Folotyn (pralatrexate injection)

What is Folotyn, and how does it work?

Folotyn (pralatrexate injection) is an antineoplastic (anti-cancer) drug used to treat T-cell lymphoma that has spread throughout the body. Folotyn is given for relapsed T-cell lymphoma, or after other medications have been tried without successful treatment.

What are the side effects of Folotyn?

Common side effects of Folotyn include:

redness or sores of the mouth/lips/throat
nausea
vomiting
loss of appetite
diarrhea
constipation
tired feeling
fatigue
cough
swelling
mild rash or itching
constipation
fever
swelling
anemia
low platelet count.

Serious skin reactions can occur. Tell your doctor if you develop rash, peeling, sores or blisters on the skin while using
Folotyn. Tell your doctor if you have unlikely but serious side effects of
Folotyn including:

signs of infection (such as fever, cough, sore throat, chills),
easy bleeding or bruising,
dehydration,
feeling weak,
looking pale, or
shortness of breath.

What is the dosage for Folotyn?

Important Dosing Information

Pretreatment Vitamin Supplementation

Folic Acid

Instruct patients to take folic acid 1 to 1.25
mg orally once daily beginning 10 days before the first dose of Folotyn.
Continue folic acid during treatment with Folotyn and for 30 days after the last
dose.

Vitamin B12

Administer vitamin B12 1 mg
intramuscularly within 10 weeks prior to the first dose of Folotyn and every
8-10 weeks thereafter. Subsequent vitamin B12 injections may be given the same
day as treatment with Folotyn.

Recommended Dosage

The recommended dosage of
Folotyn is 30 mg/m² intravenously over 3-5 minutes once weekly for 6 weeks in 7-week cycles until progressive disease or unacceptable toxicity.

Dosage Modifications For Renal Impairment And End Stage Renal Disease

Severe renal impairment (eGFR 15 to 29 mL/min/1.73 m² by MDRD): Reduce the
Folotyn dose to 15 mg/m².
End stage renal disease (ESRD: eGFR less
than 15 mL/min/1.73 m² by MDRD) with or without dialysis: Avoid
administration. If the potential benefit of administration justifies the
potential risk, monitor renal function and reduce the Folotyn dose based on
adverse reactions.

Monitoring And Dosage Modifications For Adverse Reactions

Monitoring

Monitor complete blood cell counts and severity of mucositis at baseline and weekly. Perform serum chemistry tests, including renal and hepatic function, prior to the start of the first and fourth dose of each cycle.

Recommended Dosage Modifications

Do not administer
Folotyn until:

Mucositis Grade 1 or less.
Platelet of 100,000/mcL or greater for first dose and 50,000/mcL or greater for all subsequent doses.
Absolute neutrophil count (ANC) of 1,000/mcL or greater. Dosage modifications for adverse reactions are provided in Tables 1, 2, and 3.

Table 1 :
Folotyn Dosage Modifications for Mucositis

Mucositis Grade^a on Day of TreatmentActionRecommended Dose upon Recovery to Grade 0 or 1Patients Without Severe Renal ImpairmentPatients with Severe Renal ImpairmentGrade 2Omit doseContinue prior doseContinue prior doseGrade 2 recurrenceOmit dose20 mg/m²10 g/m²Grade 3Omit dose20 mg/m²10 g/m²Grade 4Stop therapy^a Based National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE version 3.0)

Table 2 :
Folotyn Dosage Modifications for Myelosuppression

Blood Count on Day of TreatmentDuration of ToxicityActionRecommended Dose Upon RecoveryPatients Without Severe Renal ImpairmentPatients with Severe Renal ImpairmentPlatelet less than 50,000/mcL1 weekOmit doseContinue prior doseContinue prior dose2 weeksOmit dose20 mg/m²10 mg/m²3 weeksStop therapyANC 500 to 1,000/mcL and no fever1 weekOmit doseContinue prior doseContinue prior doseANC 500 to 1,000/mcL with fever or ANC less than 500/mcL1 weekOmit dose, give G-CSF or GM-CSFContinue prior dose with G-CSF or GM-CSFContinue prior dose with G-CSF or GM-CSF support2 weeks or recurrenceOmit dose, give G-CSF or GM-CSF20 mg/m² with G-CSF or GM-CSF10 mg/m² with G-CSF or GM-CSF3 weeks or nd 2 recurrenceStop therapyG-CSF=granulocyte colony-stimulating factor; GM-CSF=granulocyte macrophage colony-stimulating factor

Table 3 :
Folotyn Dosage Modifications for All Other Adverse Reactions

Toxicity Grade^a on Day of TreatmentActionRecommended Dose upon Recovery to Grade 2 or LowerPatients Without Severe Renal ImpairmentPatients with Severe Renal ImpairmentGrade 3Omit dose20 mg/m²10 mg/m²Grade 4Stop therapy^a Based on NCI CTCAE version 3.0

What drugs interact with Folotyn?

Effects Of Other Drugs On Folotyn

Coadministration of Folotyn with
probenecid increased pralatrexate plasma concentrations, which may increase the risk of adverse reactions. Avoid coadministration with probenecid or nonsteroidal anti-inflammatory drugs. If coadministration is unavoidable, monitor for increased risk of adverse reactions.

Is Folotyn safe to use while pregnant or breastfeeding?

Based on findings from animal studies and its mechanism of action, Folotyn can cause fetal harm when administered to a pregnant woman.
There are insufficient data on Folotyn use in pregnant women to evaluate for a drug-associated risk.
Folotyn was embryotoxic and fetotoxic in rats and rabbits when administered during organogenesis at doses about 1.2% (0.012 times) of the clinical dose on a mg/m² basis.
Advise pregnant women of the potential risk to a fetus.
There is no data on the presence of pralatrexate in human milk or its effects on the breastfed child or milk production.
Because of the potential for serious adverse reactions in a breastfed child, advise women not to breastfeed during treatment with Folotyn and for 1 week after the last dose.