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Active Substance: vandetanib
Common Name: vandetanib
ATC Code: L01XE
Marketing Authorisation Holder: Genzyme Europe BV
Active Substance: vandetanib
Status: Authorised
Authorisation Date: 2012-02-17
Therapeutic Area: Thyroid Neoplasms
Pharmacotherapeutic Group: Antineoplastic and immunomodulating agents

Therapeutic Indication

Caprelsa is indicated for the treatment of aggressive and symptomatic medullary thyroid cancer (MTC) in patients with unresectable locally advanced or metastatic disease.

For patients in whom re-arranged-during-transfection(RET) mutation is not known or is negative, a possible lower benefit should be taken into account before individual treatment decision.

What is Caprelsa?

Caprelsa is a medicine that contains the active substance vandetanib. It is available as tablets (100 mg and 300 mg).

What is Caprelsa used for?

Caprelsa is used to treat medullary thyroid cancer, a type of cancer affecting the thyroid gland that originates in the cells that produce the hormone calcitonin. It is used when the disease is aggressive and causes symptoms, and when the cancer cannot be removed by surgery and has progressed or spread to other parts of the body.

The medicine can only be obtained with a prescription.

How is Caprelsa used?

Treatment should be started and supervised by a doctor who has experience in treating medullary thyroid cancer, using anticancer medicines and assessing electrocardiograms (ECGs, tests that measure the electrical activity of the heart). Patients must be given a patient alert card containing important safety information and must be informed by their doctor about the risks of Caprelsa.

The recommended dose is 300 mg once a day, taken at around the same time each day. Patients who have difficulty swallowing tablets can mix the tablet in still water (no other liquids should be used).

The patient’s QTc interval (a measure of the electrical activity of the heart) and certain blood values should be assessed in advance and monitored during treatment. The doctor should stop treatment if the QTc interval reaches 500 milliseconds or above or if the patient experiences severe side effects, until an improvement is seen, after which treatment may be restarted at a lower dose.

The benefits of Caprelsa may be smaller for patients who do not have a mutation in a gene called the ‘re-arranged during transfection’ (RET) gene or if this is not known, and this should be taken into account when deciding whether to start treatment. For this purpose, it is recommended that the RET mutation status be tested before starting treatment with Caprelsa.

How does Caprelsa work?

The active substance in Caprelsa, vandetanib, is a ‘protein-tyrosine-kinase inhibitor’. This means that it blocks the activity of enzymes known as tyrosine kinases. These enzymes can be found in certain receptors (such as VEGF, EGF and RET receptors) on the surface of cancer cells, where they activate several processes including cell division and the growth of new blood vessels. By blocking the activity of VEGF receptors, the medicine reduces the blood supply to the cancer cells, slowing down the cancer’s growth. By blocking the activity of EGF receptors, the cancer cells no longer receive the messages needed for growth and multiplication. Vandetanib also blocks the activity of RET receptors, which play a role in the growth of medullary thyroid cancer cells.

How has Caprelsa been studied?

The effects of Caprelsa were first tested in experimental models before being studied in humans.

Caprelsa was compared with placebo (a dummy treatment) in a main study involving 331 patients with thyroid cancer that could not be removed by surgery or had spread to other parts of the body. The main measure of effectiveness was progression-free survival (how long the patients lived without their disease getting worse).

What benefit has Caprelsa shown during the studies?

Caprelsa was more effective than placebo at prolonging progression-free survival. On average, patients taking Caprelsa lived for 30.5 months without their disease getting worse, compared with 19.3 months for patients taking placebo.

What is the risk associated with Caprelsa?

The most commonly reported side effects with Caprelsa are diarrhoea, rash, nausea (feeling sick), hypertension (high blood pressure) and headache. For the full list of all side effects reported with Caprelsa, see the package leaflet.

Caprelsa must not be used in people who are hypersensitive (allergic) to vandetanib or any of the other ingredients. It must not be used in people with a heart problem called ‘congenital long QTc syndrome’ or who have a QTc interval over 480 milliseconds. It must not be used in women who are breast-feeding. Caprelsa must not be used in patients who are taking certain other medicines that can prolong the QTc interval. For the full list of restrictions, see the package leaflet.

Why has Caprelsa been approved?

The CHMP concluded that Caprelsa was shown to be effective in the treatment of medullary thyroid cancer although there were uncertainties about the size of the benefit in patients whose RET mutation status is negative or unknown. The Committee noted the potential risk for QTc interval prolongation, and measures were introduced to minimise this risk. The CHMP concluded that the benefits of Caprelsa outweigh its risks in patients whose disease is both aggressive and causes symptoms, since they are in urgent need of treatment. Therefore, the Committee recommended that Caprelsa be granted marketing authorisation.

Caprelsa has been given ‘conditional approval’. This means that there is more evidence to come about the medicine, in particular on the size of the benefit in patients without the RET mutation. Every year, the European Medicines Agency will review any new information that may become available and this summary will be updated as necessary.

What information is still awaited for Caprelsa?

The company that markets Caprelsa will carry out a study in patients with medullary thyroid cancer to compare the effects of Caprelsa in patients with and without the RET mutation.

What measures are being taken to ensure the safe use of Caprelsa?

The company that markets Caprelsa will ensure that doctors who are expected to prescribe Caprelsa receive educational material containing important safety information about Caprelsa, including measures to manage the risk of QTc prolongation and other potential side effects, and a patient alert card.

Other information about Caprelsa

The European Commission granted a marketing authorisation valid throughout the European Union for Caprelsa on 17 February 2012.

For more information about treatment with Caprelsa, read the package leaflet (also part of the EPAR) or contact your doctor or pharmacist.

Source: European Medicines Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.