第一个也是唯一的PARP抑制剂：RUBRACA（Rucaparib）获美国FDA批准用于治疗晚期卵巢癌 美国食品和药物管理局（FDA）于2016年12月19日，RUBRACA是一种聚（ADP-核糖）聚合酶（PARP）抑制剂，表示为治疗有害BRCA突变（种系和/或体细胞）相关晚期卵巢已经用两种或更多种化学疗法治疗的癌症。应根据FDA批准的RUBRACA伴随诊断选择患者进行治疗。 RUBRACA获得FDA的突破治疗指定和优先审查。 Biologics公司生物制药服务副总裁Brandon Tom说，“我们将能够利用我们在卵巢癌护理方面的经验，提供高接触临床支持和改善这一患者群体的结果。 RUBRACA是PARP1，PARP2和PARP3的口服小分子抑制剂。来自两个临床试验的数据来测试RUBRACA在晚期BRCA突变卵巢癌患者中的功效，所述患者在两次或更多次先前化疗后进展，显示54％的总体客观反应率（ORR）和9.2个月的中值持续时间反应。对于具有胚系BRCA-突变体卵巢癌或体细胞BRCA-突变体卵巢癌的患者和具有BRCA1基因突变或BRCA2基因突变的患者，ORR是相似的。 在美国每年大约有22,000名妇女被诊断为卵巢癌，在癌症死亡中排名第五。约25％的被诊断患有卵巢癌的女性具有种系或体细胞BRCA突变，使得针对这些突变的治疗对于该独特的亚群患者特别重要。 Biologics的多学科护理团队认识到其高度接触的患者护理模式，提供个性化护理计划，以解决每个患者独特的临床. 批准日期：2016年12月19日 公司：Clovis Oncology, Inc. HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use RUBRACA safely and effectively. See full prescribing information for RUBRACA. RUBRACA™ (rucaparib) tablets, for oral use Initial U.S. Approval: 2016 INDICATIONS AND USAGE RUBRACA is a poly (ADP-ribose) polymerase (PARP) inhibitor indicated as monotherapy for the treatment of patients with deleterious BRCA mutation (germline and/or somatic) associated advanced ovarian cancer who have been treated with two or more chemotherapies. Select patients for therapy based on an FDA-approved companion diagnostic for RUBRACA. (1, 2.1) This indication is approved under accelerated approval based on objective response rate and duration of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trials. (1, 14) DOSAGE AND ADMINISTRATION Recommended dose is 600 mg orally twice daily with or without food. (2.2) Continue treatment until disease progression or unacceptable toxicity. (2.2) For adverse reactions, consider interruption of treatment or dose reduction. (2.3) DOSAGE FORMS AND STRENGTHS Tablets: 200 mg and 300 mg (3) CONTRAINDICATIONS None. (4) WARNINGS AND PRECAUTIONS Myelodysplastic Syndrome/Acute Myeloid Leukemia (MDS/AML): MDS/AML occurred in patients exposed to RUBRACA, including one fatal event of AML. Monitor patients for hematological toxicity at baseline and monthly thereafter. Discontinue if MDS/AML is confirmed. (5.1) Embryo-Fetal Toxicity: RUBRACA can cause fetal harm. Advise females of reproductive potential of the potential risk to a fetus and to use effective contraception. (5.2, 8.1, 8.3) ADVERSE REACTIONS Most common adverse reactions (≥ 20%) were nausea, fatigue (including asthenia), vomiting, anemia, abdominal pain, dysgeusia, constipation, decreased appetite, diarrhea, thrombocytopenia, and dyspnea. (6.1) Most common laboratory abnormalities (≥ 35%) were increase in creatinine, increase in ALT, increase in AST, decrease in hemoglobin, decrease in lymphocytes, increase in cholesterol, decrease in platelets, and decrease in absolute neutrophil count. (6.1) To report SUSPECTED ADVERSE REACTIONS, contact Clovis Oncology, Inc. at 1-844-258-7662 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. USE IN SPECIFIC POPULATIONS Lactation: Advise women not to breastfeed. (8.2) See 17 for PATIENT COUNSELING INFORMATION and FDA-approved patient labeling. Revised: 12/2016 FULL PRESCRIBING INFORMATION: CONTENTS* 1 INDICATIONS AND USAGE Rubraca™ is indicated as monotherapy for the treatment of patients with deleterious BRCA mutation (germline and/or somatic) associated advanced ovarian cancer who have been treated with two or more chemotherapies. Select patients for therapy based on an FDA-approved companion diagnostic for Rubraca [see Dosage and Administration (2.1)]. This indication is approved under accelerated approval based on objective response rate and duration of response [see Clinical Studies (14)]. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trials.  2 DOSAGE AND ADMINISTRATION 2.1 Patient Selection Select patients for the treatment of advanced ovarian cancer with Rubraca based on the presence of a deleterious BRCA mutation (germline and/or somatic)[see Indications and Usage (1) and Clinical Studies (14)]. Information on the FDA-approved test for the detection of a tumor BRCA mutation in patients with ovarian cancer is available at: http://www.fda.gov/CompanionDiagnostics. 2.2 Recommended Dose The recommended dose of Rubraca is 600 mg (two 300 mg tablets) taken orally twice daily with or without food. Continue treatment until disease progression or unacceptable toxicity. If a patient misses a dose of Rubraca, instruct the patient to take the next dose at its scheduled time. Vomited doses should not be replaced. 2.3 Dose Modifications for Adverse Reactions To manage adverse reactions, consider interruption of treatment or dose reduction. Recommended dose reductions are indicated in Table 1. Table 1. Recommended Dose Adjustments Dose Reduction Dose Starting Dose 600 mg twice daily (two 300 mg tablets) First Dose Reduction 500 mg twice daily (one 300 mg tablet and one 200 mg tablet) Second Dose Reduction 400 mg twice daily (two 200 mg tablets) Third Dose Reduction 300 mg twice daily (one 300 mg tablet) 3 DOSAGE FORMS AND STRENGTHS Tablets (200 mg): blue, round, immediate-release, film-coated, debossed with “C2”. Tablets (300 mg): yellow, oval, immediate-release, film-coated, debossed with “C3”. 4 CONTRAINDICATIONS None.  5 WARNINGS AND PRECAUTIONS 5.1 Myelodysplastic Syndrome/Acute Myeloid Leukemia Myelodysplastic syndrome (MDS)/Acute Myeloid Leukemia (AML) was reported in 2 of 377 (0.5%) patients with ovarian cancer treated with Rubraca. The duration of Rubraca treatment prior to the diagnosis of MDS/AML was 57 days and 539 days. Both patients received prior treatment with platinum and other DNA damaging agents. In addition, AML was reported in 2 (< 1%) patients with ovarian cancer enrolled in a blinded, randomized trial evaluating Rubraca versus placebo. One case of AML was fatal. The duration of treatment prior to the diagnosis of AML was 107 days and 427 days. Both patients had received prior treatment with platinum and other DNA damaging agents. Monitor complete blood count testing at baseline and monthly thereafter. Do not start Rubraca until patients have recovered from hematological toxicity caused by previous chemotherapy (≤ Grade 1). For prolonged hematological toxicities, interrupt Rubraca and monitor blood counts weekly until recovery. If the levels have not recovered to Grade 1 or less after 4 weeks, refer the patient to a hematologist for further investigations, including bone marrow analysis and blood sample for cytogenetics. If MDS/AML is confirmed, discontinue Rubraca. 5.2 Embryo-Fetal Toxicity Rubraca can cause fetal harm when administered to a pregnant woman based on its mechanism of action and findings from animal studies. In an animal reproduction study, administration of rucaparib to pregnant rats during organogenesis resulted in embryo-fetal death at maternal exposure that were 0.04 times the AUC in patients receiving the recommended dose of 600 mg twice daily. Apprise pregnant women of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment and for 6 months following the last dose of Rubraca [see Use in Specific Populations (8.1, 8.3) and Clinical Pharmacology (12.1)]. 6 ADVERSE REACTIONS The following serious adverse reactions are discussed elsewhere in the labeling: Myelodysplastic Syndrome/Acute Myeloid Leukemia [see Warnings and Precautions (5.1)]. 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. Rubraca 600 mg twice daily as monotherapy, has been studied in 377 patients with ovarian cancer treated in two open-label, single arm trials. In these patients, the median age was 62 years (range 31 to 86), 100% had an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1, 38% had BRCA-mutated ovarian cancer, 45% had received 3 or more prior lines of chemotherapy, and the median time since ovarian cancer diagnosis was 43 months (range 6 to 197). Adverse reactions led to dose reduction or interruption in 62% of patients, most frequently from anemia (27%), and fatigue/asthenia (22%). Adverse reactions led to dose discontinuation in 10% of patients, most frequently from fatigue/asthenia (2%). The median duration of treatment was 5.5 months (range 0.1 to 28.0). Table 2 and Table 3 summarize the common adverse reactions and abnormal laboratory findings, respectively, observed in patients treated with Rubraca. Table 2. Adverse Reactions Reported in ≥ 20% of Patients with Ovarian Cancer Treated with Rubraca 600 mg Twice Daily Adverse Reaction All Ovarian Cancer Patients (N = 377) % Gradesa 1-4 Grades 3-4 Gastrointestinal Disorders      Nausea 77 5      Vomiting 46 4      Constipation 40 2      Diarrhea 34 2      Abdominal Pain 32 3 General Disorders      Asthenia/Fatigue 77 11 Blood and Lymphatic System Disorders      Anemia 44 25      Thrombocytopenia 21 5 Nervous System Disorders      Dysgeusia 39 0.3 Metabolism and Nutrition Disorders      Decreased appetite 39 3 Respiratory, Thoracic, and Mediastinal Disorders      Dyspnea 21 0.5 a National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE version 4.03) The following adverse reactions have been identified in < 20% of the 377 patients treated with Rubraca 600 mg twice daily: dizziness (17%), neutropenia (15%), rash (includes rash, rash erythematous, rash maculopapular and dermatitis) (13%), pyrexia (11%), photosensitivity reaction (10%), pruritus (includes pruritus and pruritus generalized) (9%), Palmar-plantar erythrodysaesthesia syndrome (2%), and febrile neutropenia (1%). Table 3. Laboratory Abnormalities Reported in ≥ 35% of Patients with Ovarian Cancer Treated with Rubraca 600 mg Twice Daily Laboratory Parameter All Patients with Ovarian Cancer (N = 377) % Grade 1-4 a Grade 3-4 Clinical Chemistry Increase in creatinine 92 1 Increase in ALTb 74 13 Increase in ASTb 73 5 Increase in cholesterol 40 2 Hematologic Decrease in hemoglobin 67 23 Decrease in lymphocytes 45 7 Decrease in platelets 39 6 Decrease in absolute neutrophil count 35 10 a At least one worsening shift in CTCAE grade and by maximum shift from baseline. b Increase in ALT/AST led to treatment discontinuation in 0.3% of patients (1/377). 8 USE IN SPECIFIC POPULATIONS 8.1 Pregnancy Risk Summary Based on findings from animal studies and its mechanism of action, Rubraca can cause fetal harm when administered to pregnant women. There are no available data in pregnant women to inform the drug-associated risk. In an animal reproduction study, administration of rucaparib to pregnant rats during organogenesis resulted in embryo-fetal death at maternal exposure that were 0.04 times the AUC0-24h in patients receiving the recommended dose of 600 mg twice daily [see Data]. Apprise pregnant women of the potential risk to a fetus. The background risk of major birth defects and miscarriage for the indicated population is unknown. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively. Data Animal Data In a dose range-finding embryo-fetal development study, pregnant rats received oral doses of 50, 150, 500, or 1000 mg/kg/day of rucaparib during the period of organogenesis. Post-implantation loss (100% early resorptions) was observed in all animals at doses greater than or equal to 50 mg/kg/day (with maternal systemic exposures approximately 0.04 times the human exposure at the recommended dose based on AUC0-24h). 8.2 Lactation Risk Summary There is no information regarding the presence of rucaparib in human milk, or on its effects on milk production or the breast-fed infant. Because of the potential for serious adverse reactions in breast-fed infants from Rubraca, advise lactating women not to breastfeed during treatment with Rubraca and for 2 weeks after the final dose. 8.3 Females and Males of Reproductive Potential Pregnancy Testing Pregnancy testing is recommended for females of reproductive potential prior to initiating Rubraca. Contraception Females Rubraca can cause fetal harm when administered to a pregnant woman [see Use in Specific Populations (8.1)]. Advise females of reproductive potential to use effective contraception during treatment and for 6 months following the final dose of Rubraca. 8.4 Pediatric Use The safety and effectiveness of Rubraca in pediatric patients have not been established. 8.5 Geriatric Use One hundred and sixty (42%) of the 377 ovarian cancer patients in clinical trials of Rubraca were 65 years of age or older. No overall differences in safety were observed between these patients and younger patients, but greater sensitivity of some older individuals cannot be ruled out. The effectiveness of Rubraca in patients with BRCA-mutant ovarian cancer who were 65 years of age or older could not be assessed due to the small number of patients (N=38). 8.6 Hepatic Impairment No starting dose adjustment is recommended for patients with mild hepatic impairment (total bilirubin less than or equal to upper limit of normal [ULN] and AST greater than ULN, or total bilirubin between 1.0 to 1.5 times ULN and any AST). No recommendation of starting dose adjustment is available for patients with moderate to severe hepatic impairment (total bilirubin greater than 1.5 times ULN) due to a lack of data [See Clinical Pharmacology (12.3)]. 8.7 Renal Impairment No starting dose adjustment is recommended for patients with mild to moderate renal impairment (creatinine clearance [CLcr] between 30 and 89 mL/min, as estimated by the Cockcroft-Gault method). There is no recommended starting dose for patients with CLcr less than 30 mL/min or patients on dialysis due to a lack of data [See Clinical Pharmacology (12.3)].  10 OVERDOSAGE There is no specific treatment in the event of Rubraca overdose, and symptoms of overdose are not established. In the event of suspected overdose, physicians should follow general supportive measures and should treat symptomatically.  11 DESCRIPTION Rucaparib is an inhibitor of the mammalian polyadenosine 5'-diphosphoribose polymerase (PARP) enzyme. The chemical name is 8-fluoro-2-{4-[(methylamino)methyl]phenyl}-1,3,4,5-tetrahydro-6H-azepino[5,4,3-cd]indol-6-one ((1S,4R)-7,7-dimethyl-2-oxobicyclo[2.2.1]hept-1-yl)methanesulfonic acid salt. The chemical formula of rucaparib camsylate is C19H18FN3O•C10H16O4S and the relative molecular mass is 555.67 Daltons. The chemical structure of rucaparib camsylate is shown below: Rucaparib camsylate is a white to pale yellow powder; formulated into a tablet for oral use. Rucaparib shows pH-independent low solubility of approximately 1 mg/mL across the physiological pH range. Rubraca (rucaparib) tablets contain rucaparib camsylate as the active ingredient. Each 200 mg tablet contains 344 mg rucaparib camsylate equivalent to 200 mg rucaparib free base. Each 300 mg tablet contains 516 mg rucaparib camsylate equivalent to 300 mg rucaparib free base. The inactive ingredients in Rubraca tablets include: microcrystalline cellulose, sodium starch glycolate, colloidal silicon dioxide, and magnesium stearate. The cosmetic blue film coating for 200 mg tablets and cosmetic yellow film coating for 300 mg tablets is Opadry II containing polyvinyl alcohol, titanium dioxide, polyethylene glycol/macrogol, and talc. The coating is colorized as blue using brilliant blue aluminum lake and indigo carmine aluminum lake, or yellow using yellow iron oxide.  12 CLINICAL PHARMACOLOGY 12.1 Mechanism of Action Rucaparib is an inhibitor of poly (ADP-ribose) polymerase (PARP) enzymes, including PARP-1, PARP-2, and PARP-3, which play a role in DNA repair. In vitro studies have shown that rucaparib-induced cytotoxicity may involve inhibition of PARP enzymatic activity and increased formation of PARP-DNA complexes resulting in DNA damage, apoptosis, and cell death. Increased rucaparib-induced cytotoxicity was observed in tumor cell lines with deficiencies in BRCA1/2 and other DNA repair genes. Rucaparib has been shown to decrease tumor growth in mouse xenograft models of human cancer with or without deficiencies in BRCA. 12.2 Pharmacodynamics The pharmacodynamic response of rucaparib has not been characterized. Cardiac Electrophysiology The effect of multiple doses of Rubraca on QTc interval was evaluated in an open-label single-arm study in 56 patients with solid tumors who were administered continuous doses of Rubraca ranging from 40 mg once daily (0.03 times the approved recommended dosage) to 840 mg twice daily (1.4 times the approved recommended dosage). The mean QTcF increase from baseline (90% confidence interval [CI]) in population pharmacokinetics estimated 95% percentile Cmax (3019 ng/mL) at steady state of 600 mg rucaparib twice daily was 14.9 msec (11.1-18.7 msec). 12.3 Pharmacokinetics All pharmacokinetics of rucaparib were characterized in patients with cancer. Rucaparib demonstrated linear pharmacokinetics over a dose range from 240 to 840 mg twice daily with time-independence and dose-proportionality. The mean steady-state rucaparib Cmax was 1940 ng/mL (54% coefficient of variation [CV]) and AUC0-12h was 16900 h·ng/mL (54% CV) at the approved recommended dosage. Accumulation was 3.5 to 6.2 fold. Median terminal half-life (T1/2) was 17 hours following a single intravenous dose of 12 to 40 mg rucaparib. Absorption The median Tmax was 1.9 hours at the approved recommended dosage. The mean absolute bioavailability of rucaparib immediate-release tablet was 36% with a range from 30% to 45%. Following a high-fat meal, the Cmax was increased by 20% and AUC0-24h was increased by 38%, and Tmax was delayed by 2.5 hours, as compared to dosing under fasted conditions [see Dosage and Administration (2.2)]. Distribution Rucaparib had a steady-state volume of distribution of 113 L to 262 L following a single intravenous dose of 12 mg to 40 mg rucaparib. In vitro, the protein binding of rucaparib was 70% in human plasma at therapeutic concentrations. Rucaparib preferentially distributed to red blood cells with a blood-to-plasma concentration ratio of 1.83. Elimination The mean terminal T1/2 of rucaparib was 17 to 19 hours, following a single oral dose of 600 mg rucaparib. The apparent clearance ranged from 15.3 to 79.2 L/hour, following continuous 600 mg rucaparib orally twice daily. The clearance ranged from 13.9 to 18.4 L/hour, following a single intravenous dose of rucaparib 12 mg to 40 mg. Metabolism In vitro, rucaparib was metabolized primarily by CYP2D6 and to a lesser extent by CYP1A2 and CYP3A4. Specific Populations Age, Race, and Body Weight Based on population pharmacokinetic analyses, age, race, and body weight did not have a clinically significant effect on rucaparib exposure. Renal Impairment In patients who received Rubraca 600 mg twice daily, those with mild renal impairment (N=148; CLcr between 60 and 89 mL/min, as estimated by the Cockcroft-Gault method) and those with moderate renal impairment (N=72; CLcr between 30 and 59 mL/min) showed approximately 15% and 32% higher steady-state AUC, respectively, compared to patients with normal renal function (N=143; CLcr greater than or equal to 90 mL/min). The pharmacokinetic characteristics of rucaparib in patients with CLcr less than 30 mL/min or patients on dialysis are unknown. Hepatic Impairment Based on population pharmacokinetic analyses, no apparent pharmacokinetic difference was observed in 34 patients with mild hepatic impairment (total bilirubin less than or equal to ULN and AST greater than ULN, or total bilirubin between 1.0 to 1.5 time ULN and any AST) who received Rubraca 600 mg twice daily as compared to patients with normal hepatic function (N=337). The pharmacokinetic characteristics of rucaparib in patients with moderate to severe hepatic impairment (total bilirubin greater than 1.5 times ULN) are unknown. CYP Enzyme Polymorphism Based on population pharmacokinetic analyses, steady-state concentrations following rucaparib 600 mg twice daily did not differ significantly across CYP2D6 or CYP1A2 genotype subgroups. Drug Interaction Studies Effects of Other Drugs on Rucaparib In vitro, rucaparib had a low metabolic turnover rate in human liver microsomes, and was metabolized primarily by CYP2D6 and to a lesser extent by CYP1A2 and CYP3A4. In vitro, rucaparib was shown to be a substrate of P-gp and BCRP, but not a substrate of renal uptake transporters OAT1, OAT3, and OCT2, or hepatic transporters OATP1B1 and OATP1B3. Concomitant treatment with proton pump inhibitors has no clinically meaningful change in steady-state exposures. Effect of Rucaparib on Other Drugs Effect of rucaparib on other drugs has not been studied in humans. Rucaparib reversibly inhibited CYP1A2, CYP2C19, CYP2C9, and CYP3A, and to a lesser extent CYP2C8, CYP2D6, and UGT1A1. Rucaparib induced CYP1A2, and down regulated CYP2B6 and CYP3A4 in human hepatocytes at clinically relevant exposures. Rucaparib was a potent inhibitor of MATE1 and MATE2-K, and a moderate inhibitor of OCT1. Weak inhibition was observed at ultra-therapeutic concentration (300 μM) of rucaparib for MRP4, OATP1B1, OATP1B3, OAT1, and OAT3. No inhibition was observed for MRP2, MRP3, or BSEP. Rucaparib was an inhibitor of BCRP and P-gp efflux transporters with IC50 of 55 μM and 283 μM, respectively. 13 NONCLINICAL TOXICOLOGY 13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility Carcinogenicity studies have not been conducted with rucaparib. Rucaparib was mutagenic in a bacterial reverse mutation (Ames) test, and clastogenic in an in vitro chromosomal aberration assay in cultured human lymphocytes. The clastogenic response in mitotically-stimulated cells was anticipated based on the mechanism of action of rucaparib and indicates potential genotoxicity in humans. Fertility studies with rucaparib have not been conducted. In 3-month repeat-dose general toxicology studies, rucaparib had no effects on male and female reproductive organs at doses up to 100 mg/kg/day and 20 mg/kg/day in rats and dogs, respectively. These dose levels resulted in systemic exposures of approximately 0.3 and 0.09 times the human exposure (AUC0-24h), respectively, at the recommended dose.  14 CLINICAL STUDIES The efficacy of Rubraca was investigated in 106 patients in two multicenter, single-arm, open-label clinical trials, Study 1 and Study 2, in patients with advanced BRCA-mutant ovarian cancer who had progressed after 2 or more prior chemotherapies. All 106 patients received Rubraca 600 mg orally twice daily as monotherapy until disease progression or unacceptable toxicity. Objective response rate (ORR) and duration of response (DOR) were assessed by the investigator and independent radiology review (IRR) according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. The median age of the patients was 59 years (range 33 to 84), the majority were Caucasian (78%), and 100% had an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1. All patients had received at least two prior platinum-based chemotherapies and 43% had received 3 or more prior lines of chemotherapy. There were 18/106 patients (17%) who had deleterious BRCA mutations detected in tumor tissue and not in whole blood specimens. Tumor BRCA mutation status was verified retrospectively in 96% (64/67) of the patients for whom a tumor tissue sample was available by the companion diagnostic FoundationFocus CDxBRCA™ test, which is FDA approved for selection of patients for Rubraca treatment. Efficacy results are summarized in Table 4. Table 4. Overall Response and Duration of Response in Patients with BRCA-mutant Ovarian Cancer Who Received 2 or More Chemotherapies in Study 1 and Study 2 Investigator-assessed N=106 Objective Response Rate (95% CI) 54% (44, 64) Complete Response 9% Partial Response 45% Median DOR in months (95% CI) 9.2 (6.6 ,11.6) Response assessment by independent radiology review was 42% (95% CI [32, 52]), with a median DOR of 6.7 months (95% CI [5.5, 11.1]). Investigator-assessed ORR was 66% (52/79; 95% CI [54, 76]) in platinum-sensitive patients, 25% (5/20; 95% CI [9, 49]) in platinum-resistant patients, and 0% (0/7; 95% CI [0, 41]) in platinum-refractory patients. ORR was similar for patients with a BRCA1 gene mutation or BRCA2 gene mutation. 16 HOW SUPPLIED/STORAGE AND HANDLING 16.1 How Supplied Rubraca is available as 200 mg and 300 mg tablets. 200 mg Tablets: Blue, round, and debossed with “C2” on one side Supplied in bottles of 60 tablets (NDC: 69660-201-91) 300 mg Tablets: Yellow, oval, and debossed with “C3” on one side Supplied in bottles of 60 tablets (NDC: 69660-203-91) 16.2 Storage Store at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F) [see USP Controlled Room Temperature].  17 PATIENT COUNSELING INFORMATION Advise the patient to read the FDA-approved patient labeling (Patient Information). MDS/AML: Advise patients to contact their healthcare provider if they experience weakness, feeling tired, fever, weight loss, frequent infections, bruising, bleeding easily, breathlessness, blood in urine or stool, and/or laboratory findings of low blood cell counts, or a need for blood transfusions. These may be signs of hematological toxicity or a more serious uncommon bone marrow problem called ‘myelodysplastic syndrome' (MDS) or ‘acute myeloid leukemia' (AML) which have been reported in patients treated with Rubraca [see Warnings and Precautions (5.1)]. Embryo-Fetal Toxicity: Advise females to inform their healthcare provider if they are pregnant or become pregnant. Inform female patients of the risk to a fetus and potential loss of the pregnancy [see Use in Specific Populations (8.1)]. Advise females of reproductive potential to use effective contraception during treatment and for 6 months after receiving the last dose of Rubraca [see Warnings and Precautions (5.2) and Use in Specific Populations (8.1, 8.3)]. Photosensitivity: Advise patients to use appropriate sun protection due to the increased susceptibility to sunburn while taking Rubraca [see Adverse Drug Reactions (6.1)]. Lactation: Advise females not to breastfeed during treatment and for 2 weeks after the last dose of Rubraca [see Use in Specific Populations (8.2)]. Dosing Instructions: Instruct patients to take Rubraca orally twice daily with or without food. Doses should be taken approximately 12 hours apart. Advise patients that if a dose of Rubraca is missed or if the patient vomits after taking a dose of Rubraca, patients should not take an extra dose, but take the next dose at the regular time [see Dosage and Administration (2.1)]. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a6d46c03-bb1d-417b-b8e5-3bffe352fe29