Newly Diagnosed FLT3-ITD positive AML
The safety of VANFLYTA (35.4 mg orally once daily with chemotherapy, 26.5 mg to 53 mg orally once daily as maintenance) in adult patients with newly diagnosed FLT3-ITD positive AML is based on QuANTUM-First, a randomized, double-blind clinical trial of VANFLYTA (n=265) or placebo (n=268) with chemotherapy [see Clinical Studies (14)]. Among patients who received VANFLYTA, 38% were exposed for 6 months or longer and 30% were exposed for greater than one year. On the VANFLYTA plus chemotherapy arm, 65% and 44% of patients completed induction and consolidation therapy, respectively, compared to 65% and 34% of patients in the placebo plus chemotherapy arm.
Serious adverse reactions in ≥5% of patients who received VANFLYTA plus chemotherapy were: febrile neutropenia (11%). Fatal adverse reactions occurred in 10% of patients who received VANFLYTA plus chemotherapy, including sepsis (5%), fungal infections (0.8%), brain edema (0.8%), and one case each of febrile neutropenia, pneumonia, cerebral infarction, acute respiratory distress syndrome, pulmonary embolism, ventricular dysfunction, and cardiac arrest.
Permanent discontinuation due to an adverse reaction in patients in the VANFLYTA plus chemotherapy arm occurred in 20% of patients. The most frequent (≥2%) adverse reaction which resulted in permanent discontinuation in the VANFLYTA arm was sepsis (5%).
Dosage interruptions of VANFLYTA due to an adverse reaction occurred in 34% of patients. Adverse reactions which required dosage interruption in ≥2% of patients in the VANFLYTA arm included neutropenia (11%), thrombocytopenia (5%), and myelosuppression (3%).
Dose reductions of VANFLYTA due to an adverse reaction occurred in 19% of patients. Adverse reactions which required dosage reductions in ≥2% of patients in the VANFLYTA arm were neutropenia (9%), thrombocytopenia (5%), and electrocardiogram QT prolonged (4%).
The most common adverse reactions (≥10% with a difference between arms of ≥2% compared to placebo), including laboratory abnormalities, were lymphocytes decreased, potassium decreased, albumin decreased, phosphorus decreased, alkaline phosphatase increased, magnesium decreased, febrile neutropenia, diarrhea, mucositis, nausea, calcium decreased, abdominal pain, sepsis, neutropenia, headache, creatine phosphokinase increased, vomiting, upper respiratory tract infections, hypertransaminasemia, thrombocytopenia, decreased appetite, fungal infections, epistaxis, potassium increased, herpesvirus infections, insomnia, electrocardiogram QT prolonged, magnesium increased, sodium increased, dyspepsia, anemia, and eye irritation.
Tables 5 and 6 summarize adverse reactions and laboratory abnormalities observed in patients receiving VANFLYTA in the clinical trial.
Table 5: Adverse Reactions (≥10%) in Patients with Newly Diagnosed FLT3-ITD positive AML Who Received VANFLYTA (with a Difference Between Arms of ≥2% Compared to Placebo) in the Clinical TrialBody System Adverse Reaction | VANFLYTA + Chemotherapy (N=265) | PLACEBO + Chemotherapy (N=268) |
|---|
All Grades % | Grade 3 or 4 % | All Grades % | Grade 3 or 4 % |
|---|
| Blood and Lymphatic System Disorders |
| Febrile neutropenia
| 44 | 43 | 42 | 41 |
| Neutropenia
| 29 | 26 | 14 | 12 |
| Thrombocytopenia
| 18 | 13 | 13 | 12 |
| Anemia
| 11 | 6 | 7 | 5 |
| Gastrointestinal Disorders |
| Diarrhea
| 42 | 8 | 39 | 8 |
| Mucositis
| 38 | 5 | 33 | 4.1 |
| Nausea | 34 | 1.5 | 31 | 1.9 |
| Abdominal pain
| 30 | 2.3 | 22 | 1.1 |
| Vomiting | 25 | 0 | 20 | 1.5 |
| Dyspepsia | 11 | 0.4 | 9 | 0.7 |
| Infections and Infestations |
| Sepsis
,
| 30 | 19 | 26 | 20 |
| Upper respiratory tract infection
| 21 | 2.6 | 12 | 3 |
| Fungal infection
,
| 16 | 6 | 10 | 3 |
| Herpesvirus infection
| 14 | 2.6 | 8 | 1.9 |
| Nervous System Disorders |
| Headache
| 28 | 0 | 20 | 0.7 |
| Hepatobiliary disorders |
| Hypertransaminasemia
| 19 | 7 | 14 | 6 |
| Metabolism and Nutrition Disorders |
| Decreased appetite | 17 | 4.9 | 13 | 1.9 |
| Respiratory, Thoracic and Mediastinal Disorders |
| Epistaxis | 15 | 1.1 | 11 | 0.4 |
| Psychiatric Disorders |
| Insomnia | 14 | 0 | 11 | 0 |
| Investigations |
| Electrocardiogram QT prolonged
| 14 | 3 | 4.1 | 1.1 |
| Eye Disorders |
| Eye irritation
| 11 | 0 | 7 | 0 |