VYLOY dosing and administration: aligning with selected chemotherapy dosing schedule.¹

INDICATION

VYLOY^® (zolbetuximab-clzb), in combination with fluoropyrimidine- and platinum-containing chemotherapy, is indicated for the first-line treatment of adults with locally advanced unresectable or metastatic human epidermal growth factor receptor 2 (HER2)-negative gastric or gastroesophageal junction (GEJ) adenocarcinoma whose tumors are claudin (CLDN) 18.2 positive as determined by an FDA-approved test.

IMPORTANT SAFETY INFORMATION

WARNINGS AND PRECAUTIONS

Hypersensitivity reactions, including serious anaphylaxis reactions, and serious and fatal infusion-related reactions (IRR) have been reported in clinical studies when VYLOY has been administered. Any grade hypersensitivity reactions, including anaphylactic reactions, occurring with VYLOY in combination with mFOLFOX6 or CAPOX was 18%. Severe (Grade 3 or 4) hypersensitivity reactions, including anaphylactic reactions, occurred in 2% of patients. Seven patients (1.3%) permanently discontinued VYLOY for hypersensitivity reactions, including two patients (0.4%) who permanently discontinued VYLOY due to anaphylactic reactions. Seventeen (3.2%) patients required dose interruption, and three patients (0.6%) required infusion rate reduction due to hypersensitivity reactions. All grade IRRs occurred in 3.2% in patients administered VYLOY in combination with mFOLFOX6 or CAPOX. Severe (Grade 3) IRRs occurred in 2 (0.4%) patients who received VYLOY. An IRR led to permanent discontinuation of VYLOY in 2 (0.4%) patients and dose interruption in 7 (1.3%) patients. The infusion rate was reduced for VYLOY for 2 (0.4%) patients due to an IRR. Monitor patients during infusion with VYLOY and for 2 hours after completion of infusion or longer if clinically indicated, for hypersensitivity reactions with symptoms and signs that are highly suggestive of anaphylaxis (urticaria, repetitive cough, wheeze, and throat tightness/change in voice). Monitor patients for signs and symptoms of IRRs, including nausea, vomiting, abdominal pain, salivary hypersecretion, pyrexia, chest discomfort, chills, back pain, cough, and hypertension. If a severe or life-threatening hypersensitivity or IRR reaction occurs, discontinue VYLOY permanently, treat symptoms according to standard medical care, and monitor until symptoms resolve. For any Grade 2 hypersensitivity or IRR, interrupt the VYLOY infusion until Grade ≤1, then resume at a reduced infusion rate for the remaining infusion. Follow Grade 2 management for Grade 3 infusion-related nausea and vomiting. Premedicate the patient with antihistamines for the subsequent infusions, and closely monitor the patient for symptoms and signs of a hypersensitivity reaction. The infusion rate may be gradually increased as tolerated.

Please see Important Safety Information continued in this video and full Prescribing Information at VYLOYhcp.com.

NURSE 1: As long as I’ve been an oncology nurse, it still gets to me every time I see a patient for their first cancer treatment infusion. The worry on their face breaks my heart.

NURSE 2: I feel the same. They don’t know what to expect, or how they’ll feel. It’s a lot of unknowns.

NURSE 1: But you know what? When I’ve done my homework, I can help my patients be better prepared for infusion day.

NURSE 2: I know, there are several VYLOY resources that have helped me learn what to expect and how to support my patients.

NURSE 1: You know what works for me? I took those resources and came up with an infusion-day check list to help keep me organized.

NURSE 2: How’s that work?

NURSE 1: First I start with the technical things I need to do as far as the infusion goes—like checking the IV line.

NURSE 1: I always make sure I’m using the recommended in-line filter and that I do not co-administer other drugs through the same infusion line as VYLOY.

NURSE 2: But what about patients who have central ports?

NURSE 1: From what I’ve read, no incompatibilities have been observed with closed system transfer devices or central ports with certain materials. The Prescribing Information has the full details.

NURSE 2: That’s really helpful to know.

NURSE 2: So what’s next on your checklist?

NURSE 1: I double check the prepared infusion bag and note the time. The prepared infusion bag can be kept at room temperature, 15 to 30 degrees Celsius or 59 to 86 degrees Fahrenheit, for no longer than 6 hours, from the end of the preparation of the infusion bag to the completion of the infusion. Once I’m done, I start with my patient checklist.

NURSE 2: I bet I know where that starts...

BOTH: Premedication.

NURSE 1: Absolutely. These patients can be pretty sick, so I always ask how they’re feeling, especially if it’s their first infusion.

NURSE 1: If they tell me they’re nauseated or they’ve been vomiting, I make sure their symptoms are reduced to Grade 1 or less before we start the first infusion.

VYLOY is emetogenic. In clinical trials, the median time to onset of nausea and/or vomiting was within the first hour after starting the VYLOY infusion. It’s important that patients are premedicated with a combination of antiemetics like NK-1 and/or 5-HT3 receptor blockers, as well as other drugs as indicated, for the prevention of nausea and vomiting. Keep in mind that there are no contraindications for VYLOY. I always let my patients know in advance that they can expect premedication with every VYLOY infusion.

NURSE 2: I think that’s a big reassurance for the patient...to know that we’re doing everything we can to help them.

NURSE 1: Exactly...and if they do experience Grade 2 or 3 nausea or vomiting, I’ll stop the infusion until the symptoms are resolved to Grade 1 or less. Then I resume the infusion at a reduced infusion rate for the remaining infusion. If the patient experiences Grade 4 vomiting, I need to immediately stop the infusion and permanently discontinue VYLOY.

NURSE 1: The prescribing information shows the infusion rates for first and subsequent infusions. I like to use this information to help patients understand how long their infusions might take.

I explain that their first VYLOY dose may take longer than their next infusions—and that all VYLOY infusions start at a slower rate for the first 30 to 60 minutes to help minimize the risk of adverse reactions. For example, for their first VYLOY infusion, the initial infusion rate will be 100 milligrams per meter squared per hour the first 30 to 60 minutes. If there are no adverse reactions after 30 to 60 minutes, the infusion can be increased to the Subsequent Infusion Rate shown in the Prescribing Information as tolerated.

NURSE 1: How long each infusion lasts depends on different things, including potential infusion interruptions or rate modifications. The first infusion is estimated to take a minimum of 3 and a half hours. Subsequent infusions are estimated to take a minimum of 2 and a half hours.

NURSE 2: That’s good to know because infusion days can be pretty long, so it helps to be able to give patients and caregivers an idea of what to expect.

NURSE 1: Oh! That reminds me... I always check to see if my patient is getting VYLOY and chemo on the same day. If so, VYLOY must be administered first.

NURSE 2: Thanks for all the great advice. I have a patient starting on VYLOY tomorrow. Mind if I use some of your ideas?

NURSE 1: Sure. I’ll bill you later.

(BOTH LAUGH)

NURSE 1: Just to recap, here are a few important things to remember.

Make sure the prepared VYLOY infusion bag is stored no longer than 6 hours at room temperature from the end of the preparation of the infusion bag to the completion of the infusion.

VYLOY is emetogenic. The most common adverse reactions were nausea and vomiting. Patients have to be premedicated with a combination of antiemetics like NK-1 and/or 5-HT3 receptor blockers as well as other drugs as clinically indicated. We can refer to the Prescribing Information for details. 

The infusion should start at a slower rate for the first 30 to 60 minutes. If tolerated, we can gradually increase the rate as recommended. 

If nausea and vomiting become Grade 2 or 3, stop the infusion. Once the symptoms are Grade 1 or less, restart it at a reduced infusion rate for the remaining infusion.

NURSE 1: You can find all of this in the VYLOY Prescribing Information.

NURSE 2: I’m so glad we talked. I know when I feel good about things, I can make a difference for my patient, too. Thanks!

NURSE 1: You’ve got this.

IMPORTANT SAFETY INFORMATION (continued)

WARNINGS AND PRECAUTIONS (continued)

Severe Nausea and Vomiting. VYLOY is emetogenic. Nausea and vomiting occurred more often during the first cycle of treatment. All grade nausea and vomiting occurred in 82% and 67% respectively of patients treated with VYLOY in combination with mFOLFOX6 and 69% and 66% in combination with CAPOX, respectively. Severe (Grade 3) nausea occurred in 16% and 9% of patients treated with VYLOY in combination with mFOLFOX6 or CAPOX respectively. Severe (Grade 3) vomiting occurred in 16% and 12% of patients treated with VYLOY in combination with mFOLFOX6 or CAPOX. Nausea led to permanent discontinuation of VYLOY in combination with mFOLFOX6 or CAPOX in 18 (3.4%) patients and dose interruption in 147 (28%) patients. Vomiting led to permanent discontinuation of VYLOY in combination with mFOLFOX6 or CAPOX in 20 (3.8%) patients and dose interruption in 150 (28%) patients. Pretreat with antiemetics prior to each infusion of VYLOY. Manage patients during and after infusion with antiemetics or fluid replacement. Interrupt the infusion, or permanently discontinue VYLOY based on severity.

ADVERSE REACTIONS

Most common adverse reactions (≥15%): Nausea, vomiting, fatigue, decreased appetite, diarrhea, peripheral sensory neuropathy, abdominal pain, constipation, decreased weight, hypersensitivity reactions, and pyrexia.

Most common laboratory abnormalities (≥15%): Decreased neutrophil count, decreased leucocyte count, decreased albumin, increased creatinine, decreased hemoglobin, increased glucose, decreased lymphocyte count, increased aspartate aminotransferase, decreased platelets, increased alkaline phosphatase, increased alanine aminotransferase, decreased glucose, decreased sodium, increased phosphate, decreased potassium, and decreased magnesium.

SPOTLIGHT Study: 279 patients with locally advanced unresectable or metastatic HER2-negative gastric or GEJ adenocarcinoma whose tumors were CLDN18.2 positive who received at least one dose of VYLOY in combination with mFOLFOX6

Serious adverse reactions occurred in 45% of patients treated with VYLOY in combination with mFOLFOX6; the most common serious adverse reactions (≥2%) were vomiting (8%), nausea (7%), neutropenia (2.9%), febrile neutropenia (2.9%), diarrhea (2.9%), intestinal obstruction (3.2%), pyrexia (2.5%), pneumonia (2.5%), respiratory failure (2.2%), pulmonary embolism (2.2%), decreased appetite (2.1%) and sepsis (2.0%). Fatal adverse reactions occurred in 5% of patients who received VYLOY in combination with mFOLFOX6 including sepsis (1.4%), pneumonia (1.1%), respiratory failure (1.1%), intestinal obstruction (0.7%), acute hepatic failure (0.4%), acute myocardial infarction (0.4%), death (0.4%), disseminated intravascular coagulation (0.4%), encephalopathy (0.4%), and upper gastrointestinal hemorrhage (0.4%). Permanent discontinuation of VYLOY due to an adverse reaction occurred in 20% of patients; the most common adverse reactions leading to discontinuation (≥2%) were nausea and vomiting. Dosage interruptions of VYLOY due to an adverse reaction occurred in 75% of patients; the most common adverse reactions leading to dose interruption (≥5%) were nausea, vomiting, neutropenia, abdominal pain, fatigue, and hypertension.

GLOW Study: 254 patients with locally advanced unresectable or metastatic HER2-negative gastric or GEJ adenocarcinoma whose tumors were CLDN18.2 positive who received at least one dose of VYLOY in combination with CAPOX

Serious adverse reactions occurred in 47% of patients treated with VYLOY in combination with CAPOX; the most common serious adverse reactions (≥2%) were vomiting (6%), nausea (4.3%), decreased appetite (3.9%), decreased platelet count (3.1%), upper gastrointestinal hemorrhage (2.8%), diarrhea (2.8%), pneumonia (2.4%), pulmonary embolism (2.3%), and pyrexia (2.0%). Fatal adverse reactions occurred in 8% of patients who received VYLOY in combination with CAPOX including sepsis (1.2%), pneumonia (0.4%), death (0.8%), upper gastrointestinal hemorrhage (0.8%), cerebral hemorrhage (0.8%), abdominal infection (0.4%), acute respiratory distress syndrome (0.4%), cardio-respiratory arrest (0.4%), decreased platelet count (0.4%), disseminated intravascular coagulation (0.4%), dyspnea (0.4%), gastric perforation (0.4%), hemorrhagic ascites (0.4%), procedural complication (0.4%), sudden death (0.4%), and syncope (0.4%). Permanent discontinuation of VYLOY due to an adverse reaction occurred in 19% of patients; the most common adverse reaction leading to discontinuation (≥2%) was vomiting. Dosage interruption of VYLOY due to an adverse reaction occurred in 55% of patients; the most common adverse reactions leading to dose interruption (≥2%) were nausea, vomiting, neutropenia, thrombocytopenia, anemia, fatigue, infusion-related reaction, and abdominal pain.

SPECIFIC POPULATIONS

Lactation Advise lactating women not to breastfeed during treatment with VYLOY and for 8 months after the last dose.

Please see Important Safety Information and full Prescribing Information at VYLOYhcp.com.

Find more videos, information on VYLOY, and other resources at VYLOYhcp-dot-com.