Rolvedon® (eflapegrastim-xnst)

How to Take Eflapegrastim-xnst

Eflapegrastim-xnst is given as a subcutaneous injection (SQ) under the skin. It is typically given as a single dose for each chemotherapy cycle, no sooner than 24 hours after the last dose of chemotherapy, and no more than 14 days before beginning the next chemotherapy cycle. To lessen the sting of the injection, it should be taken out of the refrigerator 30 minutes ahead of time.

Storage and Handling

 This medication should be stored in the refrigerator and in the original carton to protect it from light. To lessen the sting of the injection, it should be taken out of the refrigerator 30 minutes prior to being injected.

 Do not reuse single-dose vials, syringes, or needles. Do not throw the vials, syringes, or needles in the household trash. Dispose of all used needles and syringes in a puncture-proof disposable container with a lid. The FDA provides further information about the disposal of vials, syringes and needles. 

Where do I get this medication?

Depending on your insurance coverage, this medication may be given in your doctor’s office, provided through home infusion, or a specialty pharmacy. Your oncology team will work with your major medical and prescription drug plans to identify where you should receive this medication.

Insurance Information

This medication may be covered under your major medical plan or prescription drug plan. Patient assistance may be available to qualifying individuals without prescription drug coverage. Co-pay cards, which reduce your 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 Eflapegrastim-xnst

There are many things you can do to manage the side effects of eflapegrastim-xnst. 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:

Bone Pain

This medication stimulates the bone marrow to produce many white blood cells, which can lead to pain in the bones. This pain is often felt in the bones or muscles of the thighs, hips, and upper arms. Your healthcare team may not want you to take acetaminophen (Tylenol®) because it can "mask" a fever, so talk to them about what pain relievers you can take. Anti-histamines like loratidine (Claritin) may help lessen bone pain. Ask your provider or pharmacist if you should take this or any other medications to help manage this side effect.

Joint or Muscle Pain

Patients may experience joint or muscle pain. Arthralgia pain is like arthritis pain. You can have morning stiffness, and you may feel it in a few joints at different times. It often affects the elbows, shoulders, wrists, knees, feet, pelvic and hip bones, or back. Myalgia is pain or aching in the muscle. Your oncology team can recommend medication and other strategies to relieve pain.

Irritation or Burning at the Injection Site

Some people experience redness, swelling, or itching at the site of injection. This is usually temporary. The injection is known to sting or burn if given when it is cold. Take the medication out of the refrigerator 30 minutes ahead of time to allow it to come up to room temperature before administration.

Diarrhea

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 of non-alcoholic, un-caffeinated fluid a day to prevent dehydration.

Headache

Your healthcare provider can recommend medications and other strategies to help relieve pain.

Important but Less Common Side Effects

•  Allergic Reactions: In some cases, patients can have an allergic reaction to this medication. Signs of a reaction can include: shortness of breath or difficulty breathing, wheezing, rash, flushing, swelling around the mouth or eyes, fast pulse, or sweating. If you notice any changes in how you feel after the injection, let your nurse know immediately.
• Spleen Rupture: Filgrastim can cause your spleen to become enlarged and rupture. If you experience pain in the left upper stomach / abdominal area or left shoulder, contact your healthcare team or go to the emergency room immediately.
• Acute Respiratory Distress Syndrome (ARDS)/Alveolar Hemorrhage: This medication can cause a serious lung problem called acute respiratory distress syndrome. If you experience shortness of breath, fever, breathing trouble, or a fast rate of breathing, contact your healthcare team or go to the emergency room. The medication can also cause bleeding in the lungs. Go to your nearest emergency room if you start to cough up blood.
• Sickle Cell Crisis: In patients with sickle cell anemia, filgrastim can cause a sickle cell crisis. Contact your healthcare team immediately if you have symptoms of a sickle cell crisis, including pain and trouble breathing.
• Capillary Leak Syndrome: Capillary leak syndrome is a condition in which blood and components of blood leak out of vessels and into body cavities and muscles. The movement of this fluid out of the vessels can cause hypotension (low blood pressure) and organ failure. Signs and symptoms of capillary leak syndrome include: a sudden drop in blood pressure, weakness, fatigue, sudden swelling of the arms, legs, or other parts of the body, nausea, and lightheadedness. If you are having any of these symptoms, notify your healthcare provider immediately.
• Kidney Problems: This medication can cause kidney problems, which your oncology care team may monitor for using blood tests. Notify your healthcare provider if you notice decreased urine output, dark colored urine, blood in the urine, swelling in the ankles or face, or loss of appetite.
• Aortitis: This medication can cause an inflammation of your aorta (the largest artery in your body), which can occur as early as the first week of starting treatment with filgrastim. Signs of aortitis include fever, abdominal pain, fatigue, and back pain. Be sure to call your provider right away if you are experiencing any of these symptoms.
• Secondary Cancer: A secondary cancer develops as a result of cancer treatment for another cancer. This is quite rare, but you should be aware of the risk. People who have received this medication along with chemotherapy and/or radiation to treat breast or lung cancer may have an increased risk of developing MDS or AML. This can occur years after treatment. Your provider will monitor your labs closely. Consider having a complete blood count with differential checked annually by your healthcare provider.

Reproductive Concerns

 It is not known if 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. Effective birth control is necessary during treatment. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. You should consult with your healthcare team before breastfeeding while receiving this medication.