DRUGS & SUPPLEMENTS

Trazoteva

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Trazoteva uses


WARNING:TOXIC DEATHS, HEPATOTOXICITY, NEUTROPENIA,

HYPERSENSITIVITY REACTIONS, AND FLUID RETENTION

The incidence of treatment-related mortality associated with Trazoteva therapy is increased in patients with abnormal liver function, in patients receiving higher doses, and in patients with non-small cell lung carcinoma and a history of prior treatment with platinum-based chemotherapy who receive Trazoteva as a single agent at a dose of 100 mg/m 2 .

Trazoteva Injection should notbe given to patients with bilirubin > upper limit of normal (ULN),or to patients with AST and/or ALT >1.5 × ULN concomitant withalkaline phosphatase >2.5 × ULN. Patients with elevations ofbilirubin or abnormalities of transaminase concurrent with alkalinephosphatase are at increased risk for the development of grade 4 neutropenia,febrile neutropenia, infections, severe thrombocytopenia, severe stomatitis,severe skin toxicity, and toxic death. Patients with isolated elevationsof transaminase >1.5 × ULN also had a higher rate of febrileneutropenia grade 4 but did not have an increased incidence of toxicdeath. Bilirubin, AST or ALT, and alkaline phosphatase values shouldbe obtained prior to each cycle of Trazoteva Injection therapy .

Trazoteva Injection therapy should not be given to patients with neutrophilcounts of <1500 cells/mm 3. In order to monitor the occurrenceof neutropenia, which may be severe and result in infection, frequentblood cell counts should be performed on all patients receiving Trazoteva Injection. .

Severe hypersensitivity reactionscharacterized by generalized rash/erythema, hypotension and/or bronchospasm,or very rarely fatal anaphylaxis, have been reported in patients whoreceived a 3-day dexamethasone premedication. Hypersensitivityreactions require immediate discontinuation of the Trazoteva Injection infusionand administration of appropriate therapy . Trazoteva Injection must not be givento patients who have a history of severe hypersensitivity reactionsto Trazoteva or to other drugs formulated with polysorbate 80 .

Severe fluid retention occurred in 6.5% (6/92) of patients despiteuse of a 3-day dexamethasone premedication regimen. It was characterizedby one or more of the following events: poorly tolerated peripheraledema, generalized edema, pleural effusion requiring urgent drainage,dyspnea at rest, cardiac tamponade, or pronounced abdominal distention(due to ascites) .

WARNING:TOXIC DEATHS, HEPATOTOXICITY, NEUTROPENIA, HYPERSENSITIVITY REACTIONS, and FLUID RETENTION

See full prescribing information for complete boxed warning

  • Treatment-related mortality increases with abnormal liver function, at higher doses, and in patients with NSCLC and prior platinum-based therapy receiving Trazoteva at 100 mg/m 2 ( 5.1)
  • Should not be given if bilirubin > ULN, or if AST and/or ALT> 1.5 × ULN concomitant with alkaline phosphatase > 2.5 ×ULN. LFT elevations increase risk of severe or life-threatening complications. Obtain LFTs before each treatment cycle ( 8.6)
  • Should not be given if neutrophil counts are < 1500 cells/mm 3. Obtain frequent blood counts to monitor for neutropenia( 4)
  • Severe hypersensitivity, including very rare fatal anaphylaxis, has been reported in patients who received dexamethasone premedication. Severe reactions require immediate discontinuation of Trazoteva Injection and administration of appropriate therapy ( 5.4)
  • Contraindicated if history of severe hypersensitivity reactionsto Trazoteva or to drugs formulated with polysorbate 80 ( 4)
  • Severe fluid retention may occur despite dexamethasone ( 5.5)
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1. INDICATIONS AND USAGE

Trazoteva Injection is a microtubule inhibitor indicated for:


  • Breast Cancer : single agent for locally advanced or metastatic BC after chemotherapy failure; and with doxorubicin and cyclophosphamide as adjuvant treatment of operable node-positive BC ( 1.1)


  • Non-Small Cell Lung Cancer (NSCLC): single agent for locally advanced or metastatic NSCLC after platinum therapy failure; and with cisplatin for unresectable, locally advanced or metastatic untreated NSCLC ( 1.2)


  • HormoneRefractory Prostate Cancer (HRPC): with prednisone in androgen independent (hormone refractory) metastatic prostate cancer ( 1.3)


  • Gastric Adenocarcinoma (GC): with cisplatin and fluorouracil for untreated, advanced GC, including the gastroesophageal junction ( 1.4)


  • Squamous Cell Carcinoma of the Head and Neck Cancer (SCCHN): with cisplatin and fluorouracil for induction treatment of locally advanced SCCHN ( 1.5)

1.1 Breast Cancer

Trazoteva Injection is indicated for the treatment of patients with locally advanced or metastatic breast cancer after failure of prior chemotherapy.

Trazoteva Injection in combination with doxorubicin and cyclophosphamide is indicated for the adjuvant treatment of patients with operable node-positive breast cancer.

1.2 Non-Small Cell Lung Cancer

Trazoteva Injection as a single agent is indicated for the treatment of patients with locally advanced or metastatic non-small cell lung cancer after failure of prior platinum based chemotherapy.

Trazoteva Injection in combination with cisplatin is indicated for the treatment of patients with unresectable, locally advanced or metastatic non-small cell lung cancer who have not previously received chemotherapy for this condition.

1.3 Prostate Cancer

Trazoteva Injection in combination with prednisone is indicated for the treatment of patients with androgen independent metastatic prostate cancer.

1.4 Gastric Adenocarcinoma

Trazoteva Injection in combination with cisplatin and fluorouracil is indicated for the treatment of patients with advanced gastric adenocarcinoma, including adenocarcinoma of the gastroesophageal junction, who have not received prior chemotherapy for advanced disease.

1.5 Head and Neck Cancer

Trazoteva Injection in combination with cisplatin and fluorouracil is indicated for the induction treatment of patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN).

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2. DOSAGE AND ADMINISTRATION

For all indications, toxicities may warrant dosage adjustments .

Administer in a facility equipped to manage possible complications (e.g. anaphylaxis).

Administer in a facility equipped to manage possible complications (e.g., anaphylaxis).Administer intravenously over 1 hr every 3 weeks. PVC equipment is not recommended. For One-vial formulation, use only a 21 gauge needle to withdraw Trazoteva Injection from the vial.

  • BC: locally advanced or metastatic: 60 mg/m 2 to 100 mg/m 2 single agent ( 2.1)
  • BC adjuvant: 75 mg/m 2 administered 1 hour after doxorubicin 50 mg/m 2 and cyclophosphamide 500 mg/m 2 every3 weeks for 6 cycles ( 2.1)
  • NSCLC: after platinum therapy failure: 75 mg/m 2 singleagent ( 2.2)
  • NSCLC: chemotherapy-naive: 75 mg/m 2 followed by cisplatin75 mg/m 2 ( 2.2)
  • HRPC: 75 mg/m 2 with 5 mg prednisone twice a day continuously( 2.3)
  • GC: 75 mg/m 2 followed by cisplatin 75 mg/m 2 (both on day 1 only) followed by fluorouracil 750 mg/m 2 per day as a 24-hr intravenous infusion (days 1 to 5), starting at end of cisplatininfusion ( 2.4)
  • SCCHN: 75 mg/m 2 followed by cisplatin 75 mg/m 2 intravenously (day 1), followed by fluorouracil 750 mg/m 2 per day as a 24-hr intravenous infusion (days 1 to 5), starting at end of cisplatininfusion; for 4 cycles ( 2.5)
  • SCCHN: 75 mg/m 2 followed by cisplatin 100 mg/m 2 intravenously (day 1), followed by fluorouracil 1000 mg/m 2 per day as a 24-hr intravenous infusion (days 1 to 4); for 3 cycles ( 2.5)

For all patients:

  • Premedicate with oral corticosteroids ( 2.6)
  • Adjust dose as needed ( 2.7)

2.1 Breast Cancer

  • For locally advanced or metastatic breast cancer after failure of prior chemotherapy, the recommended dose of Trazoteva Injection is 60 mg/m 2 to 100 mg/m 2 administered intravenously over 1 hour every 3 weeks.
  • For the adjuvant treatment of operable node-positive breast cancer, the recommended Trazoteva Injection dose is 75 mg/m 2 administered 1-hour after doxorubicin 50 mg/m 2 and cyclophosphamide 500 mg/m 2 every 3 weeks for 6 courses. Prophylactic granulocyte - colony stimulating factor (G-CSF) may be used to mitigate the risk of hematological toxicities .

2.2 Non-Small Cell Lung Cancer

  • For treatment after failure of prior platinum-based chemotherapy, Trazoteva was evaluated as monotherapy, and the recommended dose is 75 mg/m 2 administered intravenously over 1 hour every 3 weeks. A dose of 100 mg/m 2 in patients previously treated with chemotherapy was associated with increased hematologic toxicity, infection, and treatment-related mortality in randomized, controlled trials .
  • For chemotherapy-naïve patients, Trazoteva was evaluated in combination with cisplatin. The recommended dose of Trazoteva Injection is 75 mg/m 2 administered intravenously over 1 hour immediately followed by cisplatin 75 mg/m 2 over 30 to 60 minutes every 3 weeks .

2.3 Prostate Cancer

  • For hormone-refractory metastatic prostate cancer, the recommended dose of Trazoteva Injection is 75 mg/m 2 every 3 weeks as a 1 hour intravenous infusion. Prednisone 5 mg orally twice daily is administered continuously .

2.4 Gastric Adenocarcinoma

  • For gastric adenocarcinoma, the recommended dose of Trazoteva Injection is 75 mg/m 2 as a 1 hour intravenous infusion, followed by cisplatin 75 mg/m 2, as a 1 to 3 hour intravenous infusion, followed by fluorouracil 750 mg/m 2 per day given as a 24-hour continuous intravenous infusion for 5 days, starting at the end of the cisplatin infusion. Treatment is repeated every three weeks. Patients must receive premedication with antiemetics and appropriate hydration for cisplatin administration .

2.5 Head and Neck Cancer

Patients must receive premedication with antiemetics, and appropriate hydration (prior to and after cisplatin administration). Prophylaxis for neutropenic infections should be administered. All patients treated on the Trazoteva containing arms of the TAX323 and TAX324 studies received prophylactic antibiotics.

  • Induction chemotherapy followed by radiotherapy (TAX323)

    For the induction treatment of locally advanced inoperable SCCHN, the recommended dose of Trazoteva Injection is 75 mg/m 2 as a 1 hour intravenous infusion followed by cisplatin 75 mg/m 2 intravenously over 1 hour, on day one, followed by fluorouracil as a continuous intravenous infusion at 750 mg/m 2 per day for five days. This regimen is administered every 3 weeks for 4 cycles. Following chemotherapy, patients should receive radiotherapy. .

  • Induction chemotherapy followed by chemoradiotherapy (TAX324)

    For the induction treatment of patients with locally advanced (unresectable, low surgical cure, or organ preservation) SCCHN, the recommended dose of Trazoteva Injection is 75 mg/m 2 as a 1 hour intravenous infusion on day 1, followed by cisplatin 100 mg/m 2 administered as a 30-minute to 3 hour infusion, followed by fluorouracil 1000 mg/m 2/day as a continuous infusion from day 1 to day 4. This regimen is administered every 3 weeks for 3 cycles. Following chemotherapy, patients should receive chemoradiotherapy .

2.6 Premedication Regimen

  • All patients should be premedicated with oral corticosteroids such as dexamethasone 16 mg per day (e.g., 8 mg twice daily) for 3 days starting 1 day prior to Trazoteva Injection administration in order to reduce the incidence and severity of fluid retention as well as the severity of hypersensitivity reactions .
  • For hormone-refractory metastatic prostate cancer, given the concurrent use of prednisone, the recommended premedication regimen is oral dexamethasone 8 mg, at 12 hours, 3 hours and 1 hour before the Trazoteva Injection infusion .

2.7 Dosage Adjustments During Treatment

Breast Cancer

Patients who are dosed initially at 100 mg/m 2 and who experienceeither febrile neutropenia, neutrophils <500 cells/mm 3 for more than 1 week, or severe or cumulative cutaneous reactionsduring Trazoteva Injection therapy should have the dosage adjusted from 100 mg/m 2 to 75 mg/m 2. If the patient continues to experiencethese reactions, the dosage should either be decreased from 75 mg/m 2 to 55 mg/m 2 or the treatment should be discontinued. Conversely, patients who are dosed initially at 60 mg/m 2 and who do not experience febrile neutropenia, neutrophils <500cells/mm 3 for more than 1 week, severe or cumulative cutaneousreactions, or severe peripheral neuropathy during Trazoteva Injection therapymay tolerate higher doses. Patients who develop ≥grade 3 peripheralneuropathy should have Trazoteva Injection treatment discontinued entirely.

Combination Therapy with Trazoteva Injection in the Adjuvant Treatmentof Breast Cancer

Trazoteva Injection in combination with doxorubicin and cyclophosphamide should be administered when the neutrophil count is ≥1,500 cells/mm 3. Patients who experience febrile neutropenia should receive G-CSF in all subsequent cycles. Patients who continue to experience this reaction should remain on G-CSF and have their Trazoteva Injection dose reduced to 60 mg/m 2. Patients who experience grade 3 or 4 stomatitis should have their Trazoteva Injection dose decreased to 60 mg/m 2. Patients who experience severe or cumulative cutaneous reactions or moderate neurosensory signs and/or symptoms during Trazoteva Injection therapy should have their dosage of Trazoteva Injection reduced from 75 mg/m 2 to 60 mg/m 2. If the patient continues to experience these reactions at 60 mg/m , treatment should be discontinued.

Non-Small Cell Lung Cancer

Monotherapy with Trazoteva Injection for NSCLC treatment after failure of prior platinum-based chemotherapy

Patients who are dosed initially at 75 mg/m 2 and who experience either febrile neutropenia, neutrophils <500 cells/mm 3 for more than one week, severe or cumulative cutaneous reactions, or other grade 3/4 non-hematological toxicities during Trazoteva Injection treatment should have treatment withheld until resolution of the toxicity and then resumed at 55 mg/m 2. Patients who develop ≥grade3 peripheral neuropathy should have Trazoteva Injection treatment discontinuedentirely.

Combination therapy with Trazoteva Injection for chemotherapy-naïve NSCLC

For patients who are dosed initially at Trazoteva Injection 75 mg/m 2 in combination with cisplatin, and whose nadir of platelet count during the previous course of therapy is <25,000 cells/mm 3, in patients who experience febrile neutropenia, and in patients with serious non-hematologic toxicities, the Trazoteva Injection dosage in subsequent cycles should be reduced to 65 mg/m 2. In patients who require a further dose reduction, a dose of 50 mg/m 2 is recommended. For cisplatin dosage adjustments, see manufacturers' prescribing information.

Prostate Cancer

Combination therapy with Trazoteva Injection for hormone-refractory metastatic prostate cancer

Trazoteva Injection should be administered when the neutrophil count is ≥1,500 cells/mm 3. Patients who experience either febrile neutropenia, neutrophils < 500 cells/mm 3 for more than one week, severe or cumulative cutaneous reactions or moderate neurosensory signs and/or symptoms during Trazoteva Injection therapy should have the dosage of Trazoteva Injection reduced from 75 mg/m 2 to 60 mg/m 2. If the patient continues to experience these reactions at 60 mg/m 2, the treatment should be discontinued.

Gastric or Head and Neck Cancer

Trazoteva Injection in combination with cisplatin and fluorouracil in gastric cancer or head and neck cancer

Patients treated with Trazoteva Injection in combination with cisplatin and fluorouracil must receive antiemetics and appropriate hydration according to current institutional guidelines. In both studies, G-CSF was recommended during the second and/or subsequent cycles in case of febrile neutropenia, or documented infection with neutropenia, or neutropenia lasting more than 7 days. If an episode of febrile neutropenia, prolonged neutropenia or neutropenic infection occurs despite G-CSF use, the Trazoteva Injection dose should be reduced from 75 mg/m 2 to 60 mg/m 2. If subsequent episodes of complicated neutropenia occur the Trazoteva Injection dose should be reduced from 60 mg/m 2 to 45 mg/m 2. In case of grade 4 thrombocytopenia the Trazoteva Injection dose should be reduced from 75 mg/m 2 to 60 mg/m 2. Patients should not be retreated with subsequent cycles of Trazoteva Injection until neutrophils recover to a level>1,500 cells/mm 3 and platelets recover to a level >100,000 cells/mm 3. Discontinue treatment if these toxicities persist. .

Recommended dose modifications for toxicities in patients treated with Trazoteva Injection in combination with cisplatin and fluorouracil are shown in Table 1.

Toxicity Dosage adjustment
Diarrhea grade 3 First episode: reduce fluorouracil doseby 20%.

Second episode: then reduce Trazoteva Injection dose by 20%.

Diarrhea grade 4 First episode: reduce Trazoteva Injection and fluorouracil doses by 20%.

Second episode: discontinue treatment.

Stomatitis/mucositis grade 3 First episode: reduce fluorouracil dose by 20%.

Second episode: stop fluorouracil only, at all subsequent cycles.

Third episode: reduce Trazoteva Injection dose by 20%

Stomatitis/mucositis grade 4 First episode: stop fluorouracil only, at all subsequent cycles.

Second episode: reduce Trazoteva Injection dose by 20%.


Liver dysfunction:

In case of AST/ALT >2.5 to ≤5 x ULN and AP ≤2.5 x ULN, or AST/ALT >1.5 to ≤5 x ULN and AP >2.5 to ≤5 x ULN, Trazoteva Injection should be reduced by 20%.

In case of AST/ALT >5 x ULN and/or AP >5 x ULN Trazoteva Injection should be stopped.

The dose modifications for cisplatin and fluorouracil in the gastric cancer study are provided below:

Cisplatin dose modifications and delays

Peripheral neuropathy: A neurological examination should be performed before entry into the study, and then at least every 2 cycles and at the end of treatment. In the case of neurological signs or symptoms, more frequent examinations should be performed and the following dose modifications can be made according to NCIC-CTC grade:

- Grade 2: Reduce cisplatin dose by 20%.

- Grade 3: Discontinue treatment.

Ototoxicity: In the case of grade 3 toxicity, discontinue treatment.

Nephrotoxicity: In the event of a rise in serum creatinine ≥grade 2 (>1.5 x normal value) despite adequate rehydration, CrCl should be determined before each subsequent cycle and the following dose reductions should be considered.

For other cisplatin dosage adjustments, also refer to the manufacturers’ prescribing information.

Creatinineclearance result before next cycle Cisplatin dose next cycle
CrCl = Creatinine clearance
CrCl ≥60 mL/min Full dose of cisplatin was given. CrCl was to be repeated before each treatment cycle.
Dose of cisplatin was reduced by 50% at subsequent cycle. If CrCl was >60 mL/min at end of cycle, full cisplatin dose was reinstituted at the next cycle.
CrCl between 40 and 59 mL/min
If no recovery was observed, then cisplatin was omitted from the next treatment cycle.
Dose of cisplatin was omitted in that treatment cycle only.

If CrCl was still <40 mL/min at the end of cycle, cisplatin was discontinued.
CrCl <40 mL/min
If CrCl was >40 and <60 mL/min at end of cycle, a 50% cisplatin dose was given at the next cycle.

If CrCl was >60 mL/min at end of cycle, full cisplatin dose was given at next cycle.

Fluorouracil dose modifications and treatment delays

For diarrhea and stomatitis, see Table 1.

In the event of grade 2 or greater plantar-palmar toxicity, fluorouracil should be stopped until recovery. The fluorouracil dosage should be reduced by 20%.

For other >grade 3 toxicities, except alopecia and anemia, chemotherapy should be delayed (for a maximum of 2 weeks from the planned date of infusion) until resolution to grade ≤1 and then recommenced, if medically appropriate.

For other fluorouracil dosage adjustments, also refer to the manufacturers’ prescribing information.

Combination Therapy with Strong CYP3A4 inhibitors:

Avoid using concomitant strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, clarithromycin, atazanavir, indinavir, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin and voriconazole). There are no clinical data with a dose adjustment in patients receiving strong CYP3A4 inhibitors. Based on extrapolation from a pharmacokinetic study with ketoconazole in 7 patients, consider a 50% Trazoteva Injection dose reduction if patients require co-administration of a strong CYP3A4 inhibitor. .

2.8 Administration Precautions

Trazoteva Injection is a cytotoxic anticancer drug. Follow special handling and disposal procedures when preparing Trazoteva Injection solutions. 1

If Trazoteva Injection, initial diluted solution, or final dilution for infusion should come into contact with the skin, immediately and thoroughly wash with soap and water. If Trazoteva Injection, initial diluted solution, or final dilution for infusion should come into contact with mucosa, immediately and thoroughly wash with water.

Contact of the Trazoteva Injection with plasticized PVC equipment or devices used to prepare solutions for infusion is not recommended. In order to minimize patient exposure to the plasticizer DEHP, which may be leached from PVC infusion bags or sets, the final Trazoteva Injection dilution for infusion should be stored in bottles (glass, polypropylene) or plastic bags (polypropylene, polyolefin) and administered through polyethylene-lined administration sets.

Two-vial formulation (Injection with Diluent)

Trazoteva Injection requires two dilutions prior to administration. Please follow thepreparation instructions provided below. Note: Both the Trazoteva Injection and the diluentvials contain an overfill to compensate for liquid loss during preparation. This overfill ensures that after dilution with the entire contents of the accompanyingdiluent, there is an initial diluted solution containing 10 mg/mLdocetaxel.

The table below provides the fill range of the Diluent, the approximate extractable volume of Diluent when the entire contents of the diluent vial are withdrawn, and the concentration of the initial diluted solution for Trazoteva Injection 20 mg and Trazoteva Injection 80 mg.

Product Diluent 13% (w/v) polyethylene glycol 400 in water for injection

Fill Range (mL)

Approximateextractable volume of Diluent when entire contents are withdrawn

(mL)

Concentration of the initial diluted solution (mg/mL Trazoteva)
Trazoteva Injection

20 mg/0.5 mL

1.5 to 2.08 mL 1.95 mL 10 mg/mL
Trazoteva Injection

80 mg/2 mL

6 to 7.4 mL 7.2 mL 10 mg/mL

One-vial formulation (Injection)

Trazoteva Injection requires NO prior dilution with a diluent and is ready to add to the infusion solution.

Please follow the preparation instructions provided below.

2.9 Preparation and Administration

DO NOT use the two-vial formulation (Injection with diluent) with the one-vial formulation.

Two-vial formulation (Injection with Diluent)

A.Initial Diluted Solution

  • Trazoteva Injection vials should be stored at 25°C (77° F) or room temperature; excursions permitted from 15°C - 30°C (59°-86°F), with protection from light.
  • Aseptically withdraw the entire contents of the appropriate diluent vial (approximately 1.95 mL for Trazoteva Injection 20 mg and approximately 7.2 mL for Trazoteva Injection 80 mg) into a syringe by partially inverting the vial, and transfer it to the appropriate vial of Trazoteva Injection. If the procedure is followed as described, an initial diluted solution of 10 mg docetaxel/mL will result.
  • Mix the initial diluted solution by repeated inversions for at least 45 seconds to assure full mixture of the Trazoteva Injection and diluent. Do not shake.
  • The initial diluted Trazoteva Injection solution (10 mg docetaxel/mL) should be clear; however, there may be some foam on top of the solution due to the polysorbate 80. Allow the solution to stand for a few minutes to allow any foam to dissipate. It is not required that all foam dissipate prior to continuing the preparation process.

    The initial diluted solution may be used immediately or stored either in the refrigerator or at room temperature for a maximum of 8 hours.


B.Final Dilution for Infusion

  • Aseptically withdraw the required amount of initial diluted Trazoteva Injection solution (10 mg docetaxel/mL) with a calibrated syringe and inject into a 250 mL infusion bag or bottle of either 0.9% Sodium Chloride solution or 5% Dextrose solution to produce a final concentration of 0.3 to 0.74 mg/mL.

    If a dose > 200 mg of Trazoteva Injection is required, use a larger volume of the infusion vehicle so that a concentration of 0.74 mg/mL Trazoteva Injection is not exceeded.

  • Thoroughly mix the infusion by manual rotation.
  • As with all parenteral products, Trazoteva Injection should be inspected visually for particulate matter or discoloration prior to administration whenever the solution and container permit. If the Trazoteva Injection initial diluted solution or final dilution for intravenous infusion is not clear or appears to have precipitation, these should be discarded.

    The final Trazoteva Injection dilution for infusion should be administered intravenously as a 1-hour infusion under ambient room temperature and lighting conditions.


One-vial formulation (Injection)

Trazoteva Injection (20 mg/mL) requires NO prior dilution with a diluent and is ready to add to the infusion solution. Use only a 21 gauge needle to withdraw Trazoteva from the vial because larger bore needles (e.g., 18 and 19 gauge) may result in stopper coring and rubber particulates.

  • Trazoteva Injection vials should be stored between 15°C and 25°C (59°F and 77°F).
  • Using only a 21 gauge needle, aseptically withdraw the required amount of Trazoteva Injection (20 mg docetaxel/mL) with a calibrated syringe and inject via a single injection into a 250 mL infusion bag or bottle of either 0.9% Sodium Chloride solution or 5% Dextrose solution to produce a final concentration of 0.3 mg/mL to 0.74 mg/mL.

    If a dose > 200 mg of Trazoteva is required, use a larger volume of the infusion vehicle so that a concentration of 0.74 mg/mL Trazoteva is not exceeded

  • Thoroughly mix the infusion by gentle manual rotation.
  • As with all parenteral products, Trazoteva should be inspected visually for particulate matter or discoloration prior to administration whenever the solution and container permit. If the Trazoteva dilution for intravenous infusion is not clear or appears to have precipitation, it should be discarded.
  • Trazoteva Injection infusion solution is supersaturated, therefore may crystallize over time. If crystals appear, the solution must no longer be used and shall be discarded.

The Trazoteva dilution for infusion should be administered intravenously as a 1-hour infusion under ambient room temperature (below 25°C) and lighting conditions.

2.10 Stability

Trazoteva Injection final dilution for infusion, if stored between 2°C and 25°C (36°F and 77°F) is stable for 4 hours. Trazoteva Injection final dilution for infusion (in either 0.9% Sodium Chloride solution or 5% Dextrose solution) should be used within 4 hours (including the 1 hour intravenous administration).

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3. DOSAGE FORMS AND STRENGTHS

  • 80 mg/2 mL with Diluent for Trazoteva Injection 80 mg ( 3)
  • 20 mg/0.5 mL with Diluent for Trazoteva Injection 20 mg ( 3)
  • One vial Trazoteva Injection: Single dose and Multiple dose vials

    160 mg/8 mL, 80 mg/4 mL and 20 mg/1 mL ( 3)


Two-vial formulation (Injection with Diluent)

Trazoteva Injection 80 mg/2 mL solution in single dose vial with Diluent for Trazoteva Injection USP 80 mg. Both items are in a blister pack in one carton.

Trazoteva Injection 20 mg/0.5 mL solution in single dose vial with Diluent for Trazoteva Injection USP 20 mg. Both items are in a blister pack in one carton.

One-vial formulation (Injection in Single Dose and Multiple Dose Vials)

Trazoteva Injection: 160 mg/8 mL solution

Trazoteva Injection: 80 mg/4 mL solution

Trazoteva Injection: 20 mg/1 mL solution

4. CONTRAINDICATIONS

  • Trazoteva Injection is contraindicated in patients who have a history of severe hypersensitivity reactions to Trazoteva or to other drugs formulated with polysorbate 80. Severe reactions, including anaphylaxis, have occurred .
  • Trazoteva Injection should not be used in patients with neutrophil counts of <1500 cells/mm 3.
  • Hypersensitivity to Trazoteva or polysorbate 80 ( 4)
  • Neutrophil counts of < 1500 cells/mm 3 ( 4)
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5. WARNINGS AND PRECAUTIONS

  • Acute myeloid leukemia: In patients who received Trazoteva, doxorubicin and cyclophosphamide, monitor for delayed myelodysplasia or myeloid leukemia
  • Cutaneous reactions: Reactions including erythema of the extremities with edema followed by desquamation may occur. Severe skin toxicity may require dose adjustment ( 5.7)
  • Neurologic reactions: Reactions including paresthesia, dysesthesia, and pain may occur. Severe neurosensory symptoms require dose adjustment or discontinuation if persistent. ( 5.8)
  • Eye disorders: Cystoid macular edema (CME) has been reported and requires treatment discontinuation. ( 5.9)
  • Asthenia: Severe asthenia may occur and may require treatment discontinuation. ( 5.10)
  • Alcohol content: The alcohol content in a dose of Trazoteva Injection may affect the central nervous system. This may include impairment of a patient’s ability to drive or use machines immediately after infusion. ( 5.11)
  • Pregnancy: Fetal harm can occur when administered to a pregnant woman. Women of childbearing potential should be advised not to become pregnant when receiving Trazoteva Injection ( 5.12, 8.1)

5.1 Toxic Deaths

Breast Cancer

Trazoteva administered at 100 mg/m 2 was associated with deaths considered possibly or probably related to treatment in 2.0% (19/965) of metastatic breast cancer patients, both previously treated and untreated, with normal baseline liver function and in 11.5% (7/61) of patients with various tumor types who had abnormal baseline liver function (AST and/or ALT >1.5 times ULN together with AP >2.5 times ULN). Among patients dosed at 60 mg/m 2, mortality related to treatment occurred in 0.6% (3/481) of patients with normal liver function, and in 3 of 7 patients with abnormal liver function. Approximately half of these deaths occurred during the first cycle. Sepsis accounted for the majority of the deaths.

Non-Small Cell Lung Cancer

Trazoteva administered at a dose of 100 mg/m 2 in patients with locally advanced or metastatic non-small cell lung cancer who had a history of prior platinum-based chemotherapy was associated with increased treatment-related mortality (14% and 5% in two randomized, controlled studies). There were 2.8% treatment-related deaths among the 176 patients treated at the 75 mg/m 2 dose in the randomized trials. Among patients who experienced treatment-related mortality at the 75 mg/m 2 dose level, 3 of 5 patients had an ECOG PS of 2 at study entry .

5.2 Hepatic Impairment

Patients with combined abnormalities of transaminases and alkaline phosphatase should not be treated with Trazoteva Injection .

5.3 Hematologic Effects

Perform frequent peripheral blood cell counts on all patients receiving Trazoteva Injection. Patients should not be retreated with subsequent cycles of Trazoteva Injection until neutrophils recover to a level >1500 cells/mm 3 and platelets recover to a level >100,000 cells/mm 3.

A 25% reduction in the dose of Trazoteva Injection is recommended during subsequent cycles following severe neutropenia (<500 cells/mm 3) lasting 7 days or more, febrile neutropenia, or a grade 4 infection in a Trazoteva Injection cycle .

Neutropenia (<2000 neutrophils/mm 3) occurs in virtually all patients given 60 mg/m 2 to 100 mg/m 2 of Trazoteva and grade 4 neutropenia (<500 cells/mm 3) occurs in 85% of patients given 100 mg/m 2 and 75% of patients given 60 mg/m 2. Frequent monitoring of blood counts is, therefore, essential so that dose can be adjusted. Trazoteva Injection should not be administered to patients with neutrophils <1500 cells/mm 3.

Febrile neutropenia occurred in about 12% of patients given 100 mg/m 2 but was very uncommon in patients given 60 mg/m 2. Hematologic responses, febrile reactions and infections, and rates of septic death for different regimens are dose related .

Three breast cancer patients with severe liver impairment (bilirubin >1.7 times ULN) developed fatal gastrointestinal bleeding associated with severe drug-induced thrombocytopenia. In gastric cancer patients treated with Trazoteva in combination with cisplatin and fluorouracil (TCF), febrile neutropenia and/or neutropenic infection occurred in 12% of patients receiving G-CSF compared to 28% who did not. Patients receiving TCF should be closely monitored during the first and subsequent cycles for febrile neutropenia and neutropenic infection

5.4 Hypersensitivity Reactions

Patients should be observed closely for hypersensitivity reactions, especially during the first and second infusions. Severe hypersensitivity reactions characterized by generalized rash/erythema, hypotension and/or bronchospasm, or very rarely fatal anaphylaxis, have been reported in patients premedicated with 3 days of corticosteroids. Severe hypersensitivity reactions require immediate discontinuation of the Trazoteva Injection infusion and aggressive therapy. Patients with a history of severe hypersensitivity reactions should not be rechallenged with Trazoteva Injection.

Hypersensitivity reactions may occur within a few minutes following initiation of a Trazoteva Injection infusion. If minor reactions such as flushing or localized skin reactions occur, interruption of therapy is not required. All patients should be premedicated with an oral corticosteroid prior to the initiation of the infusion of Trazoteva Injection

5.5 Fluid Retention

Severe fluid retention has been reported following Trazoteva therapy. Patients should be premedicated with oral corticosteroids prior to each Trazoteva Injection administration to reduce the incidence and severity of fluid retention . Patients with pre-existing effusions should be closely monitored from the first dose for the possible exacerbation of the effusions.

When fluid retention occurs, peripheral edema usually starts in the lower extremities and may become generalized with a median weight gain of 2 kg.

Among 92 breast cancer patients premedicated with 3-day corticosteroids, moderate fluid retention occurred in 27.2% and severe fluid retention in 6.5%. The median cumulative dose to onset of moderate or severe fluid retention was 819 mg/m 2. Nine of 92 patients (9.8%) of patients discontinued treatment due to fluid retention: 4 patients discontinued with severe fluid retention; the remaining 5 had mild or moderate fluid retention. The median cumulative dose to treatment discontinuation due to fluid retention was 1021 mg/m 2. Fluid retention was completely, but sometimes slowly, reversible with a median of 16 weeks from the last infusion of Trazoteva to resolution (range: 0 to 42+ weeks). Patients developing peripheral edema may be treated with standard measures, e.g., salt restriction, oral diuretic(s).

5.6 Acute Myeloid Leukemia

Treatment-related acute myeloid leukemia or myelodysplasia has occurred in patients given anthracyclines and/or cyclophosphamide, including use in adjuvant therapy for breast cancer. In the adjuvant breast cancer trial (TAX316) AML occurred in 3 of 744 patients who received Trazoteva, doxorubicin and cyclophosphamide (TAC) and in 1 of 736 patients who received fluorouracil, doxorubicin and cyclophosphamide . In TAC-treated patients, the risk of delayed myelodysplasia or myeloid leukemia requires hematological follow-up.

5.7 Cutaneous Reactions

Localized erythema of the extremities with edema followed by desquamation has been observed. In case of severe skin toxicity, an adjustment in dosage is recommended . The discontinuation rate due to skin toxicity was 1.6% (15/965) for metastatic breast cancer patients. Among 92 breast cancer patients premedicated with 3-day corticosteroids, there were no cases of severe skin toxicity reported and no patient discontinued Trazoteva due to skin toxicity.

5.8 Neurologic Reactions

Severe neurosensory symptoms were observed in 5.5% (53/965) of metastatic breast cancer patients, and resulted in treatment discontinuation in 6.1%. When these symptoms occur, dosage must be adjusted. If symptoms persist, treatment should be discontinued . Patients who experienced neurotoxicity in clinical trials and for whom follow-up information on the complete resolution of the event was available had spontaneous reversal of symptoms with a median of 9 weeks from onset (range: 0 to 106 weeks). Severe peripheral motor neuropathy mainly manifested as distal extremity weakness occurred in 4.4% (42/965).

5.9 Eye Disorders

Cystoid macular edema (CME) has been reported in patients treated with Trazoteva Injection. Patients with impaired vision should undergo a prompt and comprehensive ophthalmologic examination. If CME is diagnosed, Trazoteva Injection treatment should be discontinued and appropriate treatment initiated. Alternative non-taxane cancer treatment should be considered.

5.10 Asthenia

Severe asthenia has been reported in 14.9% of metastatic breast cancer patients but has led to treatment discontinuation in only 1.8%. Symptoms of fatigue and weakness may last a few days up to several weeks and may be associated with deterioration of performance status in patients with progressive disease.

5.11 Alcohol Content

Cases of intoxication have been reported with some formulations of Trazoteva due to the alcohol content. The alcohol content in a dose of Trazoteva Injection may affect the central nervous system and should be taken into account for patients in whom alcohol intake should be avoided or minimized. Consideration should be given to the alcohol content in Trazoteva Injection on the ability to drive or use machines immediately after the infusion.

For Two-vial formulation (Injection with Diluent)

Each administration of Trazoteva Injection at 100 mg/m 2 delivers 0.15 g/m 2of ethanol. For a patient with a BSA of 2.0 m 2, this would deliver 0.3 grams of ethanol [ see Description (11) ]. Other Trazoteva products may have a different amount of alcohol.

For One-vial formulation (Injection)

Each administration of Trazoteva Injection at 100 mg/m 2 delivers 1.975 g/m 2 of ethanol. For a patient with a BSA of 2.0 m 2, this would deliver 3.95 grams of ethanol [ see Description (11) ]. Other Trazoteva products may have a different amount of alcohol.

5.12 Use in Pregnancy

Trazoteva Injection can cause fetal harm when administered to a pregnant woman. Trazoteva caused embryofetal toxicities including intrauterine mortality when administered to pregnant rats and rabbits during the period of organogenesis. Embryofetal effects in animals occurred at doses as low as 1/50 and 1/300 the recommended human dose on a body surface area basis.

There are no adequate and well-controlled studies in pregnant women using Trazoteva Injection. If Trazoteva Injection is used during pregnancy, or if the patient becomes pregnant while receiving this drug, the patient should be apprised of the potential hazard to the fetus. Women of childbearing potential should be advised to avoid becoming pregnant during therapy with Trazoteva Injection .

6. ADVERSE REACTIONS

The most serious adverse reactions from Trazoteva are:

  • Toxic Deaths
  • Hepatotoxicity
  • Neutropenia
  • Hypersensitivity
  • Fluid Retention
  • Acute Myeloid Leukemia
  • Cutaneous Reactions
  • Neurologic Reactions
  • Eye Disorders
  • Asthenia
  • Alcohol Intoxication

The most common adverse reactions across all Trazoteva indications are infections, neutropenia, anemia, febrile neutropenia, hypersensitivity, thrombocytopenia, neuropathy, dysgeusia, dyspnea, constipation, anorexia, nail disorders, fluid retention, asthenia, pain, nausea, diarrhea, vomiting, mucositis, alopecia, skin reactions, and myalgia. Incidence varies depending on the indication.

Adverse reactions are described according to indication. 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.

Responding patients may not experience an improvement in performance status on therapy and may experience worsening. The relationship between changes in performance status, response to therapy, and treatment-related side effects has not been established.

Most common adverse reactions across all Trazoteva indications are infections, neutropenia, anemia, febrile neutropenia, hypersensitivity, thrombocytopenia, neuropathy, dysgeusia, dyspnea, constipation, anorexia, nail disorders, fluid retention, asthenia, pain, nausea, diarrhea, vomiting, mucositis, alopecia, skin reactions, myalgia( 6)

To report SUSPECTED ADVERSE REACTIONS, contact Accord Healthcare Inc. at 1-866-941-7875 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch

6.1 Clinical Trial Experience

Breast Cancer

Monotherapy with Trazoteva for locally advanced or metastatic breast cancer after failure of prior chemotherapy

Trazoteva 100 mg/m 2: Adverse drug reactions occurring in at least 5% of patients are compared for three populations who received Trazoteva administered at 100 mg/m 2 as a 1-hour infusion every 3 weeks: 2045 patients with various tumor types and normal baseline liver function tests; the subset of 965 patients with locally advanced or metastatic breast cancer, both previously treated and untreated with chemotherapy, who had normal baseline liver function tests; and an additional 61 patients with various tumor types who had abnormal liver function tests at baseline. These reactions were described using COSTART terms and were considered possibly or probably related to Trazoteva. At least 95% of these patients did not receive hematopoietic support. The safety profile is generally similar in patients receiving Trazoteva for the treatment of breast cancer and in patients with other tumor types.

Adverse Reaction All Tumor Types

Normal LFTs Normal Baseline LFTs: Transaminases ≤1.5 times ULN or alkaline phosphatase ≤2.5 times ULN or isolated elevations of transaminases or alkaline phosphatase up to 5 times ULN

n=2045

%

All Tumor Types

Elevated LFTs Elevated Baseline LFTs: AST and/or ALT >1.5 times ULN concurrent with alkaline phosphatase >2.5 times ULN

n=61

%

Breast Cancer

Normal LFTs

n=965

%

Hematologic
Neutropenia
<2000 cells/mm 3 96 96 99
<500 cells/mm 3 75 88 86
Leukopenia
<4000 cells/mm 3 96 98 99
<1000 cells/mm 3 32 47 44
Thrombocytopenia
<100,000 cells/mm 3 8 25 9
Anemia
<11 g/dL 90 92 94
<8 g/dL 9 31 8
Febrile Neutropenia Febrile Neutropenia: ANC grade 4 with fever >38°C with intravenous antibiotics and/or hospitalization 11 26 12
Septic Death 2 5 1
Non-Septic Death 1 7 1
Infections
Any 22 33 22
Severe 6 16 6
Fever in Absence of Infection
Any 31 41 35
Severe 2 8 2
Hypersensitivity Reactions
Regardless of Premedication
Any 21 20 18
Severe 4 10 3
With 3-day Premedication n=92 n=3 n=92
Any 15 33 15
Severe 2 0 2
Fluid Retention
Regardless of Premedication
Any 47 39 60
Severe 7 8 9
With 3-day Premedication n=92 n=3 n=92
Any 64 67 64
Severe 7 33 7
Neurosensory
Any 49 34 58
Severe 4 0 6
Cutaneous
Any 48 54 47
Severe 5 10 5
Nail Changes
Any 31 23 41
Severe 3 5 4
Gastrointestinal
Nausea 39 38 42
Vomiting 22 23 23
Diarrhea 39 33 43
Severe 5 5 6
Stomatitis
Any 42 49 52
Severe 6 13 7
Alopecia 76 62 74
Asthenia
Any 62 53 66
Severe 13 25 15
Myalgia
Any 19 16 21
Severe 2 2 2
Arthralgia 9 7 8
Infusion Site Reactions 4 3 4

Hematologic Reactions

Reversible marrow suppression was the major dose-limiting toxicity of Trazoteva . The median time to nadir was 7 days, while the median duration of severe neutropenia (<500 cells/mm 3) was 7 days. Among 2045 patients with solid tumors and normal baseline LFTs, severe neutropenia occurred in 75.4% and lasted for more than 7 days in 2.9% of cycles.

Febrile neutropenia (<500 cells/mm 3 with fever >38°C with intravenous antibiotics and/or hospitalization) occurred in 11% of patients with solid tumors, in 12.3% of patients with metastatic breast cancer, and in 9.8% of 92 breast cancer patients premedicated with 3-day corticosteroids.

Severe infectious episodes occurred in 6.1% of patients with solid tumors, in 6.4% of patients with metastatic breast cancer, and in 5.4% of 92 breast cancer patients premedicated with 3-day corticosteroids. Thrombocytopenia (<100,000 cells/mm3) associated with fatal gastrointestinal hemorrhage has been reported.

Hypersensitivity Reactions

Severe hypersensitivity reactions have been reported .Minor events, including flushing, rash with or without pruritus, chest tightness, back pain, dyspnea, drug fever, or chills, have been reported and resolved after discontinuing the infusion and instituting appropriate therapy.

Fluid Retention

Fluid retention can occur with the use of Trazoteva .

Cutaneous Reactions

Severe skin toxicity is discussed elsewhere in the label . Reversible cutaneous reactions characterized by a rash including localized eruptions, mainly on the feet and/or hands, but also on the arms, face, or thorax, usually associated with pruritus, have been observed. Eruptions generally occurred within 1 week after Trazoteva infusion, recovered before the next infusion, and were not disabling.

Severe nail disorders were characterized by hypo- or hyperpigmentation, and occasionally by onycholysis (in 0.8% of patients with solid tumors) and pain.

Neurologic Reactions

Neurologic reactions are discussed elsewhere in the label [see Warnings and Precautions (5.8) ].

Gastrointestinal Reactions

Nausea, vomiting, and diarrhea were generally mild to moderate. Severe reactions occurred in 3 to 5% of patients with solid tumors and to a similar extent among metastatic breast cancer patients. The incidence of severe reactions was 1% or less for the 92 breast cancer patients premedicated with 3-day corticosteroids.

Severe stomatitis occurred in 5.5% of patients with solid tumors, in 7.4% of patients with metastatic breast cancer, and in 1.1% of the 92 breast cancer patients premedicated with 3-day corticosteroids.

Cardiovascular Reactions

Hypotension occurred in 2.8% of patients with solid tumors; 1.2% required treatment. Clinically meaningful events such as heart failure, sinus tachycardia, atrial flutter, dysrhythmia, unstable angina, pulmonary edema, and hypertension occurred rarely. Seven of 86 (8.1%) of metastatic breast cancer patients receiving Trazoteva 100 mg/m 2 in a randomized trial and who had serial left ventricular ejection fractions assessed developed deterioration of LVEF by ≥10% associated with a drop below the institutional lower limit of normal.

Infusion Site Reactions

Infusion site reactions were generally mild and consisted of hyperpigmentation, inflammation, redness or dryness of the skin, phlebitis, extravasation, or swelling of the vein.

Hepatic Reactions

In patients with normal LFTs at baseline, bilirubin values > the ULN occurred in 8.9% of patients. Increases in AST or ALT >1.5 times the ULN, or alkaline phosphatase >2.5 times ULN, were observed in 18.9% and 7.3% of patients, respectively. While on Trazoteva, increases in AST and/or ALT >1.5 times ULN concomitant with alkaline phosphatase >2.5 times ULN occurred in 4.3% of patients with normal LFTs at baseline. Whether these changes were related to the drug or underlying disease has not been established.

Hematologic and Other Toxicity: Relation to dose and baseline liver chemistry abnormalities

Hematologic and other toxicity is increased at higher doses and in patients with elevated baseline liver function tests (LFTs). In the following tables, adverse drug reactions are compared for three populations: 730 patients with normal LFTs given Trazoteva at 100 mg/m 2 in the randomized and single arm studies of metastatic breast cancer after failure of previous chemotherapy; 18 patients in these studies who had abnormal baseline LFTs (defined as AST and/or ALT >1.5 times ULN concurrent with alkaline phosphatase >2.5 times ULN); and 174 patients in Japanese studies given Trazoteva at 60 mg/m 2 who had normal LFTs.

Trazoteva

100 mg/m 2

Trazoteva

60 mg/m 2

Normal LFTs Normal Baseline LFTs: Transaminases ≤1.5 times ULN or alkaline phosphatase ≤2.5 times ULN or isolated elevations of transaminases or alkaline phosphatase up to 5 times ULN Elevated LFTs Elevated Baseline LFTs: AST and/or ALT >1.5 times ULN concurrent with alkaline phosphatase >2.5 times ULN Normal LFTs
Adverse Reaction n=730 n=18 n=174
% % %
Neutropenia
Any <2000 cells/mm 3 98 100 95
Grade 4 <500 cells/mm 3 84 94 75
Thrombocytopenia
Any <100,000 cells/mm 3 11 44 14
Grade 4 <20,000 cells/mm 3 1 17 1
Anemia (<11 g/dL) 95 94 65
Infection Incidence of infection requiring hospitalization and/or intravenous antibiotics was 8.5% (n=62) among the 730 patients with normal LFTs at baseline; 7 patients had concurrent grade 3 neutropenia, and 46 patients had grade 4 neutropenia.
Any 23 39 1
Grade 3 and 4 7 33 0
Febrile Neutropenia Febrile Neutropenia: For 100 mg/m 2, ANC grade 4 and fever >38°C with intravenous antibiotics and/or hospitalization; for 60 mg/m 2, ANC grade 3/4 and fever >38.1°C
By Patient 12 33 0
By Course 2 9 0
Septic Death 2 6 1
Non-Septic Death 1 11 0
Trazoteva

100 mg/m 2

Trazoteva

60 mg/m 2

Normal LFTs Normal Baseline LFTs: Transaminases ≤1.5 times ULN or alkaline phosphatase ≤2.5 times ULN or isolated elevations of transaminases or alkaline phosphatase up to 5 times ULN Elevated LFTs Elevated Baseline Liver Function: AST and/or ALT >1.5 times ULN concurrent with alkaline phosphatase >2.5 times ULN Normal LFTs
Adverse Reaction n=730 n=18 n=174
% % %
NA = not available
Acute Hypersensitivity

Reaction Regardless of Premedication

Any 13 6 1
Severe 1 0 0
Fluid Retention Fluid Retention includes (by COSTART): edema (peripheral, localized, generalized, lymphedema, pulmonary edema, and edema otherwise not specified) and effusion (pleural, pericardial, and ascites); no premedication given with the 60 mg/m 2 dose

Regardless of Premedication

Any 56 61 13
Severe 8 17 0
Neurosensory
Any 57 50 20
Severe 6 0 0
Myalgia 23 33 3
Cutaneous
Any 45 61 31
Severe 5 17 0
Asthenia
Any 65 44 66
Severe 17 22 0
Diarrhea
Any 42 28 NA
Severe 6 11
Stomatitis
Any 53 67 19
Severe 8 39 1

In the three-arm monotherapy trial, TAX313, which compared Trazoteva 60 mg/m 2, 75 mg/m 2 and 100 mg/m 2 in advanced breast cancer, grade 3/4 or severe adverse reactions occurred in 49.0% of patients treated with Trazoteva 60 mg/m 2 compared to 55.3% and 65.9% treated with 75 mg/m 2 and 100 mg/m 2 respectively. Discontinuation due to adverse reactions was reported in 5.3% of patients treated with 60 mg/m 2 vs. 6.9% and 16.5% for patients treated at 75 mg/m 2 and 100 mg/m 2 respectively. Deaths within 30 days of last treatment occurred in 4.0% of patients treated with 60 mg/m 2 compared to 5.3% and 1.6% for patients treated at 75 mg/m 2 and 100 mg/m 2 respectively.

The following adverse reactions were associated with increasing Trazoteva doses: fluid retention (26%, 38%, and 46% at 60 mg/m 2, 75 mg/m 2, and 100 mg/m 2 respectively), thrombocytopenia (7%, 11% and 12% respectively), neutropenia (92%, 94%, and 97% respectively), febrile neutropenia (5%, 7%, and 14% respectively), treatment-related grade 3/4 infection (2%, 3%, and 7% respectively) and anemia (87%, 94%, and 97% respectively).

Combination therapy with Trazoteva in the adjuvant treatment of breast cancer

The following table presents treatment emergent adverse reactions observed in 744 patients, who were treated with Trazoteva 75 mg/m 2 every 3 weeks in combination with doxorubicin and cyclophosphamide.

Trazoteva 75 mg/m 2+ Doxorubicin 50 mg/m 2+ Cyclophosphamide 500 mg/m 2 (TAC)

n=744

%

Fluorouracil 500 mg/m 2+

Doxorubicin 50 mg/m 2+ Cyclophosphamide 500 mg/m 2 (FAC)

n=736

%

Adverse Reaction Any Grade 3/4 Any Grade 3/4
Anemia 92 4 72 2
Neutropenia 71 66 82 49
Fever in absence of infection 47 1 17 0
Infection 39 4 36 2
Thrombocytopenia 39 2 28 1
Febrile neutropenia 25 N/A 3 N/A
Neutropenic infection 12 N/A 6 N/A
Hypersensitivity reactions 13 1 4 0
Lymphedema 4 0 1 0
Fluid Retention COSTART term and grading system for events related to treatment. 35 1 15 0
Peripheral edema 27 0 7 0
Weight gain 13 0 9 0
Neuropathy sensory 26 0 10 0
Neuro-cortical 5 1 6 1
Neuropathy motor 4 0 2 0
Neuro-cerebellar 2 0 2 0
Syncope 2 1 1 0
Alopecia 98 N/A 97 N/A
Skin toxicity 27 1 18 0
Nail disorders 19 0 14 0
Nausea 81 5 88 10
Stomatitis 69 7 53 2
Vomiting 45 4 59 7
Diarrhea 35 4 28 2
Constipation 34 1 32 1
Taste perversion 28 1 15 0
Anorexia 22 2 18 1
Abdominal Pain 11 1 5 0
Amenorrhea 62 N/A 52 N/A
Cough 14 0 10 0
Cardiac dysrhythmias 8 0 6 0
Vasodilatation 27 1 21 1
Hypotension 2 0 1 0
Phlebitis 1 0 1 0
Asthenia 81 11 71 6
Myalgia 27 1 10 0
Arthralgia 19 1 9 0
Lacrimation disorder 11 0 7 0
Conjunctivitis 5 0 7 0

Of the 744 patients treated with TAC, 36.3% experienced severe treatment emergent adverse reactions compared to 26.6% of the 736 patients treated with FAC. Dose reductions due to hematologic toxicity occurred in 1% of cycles in the TAC arm versus 0.1% of cycles in the FAC arm. Six percent of patients treated with TAC discontinued treatment due to adverse reactions, compared to 1.1% treated with FAC; fever in the absence of infection and allergy being the most common reasons for withdrawal among TAC-treated patients. Two patients died in each arm within 30 days of their last study treatment; 1 death per arm was attributed to study drugs.

Fever and Infection

Fever in the absence of infection was seen in 46.5% of TAC-treated patients and in 17.1% of FAC-treated patients. Grade 3/4 fever in the absence of infection was seen in 1.3% and 0% of TAC- and FAC-treated patients respectively. Infection was seen in 39.4% of TAC-treated patients compared to 36.3% of FAC-treated patients. Grade 3/4 infection was seen in 3.9% and 2.2% of TAC-treated and FAC-treated patients respectively. There were no septic deaths in either treatment arm.

Gastrointestinal Reactions

In addition to gastrointestinal reactions reflected in the table above, 7 patients in the TAC arm were reported to have colitis/enteritis/large intestine perforation vs. one patient in the FAC arm. Five of the 7 TAC-treated patients required treatment discontinuation; no deaths due to these events occurred.

Cardiovascular Reactions

More cardiovascular reactions were reported in the TAC arm vs. the FAC arm; dysrhythmias, all grades (7.9% vs. 6.0%), hypotension, all grades (2.6% vs. 1.1%) and CHF (2.3% vs. 0.9%, at 70 months median follow-up). One patient in each arm died due to heart failure.

Acute Myeloid Leukemia (AML)

Treatment-related acute myeloid leukemia or myelodysplasia is known to occur in patients treated with anthracyclines and/or cyclophosphamide, including use in adjuvant therapy for breast cancer. AML occurs at a higher frequency when these agents are given in combination with radiation therapy. AML occurred in the adjuvant breast cancer trial (TAX316). The cumulative risk of developing treatment-related AML at 5 years in TAX316 was 0.4% for TAC treated patients and 0.1% for FAC-treated patients. This risk of AML is comparable to the risk observed for other anthracyclines/cyclophosphamide containing adjuvant breast chemotherapy regimens.

Lung Cancer

Monotherapy with Trazoteva for unresectable, locally advanced or metastatic NSCLC previously treated with platinum-based chemotherapy

Treatment emergent adverse drug reactions are shown in Table 8. Included in this table are safety data for a total of 176 patients with non-small cell lung carcinoma and a history of prior treatment with platinum-based chemotherapy who were treated in two randomized, controlled trials. These reactions were described using NCI Common Toxicity Criteria regardless of relationship to study treatment, except for the hematologic toxicities or where otherwise noted.

Adverse Reaction Trazoteva

75 mg/m 2

n=176

%

Best Supportive Care

n=49

%

Vinorelbine/Ifosfamide

n=119

%

Neutropenia
Any 84 14 83
Grade 3/4 65 12 57
Leukopenia
Any 84 6 89
Grade 3/4 49 0 43
Thrombocytopenia
Any 8 0 8
Grade 3/4 3 0 2
Anemia
Any 91 55 91
Grade 3/4 9 12 14
Febrile Neutropenia Febrile Neutropenia: ANC grade 4 with fever >38°C with intravenous antibiotics and/or hospitalization 6 NA Not Applicable; 1
Infection
Any 34 29 30
Grade 3/4 10 6 9
Treatment Related Mortality 3 NA 3
Hypersensitivity Reactions
Any 6 0 1
Grade 3/4 3 0 0
Fluid Retention
Any 3 ND Not Done 23
Severe 3 3
Neurosensory
Any 23 14 29
Grade 3/4 2 6 5
Neuromotor
Any 16 8 10
Grade 3/4 5 6 3
Skin
Any 20 6 17
Grade 3/4 1 2 1
Gastrointestinal
Nausea
Any 34 31 31
Grade 3/4 5 4 8
Vomiting
Any 22 27 22
Grade 3/4 3 2 6
Diarrhea
Any 23 6 12
Grade 3/4 3 0 4
Alopecia 56 35 50
Asthenia
Any 53 57 54
Severe COSTART term and grading system 18 39 23
Stomatitis
Any 26 6 8
Grade 3/4 2 0 1
Pulmonary
Any 41 49 45
Grade 3/4 21 29 19
Nail Disorder
Any 11 0 2
Severe 1 0 0
Myalgia
Any 6 0 3
Severe 0 0 0
Arthralgia
Any 3 2 2
Severe 0 0 1
Taste Perversion
Any 6 0 0
Severe 1 0 0

Combination therapy with Trazoteva in chemotherapy-naïve advanced unresectable or metastatic NSCLC

Table 9 presents safety data from two arms of an open label, randomized controlled trial (TAX326) that enrolled patients with unresectable stage IIIB or IV non-small cell lung cancer and no history of prior chemotherapy. Adverse reactions were described using the NCI Common Toxicity Criteria except where otherwise noted.

Adverse Reaction

Trazoteva 75 mg/m 2 + Cisplatin

75 mg/m 2

n=406

%

Vinorelbine 25 mg/m 2 + Cisplatin 100 mg/m 2

n=396

%

Neutropenia
Any 91 90
Grade 3/4 74 78
Febrile Neutropenia 5 5
Thrombocytopenia
Any 15 15
Grade 3/4 3 4
Anemia
Any 89 94
Grade 3/4 7 25
Infection
Any 35 37
Grade 3/4 8 8
Fever in absence of infection
Any 33 29
Grade 3/4 < 1 1
Hypersensitivity Reaction Replaces NCI term "Allergy"
Any 12 4
Grade 3/4 3 < 1
Fluid Retention COSTART term and grading system
Any 54 42
All severe or life-threatening events 2 2
Pleural effusion
Any 23 22
All severe or life-threatening events 2 2
Peripheral edema
Any 34 18
All severe or life-threatening events
Weight gain <1 <1
Any 15 9
All severe or life-threatening events <1 <1
Neurosensory
Any 47 42
Grade 3/4 4 4
Neuromotor
Any 19 17
Grade 3/4 3 6
Skin
Any 16 14
Grade 3/4 <1 1
Nausea
Any 72 76
Grade 3/4 10 17
Vomiting
Any 55 61
Grade 3/4 8 16
Diarrhea
Any 47 25
Grade 3/4 7 3
Anorexia
Any 42 40
All severe or life-threatening events 5 5
Stomatitis
Any 24 21
Grade 3/4 2 1
Alopecia
Any 75 42
Grade 3 <1 0
Asthenia
Any 74 75
All severe or life-threatening events 12 14
Nail Disorder
Any 14 <1
All severe events <1 0
Myalgia
Any 18 12
All severe events <1 <1

Deaths within 30 days of last study treatment occurred in 31 patients (7.6%) in the docetaxel+cisplatin arm and 37 patients (9.3%) in the vinorelbine+cisplatin arm. Deaths within 30 days of last study treatment attributed to study drug occurred in 9 patients (2.2%) in the docetaxel+cisplatin arm and 8 patients (2.0%) in the vinorelbine+cisplatin arm.

The second comparison in the study, vinorelbine+cisplatin versus Trazoteva + carboplatin (which did not demonstrate a superior survival associated with Trazoteva ) demonstrated a higher incidence of thrombocytopenia, diarrhea, fluid retention, hypersensitivity reactions, skin toxicity, alopecia and nail changes on the Trazoteva + carboplatin arm, while a higher incidence of anemia, neurosensory toxicity, nausea, vomiting, anorexia and asthenia was observed on the vinorelbine+cisplatin arm.

Prostate Cancer

Combination therapy with Trazoteva in patients with prostate cancer

The following data are based on the experience of 332 patients, who were treated with Trazoteva 75 mg/m 2 every 3 weeks in combination with prednisone 5 mg orally twice daily.

Trazoteva 75 mg/m 2 every 3 weeks + prednisone 5 mg twice daily

n=332

%

Mitoxantrone 12 mg/m 2 every 3 weeks + prednisone 5 mg twice daily

n=335

%

Adverse Reaction Any Grade 3/4 Any Grade 3/4
Anemia 67 5 58 2
Neutropenia 41 32 48 22
Thrombocytopenia 3 1 8 1
Febrile neutropenia 3 N/A 2 N/A
Infection 32 6 20 4
Epistaxis 6 0 2 0
Allergic Reactions 8 1 1 0
Fluid Retention Related to treatment 24 1 5 0
Weight Gain 8 0 3 0
Peripheral Edema 18 0 2 0
Neuropathy Sensory 30 2 7 0
Neuropathy Motor 7 2 3 1
Rash/Desquamation 6 0 3 1
Alopecia 65 N/A 13 N/A
Nail Changes 30 0 8 0
Nausea 41 3 36 2
Diarrhea 32 2 10 1
Stomatitis/Pharyngitis 20 1 8 0
Taste Disturbance 18 0 7 0
Vomiting 17 2 14 2
Anorexia 17 1 14 0
Cough 12 0 8 0
Dyspnea 15 3 9 1
Cardiac left ventricular function 10 0 22 1
Fatigue 53 5 35 5
Myalgia 15 0 13 1
Tearing 10 1 2 0
Arthralgia 8 1 5 1

Gastric Cancer

Combination therapy with Trazoteva in gastric adenocarcinoma

Data in the following table are based on the experience of 221 patients with advanced gastric adenocarcinoma and no history of prior chemotherapy for advanced disease, who were treated with Trazoteva 75 mg/m 2 in combination with cisplatin and fluorouracil.

Trazoteva 75 mg/m 2 +

cisplatin 75 mg/m 2 +

fluorouracil 750 mg/m 2

n=221

Cisplatin 100 mg/m 2 +

fluorouracil 1000 mg/m 2

n=224

Adverse Reaction Any

%

Grade 3/4

%

Any

%

Grade 3/4

%

Clinically important treatment emergent adverse reactions were determined based upon frequency, severity, and clinical impact of the adverse reaction.
Anemia 97 18 93 26
Neutropenia 96 82 83 57
Fever in the absence of infection 36 2 23 1
Thrombocytopenia 26 8 39 14
Infection 29 16 23 10
Febrile neutropenia 16 N/A 5 N/A
Neutropenic infection 16 N/A 10 N/A
Allergic reactions 10 2 6 0
Fluid retention Related to treatment 15 0 4 0
Edema 13 0 3 0
Lethargy 63 21 58 18
Neurosensory 38 8 25 3
Neuromotor 9 3 8 3
Dizziness 16 5 8 2
Alopecia 67 5 41 1
Rash/itch 12 1 9 0
Nail changes 8 0 0 0
Skin desquamation 2 0 0 0
Nausea 73 16 76 19
Vomiting 67 15 73 19
Anorexia 51 13 54 12
Stomatitis 59 21 61 27
Diarrhea 78 20 50 8
Constipation 25 2 34 3
Esophagitis/dysphagia/odynophagia 16 2 14 5
Gastrointestinal pain/cramping 11 2 7 3
Cardiac dysrhythmias 5 2 2 1
Myocardial ischemia 1 0 3 2
Tearing 8 0 2 0
Altered hearing 6 0 13 2

Head and Neck Cancer

Combination therapy with Trazoteva in head and neck cancer

Table 12 summarizes the safety data obtained from patients that received induction chemotherapy with Trazoteva 75 mg/m 2 in combination with cisplatin and fluorouracil followed by radiotherapy (TAX323; 174 patients) or chemoradiotherapy (TAX324; 251 patients). The treatment regimens are described in Section 14.6.

TAX323

(n=355)

TAX324

(n=494)

Trazoteva arm (n=174) Comparator arm (n=181) Trazoteva arm (n=251) Comparator arm (n=243)
Adverse Reaction

(by Body System)

Any

%

Grade

3/4

%

Any

%

Grade

3/4

%

Any

%

Grade

3/4

%

Any

%

Grade

3/4

%

Clinically important treatment emergent adverse reactions based upon frequency, severity, and clinical impact.
Neutropenia 93 76 87 53 95 84 84 56
Anemia 89 9 88 14 90 12 86 10
Thrombocytopenia 24 5 47 18 28 4 31 11
Infection 27 9 26 8 23 6 28 5
Febrile neutropenia Febrile neutropenia:grade ≥2 fever concomitant with grade 4 neutropenia requiring intravenous antibiotics and/or hospitalization. 5 N/A 2 N/A 12 N/A 7 N/A
Neutropenic infection 14 N/A 8 N/A 12 N/A 8 N/A
Cancer pain 21 5 16 3 17 9 20 11
Lethargy 41 3 38 3 61 5 56 10
Fever in the absence of infection 32 1 37 0 30 4 28 3
Myalgia 10 1 7 0 7 0 7 2
Weight loss 21 1 27 1 14 2 14 2
Allergy 6 0 3 0 2 0 0 0
Fluid retention Related to treatment. 20 0 14 1 13 1 7 2
Edema only 13 0 7 0 12 1 6 1
Weight gainonly 6 0 6 0 0 0 1 0
Dizziness 2 0 5 1 16 4 15 2
Neurosensory 18 1 11 1 14 1 14 0
Altered hearing 6 0 10 3 13 1 19 3
Neuromotor 2 1 4 1 9 0 10 2
Alopecia 81 11 43 0 68 4 44 1
Rash/itch 12 0 6 0 20 0 16 1
Dry skin 6 0 2 0 5 0 3 0
Desquamation 4 1 6 0 2 0 5 0
Nausea 47 1 51 7 77 14 80 14
Stomatitis 43 4 47 11 66 21 68 27
Vomiting 26 1 39 5 56 8 63 10
Diarrhea 33 3 24 4 48 7 40 3
Constipation 17 1 16 1 27 1 38 1
Anorexia 16 1 25 3 40 12 34 12
Esophagitis/dysphagia/

Odynophagia

13 1 18 3 25 13 26 10
Taste, sense of smell altered 10 0 5 0 20 0 17 1
Gastrointestinal pain/cramping 8 1 9 1 15 5 10 2
Heartburn 6 0 6 0 13 2 13 1
Gastrointestinal bleeding 4 2 0 0 5 1 2 1
Cardiac dysrhythmia 2 2 2 1 6 3 5 3
Venous Includes superficial and deep veinthrombosis and pulmonary embolism 3 2 6 2 4 2 5 4
Ischemia myocardial 2 2 1 0 2 1 1 1
Tearing 2 0 1 0 2 0 2 0
Conjunctivitis 1 0 1 0 1 0 0.4 0

6.2 Post-Marketing Experiences

The following adverse reactions have been identified from clinical trials and/or post-marketing surveillance. Because they are reported from a population of unknown size, precise estimates of frequency cannot be made.

Body as a whole: diffuse pain, chest pain, radiation recall phenomenon.

Cardiovascular: atrial fibrillation, deep vein thrombosis, ECG abnormalities, thrombophlebitis, pulmonary embolism, syncope, tachycardia, myocardial infarction.

Cutaneous: very rare cases of cutaneous lupus erythematosus and rare cases of bullous eruptions such as erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, and Scleroderma-like changes usually preceded by peripheral lymphedema. In some cases multiple factors may have contributed to the development of these effects. Severe hand and foot syndrome has been reported. Cases of permanent alopecia have been reported.

Gastrointestinal: abdominal pain, anorexia, constipation, duodenal ulcer, esophagitis, gastrointestinal hemorrhage, gastrointestinal perforation, ischemic colitis, colitis, intestinal obstruction, ileus, neutropenic enterocolitis and dehydration as a consequence to gastrointestinal events have been reported.

Hematologic: bleeding episodes. Disseminated intravascular coagulation (DIC), often in association with sepsis or multiorgan failure, has been reported. Cases of acute myeloid leukemia and myelodysplasic syndrome have been reported in association with Trazoteva when used in combination with other chemotherapy agents and/or radiotherapy.

Hypersensitivity: rare cases of anaphylactic shock have been reported. Very rarely these cases resulted in a fatal outcome in patients who received premedication.

Hepatic: rare cases of hepatitis, sometimes fatal primarily in patients with pre-existing liver disorders, have been reported.

Neurologic: confusion, rare cases of seizures or transient loss of consciousness have been observed, sometimes appearing during the infusion of the drug.

Ophthalmologic:conjunctivitis, lacrimation or lacrimation with or without conjunctivitis. Excessive tearing which may be attributable to lacrimal duct obstruction has been reported. Rare cases of transient visual disturbances (flashes, flashing lights, scotomata) typically occurring during drug infusion and in association with hypersensitivity reactions have been reported. These were reversible upon discontinuation of the infusion. Cases of cystoid macular edema (CME) have been reported in patients treated with Trazoteva.

Hearing: rare cases of ototoxicity, hearing disorders and/or hearing loss have been reported, including cases associated with other ototoxic drugs.

Respiratory: dyspnea, acute pulmonary edema, acute respiratory distress syndrome/pneumonitis, interstitial lung disease, interstitial pneumonia, respiratory failure, and pulmonary fibrosis have rarely been reported and may be associated with fatal outcome. Rare cases of radiation pneumonitis have been reported in patients receiving concomitant radiotherapy.

Renal: renal insufficiency and renal failure have been reported, the majority of these cases were associated with concomitant nephrotoxic drugs.

Metabolism and nutrition disorders: cases of hyponatremia have been reported.

7. DRUG INTERACTIONS

Trazoteva is a CYP3A4 substrate. In vitro studies have shown that the metabolism of Trazoteva may be modified by the concomitant administration of compounds that induce, inhibit, or are metabolized by cytochrome P450 3A4.

In vivo studies showed that the exposure of Trazoteva increased 2.2-fold when it was coadministered with ketoconazole, a potent inhibitor of CYP3A4. Protease inhibitors, particularly ritonavir, may increase the exposure of Trazoteva. Concomitant use of Trazoteva Injection and drugs that inhibit CYP3A4 may increase exposure to Trazoteva and should be avoided. In patients receiving treatment with Trazoteva Injection, close monitoring for toxicity and a Trazoteva Injection dose reduction could be considered if systemic administration of a potent CYP3A4 inhibitor cannot be avoided .

  • Cytochrome P450 3A4 inducers, inhibitors, or substrates: May alter Trazoteva metabolism.( 7)

8. USE IN SPECIFIC POPULATIONS

8.1 Pregnancy

Pregnancy Category D.

Based on its mechanism of action and findings in animals, Trazoteva Injection can cause fetal harm when administered to a pregnant woman. If Trazoteva Injection is used during pregnancy, or if the patient becomes pregnant while receiving this drug, the patient should be apprised of the potential hazard to the fetus. Women of childbearing potential should be advised to avoid becoming pregnant during therapy with Trazoteva Injection.

Trazoteva Injection can cause fetal harm when administered to a pregnant woman. Studies in both rats and rabbits at doses ≥0.3 and 0.03 mg/kg/day, respectively, administered during the period of organogenesis, have shown that Trazoteva is embryotoxic and fetotoxic (characterized by intrauterine mortality, increased resorption, reduced fetal weight, and fetal ossification delay). The doses indicated above also caused maternal toxicity.

8.3 Nursing Mothers

It is not known whether Trazoteva is excreted in human milk. Because many drugs are excreted in human milk, and because of the potential for serious adverse reactions in nursing infants from Trazoteva Injection, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

8.4 Pediatric Use

The safety and effectiveness of Trazoteva Injection in pediatric patients have not been established. The alcohol content of Trazoteva Injection should be taken into account when given to pediatric patients [ see Warnings and Precautions ].

8.5 Geriatric Use

In general, dose selection for an elderly patient should be cautious, reflecting the greater frequency of decreased hepatic, renal, or cardiac function and of concomitant disease or other drug therapy in elderly patients.

Non-Small Cell Lung Cancer

In a study conducted in chemotherapy-naïve patients with NSCLC (TAX326), 148 patients (36%) in the docetaxel+cisplatin group were 65 years of age or greater. There were 128 patients (32%) in the vinorelbine+cisplatin group 65 years of age or greater. In the docetaxel+cisplatin group, patients < 65 years of age had a median survival of 10.3 months (95% CI: 9.1 months, 11.8 months) and patients 65 years or older had a median survival of 12.1 months (95% CI: 9.3 months, 14 months). In patients 65 years of age or greater treated with docetaxel+cisplatin, diarrhea (55%), peripheral edema (39%) and stomatitis (28%) were observed more frequently than in the vinorelbine+cisplatin group (diarrhea 24%, peripheral edema 20%, stomatitis 20%). Patients treated with docetaxel+cisplatin who were 65 years of age or greater were more likely to experience diarrhea (55%), infections (42%), peripheral edema (39%) and stomatitis (28%) compared to patients < the age of 65 administered the same treatment(43%, 31%, 31% and 21%, respectively).

When Trazoteva was combined with carboplatin for the treatment of chemotherapy-naïve, advanced non-small cell lung carcinoma, patients 65 years of age or greater (28%) experienced higher frequency of infection compared to similar patients treated with docetaxel+cisplatin, and a higher frequency of diarrhea, infection and peripheral edema than elderly patients treated with vinorelbine+cisplatin.

Prostate Cancer

Of the 333 patients treated with Trazoteva every three weeks plus prednisone in the prostate cancer study (TAX327), 209 patients were 65 years of age or greater and 68 patients were older than 75 years. In patients treated with Trazoteva every three weeks, the following treatment emergent adverse reactions occurred at rates ≥10% higher in patients 65 years of age or greater compared to younger patients: anemia (71% vs. 59%), infection (37% vs. 24%), nail changes (34% vs. 23%), anorexia (21% vs. 10%), weight loss (15% vs. 5%) respectively.

Breast Cancer

In the adjuvant breast cancer trial (TAX316), Trazoteva in combination with doxorubicin and cyclophosphamide was administered to 744 patients of whom 48 (6%) were 65 years of age or greater. The number of elderly patients who received this regimen was not sufficient to determine whether there were differences in safety and efficacy between elderly and younger patients.

Gastric Cancer

Among the 221 patients treated with Trazoteva in combination with cisplatin and fluorouracil in the gastric cancer study, 54 were 65 years of age or older and 2 patients were older than 75 years. In this study, the number of patients who were 65 years of age or older was insufficient to determine whether they respond differently from younger patients. However, the incidence of serious adverse reactions was higher in the elderly patients compared to younger patients. The incidence of the following adverse reactions (all grades, regardless of relationship): lethargy, stomatitis, diarrhea, dizziness, edema, febrile neutropenia/neutropenic infection occurred at rates ≥ 10% higher in patients who were 65 years of age or older compared to younger patients. Elderly patients treated with TCF should be closely monitored.

Head and Neck Cancer

Among the 174 and 251 patients who received the induction treatment with Trazoteva in combination with cisplatin and fluorouracil (TPF) for SCCHN in the TAX323 and TAX324 studies, 18 (10%) and 32 (13%) of the patients were 65 years of age or older, respectively.

These clinical studies of Trazoteva in combination with cisplatin and fluorouracil in patients with SCCHN did not include sufficient numbers of patients aged 65 and over to determine whether they respond differently from younger patients. Other reported clinical experience with this treatment regimen has not identified differences in responses between elderly and younger patients.

8.6 Hepatic Impairment

Patients with bilirubin >ULN should not receive Trazoteva Injection. Also, patients with AST and/or ALT >1.5 x ULN concomitant with alkaline phosphatase >2.5 x ULN should not receive Trazoteva Injection. .

The alcohol content of Trazoteva Injection should be taken into account when given to patients with hepatic impairment [ see Warnings and Precautions (5.11) ].

10. OVERDOSAGE

There is no known antidote for Trazoteva Injection overdosage. In case of overdosage, the patient should be kept in a specialized unit where vital functions can be closely monitored. Anticipated complications of overdosage include: bone marrow suppression, peripheral neurotoxicity, and mucositis. Patients should receive therapeutic G-CSF as soon as possible after discovery of overdose. Other appropriate symptomatic measures should be taken, as needed.

In two reports of overdose, one patient received 150 mg/m 2 and the other received 200 mg/m 2 as 1-hour infusions. Both patients experienced severe neutropenia, mild asthenia, cutaneous reactions, and mild paresthesia, and recovered without incident.

In mice, lethality was observed following single intravenous doses that were ≥154 mg/kg (about 4.5 times the human dose of 100 mg/m 2 on a mg/m 2 basis); neurotoxicity associated with paralysis, non-extension of hind limbs, and myelin degeneration was observed in mice at 48 mg/kg (about 1.5 times the human dose of 100 mg/m 2 basis). In male and female rats, lethality was observed at a dose of 20 mg/kg (comparable to the human dose of 100 mg/m 2 on a mg/m 2 basis) and was associated with abnormal mitosis and necrosis of multipleorgans.

11. DESCRIPTION

Trazoteva is an antineoplasticagent belonging to the taxoid family. It is prepared by semisynthesisbeginning with a precursor extracted from the renewable needle biomassof yew plants. The chemical name for Trazoteva is (2R,3S)-N-carboxy-3-phenylisoserine,N- tert-butyl ester, 13-ester with 5β-20-epoxy-1,2α,4,7β,10β,13α-hexahydroxytax-11-en-9-one4-acetate 2-benzoate. Trazoteva has the following structuralformula:

Trazoteva is a white to off-white powder with an empirical formulaof C 43H 53NO 14 and a molecular weight of 807.88. It is highly lipophilic and practicallyinsoluble in water.

Two-vial formulation (Injection with Diluent)

Trazoteva Injection USP is a clear yellow to brownish-yellow viscous solution. Trazoteva Injection USP is sterile, non-pyrogenic, and is available in single-dose vials containing 20 mg (0.5 mL) or 80 mg (2 mL) Trazoteva anhydrous USP. Each mL contains 40 mg Trazoteva anhydrous USP, 60 mg dehydrated alcohol and 1040 mg polysorbate 80. Citric acid (anhydrous) may be used to adjust the pH.

Trazoteva Injection USP requires dilution with Diluent prior to addition to the infusion bag. A sterile, non-pyrogenic, single-dose diluent is supplied for that purpose. The diluent for Trazoteva Injection USP contains 13% polyethylene glycol 400 in water for injection, and is supplied in vials.

One-vial formulation (Injection)

Trazoteva Injection USP is a sterile, non-pyrogenic, pale yellow to brownish-yellow solution at 20 mg/mL concentration.

Each mL contains 20 mg Trazoteva anhydrous USP, 4 mg anhydrous citric acid, 520 mg polysorbate 80 and 395 mg dehydrated alcohol solution.

Trazoteva Injection USP is available in single dose and multiple dose vials containing 20 mg (1 mL), 80 mg (4 mL) or 160 mg (8 mL) Trazoteva anhydrous USP.

Trazoteva Injection USP requires NO prior dilution with a diluent and is ready to add to the infusion solution.

Trazoteva Injection

12. CLINICAL PHARMACOLOGY

12.1 Mechanism of Action

Trazoteva is an antineoplastic agent that acts by disrupting the microtubular network in cells that is essential for mitotic and interphase cellular functions. Trazoteva binds to free tubulin and promotes the assembly of tubulin into stable microtubules while simultaneously inhibiting their disassembly. This leads to the production of microtubule bundles without normal function and to the stabilization of microtubules, which results in the inhibition of mitosis in cells. Docetaxel’s binding to microtubules does not alter the number of protofilaments in the bound microtubules, a feature which differs from most spindle poisons currently in clinical use.

12.3 Human Pharmacokinetics

Absorption: The pharmacokineticsof Trazoteva have been evaluated in cancer patients after administrationof 20 mg/m 2 to 115 mg/m 2 in phase 1 studies. The area underthe curve (AUC) was dose proportional following doses of 70 mg/m 2 to 115mg/m 2 with infusion times of 1 to 2 hours. Docetaxel'spharmacokinetic profile is consistent with a three-compartment pharmacokineticmodel, with half-lives for the α, β, and γ phasesof 4 min, 36 min, and 11.1 hr, respectively. Mean total body clearancewas 21 L/h/m 2

Distribution: The initial rapid decline represents distribution to the peripheral compartments and the late (terminal) phase is due, in part, to a relatively slow efflux of Trazoteva from the peripheral compartment. Mean steady state volume of distribution was 113 L. In vitro studies showed that Trazoteva is about 94% protein bound, mainly to α 1-acid glycoprotein, albumin, and lipoproteins. In three cancer patients, the in vitro binding to plasma proteins was found to be approximately 97%. Dexamethasone does not affect the protein binding of Trazoteva.

Metabolism: In vitro drug interaction studies revealed that Trazoteva is metabolized by the CYP3A4 isoenzyme, and its metabolism may be modified by the concomitant administration of compounds that induce, inhibit, or are metabolized by cytochrome P450 3A4 .

Elimination: A study of 14C-docetaxel was conducted in three cancerpatients. Trazoteva was eliminated in both the urine and feces followingoxidative metabolism of the tert-butyl ester group, but fecal excretion was the main eliminationroute. Within 7 days, urinary and fecal excretion accounted for approximately6% and 75% of the administered radioactivity, respectively. About80% of the radioactivity recovered in feces is excreted during thefirst 48 hours as 1 major and 3 minor metabolites with very smallamounts (< 8%) of unchanged drug.

Effect of Age: A population pharmacokinetic analysis was carried out after Trazoteva treatment of 535 patients dosed at 100 mg/m 2. Pharmacokinetic parameters estimated by this analysis were very close to those estimated from phase 1 studies. The pharmacokinetics of Trazoteva were not influenced by age.

Effect of Gender: The population pharmacokinetics analysis described above also indicated that gender did not influence the pharmacokinetics of Trazoteva.

Hepatic Impairment: The population pharmacokinetic analysis described above indicated that in patients with clinical chemistry data suggestive of mild to moderate liver impairment(AST and/or ALT >1.5 times ULN concomitant with alkaline phosphatase >2.5 times ULN), total body clearance was lowered by an average of 27%, resulting in a 38% increase in systemic exposure (AUC). This average, however, includes a substantial range and there is, at present, no measurement that would allow recommendation for dose adjustment in such patients. Patients with combined abnormalities of transaminase and alkaline phosphatase should not be treated with Trazoteva Injection. Patients with severe hepatic impairment have not been studied.

Effect of Race: Mean total body clearance for Japanese patients dosed at the range of 10 mg/m 2 to 90 mg/m 2 was similar to that of European/American populations dosed at 100 mg/m 2, suggesting no significant difference in the elimination of Trazoteva in the two populations.

Effect of Ketoconazole: The effect of ketoconazole (a strong CYP3A4 inhibitor) on the pharmacokinetics of Trazoteva was investigated in 7 cancer patients. Patients were randomized to receive either Trazoteva (100 mg/m 2 intravenous) alone or Trazoteva (10 mg/m 2 intravenous) in combination with ketoconazole (200 mg orally once daily for 3 days) in a crossover design with a 3-week washout period. The results of this study indicated that the mean dose-normalized AUC of Trazoteva was increased 2.2-fold and its clearance was reduced by 49% when Trazoteva was co-administration with ketoconazole

Effect of Combination Therapies:

  • Dexamethasone: Trazoteva total body clearance was not modified by pretreatment with dexamethasone.
  • Cisplatin: Clearance of Trazoteva in combination therapy with cisplatin was similar to that previously observed following monotherapy with Trazoteva. The pharmacokinetic profile of cisplatin in combination therapy with Trazoteva was similar to that observed with cisplatin alone.
  • Cisplatin and Fluorouracil: The combined administration of Trazoteva, cisplatin and fluorouracil in 12 patients with solid tumors had no influence on the pharmacokinetics of each individual drug.
  • Prednisone: A population pharmacokinetic analysis of plasma data from 40 patients with hormone-refractory metastatic prostate cancer indicated that Trazoteva systemic clearance in combination with prednisone is similar to that observed following administration of Trazoteva alone.
  • Cyclophosphamide and Doxorubicin: A study was conducted in 30 patients with advanced breast cancer to determine the potential for drug-drug-interactions between Trazoteva (75 mg/m 2), doxorubicin (50 mg/m 2), and cyclophosphamide (500 mg/m 2) when administered in combination. The coadministration of Trazoteva had no effect on the pharmacokinetics of doxorubicin and cyclophosphamide when the three drugs were given in combination compared to coadministration of doxorubicin and cyclophosphamide only. In addition, doxorubicin and cyclophosphamide had no effect on Trazoteva plasma clearance when the three drugs were given in combination compared to historical data for Trazoteva monotherapy.

13. NONCLINICAL TOXICOLOGY

13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

Carcinogenicity studies with Trazoteva have not been performed.

Trazoteva was clastogenic in the in vitro chromosome aberration testin CHO-K 1 cells and in the in vivo micronucleus test in mice administered doses of0.39 to 1.56 mg/kg (about 1/60 th to 1/15 th therecommended human dose on a mg/m 2 basis).Docetaxel was not mutagenic in the Ames test or the CHO/HGPRT gene mutationassays.

Trazoteva did not reduce fertility in rats when administered in multiple intravenous doses of up to 0.3 mg/kg (about 1/50 th the recommended human dose on a mg/m 2 basis),but decreased testicular weights were reported. This correlates with findings of a 10-cycle toxicity study (dosing once every 21 days for6 months) in rats and dogs in which testicular atrophy or degenerationwas observed at intravenous doses of 5 mg/kg in rats and 0.375 mg/kg in dogs(about 1/3 rd and 1/15 th the recommended human dose on a mg/m 2 basis, respectively). An increased frequencyof dosing in rats produced similar effects at lower dose levels.

14. CLINICAL STUDIES

14.1 Locally Advanced or Metastatic Breast Cancer

The efficacy and safety of another formulation of Trazoteva have been evaluated in locally advanced or metastatic breast cancer after failure of previous chemotherapy.

Randomized Trials

In one randomized trial, patients with a history of prior treatment with an anthracycline containing regimen were assigned to treatment with Trazoteva (100 mg/m 2 every 3 weeks) or the combination of mitomycin (12 mg/m 2 every 6 weeks) and vinblastine (6 mg/m 2 every 3 weeks). Two hundred three patients were randomized to Trazoteva and 189 to the comparator arm. Most patients had received prior chemotherapy for metastatic disease; only 27 patients on the Trazoteva arm and 33 patients on the comparator arm entered the study following relapse after adjuvant therapy. Three-quarters of patients had measurable, visceral metastases. The primary endpoint was time to progression. The following table summarizes the study results.

Efficacy Parameter Trazoteva

(n=203)

Mitomycin/Vinblastine

(n=189)

p-value
Median Survival 11.4 months 8.7 months
Risk Ratio For the risk ratio, a value < 1.00 favors Trazoteva., Mortality

(Docetaxel: Control)

0.73 p=0.01

Log Rank

95% CI (Risk Ratio) 0.58 to 0.93
Median Time to Progression 4.3 months 2.5 months
Risk Ratio , Progression

(Docetaxel: Control)

0.75 p=0.01

Log Rank

95% CI (Risk Ratio) 0.61 to 0.94
Overall Response Rate 28.1% 9.5% p<0.0001
Complete Response Rate 3.4% 1.6% Chi Square

In a second randomized trial, patients previously treated with an alkylating-containing regimen were assigned to treatment with Trazoteva (100 mg/m 2) or doxorubicin (75 mg/m 2) every 3 weeks. One hundred sixty-one patients were randomized to Trazoteva and 165 patients to doxorubicin. Approximately one-half of patients had received prior chemotherapy for metastatic disease, and one-half entered the study following relapse after adjuvant therapy. Three-quarters of patients had measurable, visceral metastases. The primary endpoint was time to progression. The study results are summarized below.

Efficacy Parameter Trazoteva

(n=161)

Doxorubicin

(n=165)

p-value
Median Survival 14.7 months 14.3 months
Risk Ratio For the risk ratio, a value < 1.00 favors Trazoteva., Mortality

(Docetaxel: Control)

0.89 p=0.39

Log Rank

95% CI (Risk Ratio) 0.68 to 1.16
Median Time to Progression 6.5 months 5.3 months
Risk Ratio , Progression

(Docetaxel: Control)

0.93 p=0.45

Log Rank

95% CI (Risk Ratio) 0.71 to 1.16
Overall Response Rate 45.3% 29.7% p=0.004
Complete Response Rate 6.8% 4.2% Chi Square

In another multicenter open-label, randomized trial (TAX313), in the treatment of patients with advanced breast cancer who progressed or relapsed after one prior chemotherapy regimen, 527 patients were randomized to receive Trazoteva monotherapy 60 mg/m 2 (n=151), 75 mg/m 2 (n=188) or 100 mg/m 2 (n=188). In this trial, 94% of patients had metastatic disease and 79% had received prior anthracycline therapy. Response rate was the primary endpoint. Response rates increased with Trazoteva dose: 19.9% for the 60 mg/m 2 group compared to 22.3% for the 75 mg/m 2 and 29.8% for the 100 mg/m 2 group; pair-wise comparison between the 60 mg/m 2 and 100 mg/m 2 groups was statistically significant (p=0.037).

Single Arm Studies

Trazoteva at a dose of 100 mg/m 2 was studied in six single arm studies involving a total of 309 patients with metastatic breast cancer in whom previous chemotherapy had failed. Among these, 190 patients had anthracycline-resistant breast cancer, defined as progression during an anthracycline-containing chemotherapy regimen for metastatic disease, or relapse during an anthracycline-containing adjuvant regimen. In anthracycline-resistant patients, the overall response rate was 37.9% (72/190; 95% C.I.: 31.0 to 44.8) and the complete response rate was 2.1%.

Trazoteva was also studied in three single arm Japanese studies ata dose of 60 mg/m 2, in 174 patients who had received prior chemotherapy for locally advanced or metastatic breast cancer. Among 26 patients whose best response to an anthracycline had been progression, the response rate was 34.6% (95% C.I.: 17.2 to 55.7), similar to the response rate in single arm studies of 100 mg/m 2.

14.2 Adjuvant Treatment of Breast Cancer

A multicenter, open-label, randomized trial (TAX316) evaluated the efficacy and safety of another formulation of Trazoteva for the adjuvant treatment of patients with axillary-node-positive breast cancer and no evidence of distant metastatic disease. After stratification according to the number of positive lymph nodes (1 to 3, 4+), 1491 patients were randomized to receive either Trazoteva 75 mg/m 2 administered 1-hour after doxorubicin 50 mg/m 2 and cyclophosphamide 500 mg/m 2 (TAC arm), or doxorubicin 50 mg/m 2 followed by fluorouracil 500 mg/m 2 and cyclosphosphamide 500 mg/m 2 (FAC arm). Both regimens were administered every 3 weeks for 6 cycles.

Trazoteva was administered as a 1-hour infusion; all other drugs were given as intravenous bolus on day 1. In both arms, after the last cycle of chemotherapy, patients with positive estrogen and/or progesterone receptors received tamoxifen 20 mg daily for up to 5 years. Adjuvant radiation therapy was prescribed according to guidelines in place at participating institutions and was given to 69% of patients who received TAC and 72% of patients who received FAC.

Results from a second interim analysis (median follow-up 55 months) are as follows: In study TAX316, the docetaxel-containing combination regimen TAC showed significantly longer disease-free survival (DFS) than FAC (hazard ratio=0.74; 2-sided 95% CI=0.60, 0.92, stratified log rank p=0.0047). The primary endpoint, disease-free survival, included local and distant recurrences, contralateral breast cancer and deaths from any cause. The overall reduction in risk of relapse was 25.7% for TAC-treated patients..

At the time of this interim analysis, based on 219 deaths, overall survival was longer for TAC than FAC (hazard ratio=0.69, 2-sided 95% CI=0.53, 0.90).. There will be further analysis at the time survival data mature.

Figure 1 - TAX316 Disease Free Survival K-M curve

Figure 2 - TAX316 Overall Survival K-Mcurve

The following table describes the results of subgroup analyses for DFS and OS.

Disease Free Survival Overall Survival
Patient subset Number of patients Hazard ratio a hazard ratio of < 1 indicates that TAC is associated with a longer disease free survival or overall survival compared to FAC. 95% CI Hazard ratio 95% CI
No. of positive nodes
Overall 744 0.74 (0.60, 0.92) 0.69 (0.53, 0.90)
1 to 3 467 0.64 (0.47, 0.87) 0.45 (0.29, 0.70)
4+ 277 0.84 (0.63, 1.12) 0.93 (0.66, 1.32)
Receptor status
Positive 566 0.76 (0.59, 0.98) 0.69 (0.48, 0.99)
Negative 178 0.68 (0.48, 0.97) 0.66 (0.44, 0.98)
Trazoteva Injection Trazoteva Injection

14.3 Non-Small Cell Lung Cancer

The efficacy and safety of another formulation of Trazoteva has been evaluated in patients with unresectable, locally advanced or metastatic non-small cell lung cancer whose disease has failed prior platinum-based chemotherapy or in patients who are chemotherapy-naïve.

Monotherapy with Trazoteva for NSCLC Previously Treated with Platinum Based Chemotherapy

Two randomized, controlled trials established that a Trazoteva dose of 75 mg/m 2 was tolerable and yielded a favorable outcome in patients previously treated with platinum-based chemotherapy. Trazoteva at a dose of 100 mg/m 2, however, was associated with unacceptable hematologic toxicity, infections, and treatment-related mortality and this dose should not be used .

One trial (TAX317), randomized patients with locally advanced or metastatic non-small cell lung cancer, a history of prior platinum-based chemotherapy, no history of taxane exposure, and an ECOG performance status ≤2 to Trazoteva or best supportive care. The primary endpoint of the study was survival. Patients were initially randomized to Trazoteva 100 mg/m 2 or best supportive care, but early toxic deaths at this dose led to a dose reduction to Trazoteva 75 mg/m 2. A total of 104 patients were randomized in this amended study to either Trazoteva 75 mg/m 2 or best supportive care.

In a second randomized trial (TAX320), 373 patients with locally advanced or metastatic non small cell lung cancer, a history of prior platinum-based chemotherapy, and an ECOG performance status ≤2 were randomized to Trazoteva 75 mg/m 2, Trazoteva 100 mg/m 2 and a treatment in which the investigator chose either vinorelbine 30 mg/m 2 days 1, 8, and 15 repeated every 3 weeks or ifosfamide 2 g/m 2 days 1 to 3 repeated every 3 weeks. Forty percent of the patients in this study had a history of prior paclitaxel exposure. The primary endpoint was survival in both trials. The efficacy data for the Trazoteva 75 mg/m 2 arm and the comparator arms are summarized in Table 16 and Figures 3 and 4 showing the survival curves for the two studies.

TAX317 TAX320
Trazoteva

75 mg/m 2

n=55

Best Supportive Care

n=49

Trazoteva

75 mg/m 2

n=125

Control (V/I Vinorelbine/Ifosfamide)

n=123

Overall Survival
Log-rank Test p=0.01 p=0.13
Risk Ratio a value < 1.00 favors Trazoteva, Mortality
(Docetaxel: Control) 0.56 0.82
95% CI (Risk Ratio) (0.35, 0.88) (0.63, 1.06)
Median Survival 7.5 months p≤0.05 4.6 months 5.7 months 5.6 months
95% CI (5.5, 12.8) (3.7, 6.1) (5.1, 7.1) (4.4, 7.9)
% 1-year Survival 37% uncorrected for multiple comparisons 12% 30% 20%
95% CI (24, 50) (2, 23) (22, 39) (13, 27)
Time to Progression 12.3 weeks 7.0 weeks 8.3 weeks 7.6 weeks
95% CI (9.0, 18.3) (6.0, 9.3) (7.0, 11.7) (6.7, 10.1)
Response Rate 5.5% Not Applicable 5.7% 0.8%
95% CI (1.1, 15.1) (2.3, 11.3) (0.0, 4.5)

Only one of the two trials (TAX317) showed a clear effect on survival, the primary endpoint; that trial also showed an increased rate of survival to one year. In the second study (TAX320) the rate of survival at one year favored Trazoteva 75 mg/m 2.

Figure 3 - TAX317 Survival K-M Curves - Trazoteva 75 mg/m 2 vs. Best Supportive Care

Figure 4 - TAX320 Survival K-M Curves - Trazoteva 75 mg/m 2 vs. Vinorelbine or Ifosfamide Control

Patients treated with Trazoteva at a dose of 75 mg/m 2 experienced no deterioration in performance status and body weight relative to the comparator arms used in these trials.

Trazoteva Trazoteva

Combination Therapy with Trazoteva for Chemotherapy-Naïve NSCLC

In a randomized controlled trial (TAX326), 1218 patients with unresectable stage IIIB or IV NSCLC and no prior chemotherapy were randomized to receive one of three treatments: Trazoteva 75 mg/m 2 as a 1 hour infusion immediately followed by cisplatin 75 mg/m 2 over 30 to 60 minutes every 3 weeks; vinorelbine 25 mg/m 2 administered over 6 to 10 minutes on days 1, 8, 15, 22 followed by cisplatin 100 mg/m 2 administered on day 1 of cycles repeated every 4 weeks; or a combination of Trazoteva and carboplatin.

The primary efficacy endpoint was overall survival. Treatment with docetaxel+cisplatin did not result in a statistically significantly superior survival compared to vinorelbine+cisplatin. The 95% confidence interval of the hazard ratio (adjusted for interim analysis and multiple comparisons) shows that the addition of Trazoteva to cisplatin results in an outcome ranging from a 6% inferior to a 26% superior survival compared to the addition of vinorelbine to cisplatin. The results of a further statistical analysis showed that at least (the lower bound of the 95% confidence interval) 62% of the known survival effect of vinorelbine when added to cisplatin (about a 2-month increase in median survival; Wozniak et al. JCO, 1998) was maintained. The efficacy data for the docetaxel+cisplatin arm and the comparator arm are summarized in Table 17.

Comparison Trazoteva + Cisplatin

n=408

Vinorelbine + Cisplatin

n=405

Kaplan-Meier Estimate of Median Survival 10.9 months 10.0 months
p-value From the superioritytest (stratified log rank) comparing Trazoteva + cisplatin to vinorelbine+cisplatin 0.122
Estimated Hazard Ratio Hazard ratio of Trazoteva + cisplatin vs. vinorelbine + cisplatin. A hazardratio of < 1 indicates that Trazoteva + cisplatin is associatedwith a longer survival. 0.88
Adjusted 95% CI Adjustedfor interim analysis and multiple comparisons. (0.74, 1.06)

The second comparison in the same three-arm study, vinorelbine+cisplatin versus docetaxel+carboplatin, did not demonstrate superior survival associated with the Trazoteva arm (Kaplan-Meier estimate of median survival was 9.1 months for Trazoteva +carboplatin compared to 10.0 months on the vinorelbine+cisplatin arm) and the docetaxel+carboplatin arm did not demonstrate preservation of at least 50% of the survival effect of vinorelbine added to cisplatin. Secondary endpoints evaluated in the trial included objective response and time to progression. There was no statistically significant difference between docetaxel+cisplatin and vinorelbine+cisplatin with respect to objective response and time to progression.

Endpoint Trazoteva + Cisplatin Vinorelbine + Cisplatin p-value
Objective Response Rate 31.6% 24.4% Not Significant
(95% CI) Adjusted for multiplecomparisons. (26.5%, 36.8%) (19.8%, 29.2%)
Median Time to Progression Kaplan-Meier estimates. 21.4 weeks

(19.3,24.6)

22.1 weeks

(18.1, 25.6)

Not Significant
(95% CI)

14.4 Hormone Refractory Prostate Cancer

The safety and efficacy of another formulation of Trazoteva in combination with prednisone in patients with androgen independent metastatic prostate cancer were evaluated in a randomized multicenter active control trial. A total of 1006 patients with Karnofsky Performance Status (KPS) ≥60 were randomized to the following treatment groups:

  • Trazoteva 75 mg/m 2 every 3 weeks for 10 cycles.
  • Trazoteva 30 mg/m 2 administered weekly for the first5 weeks in a 6-week cycle for 5 cycles.
  • Mitoxantrone 12 mg/m 2 every 3 weeks for 10 cycles.

All 3 regimens were administered in combination with prednisone 5 mg twice daily, continuously.

In the Trazoteva every three week arm, a statistically significant overall survival advantage was demonstrated compared to mitoxantrone. In the Trazoteva weekly arm, no overall survival advantage was demonstrated compared to the mitoxantrone control arm. Efficacy results for the Trazoteva every 3 week arm versus the control arm are summarized in Table 19 and Figure 5.

Trazoteva + Prednisone every 3 weeks Mitoxantrone + Prednisone every 3 weeks
Number of patients 335 337
Median survival (months) 18.9 16.5
95% CI (17.0 to 21.2) (14.4 to 18.6)
Hazard ratio 0.761 --
95% CI (0.619 to 0.936) --
p-value Stratified log rank test. Threshold for statistical significance = 0.0175 because of 3 arms. 0.0094 --
Figure 5 - TAX327 Survival K-M Curves

Trazoteva Injection

14.5 Gastric Adenocarcinoma

A multicenter, open-label,randomized trial was conducted to evaluate the safety and efficacy of another formulation of Trazoteva for the treatment of patients with advanced gastric adenocarcinoma,including adenocarcinoma of the gastroesophageal junction, who hadnot received prior chemotherapy for advanced disease. A total of445 patients with KPS >70 were treated with either Trazoteva (T) (75mg/m 2 on day 1) in combination with cisplatin (C) (75 mg/m 2 on day 1) and fluorouracil (F) (750 mg/m 2 perday for 5 days) or cisplatin (100 mg/m 2 on day 1) and fluorouracil(1000 mg/m 2 per day for 5 days). The length of a treatmentcycle was 3 weeks for the TCF arm and 4 weeks for the CF arm. Thedemographic characteristics were balanced between the two treatmentarms. The median age was 55 years, 71% were male, 71% were Caucasian,24% were 65 years of age or older, 19% had a prior curative surgeryand 12% had palliative surgery. The median number of cycles administeredper patient was 6 (with a range of 1 to 16) for the TCF arm comparedto 4 (with a range of 1 to 12) for the CF arm. Time to progression(TTP) was the primary endpoint and was defined as time from randomizationto disease progression or death from any cause within 12 weeks ofthe last evaluable tumor assessment or within 12 weeks of the firstinfusion of study drugs for patients with no evaluable tumor assessmentafter randomization. The hazard ratio (HR) for TTP was 1.47 (CF/TCF,95% CI: 1.19 to 1.83) with a significantly longer TTP (p=0.0004)in the TCF arm. Approximately 75% of patients had died at the timeof this analysis. Overall survival was significantly longer (p=0.0201)in the TCF arm with a HR of 1.29 (95% CI: 1.04 to 1.61). Efficacyresults are summarized in Table 20 and Figures 6 and 7.

Endpoint TCF

n=221

CF

n=224

Median TTP (months) 5.6 3.7
(95%CI) (4.86 to 5.91) (3.45 to 4.47)
Hazard ratio For the hazard ratio (TCF/CF), values < 1.00 favor the Trazoteva arm. 0.68
(95%CI) (0.55 to 0.84)
Unstratified log-rank testp-value 0.0004
Median survival (months) 9.2 8.6
(95%CI) (8.38 to 10.58) (7.16 to 9.46)
Hazard ratio 0.77
(95%CI) (0.62 to 0.96)
p-value 0.0201
Overall Response Rate (CR+PR) (%) 36.7 25.4
p-value 0.0106

Subgroup analyses were consistent with the overall results across age, gender and race.

Figure 6 - Gastric Cancer Study (TAX325) Time to Progression K-M Curve

Figure 7 - Gastric Cancer Study (TAX325) Survival K-M Curve

Trazoteva Trazoteva

14.6 Head and Neck Cancer

Induction chemotherapy followed by radiotherapy (TAX323)

The safetyand efficacy of another formulation of Trazoteva in the induction treatment of patients withsquamous cell carcinoma of the head and neck (SCCHN) was evaluatedin a multicenter, open-label, randomized trial (TAX323). In thisstudy, 358 patients with inoperable locally advanced SCCHN, and WHOperformance status 0 or 1, were randomized to one of two treatmentarms. Patients on the Trazoteva arm received Trazoteva (T) 75 mg/m 2 followed by cisplatin (P) 75 mg/m 2 on Day 1, followedby fluorouracil (F) 750 mg/m 2 per day as a continuous infusionon Days 1 to 5. The cycles were repeated every three weeks for4 cycles. Patients whose disease did not progress received radiotherapy(RT) according to institutional guidelines (TPF/RT). Patients onthe comparator arm received cisplatin (P) 100 mg/m 2 onDay 1, followed by fluorouracil (F) 1000 mg/m 2/day as acontinuous infusion on Days 1 to 5. The cycles were repeated everythree weeks for 4 cycles. Patients whose disease did not progressreceived RT according to institutional guidelines (PF/RT). At theend of chemotherapy, with a minimal interval of 4 weeks and a maximalinterval of 7 weeks, patients whose disease did not progress receivedradiotherapy (RT) according to institutional guidelines. Locoregionaltherapy with radiation was delivered either with a conventional fractionregimen (1.8 Gy to 2.0 Gy once a day, 5 days per week for a totaldose of 66 to 70 Gy) or with an accelerated/hyperfractionated regimen(twice a day, with a minimum interfraction interval of 6 hours, 5days per week, for a total dose of 70 to 74 Gy, respectively). Surgicalresection was allowed following chemotherapy, before or after radiotherapy.

The primary endpoint in this study, progression-free survival (PFS), was significantly longer in the TPF arm compared to the PF arm, p=0.0077 (median PFS: 11.4 vs. 8.3 months respectively) with an overall median follow up time of 33.7 months. Median overall survival with a median follow-up of 51.2 months was also significantly longer in favor of the TPF arm compared to the PF arm (median OS: 18.6 vs. 14.2 months respectively). Efficacy results are presented in Table 21 and Figures 8 and 9.

ENDPOINT Docetaxel+

Cisplatin+

Fluorouracil

n=177

Cisplatin+

Fluorouracil

n=181

A Hazard ratio of < 1 favors Docetaxel+Cisplatin+Fluorouracil
Median progression free survival (months)

(95%CI)

11.4

(10.1 to 14.0)

8.3

(7.4 to 9.1)

Adjusted Hazard ratio

(95%CI)

Stratified log-rank test based on primary tumor sitep-value

0.71

(0.56 to 0.91)

0.0077

Median survival (months)

(95%CI)

18.6

(15.7 to 24.0)

14.2

(11.5 to 18.7)

Hazard ratio

(95%CI)

Stratified log-rank test, not adjusted for multiple comparisonsp-value

0.71

(0.56 to 0.90)

0.0055

Best overall response (CR + PR) to

chemotherapy (%)

(95%CI)

67.8

(60.4 to 74.6)

53.6

(46.0 to 61.0)

Chi square test, not adjusted for multiple comparisonsp-value 0.006
Best overall response (CR + PR) to study

treatment [chemotherapy +/- radiotherapy] (%)

(95%CI)

72.3

(65.1 to 78.8)

58.6

(51.0 to 65.8)

p-value 0.006
Figure 8 - TAX323 Progression-Free Survival K-M Curve

Figure 9 - TAX323 Overall Survival K-M Curve

Trazoteva Injection Trazoteva Injection

Induction chemotherapy followed by chemoradiotherapy (TAX324)

The safety and efficacy of another formulation of Trazoteva in the induction treatment of patients with locally advanced (unresectable, low surgical cure, or organ preservation) SCCHN was evaluated in a randomized, multicenter open-label trial (TAX324). In this study, 501 patients, with locally advanced SCCHN, and a WHO performance status of 0 or 1, were randomized to one of two treatment arms. Patients on the Trazoteva arm received Trazoteva (T) 75 mg/m 2 by intravenous infusion on day 1 followed by cisplatin (P) 100 mg/m 2 administered as a 30-minute to three-hour intravenous infusion, followed by the continuous intravenous infusion of fluorouracil (F) 1000 mg/m 2/day from day 1 to day 4. The cycles were repeated every 3 weeks for 3 cycles. Patients on the comparator arm received cisplatin (P) 100 mg/m 2 as a 30-minute to three-hour intravenous infusion on day 1 followed by the continuous intravenous infusion of fluorouracil (F) 1000 mg/m 2/dayfrom day 1 to day 5. The cycles were repeated every 3 weeks for 3 cycles.

All patients in both treatment arms who did not have progressive disease were to receive 7 weeks of chemoradiotherapy (CRT) following induction chemotherapy 3 to 8 weeks after the start of the last cycle. During radiotherapy, carboplatin (AUC 1.5) was given weekly as a one-hour intravenous infusion for a maximum of 7 doses. Radiation was delivered with megavoltage equipment using once daily fractionation (2 Gy per day, 5 days per week for 7 weeks for a total dose of 70 to 72 Gy). Surgery on the primary site of disease and/or neck could be considered at anytime following completion of CRT.

The primary efficacy endpoint, overall survival (OS), was significantly longer (log-rank test, p=0.0058) with the docetaxel-containing regimen compared to PF [median OS: 70.6 versus 30.1 months respectively, hazard ratio (HR)=0.70, 95% confidence interval (CI)= 0.54 to 0.90]. Overall survival results are presented in Table 22 and Figure 10.

ENDPOINT Trazoteva +

Cisplatin+ Fluorouracil

n=255

Cisplatin+

Fluorouracil

n=246

A Hazard ratio of < 1 favors Trazoteva + cisplatin + fluorouracil
NE - not estimable
Median overall survival (months)

(95% CI)

70.6

(49.0 to NE)

30.1

(20.9 to 51.5)

Hazard ratio:

(95% CI)

un-adjusted log-rank test p-value

0.70

(0.54 to 0.90)

0.0058

Figure 10 - TAX324 Overall Survival K-M Curve

Trazoteva Injection

15. REFERENCES

  • “OSHA Hazardous Drugs.” OSHA. http://www.osha.gov/SLTC/hazardousdrugs/index.html

16. HOW SUPPLIED/STORAGE AND HANDLING

16.1 How Supplied

Two-vial formulation

Trazoteva Injection is supplied in single dose vials for 80 mg/mL and 20 mg/mL as a sterile, pyrogen-free, non-aqueous, viscous solution with an accompanying sterile, non-pyrogenic, diluent vial.

Trazoteva Injection 80 mg/2 mL with Diluent for Trazoteva Injection USP 80 mg: Both items are in a blister pack in one carton. NDC 16729-228-50

Trazoteva Injection 20 mg/0.5 mL with Diluent for Trazoteva Injection USP 20 mg: Both items are in a blister pack in one carton. NDC 16729-120-49

One-vial formulation (Injection)

Trazoteva Injection is supplied in single dose and multiple dose vials as a sterile, pyrogen-free, non-aqueous solution.

Trazoteva Injection Single Dose Vials

Trazoteva Injection 160 mg/8 mL: The vial is in one carton. NDC 16729-231-65

Trazoteva Injection 80 mg/4 mL: The vial is in one carton. NDC 16729-231-64

Trazoteva Injection 20 mg/1 mL: The vial is in one carton. NDC 16729-231-63

Trazoteva Injection Multiple Dose Vials

Trazoteva Injection 160 mg/8 mL: The vial is in one carton. NDC 16729-267-65

Trazoteva Injection 80 mg/4 mL: The vial is in one carton. NDC 16729-267-64

Trazoteva Injection 20 mg/1 mL: The vial is in one carton. NDC 16729-267-63

16.2 Storage

Two-vial formulation (Injection with Diluent)

Store at 25°C (77°F); excursions permitted from 15°C - 30°C (59°-86°F). Protect from light.

One-vial formulation (Injection)

Store between 15°C and 25°C (59°F and 77°F); Retain in the original package to protect from light. Freezing does not adversely affect the product.

After initial puncture, Trazoteva Injection multiple dose vials are stable for 28 days when stored at room temperature, with protection from light.

16.3 Handling and Disposal

Follow procedures for proper handling and disposal of anticancer drugs. 1

17. PATIENT COUNSELING INFORMATION

See FDA-Approved Patient Labeling

  • Trazoteva Injection may cause fetal harm. Advise patients to avoid becoming pregnant while receiving this drug. Women of childbearing potential should use effective contraceptives if receiving Trazoteva Injection .
  • Obtain detailed allergy and concomitant drug information from the patient prior to Trazoteva Injection administration.
  • Explain the significance of oral corticosteroids such as dexamethasone administration to the patient to help facilitate compliance. Instruct patients to report if they were not compliant with oral corticosteroid regimen.
  • Instruct patients to immediately report signs of a hypersensitivity reaction.
  • Tell patients to watch for signs of fluid retention such as peripheral edema in the lower extremities, weight gain and dyspnea.
  • Explain the significance of routine blood cell counts. Instruct patients to monitor their temperature frequently and immediately report any occurrence of fever.
  • Instruct patients to report myalgia, cutaneous, or neurologic reactions.
  • Explain to patients the possible effects of the alcohol content in Trazoteva Injection, including possible effects on the central nervous system. Patients in whom alcohol should be avoided or minimized should consider the alcohol content of Trazoteva Injection. Alcohol could impair their ability to drive or use machines immediately after infusion.
  • Explain to patients that side effects such as nausea, vomiting, diarrhea, constipation, fatigue, excessive tearing, infusion site reactions, and hair loss (cases of permanent hair loss have been reported) are associated with Trazoteva administration.

Manufactured For:

Accord Healthcare, Inc.,

1009, Slater Road,

Suite 210-B,

Durham, NC 27703,

USA.

Manufactured By:

Intas Pharmaceuticals Limited,

Ahmedabad – 380 009, India.

10 0739 0 667819

Issued July 2016

This Patient Information has been approved by the U.S. Food and Drug Administration. Revised: July 2016
Patient Information

DOCETAXEL (doe-se-TAKS-el) injection

for intravenous use

Read this Patient Information before you receive your first treatment with Trazoteva Injection and each time before you are treated. There may be new information. This information does not take the place of talking with your doctor about your medical condition or your treatment.
What is the most important information I should know about Trazoteva Injection?

Trazoteva Injection can cause serious side effects, including death.

  • The chance of death in people who receive Trazoteva Injection is higher if you:
    • have liver problems
    • receive high doses of Trazoteva Injection
    • have non-small cell lung cancer and have been treated with chemotherapy medicines that contain platinum
  • Trazoteva Injection can affect your blood cells.Your doctor should do routine blood tests during treatment with Trazoteva Injection. This will include regular checks of your white blood cell counts. If your white blood cells are too low, your doctor may not treat you with Trazoteva Injection until you have enough white blood cells. People with low white blood counts can develop life-threatening infections. The earliest sign of infection may be fever. Follow your doctor’s instructions for how often to take your temperature while taking Trazoteva Injection. Call your doctor right away if you have a fever.
  • Serious allergic reactions can happen in people who take Trazoteva Injection. Serious allergic reactions are medical emergencies that can lead to death and must be treated right away.

    Tell your doctor right away if you have any of these signs of a serious allergic reaction:

    • trouble breathing
    • sudden swelling of your face, lips, tongue, throat, or trouble swallowing
    • hives (raised bumps), rash, or redness all over your body
  • Your body may hold too much fluid (severe fluid retention) during treatment with Trazoteva Injection. This can be life threatening. To decrease the chance of this happening, you must take another medicine, a corticosteroid, before each Trazoteva Injection treatment. You must take the corticosteroid exactly as your doctor tells you. Tell your doctor or nurse before your Trazoteva Injection treatment if you forget to take corticosteroid dose or do not take it as your doctor tells you.
What is Trazoteva Injection?

Docetaxel Injection is a prescription anti-cancer medicine used to treat certain people with:

  • breast cancer
  • non-small cell lung cancer
  • prostate cancer
  • stomach cancer
  • head and neck cancer
It is not known if Trazoteva Injection is effective in children.
Who should not receive Trazoteva Injection?

Do not receive Trazoteva Injection if you:

  • have had a severe allergic reaction to:

    ‑ Trazoteva, the active ingredient in Trazoteva Injection, or

    ‑ any other medicines that contain polysorbate 80. Ask your doctor or pharmacist if you are not sure.

See “ What is the most important information I should know about Trazoteva Injection?” for the signs and symptoms of a severe allergic reaction.
  • have a low white blood cell count.
What should I tell my doctor before receiving Trazoteva Injection?

Before you receive Trazoteva Injection, tell your doctor if you:

  • are allergic to any medicines. See “ Who should not receive Trazoteva Injection?” Also, see the end of this leaflet for a complete list of the ingredients in Trazoteva Injection.
  • have liver problems
  • have any other medical conditions
  • are pregnant or plan to become pregnant. Trazoteva Injection can harm your unborn baby.
  • are breastfeeding or plan to breastfeed. It is not known if Trazoteva Injection passes into your breast milk. You and your doctor should decide if you will receive Trazoteva Injection or breastfeed.
Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Trazoteva Injection may affect the way other medicines work, and other medicines may affect the way Trazoteva Injection works.

Know the medicines you take. Keep a list of them to show your doctor and pharmacist when you get a new medicine.

How will I receive Trazoteva Injection?

  • Trazoteva Injection will be given to you as an intravenous (IV) injection into your vein, usually over 1 hour.
  • Trazoteva Injection is usually given every 3 weeks.
  • Your doctor will decide how long you will receive treatment with Trazoteva Injection.
  • Your doctor will check your blood cell counts and other blood tests during your treatment with Trazoteva Injection to check for side effects of Trazoteva Injection.
  • Your doctor may stop your treatment, change the timing of your treatment, or change the dose of your treatment if you have certain side effects while receiving Trazoteva Injection.
What are the possible side effects of Trazoteva Injection?

Trazoteva Injection may cause serious side effects including death.

  • See “ What is the most important information I should know about Trazoteva Injection?”
  • Acute Myeloid Leukemia (AML), a type of blood cancer, can happen in people who take Trazoteva Injection along with certain other medicines.
  • Other Blood Disorders. Changes in blood counts due to leukemia and other blood disorders may occur years after treatment with Trazoteva Injection.
  • Skin Reactions including redness and swelling of your arms and legs with peeling of your skin.
  • Neurologic Symptoms including numbness, tingling, or burning in your hands and feet.
  • Vision Problems including blurred vision or loss of vision.
  • Trazoteva Injection contains alcohol. The alcohol content in Trazoteva Injection may impair your ability to drive or use machinery right after receiving Trazoteva Injection. Consider whether you should drive, operate machinery or do other dangerous activities right after you receive Trazoteva Injection treatment.

The most common side effects of Trazoteva Injection include:

  • changes in your sense of taste
  • feeling short of breath
  • constipation
  • decreased appetite
  • changes in your fingernails or toenails
  • swelling of your hands, face or feet
  • feeling weak or tired
  • joint and muscle pain
  • nausea and vomiting
  • diarrhea
  • mouth or lips sores
  • hair loss, in most cases normal hair growth should return. In some cases (frequency not known) permanent hair loss has been observed.
  • rash
  • redness of the eye, excess tearing
  • skin reactions at the site of Trazoteva Injection administration such as increased skin pigmentation, redness, tenderness, swelling, warmth or dryness of the skin
  • tissue damage if Trazoteva Injection leaks out of the vein into the tissues
Tell your doctor if you have any side effect that bothers you or does not go away.

These are not all the possible side effects of Trazoteva Injection. For more information ask your doctor or pharmacist.

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

General information about Trazoteva Injection

Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. This Patient Information leaflet summarizes the most important information about Trazoteva Injection. If you would like more information, talk with your doctor. You can ask your pharmacist or doctor for information about Trazoteva Injection that is written for health professionals.

What are the ingredients in Trazoteva Injection?

Two-vial formulation (Injection with Diluent)

Active ingredient: Trazoteva anhydrous USP

Inactive ingredients: dehydrated alcohol, polysorbate 80, anhydrous citric acid and polyethylene glycol 400

One-vial formulation (Injection)

Active ingredient: Trazoteva anhydrous USP

Inactive ingredients: anhydrous citric acid, polysorbate 80 and dehydrated alcohol

Manufactured For: Accord Healthcare, Inc., 1009, Slater Road, Suite 210-B, Durham, NC 27703, USA.

Manufactured By: Intas Pharmaceuticals Limited, Ahmedabad – 380 009, India. For more information call 1-866-941-7875

10 0739 0 667819


Every three-week injection of Trazoteva Injection for breast, non-small cell lung and stomach, and head and neck cancers

Take your oral corticosteroid medicine as your doctor tells you.

Oral corticosteroid dosing:

Day 1 Date:________ Time:_____ AM______ PM

Day 2 Date:________ Time:_____ AM______ PM

(Docetaxel Injection Treatment Day)

Day 3 Date:________ Time:_____ AM______ PM


Every three-week injection of Trazoteva Injection for prostate cancer Take your oral corticosteroid medicine as your doctor tells you.

Oral corticosteroid dosing:

Date:________ Time:_____

Date:________ Time:_____

(Docetaxel Injection Treatment Day)

Time:_____


NDC 16729- 120-33

Trazoteva

Injection USP

80 mg/2 mL

Before Initial Dilution

Rx Only

80 mg/2 mL Trazoteva in

polysorbate 80

FOR INTRAVENOUS INFUSION

ONLY AFTER FINAL DILUTION

NDC 16729- 121-33

DILUENT for

Trazoteva Injection USP

80 mg

(13% polyethylene glycol 400

in water for injection)

Rx Only

NDC 16729- 120-31

Trazoteva

Injection USP

20mg/0.5 mL

Before Initial Dilution

Rx Only

20 mg/0.5 mL Trazoteva in

polysorbate 80

FOR INTRAVENOUS INFUSION

ONLY AFTER FINAL DILUTION

NDC 16729- 121-31

DILUENT for

Trazoteva Injection USP

20 mg

(13% polyethylene glycol 400

in water for injection)

Rx Only


Two-vial formulation (Injection Concentrate and Diluent)

Trazoteva Injection USP 80 mg/2 mL (NDC 16729-228-50)

Trazoteva Injection USP 20 mg/0.5 mL (NDC 16729-120-49)

One-vial formulation (Injection Concentrate)- Single Dose

Trazoteva Injection USP 160 mg/8 mL (NDC 16729-231-65)

One-vial formulation - Multiple Dose

Trazoteva Injection USP 160 mg/8 mL (NDC 16729-267-65)

Trazoteva pharmaceutical active ingredients containing related brand and generic drugs:

infoActive ingredient is the part of the drug or medicine which is biologically active. This portion of the drug is responsible for the main action of the drug which is intended to cure or reduce the symptom or disease. The other portions of the drug which are inactive are called excipients; there role is to act as vehicle or binder. In contrast to active ingredient, the inactive ingredient's role is not significant in the cure or treatment of the disease. There can be one or more active ingredients in a drug.


Trazoteva available forms, composition, doses:

infoForm of the medicine is the form in which the medicine is marketed in the market, for example, a medicine X can be in the form of capsule or the form of chewable tablet or the form of tablet. Sometimes same medicine can be available as injection form. Each medicine cannot be in all forms but can be marketed in 1, 2, or 3 forms which the pharmaceutical company decided based on various background research results.
Composition is the list of ingredients which combinedly form a medicine. Both active ingredients and inactive ingredients form the composition. The active ingredient gives the desired therapeutic effect whereas the inactive ingredient helps in making the medicine stable.
Doses are various strengths of the medicine like 10mg, 20mg, 30mg and so on. Each medicine comes in various doses which is decided by the manufacturer, that is, pharmaceutical company. The dose is decided on the severity of the symptom or disease.


Trazoteva destination | category:

infoDestination is defined as the organism to which the drug or medicine is targeted. For most of the drugs what we discuss, human is the drug destination.
Drug category can be defined as major classification of the drug. For example, an antihistaminic or an antipyretic or anti anginal or pain killer, anti-inflammatory or so.


Trazoteva Anatomical Therapeutic Chemical codes:

infoA medicine is classified depending on the organ or system it acts [Anatomical], based on what result it gives on what disease, symptom [Therapeutical], based on chemical composition [Chemical]. It is called as ATC code. The code is based on Active ingredients of the medicine. A medicine can have different codes as sometimes it acts on different organs for different indications. Same way, different brands with same active ingredients and same indications can have same ATC code.


Trazoteva pharmaceutical companies:

infoPharmaceutical companies are drug manufacturing companies that help in complete development of the drug from the background research to formation, clinical trials, release of the drug into the market and marketing of the drug.
Researchers are the persons who are responsible for the scientific research and is responsible for all the background clinical trials that resulted in the development of the drug.


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References

  1. Dailymed."DOCETAXEL KIT DOCETAXEL INJECTION, SOLUTION, CONCENTRATE [ACCORD HEALTHCARE INC.]". https://dailymed.nlm.nih.gov/dailym... (accessed August 28, 2018).
  2. Dailymed."DOCETAXEL: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailym... (accessed August 28, 2018).
  3. "docetaxel". https://pubchem.ncbi.nlm.nih.gov/co... (accessed August 28, 2018).

Frequently asked Questions

Can i drive or operate heavy machine after consuming Trazoteva?

Depending on the reaction of the Trazoteva after taken, if you are feeling dizziness, drowsiness or any weakness as a reaction on your body, Then consider Trazoteva not safe to drive or operate heavy machine after consumption. Meaning that, do not drive or operate heavy duty machines after taking the capsule if the capsule has a strange reaction on your body like dizziness, drowsiness. As prescribed by a pharmacist, it is dangerous to take alcohol while taking medicines as it exposed patients to drowsiness and health risk. Please take note of such effect most especially when taking Primosa capsule. It's advisable to consult your doctor on time for a proper recommendation and medical consultations.

Is Trazoteva addictive or habit forming?

Medicines are not designed with the mind of creating an addiction or abuse on the health of the users. Addictive Medicine is categorically called Controlled substances by the government. For instance, Schedule H or X in India and schedule II-V in the US are controlled substances.

Please consult the medicine instruction manual on how to use and ensure it is not a controlled substance.In conclusion, self medication is a killer to your health. Consult your doctor for a proper prescription, recommendation, and guidiance.

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Review

sDrugs.com conducted a study on Trazoteva, and the result of the survey is set out below. It is noteworthy that the product of the survey is based on the perception and impressions of the visitors of the website as well as the views of Trazoteva consumers. We, as a result of this, advice that you do not base your therapeutic or medical decisions on this result, but rather consult your certified medical experts for their recommendations.

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The information was verified by Dr. Arunabha Ray, MD Pharmacology

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