Treatment Name: Brigatinib (Alunbrig)
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.
- 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.
The most commonly reported side effects of brigatinib 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.
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.
- 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 clinicaltrials.gov 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:
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.
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)