Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
The pooled safety population described in the WARNINGS AND PRECAUTIONS reflect exposure to LYTGOBI as a single agent at 20 mg orally once daily in 318 patients including 145 patients with cholangiocarcinoma and 173 patients with other advanced solid tumors. Among 318 patients who received LYTGOBI, 37% were exposed for 6 months or longer and 13% were exposed for greater than 12 months.
Previously Treated, Unresectable Locally Advanced or Metastatic Intrahepatic Cholangiocarcinoma
The safety of LYTGOBI was evaluated in Study TAS-120-101, which included 103 patients with previously treated, unresectable locally advanced or metastatic intrahepatic cholangiocarcinoma harboring FGFR2 fusions or other gene rearrangements [see Clinical Studies (14.1)]. Patients were treated with LYTGOBI 20 mg orally once daily until disease progression or unacceptable toxicity. The median duration of treatment was 9 months (range: 0.5 - 25 months).
Serious adverse reactions occurred in 39% of patients receiving LYTGOBI. Serious adverse reactions in ≥2% of patients who received LYTGOBI included pyrexia (3.9%), gastrointestinal hemorrhage (3.9%), ascites (2.9%), musculoskeletal pain (2.9%), and bile duct obstruction (2.9%).
Permanent discontinuation due to an adverse reaction occurred in 4.9% of patients who received LYTGOBI. Adverse reactions requiring permanent discontinuation of LYTGOBI in one patient each were esophagitis, oral dysesthesia, bile duct obstruction, dizziness, and anemia.
Dosage interruptions due to an adverse reaction occurred in 66% of patients who received LYTGOBI. Adverse reactions requiring dosage interruption in ≥5% of patients included hyperphosphatemia, palmar-plantar erythrodysesthesia syndrome, increased alanine aminotransferase, increased aspartate aminotransferase, and fatigue.
Dose reductions due to an adverse reaction occurred in 58% of patients who received LYTGOBI. Adverse reactions requiring dosage reductions in ≥2% of patients who received LYTGOBI included hyperphosphatemia, palmar-plantar erythrodysesthesia syndrome, fatigue, increased alanine aminotransferase, increased aspartate aminotransferase, nail toxicity, and stomatitis.
The most common (≥20%) adverse reactions were nail toxicity, musculoskeletal pain, constipation, diarrhea, fatigue, dry mouth, alopecia, stomatitis, abdominal pain, dry skin, arthralgia, dysgeusia, dry eye, nausea, decreased appetite, urinary tract infection, palmar-plantar erythrodysesthesia syndrome, and vomiting.
The most common laboratory abnormalities (≥20%) were increased phosphate, increased creatinine, decreased hemoglobin, increased glucose, increased calcium, decreased sodium, decreased phosphate, increased alanine aminotransferase, increased alkaline phosphatase, decreased lymphocyte, increased aspartate aminotransferase, decreased platelets, increased activated partial thromboplastin time, decreased leukocytes, decreased albumin, decreased neutrophils, increased creatine kinase, increased bilirubin, decreased glucose, increased prothrombin international normalized ratio, and decreased potassium.
Table 3 summarizes the adverse reactions in TAS-120-101. Table 4 summarizes laboratory abnormalities in TAS-120-101.
Table 3: Adverse Reactions (≥15%) in Patients Receiving LYTGOBI in Study TAS-120-101 | LYTGOBI N = 103 |
|---|
| Adverse Reaction | All Grades a (%) | Grade 3 (%) |
|---|
a Graded per NCI CTCAE 4.03. b Includes nail toxicity, nail disorder, nail discoloration, nail dystrophy, nail hypertrophy, nail infection, nail pigmentation, onychalgia, onychoclasis, onycholysis, onychomadesis, onychomycosis, and paronychia. c Includes diarrhea, colitis, and gastroenteritis. d Includes stomatitis, glossitis, mouth ulceration, mucosal inflammation, pharyngeal inflammation, and tongue ulceration. e Includes abdominal pain, abdominal discomfort, abdominal pain upper, gastrointestinal pain, and hepatic pain. f Includes vomiting and hematemesis. g Includes fatigue and asthenia. h Includes back pain, bone pain, musculoskeletal chest pain, musculoskeletal discomfort, musculoskeletal pain, musculoskeletal stiffness, myalgia, neck pain, non-cardiac chest pain, pain in extremity, and spinal pain. i Includes arthralgia and arthritis. j Includes dry eye, keratitis, lacrimation increased, photokeratitis, punctate keratitis, and ulcerative keratitis. k Includes dysgeusia, ageusia, and taste disorder. l Includes urinary tract infection, cystitis, and dysuria. |
| Skin and subcutaneous tissue disorders |
| Nail toxicity b | 47 | 1.9 |
| Alopecia | 34 | 0 |
| Dry skin | 29 | 0 |
| Palmar-plantar erythrodysesthesia syndrome | 21 | 4.9 |
| Gastrointestinal disorders |
| Constipation | 39 | 0 |
| Diarrhea c | 39 | 1 |
| Dry mouth | 35 | 0 |
| Stomatitis d | 30 | 6 |
| Abdominal pain e | 30 | 2.9 |
| Nausea | 24 | 1.9 |
| Vomiting f | 20 | 1 |
| General disorders |
| Fatigue g | 37 | 8 |
| Metabolism and nutrition disorders |
| Decreased appetite | 23 | 2.9 |
| Musculoskeletal and connective tissue disorder |
| Musculoskeletal pain h | 43 | 3.9 |
| Arthralgia i | 25 | 0 |
| Eye disorders |
| Dry eye j | 25 | 1 |
| Nervous system disorders |
| Dysgeusia k | 25 | 0 |
| Infections |
| Urinary tract infection l | 23 | 2.9 |
| Investigations |
| Weight decreased | 18 | 3.9 |
Clinically relevant adverse reactions occurring in ≤15% of patients included retinal pigment epithelial detachment (RPED, 7.8%).
Table 4: Select Laboratory Abnormalities (≥10%) Worsening from Baseline in Patients Receiving LYTGOBI in TAS-120-101 | LYTGOBI N = 103 |
|---|
| Laboratory Abnormality a | All Grades b (%) | Grades 3 or 4 (%) |
|---|
a Graded per NCI CTCAE 4.03. b Percentages are based on patients with data at both baseline and at least one post-baseline data value. c NCI CTCAE 4.03 does not define grades for increased phosphate. Laboratory value shift table categories were used to assess increased phosphorus levels (Grades ≥3 defined as >7 mg/dL). d Graded based on comparison to upper limit of normal. |
| Hematology |
| Decreased hemoglobin | 52 | 6 |
| Decreased lymphocytes | 46 | 10 |
| Decreased platelets | 42 | 1 |
| Decreased leukocytes | 33 | 1.1 |
| Decreased neutrophils | 31 | 1.6 |
| Chemistry |
| Increased phosphate c | 97 | 39 |
| Increased creatinine d | 58 | 0 |
| Increased glucose | 52 | 4.9 |
| Increased calcium | 51 | 1.2 |
| Decreased sodium | 51 | 15 |
| Decreased phosphate | 50 | 20 |
| Increased alanine aminotransferase | 50 | 7 |
| Increased alkaline phosphatase | 47 | 4.9 |
| Increased aspartate aminotransferase | 46 | 13 |
| Decreased albumin | 31 | 2.4 |
| Increased creatine kinase | 31 | 5 |
| Increased bilirubin | 28 | 0 |
| Decreased glucose | 25 | 0 |
| Decreased potassium | 22 | 2.1 |
| Increased potassium | 16 | 2 |
| Coagulation |
| Increased activated partial thromboplastin time | 36 | 8 |
| Increased prothrombin international normalized ratio | 25 | 0 |