2010年6月17日，法国Sanofi-aventis公司今天宣布美国FDA已授权) Jevtana(cabazitaxel)注射剂上市与泼尼松(prednisone)联用治疗既往用含多烯紫杉醇治疗方案的转移性激素难治前列腺癌(mHRPC)患者。 根据来自3期TROPIC临床研究结果，Jevtana，一种微观抑制剂，与泼尼松联用被批准，研究涉及755例mHRPC患者既往用含多烯紫杉醇治疗方案。来自此试验结果证实采用Jevtana与泼尼松联用对mHRPC患者，与米托蒽醌[mitoxantrone]和泼尼松标准剂量组成的阳性化疗方案比较，统计显著30%[HR=0.70(95% CI：0.59-0.83)；P<0.0001]减低死亡风险。用实体流瘤中反应评价标准(RECIST)，研究者-评估肿瘤反应率对cabazitaxel-治疗和米托蒽醌-治疗患者分别为14.4%和4.4%，p=0.0005。任何组均未观察到完全反应。 TROPIC试验北美主要研究者，新奥尔良杜兰医学院癌症研究医学博士皮尔茨(Oliver Sartor, Piltz)教授说“对前列腺癌界，这是处理尚未满足医疗需求有真实意义的公告。随着Jevtana的批准健康保健人员现在对最晚期前列腺癌患者有了一种新治疗选择，而对于他们选择很少”。“在既往用基于多西紫杉醇化疗方案治疗患者Jevtana与泼尼松联用是唯一被FDA批准显著改善总生存的方案”。 HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use JEVTANA safely and effectively. See full prescribing information for JEVTANA. JEVTANA (cabazitaxel) injection, for intravenous use Initial U.S. Approval: 2010 WARNING: NEUTROPENIA AND HYPERSENSITIVITY See full prescribing information for complete boxed warning. Neutropenic deaths have been reported. Obtain frequent blood counts to monitor for neutropenia. Do not give JEVTANA if neutrophil counts are ≤1,500 cells/mm3. (2.2)(4) Severe hypersensitivity can occur and may include generalized rash/erythema, hypotension and bronchospasm. Discontinue JEVTANA immediately if severe reactions occur and administer appropriate therapy. (2.1)(5.2) Contraindicated if history of severe hypersensitivity reactions to JEVTANA or to drugs formulated with polysorbate 80. (4) RECENT MAJOR CHANGES Dosage and Administration (2.2, 2.4) 11/2014 Dosage and Administration (2.3) 06/2015 Contraindications (4) 06/2015 Warnings and Precautions (5.1, 5.6) 06/2015 INDICATIONS AND USAGE JEVTANA is a microtubule inhibitor indicated in combination with prednisone for treatment of patients with hormone-refractory metastatic prostate cancer previously treated with a docetaxel-containing treatment regimen. (1) DOSAGE AND ADMINISTRATION Recommended dose: JEVTANA 25 mg/m2 administered every three weeks as a one-hour intravenous infusion in combination with oral prednisone 10 mg administered daily throughout JEVTANA treatment. (2.1) JEVTANA requires two dilutions prior to administration (2.5) Use the entire contents of the accompanying diluent to achieve a concentration of 10 mg/mL JEVTANA. (2.5) PVC equipment should not be used (2.5) Premedication Regimen: Administer intravenously 30 minutes before each dose of JEVTANA: Antihistamine (dexchloropheniramine 5 mg or diphenhydramine 25 mg or equivalent antihistamine) Corticosteroid (dexamethasone 8 mg or equivalent steroid) H2 antagonist (ranitidine 50 mg or equivalent H2 antagonist) (2.1) Antiemetic prophylaxis (oral or intravenous) is recommended as needed. (2.1) Dosage Modifications: See full prescribing information (2.2, 2.3, 2.4) DOSAGE FORMS AND STRENGTHS Single dose vial 60 mg/1.5 mL, supplied with diluent (5.7 mL) for JEVTANA (3) CONTRAINDICATIONS Neutrophil counts of ≤1,500/mm3 (2.2)(4) History of severe hypersensitivity to JEVTANA or polysorbate 80 (4) Severe hepatic impairment (Total Bilirubin > 3 × ULN) (4) WARNINGS AND PRECAUTIONS Bone marrow suppression (particularly neutropenia) and its clinical consequences (febrile neutropenia, neutropenic infections): Monitor blood counts frequently to determine if dosage modification or initiation of G-CSF is needed. Primary prophylaxis with G-CSF should be considered in patients with high-risk clinical features. Use caution in patients with hemoglobin < 10 g/dL. (2.2)(4)(5.1) Hypersensitivity: Severe hypersensitivity reactions can occur. Premedicate with corticosteroids and H2 antagonists. Discontinue infusion immediately if hypersensitivity is observed and treat as indicated. (4)(5.2) Gastrointestinal disorders: Nausea, vomiting, and diarrhea may occur. Mortality related to diarrhea has been reported. Rehydrate and treat with anti-emetics and anti-diarrheals as needed. If experiencing Grade ≥ 3 diarrhea, dosage should be modified. (2.2) Deaths have occurred due to gastrointestinal hemorrhage, perforation and neutropenic enterocolitis. Delay or discontinue JEVTANA. (5.3) Renal failure, including cases with fatal outcomes, has been reported. Identify cause and manage aggressively. (5.4) Elderly patients: Patients ≥ 65 years of age were more likely to experience fatal outcomes not related to disease progression and certain adverse reactions, including neutropenia and febrile neutropenia. Monitor closely. (5.5)(6)(8.5) Hepatic impairment: Reduce the JEVTANA dose to 20 mg/m2 in patients with mild hepatic impairment and to 15 mg/m2 in patients with moderate hepatic impairment. (2.3) JEVTANA can cause fetal harm when administered to a pregnant woman. (5.7)(8.1) ADVERSE REACTIONS Most common all grades adverse reactions (≥10%) are neutropenia, anemia, leukopenia, thrombocytopenia, diarrhea, fatigue, nausea, vomiting, constipation, asthenia, abdominal pain, hematuria, back pain, anorexia, peripheral neuropathy, pyrexia, dyspnea, dysgeusia, cough, arthralgia, and alopecia. (6) To report SUSPECTED ADVERSE REACTIONS, contact sanofi-aventis U.S. LLC at 1-800-633-1610 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. DRUG INTERACTIONS Avoid coadministration of JEVTANA with strong CYP3A inhibitors. If patients require co-administration of a strong CYP3A inhibitor, consider a 25% JEVTANA dose reduction. (2.4)(7.1)(12.3) See 17 for PATIENT COUNSELING INFORMATION and FDA-approved patient labeling. Revised: 6/2015 FULL PRESCRIBING INFORMATION: CONTENTS* 1 INDICATIONS AND USAGE JEVTANA® is a microtubule inhibitor indicated in combination with prednisone for the treatment of patients with hormone-refractory metastatic prostate cancer previously treated with a docetaxel-containing treatment regimen. 2 DOSAGE AND ADMINISTRATION 2.1 Dosing Information The individual dosage of JEVTANA is based on calculation of the Body Surface Area (BSA) and is 25 mg/m2 administered as a one-hour intravenous infusion every three weeks in combination with oral prednisone 10 mg administered daily throughout JEVTANA treatment. Premedicate at least 30 minutes prior to each dose of JEVTANA with the following intravenous medications to reduce the risk and/or severity of hypersensitivity [see Warnings and Precautions (5.2)]: antihistamine (dexchlorpheniramine 5 mg, or diphenhydramine 25 mg or equivalent antihistamine), corticosteroid (dexamethasone 8 mg or equivalent steroid), H2 antagonist (ranitidine 50 mg or equivalent H2 antagonist). Antiemetic prophylaxis is recommended and can be given orally or intravenously as needed [see Warnings and Precautions 5.3)]. JEVTANA injection single-use vial requires two dilutions prior to administration [see Dosage and Administration (2.5)]. 2.2 Dose Modifications for Adverse Reactions Reduce or discontinue JEVTANA dosing for adverse reactions as described in Table 1. Table 1: Recommended Dosage Modifications for Adverse Reactions in Patients Treated with JEVTANA  Toxicity Dosage Modification Prolonged grade ≥ 3 neutropenia (greater than 1 week) despite appropriate medication including granulocyte-colony stimulating factor (G-CSF) Delay treatment until neutrophil count is > 1,500 cells/mm3, then reduce dosage of JEVTANA to 20 mg/m2. Use G-CSF for secondary prophylaxis. Febrile neutropenia or neutropenic infection Delay treatment until improvement or resolution, and until neutrophil count is > 1,500 cells/mm3, then reduce dosage of JEVTANA to 20 mg/m2. Use G-CSF for secondary prophylaxis. Grade ≥ 3 diarrhea or persisting diarrhea despite appropriate medication, fluid and electrolytes replacement Delay treatment until improvement or resolution, then reduce dosage of JEVTANA to 20 mg/m2. Grade 2 peripheral neuropathy Delay treatment until improvement or resolution, then reduce dosage of JEVTANA to 20 mg/m2. Grade ≥3 peripheral neuropathy Discontinue JEVTANA Discontinue JEVTANA treatment if a patient continues to experience any of these reactions at the 20 mg/m2 dosage. 2.3 Dose Modifications for Hepatic Impairment Mild hepatic impairment (total bilirubin > 1 to ≤ 1.5 × Upper Limit of Normal (ULN) or AST >1.5 × ULN): Reduce JEVTANA starting dose to 20 mg/m2. Moderate hepatic impairment (total bilirubin > 1.5 to ≤ 3 × ULN and AST = any): Reduce JEVTANA starting dose to 15 mg/m2 based on tolerability data in these patients; however, the efficacy of this dose is unknown. Severe hepatic impairment (total bilirubin > 3 × ULN): Cabazitaxel is contraindicated in patients with severe hepatic impairment [see Warning and Precautions (5.6) and Clinical Pharmacology (12.3)]. 2.4 Dose Modifications for Use with Strong CYP3A Inhibitors Concomitant drugs that are strong CYP3A inhibitors (e.g., ketoconazole, itraconazole, clarithromycin, atazanavir, indinavir, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin, voriconazole) may increase plasma concentrations of cabazitaxel. Avoid the coadministration of JEVTANA with these drugs. If patients require co-administration of a strong CYP3A inhibitor, consider a 25% JEVTANA dose reduction [see Drug Interactions (7.1) and Clinical Pharmacology (12.3)]. 2.5 Preparation and Administration JEVTANA is a cytotoxic anticancer drug. Follow applicable special handling and disposable procedures [see References (15)].1 If JEVTANA first diluted solution, or second (final) dilution for intravenous infusion should come into contact with the skin or mucous, immediately and thoroughly wash with soap and water. Do not use PVC infusion containers or polyurethane infusions sets for preparation and administration of JEVTANA infusion solution. JEVTANA should not be mixed with any other drugs. Preparation Read this entire section carefully before mixing and diluting. JEVTANA requires two dilutions prior to administration. Follow the preparation instructions provided below, as improper preparation may lead to overdose [see Overdosage (10)]. Note: Both the JEVTANA injection and the diluent vials contain an overfill to compensate for liquid loss during preparation. This overfill ensures that after dilution with the entire contents of the accompanying diluent, there is an initial diluted solution containing 10 mg/mL JEVTANA. Inspect the JEVTANA injection and supplied diluent vials. The JEVTANA injection is a clear yellow to brownish-yellow viscous solution. Step 1 – First Dilution Each vial of JEVTANA (cabazitaxel) 60 mg/1.5 mL must first be mixed with the entire contents of supplied diluent. Once reconstituted, the resultant solution contains 10 mg/mL of JEVTANA. When transferring the diluent, direct the needle onto the inside wall of JEVTANA vial and inject slowly to limit foaming. Remove the syringe and needle and gently mix the initial diluted solution by repeated inversions for at least 45 seconds to assure full mixing of the drug and diluent. Do not shake. Let the solution stand for a few minutes to allow any foam to dissipate, and check that the solution is homogeneous and contains no visible particulate matter. It is not required that all foam dissipate prior to continuing the preparation process. The resulting initial diluted JEVTANA solution (cabazitaxel 10 mg/mL) requires further dilution before administration. The second dilution should be done immediately (within 30 minutes) to obtain the final infusion as detailed in Step 2. Step 2–Second (Final) Dilution Withdraw the recommended dose from the JEVTANA solution containing 10 mg/mL as prepared in Step 1 using a calibrated syringe and further dilute into a sterile 250 mL PVC-free container of either 0.9% sodium chloride solution or 5% dextrose solution for infusion. If a dose greater than 65 mg of JEVTANA is required, use a larger volume of the infusion vehicle so that a concentration of 0.26 mg/mL JEVTANA is not exceeded. The concentration of the JEVTANA final infusion solution should be between 0.10 mg/mL and 0.26 mg/mL. Remove the syringe and thoroughly mix the final infusion solution by gently inverting the bag or bottle. As the final infusion solution is supersaturated, it may crystallize over time. Do not use if this occurs and discard. Fully prepared JEVTANA infusion solution (in either 0.9% sodium chloride solution or 5% dextrose solution) should be used within 8 hours at ambient temperature (including the one-hour infusion), or for a total of 24 hours (including the one-hour infusion) under the refrigerated conditions. Discard any unused portion. Administration Inspect visually for particulate matter, any crystals and discoloration prior to administration. If the JEVTANA first diluted solution or second (final) infusion solution is not clear or appears to have precipitation, it should be discarded. Use an in-line filter of 0.22 micrometer nominal pore size (also referred to as 0.2 micrometer) during administration. The final JEVTANA infusion solution should be administered intravenously as a one-hour infusion at room temperature. 3 DOSAGE FORMS AND STRENGTHS JEVTANA (cabazitaxel) injection is supplied as a kit consisting of the following: –Cabazitaxel injection: 60mg/1.5mL; a clear yellow to brownish-yellow viscous solution –Diluent: 5.7mL of 13%(w/w) ethanol in water; a clear colorless solution 4 CONTRAINDICATIONS JEVTANA is contraindicated in patients with: neutrophil counts of ≤ 1,500/mm3 [see Warnings and Precautions (5.1)] history of severe hypersensitivity reactions to cabazitaxel or to other drugs formulated with polysorbate 80 [see Warnings and Precautions (5.2)] severe hepatic impairment (total bilirubin > 3 × ULN) [see Warnings and Precautions (5.6)]  5 WARNINGS AND PRECAUTIONS 5.1 Bone Marrow Suppression Bone marrow suppression manifested as neutropenia, anemia, thrombocytopenia and/or pancytopenia may occur. Neutropenic deaths have been reported. In the randomized trial, five patients (1.3%) experienced fatal infectious adverse events (sepsis or septic shock). All had grade 4 neutropenia and one had febrile neutropenia. One additional patient's death was attributed to neutropenia without a documented infection. Grade 3–4 neutropenia has been observed in 82% of patients treated with JEVTANA in the randomized trial. G-CSF may be administered to reduce the risks of neutropenia complications associated with JEVTANA use. Primary prophylaxis with G-CSF should be considered in patients with high-risk clinical features (age > 65 years, poor performance status, previous episodes of febrile neutropenia, extensive prior radiation ports, poor nutritional status, or other serious comorbidities) that predispose them to increased complications from prolonged neutropenia. Therapeutic use of G-CSF and secondary prophylaxis should be considered in all patients considered to be at increased risk for neutropenia complications. Monitoring of complete blood counts is essential on a weekly basis during cycle 1 and before each treatment cycle thereafter so that the dose can be adjusted, if needed [see Dosage and Administration (2.2)]. JEVTANA is contraindicated in patients with neutrophils ≤ 1,500/mm3 [see Contraindications (4)]. Caution is recommended in patients with hemoglobin < 10 g/dl. 5.2 Hypersensitivity Reactions Hypersensitivity reactions may occur within a few minutes following the initiation of the infusion of JEVTANA, thus facilities and equipment for the treatment of hypotension and bronchospasm should be available. Severe hypersensitivity reactions can occur and may include generalized rash/erythema, hypotension and bronchospasm. Premedicate all patients prior to the initiation of the infusion of JEVTANA [see Dosage and Administration (2.1)]. Observe patients closely for hypersensitivity reactions, especially during the first and second infusions. Severe hypersensitivity reactions require immediate discontinuation of the JEVTANA infusion and appropriate therapy. JEVTANA is contraindicated in patients with a history of severe hypersensitivity reactions to cabazitaxel or to other drugs formulated with polysorbate 80 [see Contraindications (4)]. 5.3 Gastrointestinal Adverse Reactions Nausea, vomiting and severe diarrhea, at times, may occur. Death related to diarrhea and electrolyte imbalance occurred in the randomized clinical trial. Intensive measures may be required for severe diarrhea and electrolyte imbalance. Antiemetic prophylaxis is recommended. Treat patients with rehydration, anti-diarrheal or anti-emetic medications as needed. Treatment delay or dosage reduction may be necessary if patients experience Grade ≥ 3 diarrhea [see Dosage and Administration (2.2)]. Gastrointestinal (GI) hemorrhage and perforation, ileus, enterocolitis, neutropenic enterocolitis, including fatal outcome, have been reported in patients treated with JEVTANA [see Adverse Reactions (6.2)]. Risk may be increased with neutropenia, age, steroid use, concomitant use of NSAIDs, anti-platelet therapy or anti-coagulants, and patients with a prior history of pelvic radiotherapy, adhesions, ulceration and GI bleeding. Abdominal pain and tenderness, fever, persistent constipation, diarrhea, with or without neutropenia, may be early manifestations of serious gastrointestinal toxicity and should be evaluated and treated promptly. JEVTANA treatment delay or discontinuation may be necessary. 5.4 Renal Failure In the randomized clinical trial, renal failure of any grade occurred in 4% of the patients being treated with JEVTANA, including four cases with fatal outcome. Most cases occurred in association with sepsis, dehydration, or obstructive uropathy [see Adverse Reactions (6.1)]. Some deaths due to renal failure did not have a clear etiology. Appropriate measures should be taken to identify causes of renal failure and treat aggressively. 5.5 Use in Elderly Patients In the randomized clinical trial, 3 of 131 (2%) patients < 65 years of age and 15 of 240 (6%) ≥ 65 years of age died of causes other than disease progression within 30 days of the last cabazitaxel dose. Patients ≥ 65 years of age are more likely to experience certain adverse reactions, including neutropenia and febrile neutropenia [see Adverse Reactions (6) and Use in Specific Populations (8.5)]. 5.6 Use in Patients with Hepatic Impairment Cabazitaxel is extensively metabolized in the liver. JEVTANA is contraindicated in patients with severe hepatic impairment (total bilirubin > 3 × ULN) [see Contraindications (4)]. Dose should be reduced for patients with mild (total bilirubin > 1 to ≤ 1.5 × ULN or AST > 1.5 × ULN) and moderate (total bilirubin > 1.5 to ≤ 3.0 × ULN and any AST) hepatic impairment, based on tolerability data in these patients [see Dosage and Administration (2.3) and Use in Specific Populations (8.7)]. Administration of cabazitaxel to patients with mild and moderate hepatic impairment should be undertaken with caution and close monitoring of safety. 5.7 Embryo-Fetal Toxicity JEVTANA is not indicated for use in female patients. JEVTANA can cause fetal harm when administered to a pregnant woman. In non-clinical studies in rats and rabbits, cabazitaxel was embryotoxic, fetotoxic, and abortifacient at exposures significantly lower than those expected at the recommended human dose level. There are no adequate and well-controlled studies in pregnant women using JEVTANA. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus. Females of childbearing potential should be advised to avoid becoming pregnant during treatment with JEVTANA [see Use in Specific Populations (8.1)]. 6 ADVERSE REACTIONS The following serious adverse reactions are discussed in greater detail in another section of the label: Bone Marrow Suppression [see Warnings and Precautions (5.1)]. Hypersensitivity Reactions [see Warnings and Precautions (5.2)]. Gastrointestinal Adverse Reactions [see Warnings and Precautions (5.3)]. Renal Failure [see Warnings and Precautions (5.4)]. Use in Elderly Patients [see Warnings and Precautions (5.5)]. Use in Patients with Hepatic Impairment [see Warnings and Precautions (5.6)]. Embryo-Fetal Toxicity [see Warnings and Precautions (5.7)]. 6.1 Clinical Trial Experience Because clinical trials are conducted under widely varying conditions, the adverse reaction rates observed cannot be directly compared to rates in other trials and may not reflect the rates observed in clinical practice. The safety of JEVTANA in combination with prednisone was evaluated in 371 patients with hormone-refractory metastatic prostate cancer treated in a single randomized trial, compared to mitoxantrone plus prednisone. Deaths due to causes other than disease progression within 30 days of last study drug dose were reported in 18 (5%) JEVTANA-treated patients and 3 (< 1%) mitoxantrone-treated patients. The most common fatal adverse reactions in JEVTANA-treated patients were infections (n=5) and renal failure (n=4). The majority (4 of 5 patients) of fatal infection-related adverse reactions occurred after a single dose of JEVTANA. Other fatal adverse reactions in JEVTANA-treated patients included ventricular fibrillation, cerebral hemorrhage, and dyspnea. The most common (≥ 10%) grade 1–4 adverse reactions were anemia, leukopenia, neutropenia, thrombocytopenia, diarrhea, fatigue, nausea, vomiting, constipation, asthenia, abdominal pain, hematuria, back pain, anorexia, peripheral neuropathy, pyrexia, dyspnea, dysguesia, cough, arthralgia, and alopecia. The most common (≥ 5%) grade 3–4 adverse reactions in patients who received JEVTANA were neutropenia, leukopenia, anemia, febrile neutropenia, diarrhea, fatigue, and asthenia. Treatment discontinuations due to adverse drug reactions occurred in 18% of patients who received JEVTANA and 8% of patients who received mitoxantrone. The most common adverse reactions leading to treatment discontinuation in the JEVTANA group were neutropenia and renal failure. Dose reductions were reported in 12% of JEVTANA-treated patients and 4% of mitoxantrone-treated patients. Dose delays were reported in 28% of JEVTANA-treated patients and 15% of mitoxantrone-treated patients. Table 2 – Incidence of Reported Adverse Reactions* and Hematologic Abnormalities in ≥ 5% of Patients Receiving JEVTANA in Combination with Prednisone or Mitoxantrone in Combination with Prednisone  JEVTANA 25 mg/m2 every 3 weeks with prednisone 10 mg daily n=371 Mitoxantrone 12 mg/m2 every 3 weeks with prednisone 10 mg daily n=371 Grade 1–4 n (%) Grade 3–4 n (%) Grade 1–4 n (%) Grade 3–4 n (%)   Any Adverse Reaction Blood and Lymphatic System Disorders   Neutropenia† 347 (94%) 303 (82%) 325 (87%) 215 (58%)   Febrile Neutropenia 27 (7%) 27 (7%) 5 (1%) 5 (1%)   Anemia† 361 (98%) 39 (11%) 302 (82%) 18 (5%)   Leukopenia† 355 (96%) 253 (69%) 343 (93%) 157 (42%)   Thrombocytopenia† 176 (48%) 15 (4%) 160 (43%) 6 (2%) Cardiac Disorders   Arrhythmia‡ 18 (5%) 4 (1%) 6 (2%) 1 (< 1%) Gastrointestinal Disorders   Diarrhea 173 (47%) 23 (6%) 39 (11%) 1 (< 1%)   Nausea 127 (34%) 7 (2%) 85 (23%) 1 (< 1%)   Vomiting 83 (22%) 6 (2%) 38 (10%) 0   Constipation 76 (20%) 4 (1%) 57 (15%) 2 (< 1%)   Abdominal Pain§ 64 (17%) 7 (2%) 23 (6%) 0   Dyspepsia 36 (10%) 0 9 (2%) 0 General Disorders and Administration Site Conditions   Fatigue 136 (37%) 18 (5%) 102 (27%) 11 (3%)   Asthenia 76 (20%) 17 (5%) 46 (12%) 9 (2%)   Pyrexia 45 (12%) 4 (1%) 23 (6%) 1 (< 1%)   Peripheral Edema 34 (9%) 2 (< 1%) 34 (9%) 2 (< 1%)   Mucosal Inflammation 22 (6%) 1 (< 1%) 10 (3%) 1 (< 1%)   Pain 20 (5%) 4 (1%) 18 (5%) 7 (2%) Infections and Infestations   Urinary Tract Infection# 29 (8%) 6 (2%) 12 (3%) 4 (1%) Investigations   Weight Decreased 32 (9%) 0 28 (8%) 1 (< 1%) Metabolism and Nutrition Disorders   Anorexia 59 (16%) 3 (< 1%) 39 (11%) 3 (< 1%)   Dehydration 18 (5%) 8 (2%) 10 (3%) 3 (< 1%) Musculoskeletal and Connective Tissue Disorders   Back Pain 60 (16%) 14 (4%) 45 (12%) 11 (3%)   Arthralgia 39 (11%) 4 (1%) 31 (8%) 4 (1%)   Muscle Spasms 27 (7%) 0 10 (3%) 0 Nervous System Disorders   Peripheral NeuropathyÞ 50 (13%) 3 (< 1%) 12 (3.2%) 3 (< 1%)   Dysgeusia 41 (11%) 0 15 (4%) 0   Dizziness 30 (8%) 0 21 (6%) 2 (< 1%)   Headache 28 (8%) 0 19 (5%) 0 Renal and Urinary Tract Disorders   Hematuria 62 (17%) 7 (2%) 13 (4%) 1 (< 1%)   Dysuria 25 (7%) 0 5 (1%) 0 Respiratory, Thoracic and Mediastinal Disorders   Dyspnea 43 (12%) 4 (1%) 16 (4%) 2 (< 1%)   Cough 40 (11%) 0 22 (6%) 0 Skin and Subcutaneous Tissue Disorders   Alopecia 37 (10%) 0 18 (5%) 0 Vascular Disorders   Hypotension 20 (5%) 2 (<1 %) 9 (2%) 1 (< 1%) Median Duration of Treatment 6 cycles 4 cycles Graded using NCI CTCAE version 3 Based on laboratory values, cabazitaxel: n =369, mitoxantrone: n = 370. Includes atrial fibrillation, atrial flutter, atrial tachycardia, atrioventricular block complete, bradycardia, palpitations, supraventricular tachycardia, tachyarrhythmia, and tachycardia. Includes abdominal discomfort, abdominal pain lower, abdominal pain upper, abdominal tenderness, and GI pain. Includes gastroesophageal reflux disease and reflux gastritis. Includes urinary tract infection enterococcal and urinary tract infection fungal. Includes peripheral motor neuropathy and peripheral sensory neuropathy. Neutropenia and Associated Clinical Events: Five patients experienced fatal infectious adverse events (sepsis or septic shock). All had grade 4 neutropenia and one had febrile neutropenia. One additional patient's death was attributed to neutropenia without a documented infection. Twenty-two (6%) patients discontinued JEVTANA treatment due to neutropenia, febrile neutropenia, infection, or sepsis. The most common adverse reaction leading to treatment discontinuation in the JEVTANA group was neutropenia (2%). Hematuria: Adverse events of hematuria, including those requiring medical intervention, were more common in JEVTANA-treated patients. The incidence of grade ≥ 2 hematuria was 6% in JEVTANA-treated patients and 2% in mitoxantrone-treated patients. Other factors associated with hematuria were well-balanced between arms and do not account for the increased rate of hematuria on the JEVTANA arm. Hepatic Laboratory Abnormalities: The incidences of grade 3–4 increased AST, increased ALT, and increased bilirubin were each ≤ 1%. Elderly Population: The following grade 1–4 adverse reactions were reported at rates ≥ 5% higher in patients 65 years of age or greater compared to younger patients: fatigue (40% vs. 30%), neutropenia (97% vs. 89%), asthenia (24% vs. 15%), pyrexia (15% vs. 8%), dizziness (10% vs. 5%), urinary tract infection (10% vs. 3%) and dehydration (7% vs. 2%), respectively. The incidence of the following grade 3–4 adverse reactions were higher in patients ≥ 65 years of age compared to younger patients; neutropenia (87% vs. 74%), and febrile neutropenia (8% vs. 6%) [see Use in Specific Populations (8.5)]. 6.2 Postmarketing Experience The following adverse reactions have been identified from clinical trials and/or post-marketing surveillance. Because they are reported from a population of unknown size, precise estimates of frequency cannot be made. Gastrointestinal: Gastritis, intestinal obstruction. 7 DRUG INTERACTIONS 7.1 CYP3A Inhibitors Cabazitaxel is primarily metabolized through CYP3A [see Clinical Pharmacology (12.3)]. Strong CYP3A inhibitors (e.g., ketoconazole, itraconazole, clarithromycin, atazanavir, indinavir, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin, voriconazole) may increase plasma concentrations of cabazitaxel. Avoid the co-administration of JEVTANA with strong CYP3A inhibitors. If patients require co-administration of a strong CYP3A inhibitor, consider a 25% JEVTANA dose reduction [see Dosage and Administration (2.4) and Clinical Pharmacology (12.3)]. 8 USE IN SPECIFIC POPULATIONS 8.1 Pregnancy Pregnancy category D. See 'Warnings and Precautions' section. JEVTANA is not indicated for use in female patients. JEVTANA can cause fetal harm when administered to a pregnant woman. There are no adequate and well-controlled studies of JEVTANA in pregnant women. Non-clinical studies in rats and rabbits have shown that cabazitaxel is embryotoxic, fetotoxic, and abortifacient. Cabazitaxel was shown to cross the placenta barrier within 24 hours of a single intravenous administration of a 0.08 mg/kg dose (approximately 0.02 times the maximum recommended human dose-MRHD) to pregnant rats at gestational day 17. Cabazitaxel administered once daily to female rats during organogenesis at a dose of 0.16 mg/kg/day (approximately 0.02–0.06 times the Cmax in patients with cancer at the recommended human dose) caused maternal and embryofetal toxicity consisting of increased post-implantation loss, embryolethality, and fetal deaths. Decreased mean fetal birth weight associated with delays in skeletal ossification were observed at doses ≥ 0.08 mg/kg (approximately 0.02 times the Cmax at the MRHD). In utero exposure to cabazitaxel did not result in fetal abnormalities in rats or rabbits at exposure levels significantly lower than the expected human exposures. If this drug is used during pregnancy or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus. Women of childbearing potential should be advised to avoid becoming pregnant while taking JEVTANA. 8.3 Nursing Mothers JEVTANA is not indicated for use in female patients. Cabazitaxel or cabazitaxel metabolites are excreted in maternal milk of lactating rats. It is not known whether this drug is excreted in human milk. Within 2 hours of a single intravenous administration of cabazitaxel to lactating rats at a dose of 0.08 mg/kg (approximately 0.02 times the maximum recommended human dose), radioactivity related to cabazitaxel was detected in the stomachs of nursing pups. This was detectable for up to 24 hours post-dose. Approximately 1.5% of the dose delivered to the mother was calculated to be delivered in the maternal milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from JEVTANA, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. 8.4 Pediatric Use The safety and effectiveness of JEVTANA in pediatric patients have not been established. 8.5 Geriatric Use Of the 371 patients with prostate cancer treated with JEVTANA every three weeks plus prednisone, 240 patients (64.7%) were 65 years of age and over, while 70 patients (18.9%) were 75 years of age and over. No overall differences in effectiveness were observed between patients ≥ 65 years of age and younger patients. Elderly patients (≥ 65 years of age) may be more likely to experience certain adverse reactions. The incidence of death due to causes other than disease progression within 30 days of the last cabazitaxel dose were higher in patients who were 65 years of age or greater compared to younger patients [see Warnings and Precautions (5.5)]. The incidence of grade 3–4 neutropenia and febrile neutropenia were higher in patients who were 65 years of age or greater compared to younger patients. The incidence of neutropenia, fatigue, asthenia, pyrexia, dizziness, urinary tract infection and dehydration occurred at rates ≥ 5% higher in patients who were 65 years of age or greater compared to younger patients [see Adverse Reactions (6.1)]. Based on a population pharmacokinetic analysis, no significant difference was observed in the pharmacokinetics of cabazitaxel between patients < 65 years (n=100) and older (n=70). 8.6 Renal Impairment No dose adjustment is necessary in patients with renal impairment not requiring hemodialysis. Patients presenting with end-stage renal disease (creatinine clearance CLCR < 15mL/min/1.73m2), should be monitored carefully during treatment [see Clinical Pharmacology (12.3)]. 8.7 Hepatic Impairment Cabazitaxel is extensively metabolized in the liver. Patients with mild hepatic impairment (total bilirubin > 1 to ≤ 1.5 × ULN or AST > 1.5 × ULN) should have JEVTANA dose reduced to 20 mg/m2. Administration of cabazitaxel to patients with mild hepatic impairment should be undertaken with caution and close monitoring of safety [see Clinical Pharmacology (12.3)]. The maximum tolerated dose in patients with moderate hepatic impairment (total bilirubin > 1.5 to ≤ 3.0 × ULN and AST = any) was 15 mg/m2, however, the efficacy at this dose level was unknown. Jevtana is contraindicated in patients with severe hepatic impairment (total bilirubin > 3× ULN) [see Contraindications (4)]. 10 OVERDOSAGE There is no known antidote for JEVTANA overdose. Overdose has resulted from improper preparation [see Dosage and Administration (2.5)]. Read the entire section Dosage and Administration (2) carefully before mixing or diluting. Complications of overdose include exacerbation of adverse reactions such as bone marrow suppression and gastrointestinal disorders. Overdose has led to fatal outcome. In case of overdose, the patient should be kept in a specialized unit where vital signs, chemistry and particular functions can be closely monitored. Patients should receive therapeutic G-CSF as soon as possible after discovery of overdose. Other appropriate symptomatic measures should be taken, as needed. 11 DESCRIPTION JEVTANA (cabazitaxel) injection is an antineoplastic agent belonging to the taxane class that is for intravenous use. It is prepared by semi-synthesis with a precursor extracted from yew needles. The chemical name of cabazitaxel is (2α,5β,7β,10β,13α)-4-acetoxy-13-({(2R,3S)-3-[(tertbutoxycarbonyl) amino]-2-hydroxy-3-phenylpropanoyl}oxy)-1-hydroxy-7,10-dimethoxy-9-oxo-5,20-epoxytax-11-en-2-yl benzoate – propan-2-one (1:1). Cabazitaxel has the following structural formula: Cabazitaxel is a white to almost-white powder with a molecular formula of C45H57NO14.C3H6O and a molecular weight of 894.01 (for the acetone solvate) / 835.93 (for the solvent free). It is lipophilic, practically insoluble in water and soluble in alcohol. JEVTANA (cabazitaxel) injection 60 mg/1.5 mL is a sterile, non-pyrogenic, clear yellow to brownish-yellow viscous solution and is available in single-dose vials containing 60 mg cabazitaxel (anhydrous and solvent free) and 1.56 g polysorbate 80. Each mL contains 40 mg cabazitaxel (anhydrous) and 1.04 g polysorbate 80. DILUENT for JEVTANA is a clear, colorless, sterile, and non-pyrogenic solution containing 13% (w/w) ethanol in water for injection, approximately 5.7 mL. JEVTANA requires two dilutions prior to intravenous infusion. JEVTANA injection should be diluted only with the supplied DILUENT for JEVTANA, followed by dilution in either 0.9% sodium chloride solution or 5% dextrose solution. 12 CLINICAL PHARMACOLOGY 12.1 Mechanism of Action Cabazitaxel is a microtubule inhibitor. Cabazitaxel binds to tubulin and promotes its assembly into microtubules while simultaneously inhibiting disassembly. This leads to the stabilization of microtubules, which results in the inhibition of mitotic and interphase cellular functions. 12.2 Pharmacodynamics Cardiac Electrophysiology The effect of cabazitaxel following a single dose of 25 mg/m2 administered by intravenous infusion on QTc interval was evaluated in 94 patients with solid tumors. No large changes in the mean QT interval (i.e., > 20 ms) from baseline based on Fridericia correction method were detected. However, a small increase in the mean QTc interval (i.e., < 10 ms) cannot be excluded due to study design limitations. 12.3 Pharmacokinetics A population pharmacokinetic analysis was conducted in 170 patients with solid tumors at doses ranging from 10 to 30 mg/m2 weekly or every three weeks. Absorption Based on the population pharmacokinetic analysis, after an intravenous dose of cabazitaxel 25 mg/m2 every three weeks, the mean Cmax in patients with metastatic prostate cancer was 226 ng/mL (CV 107%) and was reached at the end of the one-hour infusion (Tmax). The mean AUC in patients with metastatic prostate cancer was 991 ng∙h/mL (CV 34%). No major deviation from the dose proportionality was observed from 10 to 30 mg/m² in patients with advanced solid tumors. Distribution The volume of distribution (Vss) was 4,864 L (2,643 L/m² for a patient with a median BSA of 1.84 m²) at steady state. In vitro, the binding of cabazitaxel to human serum proteins was 89 to 92% and was not saturable up to 50,000 ng/mL, which covers the maximum concentration observed in clinical trials. Cabazitaxel is mainly bound to human serum albumin (82%) and lipoproteins (88% for HDL, 70% for LDL, and 56% for VLDL). The in vitro blood-to-plasma concentration ratio in human blood ranged from 0.90 to 0.99, indicating that cabazitaxel was equally distributed between blood and plasma. Metabolism Cabazitaxel is extensively metabolized in the liver (> 95%), mainly by the CYP3A4/5 isoenzyme (80% to 90%), and to a lesser extent by CYP2C8. Cabazitaxel is the main circulating moiety in human plasma. Seven metabolites were detected in plasma (including the 3 active metabolites issued from O-demethylation), with the main one accounting for 5% of cabazitaxel exposure. Around 20 metabolites of cabazitaxel are excreted into human urine and feces. Elimination After a one-hour intravenous infusion [14C]-cabazitaxel 25 mg/m2, approximately 80% of the administered dose was eliminated within 2 weeks. Cabazitaxel is mainly excreted in the feces as numerous metabolites (76% of the dose); while renal excretion of cabazitaxel and metabolites account for 3.7% of the dose (2.3% as unchanged drug in urine). Based on the population pharmacokinetic analysis, cabazitaxel has a plasma clearance of 48.5 L/h (CV 39%; 26.4 L/h/m² for a patient with a median BSA of 1.84 m²) in patients with metastatic prostate cancer. Following a one-hour intravenous infusion, plasma concentrations of cabazitaxel can be described by a three-compartment pharmacokinetic model with α-, β-, and γ- half-lives of 4 minutes, 2 hours, and 95 hours, respectively. Renal Impairment Cabazitaxel is minimally excreted via the kidney. A population pharmacokinetic analysis carried out in 170 patients including 14 patients with moderate renal impairment (30 mL/min ≤ CLCR < 50 mL/min) and 59 patients with mild renal impairment (50 mL/min ≤ CLCR < 80 mL/min) showed that mild to moderate renal impairment did not have meaningful effects on the pharmacokinetics of cabazitaxel. This was confirmed by a dedicated comparative pharmacokinetic study in patients with solid tumors with normal renal function (n=8, CLCR > 80 mL/min/1.73m2), or moderate (n=8, 30 mL/min/1.73m2 ≤ CLCR < 50 mL/min/1.73m2) and severe (n=9, CLCR < 30 mL/min/1.73m2) renal impairment, who received several cycles of cabazitaxel in single IV infusion up to 25 mg/m2. Limited pharmacokinetic data were available in patients with end-stage renal disease (n=2, CLCR < 15 mL/min/1.73m2). Hepatic Impairment Cabazitaxel is extensively metabolized in the liver. A dedicated study in 43 cancer patients with hepatic impairment showed no influence of mild (total bilirubin >1 to ≤1.5 × ULN or AST >1.5 × ULN) or moderate (total bilirubin >1.5 to ≤3.0 × ULN) hepatic impairment on cabazitaxel pharmacokinetics. The maximum tolerated dose (MTD) of cabazitaxel was 20 and 15 mg/m2, respectively. In 3 patients with severe hepatic impairment (total bilirubin > 3 × ULN), a 39% decrease in clearance was observed when compared to patients with mild hepatic impairment (ratio=0.61, 90% CI: 0.36–1.05), indicating some effect of severe hepatic impairment on cabazitaxel pharmacokinetics. The MTD of cabazitaxel in patients with severe hepatic impairment was not established. Based on safety and tolerability data, cabazitaxel dose should be reduced in patients with mild and moderate hepatic impairment [see Warnings and Precautions (5.6) and Use in Specific Populations (8.7)]. Cabazitaxel is contraindicated in patients with severe hepatic impairment [see Contraindications (4) and Use in Specific Populations (8.7)]. Drug interactions A drug interaction study of JEVTANA in 23 patients with advanced cancers has shown that repeated administration of ketoconazole (400 mg orally once daily), a strong CYP3A inhibitor, increased the exposure to cabazitaxel (5 mg/m2 intravenous) by 25%. A drug interaction study of JEVTANA in 13 patients with advanced cancers has shown that repeated administration of aprepitant (125 or 80 mg once daily), a moderate CYP3A inhibitor, did not modify the exposure to cabazitaxel (15 mg/m2 intravenous). A drug interaction study of JEVTANA in 21 patients with advanced cancers has shown that repeated administration of rifampin (600 mg once daily), a strong CYP3A inducer, decreased the exposure to cabazitaxel (15 mg/m2 intravenous) by 17%. A drug interaction study of JEVTANA in 11 patients with advanced cancers has shown that cabazitaxel (25 mg/m2 administered as a single 1-hour infusion) did not modify the exposure to midazolam, a probe substrate of CYP3A. Prednisone or prednisolone administered at 10 mg daily did not affect the pharmacokinetics of cabazitaxel. Based on in vitro studies, the potential for cabazitaxel to inhibit drugs that are substrates of other CYP isoenzymes (1A2,-2B6,-2C9, -2C8, -2C19, -2E1, -2D6, and CYP3A4/5) is low. In addition, cabazitaxel did not induce CYP isozymes (-1A, -2C9 and -3A) in vitro. In vitro, cabazitaxel did not inhibit the multidrug-resistance protein 1 (MRP1), 2 (MRP2) or organic cation transporter (OCT1). In vitro, cabazitaxel inhibited P-gp, BRCP, and organic anion transporting polypeptides (OATP1B1, OATP1B3). However the in vivo risk of cabazitaxel inhibiting MRPs, OCT1, P-gp, BCRP, OATP1B1 or OATP1B3 is low at the dose of 25 mg/m2. In vitro, cabazitaxel is a substrate of P-gp, but not a substrate of MRP1, MRP2, BCRP, OCT1, OATP1B1 or OATP1B3. 13 NONCLINICAL TOXICOLOGY 13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility Long-term animal studies have not been performed to evaluate the carcinogenic potential of cabazitaxel. Cabazitaxel was positive for clastogenesis in the in vivo micronucleus test, inducing an increase of micronuclei in rats at doses ≥ 0.5 mg/kg. Cabazitaxel increased numerical aberrations with or without metabolic activation in an in vitro test in human lymphocytes though no induction of structural aberrations was observed. Cabazitaxel did not induce mutations in the bacterial reverse mutation (Ames) test. The positive in vivo genotoxicity findings are consistent with the pharmacological activity of the compound (inhibition of tubulin depolymerization). Cabazitaxel may impair fertility in humans. In a fertility study performed in female rats at cabazitaxel doses of 0.05, 0.1, or 0.2 mg/kg/day there was no effect of administration of the drug on mating behavior or the ability to become pregnant. There was an increase in pre-implantation loss at the 0.2 mg/kg/day dose and an increase in early resorptions at doses ≥ 0.1 mg/kg/day (approximately 0.02–0.06 times the human clinical exposure based on Cmax). In multi-cycle studies following the clinically recommended dosing schedule, atrophy of the uterus was observed at the 5 mg/kg dose level (approximately the AUC in patients with cancer at the recommended human dose) along with necrosis of the corpora lutea at doses ≥ 1 mg/kg (approximately 0.2 times the AUC at the clinically recommended human dose). Cabazitaxel did not affect mating performances or fertility of treated male rats at doses of 0.05, 0.1, or 0.2 mg/kg/day. In multiple-cycle studies following the clinically recommended dosing schedule, however, degeneration of seminal vesicle and seminiferous tubule atrophy in the testis were observed in rats treated intravenously with cabazitaxel at a dose of 1 mg/kg (approximately 0.2–0.35 times the AUC in patients with cancer at the recommended human dose), and minimal testicular degeneration (minimal epithelial single cell necrosis in epididymis) was observed in dogs treated with a dose of 0.5 mg/kg (approximately one-tenth of the AUC in patients with cancer at the recommended human dose). 14 CLINICAL STUDIES The efficacy and safety of JEVTANA in combination with prednisone were evaluated in a randomized, open-label, international, multi-center study in patients with hormone-refractory metastatic prostate cancer previously treated with a docetaxel-containing treatment regimen. A total of 755 patients were randomized to receive either JEVTANA 25 mg/m2 intravenously every 3 weeks for a maximum of 10 cycles with prednisone 10 mg orally daily (n=378), or to receive mitoxantrone 12 mg/m2 intravenously every 3 weeks for 10 cycles with prednisone 10 mg orally daily (n=377) for a maximum of 10 cycles. This study included patients over 18 years of age with hormone-refractory metastatic prostate cancer either measurable by RECIST criteria or non-measurable disease with rising PSA levels or appearance of new lesions, and ECOG (Eastern Cooperative Oncology Group) performance status 0–2. Patients had to have neutrophils >1,500 cells/mm3, platelets > 100,000 cells/mm3, hemoglobin > 10 g/dL, creatinine < 1.5 × upper limit of normal (ULN), total bilirubin < 1×ULN, AST < 1.5 × ULN, and ALT < 1.5 × ULN. Patients with a history of congestive heart failure, or myocardial infarction within the last 6 months, or patients with uncontrolled cardiac arrhythmias, angina pectoris, and/or hypertension were not included in the study. Demographics, including age, race, and ECOG performance status (0–2) were balanced between the treatment arms. The median age was 68 years (range 46–92) and the racial distribution for all groups was 83.9% Caucasian, 6.9% Asian, 5.3% Black, and 4% Others in the JEVTANA group. Efficacy results for the JEVTANA arm versus the control arm are summarized in Table 3 and Figure 1. Table 3 - Efficacy of JEVTANA in the Treatment of Patients with Hormone Refractory Metastatic Prostate Cancer (Intent-to-Treat Analysis) JEVTANA + Prednisone n=378 Mitoxantrone + Prednisone n=377 Overall Survival Number of deaths (%) 234 (61.9 %) 279 (74%) Median survival (month) (95% CI) 15.1 (14.1–16.3) 12.7 (11.6–13.7) Hazard Ratio* (95% CI) 0.70 (0.59–0.83) p-value <0.0001 Hazard ratio estimated using Cox model; a hazard ratio of less than 1 favors JEVTANA Figure 1 - Kaplan-Meier Overall Survival Curves Investigator-assessed tumor response of 14.4% (95%CI: 9.6–19.3) was higher for patients in the JEVTANA arm compared to 4.4% (95%CI: 1.6–7.2) for patients in the mitoxantrone arm, p=0.0005. 15 REFERENCES 1.OSHA Hazardous Drugs. OSHA. http://www.osha.gov/SLTC/hazardousdrugs/index.htmlNIOSH 16 HOW SUPPLIED/STORAGE AND HANDLING 16.1 How Supplied JEVTANA is supplied as a kit containing consisting of the following: –One single-dose vial of JEVTANA (cabazitaxel) injection: a clear yellow to brownish-yellow viscous solution of 60 mg/1.5 mL in a clear glass vial with a grey rubber closure, aluminum cap, and light green plastic flip-off cap –One single-dose vial of Diluent for JEVTANA: a clear colorless solution of 13% (w/w) ethanol in water for injection in a clear glass vial with a grey rubber closure, gold-color aluminum cap, and colorless plastic flip-off cap. Both items are in a blister pack in one carton. NDC 0024-5824-11 16.2 Storage JEVTANA injection and Diluent for JEVTANA: Store at 25°C (77°F); excursions permitted between 15°–30°C (59°–86°F). Do not refrigerate. 16.3 Handling and Disposal JEVTANA is a cytotoxic anticancer drug. Follow applicable special handling and disposable procedures [see References (15)].1 17 PATIENT COUNSELING INFORMATION Advise the patient to read the FDA-approved patient labeling (Patient Information). Hypersensitivity Reactions Educate patients about the risk of potential hypersensitivity associated with JEVTANA. Confirm patients do not have a history of severe hypersensitivity reactions to cabazitaxel or to other drugs formulated with polysorbate 80. Instruct patients to immediately report signs of a hypersensitivity reaction [see Contraindications (4) and Warnings and Precautions (5.2)]. Bone Marrow Suppression Inform patients that JEVTANA decreases blood count such as white blood cells, platelets and red blood cells. Thus, it is important that periodic assessment of their blood count be performed to detect the development of neutropenia, thrombocytopenia, anemia, and/or pancytopenia [see Contraindications (4) and Warnings and Precautions (5.1)]. Instruct patients to monitor their temperature frequently and immediately report any occurrence of fever to their healthcare provider. Importance of Prednisone Explain that it is important to take the oral prednisone as prescribed. Instruct patients to report if they were not compliant with oral corticosteroid regimen [see Dosage and Administration (2.1)]. Infections, Dehydration, Renal Failure Explain to patients that severe and fatal infections, dehydration, and renal failure have been associated with cabazitaxel exposure. Patients should immediately report fever, significant vomiting or diarrhea, decreased urinary output, and hematuria to their healthcare provider [see Warnings and Precautions (5.1, 5.3, 5.4)]. Drug Interactions Inform patients about the risk of drug interactions and the importance of providing a list of prescription and non-prescription drugs to their healthcare provider [see Drug Interactions (7.1)]. Use in Elderly Patients Inform elderly patients that certain side effects may be more frequent or severe [see Warnings and Precautions (5.5) and Use in Specific Populations (8.5)]. 前列腺癌治疗新药Jevtana在欧洲获批 赛诺菲安万特新的化疗药物Jevtana在美国获批后不久，目前已在欧洲获批。 成功的临床试验表明，Jevtana（cabazitaxel）联合类固醇泼尼松可用于二线治疗晚期前列腺癌。欧洲药品管理局的人用药品委员会在III期 TROPIC研究之后曾表示认可，该III期研究显示这种联合用药对转移性激素难治性前列腺癌（mHRPC）患者有显著的生存利益。激素疗法是经常用于mHRPC患者的一线治疗方法，这些患者常常对化疗不再有反应。因此，化疗抵抗可能会成为下一个障碍，该病似乎没有成功的治疗策略。 但是，赛诺菲的全球肿瘤部负责人Debasish Roychowdhury博士指出，Jevtana联合泼尼松/强的松使死亡风险减少了近1/3且延长了疾病无进展生存期。 前列腺癌是男性第三大最常见癌症，在欧洲是第六大癌症杀手。在这种情况下，该药物在欧洲获批将对欧洲患者产生重大影响。 适应症 Jevtana是一种微管抑制剂适用于与泼尼松联用治疗既往用含多烯紫杉醇治疗方案激素难治转移性前列 腺癌患者。 用法用量 推荐剂量：每3周给予1次，Jevtana 25 mg/m2 1小时内静脉输注与口服泼尼松10 mg联用每天 给药JEVTANA治疗自始至终。  (1)给药前JEVTANA需要两次稀释。  (2)用伴随的稀释液完整内容稀释至达到10mg/mL JEVTANA浓度。   (3)不应使用聚氯乙烯(PVC)仪器。   (4)预先给药方案：每次静脉给予JEVTANA30分钟前前给予：  抗组织胺(右氯苯那敏[dexchloropheniramine] 5 mg或苯海拉明25 mg或等同抗组织胺)。  皮质甾体(地塞米松[dexamethasone]8 mg或等同甾体)  H2拮抗剂(雷尼替丁[ranitidine]50 mg或等同H2拮抗剂)。  当需要时建议用抗吐剂预防(口服或静脉)。  (5)剂量修改：见完整处方资料。 禁忌 (1)中性粒细胞计数of ≤1,500/mm3。 (2)对JEVTANA或山梨醇80严重超敏性史。 注意事项 嗜中性白血球减少症，发热性中性粒细胞：中性粒细胞减少死亡的报道。经常监测血细胞计数，以确定是否需要启动G-CSF和/或剂量修改。卡巴他赛注射液价格初级预防与G-CSF，应考虑在高风险的临床特点患者。 过敏症： 可能会发生严重的过敏反应。 Premedicate与皮质类固醇和H2受体拮抗剂。停止输液，立即如果过敏的观察和对待表示。 胃肠道症状（恶心，呕吐，腹泻）：腹泻死亡率已报告。反催吐剂和需要反-diarrheals的的水化和治疗。如果遇到等级≥3腹泻，剂量应进行修改。 肾功能衰竭，包括致命后果的案件，已报告。确定原因并积极管理。 老年患者：患者≥65岁以上的人更有可能体验到不相关的疾病的进展和某些不良反应，包括中性粒细胞减少和发热性中性粒细胞减少的致命后果。密切监察。 从随机临床试验，卡巴他赛注射液哪里卖肝功能不全：肝功能受损的患者被排除在外。肝功能受损可能增加cabazitaxel浓度。肝功能不全的病人不应给予JEVTANA。 JEVTANA可以管理到孕妇对胎儿造成伤害。 规格 单次使用小瓶60 mg/1.5mL 贮藏 低温，避光保存。