Relapsed or Refractory Follicular Lymphoma and Marginal Zone Lymphoma
The safety of UKONIQ was evaluated in a pooled safety population that included 221 adults with marginal zone lymphoma (37%) and follicular lymphoma (63%) enrolled in three single-arm, open-label trials (Study TGR-1202-101, TGR-1202-202, and UTX-TGR-205) and one open-label extension trial (Study UTX-TGR-501)
[see Clinical Studies (
14.1,
14.2)]
. These trials required hepatic transaminases ≤ 2.5 times upper limit of normal (ULN), total bilirubin ≤ 1.5 times ULN, and creatinine clearance ≥ 30 mL/min. No patients had prior exposure to a PI3K inhibitor. Patients received UKONIQ 800 mg orally once daily. Among these 221 patients who received UKONIQ, 60% were exposed for 6 months or longer and 34% were exposed for greater than one year.
The median age was 66 years (range: 29 to 88 years), 43% were female, and 97% had an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1. Race was reported in 92% of patients; of these patients, 89% were White, 6% were Black, and 3% were Asian. Patients had a median of 2 prior therapies (range 1 to 10).
Serious adverse reactions occurred in 18% of patients who received UKONIQ. Serious adverse reactions that occurred in ≥2% of patients were diarrhea-colitis (4%), pneumonia (3%), sepsis (2%), and urinary tract infection (2%). Fatal adverse reactions occurred in <1% of patients who received UKONIQ, including exfoliative dermatitis.
Permanent discontinuation of UKONIQ due to an adverse reaction occurred in 14% of patients. Adverse reactions which resulted in permanent discontinuation of UKONIQ in ≥5% of patients included diarrhea-colitis (6%) and transaminase elevation (5%).
Dose reductions of UKONIQ due to an adverse reaction occurred in 11% of patients. Adverse reactions which required dose reductions in ≥4% of patients included diarrhea-colitis (4%).
Dosage interruptions of UKONIQ due to an adverse reaction occurred in 43% of patients. Adverse reactions which required dosage interruption in ≥5% of patients included diarrhea-colitis (18%), transaminase elevation (7%), neutropenia (5%), vomiting (5%), and upper respiratory tract infection (5%).
The most common (≥15%) adverse reactions, including laboratory abnormalities, were increased creatinine, diarrhea-colitis, fatigue, nausea, neutropenia, transaminase elevation, musculoskeletal pain, anemia, thrombocytopenia, upper respiratory tract infection, vomiting, abdominal pain, decreased appetite, and rash.
Table 3 provides the adverse reactions in the pooled safety population of 221 patients with marginal zone lymphoma and follicular lymphoma who received the recommended dosage.
Table 3: Adverse Reactions Reported (≥10%) in Patients With Marginal Zone Lymphoma and Follicular Lymphoma Who Received UKONIQ in Pooled Safety Population
|
|
|
|
|
| Adverse Reactions | UKONIQ N=221 |
All Grades (%) | Grade 3 or 4 (%) |
| Gastrointestinal Disorders | |
| Diarrhea
| 58
| 10
|
| Nausea
| 38
| <1
|
| Vomiting
| 21
| <1
|
| Abdominal pain
a
| 19
| 3
|
| General Disorders and Administration Site Conditions | |
| Fatigue
b
| 41
| 3
|
| Edema
c
| 14
| <1
|
| Pyrexia
| 10
| 0
|
| Musculoskeletal and Connective Tissue Disorders | |
| Musculoskeletal pain
d
| 27
| 2
|
| Infections | |
| Upper respiratory tract infection
e
| 21
| <1
|
| Metabolism and Nutrition Disorders | |
| Decreased appetite
| 19
| 2
|
| Skin and Subcutaneous Tissue Disorders | |
| Rash
f
| 18
| 3
|
| Psychiatric Disorders | |
| Insomnia
| 14
| <1
|
Clinically relevant adverse reactions in <10% of patients who received UKONIQ included urinary tract infection (9%), dyspnea (7%), pneumonia (6%), sepsis (3%), colitis (2%), pneumonitis (<1%), and exfoliative dermatitis (<1%).
Table 4 provides the laboratory abnormalities in the pooled safety population of 221 patients with marginal zone lymphoma and follicular lymphoma who received the recommended dosage.
Table 4: Select Laboratory Abnormalities (>20%) That Worsened from Baseline in Patients with Marginal Zone Lymphoma and Follicular Lymphoma Who Received UKONIQ in Pooled Safety Population
|
| Laboratory Parameter | UKONIQ N=221 |
All Gradesa (%) | | Grade 3 or 4 (%) |
Hematologic
|
|
|
Neutrophil decreased
| 33
| 16
|
Hemoglobin decreased
| 27
| 3
|
| Platelets decreased
| 26
| 4
|
Chemistry
|
|
|
Creatinine increased
| 79
| 0
|
Alanine aminotransferase increased
| 33
| 8
|
Aspartate aminotransferase increased
| 32
| 7
|
| Potassium decreased
| 21
| 4
|