Brigatinib (ALUNBRIG)

Non-small cell lung cancer ((ALK)-positive), advanced or metastatic

Non-small cell lung cancer ((ALK)-positive), advanced or metastatic

• 90 mg once daily for the first 7 days; then if tolerated; increase to 180 mg once daily continuously until disease progression or unacceptable toxicity

Available as 30 mg, 90 mg, and 180 mg film-coated tablets. Tablets contain lactose. Tablets should NOT be crushed or broken. Store at room temperature.

Multi-targeted TKI (tyrosine kinase inhibitor) which includes action as a Anaplastic Lymphoma Kinase(ALK) Inhibitor and a ROS-1 inhibitor

Take with or without food

If a dose is missed, patients should be instructed not to take the missed dose but to resume with the next scheduled dose.

Common: Nausea, Diarrhea, Vomiting, Fatigue, Amylase increase, ALT increase, AST increase, Creatinine phosphokinase increase, Lipase increase, Hyperglycemia, Headache, Rash, Hypertension.

‍Less Common: Bradycardia, Visual disturbances, Pneumonia, PR prolongation, QT prolongation, Cerebrovascular event, Interstitial lung disease/pneumonitis, Photosensitivity reaction, Pulmonary embolism, Multiple organ dysfunction syndrome.

The adverse effects listed above are not exhaustive. Please refer to the relevant product monograph for full details.

Baseline before treatment: creatinine, alkaline phosphatase, ALT, total bilirubin, LDH, creatine phosphokinase, lipase, fasting glucose, heart rate, blood pressure, CBC & differential, sodium, potassium, magnesium, CEA, C-reactive protein and albumin (optional, and results do not have to be available to proceed with first treatment).

During treatment: alkaline phosphatase, ALT, total bilirubin, LDH every 2 weeks for 3 cycles, alkaline phosphatase, ALT, total bilirubin, LDH, creatine phosphokinase, lipase, heart rate, blood pressure at each visit.

If clinically indicated: CBC & differential, sodium, potassium, magnesium, CEA, fasting glucose, creatinine; chest X-ray and scans to monitor index lesions; chest radiograph for monitoring of dyspnea to rule out development of pneumonitis.

• Avoid grapefruit, grapefruit juice, Seville oranges, or Seville orange juice.
• This drug can impact or be impacted by metabolic enzymes for absorption and excretion. Many drugs can also affect or be affected by these enzymes, so please consult with pharmacy to assess for interactions.
• Current drug interaction databases should be consulted for more information.

• Avoid in pregnancy and lactation.
• Photosensitivity- Patients taking Brigatinib have a potential for photosensitivity upon sun exposure. Patients should wear protective clothing and/or sunblock during treatment and for five days after discontinuation of treatment.
• Hypertension is common. Monitor blood pressure closely and manage with antihypertensives and dose hold/reductions.
• Creatine phosphokinase elevations are common and should be monitored regularly. Patients should be advised to report any unexplained muscle pain, tenderness, or weakness.

BC Cancer. BC Cancer Drug Manual. Brigatinib. Vancouver, British Columbia: BC Cancer Agency. Available at: http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Brigatinib_monograph.pdf. Updated September 1, 2022. Accessed January 22, 2024.

Lexicomp. Brigatinib Monograph. In: Lexi-Drugs. Hudson, Ohio: Lexi-Comp, Inc. Available at: https://online-lexi-com.qe2a-proxy.mun.ca/lco/action/doc/retrieve/docid/patch_f/6479790?cesid=4MSx0OzYHvN&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dbrigatinib%26t%3Dname%26acs%3Dtrue%26acq%3Dbrigatinib. Updated January 24, 2024. Accessed January 28, 2024.

Cancer Care Ontario. Brigatinib Monograph. Drug Formulary. Toronto, Ontario: Cancer Care Ontario. Available at: https://www.cancercareontario.ca/en/drugformulary/drugs/monograph/57261 . Updated June 2022. Accessed January 22, 2024.Takeda Canada Inc. ALUNBRIG® product monograph. Toronto, Ontario; Updated Mar 2 2021