Tovorafenib (Ojemda) represents a targeted therapeutic advancement for patients with relapsed low-grade glioma harboring specific genetic mutations. The FDA-approved medication addresses a critical unmet need for patients whose brain tumors have returned after standard treatments have failed.
Targeted Mechanism and Patient Selection
Tovorafenib belongs to the multikinase inhibitor class and specifically targets low-grade gliomas with BRAF V600 mutations. Healthcare providers must conduct genetic testing to confirm the presence of these mutations before initiating treatment, ensuring precise patient selection for optimal therapeutic outcomes.
The medication is indicated for adults and children at least 6 months old, though safety and efficacy have not been established in infants younger than 6 months due to potential growth-related concerns.
Dosing and Administration
Tovorafenib is administered orally once weekly, available in two formulations: 100 mg tablets and 25 mg/mL oral suspension. The oral suspension provides flexibility for pediatric patients and those requiring feeding tube administration. Patients can take the medication with or without food, and the tablet formulation must be swallowed whole without crushing, chewing, or breaking.
If vomiting occurs shortly after administration, patients should take another dose and continue with their regular weekly schedule. For missed doses, patients can take the medication if less than three days have passed; otherwise, they should skip the missed dose and resume their normal schedule.
Safety Profile and Monitoring Requirements
Treatment with tovorafenib requires comprehensive monitoring due to its significant side effect profile. Regular blood tests are necessary to assess liver function, as the medication can cause serious hepatic complications including loss of appetite, nausea, vomiting, upper abdominal pain, fatigue, dark urine, clay-colored stools, and jaundice.
Bleeding complications represent another serious concern, with patients potentially experiencing prolonged bleeding from cuts, nosebleeds, abnormal vaginal bleeding, bloody or tarry stools, or coughing up blood. Any bleeding that will not stop requires immediate medical attention.
Pediatric Considerations
Tovorafenib may cause slowed growth in children, necessitating regular height monitoring throughout treatment. Healthcare providers must track pediatric patients' growth patterns to assess any treatment-related impacts on development.
Reproductive Health and Contraception
The medication poses significant reproductive risks, potentially causing infertility in both men and women and harming unborn babies. Female patients require pregnancy testing before treatment initiation and must use effective contraception during therapy and for 28 days after the final dose. Male patients with female partners of childbearing potential must use contraception during treatment and for two weeks following completion.
Tovorafenib can reduce the effectiveness of hormonal birth control pills, requiring alternative contraceptive methods such as injections, implants, patches, rings, or barrier methods.
Common Adverse Events
Frequently reported side effects include fatigue, headache, constipation, nausea, vomiting, and cold-like symptoms including stuffy nose, sneezing, sore throat, and fever. Dermatologic reactions are common, presenting as skin rash, dry skin, acne, and hair color changes. The medication increases photosensitivity, requiring patients to avoid excessive sun exposure and use sunscreen with SPF 30 or higher.
Drug Interactions and Contraindications
Tovorafenib has extensive drug interaction potential, particularly with live vaccines, which are not recommended during treatment. The medication interacts with numerous other drugs including various cancer therapies, cardiovascular medications, and immunosuppressants, requiring careful medication review and potential dose adjustments.
Storage and Handling
Tablets should be stored at room temperature in their original container, protected from moisture and heat. Unmixed oral suspension also requires room temperature storage, while mixed suspension should be handled according to specific preparation instructions provided with the medication.
