Dosing
Dose Modifications

Recommended Dose Reductions for Adverse Reactions

  • Once reduced for adverse reactions, do not subsequently increase the dose of ALUNBRIG® (brigatinib)
  • Permanently discontinue ALUNBRIG if patients are unable to tolerate the 60-mg once-daily dose
  • Avoid concomitant use of strong CYP3A inhibitors during treatment with ALUNBRIG
    • If concomitant use cannot be avoided, reduce the ALUNBRIG once-daily dose by approximately 50% (ie, from 180 mg to 90 mg, or from 90 mg to 60 mg)
    • After discontinuation of a strong CYP3A inhibitor, resume the ALUNBRIG dose that was tolerated prior to initiating the strong CYP3A inhibitor

Recommended Dose Modifications for Adverse Reactions

ADVERSE REACTION AND SEVERITYa DOSE MODIFICATION
Interstitial Lung Disease (ILD)/Pneumonitis
Grade 1
  • If new pulmonary symptoms occur during the first 7 days of treatment, withhold ALUNBRIG until recovery to baseline, then resume at same dose and do not escalate to 180 mg if ILD/pneumonitis is suspected
  • If new pulmonary symptoms occur after the first 7 days of treatment, withhold ALUNBRIG until recovery to baseline, then resume at same dose
  • If ILD/pneumonitis recurs, permanently discontinue ALUNBRIG
Interstitial Lung Disease (ILD)/Pneumonitis
Grade 2
  • If new pulmonary symptoms occur during the first 7 days of treatment, withhold ALUNBRIG until recovery to baseline. Resume at next lower dose and do not dose escalate if ILD/pneumonitis is suspected
  • If new pulmonary symptoms occur after the first 7 days of treatment, withhold ALUNBRIG until recovery to baseline. If ILD/pneumonitis is suspected, resume at next lower dose; otherwise, resume at same dose
  • If ILD/pneumonitis recurs, permanently discontinue ALUNBRIG
Interstitial Lung Disease (ILD)/Pneumonitis
Grade 3 or 4
  • Permanently discontinue ALUNBRIG for ILD/pneumonitis
Hypertension
Grade 3 hypertension (SBP ≥160 mmHg or DBP ≥100 mmHg, medical intervention indicated, more than one antihypertensive drug, or more intensive therapy than previously used indicated)
  • Withhold ALUNBRIG until hypertension has recovered to ≤ Grade 1 (SBP <140 mmHg and DBP <90 mmHg), then resume ALUNBRIG at the next lower dose
  • Recurrence: withhold ALUNBRIG until recovery to ≤ Grade 1, and resume at next lower dose or permanently discontinue treatment
Hypertension
Grade 4 hypertension (life-threatening consequences, urgent intervention indicated)
  • Withhold ALUNBRIG until recovery to ≤ Grade 1 and resume at next lower dose or permanently discontinue treatment
  • Recurrence: permanently discontinue ALUNBRIG for recurrence of Grade 4 hypertension
Bradycardia (HR <60 bpm)
Symptomatic bradycardia
  • Withhold ALUNBRIG until recovery to asymptomatic bradycardia or to a resting heart rate of 60 bpm or above
  • If a concomitant medication known to cause bradycardia is identified and discontinued or dose-adjusted, resume ALUNBRIG at same dose upon recovery to asymptomatic bradycardia or to a resting heart rate of 60 bpm or above
  • If no concomitant medication known to cause bradycardia is identified, or if contributing concomitant medications are not discontinued or dose adjusted, resume ALUNBRIG at the next lower dose level upon recovery to asymptomatic bradycardia or to a resting heart rate of 60 bpm or above
Bradycardia (HR <60 bpm)
Bradycardia with life-threatening consequences, urgent intervention indicated
  • Permanently discontinue ALUNBRIG, if no contributing concomitant medication is identified
  • If contributing concomitant medication is identified and discontinued or dose-adjusted, resume ALUNBRIG at next lower dose upon recovery to asymptomatic bradycardia or to a resting heart rate of 60 bpm or above, with frequent monitoring as clinically indicated
  • Recurrence: permanently discontinue ALUNBRIG
Visual Disturbance
Grade 2 or 3
  • Withhold ALUNBRIG until recovery to Grade 1 or baseline, then resume at the next lower dose
Visual Disturbance
Grade 4
  • Permanently discontinue ALUNBRIG
Creatine Phosphokinase (CPK) Elevation
Grade 3 elevation of CPK (>5.0 X ULN)
  • Withhold ALUNBRIG until recovery to ≤ Grade 1 (≤2.5 X ULN) or to baseline, then resume ALUNBRIG at same dose
Creatine Phosphokinase (CPK) Elevation
Grade 4 elevation of CPK (>10.0 X ULN)
OR recurrence of Grade 3 elevation
  • Withhold ALUNBRIG until recovery to ≤ Grade 1 (≤2.5 X ULN) or to baseline, then resume ALUNBRIG at next lower dose
Lipase/Amylase Elevation
Grade 3 of lipase or amylase elevation (>2.0 X ULN)
  • Withhold ALUNBRIG until recovery to ≤ Grade 1 (≤1.5 X ULN) or to baseline, then resume ALUNBRIG at same dose
Lipase/Amylase Elevation
Grade 4 lipase or amylase elevation (>5.0 X ULN)
OR recurrence of Grade 3
  • Withhold ALUNBRIG until recovery to ≤ Grade 1 (≤1.5 X ULN) or to baseline, then resume ALUNBRIG at next lower dose
Hyperglycemia
Grade 3 (>250 mg/dL or 13.9 mmol/L) or greater
  • If adequate hyperglycemic control cannot be achieved with optimal medical management, withhold ALUNBRIG until adequate hyperglycemic control is achieved and consider reduction to the next dose or permanently discontinue ALUNBRIG
Other
Grade 3
  • Withhold ALUNBRIG until recovery to baseline, then resume at same dose
  • Recurrence: withhold ALUNBRIG until recovery to baseline, then resume at the next lower dose or discontinue ALUNBRIG
Other
Grade 4
  • First occurrence: either withhold ALUNBRIG until recovery to baseline and resume at the next lower dose or permanently discontinue
  • Permanently discontinue ALUNBRIG for recurrence

bpm, beats per minute; DBP, diastolic blood pressure; HR, heart rate; SBP, systolic blood pressure; ULN, upper limit of normal.

aPer National Cancer Institute Common Terminology Criteria for Adverse Events. Version 4.0 (NCI CTCAE v4).

You are now leaving ALUNBRIG.com, the official site for ALUNBRIG® (brigatinib) and entering one that is not owned or controlled by Takeda Oncology.

Takeda Oncology makes no representation as to the accuracy of the information contained on sites we do not own or control. Takeda Oncology does not recommend and does not endorse the content on any third-party websites. Your use of third-party websites is at your own risk and subject to the terms and conditions of use for such sites.

Cancel Continue >
Close

You are now leaving ALUNBRIG.com, the official site for ALUNBRIG® (brigatinib) and entering one that is not owned or controlled by Takeda Oncology.

This link will take you to the corporate ARIAD Pharmaceuticals, Inc. website.

Cancel Continue >
Close

You are now leaving ALUNBRIG.com, the official site for ALUNBRIG® (brigatinib).

This link will take you to another Takeda Oncology website.

Cancel Continue >
Close

The site you are about to enter is intended for US healthcare professionals only.

Please confirm that you are a US healthcare professional.

Yes, I confirm that I am a US healthcare professional Cancel
Close