TRODELVY Powder for solution for infusion Ref.[28090] Active ingredients: Sacituzumab govitecan

Trodelvy must only be prescribed and administered to patients by healthcare professionals experienced in the use of anti-cancer therapies and administered in an environment where full resuscitation facilities are available.

Posology

The recommended dose of sacituzumab govitecan is 10 mg/kg body weight administered as an intravenous infusion once weekly on Day 1 and Day 8 of 21-day treatment cycles. Treatment should be continued until disease progression or unacceptable toxicity.

Prevention treatment

Prior to each dose of sacituzumab govitecan, treatment for prevention of infusion-related reactions and prevention of chemotherapy-induced nausea and vomiting (CINV) is recommended (see section 4.4).

Dose modifications for infusion-related reactions

The infusion rate of sacituzumab govitecan should be slowed down or infusion interrupted if the patient develops an infusion-related reaction. Sacituzumab govitecan should be permanently discontinued if life-threatening infusion-related reactions occur (see section 4.4).

Dose modifications for adverse reactions

Dose modifications to manage adverse reactions of sacituzumab govitecan are described in Table 1. The sacituzumab govitecan dose should not be re-escalated after a dose reduction for adverse reactions has been made.

Table 1. Recommended dose modifications for adverse reactions:

Special populations

Elderly

No dose adjustment is required in patients ≥65 years old. Data from sacituzumab govitecan in patients ≥75 years are limited.

Hepatic impairment

No adjustment to the starting dose is required when administering sacituzumab govitecan to patients with mild hepatic impairment (bilirubin ≤1.5 upper limit of normal [ULN] and aspartate aminotransferase [AST]/alanine aminotransferase [ALT] <3 ULN).

The safety of sacituzumab govitecan in patients with moderate or severe hepatic impairment has not been established. Sacituzumab govitecan has not been studied in patients with serum bilirubin >1.5 ULN, or AST or ALT >3 ULN in patients without liver metastases, or AST or ALT >5 ULN, in patients with liver metastases. The use of sacituzumab govitecan should be avoided in these patients.

Renal impairment

No adjustment to the starting dose is required when administering sacituzumab govitecan to patients with mild renal impairment. Sacituzumab govitecan has not been studied in patients with moderate renal impairment, severe renal impairment or end-stage renal disease (Creatinine Clearance [CrCl] ≤15 mL/min).

Paediatric population

The safety and efficacy of sacituzumab govitecan in children aged 0 to 18 years have not been established. No data are available.

Method of administration

Sacituzumab govitecan is for intravenous use only. It must be administered as an intravenous infusion, not as an intravenous push or bolus.

First infusion: the infusion should be administered over a period of 3 hours.

Subsequent infusions: the infusion should be administered over a period of 1 to 2 hours if prior infusions were tolerated.

Patients have to be observed during each infusion and for at least 30 minutes after each infusion for signs or symptoms of infusion-related reactions (see section 4.4).

For instructions on reconstitution of the medicinal product before administration, see section 6.6.

In clinical studies, doses of up to 18 mg/kg (approximately 1.8 times the maximum recommended dose of 10 mg/kg body weight) led to a higher incidence of severe neutropenia.

In case of overdose, patients should be closely monitored for signs or symptoms of adverse reactions, in particular severe neutropenia, and appropriate treatment instituted.

Unopened vial:

3 years.

After reconstitution:

The reconstituted solution should be used immediately to prepare the diluted solution for infusion. If not used immediately, the infusion bag containing diluted solution can be stored in a refrigerator (2°C to 8°C) for up to 24 hours protected from light.

Store in a refrigerator (2°C-8°C).

Do not freeze.

Keep the vial in the outer carton in order to protect from light.

For storage conditions after reconstitution and dilution of the medicinal product, see section 6.3.

Type I colourless, clear glass 50 mL vial, with an elastomeric butyl stopper and sealed with an aluminum flip-off overseal containing 200 mg of sacituzumab govitecan.

Each pack contains one vial.

Trodelvy is a cytotoxic medicinal product. Applicable special handling and disposal procedures have to be followed.

Reconstitution:

• Calculate the required dose (mg) of Trodelvy based on the patient’s body weight at the beginning of each treatment cycle (or more frequently if the patient’s body weight changed by more than 10% since the previous administration).
• Allow the required number of vials to warm to room temperature (20°C to 25°C).
• Using a sterile syringe, slowly inject 20 mL of sodium chloride 9 mg/mL (0.9%) solution for injection into each vial. The resulting concentration will be 10 mg/mL.
• Gently swirl vials and allow to dissolve for up to 15 minutes. Do not shake. The product should be inspected visually for particulate matter and discoloration prior to administration. The solution should be free of visible particulates, clear and yellow. Do not use the reconstituted solution if it is cloudy or discoloured.
• Use immediately to prepare a diluted solution for infusion.

Dilution:

• Calculate the required volume of the reconstituted solution needed to obtain the appropriate dose according to the patient’s body weight.
• Determine the final volume of the infusion solution to deliver the appropriate dose at a sacituzumab govitecan concentration range of 1.1 mg/mL to 3.4 mg/mL.
• Withdraw and discard a volume of sodium chloride 9 mg/mL (0.9%) solution for injection from the final infusion bag that is equivalent to the required volume of the reconstituted solution.
• Withdraw the calculated amount of the reconstituted solution from the vial(s) using a syringe. Discard any unused portion remaining in the vial(s).
• To minimize foaming, slowly inject the required volume of reconstituted solution into a polyvinyl chloride, polypropylene or ethylene/propylene copolymer infusion bag. Do not shake the contents.
• If necessary, adjust the volume in the infusion bag as needed with sodium chloride 9 mg/mL (0.9%) solution for injection, to obtain a concentration of 1.1 mg/mL to 3.4 mg/mL (the total volume should not exceed 500 mL). Only sodium chloride 9 mg/mL (0.9%) solution for injection should be used since the stability of the reconstituted product has not been determined with other infusion-based solutions.
• For patients whose body weight exceeds 170 kg, divide the total dose of Trodelvy equally between two 500 mL infusion bags and infuse sequentially over 3 hours for the first infusion and over 1-2 hours for subsequent infusions.
• If not used immediately, the infusion bag containing diluted solution can be stored refrigerated 2°C to 8°C for up to 4 hours protected from light. Do not freeze. After refrigeration, administer the diluted solution within 4 hours (including infusion time).

Administration:

• The infusion bag should be covered during administration to the subject until dosing is complete. It is not necessary to cover the infusion tubing or to use light-protective tubing during the infusion.
• Administer Trodelvy as an intravenous infusion. Protect the infusion bag from light.
• An infusion pump may be used.
• Do not mix Trodelvy, or administer as an infusion, with other medicinal products.
• Upon completion of the infusion, flush the intravenous line with 20 mL sodium chloride 9 mg/mL (0.9%) solution for injection.

Disposal:

Any unused medicinal product or waste material should be disposed of in accordance with local requirements.