KHAPZORY^® Active Isomer + Pharmacology

KHAPZORY^® is levoleucovorin, the pharmacologically active isomer in modulation of fluorouracil. KHAPZORY^® enhances the therapeutic and toxic effects of fluorouracil in mCRC¹

Levoleucovorin has unique pharmacologic properties

In pharmacokinetic studies, levoleucovorin was shown to have distinct characteristics in several dimensions

Levoleucovorin

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KHAPZORY^® Important Safety Information

Indications and Usage

KHAPZORY^® is a folate analog indicated for the treatment of adults with metastatic colorectal cancer in combination with fluorouracil, as rescue after high-dose methotrexate therapy in adult and pediatric patients with osteosarcoma, and for diminishing the toxicity associated with overdosage of folic acid antagonists or impaired methotrexate elimination in adult and pediatric patients.

Limitations of Use

KHAPZORY^® (levoleucovorin) is not indicated for the treatment of pernicious anemia and megaloblastic anemia secondary to lack of vitamin B12 because of the risk of progression of neurologic manifestations despite hematologic remission.

Important Safety Information

Contraindications

• KHAPZORY^® is contraindicated in patients who have had severe hypersensitivity to leucovorin products, folic acid, or folinic acid.

Warnings and Precautions

• Increased Gastrointestinal Toxicities with Fluorouracil: Gastrointestinal toxicities, including stomatitis and diarrhea, occur more commonly and may be of greater severity and of prolonged duration. Deaths from severe enterocolitis, diarrhea, and dehydration have occurred in elderly patients receiving weekly d,l-leucovorin and fluorouracil. Do not initiate or continue therapy with KHAPZORY^® and fluorouracil in patients with symptoms of gastrointestinal toxicity until those symptoms have resolved. Monitor patients with diarrhea until it has resolved as rapid deterioration leading to death can occur.
• Drug Interaction with Trimethoprim-Sulfamethoxazole: Concomitant use of d,l-leucovorin with trimethoprim-sulfamethoxazole for the acute treatment of Pneumocystis jiroveci pneumonia in patients with HIV infection increased treatment failure and morbidity.

Adverse Reactions

• The most common adverse reactions (≥20%) in patients receiving high-dose methotrexate therapy with levoleucovorin rescue were stomatitis (38%) and vomiting (38%).
• The most common adverse reactions (>50%) in patients receiving levoleucovorin in combination with fluorouracil for metastatic colorectal cancer were stomatitis (72%), diarrhea (70%), and nausea (62%).

Drug Interactions

Leucovorin products increase the toxicity of fluorouracil.

Use in Specific Population

There is limited data with levoleucovorin use in pregnant women. KHAPZORY^® is administered in combination with methotrexate or fluorouracil, which can cause embryo-fetal harm. Refer to methotrexate and fluorouracil Prescribing Information for additional information.

Reporting of Suspected Adverse Reactions

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

References

1. KHAPZORY^®. Prescribing Information. Acrotech Biopharma Inc.
2. Mader RM, et al. J Pharm Sci. 1994;83(9):1247-1249.
3. Straw JA, et al. Cancer Res. 1984;44(7):3114-3119.
4. Bleyer WA. Cancer. 1989;63(Suppl 6):995-1007,