ZYNYZ Concentrate for solution for infusion Ref.[110050] Active ingredients: Retifanlimab

Source: European Medicines Agency (EU)  Revision Year: 2026  Publisher: Incyte Biosciences Distribution B.V., Paasheuvelweg 25, 1105 BP Amsterdam, Netherlands

4.3. Contraindications

Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.

4.4. Special warnings and precautions for use

Traceability

In order to improve the traceability of biological medicinal products, the name and the batch number of the administered product should be clearly recorded.

Immune-related adverse reactions

Immune-related adverse reactions, which may be severe or fatal, can occur in patients treated with retifanlimab. Immune-related adverse reactions can occur in any organ or tissue and may affect more than one body system simultaneously. While immune-related adverse reactions usually occur during treatment, symptoms can also manifest after discontinuation. Important immune-related adverse reactions listed in this section are not inclusive of all possible immune-related reactions.

Early identification and management of immune-related adverse reactions is essential to ensure safe use of retifanlimab. Patients should be monitored for symptoms and signs of immune-related adverse reactions. Blood chemistries, including liver tests and thyroid function tests, should be evaluated at start of treatment and periodically during treatment. For suspected immune-related adverse reactions, adequate evaluation including specialty consultation should be ensured to confirm aetiology or exclude other causes.

Based on the severity of the adverse reaction, treatment with retifanlimab should be withheld or permanently discontinued and corticosteroids (1 to 2 mg/kg/day prednisone or equivalent) or other appropriate therapy administered. Upon improvement to Grade ≤1, corticosteroid taper should be initiated and continued for at least 1 month (see Table 1).

In patients with pre-existing autoimmune disease (AID), data from observational studies suggest that the risk of immune-mediated adverse reactions following immune-checkpoint inhibitor therapy may be increased as compared with the risk in patients without pre-existing AID. In addition, flares of the underlying AID were frequent, but the majority were mild and manageable. However, data specific to retifanlimab are scarce.

Immune-related pneumonitis

Immune-related pneumonitis has been reported in patients receiving retifanlimab (see section 4.8). Patients should be monitored for signs and symptoms of pneumonitis. Suspected pneumonitis should be confirmed with radiographic imaging and other causes excluded. Patients should be managed with retifanlimab treatment modifications and corticosteroids (see Table 1).

Immune-related colitis

Immune-related colitis has been reported in patients receiving retifanlimab (see section 4.8). Patients should be monitored for signs and symptoms of colitis and managed with retifanlimab treatment modifications, anti-diarrhoeal agents and corticosteroids (see Table 1).

Immune-related hepatitis

Immune-related hepatitis has been reported in patients receiving retifanlimab (see section 4.8). Patients should be monitored for abnormal liver tests prior to and periodically during treatment as indicated based on clinical evaluation and managed with retifanlimab treatment modifications and corticosteroids (see Table 1). For Grade 1 hepatitis, liver chemistry monitoring should be increased to twice per week until liver chemistry tests return to baseline.

Immune-related endocrinopathies

Immune-related endocrinopathies, including hypothyroidism, hyperthyroidism, adrenal insufficiency, hypophysitis and diabetic ketoacidosis have been reported in patients receiving retifanlimab (see section 4.8). Patients should be monitored for abnormal thyroid function tests prior to and periodically during treatment and for cortisol, as indicated based on symptoms and/or falling thyroid-stimulating hormone.

Hypothyroidism and hyperthyroidism:

Immune-related hypothyroidism and hyperthyroidism (including thyroiditis) have been reported in patients receiving retifanlimab. Immune-related hypothyroidism and hyperthyroidism (including thyroiditis) should be managed with retifanlimab treatment modifications as recommended in Table 1.

Hypophysitis:

Immune-related hypophysitis has been observed in patients receiving retifanlimab (see section 4.8). Patients should be monitored for signs and symptoms of hypophysitis and managed with retifanlimab treatment modifications, corticosteroids and hormone replacement, as clinically indicated (see Table 1).

Adrenal insufficiency:

Immune-related adrenal insufficiency has been reported in patients receiving retifanlimab. Patients should be monitored for clinical signs and symptoms of adrenal insufficiency and managed with corticosteroids and hormone replacement, as clinically indicated (see Table 1).

Type 1 Diabetes mellitus:

Immune-related type 1 diabetes mellitus has been observed in patients treated with PD-1 inhibitors (see section 4.8). Patients should be monitored for hyperglycaemia and signs and symptoms of diabetes as indicated based on clinical evaluation and managed with oral anti-hyperglycaemics or insulin and retifanlimab treatment modifications (see Table 1).

Immune-related nephritis

Immune-related nephritis has been reported in patients receiving retifanlimab (see section 4.8). Patients should be monitored for changes in renal function and managed with retifanlimab treatment modifications and corticosteroids (see section 4.2).

Immune-related skin reactions

Immune-related skin reactions, such as toxic epidermal necrolysis, have been reported in patients receiving retifanlimab (see section 4.8). Events of Stevens-Johnson syndrome have been reported in patients treated with PD-1 inhibitors. Patients should be monitored for signs and symptoms of skin reactions. Immune-related skin reactions should be managed as recommended in Table 1.

Caution should be used when considering the use of retifanlimab in a patient who has previously experienced a severe or life-threatening skin adverse reaction on prior treatment with other checkpoint inhibitors.

Other immune-related adverse reactions

Clinically significant, immune-related adverse reactions were reported in patients treated with retifanlimab in clinical studies including: uveitis, arthritis, myositis, demyelinating polyneuropathy (e.g. Guillain Barré syndrome), pancreatitis, myocarditis, cholangitis, and stomatitis (see section 4.8).

Patients should be monitored for signs and symptoms of immune-related adverse reactions and managed with retifanlimab treatment modifications as described in section 4.2.

Infusion-related reactions

As with any therapeutic protein, retifanlimab can cause infusion-related reactions, some of which may be severe. Patients should be monitored for signs and symptoms of infusion-related reactions. Retifanlimab treatment should be interrupted or the rate of infusion slowed or treatment should be permanently discontinued based on severity of reaction and the response to treatment (see section 4.2). Premedication with an antipyretic and/or an antihistamine should be considered for patients who have had previous clinically significant reactions to infusions of therapeutic proteins (see section 4.8).

Haematology

The concomitant administration of retifanlimab with carboplatin and paclitaxel increased the risk and severity of neutropaenia.

Frequent hematological monitoring is recommended and treatment guidelines for neutropenia should be followed.

Transplant-related adverse reactions

Solid organ transplant rejection

Solid organ transplant rejection has been reported in the post-marketing setting in patients treated with PD-1 inhibitors. Treatment with retifanlimab may increase the risk of rejection in solid organ transplant recipients. The benefit of treatment with retifanlimab versus the risk of possible organ rejection should be considered in these patients.

Complications of allogeneic haematopoietic stem cell transplant (HSCT)

Fatal and other serious complications can occur in patients who receive allogeneic haematopoietic stem cell transplantation (HSCT) before or after being treated with a PD-1/PD-L1–blocking antibody. Transplant-related complications include hyperacute graft-versus-host disease (GvHD), acute GvHD, chronic GvHD, hepatic veno-occlusive disease after reduced intensity conditioning and steroid-requiring febrile syndrome (without an identified infectious cause). These complications may occur despite intervening therapy between PD-1/PD-L1 blockade and allogeneic HSCT. Patients should be closely followed for evidence of transplant-related complications and prompt intervention may be required. Consider the benefit versus risks of treatment with a PD-1/PD-L1–blocking antibody prior to or after an allogeneic HSCT.

Patients excluded from the clinical programme

Patients with the following status were excluded from the clinical programme: Eastern Cooperative Oncology Group (ECOG) baseline performance score ≥2; symptomatic central nervous system metastases; prior immunotherapy or autoimmune disease that required systemic therapy with immunosuppressant agents; history of other malignancies within the last 3 years; organ transplant; or active hepatitis infection. Patients with uncontrolled HIV infection (CD4+ count <300 cells/μL, detectable viral load, or not receiving highly active antiretroviral therapy) were also excluded.

Sodium content

This medicinal product contains less than 1 mmol sodium (23 mg) per dose, that is essentially 'sodium-free'.

4.5. Interaction with other medicinal products and other forms of interaction

No formal pharmacokinetic drug interaction studies have been conducted with retifanlimab. Since retifanlimab is cleared from the circulation through catabolism, no metabolic drug-drug interactions are expected.

The use of systemic corticosteroids or immunosuppressants before starting retifanlimab, except for physiological doses of systemic corticosteroids (≤10 mg/day prednisone or equivalent), should be avoided because of their potential interference with the pharmacodynamic activity and efficacy of retifanlimab. However, systemic corticosteroids or other immunosuppressants can be used after starting retifanlimab to treat immune-related adverse reactions (see sections 4.2 and 4.4).

Retifanlimab is not expected to be a victim or perpetrator of drug-drug interactions involving drug transporters or CYP enzymes.

4.6. Fertility, pregnancy and lactation

Women of childbearing potential/Contraception

Women of childbearing potential should use effective contraception during treatment with retifanlimab and for at least 4 months after the last dose of retifanlimab.

Pregnancy

There are no data from the use of retifanlimab in pregnant women. Animal reproduction studies have not been conducted with retifanlimab. Animal studies have demonstrated that inhibition of the PD-1/PD-L1 pathway can lead to increased risk of immune-mediated rejection of the developing foetus resulting in foetal death. Therefore, based on its mechanism of action, retifanlimab can cause foetal harm when administered to a pregnant woman. Human IgG4 immunoglobulins are known to cross the placenta; therefore, retifanlimab has the potential to be transmitted from the mother to the developing foetus. ZYNYZ is not recommended during pregnancy and in women of childbearing potential not using effective contraception (see section 5.3).

Breast-feeding

It is unknown whether retifanlimab is excreted in human milk. There is insufficient information on the excretion of retifanlimab in animal milk.

Human IgGs are known to be excreted in breast milk during the first few days after birth; which decreases to low concentrations soon afterwards; consequently, a risk to the breast-fed infant cannot be excluded during this short period. For this specific period, a decision should be made whether to discontinue/abstain from retifanlimab therapy, taking into account the benefit of breast-feeding to the child and the benefit of therapy to the woman. Afterwards, retifanlimab could be used during breast-feeding if clinically needed.

Fertility

No clinical data are available on the possible effects of retifanlimab on fertility. Animal reproduction studies to evaluate the effect of retifanlimab on fertility have not been conducted.

4.7. Effects on ability to drive and use machines

ZYNYZ has minor influence on the ability to drive and use machines. Because of potential adverse reactions such as fatigue (see section 4.8), patients should be advised to use caution when driving or operating machinery until they are certain that retifanlimab does not adversely affect them.

4.8. Undesirable effects

Summary of the safety profile

Immune-related adverse reactions occurred with retifanlimab. Most of these, including severe reactions, resolved following initiation of appropriate medical therapy or withdrawal of retifanlimab (see "Description of selected adverse reactions" below).

The safety of retifanlimab as monotherapy has been evaluated in 452 patients with advanced solid malignancies who received the recommended 500 mg every 4 weeks dose, including 107 patients with metastatic or recurrent locally advanced MCC. Median duration of treatment was 5.4 months (range, 1 day – 27 months). The most common adverse reactions were fatigue (35.4%), rash (18.8%), diarrhoea (18.6%), anaemia (16.2%), pruritus (15.9%), arthralgia (13.3%), constipation (13.3%), nausea (13.3%), pyrexia (13.1%) and decreased appetite (12.6%). Adverse reactions were serious in 11.7% of patients; most serious adverse reactions were immune-related adverse reactions. ZYNYZ was permanently discontinued due to adverse reactions in 8% of patients; most of them were immune-related events.

The safety of retifanlimab in combination with carboplatin and paclitaxel has been evaluated in 154 patients with metastatic or with inoperable locally recurrent SCAC. Median duration of retifanlimab treatment was 7.4 months (range, 1 day – 14.6 months). The most common adverse reactions were neutropenia (70.1%), pruritus (24%), rash (23.4%), lymphopenia (14.3%), hypothyroidism (14.3%), and alanine aminotransferase increased (10.4%). Adverse reactions were serious in 13.6% of patients; most serious adverse reactions were immune-related adverse reactions. ZYNYZ was permanently discontinued due to adverse reactions in 5.8% of patients; most of them were immune-related events.

Tabulated list of adverse reactions

Adverse reactions reported in the pooled dataset for patients treated with ZYNYZ monotherapy (N=452) and in combination with carboplatin and paclitaxel (N=154) are presented in Table 2.

These reactions are presented by system organ class and by frequency. Frequencies are defined as: very common (≥1/10); common (≥1/100 to <1/10); uncommon (≥1/1 000 to <1/100); rare (≥1/10,000 to <1/1,000); very rare (<1/10,000); and not known (cannot be estimated from the available data). Within each frequency grouping, adverse reactions are presented in order of decreasing incidence.

Table 2. Adverse reactions in patients treated with retifanlimab:

 Retifanlimab monotherapy
(N=452)
Retifanlimab in combination with
carboplatin and paclitaxel
(N=154)
System organ classFrequency of all
grades
Frequency of grades
3-4
Frequency of all
grades
Frequency of grades
3-4
Blood and lymphatic
system disorders
Very common
Anaemiaa
Common
Anaemiaa
Very common
Lymphopeniab
Neutropeniac
Very common
Neutropeniac

Common
Lymphopeniab
Endocrine disordersCommon
Hypothyroidism,
Hyperthyroidism

Uncommon
Adrenal insufficiency
Thyroiditisd
Hypophysitis
Type 1 diabetes
mellituse
Uncommon
Adrenal insufficiency
Hypophysitis
Type 1 diabetes
mellituse
Very common
Hypothyroidism

Common
Adrenal insufficiency
Hyperthyroidism
Hypophysitis
Hyperglycaemia

Uncommon
Autoimmune
thyroiditis
Secondary
adrenocortical
insufficiency
Common
Adrenal insufficiency

Uncommon
Hypothyroidism
Hyperthyroidism
Secondary
adrenocortical
insufficiency
Metabolism and
nutrition disorders
Very common
Decreased appetite
Uncommon
Decreased appetite
Common
Hyponatraemia
Common
Hyponatraemia
Nervous system
disorders
Common
Paraesthesia

Uncommon
Polyneuropathyf
Radiculopathy
Vocal cord paralysis
Uncommon
Polyneuropathyf
Radiculopathy
Very common
Peripheral sensory
neuropathy

Common
Peripheral motor
neuropathy
Peripheral
sensorimotor
neuropathy
Common
Peripheral
sensorimotor
neuropathy
Eye disordersUncommon
Uveitisg
Keratitis
Uncommon
Uveitisg
  
Cardiac disordersUncommon
Pericarditis
Myocarditis
Uncommon
Myocarditis
  
Respiratory, thoracic
and mediastinal
disorders
Common
Pneumonitish
Uncommon
Pneumonitish
  
Gastrointestinal
disorders
Very common
Diarrhoea
Nausea
Constipation

Common
Colitisi

Uncommon
Pancreatitis
Uncommon
Diarrhoea
Pancreatitis
Colitisi
Very common
Colitisj

Common
Stomatitis
Common
Colitisj
Hepatobiliary
disorders
Common
Hepatocellular injury
Hepatitisk

Uncommon
Hyperbilirubinaemia
Cholangitis
Uncommon
Hepatitisk
Hepatocellular injury
Cholangitis
Hyperbilirubinaemia
Common
Hepatitisl

Uncommon
Immune-mediated
cholangitis
Common
Hepatitisl

Uncommon
Immune-mediated
cholangitis
Skin and
subcutaneous skin
disorders
Very common
Rashm
Pruritus
Common
Rashm
Very common
Pruritus
Rashn
Common
Rashn

Uncommon
Pruritus
Musculoskeletal and
connective tissue
disorders
Very common
Arthralgia

Uncommon
Arthritis°
Myositis
Eosinophilic fasciitis
Polymyalgia
rheumatica
Uncommon
Arthralgia
Arthritis°
Myositis
Eosinophilic fasciitis
Common
Arthritis
 
Renal and urinary
disorders
Common
Acute kidney injury
Renal failure

Uncommon
Tubulointerstitial
nephritis
Uncommon
Acute kidney injury
Tubulointerstitial
nephritis
  
General disorders
and administration
site conditions
Very common
Fatiguep
Pyrexia
Common
Fatiguep

Uncommon
Pyrexia
Very common
Asthenia
Common
Asthenia
InvestigationsCommon
Transaminases
increasedq
Blood creatinine
increased
Amylase increased
Lipase increased
Blood bilirubin
increased
Blood thyroid
stimulating hormone
increased

Uncommon
Blood thyroid
stimulating hormone
decreased
Common
Transaminases
increasedq

Uncommon
Blood bilirubin
increased
Lipase increased
Blood creatinine
increased
Amylase increased
Very common
Alanine
aminotransferase
increased

Common
Aspartate
aminotransferase
increased
Lipase increased
Blood creatinine
increased
Amylase increased
Common
Alanine
aminotransferase
increased
Aspartate
aminotransferase
increased
Lipase increased

Uncommon
Blood creatinine
increased
Amylase increased
Injury, poisoning
and procedural
complications
Common
Infusion-related
reactionr
Uncommon
Infusion-related
reactionr
Common
Infusion-related
reaction
Uncommon
Infusion-related
reaction

a Includes anaemia, iron deficiency anaemia, anaemia of malignant disease and anaemia vitamin B12 deficiency.
b Includes lymphopenia and lymphocyte count decreased.
c Includes neutropenia and neutrophil count decreased.
d Includes thyroiditis and autoimmune thyroiditis.
e Includes diabetic ketoacidosis.
f Includes polyneuropathy and demyelinating polyneuropathy.
g Includes uveitis and iritis.
h Includes pneumonitis, interstitial lung disease, organising pneumonia and lung infiltration.
i Includes colitis and immune mediated enterocolitis.
j Includes colitis, immune mediated enterocolitis and immune mediated diarrhoea.
k Includes hepatitis and autoimmune hepatitis.
l Includes hepatitis and immune-mediated hepatitis.
m Includes rash, rash maculo-papular, rash erythematous, rash pruritic, dermatitis, psoriasis, rash macular, rash papular, lichenoid keratosis, rash pustular, dermatitis bullous, palmar-plantar erythrodyseasthesia syndrome, toxic epidermal necrolysis and toxic skin eruption.
n Includes rash, rash erythematous, rash maculo-papular and rash pruritic.
° Includes arthritis and polyarthritis.
p Includes asthenia and fatigue.
q Includes transaminases increased, alanine aminotransferase increased and aspartate aminotransferase increased.
r Includes drug hypersensitivity and infusion related reaction.

Description of selected adverse reactions

The selected adverse reactions described below are based on the safety of retifanlimab monotherapy in a pooled safety population of 452 patients with advanced solid malignancies, including patients with metastatic or recurrent locally advanced MCC and on the safety of retifanlimab in combination with carboplatin and paclitaxel in 154 patients with metastatic or with inoperable locally recurrent SCAC. The management guidelines for these adverse reactions are described in section 4.2.

Immune-related adverse reactions (see section 4.4)

Immune-related pneumonitis

Immune-related pneumonitis occurred in 3.1% of patients receiving retifanlimab monotherapy, including 1.3% of patients with Grade 2, 0.9% of patients with Grade 3 and 0.2% of patients with Grade 5. The median time to onset of pneumonitis was 100 days (range, 43 – 673 days). Pneumonitis led to discontinuation of retifanlimab in 0.2% of patients. Among the patients with pneumonitis, 71.4% received systemic corticosteroids. Pneumonitis resolved in 78.6% of patients, with a median time to resolution of 37 days (range, 9 – 104 days).

Immune-related colitis

Immune-related colitis occurred in 2.7% of patients receiving retifanlimab monotherapy, including 1.1% of patients with Grade 2, 0.4% of patients with Grade 3 and 0.2% of patients with Grade 4. The median time to onset of colitis was 165.5 days (range, 11 – 749 days). Colitis led to discontinuation of retifanlimab in 0.9% of patients. Among the patients with colitis, 75% received systemic corticosteroids and 8.3% received another immunosuppressant (infliximab). Colitis resolved in 66.7% of patients, with a median time to resolution of 83.5 days (range, 15 – 675 days).

In patients with SCAC receiving retifanlimab in combination with carboplatin and paclitaxel, immune-related colitis occurred in 10.4% of patients, including 3.2% of patients with Grade 2, 2.6% of patients with Grade 3 and 0.6% of patients with Grade 4. The median time to onset of colitis was 83.5 days (range, 3 – 271 days). Colitis led to discontinuation of retifanlimab in 1.3% of patients. Among the patients with colitis, 93.8% received systemic corticosteroids and 6.3% received another immunosuppressant (infliximab). Colitis resolved in 93.8% of patients, with a median time to resolution of 27 days (range, 1 – 102 days).

Immune-related nephritis

Immune-related nephritis occurred in 2% of patients receiving retifanlimab monotherapy, including 0.4% of patients with Grade 2, 1.1% of patients with Grade 3 and 0.4% of patients with Grade 4. The median time to onset of nephritis was 176 days (range, 15 – 515 days). Nephritis led to discontinuation of retifanlimab in 1.1% of patients. Among the patients with nephritis, 66.7% received systemic corticosteroids. Nephritis resolved in 44.4% of patients, with a median time to resolution of 22.5 days (range, 9 – 136 days).

Immune-related endocrinopathies

Hypothyroidism occurred in 10.2% of patients receiving retifanlimab monotherapy, including 4.9% of patients with Grade 2. The median time to onset of hypothyroidism was 88 days (range, 1 – 505 days). None of the events led to discontinuation of retifanlimab. Hypothyroidism resolved in 32.6% of patients, with a median time to resolution of 56 days (range, 2 – 224 days).

In patients with SCAC receiving retifanlimab in combination with carboplatin and paclitaxel, hypothyroidism occurred in 14.3% of patients, including 9.1% of patients with Grade 2 and 0.6% of patients with Grade 4. The median time to onset of hypothyroidism was 138.5 days (range, 55 – 390 days). Hypothyroidism led to discontinuation of retifanlimab in 1 patient. Hypothyroidism resolved in 27.3% of patients, with a median time to resolution of 114 days (range, 57 – 212 days).

Hyperthyroidism occurred in 5.8% of patients receiving retifanlimab monotherapy, including 2.7% of patients with Grade 2. The median time to onset of hyperthyroidism was 55.5 days (range, 8 – 575 days). None of the events led to discontinuation of retifanlimab. Hyperthyroidism resolved in 61.5% of patients, with a median time to resolution of 74 days (range, 15 – 295 days).

In patients with SCAC receiving retifanlimab in combination with carboplatin and paclitaxel, hyperthyroidism occurred in 8.4% of patients, including 3.2% of patients with Grade 2 and 0.6% of patients with Grade 3. The median time to onset of hyperthyroidism was 82 days (range, 8 – 278 days). None of the events led to discontinuation of retifanlimab. Hyperthyroidism resolved in 76.9% of patients, with a median time to resolution of 29 days (range, 8 – 130 days).

Hypophysitis occurred in 0.7% of patients receiving retifanlimab monotherapy, including 0.4% of patients with Grade 2 and 0.2% of patients with Grade 3. The median time to onset of hypophysitis was 308 days (range, 266 – 377 days). Hypophysitis led to discontinuation of retifanlimab in 0.2% of patients. Hypophysitis resolved in 33.3% of patients, with a time to resolution of 6 days.

In patients with SCAC receiving retifanlimab in combination with carboplatin and paclitaxel, hypophysitis occurred in 2 patients (1.3%, both Grade 2). The median time to onset of hypophysitis was 192 days (range, 90 – 294 days). Neither of the events led to discontinuation of retifanlimab. Hypophysitis resolved in 1 of the 2 patients, with a time to resolution of 8 days.

Adrenal insufficiency occurred in 0.9% of patients receiving retifanlimab monotherapy, including 0.4% of patients with Grade 2 and 0.4% of patients with Grade 3. The median time to onset of adrenal insufficiency was 220.5 days (range, 146 – 275 days). None of the events led to discontinuation of retifanlimab. Adrenal insufficiency resolved in 25% of patients, with a time to resolution of 12 days.

In patients with SCAC receiving retifanlimab in combination with carboplatin and paclitaxel, adrenal insufficiency occurred in 5.8% of patients, including 1.9% of patients with Grade 2 and 1.9% of patients with Grade 3. The median time to onset of adrenal insufficiency was 197 days (range, 63 – 302 days). One event led to discontinuation of retifanlimab. Adrenal insufficiency resolved in 44.4% of patients, with a time to resolution of 13.5 days.

Type 1 diabetes mellitus presenting as diabetic ketoacidosis (Grade 3) occurred in 0.2% of patients receiving retifanlimab monotherapy. The time to onset of diabetic ketoacidosis was 284 days. The event did not lead to discontinuation of retifanlimab and resolved with a time to resolution of 6 days.

Immune-related hepatitis

Immune-related hepatitis occurred in 3.5% of patients receiving retifanlimab monotherapy, including 0.9% of patients with Grade 2, 2.4% of patients with Grade 3 and 0.2% of patients with Grade 4. The median time to onset of hepatitis was 70.5 days (range, 8 – 580 days). Hepatitis led to discontinuation of retifanlimab in 1.5% of patients. Among the patients with hepatitis, 81.3% of patients received systemic corticosteroids and 6.3% of patients received another immunosuppressant (mycophenolate mofetil). Hepatitis resolved in 56.3% of patients, with a median time to resolution of 22 days (range, 6 – 104 days).

In patients with SCAC receiving retifanlimab in combination with carboplatin and paclitaxel, immune-related hepatitis occurred in 2 patients (1.3%, both Grade 3). The median time to onset of hepatitis was 195.5 days (range, 140 – 251 days). Hepatitis led to discontinuation of retifanlimab in 1 patient. Both patients with hepatitis received systemic corticosteroids and another immunosuppressant (mycophenolate mofetil). Hepatitis resolved in both patients, with a median time to resolution of 58.5 days (range, 57 – 60 days).

Immune-related skin reactions

Immune-related skin reactions occurred in 9.5% of patients receiving retifanlimab monotherapy, including 8% of patients with Grade 2, 1.1% of patients with Grade 3 and 0.2% of patients with Grade 4. The median time to onset of skin reactions was 86 days (range, 2 – 589 days). Skin reactions led to discontinuation of retifanlimab in 0.7% of patients. Among the patients with skin reactions, 32.6% of patients received systemic corticosteroids. Skin reactions resolved in 72.1% of patients, with a median time to resolution of 37 days (range, 3 – 470 days).

In patients with SCAC receiving retifanlimab in combination with carboplatin and paclitaxel, immune-related skin reactions occurred in 11.7% of patients, including 9.7% of patients with Grade 2 and 1.9% of patients with Grade 3. The median time to onset of skin reactions was 46.5 days (range, 2 – 443 days). Skin reactions led to discontinuation of retifanlimab in 2 patients. Among the patients with skin reactions, 33.3% of patients received systemic corticosteroids. Skin reactions resolved in 72.2% of patients, with a median time to resolution of 22 days (range, 5 – 385 days).

Infusion related-reactions

Infusion-related reactions occurred in 6.2% of patients receiving retifanlimab monotherapy, including 2.2% of patients with Grade 2 and 0.4% of patients with Grade 3. Infusion-related reactions led to discontinuation of retifanlimab in 0.4% patients. In patients with SCAC receiving retifanlimab in combination with carboplatin and paclitaxel, infusion-related reactions occurred in 9.7% of patients, including 1.9% of patients with Grade 3. None of the infusion-related reactions led to discontinuation of retifanlimab.

Laboratory abnormalities

In patients with SCAC receiving retifanlimab in combination with chemotherapy, the proportion of patients who experienced a shift from baseline to a Grade 3 or 4 laboratory abnormality occurring in >3% of patients was 42.8% for decreased lymphocytes, 52% for decreased neutrophils, 4.5% for lipase, 3.9% for alanine aminotransferase, and 3.9% for aspartate aminotransferase.

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the national reporting system listed in Appendix V.

6.2. Incompatibilities

In the absence of compatibility studies, this medicinal product must not be mixed with other medicinal products and/or diluents except those mentioned in section 6.6. Other medicinal products should not be co-administered through the same infusion line.

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