Zydelig

• There have been reports of serious infections in clinical studies with the cancer medicine Zydelig. Some changes have now been made in how the medicine is used to ensure it is given as safely as possible.
• If you are taking Zydelig, you will receive antibiotics to prevent a type of lung infection (Pneumocystis jirovecii pneumonia). Because some infections have occurred after patients had finished their cancer treatment, you will have to keep taking these antibiotics for 2 to 6 months after stopping Zydelig.
• Your doctor will regularly check you for signs of infections. If you develop fever, cough or difficulty breathing you should contact your doctor straight away.
• You will have regular blood tests to check if you have a low white blood cell count, as a low count can put you at more risk of developing an infection. Your doctor may stop your treatment with Zydelig if your white blood cell count is too low
• You should not stop Zydelig without speaking to your doctor. If you are taking Zydelig and have any questions or concerns speak to your doctor, nurse or pharmacist.

• Increased rates of serious adverse effects including deaths were seen in the treatment arm of 3 clinical trials² evaluating the addition of Zydelig to standard therapy in first-line treatment of CLL and relapsed indolent non-Hodgkin lymphoma. The percentage of deaths in the treatment arms was 8% in the CLL study and 8% and 5% in the lymphoma studies, compared with 3%, 6% and 1% respectively in the placebo arms. The additional deaths were mainly caused by infections, including Pneumocystis jirovecii pneumonia and cytomegalovirus infections.
• These studies included patients with disease characteristics that were different from those covered by the currently approved indications for Zydelig and investigated use with treatment combinations that are not currently licensed and which may have influenced the infection rate. The relevance of these results to the authorised use of Zydelig is therefore limited, but suggests a need to strengthen measures to minimise the risk of infection.
• Provided that strengthened measures are followed to minimise the risk of infection (see below), Zydelig can continue to be used in combination with rituximab in CLL patients who have received at least one prior therapy, and as monotherapy in patients with follicular lymphoma that is refractory to two lines of treatment.
• Zydelig may also be used in combination with rituximab, as first line treatment in CLL in the presence of 17p deletion or TP53 mutation provided patients cannot take any alternative treatment and provided again that the below measures are followed to reduce the risk of infection.
• Patients should be informed about the risk of serious infections with Zydelig. Zydelig must not be started in patients with any evidence of ongoing systemic infection.
• All patients should receive prophylaxis for P. jirovecii pneumonia during Zydelig treatment and for 2 to 6 months after stopping treatment. Patients should be monitored for respiratory signs and symptoms. Regular clinical and laboratory monitoring for cytomegalovirus infection is also recommended and specific guidance is included in the updated summary of product characteristics (SmPC).
• Patients should also have regular checks of their blood counts to detect neutropenia. If the patient develops severe neutropenia, treatment with Zydelig may have to be interrupted, in line with the updated SmPC.

A letter will be sent to healthcare professionals, advising them of these changes.

²GS-US-312-0123 a phase 3, randomised, double blind, placebo-controlled study evaluating the efficacy and safety of idelalisib in combination with bendamustine and rituximab for previously untreated CLL; GS-US-313-0124 a phase 3, randomised, double blind, placebo-controlled study evaluating the efficacy and safety of idelalisib in combination with rituximab for previously treated iNHL; GS-US-313-0125 a phase 3, randomised, double blind, placebo-controlled study evaluating the efficacy and safety of idelalisib in combination with bendamustine and rituximab for previously treated iNHL.

Zydelig is a cancer medicine containing the active substance idelalisib. In the EU, Zydelig is authorised for the treatment of two cancers of white blood cells, chronic lymphocytic leukaemia and follicular lymphoma (one of a group of cancers called non-Hodgkin's lymphomas).

• In chronic lymphocytic leukaemia, Zydelig is used in combination with another medicine (rituximab) in patients who have received at least one previous treatment and in previously untreated patients who have genetic mutations in their cancer cells called 17p deletion or TP53 mutation and who are not eligible for other therapies.
• In follicular lymphoma, Zydelig is used on its own in patients whose disease has not responded to two previous treatments.

See more information on the approved uses of Zydelig.

The review of Zydelig was initiated at the request of the European Commission on 17 March 2016, under Article 20 of Regulation (EC) No 726/2004.

The review was first carried out by the Pharmacovigilance Risk Assessment Committee (PRAC), the Committee responsible for the evaluation of safety issues for human medicines, which made a set of recommendations. The PRAC recommendations were sent to the Committee for Medicinal Products for Human Use (CHMP), responsible for questions concerning medicines for human use, which adopted the Agency’s opinion on 21 July 2016. The CHMP opinion was forwarded to the European Commission, which issued a final legally binding decision applicable in all EU Member States on 15 September 2016.