Overview
11 DESCRIPTION Bosutinib tablet contains bosutinib, a kinase inhibitor. The chemical name for bosutinib is 3-Quinolinecarbonitrile, 4-[(2,4-dichloro-5-methoxyphenyl)amino]-6-methoxy-7-[3-(4-methyl-1-piperazinyl) propoxy]. Its chemical formula is C 26 H 29 Cl 2 N 5 O 3 ; its molecular weight is 530.45. Bosutinib has the following chemical structure: Bosutinib is a white to yellowish-tan powder.
Mechanism of Action
12 CLINICAL PHARMACOLOGY 12.1 Mechanism of Action Bosutinib is a TKI. Bosutinib inhibits the BCR-ABLkinase that promotes CML; it is also an inhibitor of Src-family kinases including Src, Lyn, and Hck. Bosutinib inhibited 16 of 18 imatinib-resistant forms of BCR-ABL kinase expressed in murine myeloid cell lines. Bosutinib did not inhibit the T315I and V299L mutant cells. 12.2 Pharmacodynamics A greater likelihood of response and a greater likelihood of safety events were observed with higher bosutinib exposure in clinical studies. The time course of bosutinib pharmacodynamic response has not been fully characterized.
Indications
- 1 INDICATIONS AND USAGE Bosutinib tablets are indicated for the treatment of: • Adult patients with chronic phase (CP) Philadelphia chromosome-positive chronic myelogenous leukemia (Ph+ CML), resistant or intolerant to prior therapy [see Clinical Studies (14.2)]. • Adult patients with accelerated phase (AP), or blast phase (BP) Ph+ CML with resistance or intolerance to prior therapy [see Clinical Studies (14.2)] . Pediatric use information is approved for PF PRISM CV’s BOSULIF® (bosutinib) tablets.
Common Doses
- 500 mg
- 100 mg
- 600 mg
- 400 mg
Dosage
2 DOSAGE AND ADMINISTRATION • Adult patients with chronic, accelerated, or blast phase Ph+ CML with resistance or intolerance to prior therapy: 500 mg orally once daily with food. ( 2.1 ) • Consider dose escalation by increments of 100 mg once daily to a maximum of 600 mg daily in adult patients who do not reach complete hematologic, cytogenetic, or molecular response and do not have Grade 3 or greater adverse reactions. ( 2.2 ) • Adjust dosage for toxicity and organ impairment ( 2 ) 2.1 Recommended Dosage The recommended dosage is taken orally once daily with food. Swallow tablets whole.
Contraindications
- 4 CONTRAINDICATIONS Bosutinib tablet is contraindicated in patients with a history of hypersensitivity to bosutinib. Reactions have included anaphylaxis [see Adverse Reactions (6.1)] . Hypersensitivity to bosutinib tablets. ( 4 )
Side Effects
- 6 ADVERSE REACTIONS The following clinically significant adverse reactions are discussed in greater detail in other sections of the labeling: Gastrointestinal toxicity [see Warnings and Precautions (5.1)] . Myelosuppression [see Warnings and Precautions (5.2)] . Hepatic toxicity [see Warnings and Precautions (5.3)] . Cardiovascular toxicity [see Warnings and Precautions (5.4)]. Fluid retention [see Warnings and Precautions (5.5)] . Renal toxicity [see Warnings and Precautions ( 5.6)] .
Interactions
- 7 DRUG INTERACTIONS • Strong and Moderate CYP3A Inhibitors: Avoid concomitant use with bosutinib tablets. ( 7.1 ) • Strong CYP3A Inducers: Avoid concomitant use with bosutinib tablets. ( 7.1 ) • Proton Pump Inhibitors: Use short-acting antacids or H2 blockers as an alternative to proton pump inhibitors. ( 7.1 ) 7.1 Effect of Other Drugs on Bosutinib Tablets Strong or Moderate CYP3A Inhibitors Avoid the concomitant use of strong or moderate CYP3A inhibitors with bosutinib tablets. Bosutinib is a CYP3A substrate.