Jemperli

Generic Name: dostarlimab-gxly injection
Brand Name: Jemperli
Drug Class: PD-1PD-L1 Inhibitors

side effects drug center jemperli (dostarlimab-gxly injection) drug

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PROFESSIONAL CONSUMER SIDE EFFECTS

Drug Description

What is JEMPERLI and how is it used?

JEMPERLI is a prescription medicine used to treat adults with a kind of uterine cancer called endometrial cancer. JEMPERLI may be used when:

your tumor has been shown by a laboratory test to be mismatch repair deficient (dMMR), and
your cancer has returned, or it has spread or cannot be removed by surgery (advanced cancer), and
you have received chemotherapy that contains platinum and it did not work or is no longer working.

It is not known if JEMPERLI is safe and effective in children.

What are the possible side effects of JEMPERLI?

JEMPERLI can cause serious side effects. See “What is the most important information I should know about JEMPERLI?”

The most common side effects of JEMPERLI include: tiredness and weakness, nausea, diarrhea, low red blood count (anemia), and constipation.

These are not all the possible side effects of JEMPERLI. For more information, ask your healthcare provider or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800FDA-1088.

DESCRIPTION

Dostarlimab-gxly is a programmed death receptor-1 (PD-1) "blocking" IgG4 humanized monoclonal antibody. Dostarlimab-gxly is produced in Chinese hamster ovary cells and has a calculated molecular weight of about 144 kDa.

JEMPERLI (dostarlimab-gxly) injection is a sterile, clear to slightly opalescent, colorless to yellow solution essentially free from visible particles. It is supplied as single-dose vials.

Each vial contains 500 mg of JEMPERLI in 10 mL of solution. Each mL of solution contains 50 mg of dostarlimab-gxly, citric acid monohydrate (0.48 mg), L-arginine hydrochloride (21.07 mg), polysorbate 80 (0.2 mg), sodium chloride (1.81 mg), trisodium citrate dihydrate (6.68 mg), and Water for Injection, USP.

Indications & Dosage

INDICATIONS

JEMPERLI is indicated for the treatment of adult patients with mismatch repair deficient (dMMR) recurrent or advanced endometrial cancer (EC), as determined by an FDA-approved test, that has progressed on or following prior treatment with a platinum-containing regimen [see DOSAGE AND ADMINISTRATION].

This indication is approved under accelerated approval based on tumor response rate and durability of response [see Clinical Studies]. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial(s).

DOSAGE AND ADMINISTRATION

Patient Selection

Mismatch Repair Deficient (dMMR)Advanced Endometrial Cancer

Select patients with recurrent or advanced endometrial cancer (EC) that has progressed on or following prior treatment with a platinum-containing regimen for treatment with JEMPERLI based on the presence of dMMR in tumor specimens [see Clinical Studies]. Information on FDA-approved tests for the detection of dMMR status is available at http://www.fda.gov/CompanionDiagnostics.

Recommended Dosage

The recommended dosage of JEMPERLI is:

Dose 1 through Dose 4: 500 mg every 3 weeks
Subsequent dosing beginning 3 weeks after Dose 4 (Dose 5 onwards): 1,000 mg every 6 weeks

Administer JEMPERLI as an intravenous infusion over 30 minutes. Treat patients until disease progression or unacceptable toxicity.

Dosage Modifications For Adverse Reactions

No dose reductions of JEMPERLI are recommended. In general, withhold JEMPERLI for severe (Grade 3) immune-mediated adverse reactions. Permanently discontinue JEMPERLI for life-threatening (Grade 4) immune-mediated adverse reactions, recurrent severe (Grade 3) immune-mediated reactions that require systemic immunosuppressive treatment, or an inability to reduce corticosteroid dose to 10 mg or less of prednisone equivalent per day within 12 weeks of initiating steroids.

Dosage modifications for JEMPERLI for adverse reactions that require management different from these general guidelines are summarized in Table 1.

Table 1: Recommended Dosage Modifications for Adverse Reactions

Adverse Reaction	Severity^a	Dosage Modifications
Immune-Mediated Adverse Reactions [see WARNINGS AND PRECAUTIONS]
Pneumonitis	Grade 2	Withhold^b
Pneumonitis	Grade 3 or 4 or recurrent Grade 2	Permanently discontinue
Colitis	Grade 2 or 3	Withhold^b
Colitis	Grade 4	Permanently discontinue
Hepatitis with no tumor involvement of the liver	AST or ALT increases to more than 3 and up to 8 times ULN or Total bilirubin increases to more than 1.5 and up to 3 times the ULN	Withhold^b
Hepatitis with no tumor involvement of the liver	AST or ALT increases to more than 8 times the ULN or Total bilirubin increases to more than 3 times the ULN	Permanently discontinue
Hepatitis with tumor involvement of the liver^c	Baseline AST or ALT is more than 1 and up to 3 times ULN and increases to more than 5 and up to 10 times ULN or Baseline AST or ALT is more than 3 and up to 5 times ULN and increases to more than 8 and up to 10 times ULN	Withhold^b
Hepatitis with tumor involvement of the liver^c	AST or ALT increases to more than 10 times ULN or Total bilirubin increases to more than 3 times ULN	Permanently discontinue
Endocrinopathies	Grade 2, 3, or 4	Withhold if not clinically stable^b
Nephritis with renal dysfunction	Grade 2 or 3 increased blood creatinine	Withhold^b
Nephritis with renal dysfunction	Grade 4 increased blood creatinine	Permanently discontinue
Exfoliative dermatologic conditions	Suspected SJS, TEN, or DRESS	Withhold^b
Exfoliative dermatologic conditions	Confirmed SJS, TEN, or DRESS	Permanently discontinue
Myocarditis	Grade 2, 3, or 4	Permanently discontinue
Neurological toxicities	Grade 2	Withhold
Neurological toxicities	Grade 3 or 4	Permanently discontinue
Other Adverse Reactions
Infusion-related reactions [see WARNINGS AND PRECAUTIONS]	Grade 1 or 2	Interrupt or slow the rate of infusion
	Grade 3 or 4	Permanently discontinue
AST = aspartate aminotransferase, ALT = alanine aminotransferase, ULN = upper limit of normal, SJS = Stevens-Johnson syndrome, TEN = toxic epidermal necrolysis, DRESS = drug rash with eosinophilia and systemic symptoms. ^a Based on National Cancer Institute Common Terminology Criteria for Adverse Events, Version 4.0. ^b Resume in patients with complete or partial resolution (Grade 0 to 1) after corticosteroid taper. Permanently discontinue if no complete or partial resolution within 12 weeks of initiating steroids or inability to reduce prednisone to less than 10 mg/day (or equivalent) within 12 weeks of initiating steroids. ^c If AST and ALT are less than or equal to ULN at baseline in patients with liver involvement, withhold or permanently discontinue JEMPERLI based on recommendations for hepatitis with no liver involvement.

Preparation And Administration

Preparation For Intravenous Infusion

Visually inspect the solution for particulate matter and discoloration. The solution is clear to slightly opalescent, colorless to yellow. Discard the vial if visible particles are observed.
Do not shake.
For the 500-mg dose, withdraw 10 mL of JEMPERLI from a vial using a disposable sterile syringe made of polypropylene and dilute into an intravenous infusion bag containing 0.9% Sodium Chloride Injection, USP or 5% Dextrose Injection, USP to a final concentration between 2 to 10 mg/mL (maximum 250 mL). JEMPERLI is compatible with an infusion bag made of polyolefine, ethylene vinyl acetate, or polyvinyl chloride with DEHP.
For the 1,000-mg dose, withdraw 10 mL from each of 2 vials (withdraw 20 mL total) and dilute into an intravenous bag containing 0.9% Sodium Chloride Injection, USP or 5% Dextrose Injection, USP to a final concentration between 4 to 10 mg/mL (maximum 250 mL).
Mix diluted solution by gentle inversion. Do not shake.
Discard any unused portion left in the vial.

Storage Of Infusion Solution

Store in the original carton until time of preparation in order to protect from light. The prepared dose may be stored either:

At room temperature for no more than 6 hours from the time of preparation until the end of infusion.
Under refrigeration at 2°C to 8°C (36°F to 46°F) for no more than 24 hours from time of preparation until end of infusion. If refrigerated, allow the diluted solution to come to room temperature prior to administration.

Discard after 6 hours at room temperature or after 24 hours under refrigeration.

Do not freeze.

Administration

Administer infusion solution intravenously over 30 minutes through an intravenous line using tubing made of polyvinyl chloride or platinum cured silicon; fittings made of polyvinyl chloride or polycarbonate; and a sterile, non-pyrogenic, low-protein binding, 0.2-micron, in-line or add-on filter.

JEMPERLI must not be administered as an intravenous push or bolus injection. Do not co-administer other drugs through the same infusion line.

HOW SUPPLIED

Dosage Forms And Strengths

Injection: 500 mg/10 mL (50 mg/mL) clear to slightly opalescent, colorless to yellow solution in a single-dose vial for intravenous infusion after dilution.

Storage And Handling

JEMPERLI (dostarlimab-gxly) injection is a clear to slightly opalescent, colorless to yellow solution supplied in a carton containing one 500 mg/10 mL (50 mg/mL), single-dose vial (NDC 0173-0898-03).

Store vial refrigerated at 2°C to 8°C (36°F to 46°F) in original carton to protect from light. Do not freeze or shake.

Manufactured by GlaxoSmithKline LLC Philadelphia, PA 19112. Distributed by : GlaxoSmithKline Research Triangle Park, NC 27709. Revised:Apr 2021

Side Effects & Drug Interactions

SIDE EFFECTS

The following clinically significant adverse reactions are described elsewhere in the labeling:

Immune-mediated adverse reactions [see WARNINGS AND PRECAUTIONS]
Infusion-related reactions [see WARNINGS AND PRECAUTIONS]

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared with rates in the clinical trials of another drug and may not reflect the rates observed in practice.

The pooled safety population described in WARNINGS AND PRECAUTIONS reflects exposure to JEMPERLI in 444 patients with advanced or recurrent solid tumors in the open-label, multicohort GARNET study including 268 patients with EC and 176 patients with other solid tumors. JEMPERLI as a single agent was administered intravenously at doses of 500 mg every 3 weeks for 4 doses followed by 1,000 mg every 6 weeks until disease progression or unacceptable toxicity. Among the 444 patients, 38% were exposed for >6 months and 12% were exposed for >1 year.

Mismatch Repair Deficient (dMMR) Endometrial Cancer

The safety of JEMPERLI was evaluated in the GARNET trial in 104 patients with advanced or recurrent dMMR EC who received at least one dose of JEMPERLI [see Clinical Studies]. Patients received JEMPERLI 500 mg every 3 weeks for 4 doses followed by 1,000 mg every 6 weeks as an intravenous infusion until disease progression or unacceptable toxicity. Among patients receiving JEMPERLI, 47% were exposed for 6 months or longer and 20% were exposed for >1 year.

Serious adverse reactions occurred in 34% of patients receiving JEMPERLI. Serious adverse reactions in >2% of patients included sepsis (2.9%), acute kidney injury (2.9%), urinary tract infection (2.9%), abdominal pain (2.9%), and pyrexia (2.9%).

JEMPERLI was permanently discontinued due to adverse reactions in 5 (4.8%) patients, including transaminases increased, sepsis, bronchitis, and pneumonitis. Dosage interruptions due to an adverse reaction occurred in 23% of patients who received JEMPERLI. Adverse reactions that required dosage interruption in ≥1% of patients who received JEMPERLI were anemia, diarrhea, increased lipase, and pyrexia.

The most common adverse reactions (≥20%) were fatigue/asthenia, nausea, diarrhea, anemia, and constipation. The most common Grade 3 or 4 adverse reactions (≥2%) were anemia and transaminases increased.

Table 2 summarizes the adverse reactions that occurred in ≥10% of patients with dMMR EC on JEMPERLI in the GARNET study.

Table 2: Adverse Reactions (≥10%) in Patients with dMMR Endometrial Cancer who Received JEMPERLI in GARNET

Adverse Reaction	JEMPERLI N = 104
Adverse Reaction	All Grades %	Grade 3 or 4 %
Blood and Lymphatic System
Anemia^a	24	13
Gastrointestinal
Nausea	30	0
Diarrhea	26	1.9
Constipation	20	0.9
Vomiting	18	0
General and Administration Site
Fatigue^b	48	1
Infections
Urinary tract infection	13	1.9
Metabolism and Nutrition
Decreased appetite	14	0
Musculoskeletal and Connective Tissue
Myalgia	12	0
Respiratory, Thoracic, and Mediastinal
Cough	14	0
Skin and Subcutaneous Tissue
Pruritus	14	1
Toxicity was graded per National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.03. ^a Includes anemia, hemoglobin decreased, iron deficiency, and iron deficiency anemia. ^b Includes fatigue and asthenia.

Table 3 summarizes Grade 3 or 4 laboratory abnormalities worsening from baseline in ≥1% of patients with dMMR EC on JEMPERLI in the GARNET study.

Table 3: Laboratory Abnormalities that Worsened from Baseline to Grade 3 or 4 Occurring in ≥1% of Patients with dMMR EC Receiving JEMPERLI in GARNET

Laboratory Test	JEMPERLI N =104
Laboratory Test	All Grades^a%	Grade 3 or 4^a%
Hematology
Lymphopenia	37	9
Leukopenia	21	2.9
Chemistry
Hypoalbuminemia	30	2.9
Increased alkaline phosphatase	25	2.9
Increased creatinine	27	2.9
Hyponatremia	26	4.8
Hypercalcemia	15	1.9
Increased alanine aminotransferase	15	2.9
Hypokalemia	15	1.9
Increased aspartate aminotransferase	16	1.9
dMMR EC = Mismatch Repair Deficient Endometrial Cancer. ^a Consists of new onset of laboratory abnormality or worsening of baseline laboratory abnormality.

Immunogenicity

As with all therapeutic proteins, there is potential for immunogenicity. The detection of antibody formation is highly dependent on the sensitivity and specificity of the assay. Additionally, the observed incidence of antibody (including neutralizing antibody) positivity in an assay may be influenced by several factors including assay methodology, sample handling, timing of sample collection, concomitant medications, and underlying disease. For these reasons, comparison of the incidence of antibodies to dostarlimab-gxly in the studies described below with the incidence of antibodies in other studies or to other products may be misleading.

The immunogenicity of dostarlimab was evaluated in the GARNET study. The treatment-emergent anti-drug antibodies (ADAs) against dostarlimab-gxly were detected in 2.5% of 315 patients treated with dostarlimab-gxly at the recommended therapeutic dose. Neutralizing antibodies were detected in 1.3% of patients. Because of the small number of patients who developed ADAs, the impact of immunogenicity on the efficacy and safety of dostarlimab-gxly is inconclusive.

DRUG INTERACTIONS

No Information provided

Warnings & Precautions

WARNINGS

Included as part of the PRECAUTIONS section.

PRECAUTIONS

Immune-Mediated Adverse Reactions

JEMPERLI is a monoclonal antibody that belongs to a class of drugs that bind to either the programmed death receptor-1 (PD-1) or PD-ligand 1 (PD-L1), blocking the PD-1/PD-L1 pathway, thereby removing inhibition of the immune response, potentially breaking peripheral tolerance, and inducing immune-mediated adverse reactions. Important immune-mediated adverse reactions listed in WARNINGS AND PRECAUTIONS may not include all possible severe and fatal immune-mediated reactions.

Immune-mediated adverse reactions, which can be severe or fatal, can occur in any organ system or tissue. Immune-mediated adverse reactions can occur at any time after starting a PD-1/PD-L1â€“blocking antibody. While immune-mediated adverse reactions usually manifest during treatment with PD-1/PD-L1â€“blocking antibodies, they can also manifest after discontinuation of PD-1/PD-L1â€“blocking antibodies.

Early identification and management of immune-mediated adverse reactions are essential to ensure safe use of PD-1/PD-L1â€“blocking antibodies. Monitor closely for symptoms and signs that may be clinical manifestations of underlying immune-mediated adverse reactions. Evaluate liver enzymes, creatinine, and thyroid function tests at baseline and periodically during treatment. In cases of suspected immune-mediated adverse reactions, initiate appropriate workup to exclude alternative etiologies, including infection. Institute medical management promptly, including specialty consultation as appropriate.

Withhold or permanently discontinue depending on severity [see DOSAGE AND ADMINISTRATION]. In general, if JEMPERLI requires interruption or discontinuation, administer systemic corticosteroids (1 to 2 mg/kg/day prednisone or equivalent) until improvement to Grade 1 or less. Upon improvement to Grade 1 or less, initiate corticosteroid taper and continue to taper over at least 1 month. Consider administration of other systemic immunosuppressants in patients whose immune-mediated adverse reaction is not controlled with corticosteroids.

Toxicity management guidelines for adverse reactions that do not necessarily require systemic steroids (e.g., endocrinopathies, dermatologic reactions) are discussed below.

Immune-Mediated Pneumonitis

JEMPERLI can cause immune-mediated pneumonitis, which can be fatal. The incidence of pneumonitis in patients receiving PD-1/PD-L1 inhibitors, including JEMPERLI, may be increased in patients who have received prior thoracic radiation.

Immune-mediated pneumonitis occurred in 1.1% (5/444) of patients receiving JEMPERLI, including Grade 2 (0.9%) and Grade 3 (0.2%) pneumonitis. Pneumonitis led to discontinuation of JEMPERLI in 0.7% patients.

Systemic corticosteroids were required in all patients with pneumonitis. Pneumonitis resolved in 80% of the 5 patients. Three patients reinitiated JEMPERLI after symptom improvement; of these 33% had recurrence of pneumonitis.

Immune-Mediated Colitis

JEMPERLI can cause immune-mediated colitis. Cytomegalovirus infection/reactivation have occurred in patients with corticosteroid-refractory immune-mediated colitis treated with PD-1/PD-L1â€“blocking antibodies. In cases of corticosteroid-refractory colitis, consider repeating infectious workup to exclude alternative etiologies.

Immune-mediated colitis occurred in 1.4% (6/444) of patients receiving JEMPERLI, including Grade 3 (0.7%) and Grade 2 (0.7%) adverse reactions. Colitis did not lead to discontinuation of JEMPERLI in any patients.

Systemic corticosteroids were required in 17% (1/6) of patients with colitis. Colitis resolved in 50% of the 6 patients. Of the 2 patients in whom JEMPERLI was withheld for colitis, both reinitiated JEMPERLI.

Immune-Mediated Hepatitis

JEMPERLI can cause immune-mediated hepatitis, which can be fatal.

Immune-mediated hepatitis occurred in 0.2% (1/444) of patients receiving JEMPERLI, which was Grade 3. Systemic corticosteroids were required and the event resolved.

Immune-Mediated Endocrinopathies

Adrenal Insufficiency

JEMPERLI can cause primary or secondary adrenal insufficiency. For Grade 2 or higher adrenal insufficiency, initiate symptomatic treatment per institutional guidelines, including hormone replacement as clinically indicated. Withhold JEMPERLI if not clinically stable [see DOSAGE AND ADMINISTRATION].

Adrenal insufficiency occurred in 0.9% (4/444) patients receiving JEMPERLI, including Grade 3 (0.5%) and Grade 2 (0.5%). Adrenal insufficiency resulted in discontinuation in 1 (0.2%) patient and resolved in 25% of the 4 patients.

Hypophysitis

JEMPERLI can cause immune-mediated hypophysitis. Hypophysitis can present with acute symptoms associated with mass effect such as headache, photophobia, or visual field cuts. Hypophysitis can cause hypopituitarism. Initiate hormone replacement as clinically indicated. Withhold JEMPERLI if not clinically stable [see DOSAGE AND ADMINISTRATION].

Thyroid Disorders

JEMPERLI can cause immune-mediated thyroid disorders. Thyroiditis can present with or without endocrinopathy. Hypothyroidism can follow hyperthyroidism. Initiate hormone replacement or medical management of hyperthyroidism as clinically indicated. Withhold JEMPERLI if not clinically stable [see DOSAGE AND ADMINISTRATION].

Thyroiditis

Thyroiditis occurred in 0.5% (2/444) of patients receiving JEMPERLI; both were Grade 2. Neither event of thyroiditis resolved; there were no discontinuations of JEMPERLI due to thyroiditis.

Hypothyroidism

Hypothyroidism occurred in 5.6% (25/444) of patients receiving JEMPERLI, all of which were Grade 2. Hypothyroidism did not lead to discontinuation of JEMPERLI and resolved in 40% of the 25 patients. Systemic corticosteroids were not required for any of the 25 patients with hypothyroidism.

Hyperthyroidism

Hyperthyroidism occurred in 1.8% (8/444) of patients receiving JEMPERLI, including Grade 2 (1.6%) and Grade 3 (0.2%). Hyperthyroidism did not lead to discontinuation of JEMPERLI and resolved in 63% of the 8 patients. Systemic corticosteroids were not required for any of the 8 patients with hyperthyroidism.

Type 1 Diabetes Mellitus, Which Can Present With Diabetic Ketoacidosis

JEMPERLI can cause type 1 diabetes mellitus, which can present with diabetic ketoacidosis. Monitor patients for hyperglycemia or other signs and symptoms of diabetes. Initiate treatment with insulin as clinically indicated. Withhold or permanently discontinue JEMPERLI depending on severity [see DOSAGE AND ADMINISTRATION].

Immune-Mediated Nephritis With Renal Dysfunction

JEMPERLI can cause immune-mediated nephritis, which can be fatal. Nephritis occurred in 0.5% (2/444) of patients receiving JEMPERLI; both were Grade 2. Nephritis did not lead to discontinuation of JEMPERLI and resolved in both patients. Systemic corticosteroids were required in 1 of the 2 patients experiencing nephritis.

Immune-Mediated Dermatologic Adverse Reactions

JEMPERLI can cause immune-mediated rash or dermatitis. Bullous and exfoliative dermatitis, including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug rash with eosinophilia and systemic symptoms (DRESS), have occurred with PD-1/PD-L1â€“blocking antibodies. Topical emollients and/or topical corticosteroids may be adequate to treat mild to moderate non-bullous/exfoliative rashes. Withhold or permanently discontinue JEMPERLI depending on severity [see DOSAGE AND ADMINISTRATION].

Other Immune-Mediated Adverse Reactions

The following clinically significant immune-mediated adverse reactions occurred in <1% of the 444 patients treated with JEMPERLI or were reported with the use of other PD-1/PD-L1â€“ blocking antibodies. Severe or fatal cases have been reported for some of these adverse reactions.

Nervous System: Meningitis, encephalitis, myelitis and demyelination, myasthenic syndrome/myasthenia gravis, Guillain-Barre syndrome, nerve paresis, autoimmune neuropathy.

Cardiac/Vascular: Myocarditis, pericarditis, vasculitis.

Ocular: Uveitis, iritis, other ocular inflammatory toxicities. Some cases can be associated with retinal detachment. Various grades of visual impairment to include blindness can occur. If uveitis occurs in combination with other immune-mediated adverse reactions, consider a Vogt-Koyanagiâ€“Harada like syndrome, as this may require treatment with systemic steroids to reduce the risk of permanent vision loss.

Gastrointestinal: Pancreatitis, including increases in serum amylase and lipase levels, gastritis, duodenitis.

Musculoskeletal and Connective Tissue: Myositis/polymyositis, rhabdomyolysis and associated sequelae including renal failure, arthritis, polymyalgia rheumatica.

Endocrine: Hypoparathyroidism.

Other (Hematologic/Immune): Hemolytic anemia, aplastic anemia, hemophagocytic lymphohistiocytosis, systemic inflammatory response syndrome, histiocytic necrotizing lymphadenitis (Kikuchi lymphadenitis), sarcoidosis, immune thrombocytopenia, solid organ transplant rejection.

Infusion-Related Reactions

Severe or life-threatening infusion-related reactions have been reported with PD-1/PD-L1â€“ blocking antibodies. Severe infusion-related reactions (Grade 3) occurred in 0.2% (1/444) of patients receiving JEMPERLI. All patients recovered from the infusion-related reactions.

Monitor patients for signs and symptoms of infusion-related reactions. Interrupt or slow the rate of infusion or permanently discontinue JEMPERLI based on severity of reaction [see DOSAGE AND ADMINISTRATION].

Complications Of Allogeneic HSCT After PD-1/PD-L1â€“Blocking Antibody

Fatal and other serious complications can occur in patients who receive allogeneic hematopoietic stem cell transplantation (HSCT) before or after being treated with a PD-1/PD-L1â€“blocking antibody. Transplant-related complications include hyperacute graft-versus-host disease (GVHD), acute GVHD, chronic GVHD, hepatic veno-occlusive disease after reduced intensity conditioning, and steroid-requiring febrile syndrome (without an identified infectious cause). These complications may occur despite intervening therapy between PD-1/PD-L1 blockade and allogeneic HSCT.

Follow patients closely for evidence of transplant-related complications and intervene promptly. Consider the benefit versus risks of treatment with a PD-1/PD-L1â€“blocking antibody prior to or after an allogeneic HSCT.

Embryo-Fetal Toxicity

Based on its mechanism of action, JEMPERLI can cause fetal harm when administered to a pregnant woman. Animal studies have demonstrated that inhibition of the PD-1/PD-L1 pathway can lead to increased risk of immune-mediated rejection of the developing fetus, resulting in fetal death. Advise pregnant women of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with JEMPERLI and for 4 months after the last dose [see Use In Specific Populations].

Patient Counseling Information

Advise the patient to read the FDA-approved patient labeling (Medication Guide).

Immune-Mediated Adverse Reactions

Inform patients of the risk of immune-mediated adverse reactions that may be severe or fatal, may occur after discontinuation of treatment, and may require corticosteroid or other treatment and interruption or discontinuation of JEMPERLI. These reactions may include:

Pneumonitis: Advise patients to contact their healthcare provider immediately for new or worsening cough, chest pain, or shortness of breath [see WARNINGS AND PRECAUTIONS].
Colitis: Advise patients to contact their healthcare provider immediately for diarrhea or severe abdominal pain [see WARNINGS AND PRECAUTIONS].
Hepatitis: Advise patients to contact their healthcare provider immediately for jaundice, severe nausea or vomiting, or easy bruising or bleeding [see WARNINGS AND PRECAUTIONS].
Immune-mediated endocrinopathies: Advise patients to contact their healthcare provider immediately for signs or symptoms of hypothyroidism, hyperthyroidism, thyroiditis, adrenal insufficiency, hypophysitis, or type 1 diabetes mellitus [see WARNINGS AND PRECAUTIONS].
Nephritis: Advise patients to contact their healthcare provider immediately for signs or symptoms of nephritis [see WARNINGS AND PRECAUTIONS].
Severe skin reactions: Advise patients to contact their healthcare provider immediately for any signs or symptoms of severe skin reactions, SJS, or TEN [see WARNINGS AND PRECAUTIONS].
Other immune-mediated adverse reactions:
- Advise patients that immune-mediated adverse reactions can occur and may involve any organ system, and to contact their healthcare provider immediately for any new signs or symptoms [see WARNINGS AND PRECAUTIONS].

Infusion-Related Reactions

Advise patients to contact their healthcare provider immediately for signs or symptoms of infusion-related reactions [see WARNINGS AND PRECAUTIONS].

Embryo-Fetal Toxicity

Advise females of reproductive potential of the potential risk to a fetus and to inform their healthcare provider of a known or suspected pregnancy [see WARNINGS AND PRECAUTIONS, Use In Specific Populations].
Advise females of reproductive potential to use effective contraception during treatment with JEMPERLI and for 4 months after the last dose [see WARNINGS AND PRECAUTIONS, Use In Specific Populations].

Lactation

Advise women not to breastfeed during treatment with JEMPERLI and for 4 months after the last dose [see Use In Specific Populations].

Nonclinical Toxicology

Carcinogenesis, Mutagenesis, Impairment Of Fertility

No studies have been performed to assess the potential of dostarlimab-gxly for carcinogenicity or genotoxicity.

Fertility studies have not been conducted with dostarlimab-gxly. In 1-and 3-month repeat-dose toxicology studies in monkeys, there were no notable effects in the male and female reproductive organs; however, many animals in these studies were not sexually mature.

Use In Specific Populations

Pregnancy

Risk Summary

Based on its mechanism of action, JEMPERLI can cause fetal harm when administered to a pregnant woman [see CLINICAL PHARMACOLOGY]. There are no available data on the use of JEMPERLI in pregnant women. Animal studies have demonstrated that inhibition of the PD-1/PD-L1 pathway can lead to increased risk of immune-mediated rejection of the developing fetus resulting in fetal death (see Data). Human IgG4 immunoglobulins (IgG4) are known to cross the placental barrier; therefore, dostarlimab-gxly has the potential to be transmitted from the mother to the developing fetus. Advise women of the potential risk to a fetus.

In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively.

Data

Animal Data

Animal reproduction studies have not been conducted with JEMPERLI to evaluate its effect on reproduction and fetal development. A central function of the PD-1/PD-L1 pathway is to preserve pregnancy by maintaining maternal immune tolerance to the fetus. In murine models of pregnancy, blockade of PD-L1 signaling has been shown to disrupt tolerance to the fetus and to result in an increase in fetal loss; therefore, potential risks of administering JEMPERLI during pregnancy include increased rates of abortion or stillbirth. As reported in the literature, there were no malformations related to the blockade of PD-1/PD-L1 signaling in the offspring of these animals; however, immune-mediated disorders occurred in PD-1 and PD-L1 knockout mice. Based on its mechanism of action, fetal exposure to dostarlimab-gxly may increase the risk of developing immune-mediated disorders or altering the normal immune response.

Lactation

Risk Summary

There is no information regarding the presence of dostarlimab-gxly in human milk or its effects on the breastfed child or on milk production. Because of the potential for serious adverse reactions in a breastfed child, advise women not to breastfeed during treatment and for 4 months after the last dose of JEMPERLI.

Females And Males Of Reproductive Potential

JEMPERLI can cause fetal harm when administered to a pregnant woman [see Use In Specific Populations].

Pregnancy Testing

Verify pregnancy status in females of reproductive potential prior to initiating JEMPERLI [see Use In Specific Populations].

Contraception

Females

Advise females of reproductive potential to use effective contraception during treatment with JEMPERLI and for 4 months after the last dose.

Pediatric Use

The safety and efficacy of JEMPERLI have not been established in pediatric patients.

Geriatric Use

Of the 444 patients treated with JEMPERLI, 49% were younger than 65 years, 39% were aged 65 through 75 years, and 12% were 75 years or older. No overall differences in safety or effectiveness were observed between these patients and younger patients.

Overdosage & Contraindications

OVERDOSE

No Information provided

CONTRAINDICATIONS

None.

Clinical Pharmacology

CLINICAL PHARMACOLOGY

Mechanism Of Action

Binding of the PD-1 ligands, PD-L1 and PD-L2, to the PD-1 receptor found on T cells inhibits T-cell proliferation and cytokine production. Upregulation of PD-1 ligands occurs in some tumors, and signaling through this pathway can contribute to inhibition of active T-cell immune surveillance of tumors. Dostarlimab-gxly is a humanized monoclonal antibody of the IgG4 isotype that binds to the PD-1 receptor and blocks its interaction with PD-L1 and PD-L2, releasing PD-1 pathway-mediated inhibition of the immune response, including the anti-tumor immune response. In syngeneic mouse tumor models, blocking PD-1 activity resulted in decreased tumor growth.

Pharmacodynamics

Dostarlimab-gxly exposure-response relationships have not been fully characterized. Dostarlimab-gxly provides sustained target engagement as measured by PD-1 binding and stimulation of IL-2 production throughout the dosing interval at the recommended dose.

Pharmacokinetics

The pharmacokinetics of dostarlimab-gxly were evaluated in patients with various solid tumors, including 150 patients with EC. Mean Cmax, AUC0-inf, and AUC0-tau increased proportionally over the dose range of 1.0 to 10 mg/kg. The Cycle 1 mean (coefficient of variation [%CV]) Cmax and AUC0-tau of dostarlimab-gxly are 171 mcg/mL (20%) and 35,730 mcg*h/mL (20%) at the dose of 500 mg once every 3 weeks and 309 mcg/mL (31%) and 95,820 mcg*h/mL (29%) at the dose of 1,000 mg every 6 weeks, respectively.

Distribution

The mean (%CV) volume of distribution of dostarlimab-gxly at steady state is 5.3 L (12%).

Elimination

The mean terminal elimination half-life of dostarlimab-gxly is 25.4 days and its mean (%CV) clearance is 0.007 L/h (31%) at steady state.

Metabolism

Dostarlimab-gxly is expected to be metabolized into small peptides and amino acids by catabolic pathways.

Specific Populations

No clinically significant differences in the pharmacokinetics of dostarlimab-gxly were observed based on age (24 to 86 years), sex (79% female), race/ethnicity (78% White, 2% Asian, 4% African American, and 16% other), tumor types, and renal impairment based on the estimated creatinine clearance (CLCR mL/min) (normal: CLCR ≥90 mL/min, n = 173; mild: CLCR = 60-89 mL/min, n = 210; moderate: CLCR = 30-59 mL/min, n = 90; severe: CLCR = 15-29 mL/min, n = 3; and end-stage renal disease: CLCR <15 mL/min, n = 1) and hepatic impairment as measured by total bilirubin (TB) and aspartate aminotransferase (AST) (normal: TB and AST less than or equal to upper limit of normal [ULN], n = 425; mild: TB>ULN to 1.5 ULN or AST>ULN, n = 48; and moderate: TB>1.5-3 ULN, any AST, n = 4).

Animal Toxicology And/Or Pharmacology

In animal models, inhibition of PD-L1/PD-1 signaling increased the severity of some infections and enhanced inflammatory responses. Mycobacterium tuberculosis-infected PD-1 knockout mice exhibit markedly decreased survival compared with wild-type controls, which correlated with increased bacterial proliferation and inflammatory responses in these animals. PD-L1 and PD-1 knockout mice and mice receiving PD-L1â€“blocking antibody have also shown decreased survival following infection with lymphocytic choriomeningitis virus.

Clinical Studies

The efficacy of JEMPERLI was evaluated in the GARNET study (NCT02715284), a multicenter, multicohort, open-label study conducted in patients with advanced solid tumors. The efficacy population consisted of a cohort of 71 patients with mismatch repair deficient (dMMR) recurrent or advanced EC who had progressed on or after treatment with a platinum-containing regimen. Patients with prior treatment with PD-1/PD-L1â€“blocking antibodies or other immune checkpoint inhibitor therapy and patients with autoimmune disease that required systemic therapy with immunosuppressant agents within 2 years were excluded from the study.

Patients received JEMPERLI 500 mg intravenously every 3 weeks for 4 doses followed by 1,000 mg intravenously every 6 weeks. Treatment continued until disease progression or unacceptable toxicity. The major efficacy outcome measures were Overall Response Rate (ORR) and Duration of Response (DOR) as assessed by blinded independent central review (BICR) according to the Response Evaluation Criteria in Solid Tumors (RECIST) v 1.1.

The baseline characteristics were: median age 64 years (49% aged 65 years or older); 82% White, 3% Asian, 1% Black; and Eastern Cooperative Oncology Group Performance Status 0 (32%) or 1 (68%).

At time of study entry, 66% of the patients with dMMR EC had International Federation of Gynecology and Obstetrics (FIGO) Stage IV disease. The most common histology seen was endometrioid carcinoma type 1 (70%), followed by serous (6%) and mixed and undifferentiated (2.8% each).

All patients with dMMR EC had received prior anticancer treatment, with 90% of patients receiving prior anticancer surgery and 79% receiving prior anticancer radiotherapy. Approximately 40% had 2 lines or more of prior anticancer treatment. Approximately 11% of patients had received 3 regimens and 4% had received 4 or more prior regimens.

The dMMR tumor status was retrospectively confirmed using the VENTANA MMR RxDx Panel assay.

Efficacy results are presented in Table 4.

Table 4: Efficacy Results in GARNET dMMR Endometrial Cancer Population

Endpoint	JEMPERLI N = 71
Confirmed Overall Response Rate
ORR	42.3%
(95% CI)	(30.6, 54.6)
Complete response rate	12.7%
Partial response rate	29.6%
Duration of Response
Median in months	Not reached
(range)^a	(2.6, 22.4+)
Patients with duration ≥6 months	93.3%
CI = Confidence interval, + = ongoing at last assessment. ^a Median follow-up for DOR was 14.1 months, measured from time of first response.

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