Indications

Mantle Cell Lymphoma: Ibrutab is indicated for the treatment of patients with Mantle Cell Lymphoma (MCL) who have received at least one prior therapy.

Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma: Ibrutab is indicated for the treatment of patients with chronic lymphocytic leukemia. Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma with 17p deletion Ibrutab is indicated for the treatment of patients with chronic lymphocytic leukemia.

Waldenstrom Macroglobulinemia (WM): Ibrutab is indicated for the treatment of patients with Waldenstrom Macroglobulinemia (WM).

Marginal Zone Lymphoma: Ibrutab is indicated for the  reatment of patients with marginal zone lymphoma (MZL) who require systemic therapy and have received at least one prior anti-CD 20-based therapy.

Pharmacology

Ibrutinib is a small-molecule inhibitor of BTK. Ibrutinib forms a covalent bond with a cysteine residue in the BTK active site, leading to inhibition of BTK enzymatic activity. BTK is a signaling molecule of the B-cell antigen receptor (BCR) and cytokine receptor pathways. BTK’s role in signaling through the B-cell surface receptors results in activation of pathways necessary for B-cell trafficking, chemotaxis, and adhesion. Nonclinical studies show that ibrutinib inhibits malignant B-cell proliferation and survival in vivo as well as cell migration and substrate adhesion in vitro.

Dosage

Mantle Cell Lymphoma and Marginal Zone Lymphoma: The recommended dose of Ibrutinib for MCL and MZL is 560 mg (four 140 mg capsules) orally once daily until disease progression or unacceptable toxicity.

Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma and Waldenstrom Macroglobulinemia (WM): The recommended dose of Ibrutinib for CLL/SLL and WM is 420 mg (three 140 mg capsules) orally once daily until disease progression or unacceptable toxicity. The recommended dose of Ibrutinib for CLL/SLL when used in combination with bendamustine and rituximab (administered every 28 days for up to 6 cycles) is 420 mg (three 140 mg capsules) orally once daily until disease progression or unacceptable toxicity.

Administration

Administer Ibrutinib orally once daily at approximately the same time each day.

Swallow the capsules whole with water. Do not open, break, or chew the capsules.

Interaction

CYP3A Inhibitors: Co-administration with strong and moderate CYP3A inhibitors should be avoided. If a moderate CYP3A inhibitor must be used, Ibrutab dose should be reduced 

CYP3A Inducers: Co-administration with strong CYP3A inducers should be avoided

Contraindications

Hypersensitivity to the active substance or to any of the excipients.

Side Effects

The following adverse reactions are discussed in more detail in other sections of the labeling: Hemorrhage, Infections, Cytopenias, Atrial Fibrillation, Hypertension, Second Primary Malignancies and Tumor Lysis Syndrome. Additional Important Adverse Reactions: Diarrhea, Visual Disturbance.

Pregnancy & Lactation

Pregnancy: Ibrutinib, a kinase inhibitor, can cause fetal harm based on findings from animal studies. In animal reproduction studies, administration of Ibrutinib to pregnant rats and rabbits during the period of organogenesis at exposures up to 2-20 times the clinical doses of 420-560 mg daily produced embryofetal toxicity including malformations. If Ibrutinib is used during pregnancy or if the patient becomes pregnant while taking Ibrutinib, the patient should be apprised of the potential hazard to the fetus. The estimated background risk of major birth defects and miscarriage for the indicated population is unknown.

Lactation: There is no information regarding the presence of Ibrutinib or its metabolites in human milk, the effects on the breast fed infant, or the effects on milk production.

Use in Special Populations

Pediatric Use: The safety and effectiveness of Ibrutab in pediatric patients has not been established.

Geriatric Use: Of the 905 patients in clinical studies of Ibrutab, 62% were ≥ 65 years of age, while 21% were ≥75 years of age. No overall differences in effectiveness were observed between younger and older patients. Anemia (all grades) and Grade 3 or higher pneumonia occurred more frequently among older patients treated with Ibrutab.

Hepatic Impairment: Ibrutab is metabolized in the liver. In a hepatic impairment study, data showed an increase in Ibrutab exposure. The safety of Ibrutab has not been evaluated in cancer patients with mild to severe hepatic impairment by Child-Pugh criteria. Monitor patients for signs of Ibrutab toxicity and follow dose modification guidance as needed. It is not recommended to administer Ibrutab to patients with moderate or severe hepatic impairment.

Overdose Effects

There is no specific experience in the management of Ibrutab over dose in patients. One healthy subject experienced reversible Grade 4 hepatic enzyme increases (AST and ALT) after a dose of 1680 mg. Closely monitor patients who ingest more than the recommended dosage and provide appropriate supportive treatment.

Storage Conditions

Store in a dry place below 30°C, protect from light. Keep out of the reach of children.