Margetuximab-Cmkb
FDA Drug Information • Also known as: Margenza
- Brand Names
- Margenza
- Drug Class
- HER2/neu Receptor Antagonist [EPC]
- Route
- INTRAVENOUS
- Dosage Form
- INJECTION, SOLUTION, CONCENTRATE
- Product Type
- HUMAN PRESCRIPTION DRUG
⚠ Boxed Warning (Black Box)
WARNING: LEFT VENTRICULAR DYSFUNCTION AND EMBRYO-FETAL TOXICITY WARNING: LEFT VENTRICULAR DYSFUNCTION AND EMBRYO-FETAL TOXICITY See full prescribing information for complete boxed warning. Left Ventricular Dysfunction: MARGENZA may lead to reductions in left ventricular ejection fraction (LVEF). Evaluate cardiac function prior to and during treatment. Discontinue MARGENZA treatment for a confirmed clinically significant decrease in left ventricular function. ( 2.2 , 5.1 , 6.1 ) Embryo-Fetal Toxicity: Exposure to MARGENZA during pregnancy can cause embryo-fetal harm. Advise patients of the risk and need for effective contraception. ( 5.2 , 8.1 , 8.3 ) Left Ventricular Dysfunction: MARGENZA may lead to reductions in left ventricular ejection fraction (LVEF). Evaluate cardiac function prior to and during treatment. Discontinue MARGENZA treatment for a confirmed clinically significant decrease in left ventricular function [see Dosage and Administration (2.2) , Warnings and Precautions (5.1) , and Adverse Reactions (6.1) ]. Embryo-Fetal Toxicity: Exposure to MARGENZA during pregnancy can cause embryo-fetal harm. Advise patients of the risk and need for effective contraception [see Warnings and Precautions (5.2) , Use in Specific Populations (8.1 , 8.3) ].
Description
11 DESCRIPTION Margetuximab-cmkb, a HER2/neu receptor antagonist, is a chimeric Fc-engineered IgG1 kappa monoclonal antibody. Margetuximab-cmkb is produced by recombinant DNA technology in a mammalian cell (Chinese Hamster Ovary) culture. Margetuximab-cmkb has an approximate molecular weight of 149 kDa. MARGENZA (margetuximab-cmkb) injection is a sterile, preservative-free, clear to slightly opalescent, colorless to pale yellow or pale brown solution that requires dilution for intravenous use. Some visible, translucent, inherent proteinaceous particles may be present. Each single-dose vial contains 250 mg of margetuximab-cmkb in 10 mL of solution. Each mL of solution contains 25 mg of margetuximab-cmkb, L-arginine hydrochloride (11 mg), polysorbate 80 (0.1 mg), sodium chloride (2.9 mg), sodium phosphate dibasic, heptahydrate (0.58 mg), sodium phosphate monobasic, monohydrate (1.1 mg), sucrose (30 mg), and Water for Injection, USP at a pH of approximately 6.1.
What Is Margetuximab-Cmkb Used For?
1 INDICATIONS AND USAGE MARGENZA is indicated, in combination with chemotherapy, for the treatment of adult patients with metastatic HER2-positive breast cancer who have received two or more prior anti-HER2 regimens, at least one of which was for metastatic disease [see Dosage and Administration (2.1) and Clinical Studies (14.1) ]. MARGENZA is a HER2/neu receptor antagonist indicated, in combination with chemotherapy, for the treatment of adult patients with metastatic HER2-positive breast cancer who have received two or more prior anti-HER2 regimens, at least one of which was for metastatic disease. ( 1 , 2.1 , 14.1 )
Dosage and Administration
2 DOSAGE AND ADMINISTRATION For intravenous infusion only. ( 2.1 ) Administer MARGENZA as an intravenous infusion at 15 mg/kg over 120 minutes for the initial dose, then over a minimum of 30 minutes every 3 weeks for all subsequent doses. ( 2.1 ) On days when both MARGENZA and chemotherapy are to be administered, MARGENZA may be administered immediately after chemotherapy completion. ( 2.1 ) 2.1 Recommended Doses and Schedules The recommended dose of MARGENZA is 15 mg/kg, administered as an intravenous infusion every 3 weeks (21-day cycle) until disease progression or unacceptable toxicity. Administer MARGENZA as an intravenous infusion at 15 mg/kg over 120 minutes for the initial dose, then over a minimum of 30 minutes every 3 weeks for all subsequent doses. On days when both MARGENZA and chemotherapy are to be administered, MARGENZA may be administered immediately after chemotherapy completion. Refer to the respective Prescribing Information for each therapeutic agent administered in combination with MARGENZA for the recommended dosage information, as appropriate. 2.2 Dose Modification or Important Dosing Considerations If a patient misses a dose of MARGENZA, administer the scheduled dose as soon as possible. Adjust the administration schedule to maintain a 3-week interval between doses. Left Ventricular Dysfunction [see Warnings and Precautions (5.1) ] Assess left ventricular ejection fraction (LVEF) before starting MARGENZA and regularly during treatment. Withhold MARGENZA dosing for at least 4 weeks for any of the following: ≥ 16% absolute decrease in LVEF from pretreatment values LVEF below institutional limits of normal (or 50% if no limits are available) and ≥ 10% absolute decrease in LVEF from pretreatment values. MARGENZA dosing may be resumed if, within 8 weeks, LVEF returns to normal limits and absolute decrease from baseline is ≤ 15%. Permanently discontinue MARGENZA if LVEF decline persists for greater than 8 weeks, or if dosing is interrupted on greater than 3 occasions for LVEF decline. Infusion-Related Reactions [see Warnings and Precautions (5.3) ] Decrease the rate of infusion for mild or moderate infusion-related reactions (IRRs). Interrupt the infusion for dyspnea or clinically significant hypotension. Permanently discontinue MARGENZA dosing in patients with severe or life-threatening IRRs . 2.3 Preparation for Administration Administer as an intravenous infusion after dilution. Preparation for Intravenous Infusion Prepare solution for infusion, using aseptic technique, as follows: Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. The solution is clear to slightly opalescent, colorless to pale yellow or pale brown. Some visible, translucent, inherent proteinaceous particles may be present. Swirl the vial(s) gently. Do not shake the vial(s). Calculate the required volume of MARGENZA needed to obtain the appropriate...
Side Effects (Adverse Reactions)
6 ADVERSE REACTIONS The following adverse reactions are discussed in greater detail in other sections of the label: Left Ventricular Dysfunction [see Warnings and Precautions (5.1) ] Embryo-Fetal Toxicity [see Warnings and Precautions (5.2) ] Infusion-Related Reactions [see Warnings and Precautions (5.3) ] The most common adverse drug reactions (>10%) with MARGENZA in combination with chemotherapy are fatigue/asthenia, nausea, diarrhea, vomiting, constipation, headache, pyrexia, alopecia, abdominal pain, peripheral neuropathy, arthralgia/myalgia, cough, decreased appetite, dyspnea, infusion-related reactions, palmar-plantar erythrodysesthesia, and extremity pain. ( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact MacroGenics at 1-844-633-6469 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect rates observed in practice. The safety of MARGENZA was evaluated in HER2-positive breast cancer patients who received two or more prior anti-HER2 regimens in SOPHIA [see Clinical Studies (14.1) ]. Patients were randomized (1:1) to receive either MARGENZA 15 mg/kg every 3 weeks plus chemotherapy or trastuzumab plus chemotherapy. Among patients who received MARGENZA, 40% were exposed for 6 months or longer and 11% were exposed for greater than one year. Serious adverse reactions occurred in 16% of patients who received MARGENZA. Serious adverse reactions in > 1% of patients included febrile neutropenia (1.5%), neutropenia/neutrophil count decrease (1.5%) and infusion related reactions (1.1%). Fatal adverse reactions occurred in 1.1% of patients who received MARGENZA, including viral pneumonia (0.8%) and aspiration pneumonia (0.4%). Permanent discontinuation due to an adverse reaction occurred in 3% of patients who received MARGENZA. Adverse reactions which resulted in permanent discontinuation in > 1% of patients who received MARGENZA included left ventricular dysfunction and infusion-related reactions. Dosage interruptions due to an adverse reaction occurred in 11% of patients who received MARGENZA. Adverse reactions which required dosage interruption in > 5% of patients who received MARGENZA included infusion-related reactions. Table 1 summarizes the adverse reactions in SOPHIA. Table 1 Adverse Reactions (>10%) in Patients with Metastatic HER2-Positive Breast Cancer Who Received MARGENZA in SOPHIA Adverse Reaction MARGENZA + Chemotherapy (n = 264) Trastuzumab + Chemotherapy (n = 266) All Grades (%) Grade 3 or 4 (%) All Grades (%) Grade 3 or 4 (%) General disorders and administration site conditions Fatigue/Asthenia 57 7 47 4.5 Pyrexia 19 0.4 14 0.4 Gastrointestinal disorders Nausea 33 1.1 32 0.4 Diarrhea 25 2.3 25 2.3 Vomiting 21 0.8 14 1.5 Constipation 19 0.8 17 0.8 Abdominal pain Includes abdominal pain, abdominal discomfort, lower abdominal pain and upper abdominal pain 17 1.5 21 1.5 Skin and Subcutaneous tissue Alopecia 18 0 15 0 Palmar-plantar erythrodysesthesia 13 0 15 3 Nervous System Disorders Headache Includes headache and migraine 19 0 16 0 Peripheral neuropathy Includes peripheral neuropathy, peripheral sensory neuropathy, peripheral motor neuropathy, and neuropathy 16 1.1 15 2.3 Respiratory, thoracic and mediastinal disorders Cough 14 0.4 12 0 Dyspnea 13 1.1 11 2.3 Metabolism and nutrition disorders Decreased appetite 14 0.4 14 0.4 Musculoskeletal and connective tissue disorders Arthralgia/Myalgia 14 0.4 12 0.8 Extremity pain 11 0.8 9 0 Injury, poisoning and procedural complications Infusion-related reaction 13 1.5 3 0 Clinically relevant adverse reactions in ≤10% of patients who received MARGENZA in combination with chemotherapy included: dizziness and stomatitis (10%) each, decreased weight, dysgeusia, rash, and insomnia (6%) each, hypertension (5%), and syncope...
Drug Interactions
7 DRUG INTERACTIONS Anthracyclines Patients who receive anthracyclines less than 4 months after stopping MARGENZA [see Clinical Pharmacology (12.3) ] may be at increased risk of cardiac dysfunction. While this interaction has not been studied with MARGENZA, clinical data from other HER2-directed antibodies warrants consideration. Avoid anthracycline-based therapy for up to 4 months after stopping MARGENZA. If concomitant use is unavoidable, closely monitor patient's cardiac function.
Contraindications
4 CONTRAINDICATIONS None. None. ( 4 )
Pregnancy and Breastfeeding
8.1 Pregnancy Risk Summary Based on findings in animals and mechanism of action, MARGENZA can cause fetal harm when administered to a pregnant woman. There are no available data on use of MARGENZA in pregnant women to inform the drug-associated risk. In postmarketing reports, use of a HER2-directed antibody during pregnancy resulted in cases of oligohydramnios and oligohydramnios sequence manifesting as pulmonary hypoplasia, skeletal abnormalities, and neonatal death. In an animal reproduction study, intravenous administration of margetuximab-cmkb to pregnant cynomolgus monkeys once every 3 weeks, starting at gestational day (GD) 20 until delivery, resulted in oligohydramnios and delayed infant kidney development. Animal exposures were ≥ 3 times the human exposures at the recommended dose, based on C max (see Data ) . Advise patients of potential risks to a fetus. There are clinical considerations if MARGENZA is used during pregnancy or within 4 months prior to conception (see Clinical Considerations ). Estimated background risk of major birth defects and miscarriage for the indicated population is unknown. In the U.S. general population, background risks of major birth defects and miscarriage in clinically recognized pregnancies are 2 - 4% and 15 - 20%, respectively. Clinical Considerations Fetal/Neonatal Adverse Reactions Monitor women who received MARGENZA during pregnancy or within 4 months prior to conception for oligohydramnios. If oligohydramnios occurs, perform fetal testing that is appropriate for gestational age and consistent with community standards of care. Data Animal Data In an enhanced pre- and post-natal development study, pregnant cynomolgus monkeys received intravenous doses of 50 or 100 mg/kg margetuximab-cmkb once every 3 weeks starting on GD 20 and until delivery. Animal exposures at doses of 50 and 100 mg/kg were 3 and 6 times, respectively, the human exposures at the recommended dose, based on C max . Treatment with 50 and 100 mg/kg...
How Supplied
16 HOW SUPPLIED/STORAGE AND HANDLING 16.1 How Supplied MARGENZA (margetuximab-cmkb) injection is a clear to slightly opalescent, colorless to pale yellow or pale brown solution in a single-dose vial supplied as: Carton Contents NDC One 250 mg/10 mL (25 mg/mL) single-dose vial NDC 74527-022-02 Four 250 mg/10 mL (25 mg/mL) single-dose vials NDC 74527-022-03 16.2 Storage Store vials refrigerated at 2°C to 8°C (36°F to 46°F) in original carton to protect from light until time of use. Do not freeze. Do not shake.
About This Information
This drug information is sourced from FDA-approved labeling via the openFDA database. It is intended for educational and reference purposes only. This is not medical advice. Always consult your healthcare provider before making decisions about medication. Drug information may be updated by the FDA; check with your pharmacist for the most current information.
What are side effects?
Side effects are unwanted reactions that can occur when taking a medication. They range from mild (headache, nausea) to severe (allergic reactions, organ damage). Not everyone experiences side effects, and severity varies. Report any concerning side effects to your doctor.
What are drug interactions?
Drug interactions occur when a medication is affected by another drug, food, or supplement. Interactions can make medications less effective or cause dangerous side effects. Always tell your doctor about all medications and supplements you take.