Drug Action
Brigatinib is a tyrosine kinase inhibitor.
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Drug reference
Brigatinib is a tyrosine kinase inhibitor.
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Anaplastic lymphoma kinase (ALK)-positive advanced non-small cell lung cancer previously treated with crizotinib (specialist use only) ▶BY MOUTH ▶Adult: Initially 90 mg once daily for 7 days, then increased to 180 mg once daily, for dose adjustments due to dose interruption or side-effects—consult product literature
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DUE TO INTERACTIONS ▶Manufacturer advises if concomitant use with potent CYP3A4 inhibitors is unavoidable, reduce brigatinib dose to 90 mg once daily; in those starting treatment or already taking a reduced dose, consult product literature.
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NICE decisions ▶Brigatinib for treating ALK-positive advanced non-small-cell lung cancer after crizotinib (March 2019) NICE TA571 Brigatinib (Alunbrig ®) is recommended, within its marketing authorisation, for treating anaplastic lymphoma kinase (ALK)-positive advanced non-small cell lung cancer in adults who have already had crizotinib. It is recommended only if the manufacturer provides it according to the commercial arrangement. www.nice.org.uk/guidance/ta571 Scottish Medicines Consortium (SMC) decisions SMC No. SMC2147 The Scottish Medicines Consortium has advised (June 2019) that brigatinib (Alunbrig ®) is accepted for use within NHS Scotland as monotherapy for the treatment of adults with anaplastic lymphoma kinase (ALK)-positive advanced non-small cell lung cancer previously treated with crizotinib. This advice is contingent upon the continuing availability of the patient access scheme in NHS Scotland or a list price that is equivalent or lower.
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RISKS OF INCORRECT DOSING OF ORAL ANTI-CANCER MEDICINES See Cytotoxic drugs p. 938.
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→Appendix 1: brigatinib
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▶Common or very common Anaemia. appetite decreased. arrhythmias. arthralgia. asthenia. cataract. chest discomfort. constipation. cough. diarrhoea. dizziness. dry mouth. dyspnoea. electrolyte imbalance. eye disorders. eye inflammation. facial swelling. fever. flatulence. gastrointestinal discomfort. glaucoma. headaches. hyperbilirubinaemia. hyperglycaemia. hyperinsulinaemia. hypertension. increased risk of infection. insomnia. memory loss. muscle complaints. musculoskeletal discomfort. nausea. nerve disorders. neurotoxicity. oedema. oral disorders. pain. palpitations. peripheral swelling. photosensitivity reaction. QT interval prolongation. respiratory disorders. sensation abnormal. skin reactions. taste altered. vision disorders. vomiting. weight decreased ▶Uncommon Pancreatitis
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Manufacturer advises effective non-hormonal contraception in females of childbearing potential during and for at least 4 months after treatment. Male patients with partners of childbearing potential should use effective contraception during and for at least 3 months after treatment.
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Manufacturer advises avoid unless potential benefit outweighs risk—toxicity in animal studies. See also Pregnancy and reproductive function in Cytotoxic drugs p. 938.
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Manufacturer advises avoid—no information available.
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Manufacturer advises caution in severe impairment. Dose adjustments Manufacturer advises dose reduction to 60 mg once daily for 7 days, then increase to 120 mg once daily in severe impairment.
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Manufacturer advises caution in severe impairment. Dose adjustments Manufacturer advises dose reduction to 60 mg once daily for 7 days, then increase to 90 mg once daily in severe impairment.
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▶Manufacturer advises monitor for new or worsening respiratory symptoms, particularly in the first week of treatment—promptly investigate if pneumonitis suspected (consult product literature). ▶Manufacturer advises monitor blood pressure, heart rate, creatine phosphokinase, amylase, and lipase regularly. ▶Manufacturer advises monitor liver function at baseline, then every 2 weeks during the first 3 months of treatment, and periodically thereafter. ▶Manufacturer advises monitor fasting serum glucose at baseline and periodically thereafter.
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There can be variation in the licensing of different medicines containing the same drug. Tablet CAUTIONARY AND ADVISORY LABELS 25 ▶Alunbrig (Takeda UK Ltd) A Brigatinib 30 mg Alunbrig 30mg tablets | 28 tablet P £1,225.00 | 56 tablet P £2,450.00 Brigatinib 90 mg Alunbrig 90mg tablets | 7 tablet P £918.75 | 28 tablet P £3,675.00 Brigatinib 180 mg Alunbrig 180mg tablets | 28 tablet P £4,900.00
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Manufacturer advises patients and carers should be told to report symptoms of visual disturbance, or unexplained muscle pain, tenderness, or weakness. Driving and skilled tasks Manufacturer advises patients and carers should be counselled on the effects on driving and performance of skilled tasks—increased risk of visual disturbance, dizziness, or fatigue.
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Initially 90 mg once daily for 7 days, then
First-line fragment. Read the complete Indications and Dose section above.
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