IMPORTANT SAFETY INFORMATION


QT interval prolongation. KISQALI has been shown to prolong the QT interval in a concentration-dependent manner. Based on the observed QT prolongation during treatment, KISQALI may require...

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Indications. KISQALI is a kinase inhibitor indicated in combination with: an aromatase inhibitor for the treatment of pre/perimenopausal or postmenopausal women with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced or metastatic breast cancer, as initial endocrine-based therapy; or fulvestrant for the treatment of postmenopausal women with HR-positive, HER2-negative advanced or metastatic breast cancer, as initial endocrine-based therapy or following disease progression on endocrine therapy

Safety Profile

Consistent and well-characterized safety profiles1-3

1L Premenopausal Women With KISQALI + an NSAI

PREMENOPAUSAL

MONALEESA-7

Majority of adverse reactions were transient, manageable, and reversible3

 

ADVERSE REACTIONS OCCURRING IN ≥10% AND ≥2% HIGHER THAN PLACEBO1


 
KISQALI + NSAI + goserelin
(n=248)
Placebo + NSAI + goserelin
(n=247)
 
Grade 3
Grade 4
ALL
 
Grade 3
Grade 4
ALL
Neutropenia
55%
10%
78%
 
2%
<1%
7%
Leukopenia
13%
<1%
29%
 
<1%
0%
3%
ALT increased
5%
0%
13%
 
1%
0%
9%
AST increased
4%
0%
13%
 
1%
0%
10%
Anemia
3%
0%
19%
 
1%
0%
8%
Infectionsa
2%
0%
35%
 
<1%
0%
24%
Arthralgia
<1%
0%
33%
 
1%
0%
29%
Rash
<1%
0%
17%
 
0%
0%
9%
Pyrexia
<1%
0%
17%
 
0%
0%
6%
Nausea
0%
0%
31%
 
0%
0%
20%
Alopecia
0%
0%
21%
 
0%
0%
13%
Constipation
0%
0%
16%
 
0%
0%
12%
Cough
0%
0%
15%
 
0%
0%
10%
Pain in extremity
0%
0%
10%
 
1%
0%
8%
Stomatitis
0%
0%
10%
 
<1%
0%
8%
Pruritus
0%
0%
10%
 
0%
0%
4%

aUrinary tract infections; respiratory tract infections; gastroenteritis; sepsis (<1%).

 

LABORATORY ABNORMALITIES IN MONALEESA-71


 
KISQALI + an NSAI + goserelin
(n=248)
Placebo + an NSAI + goserelin
(n=247)
 
Grade 3
Grade 4
ALL
 
Grade 3
Grade 4
ALL
HEMATOLOGY
Leukocyte
count decreased
34%
2%
93%
 
<1%
<1%
30%
Neutrophil
count decreased
54%
9%
92%
 
2%
0%
27%
Hemoglobin
decreased
2%
0%
84%
 
<1%
0%
51%
Lymphocyte
count decreased
12%
2%
55%
 
2%
<1%
18%
Platelet count
decreased
<1%
0%
26%
 
0%
<1%
9%
CHEMISTRY
ALT
increased
6%
0%
33%
 
1%
<1%
31%
AST
increased
5%
0%
37%
 
1%
<1%
35%
Creatinine
increased
2%
<1%
21%
 
<1%
<1%
20%
Phosphorus
decreased
2%
0%
14%
 
<1%
<1%
11%
Potassium
decreased
<1%
<1%
11%
 
<1%
<1%
14%
GGT
increased
5%
2%
42%
 
8%
1%
42%
Glucose serum
decreased
<1%
0%
10%
 
<1%
0%
10%

1L/2L Postmenopausal Women With KISQALI + Fulvestrant

POSTMENOPAUSAL

MONALEESA-3

Majority of adverse reactions were transient, manageable, and reversible3

 

ADVERSE REACTIONS OCCURRING IN ≥10% AND ≥2% HIGHER THAN PLACEBO1


 
KISQALI + fulvestrant
(n=483)
Placebo + fulvestrant
(n=241)
 
Grade 3
Grade 4
ALL
 
Grade 3
Grade 4
ALL
Neutropenia
46%
7%
69%
 
0%
0%
2%
Leukopenia
12%
<1%
27%
 
0%
0%
<1%
ALT increased
7%
2%
15%
 
<1%
0%
5%
AST increased
5%
1%
13%
 
<1%
0%
5%
Infectionsa
5%
0%
42%
 
2%
0%
30%
Anemia
3%
0%
17%
 
2%
0%
5%
Dyspnea
1%
<1%
15%
 
2%
0%
12%
Nausea
1%
0%
45%
 
<1%
0%
28%
Vomiting
1%
0%
27%
 
0%
0%
13%
Abdominal pain
1%
0%
17%
 
<1%
0%
13%
Diarrhea
<1%
0%
29%
 
<1%
0%
20%
Constipation
<1%
0%
25%
 
0%
0%
12%
Rash
<1%
0%
23%
 
0%
0%
7%
Pruritus
<1%
0%
20%
 
0%
0%
7%
Decreased appetite
<1%
0%
16%
 
0%
0%
13%
Dizziness
<1%
0%
13%
 
0%
0%
8%
Pyrexia
<1%
0%
11%
 
0%
0%
7%
Cough
0%
0%
22%
 
0%
0%
15%
Alopecia
0%
0%
19%
 
0%
0%
5%
Edema peripheral
0%
0%
15%
 
0%
0%
7%

aUrinary tract infections; respiratory tract infections; gastroenteritis; sepsis (<1%).

 

LABORATORY ABNORMALITIES IN MONALEESA-31


 
KISQALI + fulvestrant
(n=483)
Placebo + fulvestrant
(n=241)
 
Grade 3
Grade 4
ALL
 
Grade 3
Grade 4
ALL
HEMATOLOGY
Leukocyte
count decreased
25%
<1%
95%
 
<1%
0%
26%
Neutrophil
count decreased
46%
7%
92%
 
<1%
0%
21%
Hemoglobin
decreased
4%
0%
60%
 
3%
0%
35%
Lymphocyte
count decreased
14%
1%
69%
 
4%
<1%
35%
Platelet count
decreased
<1%
1%
33%
 
0%
0%
11%
CHEMISTRY
ALT
increased
8%
3%
44%
 
2%
0%
37%
AST
increased
5%
2%
49%
 
3%
0%
43%
Creatinine
increased
<1%
<1%
65%
 
<1%
0%
33%
Phosphorus
decreased
5%
0%
18%
 
<1%
0%
8%
Albumin
decreased
0%
0%
12%
 
0%
0%
8%
GGT
increased
6%
1%
52%
 
8%
2%
49%
Glucose serum
decreased
0%
0%
23%
 
0%
0%
18%

1L Postmenopausal Women With KISQALI + an AI

POSTMENOPAUSAL

MONALEESA-2

Majority of adverse reactions were transient, manageable, and reversible3

 

ADVERSE REACTIONS OCCURRING IN ≥10% AND ≥2% HIGHER THAN PLACEBO1


 
KISQALI + letrozole
(n=334)
Placebo + letrozole
(n=330)
 
Grade 3
Grade 4
ALL
 
Grade 3
Grade 4
ALL
Neutropenia
50%
10%
75%
 
1%
0%
5%
Leukopenia
20%
1%
33%
 
<1%
0%
1%
Abnormal LFTsa
8%
2%
18%
 
2%
0%
6%
Lymphopenia
6%
1%
11%
 
1%
0%
2%
Vomiting
4%
0%
29%
 
1%
0%
16%
Fatigue
2%
<1%
37%
 
1%
0%
30%
Nausea
2%
0%
52%
 
1%
0%
29%
Back pain
2%
0%
20%
 
<1%
0%
18%
Decreased appetite
2%
0%
19%
 
<1%
0%
15%
Anemia
1%
<1%
18%
 
1%
0%
5%
Diarrhea
1%
0%
35%
 
1%
0%
22%
Constipation
1%
0%
25%
 
0%
0%
19%
Rash
1%
0%
17%
 
0%
0%
8%
Pruritus
1%
0%
14%
 
0%
0%
6%
Dyspnea
1%
0%
12%
 
1%
0%
9%
UTI
1%
0%
11%
 
0%
0%
8%
Abdominal pain
1%
0%
11%
 
0%
0%
8%
Headache
<1%
0%
22%
 
<1%
0%
19%
Pyrexia
<1%
0%
13%
 
0%
0%
6%
Insomnia
<1%
0%
12%
 
0%
0%
9%
Stomatitis
<1%
0%
12%
 
0%
0%
7%
Alopecia
0%
0%
33%
 
0%
0%
16%
Edema peripheral
0%
0%
12%
 
0%
0%
10%

aAbnormal liver function tests: ALT increased, AST increased, blood bilirubin increased.

 

LABORATORY ABNORMALITIES IN MONALEESA-21


 
KISQALI + letrozole
(n=334)
Placebo + letrozole
(n=330)
 
Grade 3
Grade 4
ALL
 
Grade 3
Grade 4
ALL
HEMATOLOGY
Leukocyte
count decreased
31%
3%
93%
 
1%
<1%
29%
Neutrophil
count decreased
49%
11%
93%
 
1%
<1%
24%
Hemoglobin
decreased
2%
0%
57%
 
1%
0%
26%
Lymphocyte
count decreased
12%
2%
51%
 
3%
1%
22%
Platelet count
decreased
1%
<1%
29%
 
0%
<1%
6%
CHEMISTRY
ALT
increased
8%
2%
46%
 
1%
0%
36%
AST
increased
6%
1%
44%
 
2%
0%
32%
Creatinine
increased
1%
0%
20%
 
0%
0%
6%
Phosphorus
decreased
5%
1%
13%
 
1%
0%
4%
Potassium
decreased
1%
1%
11%
 
1%
0%
7%

Monitoring Across All Indications

Help patients get the most out of treatment with early monitoring1

 

SCHEDULED MONITORING1

 
Cycle 1
Cycle 2
Cycle 3–6
BLOOD TEST
CBC
LFTa
Electrolytesb
Baselined and Mid-cycle
Beginning and Mid-cycle
Beginning of each cycle
Baselined
Beginning of each cycle
3 ECGs
QTcFc
Beginning and Mid-cycle
Beginning
NO SCHEDULED MONITORING
NO SCHEDULED MONITORING BEYOND CYCLE 6

aIf grade ≥2 abnormalities are noted, more frequent monitoring is recommended.
bCorrect any electrolyte abnormalities prior to treatment.
cKISQALI should only be initiated in patients with QTcF <450 ms. In case of QTcF prolongation during therapy, more frequent monitoring is recommended.
dPerform baseline assessment prior to treatment initiation.

  • Any additional monitoring should be performed as clinically indicated

 

For information about dosing and administration, continue to the next page >

AI=aromatase inhibitor; ALT=alanine aminotransferase; AST=aspartate aminotransferase; CBC=complete blood count; ECGs=electrocardiograms; GGT=gamma-glutamyl transferase; LFTs=liver function tests; NSAI=nonsteroidal aromatase inhibitor; QTcF=QT interval corrected by Friderica's formula; UTI=urinary tract infection.

References: 1. Kisqali [prescribing information]. East Hanover, NJ: Novartis Pharmaceuticals Corp; 2018. 2. Hortobagyi GN, Stemmer SM, Burris HA, et al. Ribociclib as first-line therapy for HR-positive, advanced breast cancer. N Engl J Med. 2016;375(18):1738-1748. 3. Data on file. Novartis Pharmaceuticals Corp; 2018.

 

Indications
KISQALI is a kinase inhibitor indicated in combination with:
  • an aromatase inhibitor for the treatment of pre/perimenopausal or postmenopausal women with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced or metastatic breast cancer, as initial endocrine-based therapy; or
  • fulvestrant for the treatment of postmenopausal women with HR-positive, HER2-negative advanced or metastatic breast cancer, as initial endocrine-based therapy or following disease progression on endocrine therapy

IMPORTANT SAFETY INFORMATION
QT interval prolongation. KISQALI has been shown to prolong the QT interval in a concentration-dependent manner. Based on the observed QT prolongation during treatment, KISQALI may require dose interruption, reduction, or discontinuation. Across clinical trials in patients with advanced or metastatic breast cancer treated with KISQALI in combination with an aromatase inhibitor or fulvestrant (“KISQALI treatment groups”), 14 of 1054 patients (1%) had >500 ms postbaseline QTcF value, and 59 of 1054 (6%) had a >60 ms increase from baseline in QTcF intervals. These ECG changes were reversible with dose interruption and most occurred within the first 4 weeks of treatment. No cases of torsades de pointes were reported. In MONALEESA-2, on the KISQALI + letrozole treatment arm, there was 1 (0.3%) sudden death in a patient with grade 3 hypokalemia and grade 2 QT prolongation. No cases of sudden death were reported in MONALEESA-7 or MONALEESA-3.

Assess ECG prior to initiation of treatment. Initiate treatment with KISQALI only in patients with QTcF values <450 ms. Repeat ECG at approximately Day 14 of the first cycle, at the beginning of the second cycle, and as clinically indicated. Monitor serum electrolytes (including potassium, calcium, phosphorus, and magnesium) prior to the initiation of treatment, at the beginning of each of the first 6 cycles, and as clinically indicated. Correct any abnormality before starting therapy with KISQALI.

Avoid the use of KISQALI in patients who already have or who are at significant risk of developing QT prolongation, including patients with:
  • long QT syndrome
  • uncontrolled or significant cardiac disease including recent myocardial infarction, congestive heart failure, unstable angina, and bradyarrhythmias
  • electrolyte abnormalities

Avoid using KISQALI with drugs known to prolong the QT interval and/or strong CYP3A inhibitors, as this may lead to prolongation of the QTcF interval.

Increased QT Prolongation With Concomitant Use of Tamoxifen. KISQALI is not indicated for concomitant use with tamoxifen. In MONALEESA-7, the observed mean QTcF increase from baseline was ≥10 ms higher in the tamoxifen + placebo subgroup compared with the NSAI + placebo subgroup. In the placebo arm, an increase of >60 ms from baseline occurred in 6/90 (7%) of patients receiving tamoxifen, and in no patients receiving an NSAI. An increase of >60 ms from baseline in the QTcF interval was observed in 14/87 (16%) of patients in the KISQALI and tamoxifen combination and in 18/245 (7%) of patients receiving KISQALI plus an NSAI.

Hepatobiliary toxicity. Across clinical trials in patients with advanced or metastatic breast cancer, increases in transaminases were observed. Across all trials, grade 3 or 4 increases in alanine aminotransferase (ALT) (10% vs 2%) and aspartate aminotransferase (AST) (7% vs 2%) were reported in the KISQALI and placebo arms, respectively.

Among the patients who had grade ≥3 ALT/AST elevation, the median time to onset was 85 days and median time to resolution to grade ≤2 was 22 days for the KISQALI treatment groups.

In MONALEESA-2 and MONALEESA-3, concurrent elevations in ALT or AST greater than 3 times the ULN and total bilirubin greater than 2 times the ULN, with normal alkaline phosphatase, in the absence of cholestasis occurred in 6 (1%) patients and all patients recovered after discontinuation of KISQALI. No cases occurred in MONALEESA-7.

Perform liver function tests (LFTs) before initiating therapy with KISQALI. Monitor LFTs every 2 weeks for the first 2 cycles, at the beginning of each of the subsequent 4 cycles, and as clinically indicated. Based on the severity of the transaminase elevations, KISQALI may require dose interruption, reduction, or discontinuation. Recommendations for patients who have elevated AST/ALT grade ≥3 at baseline have not been established.

Neutropenia. Across trials, neutropenia was the most frequently reported adverse reaction (AR) (74%), and a grade 3/4 decrease in neutrophil count (based on laboratory findings) was reported in 58% of patients in the KISQALI treatment groups. Among the patients who had grade 2, 3, or 4 neutropenia, the median time to grade ≥2 was 16 days. The median time to resolution of grade ≥3 (to normalization or grade <3) was 12 days in the KISQALI treatment groups. Febrile neutropenia was reported in 1% of patients in the KISQALI treatment groups. Treatment discontinuation due to neutropenia was 0.8%.

Perform complete blood count (CBC) before initiating therapy with KISQALI. Monitor CBC every 2 weeks for the first 2 cycles, at the beginning of each of the subsequent 4 cycles, and as clinically indicated. Based on the severity of the neutropenia, KISQALI may require dose interruption, reduction, or discontinuation.

Embryofetal toxicity. Based on findings from animal studies and the mechanism of action, KISQALI can cause fetal harm when administered to a pregnant woman. In animal reproduction studies, administration of KISQALI to pregnant rats and rabbits during organogenesis caused embryofetal toxicities at maternal exposures that were 0.6 and 1.5 times the human clinical exposure, respectively, based on area under the curve. Advise pregnant women of the potential risk to a fetus. Advise women of reproductive potential to use effective contraception during therapy with KISQALI and for at least 3 weeks after the last dose.

Adverse reactions. Across clinical trials of patients with advanced or metastatic breast cancer, the most common ARs reported in the KISQALI treatment groups (pooled incidence ≥20%) were neutropenia (74% vs 5%), nausea (45% vs 27%), infections (41% vs 30%), fatigue (33% vs 30%), diarrhea (30% vs 22%), leukopenia (30% vs 3%), vomiting (27% vs 16%), alopecia (24% vs 12%), headache (24% vs 22%), constipation (24% vs 16%), rash (21% vs 9%), and cough (21% vs 16%). The most common grade 3/4 ARs (reported at a pooled frequency >5%) were neutropenia (59% vs 1%), leukopenia (16% vs 3%), abnormal LFTs (9% vs 2%), and lymphopenia (5% vs 1%).

Laboratory abnormalities. Across clinical trials of patients with advanced or metastatic breast cancer, the most common laboratory abnormalities reported in the KISQALI-containing arm vs placebo arm (all grades, pooled incidence ≥20% and ≥5% higher than placebo arm) were leukocyte count decrease (94% vs 30%), neutrophil count decrease (93% vs 25%), hemoglobin decrease (66% vs 38%), lymphocyte count decrease (61% vs 26%), AST increase (47% vs 38%), ALT increase (44% vs 36%), creatinine increase (38% vs 13%), and platelet count decrease (31% vs 9%). The most common grade 3/4 laboratory abnormalities (incidence >5%) were neutrophil count decrease (59% vs 2%), leukocyte count decrease (32% vs 1%), lymphocyte count decrease (15% vs 4%), ALT increase (10% vs 2%), and AST increase (7% vs 2%).

Please see full Prescribing Information.