ALUNBRIG（brigatinib）

Indications: ALUNBRIG is a kinase inhibitor suitable for patients with anaplasticlymphomakinase’s (ALK)- positive metastatic non-small cell lung cancer (NSCLC), and their condition has progressed or become intolerant after crizotinib treatment.

Dosage and administration method
Take 90 mg orally once a day for the first 7 days, and increase it to 180 mg once a day if you are tolerant. There may or may not be food to take.

The active pharmaceutical ingredient of Alunbrig is brigatinib, which is a new generation of ALK inhibitor, which can inhibit ALK and ALK fusion protein, thus inhibiting tumor growth. ALK is the second therapeutic target found in NSCLC, which exists in about 3%-5% of NSCLC patients, especially young adenocarcinoma patients who don’t smoke. The ALK gene of these patients often fuses with other genes to produce ALK fusion protein, and this mutation will lead to tumor growth.

Warnings and precautions
Interstitial lung disease (ILD)/ pneumonia: it occurred in 9.1% of patients at the recommended dose. Monitor for new or deteriorated respiratory symptoms, especially in the first week of treatment. Don’t give ALUNBRIG to new or deteriorated respiratory symptoms and evaluate ILD/ pneumonia in time. When recovering, either reduce the dose or permanently terminate ALUNBRIG.
● Hypertension: Monitor blood pressure for 2 weeks and then at least every month during treatment. For severe hypertension, ALUNBRIG is not given, and then the dose is reduced or terminated permanently.
● Bradycardia: regularly monitor heart rate and blood pressure during treatment. If it is symptomatic, ALUNBRIG is not given, and then the dose is reduced or terminated permanently.
● Visual impairment: Patients are advised to report visual symptoms. Don’t give ALUNBRIG and get an ophthalmic evaluation, then reduce the dose or permanently terminate ALUNBRIG.
● Elevated creatine phosphokinase (CPK): The level of CPK was regularly monitored during treatment. According to the severity, ALUNBRIG was not given, and then the dose was restored or reduced.
● Elevated pancreatin: Regularly monitor the levels of lipase and amylase during treatment. According to the severity, ALUNBRIG was not given, and then the dose was restored or reduced.
● Hyperglycemia: Fasting serum glucose was routinely evaluated before ALUNBRIG started and during treatment. If the optimal drug treatment can’t be controlled, ALUNBRIG will not be given, and then the dose will be reduced or terminated permanently according to the severity.
● Fetal toxicity: it may cause fetal harm. Advise women with reproductive potential about the potential risks to the fetus. And effective contraceptive method using non-hormone.

adverse effect
The most common adverse reactions (≥25%) of ALUNBRIG were nausea, diarrhea, fatigue, cough and headache.

drug interaction
● CYP3A inhibitors: Avoid the simultaneous use of ALUNBRIG and strong CYP3A inhibitors. For example, the simultaneous use of a strong CYP3A inhibitor is unavoidable. Reduce the dosage of ALUNBRIG.
● CYP3A inducer: Avoid the simultaneous use of ALUNBRIG and strong CYP3A inducer.
● CYP3A substrate: hormonal contraceptives may be ineffective due to reduced exposure.

Use in special people.
Breastfeeding: It is recommended not to breastfeed.