Ripretinib (QINLOCK)

Gastrointestinal stromal tumor, advanced

Gastrointestinal stromal tumor, advanced

• Dose – Oral: 150 mg once daily continuously until disease progression or unacceptable toxicity
• May consider dose escalation to twice daily

Available as 50 mg tablets. Tablets contain lactose. Tablets should NOT be crushed or broken. Store at room temperature in original bottle with desiccant and protect from light and moisture.

KIT proto-oncogene receptor tyrosine kinase (KIT) Inhibitor

Take with or without food

If a dose is missed, patients should be instructed to take it as soon as they can if it is within 8 hours of the missed dose. If it is over 8 hours since the missed dose, patients should skip the missed dose and resume with the next scheduled dose.

Common: Abdominal pain, Nausea, Vomiting, Fatigue, Appetite decrease, Myalgia, Alopecia, Hand-foot skin reaction.

Less Common: Impaired wound healing, Cardiac dysfunction, Cardiac ischemic event, Ejection fraction decrease, Squamous cell carcinoma, Keratocanthoma, Melanoma, Headache, Photosensitivity reaction, Hypertension.

The adverse effects listed above are not exhaustive. Please refer to the relevant product monograph for full details.

Baseline before treatment: CBC & differential, platelets, creatinine, albumin, total bilirubin, alkaline phosphatase, ALT, blood pressure.

‍During treatment: CBC & differential, platelets, total bilirubin, ALT, blood pressure.

If clinically indicated: MUGA scan or echocardiogram, creatinine, alkaline phosphatase, lipase, calcium, albumin, phosphate, sodium, potassium, creatine kinase, LDH.

• This drug can impact or be impacted by metabolic enzymes for absorption and excretion. Many drugs can also affect or be affected by these enzymes, so please consult with pharmacy to assess for interactions.
• Avoid grapefruit, grapefruit juice, Seville oranges, or Seville orange juice.
• Current drug interaction databases should be consulted for more information.

• Avoid in pregnancy and lactation.
• Exercise precaution and more frequent monitoring for hypersensitivity symptoms in patients who have experienced a hypersensitivity in association with prior use of other tyrosine kinase inhibitors.
• New primary cutaneous malignancies have been reported with ripretinib including squamous cell carcinoma and melanoma. Dermatological assessment should be performed when initiating ripretinib and patients should receive dermatological examinations routinely.
• Hypertension should be well controlled prior to starting ripretinib.
• Impaired wound healing is associated with ripretinib, drug may need to be held and restarted if patient requires surgery, discuss with team.

BC Cancer. BC Cancer Drug Manual. Ripretinib. Vancouver, British Columbia: BC Cancer Agency. Available at: http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Ripretinib_monograph.pdf.  Updated October 1, 2023. Accessed January 22, 2024.

Lexicomp. Ripretinib Monograph. In: Lexi-Drugs. Hudson, Ohio: Lexi-Comp, Inc. Available at:  https://online.lexi.com/lco/action/doc/retrieve/docid/patch_f/6947790?cesid=21lOvbaeJQm&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dselpercatinib%26t%3Dname%26acs%3Dtrue%26acq%3Dseller. Updated January 24, 2024. Accessed January 30, 2024.

Cancer Care Ontario. Ripretinib Provider Monograph. Drug Formulary. Toronto, Ontario: Cancer Care Ontario. Available at: https://www.cancercareontario.ca/en/drugformulary/regimens/monograph/68411. Updated August 2023. Accessed January 22, 2024

Medison Pharma Canada Inc. QINLOCK® Product Monograph. Toronto, Ontario. Updated May 9, 2022