encorafenib

Contraindicated in:

Wild-type BRAF melanoma (may ↑ proliferation)
Long QT syndrome, bradyarrhythmias, severe or decompensated HF, hypokalemia, or hypomagnesemia (↑ risk of QT interval prolongation)
Concurrent use of QT-interval prolonging medications
Baseline QTc interval >500 msec
Concurrent use of strong or moderate CYP3A4 inhibitors or inducers (may significantly alter levels and effects)
OB: Pregnancy (may cause fetal harm)
Lactation: Lactation.

Use Cautiously in:

Moderate or severe hepatic impairment
Severe renal impairment
Rep: Women of reproductive potential
Pedi: Safety and effectiveness not established in children.

Adv. Reactions/Side Effects ⬆ ⬇

CV: QT interval prolongation.

Derm: BASAL CELL CARCINOMA, CUTANEOUS SQUAMOUS CELL CARCINOMA, alopecia, dry skin, hyperkeratosis, pruritus, rash, nodule formation.

EENT: uveitis.

Endo: hyperglycemia.

F and E: hypermagnesemia, hyponatremia.

GI: GI HEMORRHAGE, PANCREATITIS, abdominal pain, constipation, ↑liver enzymes, nausea, vomiting.

GU: ↑serum creatinine, ↓ fertility (males).

Hemat: bleeding, anemia, leukopenia, lymphopenia, neutropenia.

MS: arthralgia, myalgia.

Neuro: peripheral neuropathy , INTRACRANIAL HEMORRHAGE, dizziness, headache, fatigue, facial paralysis.

Misc: HYPERSENSITIVITY REACTIONS, MALIGNANCY, fever.

Interactions ⬆ ⬇

Drug-Drug:

QT interval prolonging drugs may ↑ the risk of QT interval prolongation and torsades de pointes; avoid concurrent use.
Strong or moderate CYP3A4 inhibitors, including diltiazem and posaconazole may ↑ levels and risk of toxicity; avoid concurrent use, if possible (if must use concurrently, ↓ encorafenib dose).
Strong or moderate CYP3A4 inducers may ↓ levels and effectiveness; avoid concurrent use.
May ↓ effectiveness of hormonal contraceptives.

Drug-Natural Products:

St. John's wort may ↓ levels and effectiveness; avoid concurrent use.

Drug-Food:

Grapefruit juice may ↑ levels and risk of toxicity; avoid concurrent use.

Route/Dosage ⬆ ⬇

BRAF V600E or V600K Mutation-Positive Unresectable or Metastatic Melanoma

PO (Adults): 450 mg once daily until disease progression or unacceptable toxicity. Concurrent use of moderate CYP3A4 inhibitor — 225 mg once daily (if planned dose 450 mg once daily); 150 mg once daily (if planned dose 300 mg once daily); 75 mg once daily (if planned dose 225 mg once daily); Concurrent use of strong CYP3A4 inhibitor — 150 mg once daily (if planned dose 450 mg once daily); 75 mg once daily (if planned dose 300 mg once daily or 225 mg once daily).

BRAF V600E Mutation-Positive Metastatic CRC

PO (Adults): 300 mg once daily until disease progression or unacceptable toxicity. Concurrent use of moderate CYP3A4 inhibitor — 150 mg once daily (if planned dose 300 mg once daily); 75 mg once daily (if planned dose 225 mg once daily or 150 mg once daily); Concurrent use of strong CYP3A4 inhibitor — 75 mg once daily (if planned dose 300 mg once daily, 225 mg once daily, or 150 mg once daily).

Implementation ⬆ ⬇

- Melanoma reduced dose recommendations: If binimetinib is held, reduce encorafenib to maximum dose of 300 mg once daily until binimetinib is resumed. First dose reduction: 300 mg (four 75 mg capsules) orally once daily. Second dose reduction: 225 mg (three 75 mg capsules) orally once daily. Subsequent modification: Permanently discontinue if unable to tolerate encorafenib 225 mg (three 75 mg capsules) once daily.
- CRC reduced dose recommendations: If cetuximab is discontinued, discontinue encorafenib. First dose reduction: 225 mg (three 75 mg capsules) orally once daily. Second dose reduction: 150 mg (two 75 mg capsules) orally once daily. Subsequent modification: Permanently discontinue if unable to tolerate encorafenib 150 mg (two 75 mg capsules) once daily.
PO: Administer once daily without regard to food. Store in original, tightly capped bottle at room temperature; do not remove desiccant, protect from moisture.

US Brand Names ⬆ ⬇

Classifications ⬆ ⬇

Therapeutic Classification: antineoplastics

Pharmacologic Classification: kinase inhibitors

Availability ⬆ ⬇

Capsules: 75 mg;

Time/Action Profile ⬆ ⬇

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	2 hr	24 hr

Assessment ⬆ ⬇

Assess skin for lesions prior to starting, every 2 months during, and for up to 6 months following discontinuation of therapy. Manage suspicious skin lesions with excision and dermatopathologic evaluation. For Grade 2 reaction, if no improvement in 2 wk, hold encorafenib until Grade 0-1. Resume at same dose. For Grade 3, hold encorafenib until Grade 0-1. Resume at same dose if first occurrence or reduce dose if recurrent. For Grade 4, discontinue encorafenib permanently.
Monitor for Non-Cutaneous RAS Mutation-positive Malignancies. Permanently discontinue encorafenib if these malignancies occur.
Monitor for signs and symptoms of hemorrhage (bleeding GI, rectal, anal, hemorrhoidal) periodically during therapy. If Grade 2 or 1st occurrence of Grade 3: Withhold encorafenib up to 4 wk. If improves to Grade 0-1 or to pretreatment level, resume at reduced dose. If no improvement, permanently discontinue encorafenib. If 1st occurrence of Grade 4: Discontinue encorafenib permanently or withhold up to 4 wk. If improves to Grade 0-1 or to pretreatment level, resume at reduced dose. If no improvement, permanently discontinue encorafenib. If recurrent Grade 3: Consider permanently discontinuing encorafenib. If recurrent Grade 4: permanently discontinue encorafenib.
Monitor ECG in patients who already have or are at risk of QTc prolongation, including patients with known long QT syndromes, clinically significant bradyarrhythmias, severe or uncontrolled heart failure and those taking other medications leading to QT prolongation. If QTcF >500 ms and 60 ms increase from baseline, hold encorafenib until QTcF 500 ms. Resume at reduced dose. If occurs more than once, permanently discontinue encorafenib. If QTcF >500 ms and >60 ms increase from baseline, discontinue encorafenib permanently.
Assess for signs and symptoms of uveitis (visual changes, eye pain) during therapy. Perform ophthalmologic exam regularly and for new or worsening visual disturbances; follow new or persistent ophthalmologic findings. If Grade 1 or 2 does not respond to ocular therapy, or for Grade 3 uveitis, hold encorafenib for up to 6 wk. If improved, resume at same or reduced dose. If not improved, permanently discontinue encorafenib. If Grade 4 uveitis occurs, permanently discontinue encorafenib.

Lab Test Considerations:

Verify negative pregnancy status of females of reproductive potential prior to starting therapy.
- Confirm presence of a BRAF V600E or V600K mutation in tumor specimens before starting therapy for melanoma and of BRAF V600E mutation before starting therapy for CRC. Information on FDA-approved tests for the detection of BRAF V600E and V600K mutations is available at: http://www.fda.gov/CompanionDiagnostics.
- Monitor serum electrolytes periodically during therapy. Correct hypokalemia and hypomagnesemia prior to and during therapy. May also cause hyponatremia and hyperglycemia.
- May cause anemia, leukopenia, lymphopenia, and neutropenia.
- Monitor liver function periodically during therapy. May cause ↑ serum creatinine, GGT, AST, ALT, and alkaline phosphatase. If Grade 2 AST or ALT ↑: continue encorafenib dose. If no improvement within 4 wk, hold encorafenib until Grade 0-1 or to baseline levels, then resume at same dose. If no improvement, permanently discontinue encorafenib. If Grade 3 AST or ALT ↑: Consider permanently discontinuing encorafenib. If Grade 4 AST or ALT ↑: Permanently discontinue encorafenib.

Pot. Nursing Diagnoses ⬆ ⬇

Impaired skin integrity (Indications, Adverse Reactions).

Patient/Family Teaching ⬆ ⬇

Instruct patient to take encorafenib as directed. Take missed dose within 12 hr of missed dose; do not take dose within 12 hr of next dose. Advise patient to read Medication Guide before starting therapy and with each Rx refill in case of changes.
Inform patient that grapefruit products may increase amount of encorafenib in the body. Avoid grapefruit and grapefruit juice during therapy.
Inform patient that encorafenib increases risk of developing new cutaneous malignancies. Notify health care professional immediately if new lesions (wart, skin sore or reddish bump that bleeds or does not heal) or changes in size or color of existing moles or lesions occur.
Advise patient to notify health care professional immediately if signs and symptoms of bleeding (headaches, dizziness, weakness, coughing up blood or blood clots, vomiting blood or vomit looks like "coffee grounds", red or black stools that look like tar); liver dysfunction (yellow skin or whites of eyes; feeling tired; urine turns dark or brown; nausea or vomiting; loss of appetite; pain on right side of stomach); changes heart rhythm (feeling faint, lightheaded, dizzy, heart beating irregularly or fast); or eye problems (blurred vision, loss of vision, other vision changes, seeing colored dots, seeing halos or blurred outline around objects, eye pain, swelling, redness) occur.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications, especially St. John's wort.
Rep: May cause fetal harm. Encorafenib may decrease effectiveness of hormonal contraceptives. Advise female patient to use a highly effective nonhormonal form of contraception. Advise patient to notify health care professional if pregnancy is suspected and to avoid breastfeeding during and for at least 2 wk after last dose. Advise patients to seek counseling on fertility and family planning prior to beginning therapy; may impair fertility in males.
Inform patient that regular assessments of skin and assessments for signs and symptoms of other malignancies must be done every 2 mo during and for up to 6 mo after therapy. Advise patient to notify health care professional immediately if any changes in skin occur.

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Pronunciation ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Contraind./Precautions ⬆ ⬇