Osimertinib (Tagrisso) with dexamethasone

Portal Forums Lung/Thoracic Cancer EGFR Inhibitors Osimertinib (Tagrisso) with dexamethasone

This topic contains 3 replies, has 3 voices, and was last updated by  daxys 2 weeks, 4 days ago.

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June 30, 2018 at 9:46 pm  #1294717    

daxys

Is anyone on Tagrisso (osimertinib) taking or took dexamethasone? I want to start my mum on osimertinib, but she is taking dexamethasone for brain lesion edema. I learned there might be interaction between these two : dexamethasone may reduce the blood levels of osimertinib, which may make the medication less effective in some cases. Does anyone have any experience or recommendations and did you have good response from Tagrisso while on dexamethasone?

July 1, 2018 at 8:14 am  #1294718    

onthemark

Hi Daxys,

Welcome to GRACE. It’s best to discuss your concerns with your oncologist, but in the meantime if you look at the physician desk reference page on Tagrisso, which exhaustively lists all the drug interactions that are significant enough for doctors to take into account, it doesn’t list dexamethasone or decadron.

See: http://www.pdr.net/drug-summary/Tagrisso-osimertinib-3828

Drugs can have weak interactions but not enough to change how medications are prescribed or patients monitored.

Since Tagrisso crosses the blood brain barrier, hopefully your Mum has a good response and it will shrink the mets in the brain so your Mum may not need to stay on Dexamethasone. Sometimes Tagrisso is prescribed at double dose (160 mg rather than 80 mg) for patients with brain mets.


10/2015 Chest xray found a nodule as part of a physical (no symptoms).
01/2016 Upper left lobe lingula preserving lobectomy stage 2b for 1.9 cm invasive adenocarcinoma with additional 2 mm AIS nodule found in pathology.
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07/2016 Durvalumab adjuvant clinical trial discontinued after 1st dose knocked out thyroid.
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July 1, 2018 at 8:24 am  #1294719    
JimC Forum Moderator
JimC Forum Moderator

Hi daxys,

I’ll add my welcome to GRACE, as well as a bit more information in addition to what onthemark has already provided.

The interaction between osimertinib and dexamethasone is one which is predicted because dex is a weak CYP3A inducer. As onthemark points out, trial experience hasn’t revealed enough of an interaction to warrant including dex interaction in the prescribing information for Tagrisso. In a study of such possible interactions, it was concluded:

Based on observed clinical data and PBPK simulations, the recommended dose of osimertinib when dosed with strong CYP3A inducers is 160 mg once daily. PBPK modeling suggested no dose adjustment with moderate and weak CYP3A inducers.https://ascpt.onlinelibrary.wiley.com/doi/full/10.1002/psp4.12289

Although we wouldn’t expect an interaction of any significance, at worst the dosage of either Tagrisso or dexamethasone would simply need to be adjusted.

Good luck to your mum with Tagrisso!

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

July 1, 2018 at 12:38 pm  #1294735    

daxys

Thanks to both of you for your fast replies! I did some research yesterday and I guess I got basically the same information. Also I found a study which deals with various doses of osimertinib and confirms that there is no difference in efficacy :

http://oncologypro.esmo.org/Meeting-Resources/ESMO-Asia-2017-Congress/The-efficacy-of-a-reduced-dose-40mg-of-Osimertinib-with-T790M-positive-advanced-non-small-cell-lung-cancer-427P

So I guess even if there were some little interaction it should not change the effect of osimertinib. I would like that osimertinib does its best for my mum and still I would like to hear from people who took it along with dexamethasone.

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