Drug Class Description

Generic Name

Drug Description

Presentation

Indications

Adult Dosage

MabCampath should be administered under the supervision of a physician experienced in the use of cancer therapy.

Posology

During the first week of treatment, MabCampath should be administered in escalating doses: 3 mg on day 1, 10 mg on day 2 and 30 mg on day 3 assuming that each dose is well tolerated. Thereafter, the recommended dose is 30 mg daily administered 3 times weekly on alternate days up to a maximum of 12 weeks.

In most patients, dose escalation to 30 mg can be accomplished in 3-7 days. However, if acute moderate to severe adverse reactions such as hypotension, rigors, fever, shortness of breath, chills, rashes and bronchospasm (some of which may be due to cytokine release) occur at either the 3 mg or 10 mg dose levels, then those doses should be repeated daily until they are well tolerated before further dose escalation is attempted.

Median duration of treatment was 11.7 weeks for first-line patients and 9.0 weeks for previously treated patients.

Once a patient meets all laboratory and clinical criteria for a complete response, MabCampath should be discontinued and the patient monitored. If a patient improves (i.e. achieves a partial response or stable disease) and then reaches a plateau without further improvement for 4 weeks or more, then MabCampath should be discontinued and the patient monitored. Therapy should be discontinued if there is evidence of disease progression.

Concomitant medicinal products

Premedications

Patients should be premedicated with oral or intravenous steroids, an appropriate antihistamine and analgesic 30-60 minutes prior to each MabCampath infusion during dose escalation and as clinically indicated thereafter.

Prophylactic antibiotics

Antibiotics and antivirals should be administered routinely to all patients throughout and following treatment.

Dose modification guidelines

There are no dose modifications recommended for severe lymphopenia given the mechanism of action of MabCampath.

In the event of serious infection or severe haematological toxicity MabCampath should be interrupted until the event resolves. It is recommended that MabCampath should be interrupted in patients whose platelet count falls to < 25,000/μl or whose absolute neutrophil count (ANC) drops to < 250/μl. MabCampath may be reinstituted after the infection or toxicity has resolved. MabCampath should be permanently discontinued if autoimmune anaemia or autoimmune thrombocytopenia appears. The following table outlines the recommended procedure for dose modification following the occurrence of haematological toxicity while on therapy:

*If the delay between dosing is  7 days, initiate therapy at MabCampath 3 mg and escalate to 10 mg and then to 30 mg as tolerated

Special populations

Elderly (over 65 years of age)

Recommendations are as stated above for adults. Patients should be monitored carefully.

Patients with renal or hepatic impairment

No studies have been conducted.

Paediatric population

The safety and efficacy of MabCampath in children aged less than 17 years of age have not been established. No data are available.

Method of administration

The MabCampath solution must be prepared according to the instructions. All doses should be administered by intravenous infusion over approximately 2 hours.

Child Dosage

The safety and efficacy of MabCampath in children aged less than 17 years of age have not been established. No data are available.

Elderly Dosage

Recommendations are as stated for adults. Patients should be monitored carefully.

Contra Indications

 hypersensitivity to alemtuzumab, to murine proteins or to any of the excipients;

- patients with active systemic infections;

- patients infected with HIV;

- patients with active second malignancies;

- pregnancy.

Special Precautions

Interactions

Although no formal drug interaction studies have been performed with MabCampath, there are no known clinically significant interactions of MabCampath with other medicinal products. Because MabCampath is a recombinant humanized protein, a P450 mediated drug-drug interaction would not be expected. However, it is recommended that MabCampath should not be given within 3 weeks of other chemotherapeutic agents.

Although it has not been studied, it is recommended that patients should not receive live viral vaccines in, at least, the 12 months following MabCampath therapy. The ability to generate a primary or anamnestic humoral response to any vaccine has not been studied.

Adverse Reactions

The tables below report adverse reactions by MedDRA system organ classes (MedDRA SOCs). The frequencies are based on clinical trial data.

The most appropriate MedDRA term is used to describe a certain reaction and its synonyms and related conditions.

The frequencies are defined as: very common ( 1/10), common ( 1/100 to < 1/10), uncommon ( 1/1,000 to < 1/100), rare ( 1/10,000 to <1/1,000); very rare (<1/10,000). No information is available for events that occur at lower frequency, due to the size of the population studied; n=147 for first line treated patients and n=149 for previously treated patients.

The most frequent adverse reactions with MabCampath are: infusion reactions (pyrexia, chills, hypotension, urticaria, nausea, rash, tachycardia, dyspnoea), cytopenias (neutropenia, lymphopenia, thrombocytopenia, anaemia), infections (CMV viraemia, CMV infection, other infections), gastrointestinal symptoms (nausea, emesis, abdominal pain), and neurological symptoms (insomnia, anxiety). The most frequent serious adverse reactions are cytopenias, infusion reactions, and immunosuppression/infections.

Undesirable effects in first line patients

Safety data in first-line B-CLL patients are based on adverse reactions that occurred on study in 147 patients enrolled in a randomized, controlled study of MabCampath as a single agent administered at a dose of 30 mg intravenously three times weekly for up to 12 weeks, inclusive of dose escalation period. Approximately 97% of first-line patients experienced adverse reactions; the most commonly reported reactions in first line patients usually occurred in the first week of therapy.

Within each frequency grouping, undesirable effects observed during treatment or within 30 days following the completion of treatment with MabCampath are presented in order of decreasing seriousness.

Acute infusion reactions including fever, chills, nausea, vomiting, hypotension, fatigue, rash, urticaria, dyspnoea, headache, pruritus and diarrhoea have been reported. The majority of these reactions are mild to moderate in severity. Acute infusion reactions usually occur during the first week of therapy and substantially decline thereafter. Grade 3 or 4 infusion reactions are uncommon after the first week of therapy.

Undesirable effects in previously treated patients

Safety data in previously treated B-CLL patients are based on 149 patients enrolled in single-arm studies of MabCampath (Studies 1, 2, and 3). More than 80% of previously treated patients may be expected to experience adverse reactions; the most commonly reported reactions usually occur during the first week of therapy.

Within each frequency grouping, undesirable effects are presented in order of decreasing seriousness.

Undesirable effects observed during post-marketing surveillance

Infusion reactions: Serious and sometimes fatal reactions, including bronchospasm, hypoxia, syncope, pulmonary infiltrates, acute respiratory distress syndrome (ARDS), respiratory arrest, myocardial infarction, arrhythmias, acute cardiac insufficiency and cardiac arrest have been observed. Severe anaphylactic and other hypersensitivity reactions, including anaphylactic shock and angioedema, have been reported following MabCampath administration. These symptoms can be ameliorated or avoided if premedication and dose escalation are utilised.

Infections and infestations: Serious and sometimes fatal viral (e.g. adenovirus, parainfluenza, hepatitis B, progressive multifocal leukoencephalopathy (PML)), bacterial (including tuberculosis and atypical mycobacterioses, nocardiosis), protozoan (e.g. toxoplasma gondii), and fungal (e.g. rhinocerebral mucormycosis) infections, including those due to reactivation of latent infections have occurred during post-marketing surveillance. The recommended anti-infective prophylaxis treatment appears to be effective in reducing the risk of PCP and herpes infections.

EBV-associated lymphoproliferative disorders, in some cases fatal, have been reported.

Blood and lymphatic system disorders: Severe bleeding reactions have been reported.

Immune system disorders: Serious and sometimes fatal autoimmune phenomena including autoimmune haemolytic anaemia, autoimmune thrombocytopenia, aplastic anaemia, Guillain Barré syndrome and its chronic form, chronic inflammatory demyelinating polyradiculoneuropathy have been reported. A positive Coombs test has also been observed. Fatal Transfusion Associated Graft Versus Host Disease (TAGVHD) has also been reported.

Metabolism and nutritional disorders: Tumour lysis syndrome with fatal outcome has been reported.

Nervous system disorders: Intracranial haemorrhage has occurred with fatal outcome, in patients with thrombocytopenia.

Cardiac disorders: Congestive heart failure, cardiomyopathy, and decreased ejection fraction have been reported in patients previously treated with potentially cardiotoxic agents.

Manufacturer

Drug Availability

Updated