Classification: kinase inhibitor
About Brigatinib (Alunbrig™)
Brigatinib is a type of targeted therapy called a kinase inhibitor. This medication works by targeting and blocking receptors found on the cancer cells, which in turn blocks tumor growth. This medication acts specifically on tumors that have an abnormality in a gene called ALK (anaplastic lymphoma kinase).
How to Take Brigatinib
Brigatinib comes in tablet form, which is taken by mouth either with or without food. Tablets should be swallowed whole; do not break, crush or chew the tablets. If you miss a dose or vomit soon after taking your dose do not take a second dose. Rather, take your next dose at its scheduled time.
Typically, you will start with 90mg per day, for the first 7 days. If you do not have problems with this dose, you will increase the dose to 180mg per day. Your dose may be decreased or stopped if you are having side effects. If you stop taking brigatinib for 14 days or longer for a reason other than side effects, you will restart by taking 90mg for 7 days, and then increasing your dose to 180mg.
The blood levels of this medication can be affected by certain foods and medications, so they should be avoided. Some of these include: grapefruit, grapefruit juice, ketoconazole, rifampin, phenytoin, St. John’s wort, and hormonal birth control. Be sure to tell your healthcare provider about all medications and supplements you take.
Storage and Handling
Store this medication at room temperature in the original container. If you prefer to use a pillbox, discuss this with your oncology pharmacist. Ask your oncology team where to return any unused medication for disposal. Do not flush down the toilet or throw in the trash.
Where do I get this medication?
Certain cancer medications are only available through specialty pharmacies. If you need to get this medication through a specialty pharmacy, your provider will help you start this process. Where you can fill your prescriptions may also be influenced by your pharmaceutical insurance coverage. Ask your health care provider or pharmacist for assistance in identifying where you can get this medication.
This medication may be covered under your prescription drug plan. Patient assistance may be available to qualifying individuals without prescription drug coverage. Co-pay cards, which reduce the patient co-pay responsibility for eligible commercially (non-government sponsored) insured patients, may also be available. Your care team can help you find these resources, if they are available.
Possible Side Effects of Brigatinib
There are a number of things you can do to manage the side effects brigatinib. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects.
Interstitial Lung Disease/Pneumonitis
Patients can develop interstitial lung disease (scarring of the lung tissue) or pneumonitis (inflammation of the lungs) while taking this medication, especially during the first week. Notify your healthcare provider right away if you develop any new or worsening symptoms, including trouble breathing or shortness of breath, chest pain, cough or fever.
High Blood Pressure
This medication can cause high blood pressure (hypertension). Patients should have their blood pressure checked after 2 weeks of therapy, and then monthly while receiving this medication. Any hypertension should be treated. If hypertension cannot be controlled, brigatinib may be stopped. Report any headache, dizziness, blurred vision or chest pain to your provider.
This medication can cause slower than normal heart rate, which is called bradycardia. Notify your healthcare provider right away if you feel abnormal heartbeats or if you feel dizzy, light headed or faint.
Changes in Vision
This medication can cause changes in vision including blurred vision, double vision, light hurting your eyes, seeing flashes of light and worsening vision. If you experience changes in vision contact your care provider.
High Blood Sugar
This medication can cause elevated blood sugar levels in patients with and without diabetes. Your healthcare team will monitor your blood sugar. If you develop increased thirst, urination or hunger, blurry vision, headaches or your breath smells like fruit, notify your healthcare team. Diabetics should monitor their blood sugar closely and report elevations to the healthcare team.
Elevated Creatine Phosphokinase
This medication can lead to an elevated level of the enzyme creatine phosphokinase (CPK) in your blood. This level will be checked during treatment with blood tests. If you start to experience muscle pain, tenderness, or weakness, notify your health care provider as these can be signs of elevated CPK.
This medication can cause inflammation of the pancreas, which can cause upper abdominal pain that can radiate to the back that is worse with eating, weight loss, or nausea. You will have lab work drawn to monitor for pancreatitis. If you experience any of these side effects you should notify your health care provider.
Nausea and/or Vomiting
Talk to your doctor or nurse so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms.
Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.
Your oncology team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice, products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration.
Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team for helpful tips on dealing with this side effect.
Your doctor or nurse can recommend medication and other strategies to relieve pain.
This medication can cause a cough. Speak to your provider regarding strategies to relieve this cough. Do not start any medication for cough without first speaking to your provider.
Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Non-hormonal contraception should be used by women during treatment and for at least 4 months after the last dose. Men should use contraception during treatment and for 3 months after the last dose. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. You should not breastfeed while receiving this medication and for one week after.