Do not use in patients with hypersensitivity to midostaurin or its excipients. Hypersensitivity reactions have included anaphylactic shock, dyspnea, flushing, chest pain, and angioed…
FLT3 Mutation Testing
PROMPT, COMPREHENSIVE TESTING FOR FLT3 MUTATIONS MAKES A DIFFERENCE
- Testing should be performed during the diagnostic workup in all patients with newly diagnosed AML for both FLT3 ITD and TKD mutations, in parallel with cytogenetic testing, to identify appropriate patients for targeted treatment options1,2
- LeukoStrat® CDx FLT3 Mutation Assay is the only FDA-approved FLT3 companion diagnostic test for AML*
- Bone marrow or peripheral blood samples should be sent out within a maximum of 4 days after collection, with a typical turnaround time of 2 to 3 days for results3
Clinical recommendations for AML testing from the College of American Pathologists-American Society of Hematology (CAP-ASH) Guidelines and the National Comprehensive Cancer Network® (NCCN®)1,6
aFor adult patients with confirmed core binding factor (CBF) AML (AML with t(8;21)(q22;q22.1); RUNX1-RUNX1T1 or inv(16)(p13.1q22) /t(16;16)(p13.1;q22); CBFB-MYH11), the pathologist or treating clinician should ensure that appropriate mutational analysis for KIT is performed. For patients other than those with confirmed CBF-AML, acute promyelocytic leukemia, or AML with myelodysplasia-related cytogenetic abnormalities, the pathologist or treating clinician should also ensure that mutational analysis for NPM1, CEBPA, and RUNX1 is also performed.
The CAP-ASH Guidelines represent the first joint recommendations produced by these two organizations for the initial diagnostic workup of acute leukemia.6
“The accurate classification of AML requires multidisciplinary diagnostic studies using immunohistochemistry, cytochemistry, or both, in addition to molecular genetics analysis.” 1
— NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Acute Myeloid Leukemia, Version 3.2019
The National Comprehensive Cancer Network makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.
WHY: FLT3 Is a Selective Marker
Only patients newly diagnosed as FLT3 positive (FLT3+) with ITD or TKD mutations may be eligible to receive RYDAPT® (midostaurin) capsules. FLT3+ status is a prerequisite.7
In vitro, RYDAPT demonstrated the ability to inhibit FLT3 receptor signaling and cell proliferation, and it induced apoptosis in leukemic cells expressing ITD or TKD mutant FLT3 receptors or overexpressing wild-type FLT3 and PDGF receptors.7
WHO: Every Patient With Newly Diagnosed AML
All patients with newly diagnosed AML should have a FLT3 test because approximately 30% of all patients with AML are FLT3+.6,8
Patients newly diagnosed with FLT3+ AML with ITD or TKD mutations were enrolled in the RATIFY trial.7
WHEN: At Diagnosis
The LeukoStrat® CDx FLT3 Mutation Assay is selective and must be performed up front at diagnosis in parallel with cytogenetics to allow results in time for treatment decisions.3,6,7
HOW: Use the FDA-Approved FLT3 Mutation Test
The LeukoStrat® CDx FLT3 Mutation Assay* is used as an aid in the selection of patients with AML for RYDAPT treatment.7 Send out samples early to ensure fast and complete test results.‡
*FLT3 mutation testing is performed by The Laboratory for Personalized Molecular Medicine (LabPMM), a subsidiary of Invivoscribe Technologies, Inc., which has gained FDA approval for its FLT3 test as a companion diagnostic for RYDAPT in newly diagnosed FLT3+ AML. Laboratory for Personalized Molecular Medicine® is a registered trademark of Invivoscribe Technologies, Inc.
†Derived from an Ipsos Oncology MDx Biomarker testing in AML study (October-November 2016).
‡Samples must be received by LabPMM within a maximum of 4 days after collection. LabPMM usually delivers results in 2 to 3 days after the sample is received.
ATP, adenosine triphosphate; EDTA, ethylenediaminetetraacetic acid; FISH, fluorescence in situ hybridization; FLT3, FMS-like tyrosine kinase 3; ITD, internal tandem duplication; PDGF, platelet-derived growth factor receptor; TKD, tyrosine kinase domain.
- Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Acute Myeloid Leukemia V.3.2019. © National Comprehensive Cancer Network, Inc. 2019. All rights reserved. Accessed May 16, 2019. To view the most recent and complete version of the guideline, go online to NCCN.org.
- De Kouchkovsky I, Abdul-Hay M. Acute myeloid leukemia: a comprehensive review and 2016 update. Blood Cancer J. 2016;6(7):e441.
- Leukostrat® CDx FLT3 Mutation Assay technical flyer. Invivoscribe website. https://www.invivoscribe.com/uploads/products/informationalDownloads/LabPMM-Flyer_Leukostrat-CDx_FLT3_8.5x11_20170420.pdf. Accessed November 6, 2017.
- National Cancer Institute. SEER Cancer Stat Facts: Acute Myeloid Leukemia (AML). http://seer.cancer.gov/statfacts/html/amyl.html. Accessed November 6, 2017.
- Data on file. Ipsos Oncology MDx: biomarker testing in AML: US 2016 Q4. Novartis Pharmaceuticals Corp; 2016.
- Arber DA, Borowitz MJ, Cessna M, et al. Initial diagnostic workup of acute leukemia: guideline from the College of American Pathologists and the American Society of Hematology. Arch Pathol Lab Med. 2017;141(10):1342-1393.
- Rydapt [prescribing information]. East Hanover, NJ: Novartis Pharmaceuticals Corp; 2018.
- Levis M. FLT3 mutations in acute myeloid leukemia: what is the best approach in 2013? Hematology Am Soc Hematol Educ Program. 2013;2013:220-226.
INDICATION for RYDAPT® (midostaurin) capsules
Acute Myeloid Leukemia
RYDAPT is indicated, in combination with standard cytarabine and daunorubicin induction and cytarabine consolidation chemotherapy, for the treatment of adult patients with newly diagnosed acute myeloid leukemia (AML) who are FLT3 mutation–positive, as detected by an FDA-approved test.
Limitations of Use
RYDAPT is not indicated as a single-agent induction therapy for the treatment of patients with AML.
IMPORTANT SAFETY INFORMATION for RYDAPT® (midostaurin) capsules
- Do not use in patients with hypersensitivity to midostaurin or its excipients. Hypersensitivity reactions have included anaphylactic shock, dyspnea, flushing, chest pain, and angioedema
- Do not use during pregnancy. Midostaurin caused severe embryofetal abnormalities and death in animal studies
- Verify pregnancy status of females of reproductive potential within 7 days prior to initiating RYDAPT
- Advise females of reproductive potential to use effective contraception during treatment and for at least 4 months after the last dose
- Males taking RYDAPT should use effective contraception with females of reproductive potential and pregnant women and for at least 4 months after the last dose
- Pregnancy exposure registry to monitor pregnancy outcomes: Females who may have been exposed to RYDAPT during pregnancy, directly or through a male partner receiving RYDAPT, should contact Novartis Pharmaceuticals Corporation at 1-888-669-6682 and/or at https://psi.novartis.com
- Cases of interstitial lung disease and pneumonitis, some fatal, have occurred in patients treated with RYDAPT as monotherapy or with chemotherapy
- Monitor patients for pulmonary symptoms. Discontinue RYDAPT in patients who experience signs or symptoms of interstitial lung disease or pneumonitis without an infectious etiology
- Because of the potential for serious adverse reactions in breastfed infants from RYDAPT, advise women not to breastfeed during treatment with RYDAPT and for at least 4 months after the last dose
- Based on findings in animals, RYDAPT may impair fertility in females and males of reproductive potential. It is unknown whether these effects on fertility are reversible
- Strong CYP3A4 Inducers: Avoid concomitant use as strong CYP3A4 inducers decrease exposure to midostaurin and may reduce efficacy
- Strong CYP3A4 Inhibitors: Coadministration with strong CYP3A4 inhibitors may increase midostaurin concentrations and may increase the risk of toxicity. Monitor patients for increased risk of adverse reactions, especially during the first week of RYDAPT use in each chemotherapy cycle and the first week of consecutive RYDAPT administration. Consider alternative therapies that do not strongly inhibit CYP3A4 activity
Acute Myeloid Leukemia
- Most common adverse reactions (≥20%) were febrile neutropenia (83%), nausea (83%), mucositis (66%), vomiting (61%), headache (46%), petechiae (36%), musculoskeletal pain (33%), epistaxis (28%), device-related infection (24%), hyperglycemia (20%), and upper respiratory tract infection (20%)
- Most frequent grade 3/4 adverse reactions (≥10%) were febrile neutropenia (84%), device-related infection (16%), and mucositis (11%)
- Most common (≥10%) lab abnormalities were alanine aminotransferase increase (71%), hypernatremia (21%), and hypocalcemia (74%)
Please see full Prescribing Information for RYDAPT® (midostaurin) capsules.