Leukemias, lymphomas, and other hematologic cancers:
Indications for: BRUKINSA
Mantle cell lymphoma (MCL) in adults who have received at least one prior therapy. Waldenström’s macroglobulinemia (WM) in adults. Relapsed or refractory marginal zone lymphoma (MZL) in adults who have received at least one anti-CD20-based regimen. Chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) in adults.
Swallow whole with water. 160mg twice daily or 320mg once daily until disease progression or unacceptable toxicity. Severe hepatic impairment: 80mg twice daily. Concomitant strong CYP3A inhibitors: 80mg once daily. Concomitant moderate CYP3A inhibitors: 80mg twice daily. Concomitant moderate CYP3A inducers (if unavoidable): increase dose to 320mg twice daily. Dose modifications for adverse reactions: see full labeling.
Risk for serious hemorrhagic events (monitor); consider the benefit/risk of withholding treatment for 3–7 days pre- and post-surgery. Monitor for fever, infections; treat appropriately if occurs. Consider prophylaxis for opportunistic infections in high risk patients. Monitor for cytopenias; obtain CBCs during therapy; interrupt, reduce dose, or discontinue as warranted. Monitor for cardiac arrhythmias (esp. in those with cardiac risk factors, hypertension, acute infections); manage appropriately. Second primary malignancies (eg, skin cancer, solid tumors, hematologic, others); advise to use sun protection; monitor. On dialysis, hepatic impairment: monitor. Embryo-fetal toxicity. Advise females and males of reproductive potential to use effective contraception during and for 1 week after the last dose. Pregnancy: exclude status prior to initiation. Nursing mothers: not recommended (during and for 2 weeks after the last dose).
Bruton tyrosine kinase (BTK) inhibitor.
Concomitant moderate or strong CYP3A inducers may reduce zanubrutinib efficacy (eg, rifampin, efavirenz); avoid use. If concomitant moderate CYP3A inducers is unavoidable, increase zanbrutinib dose (see Adults). Concomitant moderate or strong CYP3A inhibitors may increase risk of toxicities (eg, itraconazole, fluconazole, erythromycin); reduce zanubrutinib dose (see Adults). Increased risk of hemorrhage with concomitant antiplatelets or anticoagulants; monitor.
Neutrophil count decreased, upper respiratory tract infection, platelet count decreased, rash, hemorrhage, musculoskeletal pain, hemoglobin decreased, bruising, diarrhea, pneumonia, cough.
Fecal (87%), renal (8%). Mean half-life: ~2–4 hours.
Generic Drug Availability: