These highlights do not include all the information needed to use LIBTAYO safely and effectively. See full prescribing information for LIBTAYO.LIBTAYO® (cemiplimab-rwlc) injection, for intravenous useInitial U.S. Approval: 2018
1 INDICATIONS AND USAGE
1.1 Cutaneous Squamous Cell Carcinoma
LIBTAYO is indicated for the treatment of patients with metastatic cutaneous squamous cell carcinoma (mCSCC) or locally advanced CSCC (laCSCC) who are not candidates for curative surgery or curative radiation.
1.2 Basal Cell Carcinoma
LIBTAYO is indicated for the treatment of patients with locally advanced or metastatic basal cell carcinoma (laBCC or mBCC) who have been previously treated with a hedgehog pathway inhibitor or for whom a hedgehog pathway inhibitor is not appropriate.
1.3 Non-Small Cell Lung Cancer
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LIBTAYO in combination with platinum‐based chemotherapy is indicated for the first-line treatment of adult patients with non-small cell lung cancer (NSCLC) with no EGFR, ALK or ROS1 aberrations and is:
LIBTAYO as a single agent is indicated for the first-line treatment of adult patients with NSCLC whose tumors have high PD-L1 expression [Tumor Proportion Score (TPS) ≥ 50%] as determined by an FDA-approved test [see Dosage and Administration (2.1)], with no EGFR, ALK or ROS1 aberrations, and is:
- locally advanced where patients are not candidates for surgical resection or definitive chemoradiation or
- metastatic.
2 DOSAGE AND ADMINISTRATION
2.1 Patient Selection for NSCLC
Select patients with locally advanced or metastatic NSCLC for treatment with LIBTAYO as a single agent based on PD-L1 expression on tumor cells [see Clinical Studies (14.3)].
Information on FDA-approved tests for the detection of PD-L1 expression is available at: http://www.fda.gov/CompanionDiagnostics.
2.2 Recommended Dosage
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Locally Advanced or Metastatic Basal Cell Carcinoma and Locally Advanced or Metastatic Cutaneous Squamous Cell Carcinoma
The recommended dosage of LIBTAYO is 350 mg administered as an intravenous infusion every 3 weeks until disease progression, unacceptable toxicity, or up to 24 months.
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Non-Small Cell Lung Cancer
The recommended dosage of LIBTAYO is 350 mg administered as an intravenous infusion every 3 weeks until disease progression or unacceptable toxicity.
Refer to the Prescribing Information for the agents administered in combination with LIBTAYO for recommended dosing information, as appropriate.
2.3 Dosage Modifications for Adverse Reactions
No dose reduction for LIBTAYO is recommended. In general, withhold LIBTAYO for severe (Grade 3) immune-mediated adverse reactions. Permanently discontinue LIBTAYO for life-threatening (Grade 4) immune-mediated adverse reactions, recurrent severe (Grade 3) immune-mediated reactions that require systemic immunosuppressive treatment, or an inability to reduce corticosteroid dose to 10 mg or less of prednisone equivalent per day within 12 weeks of initiating steroids.
Dosage modifications for LIBTAYO for adverse reactions that require management different from these general guidelines are summarized in Table 1.
| Immune-Mediated Adverse Reactions [see Warnings and Precautions (5.1)] | ||
| Pneumonitis | Grade 2 | WithholdResume in patients with complete or partial resolution (Grade 0 to 1) after corticosteroid taper. Permanently discontinue if no complete or partial resolution within 12 weeks of initiating steroids or inability to reduce prednisone to less than 10 mg per day (or equivalent) within 12 weeks of initiating steroids. |
| Grade 3 or 4 | Permanently discontinue | |
| Colitis | Grade 2 or 3 | Withhold |
| Grade 4 | Permanently discontinue | |
| Hepatitis with no tumor involvement of the liver | AST or ALT increases to more than 3 and up to 8 times ULN or Total bilirubin increases to more than 1.5 and up to 3 times the ULN | Withhold |
| AST or ALT increases to more than 8 times the ULN or Total bilirubin increases to more than 3 times the ULN | Permanently discontinue | |
| Hepatitis with tumor involvement of the liverIf AST and ALT are less than or equal to ULN at baseline, withhold or permanently discontinue LIBTAYO based on recommendations for hepatitis with no liver involvement | Baseline AST or ALT is more than 1 and up to 3 times ULN and increases to more than 5 and up to 10 times ULN or Baseline AST or ALT is more than 3 and up to 5 times ULN and increases to more than 8 and up to 10 times ULN | Withhold |
| AST or ALT increases to more than 10 times ULN or Total bilirubin increases to more than 3 times ULN | Permanently discontinue | |
| Endocrinopathies | Grade 3 or 4 | Withhold until clinically stable or permanently discontinue depending on severity |
| Nephritis with Renal Dysfunction | Grade 2 or 3 increased blood creatinine | Withhold |
| Grade 4 increased blood creatinine | Permanently discontinue | |
| Exfoliative Dermatologic Conditions | Suspected SJS, TEN, or DRESS | Withhold |
| Confirmed SJS, TEN, or DRESS | Permanently discontinue | |
| Myocarditis | Grade 2, 3 or 4 | Permanently discontinue |
| Neurological Toxicities | Grade 2 | Withhold |
| Grade 3 or 4 | Permanently discontinue | |
| Other Adverse Reactions | ||
| Infusion-related reactions [see Warnings and Precautions (5.2)] | Grade 1 or 2 | Interrupt or slow the rate of infusion |
| Grade 3 or 4 | Permanently discontinue | |
2.4 Preparation and Administration
- Visually inspect for particulate matter and discoloration prior to administration. LIBTAYO is a clear to slightly opalescent, colorless to pale yellow solution that may contain trace amounts of translucent to white particles. Discard the vial if the solution is cloudy, discolored or contains extraneous particulate matter other than trace amounts of translucent to white particles.
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Preparation
- Do not shake.
- Withdraw 7 mL from a vial and dilute with 0.9% Sodium Chloride Injection, USP or 5% Dextrose Injection, USP to a final concentration between 1 mg/mL to 20 mg/mL.
- Mix diluted solution by gentle inversion. Do not shake.
- Discard any unused medicinal product or waste material.
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Storage of Infusion Solution
- Store at room temperature up to 25°C (77°F) for no more than 8 hours from the time of preparation to the end of the infusion or under refrigeration at 2°C to 8°C (36°F to 46°F) for no more than 10 days from the time of preparation to the end of infusion.
- Allow the diluted solution to come to room temperature prior to administration.
- Do not freeze.
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Administration
- Administer by intravenous infusion over 30 minutes through an intravenous line containing a sterile, in-line or add-on 0.2-micron to 5-micron filter.
3 DOSAGE FORMS AND STRENGTHS
Injection: 350 mg/7 mL (50 mg/mL), clear to slightly opalescent, colorless to pale yellow solution that may contain trace amounts of translucent to white particles in a single-dose vial.
4 CONTRAINDICATIONS
None.
5 WARNINGS AND PRECAUTIONS
5.1 Severe and Fatal Immune-Mediated Adverse Reactions
LIBTAYO is a monoclonal antibody that belongs to a class of drugs that bind to either the programmed death receptor-1 (PD-1) or PD-ligand 1 (PD-L1), blocking the PD-1/PD-L1 pathway, thereby removing inhibition of the immune response, potentially breaking peripheral tolerance and inducing immune-mediated adverse reactions. Important immune-mediated adverse reactions listed under Warnings and Precautions may not include all possible severe and fatal immune-mediated reactions.
The incidence and severity of immune-mediated adverse reactions were similar when LIBTAYO was administered as a single agent or in combination with chemotherapy.
Immune-mediated adverse reactions, which may be severe or fatal, can occur in any organ system or tissue. Immune-mediated adverse reactions can occur at any time after starting PD-1/PD-L1 blocking antibody. While immune-mediated adverse reactions usually manifest during treatment with PD-1/PD-L1 blocking antibodies, immune-mediated adverse reactions can also manifest after discontinuation of PD-1/PD-L1 blocking antibodies. Immune-mediated adverse reactions affecting more than one body system can occur simultaneously.
Early identification and management of immune‐mediated adverse reactions are essential to ensure safe use of PD-1/PD-L1 blocking antibodies. Monitor closely for symptoms and signs that may be clinical manifestations of underlying immune-mediated adverse reactions. Evaluate liver enzymes, creatinine, and thyroid function at baseline and periodically during treatment. In cases of suspected immune-mediated adverse reactions, initiate appropriate workup to exclude alternative etiologies, including infection. Institute medical management promptly, including specialty consultation as appropriate.
Withhold or permanently discontinue LIBTAYO depending on severity [see Dosage and Administration (2.3)]. In general, if LIBTAYO requires interruption or discontinuation, administer systemic corticosteroid therapy (1 to 2 mg/kg/day prednisone or equivalent) until improvement to Grade 1 or less. Upon improvement to Grade 1 or less, initiate corticosteroid taper and continue to taper over at least 1 month. Consider administration of other systemic immunosuppressants in patients whose immune-mediated adverse reactions are not controlled with corticosteroids.
Toxicity management guidelines for adverse reactions that do not necessarily require systemic steroids (e.g., endocrinopathies and dermatologic reactions) are discussed below.
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Immune-Mediated Pneumonitis
LIBTAYO can cause immune-mediated pneumonitis. The definition of immune-mediated pneumonitis included the required use of systemic corticosteroids or other immunosuppressants and the absence of a clear alternate etiology. In patients treated with other PD-1/PD-L1 blocking antibodies the incidence of pneumonitis is higher in patients who have received prior thoracic radiation.
Immune-mediated pneumonitis occurred in 2.6% (33/1281) of patients receiving LIBTAYO, including Grade 4 (0.3%), Grade 3 (0.6%), and Grade 2 (1.6%) adverse reactions. Pneumonitis led to permanent discontinuation of LIBTAYO in 1.3% of patients and withholding of LIBTAYO in 1.4% of the patients.
Systemic corticosteroids were required in all patients with pneumonitis. Pneumonitis resolved in 61% of the 33 patients. Of the 18 patients in whom LIBTAYO was withheld for pneumonitis, 10 reinitiated LIBTAYO after symptom improvement; of these, 4/10 (40%) had recurrence of pneumonitis.
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Immune-Mediated Colitis
LIBTAYO can cause immune-mediated colitis. The definition of immune-mediated colitis included the required use of systemic corticosteroids or other immunosuppressants and the absence of a clear alternate etiology. The primary component of the immune-mediated colitis was diarrhea. Cytomegalovirus (CMV) infection/reactivation has been reported in patients with corticosteroid-refractory immune-mediated colitis treated with PD-1/PD-L1 blocking antibodies. In cases of corticosteroid-refractory colitis, consider repeating infectious workup to exclude alternative etiologies.
Immune-mediated colitis occurred in 2% (25/1281) of patients receiving LIBTAYO, including Grade 3 (0.8%) and Grade 2 (0.9%) adverse reactions. Colitis led to permanent discontinuation of LIBTAYO in 0.4% of patients and withholding of LIBTAYO in 1.2% of patients.
Systemic corticosteroids were required in all patients with colitis. Colitis resolved in 56% of the 25 patients. Of the 16 patients in whom LIBTAYO was withheld for colitis, 6 reinitiated LIBTAYO after symptom improvement; of these, 4/6 (67%) had recurrence of colitis.
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Immune-Mediated Hepatitis
LIBTAYO can cause immune-mediated hepatitis. The definition of immune-mediated hepatitis included the required use of systemic corticosteroids or other immunosuppressants and the absence of a clear alternate etiology.
Immune-mediated hepatitis occurred in 2.4% (31/1281) of patients receiving LIBTAYO, including fatal (< 0.1%), Grade 4 (0.3%), Grade 3 (1.6%), and Grade 2 (0.2%) adverse reactions. Hepatitis led to permanent discontinuation of LIBTAYO in 1.4% of patients and withholding of LIBTAYO in 0.7% of patients.
Systemic corticosteroids were required in all patients with hepatitis. Thirteen percent (13%) of these patients (4/31) required additional immunosuppression with mycophenolate. Hepatitis resolved in 39% of the 31 patients. Of the 9 patients in whom LIBTAYO was withheld for hepatitis, 5 patients reinitiated LIBTAYO after symptom improvement; of these, 1/5 (20%) had recurrence of hepatitis.
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Immune-Mediated Endocrinopathies
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Adrenal Insufficiency
LIBTAYO can cause primary or secondary adrenal insufficiency. For Grade 2 or higher adrenal insufficiency, initiate symptomatic treatment, including hormone replacement as clinically indicated. Withhold LIBTAYO depending on severity [see Dosage and Administration (2.3)].
Adrenal insufficiency occurred in 0.5% (6/1281) of patients receiving LIBTAYO, including Grade 3 (0.5%) adverse reactions. Adrenal insufficiency led to permanent discontinuation of LIBTAYO in 1 (< 0.1%) patient. LIBTAYO was withheld in 1 (< 0.1%) patient due to adrenal insufficiency and not reinitiated. Systemic corticosteroids were required in 83% (5/6) patients with adrenal insufficiency; of these, the majority remained on systemic corticosteroids. Adrenal insufficiency resolved in 17% of the 6 patients.
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Hypophysitis
LIBTAYO can cause immune-mediated hypophysitis. Hypophysitis can present with acute symptoms associated with mass effect such as headache, photophobia, or visual field defects. Hypophysitis can cause hypopituitarism. Initiate hormone replacement as clinically indicated. Withhold or permanently discontinue LIBTAYO depending on severity [see Dosage and Administration (2.3)].
Hypophysitis occurred in 0.5% (7/1281) of patients receiving LIBTAYO, including Grade 3 (0.2%) and Grade 2 (0.3%) adverse reactions. Hypophysitis led to permanent discontinuation of LIBTAYO in 1 (< 0.1%) patient and withholding of LIBTAYO in 2 (0.2%) patients. Systemic corticosteroids were required in 86% (6/7) patients with hypophysitis. Hypophysitis resolved in 14% of the 7 patients. Of the 2 patients in whom LIBTAYO was withheld for hypophysitis, none of the patients reinitiated.
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Thyroid Disorders
LIBTAYO can cause immune-mediated thyroid disorders. Thyroiditis can present with or without endocrinopathy. Hypothyroidism can follow hyperthyroidism. Initiate hormone replacement or medical management of hyperthyroidism as clinically indicated. Withhold or permanently discontinue LIBTAYO depending on severity [see Dosage and Administration (2.3)].
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Thyroiditis: Thyroiditis occurred in 0.6% (8/1281) of patients receiving LIBTAYO, including Grade 2 (0.3%) adverse reactions. No patient discontinued LIBTAYO due to thyroiditis. Thyroiditis led to withholding of LIBTAYO in 1 (< 0.1%) patient. Systemic corticosteroids were not required in any patient with thyroiditis. Thyroiditis resolved in 13% of the 8 patients.
Blood thyroid stimulating hormone increased and blood thyroid stimulating hormone decreased have also been reported.
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Hyperthyroidism: Hyperthyroidism occurred in 3% (39/1281) of patients receiving LIBTAYO, including Grade 3 (< 0.1%) and Grade 2 (0.9%) adverse reactions. No patient discontinued treatment due to hyperthyroidism. Hyperthyroidism led to withholding of LIBTAYO in 7 (0.5%) patients.
Systemic corticosteroids were required in 8% (3/39) of patients with hyperthyroidism. Hyperthyroidism resolved in 56% of the 39 patients. Of the 7 patients in whom LIBTAYO was withheld for hyperthyroidism, 2 patients reinitiated LIBTAYO after symptom improvement; of these, none had recurrence of hyperthyroidism.
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Hypothyroidism: Hypothyroidism occurred in 7% (87/1281) of patients receiving LIBTAYO, including Grade 3 (< 0.1%) and Grade 2 (6%) adverse reactions. Hypothyroidism led to permanent discontinuation of LIBTAYO in 3 (0.2%) patients. Hypothyroidism led to withholding of LIBTAYO in 9 (0.7%) patients.
Systemic corticosteroids were required in 1.1% (1/87) of patients. Hypothyroidism resolved in 6% of the 87 patients. The majority of patients with hypothyroidism required long-term thyroid hormone replacement.
Of the 9 patients in whom LIBTAYO was withheld for hypothyroidism, 1 reinitiated LIBTAYO after symptom improvement and did not have recurrence of hypothyroidism.
Type 1 Diabetes Mellitus, which can present with diabetic ketoacidosis
Monitor patients for hyperglycemia or other signs and symptoms of diabetes. Initiate treatment with insulin as clinically indicated. Withhold LIBTAYO depending on severity [see Dosage and Administration (2.3)].
Type 1 diabetes mellitus occurred in < 0.1% (1/1281) of patients (Grade 4). No patient discontinued treatment due to type 1 diabetes mellitus. Type 1 diabetes mellitus led to withholding of LIBTAYO in 0.1% of patients, treatment was reinitiated after symptom improvement. Patient received long-term insulin therapy.
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Immune-Mediated Nephritis with Renal Dysfunction
LIBTAYO can cause immune-mediated nephritis. The definition of immune-mediated nephritis included the required use of systemic corticosteroids or other immunosuppressants and the absence of a clear alternate etiology.
Immune-mediated nephritis occurred in 0.7% (9/1281) patients receiving LIBTAYO, including fatal (< 0.1%), Grade 3 (< 0.1%) and Grade 2 (0.5%) adverse reactions. Nephritis led to permanent discontinuation of LIBTAYO in 0.2% of patients and withholding of LIBTAYO in 0.4% of patients.
Systemic corticosteroids were required in all patients with nephritis. Nephritis resolved in 78% of the 9 patients. Of the 5 patients in whom LIBTAYO was withheld for nephritis, 4 reinitiated LIBTAYO after symptom improvement; of these, 1/4 (25%) had recurrence of nephritis.
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Immune-Mediated Dermatologic Adverse Reactions
LIBTAYO can cause immune-mediated rash or dermatitis. The definition of immune-mediated dermatologic adverse reaction included the required use of systemic corticosteroids or other immunosuppressants and the absence of a clear alternate etiology. Exfoliative dermatitis, including Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), and DRESS (Drug Rash with Eosinophilia and Systemic Symptoms), has occurred with PD-1/PD-L1 blocking antibodies. Topical emollients and/or topical corticosteroids may be adequate to treat mild to moderate non-exfoliative rashes. Withhold or permanently discontinue LIBTAYO depending on severity [see Dosage and Administration (2.3)].
Immune-mediated dermatologic adverse reactions occurred in 1.9% (24/1281) of patients receiving LIBTAYO, including Grade 3 (0.9%) and Grade 2 (0.8%) adverse reactions. Dermatologic adverse reactions led to permanent discontinuation of LIBTAYO in 0.2% of patients and withholding of LIBTAYO in 1.3% of patients.
Systemic corticosteroids were required in all patients with immune-mediated dermatologic adverse reactions. Immune-mediated dermatologic adverse reactions resolved in 71% of the 24 patients. Of the 17 patients in whom LIBTAYO was withheld for dermatologic adverse reaction, 13 reinitiated LIBTAYO after symptom improvement; of these 5/13 (38%) had recurrence of the dermatologic adverse reaction.
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Other Immune-Mediated Adverse Reactions
The following clinically significant immune-mediated adverse reactions occurred at an incidence of < 1% in 1281 patients who received LIBTAYO or were reported with the use of other PD-1/PD-L1 blocking antibodies. Severe or fatal cases have been reported for some of these adverse reactions.
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Cardiac/Vascular: Myocarditis, pericarditis, vasculitis
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Nervous System: Meningitis, encephalitis, myelitis and demyelination, myasthenic syndrome/myasthenia gravis (including exacerbation), Guillain-Barre syndrome, nerve paresis, autoimmune neuropathy
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Ocular: Uveitis, iritis, and other ocular inflammatory toxicities. Some cases can be associated with retinal detachment. Various grades of visual impairment to include blindness can occur. If uveitis occurs in combination with other immune-mediated adverse reactions, consider a Vogt-Koyanagi-Harada like syndrome, as this may require treatment with systemic steroids to reduce the risk of permanent vision loss
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Gastrointestinal: Pancreatitis to include increases in serum amylase and lipase levels, gastritis, duodenitis, stomatitis
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Musculoskeletal and Connective Tissue: Myositis/polymyositis/dermatomyositis, rhabdomyolysis and associated sequelae including renal failure, arthritis, polymyalgia rheumatica
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Endocrine: Hypoparathyroidism
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Other (Hematologic/Immune): Hemolytic anemia, aplastic anemia, hemophagocytic lymphohistiocytosis, systemic inflammatory response syndrome, histiocytic necrotizing lymphadenitis (Kikuchi lymphadenitis), sarcoidosis, immune thrombocytopenia, solid organ transplant rejection, other transplant (including corneal graft) rejection
5.2 Infusion-Related Reactions
Severe or life-threatening infusion-related reactions occurred in 0.2% of patients receiving LIBTAYO as a single agent. Monitor patients for signs and symptoms of infusion-related reactions. Common symptoms of infusion-related reaction include nausea, pyrexia, and vomiting.
Interrupt or slow the rate of infusion or permanently discontinue LIBTAYO based on severity of reaction [see Dosage and Administration (2.3)].
5.3 Complications of Allogeneic HSCT
Fatal and other serious complications can occur in patients who receive allogeneic hematopoietic stem cell transplantation (HSCT) before or after being treated with a PD-1/PD-L1 blocking antibody. Transplant-related complications include hyperacute graft-versus-host-disease (GVHD), acute GVHD, chronic GVHD, hepatic veno-occlusive disease (VOD) after reduced intensity conditioning, and steroid-requiring febrile syndrome (without an identified infectious cause). These complications may occur despite intervening therapy between PD-1/PD-L1 blockade and allogeneic HSCT.
Follow patients closely for evidence of transplant-related complications and intervene promptly. Consider the benefit versus risks of treatment with a PD-1/PD-L1 blocking antibody prior to or after an allogeneic HSCT.
5.4 Embryo-Fetal Toxicity
Based on its mechanism of action, LIBTAYO can cause fetal harm when administered to a pregnant woman. Animal studies have demonstrated that inhibition of the PD-1/PD-L1 pathway can lead to increased risk of immune-mediated rejection of the developing fetus resulting in fetal death. Advise women of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with LIBTAYO and for at least 4 months after the last dose [see Use in Specific Populations (8.1, 8.3)].
6 ADVERSE REACTIONS
The following serious adverse reactions are described elsewhere in the labeling.
- Severe and Fatal Immune-Mediated Adverse Reactions [see Warnings and Precautions (5.1)]
- Infusion-Related Reactions [see Warnings and Precautions (5.2)]
- Complications of Allogeneic HSCT [see Warnings and Precautions (5.3)]
6.1 Clinical Trials Experience
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.
The data described in Warnings and Precautions reflect exposure to LIBTAYO as a single agent in 1281 patients in three open-label, single-arm, multicohort studies, and two open-label randomized multi-center studies. These studies included 384 patients with advanced CSCC (Studies 1540 and 1423), 138 patients with advanced BCC (Study 1620), 355 patients with NSCLC (Study 1624), and 404 patients with other advanced solid tumors. LIBTAYO was administered intravenously at doses of 3 mg/kg every 2 weeks (n=235), 350 mg every 3 weeks (n=1014), or other doses (n=32). Among the 1281 patients, 53% were exposed for 6 months or longer and 26% were exposed for one year or longer. In this pooled safety population, the most common adverse reactions (≥15%) were fatigue, musculoskeletal pain, rash, diarrhea, and anemia. The most common Grade 3-4 laboratory abnormalities (≥2%) were lymphopenia, anemia, hyponatremia, hypophosphatemia, increased aspartate aminotransferase, hypokalemia, hyperkalemia, and increased alanine aminotransferase.
In addition, the data below reflect exposure to LIBTAYO in combination with platinum-based chemotherapy in 312 patients with NSCLC enrolled in a randomized, active controlled trial (Study 16113).
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Cutaneous Squamous Cell Carcinoma (CSCC)
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Study 1540
The safety of LIBTAYO was evaluated in 358 patients with advanced CSCC (metastatic or locally advanced disease) in Study 1540 [see Clinical Studies (14.1)]. Of these 358 patients, 213 had mCSCC (nodal or distant) and 145 had laCSCC. Patients received LIBTAYO 3 mg/kg every 2 weeks (n=137) or 350 mg every 3 weeks (n=221) as an intravenous infusion until disease progression, unacceptable toxicity, or completion of planned treatment. The median duration of exposure was 40 weeks (1 week to 109 weeks).
Serious adverse reactions occurred in 41% of patients. Serious adverse reactions that occurred in at least 2% of patients were pneumonia (3.6%), skin infection (3.6%), and pneumonitis (2.8%). Fatal adverse reactions occurred in 5% of patients who received LIBTAYO, including deaths due to infections (2.2%).
Permanent discontinuation due to an adverse reaction occurred in 12% of patients. Adverse reactions resulting in permanent discontinuation in at least 2 patients were pneumonitis, rash, confusional state, general physical health deterioration, hemorrhage, liver function test abnormalities, and musculoskeletal pain.
Dosage interruptions of LIBTAYO due to an adverse reaction occurred in 36% of patients. Adverse reactions which required dosage interruption in ≥ 2% of patients included diarrhea, infusion-related reaction, upper respiratory tract infection, liver function test abnormalities, musculoskeletal pain, pneumonitis, and rash.
The most common (≥ 20%) adverse reactions were fatigue, rash, musculoskeletal pain, diarrhea, pruritus, and nausea. The most common Grade 3 or 4 adverse reactions (≥ 2%) were hypertension, skin infection, pneumonia, anemia, fatigue, musculoskeletal pain, and pneumonitis. The most common (≥ 4%) Grade 3 or 4 laboratory abnormalities worsening from baseline were lymphopenia, hyponatremia, anemia, and hypophosphatemia.
Table 2 summarizes the adverse reactions that occurred in ≥ 10% of patients and Table 3 summarizes Grade 3 or 4 laboratory abnormalities worsening from baseline in ≥ 1% of patients receiving LIBTAYO.
| General and Administration Site | ||
| FatigueFatigue is a composite term that includes fatigue and asthenia | 38 | 2.2 |
| Skin and Subcutaneous Tissue | ||
| RashRash is a composite term that includes rash, rash maculo-papular, dermatitis, erythema, eczema, dermatitis bullous, rash erythematous, dermatitis acneiform, psoriasis, dermatitis contact, blister, pemphigoid, rash papular, hand dermatitis, skin exfoliation, autoimmune dermatitis, rash pruritic, rash macular, rash pustular, urticaria, dermatitis atopic, drug eruption, eczema asteatotic, skin reaction, dermatitis psoriasiform, eczema nummular, exfoliative rash, and immune-mediated dermatitis | 34 | 1.7 |
| PruritusPruritus is a composite term that includes pruritus and pruritus allergic | 22 | 0.3 |
| Actinic keratosis | 10 | 0 |
| Musculoskeletal and Connective Tissue | ||
| Musculoskeletal painMusculoskeletal pain is a composite term that includes arthralgia, back pain, myalgia, polyarthritis, pain in extremity, neck pain, non-cardiac chest pain, arthritis, musculoskeletal chest pain, musculoskeletal pain, musculoskeletal stiffness, bone pain, immune-mediated arthritis, and spinal pain | 33 | 2.5 |
| Gastrointestinal | ||
| DiarrheaDiarrhea is a composite term that includes diarrhea, colitis, and autoimmune colitis | 26 | 1.1 |
| Nausea | 21 | 0 |
| Constipation | 13 | 0.3 |
| VomitingVomiting is a composite term that includes hematemesis and vomiting | 11 | 0.6 |
| Infections and infestations | ||
| Upper respiratory tract infectionUpper respiratory tract infection is a composite term that includes upper respiratory tract infection, nasopharyngitis, sinusitis, influenza-like illness, rhinitis, influenza, viral upper respiratory tract infection, respiratory tract infection, influenza A virus test positive, and pharyngitis | 14 | 1.1 |
| Skin infectionSkin infection is a composite term that includes skin infection, cellulitis, fungal skin infection, and staphylococcal skin infection | 11 | 4.5 |
| Respiratory | ||
| CoughCough is a composite term that includes cough, productive cough, and upper airway cough syndrome | 12 | 0 |
| Metabolism and Nutrition | ||
| Decreased appetite | 11 | 0.6 |
| Nervous system disorders | ||
| HeadacheHeadache is a composite term that includes headache, sinus headache, and migraine | 10 | 0 |
| DizzinessDizziness is a composite term that includes dizziness, vertigo, vertigo positional, and dizziness postural | 10 | 0.3 |
| Hematology | |
| Lymphopenia | 7.0 |
| Anemia | 4.1 |
| Electrolytes | |
| Hyponatremia | 4.9 |
| Hypophosphatemia | 4.1 |
| Hypercalcemia | 2.0 |
| Hypokalemia | 1.5 |
| Coagulation | |
| Increased INR | 2.9 |
| Chemistry | |
| Increased aspartate aminotransferase | 1.5 |
| Hypoalbuminemia | 1.2 |
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Study 1423
In 26 patients with advanced CSCC treated with LIBTAYO in Study 1423 [see Clinical Studies (14.1)], safety data were consistent with those described above from Study 1540.
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Basal Cell Carcinoma (BCC)
The safety of LIBTAYO was evaluated in 138 patients with advanced BCC (mBCC N=54, laBCC N=84) in an open-label, single-arm trial (Study 1620) [see Clinical Studies (14.2)]. Patients received LIBTAYO 350 mg every 3 weeks as an intravenous infusion for up to 93 weeks or until disease progression or unacceptable toxicity. The median duration of exposure was 45 weeks (range: 2.1 weeks to 98 weeks).
Serious adverse reactions occurred in 34% of patients. Serious adverse reactions that occurred in > 1.5% were diarrhea (3.6%), urinary tract infection (3.6%), pneumonia (2.9%), and hemorrhage (2.2%). Fatal adverse reactions occurred in 4.3% of patients who received LIBTAYO, including acute kidney injury (0.7%) and cachexia worsening due to colitis (0.7%).
Permanent discontinuation of LIBTAYO due to an adverse reaction occurred in 14% of patients. Adverse reactions resulting in permanent discontinuation of LIBTAYO in at least 2 patients were diarrhea, acute kidney injury, general physical health deterioration, and hepatitis.
Dosage interruptions of LIBTAYO due to an adverse reaction occurred in 40% of patients. Adverse reactions which required dosage interruptions in > 2% of patients included diarrhea, acute kidney injury, musculoskeletal pain, fatigue, fall, headache, infusion-related reaction, hemorrhage, pneumonitis, upper respiratory tract infection, and urinary tract infection.
The most common adverse reactions reported in at least 15% of patients were fatigue, musculoskeletal pain, diarrhea, rash, upper respiratory tract infection, pruritus, hemorrhage, and hypertension.
The most common Grade 3 or 4 adverse reactions (> 2%) were hypertension, diarrhea, fatigue, musculoskeletal pain, hypokalemia, hyponatremia, pneumonia, urinary tract infection, visual impairment, and weight decreased. The most common (> 2%) laboratory abnormalities worsening from baseline to Grade 3 or 4 were lymphopenia and hyponatremia.
Table 4 summarizes the adverse reactions that occurred in ≥ 10% of patients and Table 5 summarizes Grade 3 or 4 laboratory abnormalities worsening from baseline in ≥ 1% of patients receiving LIBTAYO.
| General disorders and administration site conditions | ||
| FatigueFatigue is a composite term that includes fatigue, asthenia, and malaise | 50 | 4.3 |
| EdemaEdema is a composite term that includes peripheral edema, peripheral swelling, and face swelling | 10 | 0.7 |
| Musculoskeletal and connective tissue disorders | ||
| Musculoskeletal painMusculoskeletal pain is a composite term that includes arthralgia, back pain, pain in extremity, myalgia, neck pain, non-cardiac chest pain, arthritis, musculoskeletal chest pain, musculoskeletal stiffness, musculoskeletal discomfort, and spinal pain | 36 | 2.9 |
| Gastrointestinal disorders | ||
| DiarrheaDiarrhea is a composite term that includes diarrhea, colitis, autoimmune colitis, and enterocolitis | 33 | 4.3 |
| Nausea | 13 | 0.7 |
| Abdominal painAbdominal pain is a composite term that includes abdominal pain, abdominal pain upper, abdominal pain lower, and gastrointestinal pain | 12 | 1.4 |
| Constipation | 12 | 0.7 |
| Skin and subcutaneous tissue disorders | ||
| RashRash is a composite term that includes rash maculo-papular, eczema, rash, dermatitis, erythema, dermatitis acneiform, rash pruritic, rash pustular, dermatitis bullous, dyshidrotic eczema, pemphigoid, rash erythematous, urticaria, nodular rash, and skin exfoliation | 30 | 0.7 |
| Pruritus | 19 | 0 |
| Infections and infestations | ||
| Upper respiratory tract infection Upper respiratory tract infection is a composite term that includes upper respiratory tract infection, influenza-like illness, nasopharyngitis, rhinitis, sinusitis, viral rhinitis, pharyngitis, laryngitis, respiratory tract infection, influenza, viral upper respiratory tract infection, and influenza A virus test positive | 22 | 0 |
| Urinary tract infection Urinary tract infection is a composite term that includes urinary tract infection, cystitis, and urosepsis | 13 | 2.2 |
| Vascular disorders | ||
| HemorrhageHemorrhage is a composite term that includes tumor hemorrhage, hematuria, epistaxis, eye hemorrhage, hemoptysis, hemorrhage intracranial, hemorrhagic diathesis, postmenopausal hemorrhage, rectal hemorrhage, skin hemorrhage, skin neoplasm bleeding, ulcer hemorrhage, vaginal hemorrhage, wound hemorrhage, and subcutaneous hematoma | 18 | 0.7 |
| HypertensionHypertension is a composite term that includes hypertension, blood pressure increased, and hypertensive crisis | 17 | 9 |
| Metabolism and nutrition disorders | ||
| Decreased appetite | 14 | 1.4 |
| Blood and lymphatic system disorders | ||
| Anemia | 14 | 0.7 |
| Respiratory, thoracic, and mediastinal disorders | ||
| DyspneaDyspnea is a composite term that includes dyspnea and dyspnea exertional | 14 | 0 |
| Renal and urinary disorders | ||
| Acute kidney injuryAcute kidney injury is a composite term that includes blood creatinine increased, acute kidney injury, renal failure, renal impairment, glomerular filtration rate decreased, and nephropathy toxic | 14 | 0 |
| Nervous system disorders | ||
| Headache | 13 | 1.4 |
| DizzinessDizziness is a composite term that includes dizziness and vertigo | 12 | 0 |
| Peripheral neuropathyPeripheral neuropathy is a composite term that includes paresthesia, dysesthesia, hypoesthesia, peripheral motor neuropathy, burning sensation, neuralgia, and peripheral sensory neuropathy | 11 | 0 |
| Endocrine disorders | ||
| HypothyroidismHypothyroidism is a composite term that includes hypothyroidism, blood thyroid stimulating hormone increased, and immune-mediated hypothyroidism | 12 | 0 |
| Investigations | ||
| Liver function test abnormalitiesLiver function test abnormalities is a composite term that includes alanine aminotransferase increased, aspartate aminotransferase increased, bilirubin conjugated increased, blood alkaline phosphatase increased, blood bilirubin increased, and gamma-glutamyl transferase increased | 10 | 1.4 |
| Hematology | |
| Lymphopenia | 2.9 |
| Electrolytes | |
| Hyponatremia | 2.9 |
| Hypokalemia | 1.5 |
| Coagulation | |
| Activated partial thromboplastin time prolonged | 1.9 |
SPL UNCLASSIFIED SECTION
Non-Small Cell Lung Cancer (NSCLC)
SPL UNCLASSIFIED SECTION
First-line treatment of NSCLC with LIBTAYO in Combination with Platinum-based Chemotherapy
The safety of LIBTAYO in combination with platinum-based chemotherapy was evaluated in 465 patients with locally advanced or metastatic NSCLC in Study 16113 [see Clinical Studies (14.3)]. Patients received LIBTAYO 350 mg every 3 weeks plus platinum-based chemotherapy every 3 weeks for 4 cycles (n=312), or placebo every 3 weeks plus platinum-based chemotherapy every 3 weeks for 4 cycles (n=153).
Among patients who received LIBTAYO, 70% were exposed for 6 months or longer and 35% were exposed for greater than one year. The safety population characteristics were: median age of 63 years (25 to 82 years), 41% of patients 65 or older, 86% male, 86% White, 14% Asian, 86% had metastatic disease and 14% had locally advanced disease and Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) of 0 (16%) and 1 (83%).
Serious adverse reactions occurred in 25% of patients. The most frequent serious adverse reactions that occurred in at least 2% of patients were pneumonia, anemia, and neutropenia. Fatal adverse reactions occurred in 6% of patients who received LIBTAYO in combination with chemotherapy, including death not otherwise specified (2.9%), sudden death (1.0%), acute hepatitis (0.3%), acute respiratory distress syndrome (0.3%), mesenteric artery thrombosis (0.3%), pneumonia (0.3%), pneumonitis (0.3%), and pulmonary hemorrhage (0.3%). LIBTAYO was permanently discontinued due to adverse reactions in 5% of patients. Adverse reactions resulting in permanent discontinuation in at least 2 patients were increased alanine aminotransferase and anemia.
Dosage interruptions of LIBTAYO due to an adverse reaction occurred in 33% of patients. Adverse reactions which required dosage interruptions in at least 2% of patients were anemia, pneumonia, neutropenia, thrombocytopenia, fatigue, COVID-19 infection, and pyrexia.
The most common (≥ 15%) adverse reactions were alopecia, musculoskeletal pain, nausea, fatigue, peripheral neuropathy, and decreased appetite. The most common Grade 3-4 laboratory abnormalities (≥ 2%) were anemia, neutropenia, lymphopenia, leukopenia, hyponatremia, thrombocytopenia, hyperglycemia, hypophosphatemia, increased alanine aminotransferase, hypocalcemia, hyperkalemia, hypermagnesemia, hypokalemia, and increased creatinine.
Table 6 summarizes the adverse reactions that occurred in ≥ 10% of patients and Table 7 summarizes Grade 3 or 4 laboratory abnormalities in patients receiving LIBTAYO and chemotherapy.
| Skin and subcutaneous tissue disorders | ||||
| Alopecia | 37 | 0 | 43 | 0 |
| RashRash is a composite term that includes rash, rash maculo-papular, dermatitis, psoriasis, rash papular, urticaria, dermatitis allergic, erythema, lichen planus, rash macular, rash pruritic, skin reaction, skin toxicity, skin exfoliation, and dermatitis acneiform | 13 | 1.3 | 6 | 0 |
| Musculoskeletal and connective tissue disorders | ||||
| Musculoskeletal painMusculoskeletal pain is a composite term that includes arthralgia, back pain, pain in extremity, non-cardiac chest pain, myalgia, bone pain, musculoskeletal pain, neck pain, musculoskeletal chest pain, arthritis, and spinal pain | 30 | 1.6 | 36 | 0 |
| Gastrointestinal disorders | ||||
| Nausea | 25 | 0 | 16 | 0 |
| Constipation | 14 | 0.3 | 11 | 0 |
| Vomiting | 12 | 0 | 10 | 0 |
| Diarrhea | 11 | 1.3 | 7 | 0 |
| General disorders and administration site conditions | ||||
| FatigueFatigue is a composite term that includes asthenia, fatigue, and malaise | 23 | 3.8 | 18 | 2 |
| Nervous system disorders | ||||
| Peripheral neuropathyPeripheral neuropathy is a composite term that includes peripheral sensory neuropathy, peripheral neuropathy, paresthesia, polyneuropathy, hypoesthesia, peripheral sensorimotor neuropathy, neuralgia, polyneuropathy in malignant disease, and toxic neuropathy | 23 | 0 | 19 | 0 |
| Metabolism and nutrition disorders | ||||
| Decreased appetite | 17 | 1 | 12 | 0 |
| Investigations | ||||
| Weight decreased | 11 | 1.3 | 8 | 0 |
| Respiratory, thoracic, and mediastinal disorders | ||||
| DyspneaDyspnea is a composite term that includes dyspnea and dyspnea exertional | 13 | 2.2 | 7 | 0.7 |
| Psychiatric disorders | ||||
| Insomnia | 11 | 0 | 7 | 0 |
| Chemistry | ||
| Hyperglycemia | 4 | 1.5 |
| Increased alanine aminotransferase | 3 | 2.1 |
| Increased creatinine | 2 | 1.4 |
| Hypoalbuminemia | 1 | 0 |
| Hematology | ||
| Anemia | 10 | 7 |
| Neutrophil count decreased | 10 | 8 |
| Lymphocyte count decreased | 7 | 8 |
| White blood cell decreased | 6 | 4.1 |
| Platelet count decreased | 4.7 | 0.7 |
| Electrolytes | ||
| Hyponatremia | 6 | 4.1 |
| Hypophosphatemia | 3.4 | 7 |
| Hypocalcemia | 3 | 2.1 |
| Hyperkalemia | 2.7 | 2.7 |
| Hypermagnesemia | 2.4 | 2.8 |
| Hypokalemia | 2.3 | 1.4 |
| Hypercalcemia | 1.7 | 0.7 |
| Hypernatremia | 1 | 0 |
SPL UNCLASSIFIED SECTION
First-line treatment of NSCLC with LIBTAYO as a single agent
The safety of LIBTAYO was evaluated in 355 patients with locally advanced or metastatic NSCLC in Study 1624 [see Clinical Studies (14.3)]. Patients received LIBTAYO 350 mg every 3 weeks (n=355) or investigator's choice of chemotherapy (n=342), consisting of paclitaxel plus cisplatin or carboplatin; gemcitabine plus cisplatin or carboplatin; or pemetrexed plus cisplatin or carboplatin followed by optional pemetrexed maintenance. The median duration of exposure was 27.3 weeks (9 days to 115 weeks) in the LIBTAYO group and 17.7 weeks (18 days to 86.7 weeks) in the chemotherapy group. In the LIBTAYO group, 54% of patients were exposed to LIBTAYO for ≥ 6 months and 22% were exposed for ≥ 12 months.
The safety population characteristics were: median age of 63 years (31 to 79 years), 44% of patients 65 or older, 88% male, 86%White, 82% had metastatic disease and 18% had locally advanced disease, and ECOG performance score (PS) of 0 (27%) and 1 (73%).
LIBTAYO was permanently discontinued due to adverse reactions in 6% of patients; adverse reactions resulting in permanent discontinuation in at least 2 patients were pneumonitis, pneumonia, ischemic stroke, and increased aspartate aminotransferase. Serious adverse reactions occurred in 28% of patients. The most frequent serious adverse reactions in at least 2% of patients were pneumonia and pneumonitis.
Table 8 summarizes the adverse reactions that occurred in ≥ 10% of patients and Table 9 summarizes Grade 3 or 4 laboratory abnormalities in patients receiving LIBTAYO.
| Musculoskeletal and connective tissue disorders | ||||
| Musculoskeletal painMusculoskeletal pain is a composite term that includes back pain, arthralgia, pain in extremity, musculoskeletal pain, musculoskeletal chest pain, bone pain, myalgia, neck pain, spinal pain, and musculoskeletal stiffness | 26 | 0.6 | 27 | 1.5 |
| Skin and subcutaneous tissue disorders | ||||
| RashRash is a composite term that includes rash, dermatitis, urticaria, rash maculo-papular, erythema, rash erythematous, rash pruritic, psoriasis, autoimmune dermatitis, dermatitis acneiform, dermatitis allergic, dermatitis atopic, dermatitis bullous, drug eruption, dyshidrotic eczema, lichen planus, and skin reaction | 15 | 1.4 | 6 | 0 |
| Blood and lymphatic system disorders | ||||
| Anemia | 15 | 3.4 | 50 | 16 |
| General disorders and administration site conditions | ||||
| FatigueFatigue is a composite term that includes fatigue, asthenia, and malaise | 14 | 1.1 | 26 | 2 |
| Metabolism and nutrition disorders | ||||
| Decreased appetite | 12 | 0.6 | 18 | 0.3 |
| Infections and infestations | ||||
| PneumoniaPneumonia is a composite term that includes atypical pneumonia, embolic pneumonia, lower respiratory tract infection, lung abscess, paracancerous pneumonia, pneumonia, pneumonia bacterial, and pneumonia klebsiella | 11 | 5 | 12 | 5 |
| Respiratory, thoracic, and mediastinal disorders | ||||
| CoughCough is a composite term that includes cough and productive cough | 11 | 0 | 8 | 0.3 |
| Chemistry | ||
| Increased aspartate aminotransferase | 3.9 | 1.2 |
| Increased alanine aminotransferase | 2.7 | 0.3 |
| Increased alkaline phosphatase | 2.4 | 0.3 |
| Increased blood bilirubin | 2.1 | 0.3 |
| Hypoalbuminemia | 1.8 | 1.3 |
| Increased creatinine | 1.2 | 1.6 |
| Hematology | ||
| Lymphopenia | 7 | 9 |
| Anemia | 2.7 | 16 |
| Electrolytes | ||
| Hyponatremia | 6 | 7 |
| Hyperkalemia | 4.2 | 1.9 |
| Hypocalcemia | 3.9 | 3.4 |
| Hypophosphatemia | 2.4 | 4.1 |
| Hypermagnesemia | 2.1 | 1.6 |
| Hypokalemia | 1.5 | 2.2 |
| Hypercalcemia | 1.2 | 2.2 |
8 USE IN SPECIFIC POPULATIONS
8.1 Pregnancy
SPL UNCLASSIFIED SECTION
Risk Summary
Based on its mechanism of action, LIBTAYO can cause fetal harm when administered to a pregnant woman [see Clinical Pharmacology (12.1)]. There are no available data on the use of LIBTAYO in pregnant women. Animal studies have demonstrated that inhibition of the PD-1/PD-L1 pathway can lead to increased risk of immune-mediated rejection of the developing fetus resulting in fetal death (see Data). Human IgG4 immunoglobulins (IgG4) are known to cross the placenta; therefore, LIBTAYO has the potential to be transmitted from the mother to the developing fetus. Advise women of the potential risk to a fetus.
In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively.
SPL UNCLASSIFIED SECTION
Data
SPL UNCLASSIFIED SECTION
Animal Data
Animal reproduction studies have not been conducted with LIBTAYO to evaluate its effect on reproduction and fetal development. A central function of the PD-1/PD-L1 pathway is to preserve pregnancy by maintaining maternal immune tolerance to the fetus. In murine models of pregnancy, blockade of PD-L1 signaling has been shown to disrupt tolerance to the fetus and to result in an increase in fetal loss; therefore, potential risks of administering LIBTAYO during pregnancy include increased rates of abortion or stillbirth. As reported in the literature, there were no malformations related to the blockade of PD-1/PD-L1 signaling in the offspring of these animals; however, immune-mediated disorders occurred in PD-1 and PD-L1 knockout mice. Based on its mechanism of action, fetal exposure to cemiplimab-rwlc may increase the risk of developing immune-mediated disorders or altering the normal immune response.
8.2 Lactation
SPL UNCLASSIFIED SECTION
Risk Summary
There is no information regarding the presence of cemiplimab-rwlc in human milk, or its effects on the breastfed child or on milk production. Because of the potential for serious adverse reactions in breastfed children, advise women not to breastfeed during treatment and for at least 4 months after the last dose of LIBTAYO.
8.3 Females and Males of Reproductive Potential
SPL UNCLASSIFIED SECTION
Pregnancy Testing
Verify pregnancy status in females of reproductive potential prior to initiating LIBTAYO [see Use in Specific Populations (8.1)].
SPL UNCLASSIFIED SECTION
Contraception
LIBTAYO can cause fetal harm when administered to a pregnant woman [see Use in Specific Populations (8.1)].
SPL UNCLASSIFIED SECTION
Females
Advise females of reproductive potential to use effective contraception during treatment with LIBTAYO and for at least 4 months after the last dose.
8.4 Pediatric Use
The safety and effectiveness of LIBTAYO have not been established in pediatric patients.
8.5 Geriatric Use
SPL UNCLASSIFIED SECTION
LIBTAYO as a Single Agent
Of the 1281 patients who received LIBTAYO as a single agent in clinical studies, 26% were 65 years up to 75 years and 22% were 75 years or older. No overall differences in safety or effectiveness were observed between these patients and younger patients.
Of the 358 patients with mCSCC or laCSCC who received LIBTAYO as a single agent in Study 1540, 30% were 65 years up to 75 years and 48% were 75 years or older. No overall differences in safety or effectiveness were observed between these patients and younger patients.
Of the 138 patients with BCC who received LIBTAYO as a single agent in Study 1620, 27% were 65 years up to 75 years, and 31% were 75 years or older. No overall differences in safety or effectiveness were observed between these patients and younger patients.
SPL UNCLASSIFIED SECTION
LIBTAYO in Combination with Platinum-based Chemotherapy
Of the 312 patients with NSCLC who received LIBTAYO in combination with platinum-based chemotherapy in Study 16113, 35% were 65 years up to 75 years and 6% were 75 years or older. No overall differences in safety or effectiveness were observed between these patients and younger patients.
11 DESCRIPTION
Cemiplimab-rwlc is a human programmed death receptor-1 (PD-1) blocking antibody. Cemiplimab-rwlc is a recombinant human IgG4 monoclonal antibody that binds to PD-1 and blocks its interaction with PD-L1 and PD-L2. Cemiplimab-rwlc is produced by recombinant DNA technology in Chinese hamster ovary (CHO) cell suspension culture. Cemiplimab-rwlc has an approximate molecular weight of 146 kDa.
LIBTAYO (cemiplimab-rwlc) injection for intravenous use is a sterile, preservative-free, clear to slightly opalescent, colorless to pale yellow solution with a pH of 6. The solution may contain trace amounts of translucent to white particles.
Each vial contains 350 mg of cemiplimab-rwlc. Each mL contains cemiplimab-rwlc 50 mg, L-histidine (0.74 mg), L-histidine monohydrochloride monohydrate (1.1 mg), sucrose (50 mg), L-proline (15 mg), polysorbate 80 (2 mg), and Water for Injection, USP.
12 CLINICAL PHARMACOLOGY
12.1 Mechanism of Action
Binding of the PD-1 ligands PD-L1 and PD-L2 to the PD-1 receptor found on T cells inhibits T-cell proliferation and cytokine production. Upregulation of PD-1 ligands occurs in some tumors and signaling through this pathway can contribute to inhibition of active T-cell immune surveillance of tumors.
Cemiplimab-rwlc is a recombinant human immunoglobulin G4 (IgG4) monoclonal antibody that binds to PD-1 and blocks its interaction with PD-L1 and PD-L2, releasing PD-1 pathway-mediated inhibition of the immune response, including the anti-tumor immune response. In syngeneic mouse tumor models, blocking PD-1 activity resulted in decreased tumor growth.
12.2 Pharmacodynamics
Cemiplimab exposure-response relationships and the time course of pharmacodynamic response are not fully characterized.
12.3 Pharmacokinetics
Cemiplimab-rwlc pharmacokinetic data were collected in 1063 patients with various solid tumors. The pharmacokinetics of cemiplimab-rwlc were linear and dose proportional in the dose range of 1 mg/kg to 10 mg/kg LIBTAYO administered intravenously every 2 weeks.
At 350 mg every 3 weeks, the mean cemiplimab-rwlc concentrations (coefficient of variation, CV%) at steady-state ranged between a minimum concentration of 59 mg/L (47%) and a maximum concentration of 171 mg/L (27%). Steady-state exposure is achieved after 4 months of treatment.
In patients with CSCC, cemiplimab-rwlc steady-state exposure at 350 mg every 3 weeks was comparable to the exposure at 3 mg/kg every 2 weeks.
SPL UNCLASSIFIED SECTION
Distribution
The volume of distribution of cemiplimab-rwlc at steady state is 5.9 L (29%).
SPL UNCLASSIFIED SECTION
Elimination
Cemiplimab-rwlc clearance (CV%) after the first dose is 0.25 L/day (41%) and decreases over time by 11%, resulting in a steady-state clearance (CLss) (CV%) of 0.22 L/day (44%). The elimination half-life (CV%) at steady state is 22 days (42%).
SPL UNCLASSIFIED SECTION
Specific Populations
The following factors have no clinically important effect on the exposure of cemiplimab-rwlc in 1063 patients: age (27 to 96 years), sex, body weight (31 to 172 kg), cancer type, albumin level (20 to 93 g/L), renal function (creatinine clearance determined by Cockcroft-Gault 21 mL/min or greater) and hepatic function (total bilirubin greater than 1.0 times up to 3.0 times the ULN). Race [White (N=932), Asian (N=47), Black (N=21)] appears to have no clinically important effect on the exposure of cemiplimab-rwlc. LIBTAYO has not been studied in patients with severe hepatic impairment (total bilirubin greater than 3.0 times the ULN).
12.6 Immunogenicity
The observed incidence of anti-drug antibodies is highly dependent on the sensitivity and specificity of the assay. Differences in assay methods preclude meaningful comparisons of the incidence of anti-drug antibodies in the studies described below with the incidence of anti-drug antibodies in other studies, including those of cemiplimab-rwlc or of other cemiplimab products.
During the treatment period ranging from 8 to 19 months in 5 clinical studies, the incidence of anti-cemiplimab-rwlc antibodies in LIBTAYO-treated patients was 2% (22/1029).
There was no identified clinically significant effect of anti-cemiplimab-rwlc antibodies on PK of LIBTAYO over the treatment duration ranging from 8 months to 19 months. Because of the low occurrence of anti-drug antibodies, the effect of these antibodies on the pharmacodynamics, safety, and/or effectiveness of LIBTAYO is unknown.
13 NONCLINICAL TOXICOLOGY
13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility
No studies have been performed to assess the potential of cemiplimab-rwlc for carcinogenicity or genotoxicity.
In a 3-month repeat-dose toxicology study in sexually mature cynomolgus monkeys, there were no cemiplimab-rwlc-related effects on fertility parameters (menstrual cycle, semen analysis, or testicular measurements) or in male or female reproductive organs at doses up to the highest dose tested, 50 mg/kg/week (approximately 5.5 to 25.5 times the human exposure based on AUC at the clinical dose of 350 mg once every 3 weeks).
13.2 Animal Toxicology and/or Pharmacology
In animal models, inhibition of PD-L1/PD-1 signaling increased the severity of some infections and enhanced inflammatory responses. M. tuberculosis–infected PD-1 knockout mice exhibit markedly decreased survival compared with wild-type controls, which correlated with increased bacterial proliferation and inflammatory responses in these animals. PD-L1 and PD-1 knockout mice and mice receiving PD-L1 blocking antibody have also shown decreased survival following infection with lymphocytic choriomeningitis virus.
14 CLINICAL STUDIES
14.1 Cutaneous Squamous Cell Carcinoma (CSCC)
The efficacy of LIBTAYO in patients with metastatic (nodal or distant) cutaneous squamous cell carcinoma (mCSCC) or locally advanced CSCC (laCSCC) who were not candidates for curative surgery or curative radiation was evaluated in two open-label, multi-center, non-randomized, multicohort studies: Study 1423 (NCT02383212) and Study 1540 (NCT02760498). Both studies excluded patients with autoimmune disease that required systemic therapy with immunosuppressant agents within 5 years; history of solid organ transplant; prior treatment with anti–PD-1/PD-L1 blocking antibodies or other immune checkpoint inhibitor therapy; infection with HIV, hepatitis B or hepatitis C; or ECOG PS ≥ 2.
Patients received LIBTAYO 3 mg/kg intravenously every 2 weeks for up to 48 weeks in Study 1423 or up to 96 weeks (Groups 1 and 2), or 350 mg every 3 weeks for up to 54 weeks (Group 3) in Study 1540. Treatment continued until progression of disease, unacceptable toxicity, or completion of planned treatment. Tumor response assessments were performed every 8 or 9 weeks. The major efficacy outcome measures were confirmed objective response rate (ORR), defined as complete response (CR) plus partial response (PR) as assessed by independent central review (ICR), and ICR-assessed duration of response (DOR). For patients with mCSCC without externally visible target lesions, ORR was determined by Response Evaluation Criteria in Solid Tumors (RECIST 1.1). For patients with externally visible target lesions (laCSCC and mCSCC), ORR was determined by a composite endpoint that integrated ICR assessments of radiologic data (RECIST 1.1) and digital medical photography (WHO criteria).
SPL UNCLASSIFIED SECTION
Study 1540
In the efficacy analysis of 193 patients with advanced CSCC enrolled in Study 1540 who received LIBTAYO at either 3 mg/kg every 2 weeks or 350 mg every three weeks, 115 had mCSCC and 78 had laCSCC. The median age was 72 years (38 to 96 years); 83% were male; 97% were White, 2% were Asian, 1% were Black or African American, and 1% were race unknown; 45% had ECOG PS 0 and 55% had ECOG PS 1; 34% received at least one prior anti-cancer systemic therapy; 81% received prior cancer-related surgery; and 68% received prior radiotherapy. Among patients with mCSCC, 77% had distant metastases and 23% had only nodal metastases.
For the responding patients presented in Table 10 below, the median time to response was 2.1 months (range: 1.7 to 22.8 months).
Efficacy results based on the final analysis of Study 1540 are presented in Table 10.
| Confirmed Objective Response Rate (ORR) (%) | ||||
| ORR (95% CI) | 51 (37, 64) | 45 (34, 57) | 46 (33, 60) | 47 (40, 54) |
| Complete response rateOnly includes patients with complete healing of prior cutaneous involvement; laCSCC patients in Study 1540 required biopsy to confirm CR | 20 | 13 | 20 | 17 |
| Partial response rate | 31 | 32 | 27 | 30 |
| Duration of Response (DOR) | ||||
| Number of Responders | N = 30 | N = 35 | N = 26 | N = 91 |
| Median DOR in monthsBased on Kaplan-Meier estimate (Range) | NR (2.8 – 38.9) | 42 (1.9 – 54.6) | 41 (4.2 – 46.3) | 41 (1.9 – 54.6) |
| Patients with observed DOR ≥ 6 months, n (%)The numerator includes the number of patients whose observed DOR reached at least the specified times of 6 or 12 months. Patients who did not have the opportunity to reach the specified timepoint were included in the denominator only | 28 (93%) | 31 (89%) | 25 (96%) | 84 (92%) |
| Patients with observed DOR ≥ 12 months, n (%) | 23 (77%) | 24 (69%) | 23 (88%) | 70 (77%) |
SPL UNCLASSIFIED SECTION
Study 1423
Among 26 CSCC patients in Study 1423, 16 had mCSCC and 10 had laCSCC. The median age was 73 years (52 to 88 years); 81% of patients were male; 92% of patients were White; the ECOG PS was 0 (38%) and 1 (62%); 58% of patients had received at least 1 prior anti-cancer systemic therapy; 92% of patients had received prior cancer-related surgery and 81% had received prior radiotherapy. One patient in the mCSCC group was dosed at 1 mg/kg. The rest received 3 mg/kg every 2 weeks.
With a median duration of follow-up of 13.3 months, the confirmed ORR was 50% (95% CI: 30, 70); all responses were PRs. The median time to response was 1.9 months (range: 1.7 to 7.3 months) and 85% of responders had a DOR ≥ 6 months.
14.2 Basal Cell Carcinoma (BCC)
The efficacy of LIBTAYO in 138 patients with advanced basal cell carcinoma (BCC) [unresectable locally advanced (laBCC) or metastatic (nodal or distant) (mBCC)] who had progressed on hedgehog pathway inhibitor (HHI) therapy, had not had an objective response after 9 months on HHI therapy, or were intolerant of prior HHI therapy was evaluated in Study 1620 (NCT03132636), an open-label, multi-center, non-randomized study. The study excluded patients with autoimmune disease that required systemic therapy with immunosuppressant agents within 5 years; history of solid organ transplant; prior treatment with anti–PD-1/PD-L1 therapy or other immune checkpoint inhibitor therapy; infection with HIV, hepatitis B or hepatitis C; or ECOG performance score (PS) ≥ 2.
Patients received LIBTAYO 350 mg every 3 weeks for up to 93 weeks until disease progression, unacceptable toxicity, or completion of planned treatment. Tumor assessments were performed every 9 weeks for the first 45 weeks of treatment and every 12 weeks thereafter. The major efficacy outcome measures were confirmed objective response rate (ORR) and duration of response (DOR) as assessed by independent central review (ICR). For patients with mBCC without externally visible target lesions, ORR was determined by Response Evaluation Criteria in Solid Tumors (RECIST 1.1). For patients with externally visible target lesions (laBCC and mBCC), ORR was determined by a composite endpoint that integrated ICR assessments of radiologic data (RECIST 1.1) and digital medical photography (WHO criteria).
A total of 138 patients with advanced BCC were included in the efficacy analysis of Study 1620. Of these, 39% had mBCC and 61% had laBCC. In patients with laBCC, the median age was 70 years (42 to 89 years); 67% were male; 68% were White and 32% were race not reported/unknown; 61% had ECOG PS 0 and 39% had ECOG PS 1; 83% had received at least 1 prior cancer-related surgery; and 50% had received prior radiotherapy. In patients with mBCC, the median age was 63.5 years (38 to 90 years); 70% were male; 87% were White and 13% were race not reported/unknown; 67% had ECOG PS 0 and 33% had ECOG PS 1; 85% had received at least 1 prior cancer-related surgery; and 59% had received prior radiotherapy. Among patients with mBCC, 35% had distant metastases only, 9% had nodal disease only, and 54% had both distant and nodal disease.
Efficacy results are presented in Table 11. For the responding patients, the median time to response was 3.1 months (range 2 to 10.5 months) for the mBCC group and 4.3 months (range 2.1 to 21.4 months) for the laBCC group.
| Confirmed Objective Response Rate (ORR) (%) | ||
| ORR (95% CI) | 22 (12, 36) | 32 (22, 43) |
| Complete response rate | 1.9 | 7 |
| Partial response rate | 20 | 25 |
| Duration of Response | ||
| Number of Responders | N = 12 | N = 27 |
| Median DOR in monthsBased on Kaplan-Meier estimate (Range) | 16.7 (9.0 – 25.8+) | NR (2.1 – 36.8+) |
| Patients with observed DOR ≥ 6 months, n (%) | 12 (100%) | 23 (85%) |
14.3 Non-Small Cell Lung Cancer (NSCLC)
SPL UNCLASSIFIED SECTION
First-line treatment of NSCLC with LIBTAYO in combination with platinum-based chemotherapy
The efficacy of LIBTAYO in combination with platinum-based chemotherapy was evaluated in Study 16113 (NCT03409614), a randomized, multi-center, double-blind, active-controlled trial in 466 patients with locally advanced NSCLC who were not candidates for surgical resection or definitive chemoradiation or with metastatic NSCLC who had not previously received systemic treatment for metastatic NSCLC. Patients were eligible regardless of tumor PD-L1 expression status.
Patients with EGFR, ALK or ROS1 genomic tumor aberrations; a medical condition that required systemic immunosuppression; or ongoing or recent autoimmune disease that required systemic therapy were ineligible. Patients with a history of brain metastases were eligible if they had been adequately treated and had neurologically returned to baseline for at least 2 weeks prior to randomization.
Randomization was stratified by histology (non-squamous vs squamous) and PD-L1 expression (<1% versus 1% to 49% versus ≥ 50%) according to the VENTANA PD-L1 (SP263) assay. Patients were randomized (2:1) to receive either:
Platinum-based chemotherapy in either arm consisted of carboplatin AUC of 5 or 6 and paclitaxel 200 mg/m2; cisplatin 75 mg/m2 and paclitaxel 200 mg/m2; carboplatin AUC of 5 or 6 and pemetrexed 500 mg/m2; or cisplatin 75 mg/m2 and pemetrexed 500 mg/m2. Maintenance pemetrexed was mandatory for patients with non-squamous NSCLC who received a pemetrexed-containing chemotherapy regimen in the first 4 treatment cycles.
Study treatment continued until RECIST 1.1-defined progressive disease, unacceptable toxicity, or 108 weeks. Assessment of tumor status was performed every 9 weeks during year 1 and every 12 weeks after year 1. The major efficacy outcome measure was overall survival (OS). Additional efficacy outcome measures were progression-free survival (PFS) and overall response rate (ORR) as assessed by blinded independent central review (BICR).
The study population characteristics were: median age of 63 years (range: 25 to 84), 40% age 65 or older; 84% male; 87% White, 13% Asian. Fifteen percent had Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) 0 and 84% had ECOG PS 1; 85% had metastatic disease and 15% had stage IIIB or IIIC disease and were not candidates for surgical resection or definitive chemoradiation per investigator assessment; 57% had non-squamous and 43% had squamous histology; and 7% had history of treated brain metastases at baseline.
The trial demonstrated a statistically significant improvement in OS for patients randomized to LIBTAYO in combination with chemotherapy compared with placebo in combination with chemotherapy.
Efficacy results are presented in Table 12 and Figure 1.
Figure 1: Kaplan-Meier Curves for OS from Study 16113
| Overall Survival | ||
| Deaths, n (%) | 132 (42) | 82 (53) |
| Median in months (95% CI)Based on Kaplan-Meier method | 21.9 (15.5, NE) | 13.0 (11.9, 16.1) |
| Hazard ratio (95% CI)Based on stratified proportional hazards model | 0.71 (0.53, 0.93) | |
| p-valueBased on a two-sided p-value | 0.0140 | |
| Progression-free Survival per BICR | ||
| Events, n (%) | 204 (65) | 122 (79) |
| Median in months (95% CI) | 8.2 (6.4, 9.3) | 5.0 (4.3, 6.2) |
| Hazard ratio (95% CI) | 0.56 (0.44, 0.70) | |
| p-value | <0.0001 | |
| Overall Response Rate per BICR (%) | ||
| ORR (95% CI)Clopper-Pearson exact confidence interval | 43 (38, 49) | 23 (16, 30) |
| Complete response (CR) rate | 2.6 | 0 |
| Partial response (PR) rate | 41 | 23 |
| p-value | <0.0001 | |
| Duration of Response per BICR | ||
| Median in months (range) | 15.6 (1.7, 18.7+) | 7.3 (1.8, 18.8+) |
- LIBTAYO 350 mg intravenously (IV) every 3 weeks for 108 weeks plus platinum-based chemotherapy every 3 weeks for 4 cycles, or
- placebo IV every 3 weeks for 108 weeks plus platinum-based chemotherapy every 3 weeks for 4 cycles.
SPL UNCLASSIFIED SECTION
First-line treatment of NSCLC with LIBTAYO as a single agent
The efficacy of LIBTAYO was evaluated in Study 1624 (NCT03088540), a randomized, multi-center, open-label, active-controlled trial in 710 patients with locally advanced NSCLC who were not candidates for surgical resection or definitive chemoradiation, or with metastatic NSCLC.
Only patients whose tumors had high PD-L1 expression [Tumor Proportion Score (TPS) ≥ 50%] as determined by an immunohistochemistry assay using the PD-L1 IHC 22C3 pharmDx kit and who had not received prior systemic treatment for metastatic NSCLC were eligible.
Patients with EGFR, ALK or ROS1 genomic tumor aberrations; a medical condition that required systemic immunosuppression; autoimmune disease that required systemic therapy within 2 years of treatment; or who had never smoked were ineligible. Patients with a history of brain metastases were eligible if they had been adequately treated and had neurologically returned to baseline for at least 2 weeks prior to randomization.
Randomization was stratified by histology (non-squamous vs squamous) and geographic region (Europe vs Asia vs Rest of world). Patients were randomized (1:1) to receive LIBTAYO 350 mg intravenously (IV) every 3 weeks for up to 108 weeks or a platinum-doublet chemotherapy regimen for 4 to 6 cycles followed by optional pemetrexed maintenance for patients with non-squamous histology who received a pemetrexed containing regimen.
Treatment with LIBTAYO continued until RECIST 1.1-defined progressive disease, unacceptable toxicity, or up to 108 weeks. Patients who experienced IRC-assessed RECIST 1.1-defined progressive disease on LIBTAYO therapy were permitted to continue treatment with LIBTAYO (up to an additional 108 weeks) with the addition of 4 cycles of histology-specific chemotherapy until further progression was observed. Of the 203 patients randomized to receive chemotherapy who had IRC-assessed RECIST 1.1- defined disease progression, 150 (74%) patients crossed over to treatment with LIBTAYO. Assessment of tumor status was performed every 9 weeks. The major efficacy outcome measures were overall survival (OS) and progression-free survival (PFS). An additional efficacy outcome measure was overall response rate (ORR).
The study population characteristics were: median age of 63 years (range: 31 to 84), 45% age 65 or older; 85% male; 86% White, 11% Asian, and 0.6% Black. Nine percent were Hispanic or Latino. Twenty-seven percent had ECOG PS 0 and 73% had ECOG PS 1; 84% had metastatic disease and 16% had stage IIIB or IIIC disease and were not candidates for surgical resection or definitive chemoradiation per investigator assessment; 56% had non-squamous and 44% had squamous histology; and 12% had history of treated brain metastases at baseline.
The trial demonstrated a statistically significant improvement in OS and PFS for patients randomized to LIBTAYO as compared with chemotherapy.
Efficacy results are presented in Table 13 and Figure 2.
Figure 2: Kaplan-Meier Curve for OS from Study 1624
| Overall Survival | ||
| Number of deaths (%) | 108 (30) | 141 (40) |
| Median in months (95% CI)Based on Kaplan-Meier method | 22.1 (17.7, NE) | 14.3 (11.7, 19.2) |
| Hazard ratio (95% CI)Based on stratified proportional hazards model | 0.68 (0.53, 0.87) | |
| p-value | 0.0022 | |
| Progression-free Survival per BICR | ||
| Number of events (%) | 201 (57) | 262 (74) |
| Median in months (95% CI) | 6.2 (4.5, 8.3) | 5.6 (4.5, 6.1) |
| Hazard ratio (95% CI) | 0.59 (0.49, 0.72) | |
| p-value | <0.0001 | |
| Overall Response Rate per BICR (%)Clopper-Pearson exact confidence interval | ||
| ORR (95% CI) | 37 (32, 42) | 21 (17, 25) |
| Complete response (CR) rate | 3 | 1 |
| Partial response (PR) rate | 33 | 20 |
| Duration of Response per BICR | ||
| Median in months (range) | 21.0 (1.9+, 23.3+) | 6.0 (1.3+, 16.5+) |
16 HOW SUPPLIED/STORAGE AND HANDLING
SPL UNCLASSIFIED SECTION
LIBTAYO (cemiplimab-rwlc) injection is a clear to slightly opalescent, colorless to pale yellow solution that may contain trace amounts of translucent to white particles. It is supplied in a carton containing 1 single-dose vial of:
- 350 mg/7 mL (50 mg/mL) (NDC 61755-008-01)
STORAGE AND HANDLING SECTION
Store in a refrigerator at 2°C to 8°C (36°F to 46°F) in the original carton. Protect from light. Do not freeze or shake.
17 PATIENT COUNSELING INFORMATION
Advise the patient to read the FDA-approved patient labeling (Medication Guide).
SPL UNCLASSIFIED SECTION
Immune-Mediated Adverse Reactions
SPL UNCLASSIFIED SECTION
Advise patients that LIBTAYO can cause immune-mediated adverse reactions including the following [see Warnings and Precautions (5.1)]:
- Pneumonitis: Advise patients to contact their healthcare provider immediately for signs or symptoms of pneumonitis, including new or worsening symptoms of cough, chest pain, or shortness of breath.
- Colitis: Advise patients to contact their healthcare provider immediately for signs or symptoms of colitis, including diarrhea, blood or mucus in stools, or severe abdominal pain.
- Hepatitis: Advise patients to contact their healthcare provider immediately for signs or symptoms of hepatitis.
- Endocrinopathies: Advise patients to contact their healthcare provider immediately for signs or symptoms of hypothyroidism, hyperthyroidism, adrenal insufficiency, hypophysitis, or type 1 diabetes mellitus.
- Nephritis: Advise patients to contact their healthcare provider immediately for signs or symptoms of nephritis.
- Dermatologic Adverse Reactions: Advise patients to contact their healthcare provider immediately if they develop a new rash.
SPL UNCLASSIFIED SECTION
Infusion-Related Reactions
Advise patients to contact their healthcare provider immediately for signs or symptoms of infusion-related reactions [see Warnings and Precautions (5.2)].
SPL UNCLASSIFIED SECTION
Complications of Allogeneic HSCT or Solid Organ Transplant Rejection
Advise patients to contact their healthcare provider immediately if they develop signs or symptoms of post-allogeneic HSCT complications or of solid organ transplant rejection [see Warnings and Precautions (5.1, 5.3)].
SPL UNCLASSIFIED SECTION
Embryo-Fetal Toxicity
Advise females of reproductive potential that LIBTAYO can cause harm to a fetus and to inform their healthcare provider of a known or suspected pregnancy [see Warnings and Precautions (5.4) and Use in Specific Populations (8.1, 8.3)].
Advise females of reproductive potential to use effective contraception during treatment and for at least 4 months after the last dose of LIBTAYO [see Use in Specific Populations (8.3)].
SPL UNCLASSIFIED SECTION
Lactation
Advise female patients not to breastfeed while taking LIBTAYO and for at least 4 months after the last dose [see Use in Specific Populations (8.2)].
SPL UNCLASSIFIED SECTION
Manufactured by: Regeneron Pharmaceuticals, Inc. 777 Old Saw Mill River Road Tarrytown, NY 10591-6707 U.S. License No. 1760
Marketed by: Regeneron Pharmaceuticals, Inc. (Tarrytown, NY 10591) ©2024 Regeneron Pharmaceuticals, Inc. All rights reserved.
SPL MEDGUIDE SECTION
| MEDICATION GUIDELIBTAYO® (Lib-TIE-oh) (cemiplimab-rwlc) injection | ||||
| What is the most important information I should know about LIBTAYO? | ||||
| LIBTAYO is a medicine that may treat certain types of cancers by working with your immune system. LIBTAYO can cause your immune system to attack normal organs and tissues in any area of your body and can affect the way they work. These problems can sometimes become severe or life threatening and can lead to death. You can have more than one of these problems at the same time. These problems may happen anytime during treatment or even after your treatment has ended. | ||||
| Call or see your healthcare provider right away if you develop any new or worsening signs or symptoms, including: | ||||
| Lung problems. | ||||
| cough | shortness of breath | chest pain | ||
| Intestinal problems.diarrhea (loose stools) or more frequent bowel movements than usualstools that are black, tarry, sticky, or have blood or mucussevere stomach-area (abdomen) pain or tenderness | ||||
| Liver problems. | ||||
| yellowing of your skin or the whites of your eyessevere nausea or vomitingpain on the right side of your stomach-area (abdomen) | dark urine (tea colored)bleeding or bruising more easily than normal | |||
| Hormone gland problems. | ||||
| headache that will not go away or unusual headacheseye sensitivity to lighteye problemsrapid heartbeatincreased sweatingextreme tirednessweight gain or weight lossfeeling more hungry or thirsty than usual | urinating more often than usualhair lossfeeling coldconstipationyour voice gets deeperdizziness or faintingchanges in mood or behavior, such as decreased sex drive, irritability, or forgetfulness | |||
| Kidney problems. | ||||
| decrease in your amount of urineblood in your urine | swelling of your anklesloss of appetite | |||
| Skin problems. | ||||
| rashitchingskin blistering or peeling | painful sores or ulcers in mouth or nose, throat, or genital areafever or flu-like symptomsswollen lymph nodes | |||
| Problems can also happen in other organs and tissues. These are not all of the signs and symptoms of immune system problems that can happen with LIBTAYO. Call or see your healthcare provider right away for any new or worsening signs or symptoms which may include:chest pain, irregular heartbeat, shortness of breath or swelling of anklesconfusion, sleepiness, memory problems, changes in mood or behavior, stiff neck, balance problems, tingling or numbness of the arms or legsdouble vision, blurry vision, sensitivity to light, eye pain, changes in eyesightpersistent or severe muscle pain or weakness, muscle crampslow red blood cells, bruising | ||||
| Infusion reactions that can sometimes be severe or life-threatening. Signs and symptoms of infusion reactions may include: | ||||
| nauseavomitingchills or shakingitching or rashflushingshortness of breath or wheezing | dizzinessfeel like passing outfeverback or neck painfacial swelling | |||
| Rejection of a transplanted organ. Your healthcare provider should tell you what signs and symptoms you should report and monitor you, depending on the type of organ transplant that you have had. | ||||
| Complications, including graft-versus-host disease (GVHD), in people who have received a bone marrow (stem cell) transplant that uses donor stem cells (allogeneic). These complications can be serious and can lead to death. These complications may happen if you underwent transplantation either before or after being treated with LIBTAYO. Your healthcare provider will monitor you for these complications. | ||||
| Getting medical treatment right away may help keep these problems from becoming more serious. Your healthcare provider will check you for these problems during your treatment with LIBTAYO. Your healthcare provider may treat you with corticosteroid or hormone replacement medicines. Your healthcare provider may also need to delay or completely stop treatment with LIBTAYO if you have severe side effects. | ||||
| What is LIBTAYO? | ||||
| LIBTAYO is a prescription medicine used to treat:people with a type of skin cancer called cutaneous squamous cell carcinoma (CSCC). LIBTAYO may be used to treat CSCC that has spread or cannot be cured by surgery or radiation.people with a type of skin cancer called basal cell carcinoma (BCC).LIBTAYO may be used when your BCC cannot be removed by surgery (locally advanced BCC) or when it has spread (metastatic BCC), andyou have previously received treatment with a hedgehog pathway inhibitor (HHI), oryou cannot receive treatment with a HHI.adults with a type of lung cancer called non-small cell lung cancer (NSCLC).LIBTAYO may be used in combination with chemotherapy that contains a platinum medicine as your first treatment when your lung cancer:has not spread outside your chest (locally advanced lung cancer) and you cannot have surgery or chemotherapy with radiation, oryour lung cancer has spread to other areas of your body (metastatic lung cancer), andyour tumor does not have an abnormal "EGFR", "ALK" or "ROS1" geneLIBTAYO may be used alone as your first treatment when your lung cancer:has not spread outside your chest (locally advanced lung cancer) and you cannot have surgery or chemotherapy with radiation, oryour lung cancer has spread to other areas of your body (metastatic lung cancer), andyour tumor tests positive for high "PD-L1" andyour tumor does not have an abnormal "EGFR", "ALK" or "ROS1" gene | ||||
| It is not known if LIBTAYO is safe and effective in children. | ||||
| Before you receive LIBTAYO, tell your healthcare provider about all your medical conditions, including if you:have immune system problems such as Crohn's disease, ulcerative colitis, or lupushave received an organ transplanthave received or plan to receive a stem cell transplant that uses donor stem cells (allogeneic)have received radiation treatment to your chest areahave a condition that affects your nervous system, such as myasthenia gravis or Guillain-Barré syndromeare pregnant or plan to become pregnant. LIBTAYO can harm your unborn baby.Females who are able to become pregnant:Your healthcare provider will give you a pregnancy test before you start treatment with LIBTAYO.You should use an effective method of birth control during your treatment and for at least 4 months after the last dose of LIBTAYO. Talk to your healthcare provider about birth control methods that you can use during this time.Tell your healthcare provider right away if you become pregnant or think you may be pregnant during treatment with LIBTAYO.are breastfeeding or plan to breastfeed. It is not known if LIBTAYO passes into your breast milk. Do not breastfeed during treatment and for at least 4 months after the last dose of LIBTAYO. | ||||
| Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. | ||||
| How will I receive LIBTAYO?Your healthcare provider will give you LIBTAYO into your vein through an intravenous (IV) line over 30 minutes.LIBTAYO is usually given every 3 weeks.Your healthcare provider will decide how many treatments you will need.Your healthcare provider will do blood tests to check you for side effects. | ||||
| If you miss any appointments, call your healthcare provider as soon as possible to reschedule your appointment. | ||||
| What are the possible side effects of LIBTAYO? | ||||
| LIBTAYO can cause serious side effects.See "What is the most important information I should know about LIBTAYO?" | ||||
| The most common side effects of LIBTAYO when used alone include: | ||||
| tirednessmuscle or bone painrash | diarrhealow levels of red blood cells (anemia) | |||
| The most common side effects of LIBTAYO when used in combination with platinum-containing chemotherapy include: | ||||
| hair lossmuscle or bone painnausea | tirednessnumbness, pain, tingling or burning in your hands or feetdecreased appetite | |||
| These are not all the possible side effects of LIBTAYO. | ||||
| Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. | ||||
| General information about the safe and effective use of LIBTAYO. | ||||
| Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. You can ask your pharmacist or healthcare provider for information about LIBTAYO that is written for health professionals. | ||||
| What are the ingredients of LIBTAYO? | ||||
| Active ingredient: cemiplimab-rwlc | ||||
| Inactive ingredients: L-histidine, L-histidine monohydrochloride monohydrate, sucrose, L-proline, Polysorbate 80, and Water for Injection. | ||||
| Manufactured by: Regeneron Pharmaceuticals, Inc. 777 Old Saw Mill River Road Tarrytown, NY 10591-6707 U.S. License No. 1760 Marketed by: Regeneron Pharmaceuticals, Inc. (Tarrytown, NY 10591) For more information, call 1-877-542-8296 ©2023 Regeneron Pharmaceuticals, Inc. All rights reserved. | ||||