Classification: kinase inhibitor
About: Brigatinib (Alunbrig™)
A kinase is an enzyme that promotes cell growth. There are many types of kinases, which control different phases of cell growth. By blocking a particular enzyme from working, this medication can slow the growth of cancer cells.
Brigatinib works by targeting and blocking receptors found on the cancer cells called an anaplastic lymphoma kinase (ALK). In some cancers, this receptor is overactive, causing cells to grow and divide too fast. By inhibiting ALK, this medication can slow or stop cell growth of cancer cells tumor growth. Your oncology team will test your tumor for this abnormality, which must be present in order to receive the medication.
How to Take Brigatinib
Brigatinib is taken by mouth, in tablet form, taken once daily. It can be taken either with or without food. Tablets should be swallowed whole; do not break, crush or chew the tablets. If you miss a dose or vomit soon after taking your dose do not take a second dose. Rather, take your next dose at its scheduled time.
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, you will restart by taking 90mg for 7 days, and then increasing your dose to 180mg.
The tablets are 30 mg each, meaning you will need to take a number of tablets to achieve the full dose. It is important to make sure you are taking the correct amount of medication every time. Before every dose, check that what you are taking matches what you have been prescribed.
The blood levels of this medication can be affected by certain foods and medications, so they should be avoided. Some of these include: grapefruit, grapefruit juice, ketoconazole, rifampin, phenytoin, St. John’s wort, and hormonal birth control. Be sure to tell your healthcare provider about all medications and supplements you take.
Storage and Handling
Store your medication in the original, labeled container at room temperature and in a dry location (unless otherwise directed by your healthcare provider or pharmacist). This medication should not be stored in a pillbox. Keep containers out of reach of children and pets.
If a caregiver prepares your dose for you, they should consider wearing gloves or pour the pills directly from their container into the cap, a small cup, or directly into your hand. They should avoid touching the pills. They should always wash their hands before and after giving you the medication. Pregnant or nursing women should not prepare the dose for you. Ask your oncology team where to return any unused medication for disposal. Do not flush down the toilet or throw in the trash.
Where do I get this medication?
Certain cancer medications are only available through specialty pharmacies. If you need to get this medication through a specialty pharmacy, your provider will help you start this process. Where you can fill your prescriptions may also be influenced by your prescription drug coverage. Ask your health care provider or pharmacist for assistance in identifying where you can get this medication.
This medication may be covered under your prescription drug plan. Patient assistance may be available to qualifying individuals depending upon prescription drug coverage. Co-pay cards, which reduce the patient co-pay responsibility for eligible commercially (non-government sponsored) insured patients, may also be available. Your care team can help you find these resources, if they are available.
Possible Side Effects of Brigatinib
There are a number of things you can do to manage the side effects brigatinib. Talk to your care team about these recommendations. They can help you decide what will work best for you. These are some of the most common or important side effects.
Nausea and/or Vomiting
Talk to your oncology care team so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try saltines, or ginger ale to lessen symptoms.
Call your oncology care team if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.
Fatigue 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.
Decrease in Appetite
Nutrition is an important part of your care. Cancer treatment can affect your appetite and, in some cases, the side effects of treatment can make eating difficult. Ask your oncology care team about nutritional counseling services at your treatment center to help with food choices.
- Try to eat five or six small meals or snacks throughout the day, instead of 3 larger meals.
- If you are not eating enough, nutritional supplements may help.
- You may experience a metallic taste or find that food has no taste at all. You may dislike foods or beverages that you liked before receiving cancer treatment. These symptoms can last for several months or longer after treatment ends.
- Avoid any food that you think smells or tastes bad. If red meat is a problem, eat chicken, turkey, eggs, dairy products and fish without a strong smell. Sometimes cold food has less of an odor.
- Add extra flavor to meat or fish by marinating it in sweet juices, sweet and sour sauce or dressings. Use seasonings like basil, oregano or rosemary to add flavor. Bacon, ham and onion can add flavor to vegetables.
Your oncology care team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice, products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration.
High Blood Sugar
This medication can cause elevated blood sugar levels in patients with and without diabetes. Your healthcare team will monitor your blood sugar. If you develop increased thirst, urination or hunger, blurry vision, headaches or your breath smells like fruit, notify your healthcare team. Diabetics should monitor their blood sugar closely and report elevations to the healthcare team.
Less common, but important side effects can include:
- Interstitial Lung Disease/Pneumonitis: Patients can develop interstitial lung disease (scarring of the lung tissue) or pneumonitis (inflammation of the lungs) while taking this medication, especially during the first week. Notify your healthcare provider right away if you develop any new or worsening symptoms, including trouble breathing or shortness of breath, chest pain, cough or fever.
- High Blood Pressure: This medication can cause high blood pressure (hypertension). Patients should have their blood pressure checked after 2 weeks of therapy, and then monthly while receiving this medication. Any hypertension should be treated. If hypertension cannot be controlled, brigatinib may be stopped. Report any headache, dizziness, blurred vision or chest pain to your provide
- Bradycardia: This medication can cause slower than normal heart rate, which is called bradycardia. Notify your healthcare provider right away if you feel abnormal heartbeats or if you feel dizzy, light headed or faint.
- Visual Changes: This medication can cause changes in vision including blurred vision, double vision, light hurting your eyes, seeing flashes of light and worsening vision. If you experience changes in vision contact your care provider.
- Elevated Creatine Phosphokinase: This medication can lead to an elevated level of the enzyme creatine phosphokinase (CPK) in your blood. This level will be checked during treatment with blood tests. If you start to experience muscle pain, tenderness, or weakness, notify your health care provider as these can be signs of elevated CPK.
- Pancreatitic Enzyme Elevations: This medication can cause inflammation of the pancreas, which can cause upper abdominal pain that can radiate to the back that is worse with eating. You may also experience weight loss or nausea. You will have lab work drawn to monitor for pancreatitis. If you experience any of these side effects you should notify your health care provider.
Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Non-hormonal contraception should be used by women during treatment and for at least 4 months after the last dose. Males with female partners of reproductive potential should use contraception during treatment and for 3 months after the last dose. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. You should not breastfeed while taking this medication and not for one week after your last dose.