Enhertu - patient leaflet, side effects, dosage

B. PACKAGE LEAFLET

Package leaflet: Information for the patient

Enhertu 100 mg powder for concentrate for solution for infusion trastuzumab deruxtecan

This medicine is subject to additional monitoring. This will allow quick identification of new safety information. You can help by reporting any side effects you may get. See the end of section 4 for how to report side effects.

Read all of this leaflet carefully before you are given this medicine because it contains important information for you.

• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor or nurse.
• If you get any side effects, talk to your doctor or nurse. This includes any possible side effects not listed in this leaflet. See section 4.

What is in this leaflet

• 1. What Enhertu is and what it is used for

• 2. What you need to know before you are given Enhertu

• 3. How you are given Enhertu

• 4. Possible side effects

• 5. How to store Enhertu

• 6. Contents of the pack and other information

1. What Enhertu is and what it is used for

What Enhertu is

Enhertu is a cancer medicine that contains the active substance trastuzumab deruxtecan. One part of the medicine is a monoclonal antibody that attaches specifically to cells that have the protein HER2 on their surface (HER2-positive), as some breast cancer cells do. The other active part of Enhertu is DXd, a substance that can kill cancer cells. Once the medicine has attached to HER2-positive cancer cells, the DXd enters the cells and kills them.

What Enhertu is used for

Enhertu is used to treat adults who have:

• HER2-positive breast cancer that has spread to other parts of the body or cannot be removed by surgery, and
• tried at least two other treatments specifically for HER2-positive breast cancer.

2. What you need to know before you are given Enhertu

You must not be given Enhertu

• if you are allergic to trastuzumab deruxtecan or any of the other ingredients of this medicine (listed in section 6).

If you are not sure if you are allergic, talk to your doctor or nurse before you are given Enhertu.

Warnings and precautions

Talk to your doctor or nurse before you are given Enhertu, or during treatment, if you have:

• cough, shortness of breath, fever, or other new or worsening breathing problems. These may be symptoms of a serious and potentially fatal lung disease called interstitial lung disease.
• chills, fever, sores in your mouth, stomach pain or pain when urinating. These may be symptoms of an infection caused by a reduced number of white blood cells called neutrophils.
• new or worsening shortness of breath, cough, tiredness, swelling of ankles or legs, irregular heartbeat, sudden weight gain, dizziness, or loss of consciousness. These may be symptoms of a condition in which your heart cannot pump blood well enough (decreased left ventricular ejection fraction).
• liver problems. Your doctor may have to monitor your liver while you are taking this medicine.

Your doctor will carry out tests before and during treatment with Enhertu.

Children and adolescents

Enhertu is not recommended for anyone under the age of 18 years. This is because there is no information on how well it works in this age group.

Other medicines and Enhertu

Tell your doctor or nurse if you are taking, have recently taken or might take any other medicines.

Pregnancy, breast-feeding, contraception and fertility

• Pregnancy

Enhertu is not recommended during pregnancy because this medicine may harm the unborn baby.

Speak with your doctor immediately if you are pregnant, think you may be pregnant or are planning to become pregnant before or during treatment.

• Breast-feeding

You should not breast-feed during treatment with Enhertu and for at least 7 months after your last dose. This is because it is not known whether Enhertu passes into breast milk. Talk to your doctor about this.

• Contraception

Use effective contraception (birth control) to avoid becoming pregnant while being treated with Enhertu.

Women taking Enhertu should continue contraception for at least 7 months after the last dose of Enhertu.

Men taking Enhertu whose partner may become pregnant should use effective contraception:

• – during treatment and

• – for at least 4 months after the last dose of Enhertu.

Talk to your doctor about the best contraception for you. Also talk to your doctor before you stop your contraception.

• Fertility

If you are a man being treated with Enhertu, you should not father a child for 4 months after treatment and take advice on conserving sperm before treatment because the medicine may reduce your fertility. Therefore, discuss this with your doctor before starting treatment.

Driving and using machines

Enhertu is not likely to reduce your ability to drive or use machines. Be careful if you feel tired, dizzy, or have a headache.

• 3. How you are given Enhertu

Enhertu will be given to you in a hospital or clinic:

• – The recommended dose of Enhertu is 5.4 mg for every kilogram of your weight, every

3 weeks.

• Your doctor or nurse will give you Enhertu by infusion (drip) into your vein.
• Your first infusion will be given over 90 minutes. If this goes well, the infusion on your next

visits may be given over 30 minutes.

• Your doctor will decide how many treatments you need.
• If you get infusion-related symptoms, your doctor or nurse may slow down your infusion or interrupt or stop your treatment.
• Before and during treatment with Enhertu, your doctor will carry out tests that may include:

• – blood tests to check your blood cells, liver and kidneys

• – testing to check your heart and lungs.

• Your doctor may lower your dose, or temporarily or permanently stop your treatment depending on your side effects.

If you miss an appointment to get Enhertu

Contact your doctor right away to reschedule your appointment.

It is very important that you do not miss a dose of this medicine.

If you stop receiving Enhertu

Do not stop treatment with Enhertu without checking with your doctor.

If you have any further questions on the use of this medicine, ask your doctor or nurse.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them. Tell your doctor if you get any side effects, including those not listed in this leaflet.

Speak with your doctor immediately if you notice any of the following symptoms. They may be signs of a serious, possibly fatal, condition. Getting medical treatment right away may help keep these problems from becoming more serious.

Very common (may affect more than 1 in 10 people)

• A lung disease called interstitial lung disease with symptoms that can include cough, shortness of breath, fever, or other new or worsening breathing problems
• An infection caused by reduced number of neutrophils (a type of white blood cell) with symptoms that can include chills, fever, sores in your mouth, stomach pain or pain when urinating
• A heart problem called decreased left ventricular ejection fraction with symptoms that can include new or worsening shortness of breath, cough, tiredness, swelling of ankles or legs, irregular heartbeat, sudden weight gain, dizziness or unconsciousness

Other side effects

Tell your doctor or nurse if you notice any of the following side effects:

Very common (may affect more than 1 in 10 people)

• nausea (feeling sick), vomiting
• constipation
• abdominal (belly) pain, indigestion
• decreased appetite
• diarrhoea
• tiredness
• hair loss, rash
• cough
• headache
• infections of the nose and throat, including flu-like symptoms
• blisters in or around your mouth
• breathing difficulties
• nosebleed
• dry eye
• dizziness
• blood tests showing low blood potassium level
• blood tests showing decreased red or white blood cells, or platelets
• blood tests showing increased levels of the liver enzymes aspartate aminotransferase or alanine

aminotransferase

Common (may affect up to 1 in 10 people)

• reactions related to the infusion of the medicine which may include fever, chills, flushing, itching or rash
• fever along with a decreased number of white blood cells called neutrophils

Reporting of side effects

If you get any side effects, talk to your doctor or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the national reporting system listed in By reporting side effects you can help provide more information on the safety of this medicine.

5. How to store Enhertu

Enhertu will be stored by healthcare professionals at the hospital or clinic where you receive treatment. The storage details are as follows:

• Keep this medicine out of the sight and reach of children.
• Do not use this medicine after the expiry date which is stated on the outer carton and vial after EXP. The expiry date refers to the last day of that month.
• Store in a refrigerator (2 °C – 8 °C). Do not freeze.
• The prepared solution for infusion is stable for up to 24 hours at 2 °C – 8 °C protected from light

and must be discarded thereafter.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help to protect the environment.

6. Contents of the pack and other information

What Enhertu contains

• The active substance is trastuzumab deruxtecan.

One vial of powder for concentrate for solution for infusion contains 100 mg of trastuzumab deruxtecan. After reconstitution, one vial of 5 mL solution contains 20 mg/mL of trastuzumab deruxtecan.

• The other ingredients are L-histidine, L-histidine hydrochloride monohydrate, sucrose, polysorbate 80.

What Enhertu looks like and contents of the pack

Enhertu is a white to yellowish-white lyophilised powder supplied in a clear amber vial with a rubber stopper, aluminium seal and plastic flip-off cap.

Each carton contains 1 vial.

Marketing Authorisation Holder

Daiichi Sankyo Europe GmbH

Zielstattstrasse 48

81379 Munich

Germany

Manufacturer

Daiichi Sankyo Europe GmbH

Luitpoldstrasse 1

85276 Pfaffenhofen

Germany

For any information about this medicine, please contact the local representative of the Marketing Authorisation Holder:

Hrvatska AstraZeneca d.o.o. Tel: +385 1 4628 000	Romania AstraZeneca Pharma SRL Tel: +40 21 317 60 41
Ireland Daiichi Sankyo Ireland Ltd Tel: +353-(0) 1 489 3000	Slovenija AstraZeneca UK Limited Tel: +386 1 51 35 600
island Daiichi Sankyo Nordics ApS Simi: +45 (0) 88 44 45 45	Slovenská republika AstraZeneca AB, o.z. Tel: +421 2 5737 7777
Italia Daiichi Sankyo Italia S.p.A. Tel: +39–06 85 2551	Suomi/Finland Daiichi Sankyo Nordics ApS Puh/Tel: +358 (0) 9 3540 7081
Kvnpog AXeKTop Oap^aKeuTiK^ At5 TqX: +357 22490305	Sverige Daiichi Sankyo Nordics ApS Tel: +46 (0) 40 699 2524
Latvija SIA AstraZeneca Latvija Tel: +371 67377100	United Kingdom (Northern Ireland) Daiichi Sankyo Europe GmbH Tel: +49 (0) 89 7808 0

This leaflet was last revised in {MM/YYYY}

This medicine has been given ‘conditional approval’. This means that there is more evidence to come about this medicine.

The European Medicines Agency will review new information on this medicine at least every year and this leaflet will be updated as necessary.

Other sources of information

Detailed information on this medicine is available on the European Medicines Agency web site: ------------------------------------------------------------------------------------------------------------------- The following information is intended for healthcare professionals only:

In order to prevent medicinal product errors, check the vial labels to ensure that the medicinal product being prepared and administered is Enhertu (trastuzumab deruxtecan) and not trastuzumab or trastuzumab emtansine.

Appropriate procedures for the preparation of chemotherapeutic medicinal products should be used. Appropriate aseptic technique should be used for the following reconstitution and dilution procedures

Reconstitution

• Reconstitute immediately before dilution.
• More than one vial may be needed for a full dose. Calculate the dose (mg), the total volume of reconstituted Enhertu solution required, and the number of vial(s) of Enhertu needed.
• Reconstitute each 100 mg vial using a sterile syringe to slowly inject 5 mL of water for injection into each vial to obtain a final concentration of 20 mg/mL.
• Swirl the vial gently until completely dissolved. Do not shake.
• Inspect the reconstituted solution for particulates and discolouration. The solution should be clear and colourless to light yellow. Do not use if visible particles are observed or if the solution is cloudy or discoloured.
• If not used immediately, store the reconstituted Enhertu vials in a refrigerator at 2 °C to 8 °C for up to 24 hours from the time of reconstitution, protected from light. Do not freeze.
• The reconstituted product contains no preservative and is intended for single use only.

Dilution

• Dilute the calculated volume of reconstituted Enhertu in an infusion bag containing 100 mL of 5% glucose solution. Do not use sodium chloride solution. An infusion bag made of polyvinylchloride or polyolefin (copolymer of ethylene and polypropylene) is recommended.
• Gently invert the infusion bag to thoroughly mix the solution. Do not shake.
• Cover the infusion bag to protect from light.
• If not used immediately, store at room temperature for up to 4 hours including preparation and infusion or in a refrigerator at 2 °C to 8 °C for up to 24 hours, protected from light. Do not freeze.
• Discard any unused portion left in the vial.

Administration

• If the prepared infusion solution was stored refrigerated (2 °C to 8 °C), it is recommended that the solution be allowed to equilibrate to room temperature prior to administration, protected from light.
• Administer Enhertu as an intravenous infusion only with a 0.20 or 0.22 micron in-line polyethersulfone (PES) or polysulfone (PS) filter.
• The initial dose should be administered as a 90-minute intravenous infusion. If the prior infusion was well tolerated, subsequent doses of Enhertu may be administered as 30-minute infusions. Do not administer as an intravenous push or bolus.
• Do not mix Enhertu with other medicinal products or administer other medicinal products through the same intravenous line.