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About ARZERRA
ARZERRA is a prescription medicine called a monoclonal antibody. It is approved for:
- Patients who have chronic lymphocytic leukemia (CLL) and have not been treated before and whose doctor has decided not to treat them with a chemotherapy drug called fludarabine. ARZERRA is given with chlorambucil, a type of medicine called an alkylator chemotherapy
- Use with fludarabine and a chemotherapy drug called cyslophosphammide for patients whose CLL has relaped (come back)
- The continued follow-up treatment of patients who are in complete response (whose signs of cancer have disappeared) or partial response (whose extent of cancer has decreased) after being treated with at least two lines of therapy for their recurrent or progressive CLL
- Patients whose CLL is refractory (stopped responding) to treatment with fludarabine and alemtuzumab.
What is CLL?
Definition
Leukemia is a type of cancer that starts in the bone marrow from white blood cells called lymphocytes. CLL is a chronic disease whereby leukemia cells accumulate slowly over time and may spread from the bone marrow to the blood and other parts of the body (lymph nodes, spleen, and liver).
Symptoms and Diagnosis
Some patients do not have any symptoms when they are initially diagnosed with CLL, but the following are some symptoms that may indicate CLL:
- Weakness
- Tiredness
- Weight loss
- Fever
- Night sweats
- Lumps under the skin (which could be enlarged lymph nodes)
- Feeling full even after a very small meal, or feeling pain in the belly (which could be due to an enlarged spleen and/or liver)
After you have discussed your signs and symptoms, your doctor will want to take a complete medical history and perform a physical exam, with special attention to your lymph nodes and other parts of your body that may be affected. In order to confirm the diagnosis of CLL, you may be prescribed the following tests:
- Blood tests to measure the different types of cells in the blood (blood cell count) and determine whether any cells look abnormal
- Flow cytometry to detect certain substances on or in cells (markers), and identify what types of cells they are and if they are cancer cells
- Bone marrow tests (bone marrow aspiration and biopsy) to determine the extent of the disease and how advanced it is
- Genetic tests (examination of chromosomes) to determine whether there are any chromosome changes
- Lymph node biopsy is rarely used to diagnose CLL, but it could be used when the lymph nodes have grown very large to see if the disease has changed (transformation)
- Lumbar puncture (or spinal tap) to examine the fluid surrounding the brain and spinal cord if your doctor suspects that cancer cells have spread to these areas
- Imaging tests, such as computed tomography scan, magnetic resonance imaging, and ultrasound, to see how far the cancer has spread or if you are responding to the treatment you were given
Why ARZERRA?
ARZERRA has shown to be an effective treatment option for a variety of patients with CLL:
For adults with CLL who have not yet been treated, ARZERRA has shown to be an effective treatment option. In one clinical trial, previously untreated patients who took ARZERRA plus chlorambucil, a type of chemotherapy, were compared with patients who only took chlorambucil. The results from this trial showed that:
- Patients who took ARZERRA plus chlorambucil did not have their disease progress (advance) for a median of 22.4 months compared with a median 13.1 months for patients who only took chlorambucil
- The majority of patients – 82.4% – treated with ARZERRA plus chlorambucil had their CLL respond to treatment, vs 68.6% of patients treated with just chlorambucil
For patients with relapsed CLL, ARZERRA has been shown to be an effective treatment option. In one clinical trial, patients who took ARZERRA plus two chemotherapy drugs, called fludarabine and cyclophosphamide (FC), were compared with patients who only took FC. The results from this trial showed that:
- Patients who took ARZERRA plus FC did not have their disease progress (advance) for a median of 28.9 months compared with a median of 18.8 months for patients who only took FC
- The majority of patients treated with ARZERRA plus FC – 84% – had their CLL respond to treatment, compared with 68% of patients treated with just FC
For patients with CLL that has responded to treatment, either partially or completely, after having 2 or more different types of treatment, ARZERRA has shown be an effective form of follow-up treatment. In one clinical trial, patients who took ARZERRA alone as follow-up treatment were compared with those who had no follow-up treatment. The results from this trial showed that:
- Patients who took ARZERRA did not have their disease progress (advance) for a median of 29.4 months compared with 15.2 months for patients who did not have follow-up treatment
For patients with CLL who have stopped responding to treatment with a chemotherapy drug called fludarabine and another treatment called alemtuzumab, ARZERRA has shown be an effective treatment option. In one clinical trial, patients who stopped responding to fludarabine and alemtuzumab were treated with ARZERRA alone. The results from this trial showed that:
- 42% of patients given ARZERRA alone had their CLL respond to treatment
Dosing
How ARZERRA is given
ARZERRA is given by intravenous (IV) infusion; that is, through a needle placed in a vein in your arm. Before the treatment, you will be given 3 medicines to help decrease the chance of a possible reaction to the infusion. These medicines are a pain reliever, an antihistamine to reduce allergic reactions, and a steroid to reduce swelling and other symptoms of inflammation. Your health care provider will tell you where you will receive the treatment—for example, a hospital, clinic, or treatment facility.
How long is each infusion of ARZERRA?
Your first infusion of ARZERRA may last 5 hours or longer. The rest of your infusions may take 4 to 4.5 hours. Your health care provider will watch you carefully to see how your body reacts to ARZERRA. That will help him or her know how slowly you should receive your infusion. How long your entire treatment visit may take will depend on how your body reacts to the infusion.
Infusion Schedules
Treatment with ARZERRA is scheduled as follows, based on your condition:
Your treatment will be scheduled in 28-day cycles. You will receive 2 infusions during the first cycle (300 mg on Day 1 and 1000 mg on Day 8). On Day 1 of the following cycles, you will receive a 1000-mg infusion for at least 3 cycles, until best response, or as many as 12 cycles. Your doctor will decide the number of treatment cycles you’ll receive, depending on how your CLL responds to the treatment.
This is an example of an infusion schedule. Your health care provider will decide what infusion schedule is right for you.
Your treatment will be scheduled in 28-day cycles. You will receive 2 infusions during the first cycle (300 mg on Day 1 and 1000 mg on Day 8). On Day 1 of the following cycles, you will receive a 1000-mg infusion for as many as 6 cycles. Your doctor will decide the number of treatment cycles you’ll receive, depending on how your CLL responds to the treatment.
This is an example of an infusion schedule. Your health care provider will decide what infusion schedule is right for you.
You will receive 300 mg on Day 1 and 1000 mg on Day 8. You will then receive 1000 mg 7 weeks later and every 8 weeks for a maximum of 2 years. Your doctor will decide the number of treatment cycles you’ll receive, depending on how your CLL responds to the treatment.
You will receive 300 mg on Day 1, then 1 week later, you will receive 2000 mg weekly for 7 doses. Four weeks later, you will receive 2000 mg every 4 weeks for 4 doses.
This is an example of an infusion schedule. Your health care provider will decide what infusion schedule is right for you.
Infusion Reactions
Treatment with ARZERRA may cause a side effect called an infusion reaction, which may be serious and may even lead to death in some people. Your doctor or nurse will stop your treatment so the infusion reaction can be treated. If you experience severe allergic reactions (anaphylaxis), your infusion will be stopped and you will not continue treatment with ARZERRA. If a reaction occurs, it is most likely to happen with the first 2 infusions and less likely with later infusions.
Signs and symptoms of infusion reactions may include:
- Fever
- Chills
- Rash
- Hives
- Chest pain
- Back pain
- Stomach pain
- Swelling
- Dizziness
- Blurred vision
- Drowsiness
- Headache
- Cough
- Wheezing
- Trouble breathing
Most Common Side Effects
- Infusion reactions
- Low white blood cell count
- Pneumonia
- Fever
- Cough
- Diarrhea
- Low red blood cell count
- Feeling tired
- Shortness of breath
- Rash
- Nausea
- Bronchitis
- Upper respiratory tract infection
Tell your health care provider right away if you have any of the following serious side effects during or after treatment:
- Fever
- Chills
- Rash
- Cough
- Breathing problems
- Bleeding
- Bruise easily
- Small red or purple spots on the skin
- Pale skin
- Feeling tiredness or weakness that is worse than before
- Confusion
- Dizziness or loss of balance
- Trouble talking
- Trouble walking
- Vision problems
- New or worsening abdominal pain or nausea
- Generally feeling much sicker than before
Other Serious Side Effects
Use of ARZERRA may cause:
- Hepatitis B virus reactivation or infection
- Progressive multifocal leukoencephalopathy, a potentially deadly brain disease
- Tumor lysis syndrome, a complication from cancer treatment that may cause damage to certain organs of the body, such as the heart and kidneys
- Cytopenias, conditions that reduce the creation of blood cells
These are not all of the possible side effects of ARZERRA. Tell your health care provider about any side effects you experience.
For more information about ARZERRA, speak to your health care provider.
In addition, click here to download the "What You Need to Know About ARZERRA" PDF booklet.
Patient Assistance
Novartis Oncology is committed to helping patients who are living with cancer receive the medicines they need. Patient Assistance Now Oncology (PANO) offers quick and easy access to information about our wide range of resources.
You can get information about our PANO support programs in 2 ways:
- Call 1-800-282-7630 to speak with a member of our knowledgeable staff dedicated to making access to therapy as simple and convenient as possible; or
- Visit our website at: www.OncologyAccessNow.com/patient
