Starting AYVAKIT—one tablet, once-daily dosing1
The recommended dosage of AYVAKIT for Advanced SM is 200 mg orally once daily.
AYVAKIT should be taken1:
One tablet orally
One time each day
On an empty stomach, at least 1 hour before or 2 hours after a meal
Do not initiate AYVAKIT in patients with platelet counts <50 x 109/L.
Treatment should continue until disease progression or unacceptable toxicity.
Do not take an additional dose if vomiting occurs after AYVAKIT has been taken, but continue with the next scheduled dose.
AYVAKIT is also available in dose strengths of 100 mg, 50 mg, and 25 mg for dose modification for adverse reactions or drug interactions (for example, CYP3A inhibitors).
Avoid coadministration of AYVAKIT with strong or moderate CYP3A inhibitors. If coadministration with a moderate CYP3A inhibitor cannot be avoided, reduce dose of AYVAKIT. Avoid coadministration of AYVAKIT with strong or moderate CYP3A inducers. If contraception requires estrogen, limit ethinyl estradiol to ≤20 mcg unless a higher dose is necessary.
Watch Dr McCloskey review information about managing patients who have started treatment with AYVAKIT.
Patient monitoring for initiating and continuing treatment with AYVAKIT1
PLATELET MONITORING
A platelet count must be performed prior to initiation of therapy, during the first 8 weeks of treatment, and potentially longer depending on what is clinically indicated. AYVAKIT is not recommended for patients with platelet counts <50 x 109/L.1
| Time on therapy | Monitoring plan | Treatment plan |
|---|---|---|
| Prior to initiation | Perform platelet count. | AYVAKIT is not recommended in Advanced SM patients with platelet counts <50 x 109/L. |
| First 8 weeks | Perform platelet count every 2 weeks regardless of baseline platelet count. | Due to risk of ICH, dose interruption or reduction should be considered if platelet counts decrease below 50 x 109/L during treatment. If platelet count <50 x 109/L occurs, interrupt AYVAKIT until platelet count is ≥50 x 109/L, then resume at reduced dose. If platelet counts do not recover above 50 x 109/L, consider platelet support. |
| After 8 weeks | Monitor platelet counts:
|
Monitor patients closely for risk factors of ICH which may include history of vascular aneurysm, ICH or cerebrovascular accident within the prior year, concomitant use of anticoagulant drugs, or thrombocytopenia.
If any ICH occurs, permanently discontinue AYVAKIT.
Manage platelet counts of <50 x 109/L by treatment interruption or dose reduction of AYVAKIT. Platelet support may be necessary.
It was common to modify AYVAKIT dosage1
MANY PATIENTS IN THE EXPLORER AND PATHFINDER TRIALS HAD THEIR DOSE REDUCED OR INTERRUPTED DUE TO ADVERSE REACTIONS1
AYVAKIT DOSE REDUCTIONS AND INTERRUPTIONS IN CLINICAL TRIALS1
Among patients with Advanced SM in clinical trials who started at 200 mg (N=80), many patients had their dose modified.
60%
Dose interruption1
68%
Dose reduction (median time to reduction: 6.9 weeks)1,2
10%
Permanent discontinuation due to adverse reaction1
Adverse reactions requiring dosage interruption or dose reduction in >2% of patients who received AYVAKIT at 200 mg once daily:
- Thrombocytopenia
- Neutropenia
- Edema peripheral
- Neutrophil count decreased
- Platelet count decreased
- Periorbital edema
- Cognitive disorder
- Anemia
- Fatigue
- Arthralgia
- Blood alkaline phosphatase increased
- White blood cell count decreased
RECOMMENDED DOSE REDUCTIONS FROM THE 200 MG ONCE-DAILY STARTING DOSE1
| Recommended dose reductions for adverse reactions | |
|---|---|
| Dose Reduction | Starting Dose (200 mg)a |
| First | 100 mg once daily |
| Second | 50 mg once daily |
| Third | 25 mg once daily |
aPermanently discontinue AYVAKIT in patients who are unable to tolerate a dose of 25 mg daily.
RECOMMENDED DOSE MODIFICATIONS FOR PATIENTS EXPERIENCING ADVERSE REACTIONS1
| Adverse Reaction | Severityb | Dosage Modification |
|---|---|---|
| Intracranial Hemorrhage | Any Grade | Permanently discontinue AYVAKIT. |
| Cognitive Effects | Grade 1 | Continue AYVAKIT at same dose or reduced dose or withhold until improvement to baseline or resolution. Resume at same dose or reduced dose. |
| Grade 2 or Grade 3 | Withhold AYVAKIT until improvement to baseline, Grade 1, or resolution. Resume at same dose or reduced dose. | |
| Grade 4 | Permanently discontinue AYVAKIT. | |
| Thrombocytopenia | <50 x 109/L | Interrupt AYVAKIT until platelet count is ≥50 x 109/L, then resume at reduced dose per the recommended reductions. If platelet counts do not recover above 50 x 109/L, consider platelet support. |
| Other | Grade 3 or Grade 4 | Withhold AYVAKIT until improvement to Grade ≤2. Resume at same dose or reduced dose, as clinically appropriate. |
bSeverity as defined by the National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0.
For further information on dose modifications and patient monitoring, review the Prescribing Information and download the AYVAKIT Dosing and Administration Guide
For patients experiencing adverse reactions, dose modification may be necessary1
For patients who experience certain adverse reactions, additional information is provided below and in the AYVAKIT Prescribing Information to help guide in modifying and managing their treatment.
Intracranial Hemorrhage (ICH)1
Thrombocytopenia1
Cognitive Effects1
Other Adverse Reactions1
See hypothetical profiles of patients taking AYVAKIT
References: 1. AYVAKIT [prescribing information]. Cambridge, MA: Blueprint Medicines Corporation; November 2024. 2. Data on file. Blueprint Medicines Corporation, Cambridge, MA.