HIGHLIGHTS OF PRESCRIBING INFORMATION
These highlights do not include all the information needed to use
ALECENSA safely and effectively. See full prescribing information for
ALECENSA.
ALECENSA® (alectinib) capsules, for oral use
Initial U.S. Approval: 2015
--------------------------- INDICATIONS AND USAGE---------------------------­
ALECENSA is a kinase inhibitor indicated for the treatment of patients with
anaplastic lymphoma kinase (ALK)-positive, metastatic non-small cell lung
cancer (NSCLC) who have progressed on or are intolerant to crizotinib. This
indication is approved under accelerated approval based on tumor response
rate and duration of response. Continued approval for this indication may be
contingent upon verification and description of clinical benefit in
confirmatory trials. (1)

•  Interstitial Lung Disease (ILD)/Pneumonitis: Occurred in 0.4% of patients.
Immediately withhold ALECENSA in patients diagnosed with
ILD/pneumonitis and permanently discontinue if no other potential causes
of ILD/pneumonitis have been identified. (2.2, 5.2)
•  Bradycardia: Monitor heart rate and blood pressure regularly. If
symptomatic, withhold ALECENSA then reduce dose, or permanently
discontinue. (2.2, 5.3)
•  Severe Myalgia and Creatine Phosphokinase (CPK) Elevation: Occurred in
1.2% and 4.6% of patients, respectively. Assess CPK every 2 weeks during
the first month of treatment and in patients reporting unexplained muscle
pain, tenderness, or weakness. In case of severe CPK elevations, withhold,
then resume or reduce dose. (2.2, 5.4)
•  Embryo-Fetal Toxicity: ALECENSA can cause fetal harm. Advise females
of reproductive potential of the potential risk to a fetus and to use effective
contraception. (5.5, 8.1 8.3)

-----------------------DOSAGE AND ADMINISTRATION ----------------------­
600 mg orally twice daily. Administer ALECENSA with food. (2.1)

------------------------------ ADVERSE REACTIONS -----------------------------­
The most common adverse reactions (incidence ≥20%) were fatigue,
constipation, edema and myalgia. (6)

--------------------- DOSAGE FORMS AND STRENGTHS---------------------­
Capsules: 150 mg (3)

To report SUSPECTED ADVERSE REACTIONS, contact Genentech at
1-888-835-2555 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

------------------------------ CONTRAINDICATIONS -----------------------------­
None. (4)

------------------------USE IN SPECIAL POPULATIONS -----------------------­
Lactation: Do not breastfeed. (8.2)

----------------------- WARNINGS AND PRECAUTIONS-----------------------­
•  Hepatotoxicity: Monitor liver laboratory tests every 2 weeks during the
first 2 months of treatment, and then periodically during treatment. In case
of severe ALT, AST, or bilirubin elevations, withhold, then reduce dose, or
permanently discontinue ALECENSA. (2.2, 5.1)

See 17 for PATIENT COUNSELING INFORMATION and FDAapproved patient labeling.
Revised: 12/2015

FULL PRESCRIBING INFORMATION: CONTENTS*
1
2

3
4
5

6
7
8

INDICATIONS AND USAGE
DOSAGE AND ADMINISTRATION
2.1 Dosing and Administration
2.2 Dose Modifications for Adverse Reactions
DOSAGE FORMS AND STRENGTHS
CONTRAINDICATIONS
WARNINGS AND PRECAUTIONS
5.1 Hepatotoxicity
5.2 Interstitial Lung Disease (ILD)/Pneumonitis
5.3 Bradycardia
5.4 Severe Myalgia and Creatine Phosphokinase (CPK) Elevation
5.5 Embryo-Fetal Toxicity
ADVERSE REACTIONS
6.1 Clinical Trials Experience
DRUG INTERACTIONS
USE IN SPECIFIC POPULATIONS
8.1 Pregnancy
8.2 Lactation

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11
12

13
14
16
17

8.3 Females and Males of Reproductive Potential
8.4 Pediatric Use
8.5 Geriatric Use
8.6 Renal Impairment
8.7 Hepatic Impairment
OVERDOSAGE
DESCRIPTION
CLINICAL PHARMACOLOGY
12.1 Mechanism of Action
12.2 Pharmacodynamics
12.3 Pharmacokinetics
NONCLINICAL TOXICOLOGY
13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility
CLINICAL STUDIES
HOW SUPPLIED/STORAGE AND HANDLING
PATIENT COUNSELING INFORMATION

*Sections or subsections omitted from the full prescribing information are not
listed

 1

FULL PRESCRIBING INFORMATION

2
3

1

INDICATIONS AND USAGE

4
5

ALECENSA is indicated for the treatment of patients with anaplastic lymphoma kinase (ALK)-positive,
metastatic non-small cell lung cancer (NSCLC) who have progressed on or are intolerant to crizotinib.

6
7
8

This indication is approved under accelerated approval based on tumor response rate and duration of response
[see Clinical Studies (14)]. Continued approval for this indication may be contingent upon verification and
description of clinical benefit in a confirmatory trial.

9
10

2

DOSAGE AND ADMINISTRATION

11

2.1

Dosing and Administration

12
13

The recommended dose of ALECENSA is 600 mg orally twice daily with food [see Clinical Pharmacology
(12.3)]. Administer ALECENSA until disease progression or unacceptable toxicity.

14

Do not open or dissolve the contents of the capsule.

15
16

If a dose of ALECENSA is missed or vomiting occurs after taking a dose of ALECENSA, take the next dose at
the scheduled time.

17

2.2

18

The dose reduction schedule for ALECENSA is provided in Table 1.

19

Table 1. ALECENSA Dose Reduction Schedule

Dose Modifications for Adverse Reactions

Dose reduction schedule

Dose level

Starting dose

600 mg taken orally twice daily

First dose reduction

450 mg taken orally twice daily

Second dose reduction

300 mg taken orally twice daily

20
21

Discontinue if patients are unable to tolerate the 300 mg twice daily dose.

22

Recommendations for dose modifications of ALECENSA in case of adverse reactions are provided in Table 2.

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Table 2. ALECENSA Dose Modifications for Adverse Reactions
Criteriaa

ALECENSA Dose Modification

ALT or AST elevation of greater than 5 times upper limit
of normal (ULN) with total bilirubin less than or equal to 2
times ULN

Temporarily withhold until recovery to baseline or to less
than or equal to 3 times ULN, then resume at reduced dose
as per Table 1.

ALT or AST elevation greater than 3 times ULN with total
bilirubin elevation greater than 2 times ULN in the absence
of cholestasis or hemolysis

Permanently discontinue ALECENSA.

Total bilirubin elevation of greater than 3 times ULN

Temporarily withhold until recovery to baseline or to less
than or equal to 1.5 times ULN, then resume at reduced
dose as per Table 1.

Any grade treatment-related interstitial lung disease
(ILD)/pneumonitis

Permanently discontinue ALECENSA.

Symptomatic bradycardia

Withhold ALECENSA until recovery to asymptomatic
bradycardia or to a heart rate of 60 bpm or above.
If contributing concomitant medication is identified and
discontinued, or its dose is adjusted, resume ALECENSA at
previous dose upon recovery to asymptomatic bradycardia
or to a heart rate of 60 bpm or above.
If no contributing concomitant medication is identified, or
if contributing concomitant medications are not
discontinued or dose modified, resume ALECENSA at
reduced dose (see Table 1) upon recovery to asymptomatic
bradycardia or to a heart rate of 60 bpm or above.

Bradycardiab (life-threatening consequences, urgent
intervention indicated)

Permanently discontinue ALECENSA if no contributing
concomitant medication is identified.
If contributing concomitant medication is identified and
discontinued, or its dose is adjusted, resume ALECENSA at
reduced dose (see Table 1) upon recovery to asymptomatic
bradycardia or to a heart rate of 60 bpm or above, with
frequent monitoring as clinically indicated. Permanently
discontinue ALECENSA in case of recurrence.

CPK elevation greater than 5 times ULN

Temporarily withhold until recovery to baseline or to less
than or equal to 2.5 times ULN, then resume at same dose.

CPK elevation greater than 10 times ULN or second
occurrence of CPK elevation of greater than 5 times ULN

Temporarily withhold until recovery to baseline or to less
than or equal to 2.5 times ULN, then resume at reduced
dose as per Table 1.

a

24
25
26
27
28

3

29
30

150 mg hard capsules, white, with “ALE” printed in black ink on the cap and “150 mg” printed in black ink on
the body.

ALT = alanine transaminase; AST = aspartate transaminase; ULN = upper limit of normal; ILD = interstitial lung
disease; CPK = blood creatine phosphokinase
b
Heart rate less than 60 beats per minute (bpm)

DOSAGE FORMS AND STRENGTHS

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4

CONTRAINDICATIONS

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None.

34

5

WARNINGS AND PRECAUTIONS

35

5.1

Hepatotoxicity

36
37
38
39
40
41
42

Elevations of AST greater than 5 times the upper limit of normal (ULN) occurred in 3.6% of patients, and
elevations of ALT greater than 5 times the ULN occurred in 4.8% of patients. Elevations of bilirubin greater
than 3 times the ULN occurred in 2.8% of patients. The majority (73% of the patients with hepatic transaminase
elevations and 49% of the patients with bilirubin elevations) of these events occurred during the first 2 months
of treatment. Four patients discontinued ALECENSA for Grade 3-4 AST and/or ALT elevations, and 3 patients
discontinued ALECENSA for Grade 3 bilirubin elevations. Two patients with Grade 3-4 AST/ALT elevations
had documented drug induced liver injury by liver biopsy.

43
44
45
46
47

Monitor liver function tests including ALT, AST, and total bilirubin every 2 weeks during the first 2 months of
treatment, then periodically during treatment, with more frequent testing in patients who develop transaminase
and bilirubin elevations. Based on the severity of the adverse drug reaction, withhold ALECENSA and resume
at a reduced dose, or permanently discontinue ALECENSA as described in Table 2 [see Dosage and
Administration (2.2)].

48

5.2

49

Severe ILD (Grade 3) occurred in one (0.4%) of 253 patients exposed to ALECENSA in clinical trials.

50
51

Promptly investigate for ILD/pneumonitis in any patient who presents with worsening of respiratory symptoms
indicative of ILD/pneumonitis (e.g., dyspnea, cough and fever).

52
53
54

Immediately withhold ALECENSA treatment in patients diagnosed with ILD/pneumonitis and permanently
discontinue ALECENSA if no other potential causes of ILD/pneumonitis have been identified [see Dosage and
Administration (2.2) and Adverse Reactions (6)].

55

5.3

56
57
58

Symptomatic bradycardia can occur with ALECENSA. Cases of bradycardia (7.5%) have been reported in
patients treated with ALECENSA. Twenty percent of 221 patients treated with ALECENSA for whom serial
ECGs were available had heart rates of less than 50 beats per minute (bpm).

59
60
61
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66
67

Monitor heart rate and blood pressure regularly. Dose modification is not required in cases of asymptomatic
bradycardia. In cases of symptomatic bradycardia that is not life-threatening, withhold ALECENSA until
recovery to asymptomatic bradycardia or to a heart rate of 60 bpm or above and evaluate concomitant
medications known to cause bradycardia, as well as anti-hypertensive medications. If attributable to a
concomitant medication, resume ALECENSA at a reduced dose (see Table 1) upon recovery to asymptomatic
bradycardia or to a heart rate of 60 bpm or above, with frequent monitoring as clinically indicated. Permanently
discontinue ALECENSA in case of recurrence. Permanently discontinue ALECENSA in cases of life­
threatening bradycardia if no contributing concomitant medication is identified [see Dosage and Administration
(2.2)].

68

5.4

69
70
71

Myalgia or musculoskeletal pain occurred in 29% of patients in Study 1 and Study 2. The incidence of Grade 3
myalgia/musculoskeletal pain was 1.2%. Dose modifications for myalgia/musculoskeletal pain were required in
0.8% of patients.

72
73
74

Elevations of CPK occurred in 43% of 218 patients with CPK laboratory data available in Study 1 and Study 2.
The incidence of Grade 3 elevations of CPK was 4.6%. Median time to Grade 3 CPK elevation was 14 days
(interquartile range 13-14 days). Dose modifications for elevation of CPK occurred in 5.0% of patients.

Interstitial Lung Disease (ILD)/Pneumonitis

Bradycardia

Severe Myalgia and Creatine Phosphokinase (CPK) Elevation

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Advise patients to report any unexplained muscle pain, tenderness, or weakness. Assess CPK levels every two
weeks for the first month of treatment and as clinically indicated in patients reporting symptoms. Based on the
severity of the CPK elevation, withhold ALECENSA, then resume or reduce dose [see Dosage and
Administration (2.2)].

79

5.5

80
81
82
83
84

Based on findings from animal studies and its mechanism of action, ALECENSA can cause fetal harm when
administered to pregnant women. Administration of alectinib to pregnant rats and rabbits during the period of
organogenesis resulted in embryo-fetal toxicity and abortion at maternally toxic doses with exposures
approximately 2.7-times those observed in humans with alectinib 600 mg twice daily. Advise pregnant women
of the potential risk to a fetus.

85
86
87

Advise females of reproductive potential to use effective contraception during treatment with ALECENSA and
for 1 week following the final dose [see Use in Specific Populations (8.1 and 8.3) and Clinical Pharmacology
(12.1)].

88

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89

The following adverse reactions are discussed in greater detail in other sections of the label:

Embryo-Fetal Toxicity

ADVERSE REACTIONS

90

•

Hepatotoxicity [see Warnings and Precautions (5.1)]

91

•

Interstitial Lung Disease (ILD)/Pneumonitis [see Warnings and Precautions (5.2)]

92

•

Bradycardia [see Warnings and Precautions (5.3)]

93

•

Severe Myalgia and Creatine Phosphokinase (CPK) Elevation [see Warnings and Precautions (5.4)]

94

•

Embryo-Fetal Toxicity [see Warnings and Precautions (5.5)]

95

6.1

Clinical Trials Experience

96
97
98

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.

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100
101
102
103
104
105

The safety of ALECENSA was evaluated in 253 patients with ALK-positive non-small cell lung cancer
(NSCLC) treated with ALECENSA 600 mg orally twice daily in two clinical trials, Studies 1 and 2. The median
duration of exposure to ALECENSA was 9.3 months. One hundred sixty-nine patients (67%) were exposed to
ALECENSA for more than 6 months, and 100 patients (40%) for more than one year. The population
characteristics were: median age 53 years, age less than 65 (86%), female (55%), White (74%), Asian (18%),
NSCLC adenocarcinoma histology (96%), never or former smoker (98%), ECOG Performance Status (PS) 0 or
1 (91%), and prior chemotherapy treatment (78%).

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107
108
109
110
111
112
113
114
115

Serious adverse reactions occurred in 19% of patients; the most frequently reported serious adverse reactions
were pulmonary embolism (1.2%), dyspnea (1.2%), and hyperbilirubinemia (1.2%). Fatal adverse reactions
occurred in 2.8% of patients and included hemorrhage (0.8%), intestinal perforation (0.4%), dyspnea (0.4%),
pulmonary embolism (0.4%), and endocarditis (0.4%). Permanent discontinuation of ALECENSA for adverse
reactions occurred in 6% of patients. The most frequent adverse reactions that led to permanent discontinuation
were hyperbilirubinemia (1.6%), increased ALT levels (1.6%), and increased AST levels (1.2%). Overall, 23%
of patients initiating treatment at the recommended dose required at least one dose reduction. The median time
to first dose reduction was 48 days. The most frequent adverse reactions that led to dose reductions or
interruptions were elevations in bilirubin (6%), CPK (4.3%), ALT (4.0%), and AST (2.8%), and vomiting
(2.8%).

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Table 3 summarizes adverse reactions in Studies 1 and 2.

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 Table 3. Adverse Reactions in ≥ 10% (All Grades) or ≥ 2% (Grade 3-4) of Patients in Studies 1 and 2

117

ALECENSA
N=253

Adverse Reactions
All Grades (%)

Grades 3-4 (%)*

Fatigue a

41

1.2

Constipation

34

0

Edema b

30

0.8

Myalgia c

29

1.2

Cough

19

0

Rash d

18

0.4

Nausea

18

0

Headache

17

0.8

Diarrhea

16

1.2

Dyspnea

16

3.6 e

Back pain

12

0

Vomiting

12

0.4

Increased weight

11

0.4

Vision disorder f

10

0

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120
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122
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124

*

Per Common Terminology Criteria for Adverse Events (CTCAE) version 4.0
Includes fatigue and asthenia.
b
Includes peripheral edema, edema, generalized edema, eyelid edema, and periorbital edema.
c
Includes myalgia and musculoskeletal pain.
d
Includes rash, maculopapular rash, acneiform dermatitis, erythema, generalized rash, papular rash, pruritic rash, and macular rash.
e
Includes one Grade 5 event
f
Includes blurred vision, vitreous floaters, visual impairment, reduced visual acuity, asthenopia, and diplopia.
a

125
126

Additional safety information from clinical trial experience

127
128
129

Photosensitivity occurred in 9.9% of patients exposed to ALECENSA in Studies 1 and 2. Patients were advised
to avoid sun exposure and to use broad-spectrum sunscreen. The incidence of Grade 2 photosensitivity was
0.4%; the remaining events were Grade 1 in severity.

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Table 4 summarizes laboratory abnormalities of ALECENSA in Studies 1 and 2.

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Table 4. Laboratory Abnormalities Occurring in >20% of Patients in Studies 1 and 2
Alectinib N=250
All Grades (%)
Grades 3-4 (%)*

Parameter
Chemistry
Increased AST
Increased Alkaline Phosphatase
Increased CPK a
Hyperbilirubinemia
Hyperglycemiab
Increased ALT
Hypocalcemia
Hypokalemia
Increased Creatinine c
Hypophosphatemia
Hyponatremia

51
47
43
39
36
34
32
29
28
21
20

3.6
1.2
4.6
2.4
2.0
4.8
0.4
4.0
0
2.8
2.0

Anemia
Lymphopenia d

56
22

2.0
4.6

Hematology

132
133
134
135
136
137
138

*

139
140

No pharmacokinetic interactions with alectinib requiring dosage adjustment have been identified [see Clinical
Pharmacology (12.3)].

Per CTCAE version 4.0
n=218 for CPK (with baseline values missing for 91 of these patients).
b
n=152 for fasting blood glucose (with baseline values missing for 5 of these patients).
c
Only patients with creatinine increases based on ULN definition.
d
n=217 for lymphocytes (with baseline values missing for 5 of these patients).
a

7

DRUG INTERACTIONS

141
142

8

USE IN SPECIFIC POPULATIONS

143

8.1

Pregnancy

144

Risk Summary

145
146
147

Based on animal studies and its mechanism of action, ALECENSA can cause fetal harm when administered to a
pregnant woman [see Clinical Pharmacology (12.1)]. There are no available data on ALECENSA use in
pregnant women.

148
149
150
151

Administration of alectinib to pregnant rats and rabbits by oral gavage during the period of organogenesis
resulted in embryo-fetal toxicity and abortion at maternally toxic doses with exposures approximately 2.7-times
those observed in humans treated with alectinib at 600 mg twice daily [see Data]. Advise pregnant women of
the potential risk to a fetus.

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153

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.

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Data

155

Animal Data

156
157
158
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162
163
164
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166

In a preliminary rabbit embryo-fetal study, administration of alectinib by oral gavage during the period of
organogenesis resulted in abortion or complete embryo-fetal mortality at a maternally toxic dose of 27
mg/kg/day (approximately 2.9-fold the estimated area under the curve (AUC0-24h,ss) in humans treated with
alectinib 600 mg BID) in three of six pregnant rabbits. The remaining three pregnant rabbits in this group had
few live fetuses, decreased fetal and placental weights, and retroesophageal subclavian artery. In a rat
preliminary embryo-fetal development study, administration of alectinib during organogenesis resulted in
complete litter loss in all pregnant rats at 27 mg/kg/day (approximately 4.5-fold the estimated AUC0-24h,ss in
humans treated with alectinib 600 mg BID). Doses greater than or equal to 9 mg/kg/day (approximately 2.7-fold
the estimated human AUC0-24h,ss in humans treated with alectinib 600 mg BID), resulted in maternal toxicity as
well as developmental toxicities including decreased fetal weight, dilated ureter, thymic cord, small ventricle
and thin ventricle wall, and reduced number of sacral and caudal vertebrae.

167

8.2

168

Risk Summary

169
170
171
172

There are no data on the presence of alectinib or its metabolites in human milk, the effects of alectinib on the
breast-fed infant, or its effects on milk production. Because of the potential for serious adverse reactions in
breast-fed infants from alectinib, advise a lactating woman not to breastfeed during treatment with ALECENSA
and for 1 week after the final dose.

173

8.3

174

Contraception

175

Females

176
177
178

ALECENSA can cause fetal harm when administered to a pregnant woman. Advise females of reproductive
potential to use effective contraception during treatment with ALECENSA and for 1 week after the final dose
[see Use in Specific Populations (8.1)].

179

Males

180
181
182

Based on genotoxicity findings, advise males with female partners of reproductive potential to use effective
contraception during treatment with ALECENSA and for 3 months following the final dose [see Non Clinical
Toxicology (13.1)].

183

8.4

184

The safety and effectiveness of ALECENSA in pediatric patients have not been established.

185

Animal Data

186
187
188
189
190
191

Juvenile animal studies have not been conducted using alectinib. In general toxicology studies, treatment of rats
with doses of alectinib resulting in exposures greater than or equal to approximately 4.5 times those in humans
treated with alectinib at 600 mg twice daily resulted in changes in the growing teeth and bones. Findings in
teeth included discoloration and changes in tooth size along with histopathological disarrangement of the
ameloblast and odontoblast layers. There were also decreases in the trabecular bone and increased osteoclast
activity in the femur and sternum.

192

8.5

193
194

Clinical studies of ALECENSA did not include sufficient number of subjects aged 65 and older to determine
whether they respond differently from younger subjects.

Lactation

Females and Males of Reproductive Potential

Pediatric Use

Geriatric Use

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8.6

Renal Impairment

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199
200

No dose adjustment is recommended for patients with mild or moderate renal impairment. The safety of
ALECENSA in patients with severe renal impairment (creatinine clearance less than 30 mL/min) or end-stage
renal disease has not been studied [see Clinical Pharmacology (12.3)].

201

8.7

202
203
204
205

No dose adjustment is recommended for patients with mild hepatic impairment (total bilirubin less than or equal
to upper limit of normal (ULN) and aspartate transaminase (AST) greater than ULN or total bilirubin greater
than 1.0 to 1.5 times ULN and any AST). The safety of ALECENSA in patients with moderate or severe hepatic
impairment has not been studied [see Clinical Pharmacology (12.3)].

206

10

207
208
209

No experience with overdose is available. There is no specific antidote for overdose with ALECENSA.
Alectinib and its major active metabolite M4 are > 99% bound to plasma proteins; therefore, hemodialysis is
likely to be ineffective in the treatment of overdose.

210

11

211
212
213
214
215

ALECENSA (alectinib) is a kinase inhibitor for oral administration. The molecular formula for alectinib is
C30H34N4O2 • HCl. The molecular weight is 482.62 g/mol (free base form) and 519.08 g/mol (hydrochloride
salt). Alectinib is described chemically as 9-ethyl-6, 6-dimethyl-8-[4-(morpholin-4-yl)piperidin-1-yl]-11-oxo-6,
11-dihydro-5H-benzo[b]carbazole-3-carbonitrile hydrochloride. The chemical structure of alectinib is shown
below:

Hepatic Impairment

OVERDOSAGE

DESCRIPTION

216
217
218
219
220
221
222

Alectinib HCl is a white to yellow white powder or powder with lumps with a pKa of 7.05 (base).

223
224
225
226
227
228

ALECENSA is supplied as hard capsules containing 150 mg of alectinib (equivalent to 161.33 mg alectinib HCl)
and the following inactive ingredients: lactose monohydrate, hydroxypropylcellulose, sodium lauryl sulfate,
magnesium stearate, and carboxymethylcellulose calcium. The capsule shell contains hypromellose,
carrageenan, potassium chloride, titanium dioxide, corn starch, and carnauba wax. The printing ink contains red
iron oxide (E172), yellow iron oxide (E172), FD&C Blue No. 2 aluminum lake (E132), carnauba wax, white
shellac, and glyceryl monooleate.

229

12

230

12.1 Mechanism of Action

231
232
233
234

Alectinib is a tyrosine kinase inhibitor that targets ALK and RET. In nonclinical studies, alectinib inhibited
ALK phosphorylation and ALK-mediated activation of the downstream signaling proteins STAT3 and AKT,
and decreased tumor cell viability in multiple cell lines harboring ALK fusions, amplifications, or activating
mutations. The major active metabolite of alectinib, M4, showed similar in vitro potency and activity.

235
236

Alectinib and M4 demonstrated in vitro and in vivo activity against multiple mutant forms of the ALK enzyme,
including some mutations identified in NSCLC tumors in patients who have progressed on crizotinib.

237
238
239

In mouse models implanted with tumors carrying ALK fusions, administration of alectinib resulted in antitumor
activity and prolonged survival, including in mouse models implanted intracranially with ALK-driven tumor
cell lines.

CLINICAL PHARMACOLOGY

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12.2 Pharmacodynamics

241

Cardiac Electrophysiology

242
243
244
245

The ability of alectinib to prolong the QT interval was assessed in 221 patients administered ALECENSA 600
mg twice daily in clinical studies. ALECENSA did not prolong the QTc (QT corrected for heart rate) interval to
any clinically relevant extent. One patient had a maximum post-baseline QTcF value of greater than 500 msec
and one patient had a maximum QTcF change from baseline of greater than 60 msec.

246

12.3 Pharmacokinetics

247
248

The pharmacokinetics of alectinib and its major active metabolite M4 have been characterized in patients with
ALK-positive NSCLC and healthy subjects.

249
250
251
252
253
254
255

In patients with ALK-positive NSCLC, the geometric mean (coefficient of variation %) steady-state maximal
concentration (Cmax,ss) for alectinib was 665 ng/mL (44%) and for M4 was 246 ng/mL (45%) with peak to
trough concentration ratio of 1.2. The geometric mean steady-state area under the curve from 0 to 12 hours
(AUC0-12h,ss) for alectinib was 7,430 ng*h/mL (46%) and for M4 was 2,810 ng*h/mL (46%). Alectinib exposure
is dose proportional across the dose range of 460 mg to 900 mg (i.e., 0.75 to 1.5 times the approved
recommended dosage) under fed conditions. Alectinib and M4 reached steady-state concentrations by day 7.
The geometric mean accumulation was approximately 6-fold for both alectinib and M4.

256

Absorption

257
258

Alectinib reached maximal concentrations at 4 hours following administration of ALECENSA 600 mg twice
daily under fed conditions in patients with ALK-positive NSCLC.

259

The absolute bioavailability of alectinib was 37% (90% CI: 34%, 40%) under fed conditions.

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261

A high-fat, high-calorie meal increased the combined exposure (AUC0-inf) of alectinib plus M4 by 3.1-fold (90%
CI: 2.7, 3.6) following oral administration of a single 600 mg dose of ALECENSA.

262

Distribution

263

The apparent volume of distribution is 4,016 L for alectinib and 10,093 L for M4.

264

Alectinib and M4 are bound to human plasma proteins greater than 99%, independent of drug concentration.

265
266

Alectinib concentrations in the cerebrospinal fluid in patients with ALK-positive NSCLC approximate
estimated alectinib free concentrations in the plasma.

267
268
269

In vitro studies suggest that alectinib is not a substrate of P-glycoprotein (P-gp), but M4 is a substrate of P-gp.
Alectinib and M4 are not substrates of breast cancer resistance protein (BCRP), organic anion-transporting
polypeptide (OATP) 1B1, or OATP1B3.

270

Elimination

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272

The apparent clearance (CL/F) is 81.9 L/hour for alectinib and 217 L/hour for M4. The geometric mean
elimination half-life is 33 hours for alectinib and 31 hours for M4 in patients with ALK-positive NSCLC.

273

Metabolism

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276

Alectinib is metabolized by CYP3A4 to its major active metabolite M4. The geometric mean metabolite/parent
exposure ratio at steady-state is 0.40. M4 is subsequently metabolized by CYP3A4. Alectinib and M4 were the
main circulating moieties in plasma, constituting 76% of the total radioactivity.

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Excretion

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279
280
281

Ninety-eight percent of the radioactivity was excreted in feces following oral administration of a single
radiolabeled dose of alectinib under fed conditions. Eighty-four percent of the dose was excreted in the feces as
unchanged alectinib and 6% of the dose was excreted as M4. Excretion of radioactivity in urine was less than
0.5% of administered radiolabeled dose of alectinib.
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Specific Populations

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284
285
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287

Age, body weight, mild hepatic impairment, mild to moderate renal impairment (creatinine clearance 30 to 89
mL/min), race (White, Asian, and Other), and sex had no clinically meaningful effect on the systemic exposure
of alectinib and M4. The pharmacokinetics of alectinib has not been studied in patients with severe renal
impairment, end-stage renal disease or moderate to severe hepatic impairment [see Use in Specific Populations
(8.6, 8.7)].

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Drug Interactions

289

Effect of Other Drugs on Alectinib

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291
292

No clinically meaningful effect on the combined exposure of alectinib plus M4 was observed in clinical studies
following co-administration of ALECENSA with a strong CYP3A inhibitor (posaconazole), a strong CYP3A
inducer (rifampin), or an acid-reducing agent (esomeprazole).

293

Effect of Alectinib on Other Drugs

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295

No clinically meaningful effect on the exposure of midazolam (sensitive CYP3A substrate) or repaglinide
(sensitive CYP2C8 substrate) is expected following co-administration with ALECENSA.

296

In vitro studies suggest that alectinib and M4 do not inhibit CYP1A2, 2B6, 2C9, 2C19 or 2D6.

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298

In vitro studies suggest that alectinib and M4 inhibit P-gp and BCRP. Alectinib did not inhibit OATP1B1,
OATP1B3, OAT1, OAT3, or OCT2 transport activity in vitro.

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13

300

13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

301

Carcinogenicity studies with alectinib have not been conducted.

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304

Alectinib was not mutagenic in vitro in the bacterial reverse mutation (Ames) assay, but was positive with an
increased number of micronuclei in a rat bone marrow micronucleus test. The mechanism of micronucleus
induction was abnormal chromosome segregation (aneugenicity) and not a clastogenic effect on chromosomes.

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306
307

No studies in animals have been performed to evaluate the effect of alectinib on fertility. No adverse effects on
male and female reproductive organs were observed in general toxicology studies conducted in rats and
monkeys.

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The safety and efficacy of ALECENSA were established in two single-arm, multicenter clinical trials (Studies 1
and 2). Patients with locally advanced or metastatic ALK-positive NSCLC, who have progressed on crizotinib,
with documented ALK positive NSCLC based on an FDA-approved test, and ECOG PS of 0-2 were enrolled in
both studies. Eligibility criteria permitted enrollment of patients with prior chemotherapy and prior CNS
radiotherapy provided that CNS metastases were stable for at least two weeks. All patients received
ALECENSA 600 mg orally twice daily. The major efficacy outcome measure in both studies was objective
response rate (ORR) according to Response Evaluation Criteria in Solid Tumours (RECIST v1.1) as evaluated
per Independent Review Committee (IRC). Additional outcome measures as evaluated by the IRC included
duration of response (DOR), CNS ORR, and CNS DOR.

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Study 1 was conducted in North America and enrolled 87 patients. Baseline demographic and disease
characteristics in Study 1 were median age 54 years old (range 29 to 79, 18% 65 and over), 84% White and 8%
Asian, 55% female, 35% ECOG PS 0 and 55% ECOG PS 1, 100% never or former smokers, 99% Stage IV,
94% adenocarcinoma, and 74% prior chemotherapy. The most common sites of extra-thoracic metastasis
included 60% CNS (of whom 65% had received CNS radiation), 43% lymph nodes, 36% bone, and 34% liver.

NONCLINICAL TOXICOLOGY

CLINICAL STUDIES

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327

Study 2 was conducted internationally and enrolled 138 patients. Baseline demographic and disease
characteristics in Study 2 were median age 52 years old (range 22 to 79, 10% 65 and over), 67% White and
26% Asian, 56% female, 32% ECOG PS 0 and 59% ECOG PS 1, 98% never or former smokers, 99% Stage IV,
96% adenocarcinoma, and 80% prior chemotherapy. The most common sites of extra-thoracic metastasis
included 61% CNS (of whom 73% had received CNS radiation), 51% bone, 38% lymph nodes, and 30% liver.

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Efficacy results from Studies 1 and 2 in all treated patients are summarized in Table 5. The median duration of
follow-up on Study 1 was 4.8 months for both IRC and Investigator assessments and on Study 2, 10.9 months
for IRC assessment and 7.0 months for Investigator assessment. All responses were partial responses.

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Table 5: Efficacy Results in Studies 1 and 2
Efficacy Parameter
Objective Response Rate (95% CI)
Number of Responders
Duration of Response, median in
months (95% CI)

Study 1 (N=87)
IRC*
Investigator
Assessment
Assessment
38%
46%
(28; 49)
(35; 57)
33
40

Study 2 (N=138)
IRC*
Investigator
Assessment
Assessment
44%
48%
(36; 53)
(39; 57)
61
66

7.5
(4.9, Not
Estimable)

11.2
(9.6, Not
Estimable)

NE
(4.9, Not
Estimable)

7.8
(7.4, 9.2)

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333

* 18 patients in Study 1 and 16 patients in Study 2 did not have measurable disease at baseline as per IRC
assessment and were classified as non-responders in the IRC analysis.

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338

An assessment of ORR and duration of response for CNS metastases in the subgroup of 51 patients in Studies 1
and 2 with baseline measurable lesions in the CNS according to RECIST v1.1 are summarized in Table 6.
Thirty-five (69%) patients with measurable CNS lesions had received prior brain radiation, including 25 (49%)
who completed radiation treatment at least 6 months before starting treatment with ALECENSA. Responses
were observed irrespective of prior brain radiation status.

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Table 6: CNS Objective Response in Patients with Measurable CNS Lesions in Studies 1 and 2
Efficacy Parameter
CNS Objective Response Rate
(95% CI)
Complete Response
Partial Response
CNS Duration of Response,
median in months (95% CI)

N=51
61%
(46, 74)
18%
43%
9.1
(5.8, not evaluable)

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Hard capsules, white 150 mg capsules with “ALE” printed in black ink on the cap and “150 mg” printed in
black ink on the body, available in:

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240 capsules per bottle:

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Storage and stability: Do not store above 30°C (86°F). Store in the original container to protect from light and
moisture.

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17

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Advise the patient to read the FDA-approved patient labeling (Patient Information).

HOW SUPPLIED/STORAGE AND HANDLING

NDC 50242-130-01

PATIENT COUNSELING INFORMATION

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Inform patients of the following:

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Hepatotoxicity

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353

Inform patients of the signs and symptoms of bilirubin and hepatic transaminase elevations. Advise patients to
contact their healthcare provider immediately for signs or symptoms of bilirubin and hepatic transaminase
elevations [see Warnings and Precautions (5.1)].

354

Interstitial Lung Disease (ILD)/Pneumonitis

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356

Inform patients of the risks of severe ILD/pneumonitis. Advise patients to contact their healthcare provider
immediately to report new or worsening respiratory symptoms [see Warnings and Precautions (5.2)].

357

Bradycardia

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359
360
361

Inform patients that symptoms of bradycardia including dizziness, lightheadedness, and syncope can occur
while taking ALECENSA. Advise patients to contact their healthcare provider to report these symptoms and to
inform their healthcare provider about the use of any heart or blood pressure medications [see Warnings and
Precautions (5.3)].

362

Severe Myalgia/CPK elevation

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364
365

Inform patients of signs and symptoms of myalgia, including unexplained and/or persistent muscle pain,
tenderness, or weakness. Advise patients to contact their healthcare provider immediately to report new or
worsening symptoms of muscle pain or weakness [see Warnings and Precautions (5.4)].

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Photosensitivity

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368
369
370

Inform patients of the signs and symptoms of photosensitivity. Advise patients to avoid prolonged sun exposure
while taking ALECENSA and for at least 7 days after study drug discontinuation and to use proper protection
from the sun. Advise patients to use a broad spectrum ultraviolet A (UVA)/ultraviolet B (UVB) sunscreen and
lip balm (SPF ≥50) to help protect against potential sunburn [see Adverse Reactions (6.1)].

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Embryo-Fetal Toxicity

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373

ALECENSA can cause fetal harm if taken during pregnancy. Advise a pregnant woman of the potential risk to
a fetus [see Warnings and Precautions (5.5) and Use in Specific Populations (8.1, 8.3)].

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375
376

Advise females of reproductive potential to use effective contraception during treatment with ALECENSA and
for at least 1 week after the last dose of ALECENSA. Advise patients to inform their healthcare provider of a
known or suspected pregnancy [see Warnings and Precautions (5.5) and Use in Specific Populations (8.1, 8.3)].

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379

Advise male patients with female partners of reproductive potential to use effective contraception during
treatment with ALECENSA and for 3 months after the last dose [see Use in Specific Populations (8.3) and
Nonclinical Toxicology (13.1)].

380

Lactation

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382

Advise women not to breastfeed during treatment with ALECENSA and for one week after the last dose [see
Use in Specific Populations (8.2)].

383

Administration

384
385

Instruct patients to take ALECENSA twice a day. Advise patients to take ALECENSA with food and to
swallow ALECENSA capsules whole [see Dosage and Administration (2.1)].

386

Missed Dose

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388
389

Advise patients that if a dose of ALECENSA is missed or if the patient vomits after taking a dose of
ALECENSA, patients should be advised not to take an extra dose, but to take the next dose at the regular time
[see Dosage and Administration (2.1)].

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 Distributed by:

Genentech USA, Inc.

A Member of the Roche Group
1 DNA Way
South San Francisco, CA 94080-4990

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ALECENSA® is a registered trademark of

Chugai Pharmaceutical Co., Ltd., Tokyo, Japan

©2015 Genentech, Inc. All rights reserved.


 396
PATIENT INFORMATION
®
ALECENSA (a-le-sen'-sah)
(alectinib)
capsules
What is the most important information I should know about ALECENSA?
ALECENSA may cause serious side effects, including:
• Liver problems (hepatotoxicity). ALECENSA may cause liver injury. Your healthcare provider will do blood tests at
least every 2 weeks for the first 2 months and as needed during treatment with ALECENSA. Tell your healthcare
provider right away if you get any of the following signs and symptoms:
o
feeling tired
o
itchy skin
o
feeling less hungry than usual
o
nausea or vomiting
o
yellowing of your skin or the whites of your eyes
o
pain on the right side of your stomach area
o
dark urine
o
bleeding or bruising more easily than normal
• Lung problems. ALECENSA may cause severe or life-threatening swelling (inflammation) of the lungs during
treatment. Symptoms may be similar to those symptoms from lung cancer. Tell your healthcare provider right away if
you have any new or worsening symptoms, including trouble breathing, shortness of breath, cough, or fever.
• Slow heartbeat (bradycardia). ALECENSA may cause very slow heartbeats that can be severe. Your healthcare
provider will check your heart rate and blood pressure during treatment with ALECENSA. Tell your healthcare
provider right away if you feel dizzy, lightheaded, or faint during treatment with ALECENSA. Tell your healthcare
provider if you take any heart or blood pressure medicines.
•

Muscle pain, tenderness, and weakness (myalgia). Muscle problems are common with ALECENSA and can be
severe. Your healthcare provider will do blood tests at least every 2 weeks for the first month and as needed during
treatment with ALECENSA. Tell your healthcare provider right away if you get new or worsening signs and
symptoms of muscle problems, including unexplained muscle pain or muscle pain that does not go away,
tenderness, or weakness.

See “What are the possible side effects of ALECENSA?” for more information about side effects.
What is ALECENSA?
ALECENSA is a prescription medicine used to treat people with non-small cell lung cancer (NSCLC) that.
• has a certain type of abnormal anaplastic lymphoma kinase (ALK) gene, and
• has spread to other parts of your body, and
• who have taken the medicine crizotinib, but their NSCLC worsened or they cannot tolerate taking crizotinib.
It is not known if ALECENSA is safe and effective in children.
Before you take ALECENSA, tell your healthcare provider about all of your medical conditions, including if you:
• have liver problems
• have lung or breathing problems
• have a slow heartbeat
• are pregnant or plan to become pregnant. ALECENSA can harm your unborn baby. Tell your healthcare provider
right away if you become pregnant during treatment with ALECENSA or think you may be pregnant.
o Females who are able to become pregnant should use effective birth control during treatment with ALECENSA
and for 1 week after the final dose of ALECENSA.
o Males who have female partners that are able to become pregnant should use effective birth control during
treatment with ALECENSA and for 3 months after the final dose of ALECENSA.
• are breastfeeding or plan to breastfeed. It is not known if ALECENSA passes into your breast milk. Do not
breastfeed during treatment with ALECENSA and for 1 week after the final dose of ALECENSA. Talk to your
healthcare provider about the best way to feed your baby during this time.
Tell your healthcare provider about all the medicines you take, including prescription medicines, over-the-counter
medicines, vitamins, or herbal supplements.
How should I take ALECENSA?
• Take ALECENSA exactly as your healthcare provider tells you to take it. Do not change your dose or stop taking
ALECENSA unless your healthcare provider tells you to.
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 •
•
•
•
•
•

Your healthcare provider may change your dose, temporarily stop, or permanently stop treatment with ALECENSA if
you have side effects.
Take ALECENSA 2 times a day.
Take ALECENSA with food.
Swallow ALECENSA capsules whole. Do not open or dissolve the capsule contents.
If you miss a dose of ALECENSA, do not take the missed dose. Take your next dose at your regular time.
If you vomit after taking a dose of ALECENSA, do not take an extra dose. Take your next dose at your regular time.

What should I avoid while taking ALECENSA?
• Avoid spending time in the sunlight during treatment with ALECENSA and for 7 days after the final dose of
ALECENSA. You may burn more easily and get severe sunburns. Use sunscreen and lip balm with a SPF 50 or
greater to help protect against sunburn.
What are the possible side effects of ALECENSA?
ALECENSA may cause serious side effects, including:
• See “What is the most important information I should know about ALECENSA?”
The most common side effects of ALECENSA include:
• tiredness
• constipation
• swelling in your hands, feet, ankles, and eyelids
These are not all of the possible side effects of ALECENSA. For more information, ask your healthcare provider or
pharmacist.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
How should I store ALECENSA?
• Do not store ALECENSA at temperatures above 86°F (30°C).
• Store ALECENSA capsules in the original container.
• Keep ALECENSA capsules dry and away from light.
Keep ALECENSA and all medicines out of the reach of children.
General information about the safe and effective use of ALECENSA.
Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use
ALECENSA for a condition for which it was not prescribed. Do not give ALECENSA to other people, even if they have
the same symptoms you have. It may harm them. You can ask your healthcare provider or pharmacist for more
information about ALECENSA that is written for health professionals.
What are the ingredients in ALECENSA?
Active ingredient: alectinib
Inactive ingredients: lactose monohydrate, hydroxypropylcellulose, sodium lauryl sulfate, magnesium stearate and
carboxymethylcellulose calcium. Capsule shell contains: hypromellose, carrageenan, potassium chloride, titanium
dioxide, corn starch, and carnauba wax. Printing ink contains: red iron oxide (E172), yellow iron oxide (E172), FD&C
Blue No. 2 aluminum lake (E132), carnauba wax, white shellac, and glyceryl monooleate.

397

Distributed by: Genentech, Inc. A Member of the Roche Group, 1 DNA Way, South San Francisco, CA 94080-4990
®
ALECENSA is a registered trademark of Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
©2015 Genentech, Inc. For more information, go to www.ALECENSA.com or call 1-800-253-2367.
This Patient Information has been approved by the U.S. Food and Drug Administration

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Issued: December 2015