(vis moe DEG ib)
- Hedgehog Antagonist GDC-0449
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Erivedge: 150 mg
Brand Names: U.S.
- Antineoplastic Agent, Hedgehog Pathway Inhibitor
Basal cell cancer is associated with mutations in Hedgehog pathway components. Hedgehog regulates cell growth and differentiation in embryogenesis; while generally not active in adult tissue, Hedgehog mutations associated with basal cell cancer can activate the pathway resulting in unrestricted proliferation of skin basal cells. Vismodegib is a selective Hedgehog pathway inhibitor which binds to and inhibits Smoothened homologue (SMO), the transmembrane protein involved in Hedgehog signal transduction.
Vd: 16.4 to 26.6 L
Males: In a small pharmacokinetic study, the average vismodegib concentration in semen was 6.5% of the average steady state plasma concentration on day 8
Metabolized by oxidation, glucuronidation, and pyridine ring cleavage, although >98% of circulating components are as the parent drug
Feces (82%); urine (4%)
Time to Peak
~2.4 days (Graham 2011)
Continuous daily dosing: ~4 days; Single dose: ~12 days
>99%; primarily to serum albumin and alpha1 acid glycoprotein (AAG)
Special Populations: Hepatic Function Impairment
In patients with mild hepatic impairment (normal total bilirubin and AST >ULN or total bilirubin >1 to 1.5 times ULN), the mean systemic vismodegib exposure was increased 24% as compared to patients with normal hepatic function. Systemic exposure was increased 31% in patients with moderate impairment (total bilirubin >1.5 to 3 times ULN) and decreased 14% in patients with severe impairment (total bilirubin >3 to 10 times ULN), respectively, compared to patients with normal hepatic function.
Use: Labeled Indications
Basal cell carcinoma, metastatic or locally advanced: Treatment of metastatic basal cell carcinoma, or locally-advanced basal cell carcinoma that has recurred following surgery or in patients who are not candidates for surgery, and not candidates for radiation therapy
There are no contraindications listed in the manufacturer’s US labeling.
Canadian labeling: Hypersensitivity to vismodegib or any component of the formulation; pregnancy or females at risk of becoming pregnant; breast-feeding; male patients or female patients of childbearing potential who do not comply with the Erivedge Pregnancy Prevention Program; children and adolescents <18 years of age.
Basal cell carcinoma, metastatic or locally advanced: Oral: 150 mg once daily until disease progression or unacceptable toxicity.
Missed doses: If a dose is missed, do not make up; resume dosing with the next scheduled dose.
Dosing: Renal Impairment
No dosage adjustment necessary.
Dosing: Hepatic Impairment
No dosage adjustment necessary.
Dosing: Adjustment for Toxicity
In clinical trials, no dosage reductions were allowed for toxicities, however, treatment interruptions up to 4 to 8 weeks were allowed for toxicity recovery (Basset-Seguin 2015; Sekulic 2012).
Oral: May be taken with or without food. Swallow capsules whole; do not open or crush.
Store at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). Keep bottle closed tightly to protect from moisture.
There are no known significant interactions.
Central nervous system: Fatigue (40%)
Dermatologic: Alopecia (64%)
Endocrine & metabolic: Amenorrhea (≤30%)
Gastrointestinal: Dysgeusia (55%), weight loss (45%), nausea (30%), diarrhea (29%), decreased appetite (25%), constipation (21%), vomiting (14%), ageusia (11%)
Neuromuscular & skeletal: Muscle spasm (72%), arthralgia (16%)
1% to 10%:
Endocrine & metabolic: Hypokalemia, hyponatremia
Neuromuscular & skeletal: Increased creatinine phosphokinase
Concerns related to adverse effects:
• Amenorrhea: Amenorrhea was observed in women of reproductive potential; it is unknown if this is reversible.
• Gastrointestinal toxicity: Nausea, vomiting, diarrhea, constipation, abdominal pain, and decreased appetite may occur (usually grade 1 or 2).
Concurrent drug therapy issues:
• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.
• Pediatrics: Premature fusion of the epiphyses has been reported in pediatric patients exposed to vismodegib; the fusion progressed after vismodegib discontinuation in some cases.
• Pregnancy: [US Boxed Warnings]: May result in severe birth defects or embryo-fetal death. Teratogenic effects (severe midline defects, missing digits, and other irreversible malformations), embryotoxic, and fetotoxic events were observed in animal reproduction studies. Verify pregnancy status (in females of reproductive potential) within 7 days prior to initiating treatment and advise patients (female and male) of the risk of birth defects, the need for contraception and risk of exposure through semen and to use condoms with a pregnant partner or a female partner of childbearing potential.
• Blood donations: Advise patients not to donate blood or blood products during vismodegib treatment and for at least 24 months after the last vismodegib dose.
• Semen donations: Vismodegib is present in semen, although the amount of drug in semen that may cause embryotoxicity and/or fetotoxicity is not known. Advise male patients not to donate sperm during vismodegib treatment and for 3 months after the last vismodegib dose.
• Toxicity duration: In a study of vismodegib in patients with basal cell nevus syndrome (not an approved use), with discontinuation of vismodegib treatment, taste alteration and muscle cramps abated within 1 month, and scalp and body hair began to regrow within 3 months (Tang 2012).
Pregnancy test within 1 week prior to treatment initiation.
[US Boxed Warning]: May result in severe birth defects or embryo-fetal death. Teratogenic effects (severe midline defects, missing digits, and other irreversible malformations), embryotoxic, and fetotoxic events were observed in animal reproduction studies when administered in doses less than the normal human dose. Based on its mechanism of action adverse effects on pregnancy would be expected. [US Boxed Warning]: Verify pregnancy status (in females of reproductive potential) within 7 days prior to initiating treatment and advise patients (female and male) of the risk of birth defects, the need for contraception and risk of exposure through semen and to use condoms with a pregnant partner or a female partner of childbearing potential. In females of childbearing potential, obtain pregnancy test within 7 days prior to treatment initiation; after the negative pregnancy test, initiate highly effective contraception prior to the first vismodegib dose and continue during treatment and for 24 months after the final dose. During treatment (including treatment interruptions) and for 3 months after treatment, male patients should not donate sperm and should use condoms with spermicide (even after vasectomy) if their partner is of childbearing potential.
Women exposed to vismodegib during pregnancy (directly or via seminal fluid) are encouraged to participate in the Erivedge Pregnancy Pharmacovigilance program by contacting the Genentech Adverse Event Line (1-888-835-2555). Pregnancies occurring during or within 7 months after treatment should be reported to the Genentech Adverse Event Line.
In Canada, vismodegib is available only through a controlled distribution program (Erivedge Pregnancy Prevention Program). Female and male patients of reproductive potential must be registered with the program and comply with all requirements. Females of childbearing potential should use 2 simultaneous forms of effective contraception beginning at least 4 weeks prior to treatment initiation, during treatment (including treatment interruptions), and for 24 months after discontinuation. Pregnancy testing should be performed within 7 days prior to treatment initiation, monthly during treatment (including treatment interruptions), and for 24 months after discontinuation. For females of child bearing potential, a new prescription is required each month to allow for monthly pregnancy testing. During treatment (including treatment interruptions) and for 2 months after treatment, male patients should not donate sperm and should use condoms with spermicide (even after vasectomy) if their partner is of childbearing potential. Any suspected exposure (directly or via seminal fluid) during pregnancy should be immediately reported to the Erivedge Pregnancy Prevention Program at 1-888-748-8926.
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Patient may experience nausea, vomiting, alopecia, constipation, lack of appetite, loss of strength and energy, weight loss, diarrhea, muscle pain, joint pain, or change in taste (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
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- Drug class: hedgehog pathway inhibitors
Other brands: Erivedge