ARASENS
The safety of NUBEQA, in combination with docetaxel, in mCSPC patients was evaluated in ARASENS, a randomized (1:1), double-blind, placebo-controlled, multi-center clinical study [see Clinical Studies (14)]. Patients were to receive either NUBEQA at a dose of 600 mg, or a placebo, twice a day in combination with docetaxel at a dose of 75 mg/m2 every 21 days for 6 cycles. All patients in the ARASENS study received a concomitant gonadotropin-releasing hormone (GnRH) agonist or antagonist or had a bilateral orchiectomy. Among patients who received NUBEQA, the median duration of exposure was 41 months (range: 0.1 to 56.5 months) vs. 16.7 months (range 0.3 to 55.8) with placebo. Eighty-eight percent and 86% of patients received the 6 planned cycles of docetaxel, in the NUBEQA with docetaxel arm and placebo with docetaxel arm, respectively.
Serious adverse reactions occurred in 45% of patients receiving NUBEQA with docetaxel. Serious adverse reactions in ≥ 2% of patients who received NUBEQA with docetaxel included febrile neutropenia (6%), neutrophil count decreased (2.8%), musculoskeletal pain (2.6%) and pneumonia (2.6%). Fatal adverse reactions occurred in 4% of patients receiving NUBEQA with docetaxel. Fatal adverse reactions in ≥2 patients who received NUBEQA included COVID-19/COVID-19 pneumonia (0.8%), myocardial infarction (0.3%), and sudden death (0.3%).
Permanent discontinuation of NUBEQA due to adverse reactions occurred in 14% of patients treated in the NUBEQA with docetaxel arm. The most common adverse reactions which resulted in permanent discontinuation of NUBEQA were rash (1.1%), musculoskeletal pain (0.9%), and increased aspartate aminotransferase (AST) (0.9%).
Dosage interruptions of NUBEQA due to adverse reactions occurred in 23% of patients treated in the NUBEQA with docetaxel arm. The most common (>2%) adverse reactions requiring dosage interruption of NUBEQA were increased alanine aminotransferase (ALT) (3.2%), increased AST (3.1%) and febrile neutropenia (2.1%).
Dosage reductions of NUBEQA due to adverse reactions occurred in 9% of patients treated in the NUBEQA with docetaxel arm. The most common (>2%) adverse reactions requiring dosage reduction of NUBEQA were increased ALT (2.8%) and increased AST (2.5%).
The most common (>10% with a ≥2% increase over placebo with docetaxel) adverse reactions are constipation, rash, decreased appetite, hemorrhage, increased weight, and hypertension. The most common laboratory test abnormalities (≥30%) are anemia, hyperglycemia, decreased lymphocyte count, decreased neutrophil count, increased AST, increased ALT, and hypocalcemia.
Table 5 summarizes the adverse reactions in ARASENS.
Table 5: Adverse Reactions (≥10% with a ≥2% increase compared to placebo with docetaxel) in ARASENS| Adverse Reaction | NUBEQA with docetaxel (N=652) | Placebo with docetaxel (N=650) |
|---|
All Grades % | Grades 3 or 4 % | All Grades % | Grades 3 or 4 % |
|---|
| Constipation | 23 | 0.3 | 20 | 0.3 |
| Rash
| 20 | 1.8 | 15 | 0.2 |
| Decreased Appetite | 19 | 0.2 | 13 | 0.6 |
| Hemorrhage
| 18 | 1.4 | 13 | 1.4 |
| Weight Increased | 18 | 2.1 | 16 | 1.2 |
| Hypertension
| 14 | 7 | 10 | 3.6 |
Clinically relevant adverse reactions in < 10% of patients who received NUBEQA with docetaxel included fractures (8%), ischemic heart disease (3.2%), seizures (0.6%), and drug-induced liver injury (0.3%).
Table 6 summarizes laboratory test abnormalities in the ARASENS study.
Table 6: Laboratory Test Abnormalities (≥30%) in ARASENS| Laboratory Abnormality | NUBEQA with docetaxel
(N=652) | Placebo with docetaxel
(N=650) |
|---|
All Grades % | Grade 3-4 % | All Grades % | Grade 3-4 % |
|---|
| Anemia | 72 | 6 | 71 | 7 |
| Hyperglycemia | 57 | 7 | 53 | 10 |
| Lymphocyte count decreased | 52 | 12 | 49 | 13 |
| Neutrophil count decreased | 49 | 33 | 44 | 31 |
| AST increased
| 40 | 3.6 | 35 | 2.3 |
| ALT increased
| 37 | 3.7 | 31 | 2.9 |
| Hypocalcemia | 31 | 2.8 | 28 | 1.9 |
Clinically relevant laboratory test abnormalities in < 30% of patients who received NUBEQA with docetaxel included blood bilirubin increased (all grades 20%, Grade 3-4 0.5%) compared to placebo with docetaxel (all grades 10%, grades 3-4 0.3%).