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TAGRISSO (osimertinib)
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Safety profile and side effects - FLAURA

Logo for Tagrisso (osimertinib) which is coloured lime teal and purple and shaped like lungs

Safety Profile and Side Effects: FLAURA

In the FLAURA study, most adverse events were mild to moderate.1

Quality of life matters; TAGRISSO treatment arm had fewer AEs than gefitinib / erlotinib1–3

  • Grade ≥3 AEs were generally less frequent with TAGRISSO than with gefitinib/erlotinib1
  • In FLAURA, 4% of  patients had dose reductions due to AEs. 13% of patients discontinued TAGRISSO due to AEs1
  • AEs causally-related in the TAGRISSO arm (n=279) was 10% compared to 14% in the gefitinib/erlotinib arm (n=277)4

TAGRISSO table of side effects: FLAURA trial1

AEs with an incidence of ≥ 10% in either arm are shown.

 TAGRISSO (n=279)gefitinib / erlotinib (n=277)
 Any gradeGrade ≥3Any gradeGrade ≥ 3
Any AE
98%32%98%41%
Rash or acne†
58%1%78%7%
Diarrhoea‡
58%2%57%2%
Dry skin†
36%<1%36%1%
Paronychia†
35%<1%33%1%
Stomatitis
29%<1%20%<1%
Decreased appetite
20%3%19%2%
Pruritus
17%<1%16%0
Cough
16%
0
15%
<1%
Constipation
15%
0
13%
0
Nausea‡
14%
0
19%
0
Fatigue
14%
<1%12%
<1%
Dyspnoea‡
13%
<1%
7%
1%
Anaemia
12%
1%
9%
1%
Headache
12%
<1%
7%
0
Vomiting
11%
010%
1%
URTI
10%
06%
0
Pyrexia
10%
04%
<1%
Prolonged QT interval ECG
10%
2%
4%
<1%
AST elevation
9%
<1%
25%
4%
Alopecia
7%
013%
0
ALT elevation
6%
<1%
27%
9%

Adapted from Soria JC et al. N Engl J Med 2018.1

AE, adverse event; ALT, alanine aminotransferase; AST, aspartate transferase; ECG, electrocardiogram; URTI, upper respiratory tract infection

† This category represents a grouped term for the event. If a patient had multiple preferred-term events within a specific grouped-term adverse event, then the maximum grade (according to the Common Terminology Criteria for Adverse Events) across those events was counted.

‡ In the standard EGFR-TKI group, there were two patients who had missing data on grade, one with diarrhoea and one with nausea. In addition, there was one patient with grade 5 diarrhoea and one patient with grade 5 dyspnoea.

TAGRISSO Safety Considerations2,3

Please refer to product labelling for more information.

Patients with acute onset and/or unexplained worsening of pulmonary symptoms (dyspnoea, cough, fever) should have their treatment interrupted while investigations are performed to exclude ILD. If ILD is diagnosed, TAGRISSO should be discontinued and appropriate treatment initiated as necessary. Reintroduction should be considered only after careful consideration of the individual patient’s benefits and risk.

QTc interval prolongation occurs in patients treated with TAGRISSO. QTc interval prolongation may lead to an increased risk for ventricular tachyarrhythmias (e.g. torsade de pointes) or sudden death. When possible, TAGRISSO should be avoided in patients with congenital long QT syndrome. Periodic monitoring with electrocardiograms and electrolytes should be considered in patients with congestive heart failure, electrolyte abnormalities, or those who are taking medicinal products that are known to prolong the QTc interval. Treatment should be withheld in patients who develop a QTc interval greater than 500 msec on at least 2 separate ECGs until the QTc interval is less than 481 msec or recovery to baseline if the QTc interval is greater than or equal to 481 msec then resume TAGRISSO at a reduced dose. TAGRISSO should be permanently discontinued in patients who develop QTc interval prolongation in combination with any of the following: torsade de pointes, polymorphic ventricular tachycardia, signs/symptoms of serious arrhythmia.

Patients presenting with signs and symptoms suggestive of keratitis such as acute or worsening eye inflammation, lacrimation, light sensitivity, blurred vision, eye pain, and/or red eye should be referred promptly to an ophthalmology specialist.

Rare cases of aplastic anaemia, including fatal events, have been reported in association with TAGRISSO treatment. Before initiating treatment, patients should be advised of signs and symptoms of aplastic anaemia including, but not limited, to persistent fever, bruising, bleeding, pallor, infection and fatigue. If signs and symptoms suggestive of aplastic anaemia develop, close patient monitoring and drug interruption or discontinuation of TAGRISSO should be considered. TAGRISSO should be discontinued in patients with confirmed aplastic anaemia.

Before initiating treatment, patients should be advised of signs and symptoms of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). If signs and symptoms suggestive of SJS or TEN appear, TAGRISSO should be interrupted. TAGRISSO should be discontinued immediately if SJS or TEN are diagnosed.

LVEF decreases ≥10% and a drop to less than 50% occurred in 4.2% (65/1557) of TAGRISSO-treated patients who had baseline and at least one follow-up LVEF assessment. In patients with cardiac risk factors and those with conditions that can affect LVEF, cardiac monitoring, including an assessment of LVEF at baseline and during treatment, should be considered. In patients who develop relevant cardiac signs/symptoms during treatment, cardiac monitoring including LVEF assessment should be considered.

 

For the latest recommendations on cardiovascular monitoring, please refer to the 2022 ESC guidelines on cardio-oncology.5

Advise patients Hepatitis B Virus (HBV) reactivation can occur if treated with TAGRISSO, and in some cases, may result in fulminant hepatitis, hepatic failure, and death. Patients with evidence of positive HBV serology should be monitored for clinical and laboratory signs of HBV reactivation while receiving TAGRISSO. In patients who develop reactivation of HBV while on TAGRISSO, treatment with TAGRISSO should be withheld and they should be managed according to local institutional guidelines.

Elderly patients (>65 years) or patients with low body weight (<50 kg) may be at increased risk of developing adverse events of Grade 3 or higher. Close monitoring is recommended in these patients.

There are no or limited data from the use of TAGRISSO in pregnant women; studies in animals have shown reproductive toxicity (embryolethality, reduced foetal growth and neonatal death). TAGRISSO should not be used during pregnancy unless the clinical condition of the woman requires treatment with TAGRISSO.

Explore TAGRISSO’s results

Take a closer look at how TAGRISSO is administered: FLAURA trial

Explore dosing and administration

Take a look at real patient case studies: FLAURA trial


Explore case studies

Learn more about how TAGRISSO works

Explore MOA

AE, adverse event; ALT, alanine aminotransferase; AST, aspartate transferase; ECG, electrocardiogram; EGFR, epidermal growth factor receptor; EGFRm, epidermal growth factor receptor mutant; ILD, interstitial lung disease; LVEF, left ventricular ejection fraction; MOA, mode of action; NSCLC, non-small cell lung cancer; QTc, corrected QT interval; SJS, Stevens-Johnson syndrome; TEN, toxic epidermal necrolysis; URTI, upper respiratory tract infection

 

  1. Soria JC, Ohe Y, Vansteenkiste J, Reungwetwattana T, Chewaskulyong B, Lee KH, et al. Osimertinib in Untreated EGFR-Mutated Advanced Non-Small-Cell Lung Cancer. N Engl J Med. 2018 Jan 11;378(2):113-25.
  2. TAGRISSO (osimertinib) 40 mg Summary of Product Characteristics.
  3. TAGRISSO (osimertinib) 80 mg Summary of Product Characteristics.
  4. Soria JC, Ohe Y, Vansteenkiste J, Reungwetwattana T, Chewaskulyong B, Lee KH, et al. Osimertinib in Untreated EGFR-Mutated Advanced Non-Small-Cell Lung Cancer (Supplementary Appendix). N Engl J Med. 2018 Jan 11;378(2):113-25.
  5. Lyon A et al. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS): Developed by the task force on cardio-oncology of the European Society of Cardiology (ESC). Eur Heart J. 2022 Nov 1;43(41):4229–361.

GB-71909  |  DOP: December 2025

Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. Adverse events should also be reported to AstraZeneca by visiting https://contactazmedical.astrazeneca.com/ or by calling ‌‌‌0‌‌‌8‌‌‌‌‌0‌‌‌‌0‌‌‌ ‌‌7‌‌‌‌‌‌8‌‌‌3‌‌‌ ‌‌0‌‌‌‌‌0‌‌‌‌3‌‌‌‌3‌‌‌.

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