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PEMAZYRE dosing and administration — 3 of 5
PEMAZYRE allows simple dose modifications
Tablets are available in 3 strengths (13.5 mg, 9 mg and 4.5 mg) to enable dose modification as needed1
Recommended dose reductions1
Recommended dose
13.5 mg
taken orally once daily for 14 days on, followed by 7 days off therapy
First dose reduction
9 mg
taken orally once daily for 14 days on, followed by 7 days off therapy
Second dose reduction
4.5 mg
taken orally once daily for 14 days on, followed by 7 days off therapy
Permanently discontinue if unable to tolerate PEMAZYRE 4.5 mg once daily1
Adapted from Swiss Professional Information PEMAZYRE® (pemigatinib) on www.swissmedicinfo.ch; ref. 1.
For further information, please refer to the PEMAZYRE Swissmedic Professional Information.1
- Dose modifications or interruption of dosing should be considered for the management of toxicities1
- Concurrent use of PEMAZYRE with strong CYP3A4 inhibitors should be avoided and requires dose adjustment1
- If co-administration with a strong CYP3A4 inhibitor is necessary, the dose of patients who are taking 13.5 mg PEMAZYRE once daily should be reduced to 9 mg once daily and the dose of patients who are taking 9 mg PEMAZYRE once daily should be reduced to 4.5 mg once daily1
Special populations
Interaction with other medicinal products and other forms of interaction
Special populations
Elderly patients
- The dose of PEMAZYRE is the same in elderly patients as younger adult patients1
Renal impairment
- Dose adjustment is not required for patients with mild or moderate renal impairment or end-stage renal disease (ESRD) on haemodialysis1
- For patients with severe renal impairment, the dose of patients who are taking 13.5 mg PEMAZYRE once daily should be reduced to 9 mg once daily and the dose of patients who are taking 9 mg PEMAZYRE once daily should be reduced to 4.5 mg once daily1
Hepatic impairment
- Dose adjustment is not required for patients with mild or moderate hepatic impairment1
- For patients with severe hepatic impairment, the dose of patients who are taking 13.5 mg PEMAZYRE once daily should be reduced to 9 mg once daily and the dose of patients who are taking 9 mg PEMAZYRE once daily should be reduced to 4.5 mg once daily1
Children and adolescents
- The safety and efficacy of PEMAZYRE in patients less than 18 years of age have not been established. No data are available1
Interaction with other medicinal products and other forms of interaction
- Concomitant administration of PEMAZYRE and strong CYP3A4 inhibitors should be avoided and requires a dose adjustment. Patients should be advised to avoid eating grapefruit or drinking grapefruit juice while taking PEMAZYRE1
- Concomitant use of PEMAZYRE with strong (eg, carbamazepine, phenytoin, phenobarbital, rifampicin) or moderate CYP3A4 inducers is not recommended. Concomitant use of PEMAZYRE with St John’s wort is contraindicated. If needed, other enzyme inducers
(eg, efavirenz) should be used under close surveillance1 - Concomitant use of PEMAZYRE with proton pump inhibitors should be avoided1
- Co-administration of PEMAZYRE with CYP2B6 substrates (eg, cyclophosphamide, ifosfamide, methadone, efavirenz) may decrease their exposure. Close clinical surveillance is recommended when PEMAZYRE is administered with these medicinal products1
- Co-administration of PEMAZYRE with P-gp substrates (eg, digoxin, dabigatran, colchicine) may increase their exposure and thus their toxicity. PEMAZYRE administration should be separated by at least 6 hours before or after administration of P-gp substrates with a narrow therapeutic index1
Date of preparation: April 2023
References
- Swiss Professional Information PEMAZYRE® (pemigatinib) on www.swissmedicinfo.ch.
- Rizvi S and Borad MJ. The rise of the FGFR inhibitor in advanced biliary cancer: the next cover of Time magazine? J Gastrointest Oncol. 2016;7:789–96.
- Ghouri YA, et al. Cancer review: Cholangiocarcinoma. J Carcinog. 2015;14:1.
- Sharma P and Yadav S. Demographics, tumor characteristics, treatment, and survival of patients with Klatskin tumors. Ann Gastroenterol. 2018;31:231–6.
- Blechacz B. Cholangiocarcinoma: Current knowledge and new developments. Gut Liver. 2017;11:13–26.
- Valle JW, et al. New horizons for precision medicine in biliary tract cancers. Cancer Discov. 2017;7:943–62.
- Bañales JM, et al. Cholangiocarcinoma 2020: The next horizon in mechanisms and management. Nat Rev Gastroenterol Hepatol. 2020;17:557–88.
- Bañales JM, et al. Expert consensus document: Cholangiocarcinoma: Current knowledge and future perspectives consensus statement from the European Network for the Study of Cholangiocarcinoma (ENS-CCA). Nat Rev Gastroenterol Hepatol. 2016;13:261–80.
- Bertuccio P, et al. A comparison of trends in mortality from primary liver cancer and intrahepatic cholangiocarcinoma in Europe. Ann Oncol. 2013;24:1667–74.
- Blechacz B, et al. Clinical diagnosis and staging of cholangiocarcinoma. Nat Rev Gastroenterol Hepatol. 2011;8:512–22.
- Forner A, et al. Clinical presentation, diagnosis and staging of cholangiocarcinoma. Liver Int. 2019;39(suppl 1):98–107.
- Vogel A, et al. Biliary tract cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2023;34:127–40.
- Lowery MA, et al. Comprehensive molecular profiling of intrahepatic and extrahepatic cholangiocarcinomas: potential targets for intervention. Clin Cancer Res. 2018;24:4154–61.
- Jain A, et al. Cholangiocarcinoma with FGFR genetic aberrations: A unique clinical phenotype. JCO Precis Oncol. 2018;2:1–12.
- Ross JS, et al. New routes to targeted therapy of intrahepatic cholangiocarcinomas revealed by next-generation sequencing. Oncologist. 2014;19:235–42.
- Farshidfar F, et al. Integrative genomic analysis of cholangiocarcinoma identifies distinct IDH-mutant molecular profiles. Cell Rep. 2017;18:2780–94.
- Graham RP, et al. Fibroblast growth factor receptor 2 translocations in intrahepatic cholangiocarcinoma. Hum Pathol. 2014;45:1630–8.
- Churi CR, et al. Mutation profiling in cholangiocarcinoma: Prognostic and therapeutic implications. PLoS One. 2014;9:e115383.
- Arai Y, et al. Fibroblast growth factor receptor 2 tyrosine kinase fusions define a unique molecular subtype of cholangiocarcinoma. Hepatology. 2014;59:1427–34.
- Borad MJ, et al. Fibroblast growth factor receptor 2 fusions as a target for treating cholangiocarcinoma. Curr Opin Gastroenterol. 2015;31:264–68.
- Silverman IM, et al. Clinicogenomic analysis of FGFR2-rearranged cholangiocarcinoma identifies correlates of response and mechanisms of resistance to pemigatinib. Cancer Discov. 2021;11:326–39.
- Barr FG. Fusion genes in solid tumors: The possibilities and the pitfalls. Expert Rev Mol Diagn. 2016;16:921–3.
- Liu PCC, et al. INCB054828 (pemigatinib), a potent and selective inhibitor of fibroblast growth factor receptors 1, 2, and 3, displays activity against genetically defined tumor models. PLoS One. 2020;15:e0231877.
- Abou-Alfa GK, et al. Pemigatinib for previously treated, locally advanced or metastatic cholangiocarcinoma: A multicentre, open-label, phase 2 study. Lancet Oncol. 2020;21:671–84.
All references are available upon request
Abbreviations
Abbreviated Prescribing Information
▼ This medicinal product is subject to additional monitoring. For further information, see product information Pemazyre on www.swissmedicinfo.ch.
Revision date: January 2023. Marketing authorisation holder: Incyte Biosciences International Sàrl, CH-1110 Morges. Refer to www.swissmedicinfo.ch for detailed information.
Resources and support
For further information, please refer to the PEMAZYRE Swissmedic Professional Information.1
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