In combination with fulvestrant for patients with HR+/HER2− aBC or mBC with PIK3CA, AKT1, or PTEN alterations following progression on or after ET ± CDK4/6i1
Adverse Reactions
Adverse reactions were mostly Grade 1 or 21*
ARs in ≥10% (all Grades) of patients
| Adverse reactions | TRUQAP + fulvestrant (n=155) | Placebo + fulvestrant (n=133) | ||
|---|---|---|---|---|
| All Grades (%) | Grade 3-4 (%) | All Grades (%) | Grade 3-4 (%) | |
| Gastrointestinal disorders | ||||
| Diarrhea | 77 | 12 | 19 | 0.8 |
| Nausea | 35 | 1.3 | 14 | 0.8 |
| Stomatitis† | 25 | 1.9 | 5 | 0 |
| Vomiting | 21 | 1.9 | 7 | 0.8 |
| Skin and subcutaneous tissue disorders | ||||
| Cutaneous adverse reactions‡ | 56 | 15 | 16 | 0.8 |
| General disorders and administration site conditions | ||||
| Fatigue† | 38 | 1.9 | 27 | 1.5 |
| Metabolism and nutrition disorders | ||||
| Decreased appetite | 17 | 0 | 8 | 0.8 |
| Nervous system disorders | ||||
| Headache† | 17 | 0 | 13 | 0.8 |
| Infections and infestations | ||||
| Urinary tract infections† | 14 | 0.6 | 5 | 0 |
| Renal and urinary disorders | ||||
| Renal injury§ | 11 | 2.6 | 1.5 | 0.8 |
Other clinically relevant ARs reported in less than 10% of patients in the TRUQAP + fulvestrant group included1:
- Anemia, hypersensitivity (including anaphylactic reaction), dysgeusia, dyspepsia, pneumonia, and pyrexia
In CAPItello-291, primary prophylaxis for diarrhea, rash, or hyperglycemia was not administered prior to initiation of TRUQAP + fulvestrant2
CAPItello-291 allowed for patients with HbA1C <8% and diabetes not requiring insulin1
Laboratory Abnormalities
Laboratory abnormalities (≥10% of patients) that worsened from baseline1
| Laboratory abnormality | TRUQAP + fulvestrant* | Placebo + fulvestrant† | ||
|---|---|---|---|---|
| All Grades (%) | Grade 3-4 (%) | All Grades (%) | Grade 3-4 (%) | |
| Glucose metabolism | ||||
| Increased random glucose | 58 | 9 | 17 | 0 |
| Increased fasting glucose | 37 | 0.6 | 29 | 0 |
| Hematology | ||||
| Decreased lymphocytes | 49 | 11 | 14 | 2.3 |
| Decreased hemoglobin | 47 | 2 | 22 | 2.3 |
| Decreased leukocytes | 35 | 0.6 | 23 | 0 |
| Decreased neutrophils | 25 | 1.9 | 16 | 0.8 |
| Decreased platelets | 12 | 1.9 | 6 | 0.8 |
| Other | ||||
| Increased triglycerides | 30 | 0.7 | 22 | 0.9 |
| Increased alanine aminotransferase | 23 | 2.6 | 13 | 0 |
| Electrolytes/Renal | ||||
| Decreased corrected calcium | 19 | 0.6 | 8 | 0 |
| Increased creatinine | 19 | 1.3 | 4.6 | 0.8 |
| Decreased potassium | 17 | 4.5 | 8 | 0 |
Rates of Dose Adjustment
Rates of dose discontinuation/reduction due to ARs1
TRUQAP discontinuation due to ARs occurred in 10% of patients
- The most frequent (≥2%) AR leading to discontinuation was cutaneous adverse reactions (6%)
- The discontinuation rates for hyperglycemia and diarrhea were 0.6% and 2%, respectively
Dose reductions due to ARs occurred in 21% of patients receiving TRUQAP + fulvestrant
- The most frequent (≥2%) ARs leading to dose reduction were diarrhea and cutaneous adverse reactions (8% each)
Had a low rate of discontinuation due to ARs (10%)
NCCN
CATEGORY 1 PREFERRED
NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Breast Cancer recommends capivasertib (TRUQAP®) + fulvestrant as a Category 1 Preferred treatment option for HR+/HER2− aBC or mBC with at least one or more PIK3CA or AKT1 activating mutations or PTEN alterations following progression after a prior line of ET + CDK4/6i3
Explore efficacy
See the TRUQAP
dosing schedule
IMPORTANT SAFETY INFORMATION ABOUT TRUQAP® (capivasertib) tablets
TRUQAP is contraindicated in patients with severe hypersensitivity to TRUQAP or any of its components.
Hyperglycemia
TRUQAP can cause severe hyperglycemia, including diabetic ketoacidosis and fatal outcomes
Metastatic HR-Positive, HER2-Negative Breast Cancer
- In CAPItello-291, increased fasting
glucose (FG) from baseline occurred in 37% of patients treated
with TRUQAP, including 11% of patients with Grade 2 (FG >160 to 250 mg/dL), 2% with Grade 3 (FG >250 to 500 mg/dL), and 1.1% with Grade 4 (FG >500 mg/dL) events - The median time to first occurrence of hyperglycemia was 15 days (range: 1 to 367). Dose reduction for hyperglycemia was required in 0.6% of patients and permanent discontinuation was required in 0.6% of patients. Diabetic metabolic decompensation occurred in 0.6% of patients, including diabetic ketoacidosis in 0.3%
- In the study, 12% (43/355) of patients who received TRUQAP had an anti-hyperglycemic medication regimen either initiated or changed, including treatment with insulin in 4.8% (17/355) of patients
PTEN-Deficient Metastatic Androgen Pathway Modulation-Naïve or -Sensitive Prostate Cancer
- In CAPItello-281, increased fasting glucose (FG) from baseline occurred in 69% of patients treated with TRUQAP, including 25% of patients with Grade 2 (FG >160 to 250 mg/dL), 12% with Grade 3 (FG >250 to 500 mg/dL), and 1.2% of patients with Grade 4 (FG >500 mg/dL) events
- The median time to first occurrence of hyperglycemia was 71 days (range: 1 to 1454). Dose reduction for hyperglycemia was required in 8.7% of patients and permanent discontinuation was required in 2.4% of patients. Diabetic ketoacidosis occurred in 1.2% of patients
- In the study, 41% (204/503) of patients who received TRUQAP had an anti-hyperglycemic medication regimen either initiated or changed, including treatment with insulin in 16% (81/503) of patients
The safety of TRUQAP has not been established in patients with Type 1 diabetes or Type 2 diabetes that is uncontrolled or requiring insulin at baseline as these patients were excluded from clinical studies. Before initiating treatment with TRUQAP, test fasting glucose levels (FPG or FBG), HbA1C levels, and optimize fasting glucose. After initiating treatment with TRUQAP, monitor or self-monitor FG levels on Day 3 or 4 of the dosing week during weeks 1, 2, 4, 6, and 8; then monthly while on treatment with TRUQAP; and as clinically indicated. Monitor HbA1C levels every 3 months during treatment with TRUQAP and as clinically indicated. Patients with a history of well-controlled Type 2 diabetes mellitus may require intensified anti-hyperglycemic treatment and close monitoring of FG levels.
For patients who experience hyperglycemia during treatment with TRUQAP, monitor FG at least twice weekly, on days on and off TRUQAP, until FG decreases to baseline levels. During treatment with anti-diabetic medications, monitor FG at least once a week for 2 months, followed by once every 2 weeks, or as clinically indicated. Consider consultation with a healthcare practitioner with expertise in the treatment of hyperglycemia and initiation of FG monitoring at home for patients who have risk factors for hyperglycemia or who experience hyperglycemia. Advise patients on the signs and symptoms of hyperglycemia and counsel patients on lifestyle changes.
Withhold TRUQAP immediately when ketoacidosis is suspected. If ketoacidosis is confirmed, permanently discontinue TRUQAP. Withhold TRUQAP in clinical situations known to increase the risk of severe hyperglycemia or ketoacidosis (eg, suspected serious infection or acute illness). Based on the severity of hyperglycemia, withhold, reduce dose, or permanently discontinue TRUQAP.
Diarrhea
TRUQAP can cause severe diarrhea associated with dehydration
Metastatic HR-Positive, HER2-Negative Breast Cancer
- In CAPItello-291, diarrhea occurred in 72% of patients. Grade 3 or 4 diarrhea occurred in 9% of patients
- The median time to first
occurrence was 8 days (range: 1 to 519). In the study, dose reductions were required in 8% of patients, and 2% of patients permanently discontinued TRUQAP due to diarrhea. In patients with Grade ≥2 diarrhea (n=93) with at least 1 grade improvement (n=89), median time to improvement from the first event was 4 days (range: 1 to 154) - In the 257 patients with diarrhea, 59% required anti-diarrheal medications to manage symptoms
PTEN-Deficient Metastatic Androgen Pathway Modulation-Naïve or -Sensitive Prostate Cancer
- In CAPItello‑281, diarrhea of any grade occurred in 264 (52%) patients. Grade 3 occurred in 31 (6%) patients and Grade 4 occurred in 1 (0.2%) patient
- The median time to first
occurrence was 12 days (range: 3 to 48). In the study, dose reductions were required in 26 (5%) patients and 6 (1.2%) patients discontinued TRUQAP due to diarrhea - In the 264 patients with diarrhea, anti-diarrheal medication was required in 64% (170/264) of patients to manage diarrhea symptoms
Monitor patients for signs and symptoms of diarrhea. Advise patients to increase oral fluids and start anti-diarrheal treatment at the first sign of diarrhea while taking TRUQAP. Withhold, reduce dose, or permanently discontinue TRUQAP based on severity.
Cutaneous Adverse Reactions
TRUQAP can cause cutaneous adverse reactions, which can be severe, including erythema multiforme (EM), palmar-plantar erythrodysesthesia (PPE), and drug reaction with eosinophilia and systemic symptoms (DRESS).
Metastatic HR-Positive, HER2-Negative Breast Cancer
- In CAPItello-291, cutaneous adverse reactions occurred in 58% of patients. Grade 3 or 4 cutaneous adverse reactions occurred in 17% of patients receiving TRUQAP. EM occurred in 1.7% of patients, and DRESS occurred in 0.3% of patients
- The median time to onset of cutaneous adverse reactions was 13
days (range: 1 to 575 days). Dose reduction was required in 7% of patients and 7% of patients permanently discontinued TRUQAP due to cutaneous adverse reactions - Among the 204 patients with cutaneous adverse reactions, 44% (90/204) required corticosteroid treatment. Of these, 37% (76/204) were treated with topical corticosteroids and 19% (39/204) with systemic corticosteroids. In patients with Grade ≥2 cutaneous adverse reaction (n=116) with at least 1 grade improvement (n=104), median time to improvement from the first event was 12 days (range: 2 to 544)
PTEN-Deficient Metastatic Androgen Pathway Modulation-Naïve or -Sensitive Prostate Cancer
- In CAPItello-281, cutaneous adverse reactions occurred in 53% of patients. Grade 3 cutaneous adverse reactions occurred in 84 (17%) patients and Grade 4 occurred in 1 (0.2%) patients
- The median time to onset of rash was 13 days (range: 11 to 63 days). In the study, dose reduction was required in 58 (12%) patients and 38 (8%) patients discontinued TRUQAP due to rash
- Among the 265 patients with cutaneous adverse reactions, 80% (212/265) required treatment and 91% (242/265) recovered in the study. Of these, 54% (115/212) were treated with topical corticosteroids and 25% (54/212) with systemic corticosteroids
Monitor patients for signs and symptoms of cutaneous adverse reactions. Early consultation with a dermatologist is recommended. Withhold, reduce dose, or permanently discontinue TRUQAP based on severity.
Embryo-Fetal Toxicity
Based on findings from animals and mechanism of action, TRUQAP can cause fetal harm when administered to a pregnant woman. Advise pregnant women and females of reproductive potential of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with TRUQAP and for
1 month after the last dose.
Advise male patients with female partners of reproductive potential to use effective contraception during treatment with TRUQAP and for 4 months after the last dose.
TRUQAP is used in combination with fulvestrant or abiraterone. Refer to the full Prescribing Information of fulvestrant or abiraterone for pregnancy and contraception information.
ADVERSE REACTIONS
Metastatic HR-Positive, HER2-Negative Breast Cancer
- Among the 355 patients who received TRUQAP in CAPItello-291, the most common (≥20%) adverse reactions, including laboratory abnormalities, were diarrhea (72%), cutaneous adverse reactions (58%), increased random glucose (57%), decreased lymphocytes (47%), decreased hemoglobin (45%), increased fasting glucose (37%), nausea and fatigue (35% each), decreased leukocytes (32%), increased triglycerides (27%), decreased neutrophils (23%), increased creatinine (22%), vomiting (21%), and stomatitis (20%)
- In the 155 patients with PIK3CA/AKT1/PTEN alterations treated with TRUQAP + fulvestrant, dose reductions due to adverse reactions were reported in 21% of patients. Permanent TRUQAP discontinuation due to an adverse reaction occurred in 10% of patients. Dose interruptions of TRUQAP occurred in 39% of patients
PTEN-Deficient Metastatic Androgen Pathway Modulation-Naïve or -Sensitive Prostate Cancer
- Among the 503 patients who received TRUQAP in CAPItello-281, the most common (≥20%) adverse reactions including laboratory abnormalities were increased fasting glucose (70%), decreased hemoglobin (61%), decreased lymphocytes (58%), cutaneous adverse reactions (53%), diarrhea (53%), decreased potassium (51%), increased creatinine (49%), increased non-fasting glucose (49%), increased alanine aminotransferase (38%), increased triglycerides (37%), increased aspartate aminotransferase (36%), decreased sodium (30%), and fatigue (26%)
- In the 503 patients treated with TRUQAP + abiraterone and prednisone, dose reductions due to adverse reactions were reported in 32% of patients. Permanent TRUQAP discontinuation due to an adverse reaction occurred in 20% of patients. Dose interruptions of TRUQAP occurred in 65% of patients
DRUG INTERACTIONS
Strong CYP3A Inhibitors: Avoid concomitant use with a strong CYP3A inhibitor. If concomitant use cannot be avoided, reduce the dose of TRUQAP and monitor patients for adverse reactions.
Moderate CYP3A Inhibitors: When concomitantly used with a moderate CYP3A inhibitor, reduce the dose of TRUQAP and monitor patients for adverse reactions.
Strong or Moderate CYP3A Inducers: Avoid concomitant use of TRUQAP with strong or moderate CYP3A inducers.
INDICATIONS AND USAGE
- TRUQAP in combination with fulvestrant is indicated for the treatment of adult patients with hormone receptor (HR)‑positive, human epidermal growth factor receptor 2 (HER2)-negative locally advanced or metastatic breast cancer with one or more PIK3CA/AKT1/PTEN alteration as detected by an FDA-authorized test following progression on at least one endocrine-based regimen in the metastatic setting or recurrence on or within 12 months of completing adjuvant therapy
- TRUQAP in combination with abiraterone and prednisone is indicated for the treatment of adult patients with metastatic androgen pathway modulation-naïve or -sensitive (mAPMN/S) prostate cancer that is PTEN-deficient as detected by an FDA-authorized test
Please see full Prescribing Information, including Patient Information for TRUQAP.
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INDICATIONS AND USAGE
- TRUQAP in combination with fulvestrant is indicated for the treatment of adult patients with hormone receptor (HR)‑positive, human epidermal growth factor receptor 2 (HER2)-negative locally advanced or metastatic breast cancer with one or more PIK3CA/AKT1/PTEN alteration as detected by an FDA-authorized test following progression on at least one endocrine-based regimen in the metastatic setting or recurrence on or within 12 months of completing adjuvant therapy
- TRUQAP in combination with abiraterone and prednisone is indicated for the treatment of adult patients with metastatic androgen pathway modulation-naïve or -sensitive (mAPMN/S) prostate cancer that is PTEN-deficient as detected by an FDA-authorized test
