Pemazyre
Pemazyre (pemigatinib) is an oral pill used to treat certain bile duct cancers and a rare blood cancer called myeloid/lymphoid neoplasms (MLNs). It’s FDA approved for cancers with a specific fibroblast growth factor receptor (FGFR) genetic change, when other treatments haven’t worked and surgery isn’t an option. You typically take it by mouth once a day, either every day or in cycles, depending on what condition you’re treating. Common side effects include nail changes, hair loss, and mouth sores.
What is Pemazyre (pemigatinib)?
What is Pemazyre (pemigatinib) used for?
- Advanced or metastatic bile duct cancer with FGFR2 genetic changes, when other treatments no longer work and surgery isn’t an option
- Advanced blood cancer called myeloid/lymphoid neoplasms (MLNs) with a FGFR1 genetic change
How Pemazyre (pemigatinib) works
Pemazyre (pemigatinib) is an FGFR inhibitor. It works by blocking FGFR proteins that normally tell cells to grow and divide. In some cancers, a mutation (change) in the FGFR gene makes these proteins too active. This causes cancer cells to grow out of control.
By attaching to FGFR proteins, Pemazyre (pemigatinib) helps shut down these growth signals. This can slow or stop the cancer from growing and spreading.
Drug facts
| Common Brands | Pemazyre |
|---|---|
| Drug Class | FGFR Inhibitor |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | No lower-cost generic available |
| Availability | Prescription only |
Side effects of Pemazyre (pemigatinib)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
Bile duct cancer:
- Higher phosphate levels (up to 94%)
- Lower phosphate levels (68%)
- Hair loss (49%)
- Diarrhea (47%)
- Lower blood cell counts (up to 43%)
- Nail changes (43%)
- Tiredness (42%)
- Higher in liver enzymes (up to 43%)
- Changes in electrolytes (up to 43%)
- Higher creatinine (41%)
- Nausea (40%)
- Changes in taste (40%)
- Higher blood sugar (36%)
- Constipation (35%)
- Mouth sores (35%)
- Dry eyes (35%)
- Dry mouth (34%)
- Reduced appetite (33%)
MLNs:
- Higher phosphate levels (up to 97%)
- Lower blood cell counts (up to 74%)
- Nail changes (62%)
- Hair loss (59%)
- Mouth sores (53%)
- Diarrhea (50%)
- Higher in liver enzymes (50%)
- Tiredness (44%)
- Higher creatinine (44%)
- Lower phosphate levels (41%)
- Changes in electrolytes (up to 41%)
- Skin rash (35%)
- Stomach pain (35%)
- Higher blood sugar (33%)
- Dry mouth (32%)
Less Common Side Effects
Bile duct cancer:
- Vomiting
- Joint pain
- Back pain
- Stomach pain
- Weight loss
- Headache
- Urinary tract infection
- Swelling
- Dehydration
- Redness on hands or feet
- Pain in the arms or legs
MLNs:
- Nosebleeds
- Retinal changes in the eye
- Pain in the arms or legs
- Back pain
- Reduced appetite
- Dry skin
- Reduced appetite
- Blurred vision
- Swelling
- Dizziness
- Fever
- Pain in the arms or legs
Pemazyre (pemigatinib) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Eye problems: changes in vision, blurred vision, flashes of light, seeing black spots.
- High phosphate levels: muscle cramps, numbness or tingling around the mouth
The following Pemazyre (pemigatinib) 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
- Blurry vision, vision loss, seeing wavy or bent objects or blind spots with dark, light, or flashing spots
- High phosphorus level—muscle pain or cramps, bone or joint pain, numbness and tingling around the mouth
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 Pemazyre (pemigatinib)
Pros
- Available as a pill taken by mouth
- Only taken once a day
- Targeted therapy that works in a more specific way
Cons
- Causes high blood phosphate levels in most people
- Requires regular eye exams
- Interacts with many other medications
Pharmacist tips for Pemazyre (pemigatinib)
- You can take Pemazyre (pemigatinib) with or without food. Take it at the same time each day. Swallow the tablets whole, and don’t crush or split them.
- If you miss a dose of Pemazyre (pemigatinib) by 4 hours or more, skip it and take your next dose at the usual time. If you vomit after taking it, don’t take another dose that day.
- Tell your care team about all medications, supplements, and herbs you take before starting Pemazyre (pemigatinib). This medication can interact with many other products.
- Avoid grapefruit or grapefruit juice while taking Pemazyre (pemigatinib) because it can raise the amount of the medication in your blood and increase the risk of side effects.
- Pemazyre (pemigatinib) can cause eye problems, like dry eyes. You’ll need regular eye exams, and you might need to use artificial tears or eye gels. Tell your oncologist if you notice dry eyes or vision changes.
- Pemazyre (pemigatinib) often raises phosphate levels in your blood. Your care team will check this with blood tests and might suggest avoiding high-phosphorus foods or start medications to lower your levels. Call your care team if you have muscle cramps or tingling around your mouth.
- Pemazyre (pemigatinib) can cause nail changes, such as rough nails or nail lifting. These usually start within 1 to 2 months. Avoid biting your nails or using harsh nail products, and tell your care team if it becomes bothersome.
- Pemazyre (pemigatinib) might harm an unborn baby based on animal studies. Men and women should use effective birth control while taking this medication and for at least 1 week after the last dose.
- It’s not known if Pemazyre (pemigatinib) is safe during breastfeeding. To be safe, don’t breastfeed while taking it and for 1 week after your last dose.
Risks and warnings for Pemazyre (pemigatinib)
Pemazyre (pemigatinib) 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.
Eye problems
In studies, some people taking Pemazyre (pemigatinib) had eye problems, such as dry eyes or a condition called retinal pigment epithelial detachment (RPED). RPED can cause blurry vision or other vision changes, which usually happens within the first 2 months after starting the medication. You’ll need an eye exam before starting treatment and then every 2 to 3 months while taking Pemazyre (pemigatinib).
If you have dry eyes, artificial tears might help relieve symptoms. Let your care team know right away if you have any changes in vision, blurry vision, or flashes of light, black spots in your vision. Your oncologist might need to change your dose or treatment schedule while managing these eye problems.
High phosphate levels (hyperphosphatemia)
Pemazyre (pemigatinib) often raises the level of phosphate in your blood (hyperphosphatemia), which can start within the first week of treatment. This is often managed by avoiding foods high in phosphorus or taking medications to lower phosphate levels.
In rare cases, very high phosphate levels can cause painful calcium buildup in tissues or blood vessels (calciphylaxis). Your oncology team will regularly check your phosphate levels with blood tests during treatment. Tell your care team if you have new or worsening muscle cramps or tingling around your mouth, since these can be signs of high phosphate. Your oncologist might adjust how you take Pemazyre (pemigatinib) to help manage this side effect.
Harm to unborn babies
Based on animal studies, Pemazyre (pemigatinib) might harm an unborn baby. If you can become pregnant, you’ll have a pregnancy test before starting treatment to make sure it’s safe to take. Both men and women should use effective birth control while taking Pemazyre (pemigatinib) and for 1 week after the last dose.
Pemazyre (pemigatinib) dosage
Typical dosage for Pemazyre (pemigatinib)
- Bile duct cancer: The typical dose is 13.5 mg by mouth once a day for 14 days, then take 7 days off. This makes a 21-day cycle.
- MLNs: The typical dose is 13.5 mg by mouth once a day every day, without breaks.
Your dose might be lower if you have liver or kidney problems, have certain side effects, or take other medications that interact with Pemazyre (pemigatinib).
