FDA批准注射剂Unituxin 17.5mg/5mL injection（dinutuximab）为治疗神经母细胞瘤药品
美国FDA3月10日宣布批准Unituxin(dinutuximab)作为高风险神经母细胞瘤患儿综合治疗方案（包括手术、化疗、放射治疗）中的一线治疗药物。
神经母细胞瘤是未成熟神经细胞演变成的一种罕见肿瘤，通常始发于肾上腺，也可能发作于腹部、胸部或临近脊柱的神经组织，常见于小于5岁的儿童。根据美国国立癌症研究所的统计，神经母细胞瘤在儿童中的发病率为1/100000，在男孩中相对常见一些。美国每年有新确诊神经母细胞瘤患者约650例。如果给予积极治疗，这类患者中40%~50%有长期生存的机会。
Unituxin是一种抗体药物，可以结合在神经母细胞瘤细胞的表面，此次被批准为神经母细胞瘤综合治疗方案中的一线药物，适用于对既往综合治疗方案至少产生部分应答的神经母细胞瘤患者。
美国FDA药品评价和研究中心血液疾病和肿瘤产品办公室主任Richard Pazdur博士表示：“Unituxin是FDA批准的首个特异性针对高风险神经母细胞瘤患者的治疗药物，可在一定程度上满足高风险神经母细胞瘤儿童延长存活期的需求”。
Unituxin的安全性和疗效在一项涉及226例高风险神经母细胞瘤患儿的临床试验中得到证实。这些患儿的肿瘤在接受了骨髓移植、多药化疗和手术后缩小或消失。受试者随机接受维甲酸、异维A酸、Unituxin+IL-2+GM-CSF。治疗后3年，Unituxin联合用药组中63%的患者存活和无肿瘤生长或复发，异维甲酸组为46%。在最新的生存分析中，Unituxin联合用药组存活比例为73%，异维甲酸组为58%。
Unituxin的药品标签中附有黑框警告，提示患者和卫生保健人员Unituxi会刺激神经细胞，从而导致严重疼痛并需要使用静脉麻醉药品治疗，Unituxi还可能会发生导致神经损伤和危及生命的注射反应，包括上呼吸道肿胀、呼吸困难、低血压。Unituxin的其他严重副作用包括感染、眼科问题、电解质异常和骨髓抑制。
Unituxin最常见的副作用包括严重疼痛、发热、低血小板计数、输注反应、低血压、低钠血症、肝酶升高、贫血、呕吐、腹泻、低钾血症、毛细血管渗漏综合征、中性粒细胞减少和淋巴细胞减少、荨麻疹和低钙血症。
UNITUXIN Rx
Generic Name and Formulations:
Dinutuximab 3.5mg/mL; soln for IV infusion after dilution; preservative-free.
Company:
United Therapeutics Corp.
Indications for UNITUXIN:
In combination with granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin-2 (IL-2) and 13-cis-retinoic acid (RA), for the treatment of children with high-risk neuroblastoma who achieve at least a partial response to prior first-line multiagent, multimodality therapy.
Adult:
Not applicable.
Children:
Confirm adequate hematologic, respiratory, hepatic, and renal function prior to each course. Hydrate and premedicate with antihistamines, analgesics (eg, IV opioids), and antipyretics prior to each dose: see full labeling. Give via IV infusion over 10–20 hours for 4 consecutive days; max 5 cycles. Initial rate: 0.875mg/m2/hr for 30mins; may gradually increase as tolerated up to max 1.75mg/m2/hr. Cycles 1, 3, and 5 (24-day cycle): 17.5mg/m2/day on Days 4–7. Cycles 2 and 4 (32-day cycle): 17.5mg/m2/day on Days 8–11. Dose modifications: see full labeling.
Warnings/Precautions:
Risk of serious infusion reactions; monitor during and at least 4 hours after completion of each infusion; interrupt or discontinue if severe or prolonged infusion reactions occur. Have resuscitative medications and equipment available. Risk of serious neurotoxicity including severe neuropathic pain and peripheral neuropathy. Permanently discontinue if life-threatening infusion reactions, Grade 3 pain unresponsive to max supportive measures, Grade 4 sensory neuropathy or Grade 3 sensory neuropathy that interferes with daily activities for more than 2 weeks, Grade ≥2 peripheral motor neuropathy, recurrent signs of eye disorders or vision loss, urinary retention that persists following opioid discontinuation, transverse myelitis, signs/symptoms of RPLS, signs of atypical hemolytic uremic syndrome occurs. Interrupt or discontinue if symptomatic or severe capillary leak syndrome, symptomatic hypotension, systolic BP less than lower limit of normal for age or decreased by >15% compared to baseline develops. Monitor for systemic infection; temporarily discontinue until resolves. Monitor BP, peripheral blood counts during therapy, and serum electrolytes daily. Renal or hepatic impairment. Pregnancy; avoid. Use effective contraception during therapy and for at least 2 months after last dose. Nursing mothers: not recommended.
Pharmacological Class:
GD2-binding monoclonal antibody.
Adverse Reactions:
Pain, pyrexia, infusion reactions, hypotension, hyponatremia, hypokalemia, hypocalcemia, hypoalbuminemia, increased ALT/AST, vomiting, diarrhea, capillary leak syndrome, urticaria, infections, bone marrow suppression (eg, thrombocytopenia, anemia, neutropenia, lymphopenia).
Generic Availability:
NO
How Supplied:
Single-use vial (5mL)—1 |
