WARNINGS
Included as part of the PRECAUTIONS section.
PRECAUTIONS
Acute Infusion Reactions
Acute infusion reactions (reported within 1 day of
infusion) may occur and include nausea, vomiting, fatigue, fever, rigor or
chills, respiratory events (dyspnea, hypoxia, and bronchospasm), syncope, hypotension,
hypertension, and tachycardia. Acute infusion reactions (reported within 1 day
of infusion) may occur and include nausea, vomiting, fatigue, fever, rigor or
chills, respiratory events (dyspnea, hypoxia, and bronchospasm), syncope,
hypotension, hypertension, and tachycardia.
In controlled clinical trials, 71.2% of patients in the
PROVENGE group developed an acute infusion reaction. The most common events
(≥ 20%) were chills, fever, and fatigue. In 95.1% of patients reporting
acute infusion reactions, the reactions were mild or moderate. Fevers and
chills generally resolved within 2 days (71.9% and 89%, respectively). In
controlled clinical trials, 71.2% of patients in the PROVENGE group developed
an acute infusion reaction. The most common events (≥ 20%) were chills,
fever, and fatigue. In 95.1% of patients reporting acute infusion reactions,
the reactions were mild or moderate. Fevers and chills generally resolved
within 2 days (71.9% and 89%, respectively).
In controlled clinical trials, severe (Grade 3) acute
infusion reactions were reported in 3.5% of patients in the PROVENGE group.
Reactions included chills, fever, fatigue, asthenia, dyspnea, hypoxia, bronchospasm,
dizziness, headache, hypertension, muscle ache, nausea, and vomiting. The
incidence of severe events was greater following the second infusion (2.1% vs.
0.8% following the first infusion), and decreased to 1.3% following the third
infusion. Some (1.2%) patients in the PROVENGE group were hospitalized within 1
day of infusion for management of acute infusion reactions. No Grade 4 or 5 acute
infusion reactions were reported in patients in the PROVENGE group. In
controlled clinical trials, severe (Grade 3) acute infusion reactions were
reported in 3.5% of patients in the PROVENGE group. Reactions included chills,
fever, fatigue, asthenia, dyspnea, hypoxia, bronchospasm, dizziness, headache,
hypertension, muscle ache, nausea, and vomiting. The incidence of severe events
was greater following the second infusion (2.1% vs. 0.8% following the first
infusion), and decreased to 1.3% following the third infusion. Some (1.2%)
patients in the PROVENGE group were hospitalized within 1 day of infusion for
management of acute infusion reactions. No Grade 4 or 5 acute infusion
reactions were reported in patients in the PROVENGE group.
Closely monitor patients with cardiac or pulmonary
conditions. In the event of an acute infusion reaction, decrease the infusion
rate or stop the infusion, depending on the severity of the reaction. Administer
appropriate medical treatment as needed. [ ] Closely monitor patients with
cardiac or pulmonary conditions. In the event of an acute infusion reaction,
decrease the infusion rate or stop the infusion, depending on the severity of
the reaction. Administer appropriate medical treatment as needed. [ See
DOSAGE AND ADMINISTRATION]
Thromboembolic Events
Thromboembolic events, including deep venous thrombosis
and pulmonary embolism, can occur following infusion of PROVENGE. The clinical
significance and causal relationship are uncertain. Most patients had multiple
risk factors for these events. PROVENGE should be used with caution in patients
with risk factors for thromboembolic events. Thromboembolic events, including
deep venous thrombosis and pulmonary embolism, can occur following infusion of
PROVENGE. The clinical significance and causal relationship are uncertain. Most
patients had multiple risk factors for these events. PROVENGE should be used
with caution in patients with risk factors for thromboembolic events.
Vascular Disorders
In controlled clinical trials, cerebrovascular events
(hemorrhagic and ischemic strokes) were observed in 3.5% of patients in the
PROVENGE group compared with 2.6% of patients in the control group. In the
postmarketing setting, cerebrovascular events, including transient ischemic
attacks, have been observed following infusion of Provenge. The clinical
significance and causal relationship are uncertain. Most patients had multiple
risk factors for these events. Cerebrovascular disease: In controlled clinical
trials, cerebrovascular events (hemorrhagic and ischemic strokes) were observed
in 3.5% of patients in the PROVENGE group compared with 2.6% of patients in the
control group. In the postmarketing setting, cerebrovascular events, including
transient ischemic attacks, have been observed following infusion of Provenge.
The clinical significance and causal relationship are uncertain. Most patients
had multiple risk factors for these events.
In controlled clinical trials, myocardial infarctions were
observed in 0.8% of patients in the PROVENGE group compared with 0.3% of
patients in the control group. In the postmarketing setting, myocardial
infarctions have been observed following infusion of Provenge. The clinical
significance and causal relationship are uncertain. Most patients had multiple
risk factors for these events. Cardiovascular disorders: In controlled clinical
trials, myocardial infarctions were observed in 0.8% of patients in the
PROVENGE group compared with 0.3% of patients in the control group. In the postmarketing
setting, myocardial infarctions have been observed following infusion of
Provenge. The clinical significance and causal relationship are uncertain. Most
patients had multiple risk factors for these events.
Handling Precautions For Control Of Infectious Disease
PROVENGE is not tested for transmissible infectious
diseases. Therefore, patient leukapheresis material and PROVENGE may carry the
risk of transmitting infectious diseases to health care professionals handling
the product. Accordingly, health care professionals should employ universal precautions
when handling leukapheresis material or PROVENGE.
Concomitant Chemotherapy Or Immunosuppressive Therapy
Use of either chemotherapy or immunosuppressive agents
(such as systemic corticosteroids) given concurrently with the leukapheresis
procedure or PROVENGE has not been studied. PROVENGE is designed to stimulate
the immune system, and concurrent use of immune-suppressive agents may alter the
efficacy and/or safety of PROVENGE. Therefore, evaluate patients carefully to
determine whether it is medically appropriate to reduce or discontinue
immunosuppressive agents prior to treatment with PROVENGE.
Product Safety Testing
PROVENGE is released for infusion based on the microbial
and sterility results from several tests: microbial contamination determination
by Gram stain, endotoxin content, and in-process sterility with a 2-day
incubation to determine absence of microbial growth. The final (7-day
incubation) sterility test results are not available at the time of infusion.
If the sterility results become positive for microbial contamination after
PROVENGE has been approved for infusion, Dendreon will notify the treating physician.
Dendreon will attempt to identify the microorganism, perform antibiotic
sensitivity testing on recovered microorganisms, and communicate the results to
the treating physician. Dendreon may request additional information from the
physician in order to determine the source of contamination.
Patient Counseling Information
- Advise the patient to read the FDA-approved patient
labeling ( PATIENT INFORMATION).
- Inform the patient or caregiver about the following:
- The recommended course of therapy for PROVENGE is 3
complete doses. Each infusion of PROVENGE is preceded by a leukapheresis
procedure approximately 3 days prior. It is important to maintain all scheduled
appointments and arrive at each appointment on time because the leukapheresis
and infusions must be appropriately spaced and the PROVENGE expiration time
must not be exceeded.
- If the patient is unable to receive an infusion of
PROVENGE, the patient will need to undergo an additional leukapheresis
procedure if the treatment is to be continued.
- Counsel the patient on the importance of adhering to
preparation instructions for the leukapheresis procedure, the possible side
effects of leukapheresis, and post-procedure care.
- If the patient does not have adequate peripheral venous
access to accommodate the leukapheresis procedure and infusion of PROVENGE,
inform the patient about the need for a central venous catheter. Counsel the
patient on the importance of catheter care. Instruct the patient to tell their doctor
if they are experiencing fevers or any swelling or redness around the catheter
site, because these symptoms could be signs of an infected catheter.
- Report signs and symptoms of acute infusion reactions
such as fever, chills, fatigue, breathing problems, dizziness, high blood
pressure, low blood pressure, lightheadedness, nausea, vomiting, headache, or
muscle aches.
- Report any symptoms suggestive of a cardiac arrhythmia.
- Report any symptoms suggestive of cardiac ischemia.
- Report any symptoms suggestive of cerebral ischemia.
- Report any symptoms suggestive of deep vein thrombosis.
- Report any symptoms suggestive of pulmonary embolism.
- Inform their doctor if they are taking immunosuppressive
agents.
For more information, please call the toll-free number:
1-877-336-3736.
Nonclinical Toxicology
No Information provided
Use In Specific Populations
Geriatric
In controlled clinical trials, 72.9% of patients (438 of
601) in the PROVENGE group were ≥ 65 years of age. There were no apparent
differences in the safety of PROVENGE between patients ≥ 65 years of age
and younger patients.
In a survival analysis of the controlled clinical trials
of PROVENGE in metastatic castrate-resistant prostate cancer, 78.3% of
randomized patients (382 of 488) were ≥ 65 years of age. The median survival
of patients in the PROVENGE group ≥ 65 years of age was 23.4 months (95%
confidence interval 22.0, 27.1), compared with 17.3 months in the control group
(95% confidence interval: 13.5, 21.5).
Race
In controlled clinical trials, 90.6% of patients were
Caucasian, 5.8% were African American, and 3.7% were “Other”. Due to the low
numbers of non-Caucasian patients in the trials, no conclusions can be made
regarding the safety or efficacy of PROVENGE by race.