Oral Refractory acute myeloid leukaemia with FLT3 mutation, Relapsed acute myeloid leukaemia with FLT3 mutation
Adult: Initially, 120 mg once daily. Continue treatment for at least 6 months or until disease progression or unacceptable toxicity occurs. If no response (did not achieve composite complete remission [CRc]) is observed after 4 weeks, dose may be increased to 200 mg once daily if tolerated. Dose reduction, dosing interruption, or discontinuation may be required if serious adverse effects occur (refer to specific product guidelines).
Administration
May be taken with or without food. Swallow whole, do not break/crush/chew.
Contraindications
Pregnancy and lactation.
Special Precautions
Patient with relevant cardiac history, risk factors for QT-interval prolongation (e.g. hypokalaemia, hypomagnesaemia).
Adverse Reactions
Significant: Prolonged QT interval, pancreatitis, hypersensitivity reactions (e.g. anaphylactic reactions). Rarely, posterior reversible encephalopathy syndrome. Blood and lymphatic system disorders: Febrile neutropenia. Cardiac disorders: Pericardial effusion, pericarditis, cardiac failure. Gastrointestinal disorders: Diarrhoea, nausea, constipation. General disorders and administration site conditions: Fatigue, asthenia, peripheral oedema, malaise. Investigations: Increased ALT, AST, blood creatine phosphokinase, and alkaline phosphatase. Musculoskeletal and connective tissue disorders: Arthralgia, myalgia, pain in extremity, musculoskeletal pain. Nervous system disorders: Dizziness. Renal and urinary disorders: Acute kidney injury. Respiratory, thoracic and mediastinal disorders: Cough, dyspnoea. Skin and subcutaneous tissue disorders: Rash. Vascular disorders: Hypotension. Potentially Fatal: Differentiation syndrome.
Patient Counseling Information
This drug may cause dizziness, if affected, do not drive or operate machinery. Females of reproductive potential must use effective contraception during therapy and for at least 6 months after stopping the treatment; an additional barrier method is recommended in women using hormonal contraceptives. Males with female partners of reproductive potential must use effective contraception during therapy and for at least 4 months after the last dose.
Monitoring Parameters
Confirm FLT3 mutation prior to initiation of therapy. Perform pregnancy tests in females of reproductive potential within 7 days before treatment initiation. Obtain blood chemistries including creatine phosphokinase before initiating treatment, then at least once weekly for the 1st month, then once every other week for the 2nd month, and once monthly thereafter. Monitor ECG before initiating treatment, on Days 8 and 15 of cycle 1, and before the start of the next 2 subsequent cycles. Correct hypokalaemia or hypomagnesaemia before and during treatment. Monitor adherence; signs and symptoms of differentiation syndrome, pancreatitis, and posterior reversible encephalopathy syndrome.
Drug Interactions
Decreased exposure and efficacy with P-gp and strong CYP3A4 inducers (e.g. phenytoin, rifampicin). Increased exposure with strong inhibitors of CYP3A4, P-gp, and/or breast cancer resistant protein (BCRP) (e.g. voriconazole, itraconazole, posaconazole, and clarithromycin). May reduce the effects of drugs that target 5-HT2B receptor or sigma nonspecific receptors (e.g. escitalopram, sertraline, fluoxetine).
Food Interaction
St. John’s wort may decrease the plasma concentrations of gilteritinib.
Action
Description: Mechanism of Action: Gilteritinib is a tyrosine kinase inhibitor which inhibits FMS-like tyrosine kinase 3 (FLT3) receptor signalling and proliferation in cells exogenously expressing FLT3, including FLT3-ITD, tyrosine kinase domain mutations FLT3-D835Y and FLT3-ITD-D835Y. It also induces apoptosis in leukaemic cells expressing FLT3-ITD mutations. Onset: Inhibition of FLT3 phosphorylation: Within 24 hours after the 1st dose. Pharmacokinetics: Absorption: Time to peak plasma concentration: Approx 4-6 hours. Distribution: Extensively distributed to body tissues. Volume of distribution: 1,092 L (central); 1,100 L (peripheral). Plasma protein binding: Approx 90%, mainly to albumin. Metabolism: Metabolised in the liver mainly by CYP3A4 isoenzyme into M17 (via N-dealkylation and oxidation), M16 and M10 metabolites (both via N-dealkylation). Excretion: Mainly via faeces (64.5%); urine (approx 16.4% as unchanged drug and metabolites). Elimination half-life: 113 hours.
Chemical Structure
Gilteritinib Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 49803313, Gilteritinib. https://pubchem.ncbi.nlm.nih.gov/compound/Gilteritinib. Accessed Sept. 28, 2022.
Storage
Store between 15-30°C. Protect from moisture, light, and humidity. Follow applicable procedures for receiving, handling, administration, and disposal.
L01EX13 - gilteritinib ; Belongs to the class of other protein kinase inhibitors. Used in the treatment of cancer.
References
Anon. Gilteritinib. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 06/09/2022.Anon. Gilteritinib. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 06/09/2022.Buckingham R (ed). Gilteritinib. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/09/2022.Joint Formulary Committee. Gilteritinib. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/09/2022.Xospata 40 mg Film-coated Tablets (Astellas Pharma Europe B.V.). European Medicines Agency [online]. Accessed 06/09/2022.Xospata Film-coated Tablets (Astellas Pharma Hong Kong Co Ltd). MIMS Hong Kong. http://www.mims.com/hongkong. Accessed 06/09/2022.Xospata Tablet (Astellas Pharma US, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 06/09/2022.
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