VERZENIO SIDE EFFECTS
- Generic Name: abemaciclib tablets
- Brand Name: Verzenio
- Drug Class: Antineoplastics CDK Inhibitors
SIDE EFFECTS
The following adverse reactions are discussed in greater detail in other sections of the labeling:
- Diarrhea
- Neutropenia
- Hepatotoxicity
- Venous Thromboembolism
Clinical Studies 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 the rates observed in practice.
MONARCH 3
VERZENIO In Combination With An Aromatase Inhibitor (Anastrozole Or Letrozole) As Initial Endocrine-Based Therapy
Postmenopausal Women with HR-positive, HER2-negative Locoregionally Recurrent Or Metastatic Breast Cancer With No Prior Systemic Therapy In This Disease Setting
MONARCH 3 was a study of 488 women receiving VERZENIO plus an aromatase inhibitor or placebo plus an aromatase inhibitor. Patients were randomly assigned to receive 150 mg of VERZENIO or placebo orally twice daily, plus physician’s choice of anastrozole or letrozole once daily. Median duration of treatment was 15.1 months for the VERZENIO arm and 13.9 months for the placebo arm. Median dose compliance was 98% for the VERZENIO arm and 99% for the placebo arm.
Dose reductions due to an adverse reaction occurred in 43% of patients receiving VERZENIO plus anastrozole or letrozole. Adverse reactions leading to dose reductions in ≥5% of patients were diarrhea and neutropenia. VERZENIO dose reductions due to diarrhea of any grade occurred in 13% of patients receiving VERZENIO plus an aromatase inhibitor compared to 2% of patients receiving placebo plus an aromatase inhibitor. VERZENIO dose reductions due to neutropenia of any grade occurred in 11% of patients receiving VERZENIO plus an aromatase inhibitor compared to 0.6% of patients receiving placebo plus an aromatase inhibitor.
Permanent treatment discontinuation due to an adverse event was reported in 13% of patients receiving VERZENIO plus an aromatase inhibitor and in 3% of patients receiving placebo plus an aromatase inhibitor. Adverse reactions leading to permanent discontinuation for patients receiving VERZENIO plus an aromatase inhibitor were diarrhea (2%), ALT increased (2%), infection (1%), venous thromboembolic events (VTE) (1%), neutropenia (0.9%), renal impairment (0.9%), AST increased (0.6%), dyspnea (0.6%), pulmonary fibrosis (0.6%) and anemia, rash, weight decreased and thrombocytopenia (each 0.3%).
Deaths during treatment or during the 30-day follow up, regardless of causality, were reported in 11 cases (3%) of VERZENIO plus an aromatase inhibitor treated patients versus 3 cases (2%) of placebo plus an aromatase inhibitor treated patients. Causes of death for patients receiving VERZENIO plus an aromatase inhibitor included: 3 (0.9%) patient deaths due to underlying disease, 3 (0.9%) due to lung infection, 3 (0.9%) due to VTE event, 1 (0.3%) due to pneumonitis, and 1 (0.3%) due to cerebral infarction.
The most common adverse reactions reported (≥20%) in the VERZENIO arm and ≥2% than the placebo arm were diarrhea, neutropenia, fatigue, infections, nausea, abdominal pain, anemia, vomiting, alopecia, decreased appetite, and leukopenia (Table 6). The most frequently reported (≥5%) Grade 3 or 4 adverse reactions were neutropenia, diarrhea, leukopenia, increased ALT, and anemia. Diarrhea incidence was greatest during the first month of VERZENIO dosing. The median time to onset of the first diarrhea event was 8 days, and the median durations of diarrhea for Grades 2 and for Grade 3 were 11 days and 8 days, respectively. Most diarrhea events recovered or resolved (88%) with supportive treatment and/or dose reductions. Nineteen percent of patients with diarrhea required a dose omission and 13% required a dose reduction. The median time to the first dose reduction due to diarrhea was 38 days.
Table 1: Adverse Reactions ≥10% of Patients Receiving VERZENIO Plus Anastrozole or Letrozole and ≥2% Higher Than Placebo Plus Anastrozole or Letrozole in MONARCH 3
| VERZENIO plus Anastrozole or Letrozole N=327 |
Placebo plus Anastrozole or Letrozole N=161 |
|||||
| All Grades % |
Grade 3 % |
Grade 4 % |
All Grades % |
Grade 3 % |
Grade 4 % |
|
| Gastrointestinal Disorders | ||||||
| Diarrhea | 81 | 9 | 0 | 30 | 1 | 0 |
| Nausea | 39 | <1 | 0 | 20 | 1 | 0 |
| Abdominal pain | 29 | 1 | 0 | 12 | 1 | 0 |
| Vomiting | 28 | 1 | 0 | 12 | 2 | 0 |
| Constipation | 16 | <1 | 0 | 12 | 0 | 0 |
| Infections and Infestations | ||||||
| Infectionsa | 39 | 4 | <1 | 29 | 2 | <1 |
| Blood and Lymphatic System Disorders | ||||||
| Neutropenia | 41 | 20 | 2 | 2 | <1 | <1 |
| Anemia | 28 | 6 | 0 | 5 | 1 | 0 |
| Leukopenia | 21 | 7 | <1 | 2 | 0 | <1 |
| Thrombocytopenia | 10 | 2 | <1 | 2 | <1 | 0 |
| General Disorders and Administration Site Conditions | ||||||
| Fatigue | 40 | 2 | 0 | 32 | 0 | 0 |
| Influenza like illness | 10 | 0 | 0 | 8 | 0 | 0 |
| Skin and Subcutaneous Tissue Disorders | ||||||
| Alopecia | 27 | 0 | 0 | 11 | 0 | 0 |
| Rash | 14 | <1 | 0 | 5 | 0 | 0 |
| Pruritus | 13 | 0 | 0 | 9 | 0 | 0 |
| Metabolism and Nutrition Disorders | ||||||
| Decreased appetite | 24 | 1 | 0 | 9 | <1 | 0 |
| Investigations | ||||||
| Blood creatinine increased | 19 | 2 | 0 | 4 | 0 | 0 |
| Alanine aminotransferase increased | 16 | 6 | <1 | 7 | 2 | 0 |
| Aspartate aminotransferase increased | 15 | 3 | 0 | 7 | 1 | 0 |
| Weight decreased | 10 | <1 | 0 | 3 | <1 | 0 |
| Respiratory, Thoracic, and Mediastinal Disorders | ||||||
| Cough | 13 | 0 | 0 | 9 | 0 | 0 |
| Dyspnea | 12 | <1 | <1 | 6 | <1 | 0 |
| Nervous System Disorders | ||||||
| Dizziness | 11 | <1 | 0 | 9 | 0 | 0 |
| a Includes all reported preferred terms that are part of the Infections and Infestations system organ class. Most common infections (>1%) include upper respiratory tract infection, lung infection, and pharyngitis. | ||||||
Additional adverse reactions in MONARCH 3 include venous thromboembolic events (deep vein thrombosis, pulmonary embolism, and pelvic venous thrombosis), which were reported in 5% of patients treated with VERZENIO plus anastrozole or letrozole as compared to 0.6% of patients treated with anastrozole or letrozole plus placebo.
Table 2: Laboratory Abnormalities ≥10% in Patients Receiving VERZENIO Plus Anastrozole or Letrozole and ≥2% Higher Than Placebo Plus Anastrozole or Letrozole in MONARCH 3
| Laboratory Abnormality | VERZENIO plus Anastrozole or Letrozole N=327 |
Placebo plus Anastrozole or Letrozole N=161 |
||||
| All Grades % |
Grade 3 % |
Grade 4 % |
All Grades % |
Grade 3 % |
Grade 4 % |
|
| Creatinine increased | 98 | 2 | 0 | 84 | 0 | 0 |
| White blood cell decreased | 82 | 13 | 0 | 27 | <1 | 0 |
| Anemia | 82 | 2 | 0 | 28 | 0 | 0 |
| Neutrophil count decreased | 80 | 19 | 3 | 21 | 3 | 0 |
| Lymphocyte count decreased | 53 | 7 | <1 | 26 | 2 | 0 |
| Platelet count decreased | 36 | 1 | <1 | 12 | <1 | 0 |
| Alanine aminotransferase increased | 48 | 6 | <1 | 25 | 2 | 0 |
| Aspartate aminotransferase increased | 37 | 4 | 0 | 23 | <1 | 0 |
Creatinine Increased
Abemaciclib has been shown to increase serum creatinine due to inhibition of renal tubular secretion transporters, without affecting glomerular function. Across the clinical studies, increases in serum creatinine (mean increase, 0.2- 0.3 mg/dL) occurred within the first 28-day cycle of VERZENIO dosing, remained elevated but stable through the treatment period, and were reversible upon treatment discontinuation. Alternative markers such as BUN, cystatin C, or calculated GFR, which are not based on creatinine, may be considered to determine whether renal function is impaired.
MONARCH 2
VERZENIO In Combination With Fulvestrant
Women with HR-positive, HER2-negative Advanced Or Metastatic Breast Cancer With Disease Progression On Or After Prior Adjuvant Or Metastatic Endocrine Therapy
The safety of VERZENIO (150 mg twice daily) plus fulvestrant (500 mg) versus placebo plus fulvestrant was evaluated in MONARCH 2. The data described below reflect exposure to VERZENIO in 441 patients with HR-positive, HER2-negative advanced breast cancer who received at least one dose of VERZENIO plus fulvestrant in MONARCH 2.
Median duration of treatment was 12 months for patients receiving VERZENIO plus fulvestrant and 8 months for patients receiving placebo plus fulvestrant.
Dose reductions due to an adverse reaction occurred in 43% of patients receiving VERZENIO plus fulvestrant. Adverse reactions leading to dose reductions in ≥5% of patients were diarrhea and neutropenia. VERZENIO dose reductions due to diarrhea of any grade occurred in 19% of patients receiving VERZENIO plus fulvestrant compared to 0.4% of patients receiving placebo and fulvestrant. VERZENIO dose reductions due to neutropenia of any grade occurred in 10% of patients receiving VERZENIO plus fulvestrant compared to no patients receiving placebo plus fulvestrant.
Permanent study treatment discontinuation due to an adverse event were reported in 9% of patients receiving VERZENIO plus fulvestrant and in 3% of patients receiving placebo plus fulvestrant. Adverse reactions leading to permanent discontinuation for patients receiving VERZENIO plus fulvestrant were infection (2%), diarrhea (1%), hepatotoxicity (1%), fatigue (0.7%), nausea (0.2%), abdominal pain (0.2%), acute kidney injury (0.2%), and cerebral infarction (0.2%).
Deaths during treatment or during the 30-day follow up, regardless of causality, were reported in 18 cases (4%) of VERZENIO plus fulvestrant treated patients versus 10 cases (5%) of placebo plus fulvestrant treated patients. Causes of death for patients receiving VERZENIO plus fulvestrant included: 7 (2%) patient deaths due to underlying disease, 4 (0.9%) due to sepsis, 2 (0.5%) due to pneumonitis, 2 (0.5%) due to hepatotoxicity, and one (0.2%) due to cerebral infarction.
The most common adverse reactions reported (≥20%) in the VERZENIO arm were diarrhea, fatigue, neutropenia, nausea, infections, abdominal pain, anemia, leukopenia, decreased appetite, vomiting, and headache (Table 3). The most frequently reported (≥5%) Grade 3 or 4 adverse reactions were neutropenia, diarrhea, leukopenia, anemia, and infections.
Table 3: Adverse Reactions ≥10% in Patients Receiving VERZENIO Plus Fulvestrant and ≥2% Higher Than Placebo Plus Fulvestrant in MONARCH 2
| VERZENIO plus Fulvestrant N=441 |
Placebo plus Fulvestrant N=223 |
|||||
| All Grades % |
Grade 3 % |
Grade 4 % |
All Grades % |
Grade 3 % |
Grade 4 % |
|
| Gastrointestinal Disorders | ||||||
| Diarrhea | 86 | 13 | 0 | 25 | <1 | 0 |
| Nausea | 45 | 3 | 0 | 23 | 1 | 0 |
| Abdominal paina | 35 | 2 | 0 | 16 | 1 | 0 |
| Vomiting | 26 | <1 | 0 | 10 | 2 | 0 |
| Stomatitis | 15 | <1 | 0 | 10 | 0 | 0 |
| Infections and Infestations | ||||||
| Infectionsb | 43 | 5 | <1 | 25 | 3 | <1 |
| Blood and Lymphatic System Disorders | ||||||
| Neutropeniac | 46 | 24 | 3 | 4 | 1 | <1 |
| Anemiad | 29 | 7 | <1 | 4 | 1 | 0 |
| Leukopeniae | 28 | 9 | <1 | 2 | 0 | 0 |
| Thrombocytopeniaf | 16 | 2 | 1 | 3 | 0 | <1 |
| General Disorders and Administration Site Conditions | ||||||
| Fatigueg | 46 | 3 | 0 | 32 | <1 | 0 |
| Edema peripheral | 12 | 0 | 0 | 7 | 0 | 0 |
| Pyrexia | 11 | <1 | <1 | 6 | <1 | 0 |
| Metabolism and Nutrition Disorders | ||||||
| Decreased appetite | 27 | 1 | 0 | 12 | <1 | 0 |
| Respiratory, Thoracic and Mediastinal Disorders | ||||||
| Cough | 13 | 0 | 0 | 11 | 0 | 0 |
| Skin and Subcutaneous Tissue Disorders | ||||||
| Alopecia | 16 | 0 | 0 | 2 | 0 | 0 |
| Pruritus | 13 | 0 | 0 | 6 | 0 | 0 |
| Rash | 11 | 1 | 0 | 4 | 0 | 0 |
| Nervous System Disorders | ||||||
| Headache | 20 | 1 | 0 | 15 | <1 | 0 |
| Dysgeusia | 18 | 0 | 0 | 3 | 0 | 0 |
| Dizziness | 12 | 10 | 0 | 6 | 0 | 0 |
| Investigations | ||||||
| Alanine aminotransferase increased | 13 | 4 | <1 | 5 | 2 | 0 |
| Aspartate aminotransferase increased | 12 | 2 | 0 | 7 | 3 | 0 |
| Creatinine increased | 12 | <1 | 0 | <1 | 0 | 0 |
| Weight decreased | 10 | <1 | 0 | 2 | <1 | 0 |
| a Includes abdominal pain, abdominal pain upper, abdominal pain lower, abdominal discomfort, abdominal tenderness. b Includes upper respiratory tract infection, urinary tract infection, lung infection, pharyngitis, conjunctivitis, sinusitis, vaginal infection, sepsis. c Includes neutropenia, neutrophil count decreased. d Includes anemia, hematocrit decreased, hemoglobin decreased, red blood cell count decreased. e Includes leukopenia, white blood cell count decreased. f Includes platelet count decreased, thrombocytopenia. g Includes asthenia, fatigue. |
||||||
Additional adverse reactions in MONARCH 2 include venous thromboembolic events (deep vein thrombosis, pulmonary embolism, cerebral venous sinus thrombosis, subclavian vein thrombosis, axillary vein thrombosis, and DVT inferior vena cava), which were reported in 5% of patients treated with VERZENIO plus fulvestrant as compared to 0.9% of patients treated with fulvestrant plus placebo.
Table 4: Laboratory Abnormalities ≥10% in Patients Receiving VERZENIO Plus Fulvestrant and ≥2% Higher Than Placebo Plus Fulvestrant in MONARCH 2
| VERZENIO plus Fulvestrant N=441 |
Placebo plus Fulvestrant N=223 |
|||||
| All Grades % |
Grade 3 % |
Grade 4 % |
All Grades % |
Grade 3 % |
Grade 4 % |
|
| Creatinine increased | 98 | 1 | 0 | 74 | 0 | 0 |
| White blood cell decreased | 90 | 23 | <1 | 33 | <1 | 0 |
| Neutrophil count decreased | 87 | 29 | 4 | 30 | 4 | <1 |
| Anemia | 84 | 3 | 0 | 33 | <1 | 0 |
| Lymphocyte count decreased | 63 | 12 | <1 | 32 | 2 | 0 |
| Platelet count decreased | 53 | <1 | 1 | 15 | 0 | 0 |
| Alanine aminotransferase increased | 41 | 4 | <1 | 32 | 1 | 0 |
| Aspartate aminotransferase increased | 37 | 4 | 0 | 25 | 4 | <1 |
Creatinine Increased
Abemaciclib has been shown to increase serum creatinine due to inhibition of renal tubular secretion transporters, without affecting glomerular function. In clinical studies, increases in serum creatinine (mean increase, 0.2-0.3 mg/dL) occurred within the first 28-day cycle of VERZENIO dosing, remained elevated but stable through the treatment period, and were reversible upon treatment discontinuation. Alternative markers such as BUN, cystatin C, or calculated glomerular filtration rate (GFR), which are not based on creatinine, may be considered to determine whether renal function is impaired.
VERZENIO Administered As A Monotherapy In Metastatic Breast Cancer (MONARCH 1)
Patients with HR-positive, HER2-negative Breast Cancer Who Received Prior Endocrine Therapy And 1-2 Chemotherapy Regimens In The Metastatic Setting
Safety data below are based on MONARCH 1, a single-arm, open-label, multicenter study in 132 women with measurable HR-positive, HER2-negative metastatic breast cancer. Patients received 200 mg VERZENIO orally twice daily until development of progressive disease or unmanageable toxicity. Median duration of treatment was 4.5 months.
Ten patients (8%) discontinued study treatment from adverse reactions due to (1 patient each) abdominal pain, arterial thrombosis, aspartate aminotransferase (AST) increased, blood creatinine increased, chronic kidney disease, diarrhea, ECG QT prolonged, fatigue, hip fracture, and lymphopenia. Forty-nine percent of patients had dose reductions due to an adverse reaction. The most frequent adverse reactions that led to dose reductions were diarrhea (20%), neutropenia (11%), and fatigue (9%).
Deaths during treatment or during the 30-day follow up were reported in 2% of patients. Cause of death in these patients was due to infection.
The most common reported adverse reactions (≥20%) were diarrhea, fatigue, nausea, decreased appetite, abdominal pain, neutropenia, vomiting, infections, anemia, headache, and thrombocytopenia (Table 10). Severe (Grade 3 and 4) neutropenia was observed in patients receiving abemaciclib.
Table 5: Adverse Reactions (≥10% of Patients) in MONARCH 1
| VERZENIO N=132 |
|||
| All Grades % |
Grade 3 % |
Grade 4 % |
|
| Gastrointestinal Disorders | |||
| Diarrhea | 90 | 20 | 0 |
| Nausea | 64 | 5 | 0 |
| Abdominal pain | 39 | 2 | 0 |
| Vomiting | 35 | 2 | 0 |
| Constipation | 17 | <1 | 0 |
| Dry mouth | 14 | 0 | 0 |
| Stomatitis | 14 | 0 | 0 |
| Infections and Infestations | |||
| Infections | 31 | 5 | 2 |
| General Disorders and Administration Site Conditions | |||
| Fatiguea | 65 | 13 | 0 |
| Pyrexia | 11 | 0 | 0 |
| Blood and Lymphatic System Disorders | |||
| Neutropeniab | 37 | 19 | 5 |
| Anemiac | 25 | 5 | 0 |
| Thrombocytopeniad | 20 | 4 | 0 |
| Leukopeniae | 17 | 5 | <1 |
| Metabolism and Nutrition Disorders | |||
| Decreased appetite | 45 | 3 | 0 |
| Dehydration | 10 | 2 | 0 |
| Respiratory, Thoracic and Mediastinal Disorders | |||
| Cough | 19 | 0 | 0 |
| Musculoskeletal and Connective Tissue Disorders | |||
| Arthralgia | 15 | 0 | 0 |
| Nervous System Disorders | |||
| Headache | 20 | 0 | 0 |
| Dysgeusia | 12 | 0 | 0 |
| Dizziness | 11 | 0 | 0 |
| Skin and Subcutaneous Tissue Disorders | |||
| Alopecia | 12 | 0 | 0 |
| Investigations | |||
| Creatinine increased | 13 | <1 | 0 |
| Weight decreased | 14 | 0 | 0 |
| a Includes asthenia, fatigue. b Includes neutropenia, neutrophil count decreased. c Includes anemia, hematocrit decreased, hemoglobin decreased, red blood cell count decreased. d Includes platelet count decreased, thrombocytopenia. e Includes leukopenia, white blood cell count decreased. |
|||
Table 6: Laboratory Abnormalities for Patients Receiving VERZENIO in MONARCH 1
| VERZENIO N=132 |
|||
| All Grades % |
Grade 3 % |
Grade 4 % |
|
| Creatinine increased | 98 | <1 | 0 |
| White blood cell decreased | 91 | 28 | 0 |
| Neutrophil count decreased | 88 | 22 | 5 |
| Anemia | 68 | 0 | 0 |
| Lymphocyte count decreased | 42 | 13 | <1 |
| Platelet count decreased | 41 | 2 | 0 |
| ALT increased | 31 | 3 | 0 |
| AST increased | 30 | 4 | 0 |
Creatinine Increased
Abemaciclib has been shown to increase serum creatinine due to inhibition of renal tubular secretion transporters, without affecting glomerular function. In clinical studies, increases in serum creatinine (mean increase, 0.2-0.3 mg/dL) occurred within the first 28-day cycle of VERZENIO dosing, remained elevated but stable through the treatment period, and were reversible upon treatment discontinuation. Alternative markers such as BUN, cystatin C, or calculated GFR, which are not based on creatinine, may be considered to determine whether renal function is impaired.
Postmarketing Experience
The following adverse reactions have been identified during post-approval use of VERZENIO. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
Respiratory disorders: Interstitial lung disease (ILD)/pneumonitis.
SRC: NLM .