`
`Developed urderthedirectioniidsponsnrstfii ufGenerrtech, it...
`
`
` lm rtantSa lnfonnab'on | Full Prescribin Information
`
`
`Brand Alert - Article Page
`
`IDKadcgla
`
`ado-iiirasiuzumab emiansine
`or njssiior
`
`KADCYLA® (ado-trastuzumab emtansine) was
`
`designed to maintain the HERZ suppression and
`
`anticancer activities of trastuzumab and to provide the
`
`cytotoxic strength of Dlitl11
`
`
`
`Learn the full MBA story on KADGYLA.com
`
`
`Indication
`
`KADE‘I'LA“ [ado—bastuaurnab errrlansinel. as a single agent, is indicated for the treatment of patients with HERZ—
`positive [HERE-r]. metastatic breast cancer [BBC] who previously received trastuzumab and a taxane, separately
`or in combination. Patients should have either:
`
`- Received prior therapy for metastatic disease, or
`- Developed disease recunence during or within six months of completing adirrvant ttrerapy
`
`Proposed mechanism of action, based on preclinical models'
`
`HERE binding
`KADCYLA selectively Ends to HERE receptor at subdtlma'l'l I‘v"
`
`2 Trastuzumab activities
`
`Inhibits HER2 receptor signaling
`
`-
`
`- Triggers the ADGC immune response
`
`-
`
`lnhirits HER2 shedding
`
`internalization
`
`Once bound, the ICADGYLNHERQ receptor complex is
`internaiaed vrl endocytosis
`
`DMt" release
`
`is degraded inside the hrmor to release [Hult
`
`5 DMt" cytotoxicity
`
`DMt binds to microtubuies and Tnhdrits their polymerization, causing
`cell—cycle arrest and cell death
`
`HADE‘I'LA
`
`Immune Call
`
`
`
`N ADETLA
`
`out
`
`Microtubules
`
`ADGC=aItitdey-dopem:lent cell-mediated cytotoxirjty.
`*Gylottoric crewman“; cataboiiles [prirrrtu'ly lysine-tunnd my.
`
`Important Safety Information
`
`Boxed WARNINGS: HEPAToToxlcrrY, CARDIAC Tuxlcrrv, EllElR‘l'D—FEI'AL Toxlclrv
`
`- Do Hot Substitute KADEYLA for or with Trastuzllllah
`
`-
`
`t-tepatotoxicity: Serious hepatotoxicity has been reported, including liver failure and death in patients
`treated wittr KADE‘ftA. Monitor serum transaninases and bilirubin priorto initiation of KADC‘I'LA
`treatment and prior to each KADE‘ftA dose. Reduce dose or discontinue KADC‘I'LA as appropriate in
`cases of increased semm transaminases or total bilinrbin
`
`- Cardiac Toxicity: KADC‘I'LA administration may lead to reductions in left ventricularejeclion fraction
`[Lil'EF]. Evaluate left ventricularfun-ction in all patients prior to and during beabnent with KADE‘l'lA.
`Withhold treatment for clinically significant decrease in leftventricular function
`
`- Embryo-Fetal Toxicity: Exposure to KADC‘I'LA can result in embryo-fetal death or birth defects. Advise
`patients of these risks and the need for effective contraception
`
`Additional Important Safety Information
`
`Left Venbicuiar Dysfunction [LHDJ
`
`- Patients treated with KADCYLA are at increased risk of developing L‘v'D. In EMILIAH L'ir'D occurred in 1.8% of
`patients in the KADD‘I'LA—h'eated group and in 3.3% in the comparator group. Pennanentty disconfinue KADGYLA
`if L‘v'EF has not improved or has declined further
`
`Pregnancy Registry
`
`- Advise patients to contact their healthcare provider immediately if they suspect they may be pregnant Encourage
`women who may be exposed to KADGYLA during pregnancy to enrol in the Mott-EER Pregnancy Registry by
`contacting t-Bflfl-d-Qfl-di’m
`
`Pulnonary Toxicity
`
`- Cases of interstitiai [ung disease [ILDL including pneumonilis, some leading to acute respiatory distress synd'ome
`orfatal outcome have been reported it clinicat trials with KADCYLA In EMIIJA, the overall tremency of
`pneumonilis was 1.2%
`
`- Treatment with KADGYLA should be pemranentiy {Escontinued in patients diagnosed with ILD or pneurnonitis
`
`Infusion-Related Reactions. Hypersensitivity Reactions
`
`- Treatment with ICAD-GYLA has not been sturied in patients who had trastuzumab permanently discontinued the to
`infusion-related reactions {IRE} andl'or hypemnsiliviy reactions; treatment with ICADCYLA is not recommended
`for these patients. In EMIIJA, the overall frequency of IRRs in patients treated with KADGYLA was 1.455
`
`- KADCYLA treatment should be intemrpted in patients with severe IR and pennanentty discontinued 'II the event
`of a life-threatening IRR. Patients should be closely monitored for IRR reactions, especialiy during the fist inhrsion
`
`Thrombocytopenia
`
`-
`
`In EMIIJA, the incidence of 2 Grade 3 thrombocytopenia was 145.5% in the KADGYLA-h'eated group and {1.4% in
`the comparator group [overall incidence 31.2% and 3.3%, respectively]:
`
`- Monitor platelet counts prior to initiation of KADCYLA and prior to each KADCYLA dose lnstihrte dose
`modifications as appropriate
`
`tteurotoxicity
`
`-
`
`In EMIIJA, the incidence of 2 Grade 3 peripheral neuropathy was 2.2% in the KADGYLA—treated group and H.255 in
`the comparator group [overall incidence 21.2% and 13.5%, respectivei'y]:
`
`- Monitor for signs or symptonrs of neurotoxicty. KADCYLA shouid be temporariiy riscontilued in patients
`experiencing Grade 3 or at peripherai neuropathy until resolution to 5 Grade 2
`
`HER2 Testing
`
`- Detection of HER2 protein overexpression or gene amplification is necessary for selection of patients appropriate
`for KADCYLA Perform ushg FDA approved tesls by laboratories with demonstrated proficiency
`
`Extravasation
`
`-
`
`In RADGYLA clinical studies, reaclions secondary to extravasation have been observed and were generally mild.
`The intusion site shouid be dosely monitored for possible subcutaneous infiltration dining ol'ug adninistration.
`Specific treatment tor ICADGYLA extravasalion is unknown
`
`Nursing Mothers
`
`- Discontinue nursing or {Escontinue KADGYLAtaIdng into consideration the inportance of the dug to the mother
`
`Adverse Reactions
`
`- The most common ADRs seen with KADGYLA in EhlllJA [frequency a 25%} were nausea, fatigue,
`musculosireletat pain, thromhocytopenia, increased transaminases, headache, and constipation. The rrrost
`common NCI-CTCAE [version 312 Grade 3 ADRs [frequency 2:256] were thrombocytopenia, increased
`transarninases, anemia, hypoiralemia, peripheral neuropathy and fafigrre
`
`You are encouraged to report side effects to Genentech and the FDA You may contact Genentech by eating 1-383-335—
`2555. You may contact the FDA by visiting wmvjdagovtmedwatch or calling 1-3flb—FDA—1D83.
`
`Cliclr here forfull Prescribing Information for additional important safety information, including Boxed
`WARNINGS.
`
`Reference: 1. KADGYEA Pres-raib'lig lnforrnation. Genentech, Inc. May 2|]13.
`
`G 2013 Genentech USA. Inc. All riglrts resenred. TDMflthtElo—ft Ill}
`Genentedi USA. Inc.
`
`1 DNA Way
`Semi San ancisco, CA.
`941W
`
`Genentech
`:‘I
`.Hr‘rtibr’r' [PJ'- i'tlr’ Rustin |.',:'r'{:lrrJ|':I
`
`IMMUNOGEN 2234, pg. 1
`Phigenix v. Immunogen
`|PR2014—00676
`
`IMMUNOGEN 2234, pg. 1
`Phigenix v. Immunogen
`IPR2014-00676
`
`
`
`IHFDRIIIATIDH FRO" IH DUSTR‘I'
`
`Session Generated View
`
`),__) Kadcgla
`
`ado-ttirastuzumab elmansine
`:‘IIIc
`||'i'El:I
`
`
`
`KADCYLA‘E' (ado-trastuzumab emtansine) was designed to
`
`maintain the HER2 suppression and anticancer activities of
`
`trastuzumab and to provide the cytotoxic strength of IZJl'iil11
`
`Learn the 1l‘ull MBA story on KADCYLAcom
`
`Indication
`
`KAEICYLAE' [ado-trastuzu malJ emtansine}, as a single agent, is indicated for the treatment of patients with HERE-positive [HER2+]_.
`metastatic breast cancer [MEC] 1.vho previously received trastuzumab and a taxane, separately or in combination. Patients should
`have either:
`
`- Received prior therapy for meta static disease. or
`
`IMMUNOGEN 2234, pg. 2
`Phigenix v. Immunogen
`IPR2014-00676
`
`
`
`KADCYLA‘E tadc-trastuzumab emtansinei, as a single agentI is indicated far the treatment at patients with H ER2_pasitiv'e {HERB},
`metastatic: breast cancer {l'IilElCi who previpuslv received trastuzumab and a taxane, separately.r er in cdrnbiitatid rr. Patients shculd
`have either:
`
`IHFURHA'IIDII FRIEH IIIDU STR‘I'
`
`g If '
`Tfi was
`
`aft...
`
`.E
`
`1* I
`
`- Received pricr therapv fcr metastatic disease! or
`- Develcped disease recurrence during cr within six months cf campleting adjuvant therapy
`
`-..-""
`
`Proposed mechanism of action, based on preclinical mantle-la1
`
`tivelv binds ta HERE receptc-r at subdamain |‘-.-"
`
`~
`
`a
`
`‘
`'
`HERE
`
`"I
`
`_
`
`I
`
`I _
`
`I
`
`:5: HERE shedding
`
`lubE'I'Ll.
`
`I
`.-
`
`:
`
`‘I
`
`Immn: Call
`
`'& HERE
`i“ "-
`
`I.
`
`!
`
`“'-
`
`IMMUNOGEN 2234, pg. 3
`Phigenix v. Immunogen
`IPR2014-00676
`
`
`
`'1
`
`intern a] izatien
`
`IHFDRIIIA'I'IDN FRUIII IN DUSTR‘I'
`
`Once bound, the KADCW'LNHERE resents!" complex is internalized via endeaytasis
`
`DM1 i: release
`
`is degraded inside the In mar to release DM1
`
`DMI
`
`DM‘I": cytotoxicity
`[mil binds to mieretubuies and inhibits their polymerization, causing eell—qrde arrest
`and cell death
`
`HADETLA
`
`{
`
`Ill-ii.
`
`Hitrntuhuies
`
`IMMUNOGEN 2234, pg. 4
`Phigenix v. Immunogen
`IPR2014-00676
`
`
`
`IHFDRIIIATI'DN FRUIII IN DUSTR‘I'
`
`ADCC=anlihody-dependenI cell-medialecl cytotoxicity.
`”Cytotoxic DM't-containing catatiolites {primarily lysine-bound cmtansine}.
`
`Important Safety Information
`
`Boxed WARNING S: HEPATUTDKICITY. CARDIAC TOXICITY, EMBRYG—FETAL TICIJtIlZII‘i't'r
`
`- Do Not Substitute KADIIYLA for or with Trastuzumah
`
`Cardiac Toxicity: KADCYLA administration may lead to reductions in left ventricular ejection fraction [L'v'EFL Evaluate left
`ventricular function in all patients prior to and during treatment Iillrith KADCYLA. Withheld treatment for clinically significant
`decrease in left ventricular function
`
`Embryo—Fetal Toxicity: Exposure to KADCYLA can result in embryo—fetal death or birth defects. Advise patients of these risks
`and the need for effective contraception
`
`Hepatotoxicity: Serious hepatotoxicity has been reported, including liverfailure and death in patients treated with KADCYLA.
`Monitor serum transaminases and hilirubin prior to initiation of KADCYLA treatment and prior to each KADCYLA dose. Reduce
`dose or discontinue KADCYLA as appropriate in cases of increased serum transaminases or total hiliruhin
`
`
`
`Additional Important Safety Information
`
`Left 1il'entricula r Dysfu nction [LVD]
`
`- Patients treated with KADC‘FLA are at increased risit of developing L'v'D. In Eh-iILIA. LIFE: occurred in 1.3% of patients: in the KADC‘r'L-i‘t-
`treated group and in 3.3942.
`in the comparator group. Permanently discontinue ItADC‘r’L-Et if Lv'EF has not improved or has declined further
`
`Pregnancy Registry
`
`IMMUNOGEN 2234, pg. 5
`Phigenix v. Immunogen
`IPR2014-00676
`
`
`
`- Advise patients to contact their healthcare provider immediately if they suspect they may be pregnant. Encourage women who may he
`exposed to KADC‘r’LA during pregnancy to enroll in the tv'lotHEFt Pregnancy Ftegistry try contacting 'i—Bflfi-EiQti-EiTZD
`
`IHFDRIIIATI'DN FRUIII IN DUSTR‘I'
`
`Pulmonary Toxicity
`
`-
`
`IEases of interstitial lung disease ilLEIi. including pneumonitis. some lea ding to acute respiratory distress syndrome or fatal outcome
`have been reported in clinical trials with FADCYLA. In Eh-llLli—t. the overall frequency of pneumonitis was 1.2%
`
`- Treatment with FADEW‘LA should he permanently discontinued in patients diagnosed with ILD or pneumonitis
`
`Infusion-Related Reactions, Hypersensitivity Reactions
`
`- Treatment with FADCY'LA has not been studied in patients who had trastusumah pennanentty discontinued due to infusion-related
`reactions iletRji andior hypersensitivity reactions; treatment with FADCY'LA is not recommended for these patients. In EMILIA, the overall
`frequency of lFtFts in patients: treated with FADE‘fLA was 'i.atti-:':.
`
`- KADC‘r’Li-‘t treatment should he intenupted in patients: with severe IRH and pennanentty discontinued in the event of a life-threatening
`IFtR. Patients should be closely monitored for lFtFt reactions. especially dun'ng the first infusion
`
`group {overall incidence 21..-_-..-u and 13.5%, respectively]
`
`Th rom hocytopenia
`
`-
`
`In EMILIA: the incidence of :2 Grade 3 thromhocytopenia was 'iat.5'=.i-Et in the KADCY'LA-treated group and nae-:3. in the comparator group
`{overall incidence 31.2% and 3.3%: respectively}
`
`- Monitor platelet counts prior to initiation of voteche and prior to each KADC‘r’LA dose. institute dose modifications as appropriate
`
`Neurotoxicity
`
`-
`
`In ElvtlLlifi'c the incidence of a Grade 3 peripheral neuropathy was 2.2% in the Pattim'LA—treated group and DEE-ti in the comparator
`
`IMMUNOGEN 2234, pg. 6
`Phigenix v. Immunogen
`IPR2014-00676
`
`
`
`- Monitor for signs or symptoms of neurotosicity. PEDGYLA should be temporan'ly discontinued in patients experiencing Grade :3 orsi
`peripheral neuropathy until resolution to 5: Grade 2
`
`IHFDRIIIATI'DN FRUIII IN DUSTR‘I'
`
`HER}. Testing
`
`on or gene amplification is: necessary for selection of patients appropriate for MDG‘H’LA. F'erform
`- Detection of HERE protein overespr
`using FDA approved tests by laboratories with demonstrated proficiency
`
`Extravasation
`
`-
`
`in PEDDYLA clinical studies. reactions secondary to e::e:travasation have been observed and were generally mild. The infusion site should
`be closely monitored for po.:..:.l_ule subcutaneous infiltration during dmg administration. Specific treatment for lfltDGfi'LA estravasation is
`unknown
`
`'1. KADG'y'L-E. Prescribing lnfon'nation. Genentech. Inc. I'Iday 2013-.
`
`Nursing Mothers
`
`- Discontinue nursing or discontinue FADD‘f'Li-“t tat-ting into consideration the importance of the drug to the mother
`
`Adverse Reactions
`
`25%] were nausea, fatigue. musculositeletal pain,
`- The most common ADHs seen with FUEDDTLA in EMILIA {frequency
`thrombocytopenia. increased tra nsaminases, headache. and constipation. The most common NCI-CTCAE ijversion 3} 1- Grade 3 ADRs
`{frequency :=-2s-si were thrombocytopenia. increased tra nsaminases, anemia, hypolcalemia, peripheral neuropathy and fatigue
`
`You are encouraged to report side effects to Genentech and the FDA ‘r’ou may contact Genentech by calling 1-EEa-- 5-2555. You may contact
`the FDA by visiting vnwada.govfmedwatcb or calling 'i—EiJEI—FDA—mEit-‘a.
`
`Click here for full Pi'esci'i bin
`
`Informatioi'i for additional important safety information, including Boxed WARNINGS.
`
`Reference:
`
`IMMUNOGEN 2234, pg. 7
`Phigenix v. Immunogen
`IPR2014-00676
`
`
`
`I'ilursing Mothers
`
`IHFDRIIIATI'DN FRUIII IIIIEI'USTFI‘IIr
`
`- Discontinue nursing or discontinue KADDYLPI taking into consideration the importance ofthe drug to the mother
`
`Adve rse Reactions
`
`2.5%] were nausea, fatigue. musculosI-teletal pain,
`- The most common hDFts seen with PMDC‘I'LA in EMILIA {frequenc -'
`thromhocy'topenia. increased tra nsaminases, headache. and constipation. The most common NCI-CTCAE {version 3} :- Grade 3 ADELE
`ijfrequen c1; :29st were thromhocytopenia. increased tra nsaminases, anemia, hypoltalemia, peripheral neuropaflw and fatigue
`
`You are encouraged to report side effects to Denentech and the FDH. ‘r’ou may
`the FDA by visiting trnuwtda.goirfmedwatch or calling 'i-EIJEI-FDA-HIIBE.
`
`contact Genehtech lw calling 1-333-335-2555. ‘fou may contact
`
`Click here for full Pi'ssci'i IJin
`
`Information for additional important saer information, including Eloxed WARNINGS.
`
`.‘ift'rnhe’r' of my Hr:u-‘1'o:=- Urn-“1r:-
`
`Reference:
`
`'1. KADD'H’LA Prescribing lnfonriation. Genentech. Inc. |"."|a;n.r 2013.
`
`321113 Genentech USA. Inc. All rights reserved. TE:I".|I[|[|{|'1 95T1UIJ
`Genenlech USA, Inc.
`1 Dt-h'JtWay
`South San Francisco. CA
`squad—dean
`
`Genentech
`at
`
`IMMUNOGEN 2234, pg. 8
`Phigenix v. Immunogen
`IPR2014-00676
`
`
`
`Dr hi M e [I
`
`
`sEAacH
`Medgggpe Family Medicine
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`IMMUNOGEN 2234, pg. 9
`Phigenix v. Immunogen
`IPR2014-00676
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`IMMUNOGEN 2234, pg. 9
`Phigenix v. Immunogen
`IPR2014-00676
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