The FDA has approved an updated drug labeling for Sandoz's fludarabine phosphate injection in the treatment of B-cell chronic lymphocytic leukemia (CLL) through the Oncology Center of Excellence's Project Renewal initiative. This update ensures that the labeling information is clinically meaningful and scientifically current, marking the third drug to receive such an update under this project.
Project Renewal is designed to update labeling information for older cancer drugs by leveraging external oncology experts and early-career scientists to review existing literature. This collaborative approach aims to provide transparency in the FDA’s evaluation process and evidentiary standards, while keeping the labeling of commonly prescribed oncology drugs up to date. The initiative is limited to older oncology drugs with substantial post-marketing experience.
Labeling Updates for Fludarabine Phosphate Injection
The updated labeling for Sandoz's fludarabine phosphate injection includes several key changes. Notably, a boxed warning has been removed and incorporated into the Warnings and Precautions section of the label. The revised label also updates the dosing regimen to include recommended dosages for use in combination with cyclophosphamide and rituximab.
The previous FDA dosing recommendations cited a dose of 25 mg/m² administered intravenously over 30 minutes daily for five consecutive days, with each course repeated every 28 days. The label also advised dose reduction for patients with creatinine clearance between 30 and 70 mL/min per square meter of body surface area. The previous indication cautioned against use in patients with advanced age, renal impairment, or bone marrow impairment due to increased toxicity, recommending close monitoring and dose modification as needed.
Current Indications and Usage
Sandoz's fludarabine phosphate injection is currently approved for two indications. It is used as part of a combination regimen for treating adults with B-cell CLL and as a treatment for adults with B-cell CLL who have not responded to or have progressed on at least one alkylating-agent containing regimen. While the optimal duration of treatment has not been clearly established, it is recommended that three additional cycles of the injection are administered following the achievement of maximal response, after which the drug should be discontinued.
