 2, 3, 4, or 5 or more prior lines of TKIs were 48%, 31%, 15%, and 6%, respectively. The median duration of treatment was 103 weeks (range, 0.1 to 201 weeks) for patients receiving SCEMBLIX and 31 weeks (range, 1 to 188 weeks) for patients receiving bosutinib. The main efficacy outcomes from ASCEMBL are summarized in Table 11. Table 11: Efficacy Results in Patients with Ph+ CML-CP, Previously Treated with Two or More TKIs (ASCEMBL) Abbreviations: MMR, major molecular response ( BCR::ABL1 IS ≤ 0.1%); CCyR, complete cytogenetic response (0% of Philadelphia-positive metaphases in bone marrow aspirate with at least 20 examined). a Estimated using a common risk difference stratified by baseline major cytogenetic response status. b Estimated using a Cochran-Mantel-Haenszel two-sided test stratified by baseline major cytogenetic response status. c CCyR analysis based on patients who were not in CCyR at baseline.
SCEMBLIX 40 mg twice daily Bosutinib 500 mg once daily Difference (95% CI) p-value MMR rate, % (95% CI) at 24 weeks N = 157 25 N = 76 13 12 a 0.029 b MMR rate, % (95% CI) at 96 weeks N = 157 38 N = 76 16 22 a 0.001 b CCyR rate, % (95% CI) at 24 weeks N = 103 c 41 N = 62 c 24 17 CCyR rate, % (95% CI) at 96 weeks N = 103 c 40 N = 62 c 16 24 a With a median duration of follow-up of 28 months (range, 1 day to 45 months), the median duration of response for patients treated with SCEMBLIX had not yet been reached.
Ph+
CML-CP with the T315I Mutation The efficacy of SCEMBLIX in the treatment of patients with Ph+ CML-CP with the T315I mutation was evaluated in a multi-center open-label study CABL001X2101 (NCT02081378). Testing for T315I mutation utilized a qualitative p210 BCR::ABL1 mutation test on peripheral blood using Sanger Sequencing. Efficacy was based on 45 patients with Ph+ CML-CP with the T315I mutation who received SCEMBLIX at a dose of 200 mg twice daily. Patients continued treatment until unacceptable toxicity or treatment failure occurred.
Of the 45 patients, 80% were male and 20% female; 31% were 65 years or older, while 9% were 75 years or older with a median age of 54 years (range, 26 to 86 years). The patients were White (47%), Asian (27%), and Black or African American (2.2%), and 24% were unreported or unknown. Seventy-three percent and 27% of patients had ECOG performance status 0 and 1, respectively. Patients who had previously received 1, 2, 3, 4, and 5 or more TKIs were 18%, 31%, 36%, 13%, and 2.2%, respectively.
MMR was achieved by 24 weeks in 42% (19/45, 95% CI: 28% to 58%) of the 45 patients treated with SCEMBLIX. MMR was achieved by 96 weeks in 49% (22/45, 95% CI: 34% to 64%) of the 45 patients treated with SCEMBLIX. The median duration of treatment was 108 weeks (range, 2 to 215 weeks).
Drug information sourced from the FDA. This content is for informational purposes only and does not constitute medical advice. Consult a healthcare professional before making any medication decisions.
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