WARNINGS
Included as part of the PRECAUTIONS section.
PRECAUTIONS
Embryo-fetal Toxicity
ODOMZO can cause embryo-fetal death or severe birth
defects when administered to a pregnant woman. In animal reproduction studies,
sonidegib was embryotoxic, fetotoxic, and teratogenic at maternal exposures
below the recommended human dose of 200 mg. Advise pregnant women of the
potential risk to a fetus [see Use in Specific Populations].
Females Of Reproductive Potential
Verify pregnancy status of females of reproductive
potential prior to initiating ODOMZO treatment. Advise females to use effective
contraception during treatment with ODOMZO and for at least 20 months after the
last dose [see Use in Specific Populations].
Males
Advise male patients with female partners to use condoms,
even after a vasectomy, during treatment with ODOMZO and for at least 8 months
after the last dose to avoid potential drug exposure in pregnant females or
females of reproductive potential [see Use in Specific Populations].
Blood Donation
Advise patients not to donate blood or blood products
while taking ODOMZO and for at least 20 months after the last dose of ODOMZO
because their blood or blood products might be given to a female of
reproductive potential.
Musculoskeletal Adverse Reactions
Musculoskeletal adverse reactions, which may be
accompanied by serum creatine kinase (CK) elevations, occur with ODOMZO and
other drugs which inhibit the hedgehog pathway.
In a pooled safety analysis of 12 clinical studies
involving 571 patients with various advanced cancers treated with ODOMZO at
doses ranging from 100 mg to 3000 mg, rhabdomyolysis (defined as serum CK
increase of more than ten times the baseline value with a concurrent 1.5-fold
or greater increase in serum creatinine above baseline value) occurred in one
patient (0.2%) treated with ODOMZO 800 mg.
In Study 1, musculoskeletal adverse reactions occurred in
68% (54/79) of patients treated with ODOMZO 200 mg daily with 9% (7/79)
reported as Grade 3 or 4. The most frequent manifestations of musculoskeletal
adverse reactions reported as an adverse event were muscle spasms (54%),
musculoskeletal pain (32%), and myalgia (19%). Increased serum CK laboratory
values occurred in 61% (48/79) of patients with 8% (6/79) of patients having
Grade 3 or 4 serum CK elevations. Musculoskeletal pain and myalgia usually
preceded serum CK elevation. Among patients with Grade 2 or higher CK
elevations, the median time to onset was 12.9 weeks (range: 2 to 39 weeks) and
the median time to resolution (to &e; Grade 1) was 12 days (95% CI: 8 to 14
days). ODOMZO was temporarily interrupted in 8% of patients or permanently
discontinued in 8% of patients for musculoskeletal adverse reactions. The
incidence of musculoskeletal adverse reactions requiring medical intervention
(magnesium supplementation, muscle relaxants, and analgesics or narcotics) was
29%, including four patients (5%) who received intravenous hydration or were
hospitalized.
Obtain baseline serum CK and creatinine levels prior to
initiating ODOMZO, periodically during treatment, and as clinically indicated
(e.g., if muscle symptoms are reported). Obtain serum creatinine and CK levels
at least weekly in patients with musculoskeletal adverse reactions with
concurrent serum CK elevation greater than 2.5 times ULN until resolution of
clinical signs and symptoms. Depending on the severity of symptoms, temporary
dose interruption or discontinuation may be required for musculoskeletal adverse
reactions or serum CK elevation [see DOSAGE AND ADMINISTRATION]. Advise
patients starting therapy with ODOMZO of the risk of muscle-related adverse
reactions. Advise patients to report promptly any new unexplained muscle pain,
tenderness or weakness occurring during treatment or that persists after
discontinuing ODOMZO.
Patient Counseling Information
Advise the patient to read the FDA-approved patient
labeling (Medication Guide).
Embryo-Fetal Toxicity
[see WARNINGS AND
PRECAUTIONS and Use In Specific Populations].
- Advise female patients of the potential risk to a fetus.
- Advise females of reproductive potential to use effective
contraception during treatment with ODOMZO and for at least 20 months after the
last dose.
- Advise males, even those with prior vasectomy, to use
condoms, to avoid potential drug exposure in both pregnant partners and female
partners of reproductive potential during treatment with ODOMZO and for at
least 8 months after the last dose.
- Advise female patients and female partners of male
patients to contact their healthcare provider with a known or suspected
pregnancy.
- Advise females who may have been exposed to ODOMZO during
pregnancy, either directly or through seminal fluid, to contact the Novartis
Pharmaceuticals Corporation at 1-888-669-6682.
Blood Donation
Advise patients not to donate blood or blood products
while taking ODOMZO and for 20 months after stopping treatment.
Musculoskeletal Adverse Reactions
Advise patients to contact their healthcare provider
immediately for new or worsening signs or symptoms of muscle toxicity, dark
urine, decreased urine output, or the inability to urinate [see WARNINGS AND
PRECAUTIONS].
Administration Instructions
Advise patients to take ODOMZO on an empty stomach, at
least 1 hour before or 2 hours after a meal [see DOSAGE AND ADMINISTRATION].
Lactation
Advise women not to breastfeed during treatment with
ODOMZO and for up to 20 months after the last dose [see Use in Specific
Populations].
Nonclinical Toxicology
Carcinogenesis, Mutagenesis,
Impairment Of Fertility
Carcinogenicity studies with
sonidegib have not been performed.
Sonidegib was not mutagenic in
the in vitro bacterial reverse mutation (Ames) assay and was not clastogenic or
aneugenic in the in vitro human chromosome aberration assay or in vivo rat bone
marrow micronucleus assay.
Sonidegib resulted in a lack of
fertility when administered to female rats at ≥ 20 mg/kg/day
(approximately 1.3 times the recommended human dose based on body surface area
(BSA). A reduction of the number of pregnant females, an increase in the number
of early resorptions, and a decrease in the number of viable fetuses was also
noted at 2 mg/kg/day (approximately 0.12 times the recommended human dose based
on BSA). In addition, in a 6 month repeat-dose toxicology study in rats, effects
on female reproductive organs included atrophy of the uterus and ovaries at
doses of 10 mg/kg (approximately ≥ 2 times the exposure in humans at the
recommended dose of 200 mg based on AUC). No adverse effects on fertility were
noted when male rats were administered sonidegib at doses up to 20 mg/kg/day,
the highest dose tested.
Use In Specific Populations
Pregnancy
Risk Summary
Based on its mechanism of
action and data from animal reproduction studies, ODOMZO can cause fetal harm
when administered to a pregnant woman [see CLINICAL PHARMACOLOGY]. There
are no available data on the use of ODOMZO in pregnant women. In animal
reproduction studies, oral administration of sonidegib during organogenesis at
doses below the recommended human dose of 200 mg resulted in embryotoxicity,
fetotoxicity, and teratogenicity in rabbits [see Data]. Teratogenic
effects observed included severe midline defects, missing digits, and other
irreversible malformations. Advise pregnant women of the potential risk to a
fetus. Report pregnancies to Novartis Pharmaceuticals Corporation at
1-888-669-6682.
The background risk of major
birth defects and miscarriage for the indicated population is unknown; however,
the background risk in the U.S. general population of major birth defects is
2-4% and of miscarriage is 15-20% of clinically recognized pregnancies.
Data
Animal Data
Daily oral administration of
sonidegib to pregnant rabbits resulted in abortion, complete resorption of
fetuses, or severe malformations at ≥ 5 mg/kg/day (approximately 0.05
times the recommended human dose based on AUC). Teratogenic effects included
vertebral, distal limb and digit malformations, severe craniofacial
malformations, and other severe midline defects. Skeletal variations were
observed when maternal exposure to sonidegib was below the limit of detection.
Lactation
No data are available regarding
the presence of sonidegib in human milk, the effects of the drug on the breast
fed infant, or the effects of the drug on milk production. Because of the
potential for serious adverse reactions in breastfed infants from sonidegib,
advise a nursing woman not to breastfeed during treatment with ODOMZO and for
20 months after the last dose.
Females And Males Of Reproductive
Potential
Based on its mechanism of
action and animal data, ODOMZO can cause fetal harm when administered to a
pregnant woman [see Use in Specific Populations].
Pregnancy Testing
Verify the pregnancy status of
females of reproductive potential prior to initiating ODOMZO treatment.
Contraception
Females
Advise females of reproductive
potential to use effective contraception during treatment with ODOMZO and for
at least 20 months after the last dose.
Males
It is not known if sonidegib is
present in semen. Advise male patients to use condoms, even after a vasectomy,
to avoid potential drug exposure to pregnant partners and female partners of
reproductive potential during treatment with ODOMZO and for at least 8 months
after the last dose. Advise males not to donate semen during treatment with
ODOMZO and for at least 8 months after the last dose.
Infertility
Based on findings from animal
studies, female fertility may be compromised with ODOMZO [see Nonclinical
Toxicology].
Pediatric Use
The safety and effectiveness of
ODOMZO have not been established in pediatric patients.
Juvenile Animal Data
In a 5-week juvenile rat
toxicology study, effects of sonidegib were observed in bone, teeth, reproductive
tissues, and nerves at doses ≥ 10 mg/kg/day (approximately 1.2 times the
recommended human dose based on AUC). Bone findings included thinning/closure
of bone growth plate, decreased bone length and width, and hyperostosis.
Findings in teeth included missing or fractured teeth, and atrophy.
Reproductive tissue toxicity was evidenced by atrophy of testes, ovaries, and
uterus, partial development of the prostate gland and seminal vesicles, and
inflammation and aspermia of the epididymis. Nerve degeneration was also noted.
Geriatric Use
Of the 229 patients who
received ODOMZO (79 patients receiving 200 mg daily and 150 patients receiving
800 mg daily) in Study 1, 54% were 65 years and older, while 28% were 75 years
and older. No overall differences in effectiveness were observed between these
patients and younger patients. There was a higher incidence of serious adverse
events, Grade 3 and 4 adverse events, and adverse events requiring dose
interruption or discontinuation in patients ≥ 65 years compared with
younger patients; this was not attributable to an increase in any specific
adverse event.