KEYTRUDA PM e

PRODUCT MONOGRAPH INCLUDING PATIENT MEDICATION INFORMATION KEYTRUDA® Pembrolizumab powder for solution for infusion 50 mg solution for infusion 100 mg/4mL vial Antineoplastic agent, monoclonal antibody KEYTRUDA® has been issued marketing authorization with conditions, pending the results of studies to verify its clinical benefit Patients should be advised of the nature of the authorization For further information for KEYTRUDA®, please refer to Health Canada’s Notice of Compliance with conditions – drug products website: http://www.hc-sc.gc.ca/dhpmps/prodpharma/notices-avis/conditions/index-eng.php KEYTRUDA® is indicated for the treatment of: • adult patients with metastatic non-small cell lung carcinoma (NSCLC) as monotherapy, whose tumours express PD-L1 [(Tumour Proportion Score (TPS) ≥ 1%)] as determined by a validated test and who have disease progression on or after platinum-containing chemotherapy Patients with EGFR or ALK genomic tumour aberrations should have received authorized therapy for these aberrations prior to receiving KEYTRUDAđ ã adult patients with refractory or relapsed classical Hodgkin Lymphoma (cHL), as monotherapy, who have failed autologous stem cell transplant (ASCT) and brentuximab vedotin (BV) or who are not ASCT candidates and have failed BV KEYTRUDAđ (pembrolizumab) Page of 87 ã adult and pediatric patients with refractory Primary Mediastinal B-cell Lymphoma (PMBCL) or who have relapsed after or more lines of therapy, as monotherapy KEYTRUDA® has been issued marketing authorization without conditions for the treatment of patients with: • Unresectable or metastatic melanoma who have not received prior treatment with ipilimumab Subjects with BRAF V600 mutant melanoma may have received prior BRAF inhibitor therapy • Unresectable or metastatic melanoma and disease progression following ipilimumab therapy and, if BRAF V600 mutation positive, following a BRAF or MEK inhibitor • Metastatic non-small cell lung carcinoma (NSCLC) as monotherapy, in adults whose tumours have high PD-L1 expression (TPS ≥50%) as determined by a validated test, with no EGFR or ALK genomic tumour aberrations, and no prior systemic chemotherapy treatment for metastatic NSCLC • Locally advanced or metastatic urothelial carcinoma who have disease progression during or following platinum-containing chemotherapy or within 12 months of completing neoadjuvant or adjuvant platinumcontaining chemotherapy Merck Canada Inc 16750 route Transcanadienne Kirkland QC Canada H9H 4M7 http://www.merck.ca Date of Approval: January 15, 2019 Submission Control No: 215119 KEYTRUDA® (pembrolizumab) Page of 87 This product has been approved under the Notice of Compliance with Conditions (NOC/c) policy for one or all of its indicated uses What is a Notice of Compliance with Conditions (NOC/c)? An NOC/c is a form of market approval granted to a product on the basis of promising evidence of clinical effectiveness following review of the submission by Health Canada Products approved under Health Canada’s NOC/c policy are intended for the treatment, prevention or diagnosis of a serious, life-threatening or severely debilitating illness They have demonstrated promising benefit, are of high quality and possess an acceptable safety profile based on a benefit/risk assessment In addition, they either respond to a serious unmet medical need in Canada or have demonstrated a significant improvement in the benefit/risk profile over existing therapies Health Canada has provided access to this product on the condition that sponsors carry out additional clinical trials to verify the anticipated benefit within an agreed upon time frame What will be different about this Product Monograph? The following Product Monograph will contain boxed text at the beginning of each major section clearly stating the nature of the market authorization Sections for which NOC/c status holds particular significance will be identified in the left margin by the symbol NOC/c These sections may include, but are not limited to, the following: / - Indications and Clinical Uses; - Action; - Warnings and Precautions; - Adverse Reactions; - Dosage and Administration; and - Clinical Trials Adverse Reaction Reporting and Re-Issuance of the Product Monograph Health care providers are encouraged to report Adverse Drug Reactions associated with normal use of these and all drug products to Health Canada’s Canada Vigilance Program at 1-866-2342345 The Product Monograph will be re-issued in the event of serious safety concerns previously unidentified or at such time as the sponsor provides the additional data in support of the product’s clinical benefit Once the latter has occurred, and in accordance with the NOC/c policy, the conditions associated with market authorization will be removed KEYTRUDA® (pembrolizumab) Page of 87 Table of Contents PART I: HEALTH PROFESSIONAL INFORMATION SUMMARY PRODUCT INFORMATION DESCRIPTION INDICATIONS AND CLINICAL USE CONTRAINDICATIONS WARNINGS AND PRECAUTIONS ADVERSE REACTIONS 13 DRUG INTERACTIONS 38 DOSAGE AND ADMINISTRATION 38 OVERDOSAGE 42 ACTION AND CLINICAL PHARMACOLOGY 43 STORAGE AND STABILITY 45 SPECIAL HANDLING INSTRUCTIONS 45 DOSAGE FORMS, COMPOSITION AND PACKAGING 45 PART II: SCIENTIFIC INFORMATION 46 PHARMACEUTICAL INFORMATION 47 TOXICOLOGY 73 REFERENCES 79 PART III: PATIENT MEDICATION INFORMATION 80 KEYTRUDA® (pembrolizumab) Page of 87 KEYTRUDA® pembrolizumab PART I: HEALTH PROFESSIONAL INFORMATION KEYTRUDA® has been issued marketing authorization with conditions, pending the results of studies to verify its clinical benefit Patients should be advised of the nature of the authorization For further information for KEYTRUDA®, please refer to Health Canada’s Notice of Compliance with conditions – drug products website: http://www.hc-sc.gc.ca/dhpmps/prodpharma/notices-avis/conditions/index-eng.php KEYTRUDA® is indicated for the treatment of: • adult patients with metastatic non-small cell lung carcinoma (NSCLC) as monotherapy, whose tumours express PD-L1 [(Tumour Proportion Score (TPS) ≥ 1%)] as determined by a validated test and who have disease progression on or after platinum-containing chemotherapy Patients with EGFR or ALK genomic tumour aberrations should have received authorized therapy for these aberrations prior to receiving KEYTRUDAđ ã adult patients with refractory or relapsed classical Hodgkin Lymphoma (cHL), as monotherapy, who have failed autologous stem cell transplant (ASCT) and brentuximab vedotin (BV) or who are not ASCT candidates and have failed BV • adult and pediatric patients with refractory Primary Mediastinal B-cell Lymphoma (PMBCL) or who have relapsed after or more lines of therapy, as monotherapy KEYTRUDA® has been issued marketing authorization without conditions for the treatment of patients with: • Unresectable or metastatic melanoma who have not received prior treatment with ipilimumab Subjects with BRAF V600 mutant melanoma may have received prior BRAF inhibitor therapy • Unresectable or metastatic melanoma and disease progression following ipilimumab therapy and, if BRAF V600 mutation positive, following a BRAF or MEK inhibitor • Metastatic non-small cell lung carcinoma (NSCLC) as monotherapy, in adults whose tumours have high PD-L1 expression (TPS ≥50%) as determined by a validated test, with no EGFR or ALK genomic tumour aberrations, and no prior systemic chemotherapy treatment for metastatic NSCLC KEYTRUDA® (pembrolizumab) Page of 87 • Locally advanced or metastatic urothelial carcinoma who have disease progression during or following platinum-containing chemotherapy or within 12 months of completing neoadjuvant or adjuvant platinumcontaining chemotherapy SUMMARY PRODUCT INFORMATION Route of Administration Intravenous infusion Dosage Form / Strength Powder for solution for infusion 50 mg Solution for infusion 100 mg/4 mL vial Clinically Relevant Nonmedicinal Ingredients None For a complete listing see Dosage Forms, Composition and Packaging section DESCRIPTION KEYTRUDA® (pembrolizumab) is a selective humanized monoclonal antibody designed to block the interaction between programmed cell death receptor-1 (PD-1) and its ligands, PD-L1 and PD-L2 Pembrolizumab is an IgG4 kappa immunoglobulin with an approximate molecular weight of 149 kDa INDICATIONS AND CLINICAL USE Melanoma KEYTRUDA® is indicated for the treatment of patients with unresectable or metastatic melanoma who have not received prior treatment with ipilimumab Subjects with BRAF V600 mutant melanoma may have received prior BRAF inhibitor therapy KEYTRUDA® is indicated for the treatment of patients with unresectable or metastatic melanoma and disease progression following ipilimumab therapy and, if BRAF V600 mutation positive, following a BRAF or MEK inhibitor Non-Small Cell Lung Carcinoma KEYTRUDA® as monotherapy is indicated for the treatment of metastatic non-small cell lung carcinoma (NSCLC) in adults whose tumours have high PD-L1 expression [Tumour Proportion Score (TPS) ≥50%] as determined by a validated test, with no EGFR or ALK genomic tumour aberrations, and no prior systemic chemotherapy treatment for metastatic NSCLC NOC/c KEYTRUDA® as monotherapy is indicated for the treatment of metastatic non-small cell lung carcinoma (NSCLC), in adults whose tumours express PD-L1 (TPS ≥ 1%) as determined by a validated test and who have disease progression on or after platinum-containing chemotherapy KEYTRUDA® (pembrolizumab) Page of 87 Patients with EGFR or ALK genomic tumour aberrations should have received an authorized therapy for these aberrations prior to receiving KEYTRUDA® NOC/c Hodgkin Lymphoma KEYTRUDA® as monotherapy is indicated for the treatment of adult patients with refractory or relapsed classical Hodgkin Lymphoma (cHL) who have failed autologous stem cell transplant (ASCT) and brentuximab vedotin (BV) or who are not ASCT candidates and have failed BV An improvement in survival or disease-related symptoms has not yet been established NOC/c Primary Mediastinal B-cell Lymphoma KEYTRUDA® as monotherapy is indicated for the treatment of adult and pediatric patients with refractory primary mediastinal B-cell lymphoma (PMBCL), or who have relapsed after or more lines of therapy An improvement in survival or disease-related symptoms has not been established Urothelial Carcinoma KEYTRUDA® is indicated for the treatment of patients with locally advanced or metastatic urothelial carcinoma who have disease progression during or following platinum-containing chemotherapy or within 12 months of completing neoadjuvant or adjuvant platinum-containing chemotherapy Geriatrics (> 65 years of age): No overall differences in safety or efficacy were reported between elderly patients (65 years and over) and younger patients (less than 65 years) Limited safety and efficacy information is available for KEYTRUDA® in cHL ≥ 65 years of age (n=20) (See WARNINGS AND PRECAUTIONS; Geriatrics) NOC/c Pediatrics (