Clinical and pharmacological group: & nbsp

Antineoplastic agents

Included in the formulation
  • Jevtana®
    concentrate d / infusion 
  • Cabazred®
    concentrate d / infusion 
  • АТХ:

    L.01.C.D.04   Cabazitaxel

    Pharmacodynamics:

    Cabazitaxel is an antitumor agent that acts by destroying the microtubular cell network. Cabazitaxel binds to tubulin, promotes the assembly of tubulin in microtubules, and simultaneously inhibits their disassembly. This leads to the stabilization of microtubules, which eventually inhibits the mitotic and interphase activity of the cell.

    Kabasitaxel demonstrated a wide range of antitumor activity against late stages of human tumors, xenotransplanted to mice. It is active against docetaxel-sensitive tumors. Besides, cabazitaxel showed activity against tumor models that are insensitive to chemotherapy, including docetaxel.

    Pharmacokinetics:

    Absorption. After a one-hour intravenous infusion of cabazitaxel at a dose of 25 mg / m2 in patients with metastatic prostate cancer Cmax kabasitaxel in blood plasma was reached by the end of a one-hour infusion, the mean Cmax was 226 ng / ml. The mean AUC was 991 ng×h / ml.

    In patients with locally advanced solid tumors, there were no large deviations in the dose-proportionality of concentrations of cabazitaxel in blood plasma in the dose range of 10-30 mg / m2.

    Distribution. Vss was 4870 liters (2640 liters / m2 - for patients with a median body surface area of ​​1.84 m2). In vitro the binding of cabazitaxel to human serum proteins was 89-92% and was unsaturated to a concentration of 50,000 ng / ml, which was greater than Cmax, observed during clinical use of the drug. Cabazitaxel mainly associated with serum albumin (82%) and lipoproteins. In vitro in human blood, the ratios of blood concentrations and plasma concentrations are in the range 0.9-0.99, indicating an equal distribution of cabazitaxel in blood and blood plasma.

    Studies in animals have shown that cabazitaxel and its metabolites are excreted into breast milk, and cabazitaxel penetrates the placental barrier.

    Metabolism. Cabazitaxel is extensively metabolized in the liver (≥ 95%), mainly with the help of the CYP3A4 isoenzyme (80-90%). Cabazitaxel is the main compound circulating in the blood plasma.Besides it 7 metabolites were identified in plasma (including 3 active, resulting from O-demethylation). The concentration in the blood plasma of the main of them is 5% of the concentration in the blood plasma of unchanged cabazitaxel. About 20 cabazitaxel metabolites excreted by the kidneys (urine) and intestine (faeces).

    The potential risk of inhibition cabazitaxel at clinically relevant concentrations of hepatic metabolism regarding possible drugs that mainly are substrates isoenzyme CYP3A. However, absent any potential risk of inhibition of the metabolism of drugs that are substrates other isozymes CYP (1A2, 2B6, 2C8, 2C9, 2C19, 2E1, and 2D6), and there is no potential risk of induction cabazitaxel metabolism of drugs that are substrates isoenzymes CYP1A, CYP2C9 iCYP3A .

    Strong inducers or inhibitors of CYP3A isoenzyme may alter plasma concentrations of cabazitaxel in plasma, as cabazitaxel is mainly metabolized by the CYP3A isoenzyme.

    Prednisolone or prednisone, taken in a dose of 10 mg per day, do not change the pharmacokinetics of cabazitaxel.

    In vitro cabazitaxel does not inhibit proteins of multiple resistance to chemotherapeutic drugs (MRP1 and MRP2). Cabazitaxel inhibits the transport of P-glycoprotein (P-gP) (substrates - digoxin, vinblastine) and protein resistance to chemotherapeutic drugs for breast cancer (BCRP) (substrate - methotrexate) at concentrations 38 times higher than those observed in clinical settings. Therefore, the risk of kabasitaxel interaction at a dose of 25 mg / m2 with substrates MRP, (P-gP) and BCRP in vivo unlikely.

    Excretion. After a one-hour intravenous infusion 14C-cabazitaxel (labeled with radioisotope cabazitaxel) at a dose of 25 mg / m2 Oncological patients approximately 80% of the administered dose is withdrawn within 2 weeks. Cabazitaxel mainly excreted from the body through the intestine (with feces) in the form of numerous metabolites (76% of the dose); while renal excretion of cabazitaxel and its metabolites is less than 4% of the administered dose (2.3% of the administered dose is excreted unchanged in urine).

    Cabazitaxel has a high plasma clearance of 48.5 l / h (26.44 l / h / m2 - in patients with a median body surface area of ​​1.84 m2), and a long half-life, which is 95 h.

    Special groups of patients

    Patients of advanced age. In a population analysis of the pharmacokinetic data of patients aged 65 years and older, there was no age effect on the pharmacokinetics of cabazitaxel.

    Patients of childhood. Safety and effectiveness of the drug in children and adolescents under 18 years are not established.

    Liver failure. Official pharmacokinetic studies in patients with hepatic insufficiency have not been conducted. However, due to the fact that cabazitaxel is excreted from the body mainly by the metabolic pathway, in patients with hepatic insufficiency, an increase in the systemic exposure of cabazitaxel can be expected.

    Renal failure. Cabazitaxel slightly excreted by the kidneys (2.3% of the dose). There were no official pharmacokinetic studies of cabazitaxel in patients with renal insufficiency. However, a population pharmacokinetic analysis based on data from 170 patients consisting of 14 patients with moderate renal insufficiency (creatinine clearance within 30-50 ml / min) and 59 patients with mild renal insufficiency (creatinine clearance 50- 80 ml / min), showed,that renal insufficiency of mild and moderate severity did not have a significant effect on the pharmacokinetics of cabazitaxel.

    Indications:

    Hormone-resistant metastatic prostate cancer in patients who previously received chemotherapy with docetaxel (in combination with prednisolone or prednisone).

    II.C76-C80.C79   Secondary malignant neoplasm of other sites

    II.C60-C63.C61   Malignant neoplasm of prostate

    Contraindications:

    - the number of neutrophils in the peripheral blood is less than 1500 / μl;

    - hepatic insufficiency (bilirubin ≥ 1 × upper limit of the norm, aspartate aminotransferase and / or alanine aminotransferase ≥ 1.5 × upper limit of the norm);

    - simultaneous vaccination with the vaccine against yellow fever;

    - Pregnancy;

    - lactation period;

    - children and adolescents under 18 years of age (safety and efficacy not established);

    - hypersensitivity to cabazitaxel or excipients of the drug (polysorbate-80);

    - Hypersensitivity to other taxanes.

    Carefully:

    - in patients with moderate renal insufficiency (creatinine clearance 30-50 ml / min) (limited clinical data on the use of the drug),in patients with severe renal insufficiency (creatinine clearance less than 30 ml / min) and terminal stage of renal failure (lack of clinical data on the use of the drug) (thorough medical supervision is required during treatment);

    - in patients with a hemoglobin content in peripheral blood <10 g / dl;

    - in patients with conditions or diseases that cause a predisposition to develop neutropenia and / or increase complications with prolonged neutropenia (age over 65, low overall status, low body weight, previous episodes of febrile neutropenia, previous intensive radiation therapy, other serious concomitant disease) (requires careful medical supervision during treatment, possibly preventive administration granulocyte colony-stimulating factor).

    Pregnancy and lactation:

    FDA Action Category - D.

    Cabazitaxel is contraindicated in pregnancy and lactation (breastfeeding).

    Dosing and Administration:

    Intravenous infusion

    During the introduction of the infusion solution of cabazitaxel, a filter with a nominal pore diameter of 0.22 μm inserted with the system for intravenous infusions should be used.

    The drug should not be mixed with other drugs and solutions, with the exception of 5% dextrose and 0.9% sodium chloride solution. The preparation contains polysorbate 80, which, as is known, increases the rate of extraction of di- (2-ethylhexyl) phthalate from polyvinyl chloride. Therefore, it is not possible to use containers for infusion liquids from polyvinyl chloride and kits for carrying out infusions from polyurethane for the preparation and administration of an infusion solution of cabazitaxel.

    Treatment with the drug

    As with other antitumor drugs, care should be taken and gloves used when handling the drug and when preparing its infusion solution.

    If the solution of the drug at any stage of work with it has got on the skin, immediately wash it thoroughly with soap and water, if it gets on the mucous membranes - only with water.

    Work with the drug should only personnel who have skills in handling cytotoxic drugs.

    Pregnant women should not work with this drug.

    Side effects:

    Infectious and parasitic diseases: often - septic shock, sepsis, cellulitis, urinary tract infections of all severity, flu, cystitis, upper respiratory tract infection, herpes zoster, candidiasis; infrequently - cellulite, cystitis.

    On the part of the hematopoiesis system: very often - neutropenia of all degrees of severity, including neutropenia with clinical manifestations, anemia of all severity, leukopenia of all severity, thrombocytopenia; often - febrile neutropenia, thrombocytopenia.

    From the immune system: often - hypersensitivity reactions, including severe reactions, such as generalized rash / erythema, lowering blood pressure and bronchospasm.

    From the side of metabolism: very often - anorexia; often - dehydration of all degrees of severity, hyperglycemia, hypokalemia, weight loss; infrequently - anorexia, hyperglycemia, hypokalemia.

    From the nervous system: very often - dysgeusia (perversion of taste); often-peripheral neuropathy: peripheral sensory neuropathy (paresthesia, dysesthesia, hypoesthesia) and peripheral motor neuropathy; dizziness, headache, lethargy, sciatica, restlessness, confusion; infrequently peripheral neuropathy, peripheral sensory neuropathy, lethargy, sciatica.

    From the side of the organ of vision: often - conjunctivitis, increased tearing.

    From the side of the organ of hearing and balance: often - ringing in the ears, vertigo (feeling of deviation or twisting of one's own body or surrounding objects).

    From the cardiovascular system: often - atrial fibrillation (atrial fibrillation), tachycardia, decreased blood pressure, deep vein thrombosis of all severities, increased blood pressure, orthostatic hypotension, flushing to the skin with a feeling of heat, hyperthermia; infrequently - atrial fibrillation (atrial fibrillation), lowering blood pressure, increasing blood pressure, orthostatic hypotension.

    From the respiratory system: very often - shortness of breath, cough; often - shortness of breath, pain in the mouth and pharyngeal cavity, pneumonia of all degrees of severity.

    From the digestive system: very often - diarrhea, nausea, vomiting, constipation, abdominal pain; often - an increase in activity of aspartate aminotransferase, diarrhea, nausea, vomiting, constipation, abdominal pain, dyspepsia, epigastric pain, hemorrhoids, gastroesophageal reflux disease,bleeding from the rectum, dry mouth, bloating; infrequently - an increase in serum bilirubin concentration, increased activity of alanine aminotransferase, rectal bleeding, dry mouth, bloating.

    From the skin and subcutaneous tissues: very often - alopecia; often - dry skin, erythema.

    From the musculoskeletal system: very often - pain in the spine, arthralgia; often - pain in the spine, arthralgia, pain in the extremities of all degrees of severity, muscle spasms, myalgia, musculoskeletal pain in the thorax, pain along the lateral surfaces of the trunk; infrequently - myalgia, musculoskeletal pain in the chest area, pain along the lateral surfaces of the trunk.

    From the urinary system: very often - hematuria; often acute renal failure of all degrees of severity, renal failure of all degrees of severity, dysuria, renal colic, hematuria, pollakiuria, hydronephrosis, urinary retention, urinary incontinence, obstruction of ureters of all severity; infrequently - renal colic, pollakiuria, hydronephrosis, urinary retention.

    On the part of the genitals: often - pelvic pain; infrequently - pain in the pelvic area.

    Common violations: very often - weakness, asthenia, pyrexia; often - weakness; asthenia, pyrexia, peripheral edema, inflammation of the mucous membranes, pain in the chest, swelling, chills, malaise; infrequent - peripheral edema, inflammation of the mucous membranes, pain in the chest, swelling.

    Overdose:

    Symptoms: can be expected - the increase in dose-dependent side effects, such as symptoms of suppression of bone marrow hematopoiesis and disorders of the gastrointestinal tract.

    Treatment: the antidote of cabazitaxel is unknown. In case of an overdose, the patient should be placed in a specialized department under careful medical supervision. After becoming aware of an overdose, patients should start receiving as soon as possible granulocyte colony stimulating factor. Other symptomatic treatment should also be done.

    Interaction:

    Special studies on the interaction of cabazitaxel with other drugs have not been conducted.

    In studies in vitro shown, that cabazitaxel mainly metabolized with the participation of the isoenzyme CYP3A (80-90%) and inhibits the isoenzyme CYP3A.

    With the simultaneous use of cabazitaxel with potent inhibitors of the CYP3A isoenzyme (such as ketoconazole, itraconazole, clarithromycin, atazanavir, indinavir, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin, voriconazole) is expected to increase the concentration of cabazitaxel in blood plasma. Therefore, simultaneous use of cabazitaxel and potent inhibitors of the CYP3A isoenzyme should be avoided. Caution should be exercised while using cabazitaxel and moderate inhibitors of the CYP3A isoenzyme.

    With the simultaneous use of cabazitaxel with powerful inducers of the CYP3A isoenzyme (such as phenytoin, carbamazepine, rifampicin, rifabutin, rifapentin, phenobarbital) is expected to reduce the concentration of cabazitaxel in blood plasma. Therefore, simultaneous use of cabazitaxel and powerful inductors of the CYP3A isoenzyme should be avoided. In addition, patients receiving cabazitaxel, should refrain from taking medicinal herbs of St. John's wort.

    Prednisolone / prednisone a dose of 10 mg daily does not affect the pharmacokinetics of cabazitaxel.

    Warfarin. Cabazitaxel does not inhibit in vitro the main pathway of biotransformation of warfarin to 7-hydroxyvarfarin, in which the isozyme CYP2C9 participates. Therefore, no pharmacokinetic interaction between cabazitaxel and warfarin is expected in vivo.

    Vaccination. The use of live vaccines or weakened live vaccines in patients with reduced immunity due to the treatment with chemotherapeutic drugs can lead to the development of serious or fatal infections. Vaccination with live attenuated vaccines should be avoided in patients receiving cabazitaxel treatment. Killed or inactivated vaccines can be used; However, the response of the body to such vaccines may be less pronounced.

    Special instructions:

    Caution should be applied cabazitaxel in patients with moderate renal insufficiency (creatinine clearance 30-50 ml / min) (limited clinical data on the use of the drug), in patients with severe renal insufficiency (creatinine less than 30 ml / min) and terminal stage of renal failureinsufficiency (lack of clinical data on the use of the drug) (requires thorough medical supervision during treatment); in patients with a hemoglobin content in peripheral blood <10 g / dl; in patients with conditions or diseases that cause a predisposition to develop neutropenia and / or increase complications with prolonged neutropenia (age over 65, low overall status, low body weight, previous episodes of febrile neutropenia, previous intensive radiation therapy, other serious co-morbidities ) (requires thorough medical supervision during treatment, possibly preventive administration granulocyte colony-stimulating factor).

    Patients should be closely monitored to detect the development of hypersensitivity reactions, especially during the first few minutes after infusion of cabazitaxel. During the infusion it is necessary to have the appropriate equipment and medicines to provide emergency care while lowering blood pressure or developing bronchospasm.Possible development of severe reactions, such as generalized rash / erythema, lowering blood pressure and bronchospasm. With the development of severe hypersensitivity reactions, an immediate cessation of infusion of cabazitaxel and the necessary treatment are required. Patients with a history of a severe hypersensitivity reaction can not be re-administered cabazitaxel.

    In accordance with the recommendations of the American Society of Clinical Oncology and / or modern approved guidelines to reduce the risk of occurrence or treatment of neutropenic complications (febrile neutropenia, prolonged neutropenia or neutropenic infection), patients receiving cabazitaxel, you can prophylactically appoint granulocyte colony stimulating factor.

    During the first cycle (cycle 1) of treatment and before each new treatment cycle, weekly monitoring of the number of blood elements (a common blood test) is required in order to reduce the dose in the next cycle if necessary. With the development of febrile neutropenia or prolonged neutropenia, despite the appropriate treatment,The treatment with cabazitaxel can be continued only after an increase in the number of neutrophils in the peripheral blood to ≥ 1500 / μl.

    If patients develop diarrhea after administration of cabazitaxel, then conventional antidiarrhoeal drugs should be treated. It is necessary to take appropriate measures to restore fluid loss, monitor and correct the electrolyte composition of blood, especially the concentration of potassium ions. Diarrhea can develop more often in patients who received prior abdominal-pelvic radiation therapy. Dehydration often develops in patients aged 65 years and older. With the development of diarrhea of ​​the third degree of severity, it may be necessary to postpone the next cycle of treatment or reduce the dose. With nausea and vomiting, antiemetics can be used.

    In patients who received cabazitaxel, there were cases of peripheral neuropathy, peripheral sensory neuropathy (paresthesia, dysesthesia) and peripheral motor neuropathy. Patients receiving cabazitaxel, should be advised before continuing treatment to inform their attending physician about the symptoms of neuropathy developed in them, such as pain, burning sensation, tingling, numbness.The physician should evaluate the presence or intensification of the symptoms of neuropathy before each treatment cycle. The administration of cabazitaxel should be delayed until symptoms decrease. With persistent peripheral neuropathy ≥ 2 degrees of severity, the dosage of cabazitaxel should be reduced from 25 mg / m2 body surface up to 20 mg / m2 surface of the body.

    Reported violations of kidney function in combination with sepsis, severe dehydration due to diarrhea and vomiting and obstructive uropathy. There was a development of renal failure, including fatal cases. Appropriate measures should be taken to identify the cause and to conduct intensive therapy with developing renal failure. Kidney function should be monitored.

    When treating cabazitaxel, adequate hydration should be performed.

    The patient should be advised to immediately report any changes in the amount of urine released per day. The creatinine content should be determined before treatment, with each study of a general blood test and in the case of a patient reporting a change in urine output. If renal failure is ≥ 3 degrees of severity, treatment with cabazitaxel should be discontinued.

    Elderly patients (≥65 years of age) may be more prone to some adverse reactions, including neutropenia and febrile neutropenia.

    It is recommended to use caution cabazitaxel in patients with a hemoglobin content in peripheral blood <10 g / dl. It is necessary to conduct appropriate therapeutic measures aimed at increasing the concentration of hemoglobin in peripheral blood.

    Due to possible adverse effects on male gametes and possible drug delivery to semen, patients receiving cabazitaxel, and their sexual partners should use effective methods of contraception during treatment and within 6 months after the administration of the last dose of cabazitaxel. In connection with the possible intake of cabazitaxel in seminal fluid, men receiving cabazitaxel, during treatment should prevent the contact of the ejaculate with the tissues of another person. Patients who are scheduled for treatment with cabazitaxel are advised to cryopreserve sperm before starting treatment.

    During treatment, patients should refrain from driving and other potentially dangerousActivities that require increased concentration and speed of psychomotor reactions.

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