Alunbrig
Alunbrig (brigatinib) is an anticancer medication that treats anaplastic lymphoma kinase (ALK) positive non-small cell lung cancer (NSCLC) that has spread to other parts of the body. It’s taken by mouth once a day with or without food. Alunbrig (brigatinib) can cause some bothersome side effects, like stomach upset and make your skin more sensitive to the sun.
What is Alunbrig (brigatinib)?
What is Alunbrig (brigatinib) used for?
Anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer that has spread to other parts of the body
How Alunbrig (brigatinib) works
Alunbrig (brigatinib) is a targeted anticancer medication that blocks a protein called anaplastic lymphoma kinase (ALK) made by the ALK gene. In people with ALK-positive NSCLC, this gene doesn’t work like it should. It ends up making abnormal proteins and causing cancer. By blocking the abnormal ALK protein, Alunbrig (brigatinib) can help slow or stop the spread of NSCLC cells that are ALK-positive.
Drug Facts
What are the side effects of Alunbrig (brigatinib)?
Common Side Effects
- Labs (higher creatine phosphokinase), suggesting muscle damage (up to 81%)
- Abnormal liver labs (up to 72%)
- Abnormal pancreas labs (up to 59%)
- Higher blood sugar (up to 56%)
- Diarrhea (up to 53%)
- Rash (up to 40%)
- Cough (up to 35%)
- Nausea (up to 33%)
- High blood pressure (hypertension, up to 32%)
- Tiredness (up to 32%)
- Muscle pain (up to 28%)
- Headache (up to 28%)
- Trouble breathing (up to 27%)
- Abnormal kidney labs (up to 25%)
Other Side Effects
- Stomach pain
- Vomiting
- Lower appetite
- Back pain
- Itchy skin
- Constipation
- Swelling of face, arms, or legs
- Fever
- Dizziness
- Infection in lungs or throat
Serious Side Effects
- Severe lung problems: new or worsening breathing problems (e.g., coughing or trouble breathing), chest pain, or fever
- Dangerously slow heart beat: Tiredness, weakness, feeling dizzy or confused, feeling faint, trouble breathing, chest pain, getting tired easily during physical activity
- Serious liver problems: feeling very tired, nausea, vomiting, itchy skin, yellowing of the whites of the eyes or skin, stomach pain and swelling, swelling in the legs or ankles, dark-colored urine, pale-colored stool
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Dry cough, shortness of breath or trouble breathing
- High blood sugar (hyperglycemia)—increased thirst or amount of urine, unusual weakness or fatigue, blurry vision
- Increase in blood pressure
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Muscle injury—unusual weakness or fatigue, muscle pain, dark yellow or brown urine, decrease in amount of urine
- Pancreatitis—severe stomach pain that spreads to your back or gets worse after eating or when touched, fever, nausea, vomiting
- Slow heartbeat—dizziness, feeling faint or lightheaded, confusion, trouble breathing, unusual weakness or fatigue
- Sudden eye pain or change in vision such as blurry vision, seeing halos around lights, vision loss
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
Pros and cons of Alunbrig (brigatinib)
Pros
One of the preferred treatment options in ALK-positive NSCLC
Works well in people who’ve failed another treatment for ALK-positive NSCLC
Taken by mouth, so good for people who don’t like needles
Cons
Need to do blood work regularly to check for certain side effects, such as liver or muscle damage
Can cause serious breathing problems
Can raise blood sugar or blood pressure
Pharmacist tips for Alunbrig (brigatinib)
Take Alunbrig (brigatinib) with or without food at the same time every day. Swallow the tablet whole so that the medication works properly. Don’t cut, chew, or crush the tablet.
If you miss a dose of Alunbrig (brigatinib) or vomit after taking a dose, don’t take another dose to make it up. Just take your next dose at the next scheduled time.
If you miss your doses of Alunbrig (brigatinib) for two weeks or longer, let your provider know before you start taking your doses again. Your provider will need to restart you at a lower dose of 90 mg daily for one week, before raising you to the maintenance dose of 180 mg daily. You can use a tracker to stay on schedule with your medication.
You should avoid grapefruit and grapefruit juice while taking Alunbrig (brigatinib). These foods or drinks can raise the levels of the medication in your body and raise your risk of more side effects.
It's not known if Alunbrig (brigatinib) can pass into your breastmilk or affect your milk production. To avoid the risk of causing harm to your baby, don't breastfeed during your treatment and for 1 week after the last dose.
Alunbrig (brigatinib) can cause possible muscle damage and you might experience muscle pain, tenderness, or weakness. Let your provider know right away if your experience any new or worsening muscle problems while taking Alunbrig (brigatinib) because they might need to lower your dose. Your provider will also order blood work to check for signs of muscle damage regularly through labs (creatine phosphokinase or CPK) during treatment.
Ask your provider or pharmacist about the best way to handle and throw away Alunbrig (brigatinib) safely. Anticancer medications can be very harmful to people who handle or come into contact with them.
Frequently asked questions about Alunbrig (brigatinib)
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What are the risks and warnings for Alunbrig (brigatinib)?
Alunbrig (brigatinib) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Lung problems
Alunbrig (brigatinib) can cause serious or life-threatening lung problems, like inflammation of your lungs (pneumonitis) or interstitial lung disease. Some people experience these side effects as early as within the first week of starting Alunbrig (brigatinib). Your provider will monitor you for symptoms of new or worsening breathing problems, especially when you first start the medication. If you develop lung problems, your provider might tell you to stop taking Alunbrig (brigatinib), either temporarily or permanent, depending on how severe your symptoms were. Let your provider know right away if you start to have any new or worsening breathing problems (e.g., coughing or trouble breathing), chest pain, or fever.
High blood pressure
Taking Alunbrig (brigatinib) can raise your blood pressure (hypertension). Your provider will make sure your blood pressure is under control before you can start this medication. During Alunbrig (brigatinib) treatment, you’ll need to check your blood pressure at least once a month. If your blood pressure rises too high and isn’t well-controlled with blood pressure medications, your provider might as you to stop Alunbrig (brigatinib) to see if your blood pressure can get back to a safe range. If your blood pressure is dangerously high, then your provider might ask you to switch to a different medication. Let your provider know right away if you experience any symptoms of dangerously high blood pressure. These can include headaches, dizziness, blurry vision, chest pain, or trouble breathing
Slow heart rate
Risk factors: Taking other medications that slow your heart rate
Alunbrig (brigatinib) can slow your heart rate and cause symptoms such as dizziness, chest pain, trouble breathing, and extreme tiredness. Your provider will monitor your heart rate while you’re taking Alunbrig (brigatinib). If you experience symptoms of slow heart rate, your provider will likely stop your treatment with this medication until they can figure out the cause. They might restart Alunbrig (brigatinib) for you at a lower dose if they think it’s safe to do so.
Vision changes
Alunbrig (brigatinib) can cause you to experience blurry vision, double vision, sensitivity to light, or seeing floaters or flashes of light. Let your provider know if you experience any changes in your vision while taking Alunbrig (brigatinib) because you’ll need to stop this medication. Your provider will likely refer you to an eye specialist to figure out the cause of the vision changes. Once your vision recovers, your provider might continue Alunbrig (brigatinib) for you at a lower dose. If your vision changes are severe, your provider might switch you to a different medication.
Risk of damage to liver or pancreas
Alunbrig (brigatinib) can cause liver or pancreas problems. Most people don’t experience any symptoms, but find out through lab results that show abnormal liver or pancreatic enzymes. Your provider will check for these problems through lab work, especially during the first 3 months after you start Alunbrig (brigatinib). If there are signs of possible damage to the liver or pancreas, your provider might ask you to stop taking Alunbrig (brigatinib) temporarily or lower your dose. If the problems are serious, then you might need to stop Alunbrig (brigatinib) completely. Tell your provider about any symptoms of liver or pancreas problems, such as stomach pain, weight loss or lower appetite, nausea or vomiting, yellowing of your skin or eyes, dark-colored urine, itchy skin, or feeling more tired.
High blood sugars
People who take Alunbrig (brigatinib) commonly experience higher blood sugar levels. Because of this risk, your provider will check your blood sugar levels before you start taking the medication. They’ll also monitor your blood sugars periodically through treatment. If your blood sugars get too high, your provider might have you take medications to lower your blood sugar. Your provider might also have you stop taking Alunbrig (brigatinib) until your blood sugar levels return to a safer level. They can also lower your dose of Alunbrig (brigatinib). Let your provider know if you experience any symptoms of dangerously high blood sugar, such as feeling more thirsty or hungry, urinating more often, feeling tired, or nausea.
Harm during pregnancy
Alunbrig (brigatinib) shouldn't be taken during pregnancy because there's a risk that it can harm to both mother and unborn baby. If you're female and able to become pregnant, you should take birth control during Alunbrig (brigatinib) treatment and for at least 4 months after your last dose. If you're male and have partners who are able to become pregnant, make sure to use birth control during Alunbrig (brigatinib) treatment and for at least 3 months after your last dose.
Alunbrig (brigatinib) dosage forms
Typical dosing for Alunbrig (brigatinib)
The typical starting dose of Alunbrig (brigatinib) is 90 mg taken by mouth once daily for a week. After that, your provider will raise your dose to 180 mg once daily.
Your dose might be different if you have liver or kidney problems.
What are alternatives to Alunbrig (brigatinib)?
Anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer that has spread to other parts of the body
Anaplastic lymphoma kinase (ALK)-positive metastatic non-small cell lung cancer (NSCLC) in adults
Early stage ALK-positive NSCLC in adults after surgery
Anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer that has spread to other parts of the body
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References
Best studies we foundALK Positive. (n.d.). What is ALK-positive lung cancer?
American Lung Association. (2022). ALK and lung cancer.
Aujla, R. S., et al. (2022). Creatine phosphokinase. StatPearls.
Camidge, D.R., et al. (2018). Brigatinib versus crizotinib in ALK-positive non–small-cell lung cancer. The New England Journal of Medicine.
Gettinger, S. N., et al. (2022). Long-term efficacy and safety of brigatinib in crizotinib-refractory ALK+ NSCLC: Final results of the phase 1/2 and randomized phase 2 (ALTA) trials. Journal of Thoracic Oncology Clinical and Research Reports.
National Cancer Institute. (n.d.). Anaplastic lymphoma kinase.
National Cancer Institute. (n.d.). Pneumonitis.
National Cancer Institute. (2021). Diarrhea: Cancer treatment side effect.
National Cancer Institute. (2023). Non-small cell lung cancer treatment (PDQ®)–Patient version.
National Comprehensive Cancer Network. (2023). Metastatic non-small cell lung cancer.
Takeda Pharmaceuticals America, Inc. (2022). Tracking and planning your treatment with Alunbrig® (brigatinib).
Takeda Pharmaceuticals America, Inc. (2023). Alunbrig- brigatinib tablet, film coated; brigatinib kit [package insert]. DailyMed.
Takeda Pharmaceutical Company Limited. (2020). U.S. FDA approves Takeda’s Alunbrig® (brigatinib) as a first-line treatment option for patients diagnosed with rare and serious form of lung cancer. Business Wire.
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