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Treatment Name: Brigatinib (Alunbrig®)

Brigatinib (Alunbrig®) is a Treatment Regimen for Lung Cancer, Non-Small Cell Lung Cancer (NSCLC)

How does brigatinib (Alunbrig™) work?
Brigatinib is a tyrosine kinase inhibitor (TKI) designed to bind to and block the function of a mutated protein called “anaplastic lymphoma kinase” (ALK) present in certain Non-Small Cell Lung Cancer (NSCLC) cells. The mutated ALK protein causes the cancer cell to grow and divide more rapidly than healthy lung cells. Approximately 2% to 7% of patients with NSCLC have this mutation. By blocking the function of the abnormally active ALK protein, brigatinib slows the growth of the cancer and causes some of the cancer cells to die.

Goals of therapy:
Brigatinib is given to patients to slow the progression and to stop the spreading of the disease in patients who have progressed or are intolerant to Crizotinib (Xalkori®). Brigatinib is not usually given with the goal of cure.


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  • Usual Brigatinib (Alunbrig™) starting dose: 90 mg oral tablet daily for seven days
    • If tolerated, beginning Day 8, the dose is increased to 180 mg (two 90 mg tablets) once daily thereafter
    • Brigatinib may be taken with or without food

Brigatinib is usually taken at home every day until it no longer works or unacceptable side effects are experienced.

Note: Individual doses may vary based upon your Doctor's recommendation, or drug availability.

Side Effects

The most commonly reported brigatinib side effects for NSCLS are shown here. Side effects sometimes have percentage ranges [example: 38 – 49%] because the doses in the clinical study ranged from 90 mg to 180 mg daily:

  • High blood sugar [hyperglycemia] (38 - 49%)
  • Nausea (33 - 40%)
  • Low red blood cells [anemia] (23 - 40%)
  • Diarrhea (19 - 38%)
  • Fatigue (29 - 36%)
  • Cough (18 - 34%)
  • Headache (27 - 28%)
  • Shortness of breath (21 - 27%)
  • Vomiting (23 - 24%)
  • Rash (15 - 24%)
  • Decreased appetite (15 - 22%)
  • High blood pressure (11 - 21%)
  • Constipation (15 - 19%)
  • Muscle spasms (12 - 17%)
  • Abdominal pain (10 - 17%)
  • Back pain (10 - 15%)
  • Joint pain (14%)
  • Fever (6 - 14%)
  • Nerve pain (13%)
  • Trouble sleeping (7 - 11%)
  • Vision changes (7 - 10%)
  • Pneumonia (5 - 10%)

Roughly 3% to 8% of patients discontinued brigatinib due to unacceptable side effects.

Side effect videos Side Effect Videos
Nausea and VomitingNausea and VomitingAnemiaAnemiaDiarrheaDiarrheaFatigue Fatigue ConstipationConstipationPainPain


How often is monitoring needed?
Labs (blood tests) may be checked before treatment then monthly until stable. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), blood glucose (sugar), amylase, lipase, creatine phosphokinase (CPK) plus any others your doctor may order. Your doctor may assess for visual changes during treatment, a slow heart rate, high blood pressure, or interstitial lung diseases (ILD), which are lung diseases that can scar the lungs. Your doctor may recommend a pregnancy test prior to starting therapy with brigatinib if you are a woman of childbearing potential.

How often is imaging needed?
Imaging may be checked before treatment and periodically during treatment or until stable. Imaging may include: magnetic resonance imaging (MRI), computerized tomography (CT) scan, or positron emission tomography (PET) scans.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue brigatinib as planned, reduce the dose of future treatments, delay the next dose until the side effect goes away, or switch to an alternative therapy.

A blood test known as serum creatine phosphokinase (CPK) may be recommended by your doctor if you have new or worsening unexplained muscle pain, tenderness or weakness.

If you are diabetic, monitor and record your blood sugar readings regularly to let your doctor know if they under control Brigatinib may cause pancreas enzyme increases in the blood. This could be a sign of pancreatitis. Tell your doctor if you have abdominal pain or discomfort, nausea, vomiting, or a change in bowel habits.

ChemoExperts Tips

  • Report any new or worsening problems with breathing. Serious lung reactions may occur while taking brigatinib
  • High blood pressure may occur while taking brigatinib. Keep a journal of your blood pressure recordings and bring it to your clinic visits
  • Because brigatinib may slow the heart rate, be sure to tell your doctor if you are taking any heart or blood pressure medications
  • Hormonal contraceptives may not be effective if taken with brigatinib. Therefore, women of childbearing age should use non-hormonal forms of birth control while taking brigatinib and advised not to become pregnant for four months following the final dose. Women should not breast feed while taking brigatinib as it is not known if brigatinib is secreted into human breast milk
  • Tell your doctor if you have any changes in vision after starting treatment with brigatinib
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for Non-Small Cell Lung Cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to to search for other centers offering study medications

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Brigatinib (Alunbrig®), we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Brigatinib (Alunbrig®). Depending upon your income, they may be able to help cover the cost of:

  • Brigatinib

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Brigatinib (Alunbrig®) and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with Brigatinib (Alunbrig®)

Individual Drug Label Information

Brigatinib (Alunbrig®)

  • Is a white to off-white oral tablet in 30 mg or 90 mg doses
  • Warnings and Precautions include: interstitial lung disease or lung inflammation, high blood pressure, slow heart rate, vision disturbances/changes, serum creatine phosphokinase (CPK) elevation (a blood test), pancreas enzyme elevation (blood tests), high blood sugar, and potential risk to a fetus
  • Brigatinib is usually taken with or without food and swallowed whole. Brigatinib should not be crushed or chewed. Take at the same time every day
  • If you miss a dose or vomit-up a dose, do not take an additional dose. Take the next dose when it is due at the regular scheduled time
  • Store tablets at room temperature 59°F to 86°F (15°C to 30°C), ideally between 68°F to 77°F (20°C to 25°C) 
  • Dosage adjustments may be required based on tolerability or side effects
  • May interact with grapefruit and grapefruit juice, pomegranate, star fruit, or seville oranges (in marmalade) causing increased blood levels of brigatinib. This could increase your risk of experiencing side effects. Avoid eating or drinking these foods during treatment 
  • Do not take St. John’s Wort while on brigatinib
  • May interact with prescription or over-the-counter medications. Have a pharmacist check for drug interactions before starting therapy
  • Women of child bearing age should use non-hormonal forms of birth control while on brigatinib and not become pregnant for four months following the final dose. Women should not breast feed while on this drug
  • Men taking this drug should use contraception while taking brigatinib for at least three months following the final dose
General side effects from brigatinib (Alunbrig™):
  • High blood sugar [hyperglycemia]
  • Nausea
  • Fatigue
  • Headache
  • Shortness of breath
  • Vomiting
  • Low red blood cells [anemia]
  • Decreased appetite
  • Diarrhea
  • Constipation
  • Cough
  • Abdominal pain
  • Rash
  • Joint pain
  • Fever
  • Nerve pain
  • Muscle spasms
  • High blood pressure
  • Trouble sleeping
  • Back pain
  • Vision changes
  • Pneumonia
  • Click on the brigatinib (Alunbrig™) package insert below for reported side effects, possible drug interactions, and other drug prescribing information

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaFatigue Fatigue ConstipationConstipationPainPainAnemiaAnemia

See DailyMed package insert.

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1) Gettinger SN, Bazhenova LA, Langer CJ, et al. Activity and safety of brigatinib in ALK-rearranged non-small-cell lung cancer and other malignancies: a single-arm, open-label, phase 1/2 trial. Lancet Oncol. 2016;17:1683-1696.

2) Sabari JK, Santini FC, Schram AM, et al. The activity, safety, and evolving role of brigatinib in patients with ALK-rearranged non-small cell lung cancers. Onco Targets Ther. 2017;10:1983-1992.

Created: July 14, 2017 Updated: November 6, 2018

What is Lung Cancer, Non-Small Cell Lung Cancer (NSCLC)?

What is Non-Small Cell Lung Cancer?
A disease of the tissue found in the lung.  Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. Known causes include smoking and exposure to environmental toxins.  The stage of NSCLC can vary at diagnosis and throughout treatment.  Stages include stage I, II, III, and IV.  The effectiveness of the treatment may depend upon the stage at diagnosis.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What does Cure mean?

The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.

Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

14) Serum calcium

What is amylase?

Amylase is an enzyme that is produced by the pancreas that helps the body break down and digest carbohydrates. When the pancreas is injured, amylase is leaked out into the blood. 

Amylase, along with lipase, can be monitored to check for possible injury to the pancreas, indicated by elevated levels of the enzymes in the blood.

What is Lipase?

Lipase is an enzyme that is produced by the pancreas that helps the body break down fats. When the pancreas is injured, lipase is leaked out into the blood. Lipase, along with amylase, can be monitored to check for possible injury to the pancreas, indicated by elevated levels of the enzymes in the blood.

What is Creatine phosphokinase (CPK)?

Creatine phosphokinase (CPK) is a muscle breakdown product and can increase in the blood if the either muscle is rapidly breaking down, the kidneys are not working well, or both. An elevation well above the normal range, may suggest muscle damage