Brigatinib (Alunbrig™)

A kinase is an enzyme that promotes cell growth. There are many types of kinases, which control different phases of cell growth. By blocking a particular enzyme from working, this medication can slow the growth of cancer cells.

Brigatinib works by targeting and blocking receptors found on the cancer cells called an anaplastic lymphoma kinase (ALK). In some cancers, this receptor is overactive, causing cells to grow and divide too fast. By inhibiting ALK, this medication can slow or stop cell growth of cancer cells tumor growth. Your oncology team will test your tumor for this abnormality, which must be present in order to receive the medication.

How to Take Brigatinib

Brigatinib is taken by mouth, in tablet form, taken once daily. It can be taken either with or without food. Tablets should be swallowed whole; do not break, crush or chew the tablets. If you miss a dose or vomit soon after taking your dose do not take a second dose. Rather, take your next dose at its scheduled time.

It is important to make sure you are taking the correct amount of medication every time. Before every dose, check that what you are taking matches what you have been prescribed.

The blood levels of this medication  can be affected by  certain foods and medications, so they should be avoided. Some of these include: grapefruit, grapefruit juice, ketoconazole, rifampin, phenytoin, St. John’s wort, and hormonal birth control. Be sure to tell your  healthcare provider about all medications and supplements you take.

Storage and Handling

Store your medication in the original, labeled container at room temperature and in a dry location (unless otherwise directed by your healthcare provider or pharmacist). This medication should not be stored in a pillbox. Keep containers out of reach of children and pets.

If a caregiver prepares your dose for you, they should consider wearing gloves or pour the pills directly from their container into the cap, a small cup, or directly into your hand. They should avoid touching the pills. They should always wash their hands before and after giving you the medication. Pregnant or nursing women should not prepare the dose for you. Ask your oncology team where to return any unused medication for disposal. Do not flush down the toilet or throw in the trash.

Where do I get this medication?

Certain cancer medications are only available through specialty pharmacies. If you need to get this medication through a specialty pharmacy, your provider will help you start this process. Where you can fill your prescriptions may also be influenced by your prescription drug coverage. Ask your health care provider or pharmacist for assistance in identifying where you can get this medication.

Insurance Information

This medication may be covered under your prescription drug plan. Patient assistance may be available to qualifying individuals depending upon prescription drug coverage. Co-pay cards, which reduce the patient co-pay responsibility for eligible commercially (non-government sponsored) insured patients, may also be available. Your care team can help you find these resources, if they are available.

Possible Side Effects of Brigatinib

There are a number of things you can do to manage the side effects brigatinib. Talk to your care team about these recommendations. They can help you decide what will work best for you. These are some of the most common or important side effects.

Diarrhea

Your oncology care team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice, products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses of non-alcoholic, un-caffeinated fluid a day to prevent dehydration.

Rash

Some patients may develop a rash, scaly skin, or red itchy bumps. Use an alcohol-free moisturizer on your skin and lips; avoid moisturizers with perfumes or scents. Your oncology care team can recommend a topical medication if itching is bothersome. If your skin does crack or bleed, be sure to keep the area clean to avoid infection. Be sure to notify your oncology care team of any rash that develops, as this can be a reaction. They can give you more tips on caring for your skin.

Nausea and/or Vomiting

Talk to your oncology care team so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try saltines, or ginger ale to lessen symptoms.

Call your oncology care team if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.

Fatigue

Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team for helpful tips on dealing with this side effect.

Muscle or Joint Pain/Aches and Headache

Your healthcare provider can recommend medications and other strategies to help relieve pain.

Diarrhea

Your oncology care team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole-grain breads, cereals, and seeds. Soluble fiber is found in some foods and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice, products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses of non-alcoholic, un-caffeinated fluid a day to prevent dehydration.

High  Blood Sugar 

This medication can cause elevated blood sugar levels in patients with and without diabetes. Your  healthcare team will monitor your blood sugar. If you develop increased thirst, urination or  hunger, blurry  vision,  headaches or your breath  smells like fruit, notify your healthcare team. Diabetics should monitor their blood sugar closely and report elevations to the  healthcare team.

Decrease in Appetite

Nutrition is an important part of your care. Cancer treatment can affect your appetite and, in some cases, the side effects of treatment can make eating difficult. Ask your oncology care team about nutritional counseling services at your treatment center to help with food choices.

• Try to eat five or six small meals or snacks throughout the day, instead of 3 larger meals.
• If you are not eating enough, nutritional supplements may help.
• You may experience a metallic taste or find that food has no taste at all. You may dislike foods or beverages that you liked before receiving cancer treatment. These symptoms can last for several months or longer after treatment ends.
• Avoid any food that you think smells or tastes bad. If red meat is a problem, eat chicken, turkey, eggs, dairy products and fish without a strong smell. Sometimes cold food has less of an odor.
• Add extra flavor to meat or fish by marinating it in sweet juices, sweet and sour sauce or dressings. Use seasonings like basil, oregano or rosemary to add flavor. Bacon, ham and onion can add flavor to vegetables.

Important but Less Common Side Effects

• Interstitial Lung Disease/Pneumonitis: Patients can develop interstitial lung disease (scarring of the lung tissue) or pneumonitis (inflammation of the lungs) while taking this medication, especially during the first week.  Notify your healthcare provider right away if you develop any new or worsening symptoms, including trouble breathing or shortness of breath, chest pain, cough, or fever.
• High Blood Pressure: This medication can cause high blood pressure (hypertension). Patients should have their blood pressure checked after 2 weeks of therapy, and then monthly while receiving this medication. Any hypertension should be treated. If hypertension cannot be controlled, brigatinib may be stopped.  Report any headache, dizziness, blurred vision or chest pain to your provide
• Bradycardia: This medication  can cause slower than normal heart rate, which is called bradycardia. Notify your healthcare provider right away if you feel abnormal  heartbeats or if you feel dizzy, lightheaded, or faint.
• Visual Changes: This medication can cause changes in vision including blurred vision, double vision, light hurting your eyes, seeing flashes of light, and worsening vision. If you experience changes in vision contact your care provider.
• Elevated Creatine Phosphokinase: This medication can lead to an elevated level of the enzyme creatine phosphokinase (CPK) in your blood. This level will be checked during treatment with blood tests. If you start to experience muscle pain, tenderness, or weakness, notify your health care provider as these can be signs of elevated CPK.
• Pancreatic Enzyme Elevations: This medication can cause inflammation of the pancreas, which can cause upper abdominal pain that can radiate to the back that is worse with eating. You may also experience weight loss or nausea. You will have lab work drawn to monitor for pancreatitis. If you experience any of these side effects you should notify your health care provider.
• Photosensitivity: Your skin may be more sensitive to the sun, which can result in severe sunburn or rash. Sun sensitivity can last even after chemotherapy is completed. Avoid the sun between 10-2pm, when it is strongest. Wear sunscreen (at least SPF 30 with UVA/UVB protection) every day and reapply when in the sun for extended periods of time); wear sunglasses with UVA/UVB protection, a hat, and long sleeves/pants to protect your skin and seek out shade whenever possible.
• Liver Toxicity: This medication can cause liver toxicity, which your provider may monitor for using blood tests called liver function tests. If you develop elevations in your liver function tests, your healthcare provider may need to lower your dose or stop the medication. Notify your healthcare provider if you notice yellowing of the skin or eyes, your urine appears dark or brown or pain in your abdomen (belly), as these can be signs of liver toxicity.

Reproductive Concerns 

Exposure of an unborn child to this medication could cause birth  defects, so you should not become pregnant or father a child while on this medication. Non-hormonal contraception should be used by women during treatment and for at least 4 months after the last dose. Males with female partners of reproductive potential should use contraception during treatment and for 3 months after the last dose. Even if your menstrual cycle stops or you believe  you are not producing sperm, you could still be fertile and conceive. You should not breastfeed while taking this medication and not for 1 week after your last dose.