Fotivda · 4.3 Contraindications · 1

HOS-217299 · has-adverse-reaction-information · PDF-Seite 7

Summary of the safety profile Pooled data of 674 patients with advanced RCC who continued to receive tivozanib as their initial on trial therapy in the five core RCC monotherapy studies have been evaluated in the overall assessment of safety and tolerability of tivozanib. The most important serious adverse reaction is hypertension. The most common adverse reactions of any grade include hypertension (47.6%), dysphonia (26.9%), fatigue (25.8%) and diarrhoea (25.5%). In the five core RCC monotherapy studies tivozanib was discontinued in a total of 20 patients (3%) owing to adverse reactions, most commonly due to hypertension (0.4%), persistent severe hypertension (0.3%), or acute myocardial infarction (0.3%). The most frequent adverse reactions leading to tivozanib dose reduction/ interruption were hypertension (4.7%), diarrhoea (3.1%), fatigue (1.8%). In patients receiving tivozanib as initial therapy, there were three adverse reactions with outcome death; one was uncontrolled hypertension in the setting of a suspected overdose (see section 4.9) and two were reported simply as death. Tabulated summary of adverse reactions Adverse reactions occurring in patients who continued to receive tivozanib as their initial on trial therapy in the five RCC monotherapy studies were pooled and are listed below by MedDRA body system organ class (SOC) and frequency. Frequencies are defined as follows: very common (≥ 1/10); common (≥ 1/100 to < 1/10); uncommon (≥ 1/1,000 to < 1/100), rare (≥ 1/10,000 to < 1/1,000) and not known (cannot be estimated from available data). Within each SOC, adverse reactions are presented in order of decreasing seriousness. 7 Table 1: Tabulated list of adverse reactions (presented using frequencies for all-causality adverse events) System Very common Common Uncommon Rare Not known Organ Class Infections and Fungal infection infestations Pustular rash Blood and Anaemia Thrombocytopenia lymphatic Haemoglobin system disorders increased Endocrine Hypothyroidism Hyperthyroidism disorders

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HOS-217295 · has-contraindication-information · PDF-Seite 3

Hypersensitivity to the active substance or to any of the excipients listed in section 6.1. Co-administration with herbal preparations containing St. John’s wort (Hypericum perforatum) (see section 4.5). 3

HOS-217294 · has-indication-information · PDF-Seite 2

Fotivda is indicated for the first line treatment of adult patients with advanced renal cell carcinoma (RCC) and for adult patients who are VEGFR and mTOR pathway inhibitor-naïve following disease progression after one prior treatment with cytokine therapy for advanced RCC.

HOS-217297 · has-interaction-information · PDF-Seite 6

Contraindication of concomitant use Herbal preparations containing St. John's wort (Hypericum perforatum) are contraindicated. If a patient is already taking St John’s wort, this should be stopped before starting tivozanib treatment. The inducing effect of St John’s wort may persist for at least 2 weeks after cessation of treatment with St John’s wort (see section 4.3). Strong CYP3A4 inducers In a clinical study in healthy volunteers, co-administration of a single 1340 microgram dose of tivozanib with a strong CYP3A4 inducer at steady-state (rifampin 600 mg once daily) decreased the average half-life of tivozanib from 121 to 54 hours which was associated with a decrease in the single dose AUC0-∞ of 48% compared with AUC0-∞ in the absence of rifampin. Average Cmax and AUC0-24hr were not significantly affected (8% increase and 6% decrease respectively). The clinical effects of strong CYP3A4 inducers on repeated daily dosing of tivozanib has not been studied but potentially the average time to reach steady-state and the average steady-state serum concentration of tivozanib may be reduced, due to the reduction in half-life. It is recommended that concomitant administration of tivozanib with strong CYP3A4 inducers, if used, should be undertaken with caution. Moderate CYP3A4 inducers are not expected to have a clinically relevant effect on tivozanib exposure. CYP3A4 inhibitors In a clinical study in healthy volunteers, co-administration of tivozanib with a potent CYP3A4 inhibitor, ketoconazole (400 mg once daily), had no influence on tivozanib serum concentrations (Cmax or AUC); therefore, tivozanib exposure is unlikely to be altered by CYP3A4 inhibitors. Medicinal products for which intestinal absorption is restricted by BCRP Tivozanib inhibits the transporter protein BCRP in vitro, but the clinical relevance of this finding is unknown (see section 5.2). Caution should be exercised if tivozanib is co-administered with rosuvastatin. Alternatively, a statin not subject to restriction of intestinal absorption by BCRP should be considered. Patients taking an oral BCRP substrate with a clinically-relevant efflux interaction in the gut should ensure that a suitable time window (e.g. 2 hours) is applied between administration of tivozanib and the BCRP substrate. Contraceptives It is currently unknown whether tivozanib may reduce the effectiveness of hormonal contraceptives, and therefore women using hormonal contraceptives should add a barrier method (see section

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HOS-217298 · has-pregnancy-information · PDF-Seite 6

Women of childbearing potential/Contraception in males and females Women of childbearing potential should avoid becoming pregnant while on tivozanib. Female partners of male patients taking tivozanib should also avoid pregnancy. Effective methods of contraception should be used by male and female patients and their partners during therapy, and for at least one month after completing therapy. It is currently unknown whether tivozanib may reduce the effectiveness of hormonal contraceptives and therefore women using hormonal contraceptives should add a barrier method. Pregnancy There are no data from the use of tivozanib in pregnant women. Studies in animals have shown reproductive toxicity (see section 5.3). 6 Tivozanib should not be used during pregnancy. If tivozanib is used during pregnancy, or if the patient becomes pregnant while receiving tivozanib, the potential hazard to the foetus must be explained to the patient. Breast-feeding It is unknown whether tivozanib is excreted in human milk, but the potential exists. Because of the potential for tivozanib-mediated adverse reactions in breastfed infants, women should not breast-feed while taking tivozanib. Fertility Animal studies indicate that male and female fertility may be affected by treatment with tivozanib (see section 5.3).

HOS-217296 · has-warning-information · PDF-Seite 4

Hypertension In clinical studies with tivozanib, hypertension (including persistent severe hypertension) has occurred (see section 4.8). In approximately one-third of the patients, hypertension developed within the first 2 months of treatment. Blood pressure should be well controlled prior to initiating tivozanib. During treatment, patients should be monitored for hypertension and treated as needed with anti-hypertensive therapy according to standard medical practice. In the case of persistent hypertension despite use of anti-hypertensive therapy, the tivozanib dose should be reduced, or the treatment interrupted and re-initiated at a lower dose once the blood pressure is controlled, according to clinical judgment (see section 4.2). Discontinuation of treatment should be considered in cases of persistent severe hypertension, posterior reversible encephalopathy syndrome (see below), or other complications of hypertension. Patients receiving anti-hypertensive medicinal product should still be monitored for hypotension when tivozanib is either interrupted or discontinued. Arterial thromboembolic events In clinical studies with tivozanib, arterial thromboembolic events (ATEs) have occurred (see section 4.8). Risk factors for ATE include malignant disease, age > 65 years, hypertension, diabetes mellitus, smoking, hypercholesterolaemia, and prior thromboembolic disease. Tivozanib has not been studied in patients who had an ATE within the preceding 6 months of clinical study initiation. Tivozanib must be used with caution in patients who are at risk for, or who have a history of these events (such as myocardial infarction, stroke). Venous thromboembolic events In clinical studies with tivozanib, venous thromboembolic events (VTEs) have been reported including pulmonary embolism and deep vein thrombosis (see section 4.8). Risk factors for VTEs include major surgery, multiple trauma, prior VTEs, advanced age, obesity, cardiac or respiratory failure, and prolonged immobility. Tivozanib has not been studied in patients who had a VTE within the preceding 6 months of clinical study initiation. Treatment decision, especially in patients who are at risk for VTEs, should be based on individual patient benefit/risk assessment. Cardiac failure In clinical studies with tivozanib as monotherapy for the treatment of patients with RCC, cardiac failure has been reported (see section 4.8). Signs or symptoms of cardiac failure should be periodically monitored throughout treatme

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