Oncology Drug Reference Sheet: Pemigatinib

March 28, 2023 by Kimberly Rivera DNP, RN-BC, OCN®, NPD-BC

Category/Class

Oral targeted agent, small molecule kinase inhibitor targeting (https://www.pemazyre.com/pdf/prescribing-information.pdf) FGFR1, FGFR2, FGFR3, and FGFR4

Mechanism of Action

Pemigatinib inhibits phosphorylation and signaling (https://hcp.pemazyre.com/), which prevents tumor cell proliferation and survival in FGFR-driven tumors.

Indication

Dosing

Administration

Take by mouth (https://www.pemazyre.com/pdf/prescribing-information.pdf) with or without food at the same time each day. Swallow the tablets whole; do not crush, chew, split or dissolve tablets. If you miss a dose by more than four hours or vomit a dose, do not take an extra dose; rather, wait and resume your dosing at the next scheduled time.

Adverse Reactions

The package insert contains warnings and precautions (https://www.pemazyre.com/pdf/prescribing-information.pdf) for hyperphosphatemia (which can lead to soft tissue mineralization), embryo-fetal toxicity, and retinal pigment epithelial detachment. More than 20% of patients taking pemigatinib for MLNs experience (https://www.pemazyre.com/pdf/prescribing-information.pdf) hyper- or hypophosphatemia, anemia, decreased appetite, nausea, dyspepsia, abdominal pain, diarrhea, constipation, nail toxicity, alopecia, stomatitis, dry skin, dry mouth, dry eye, blurred vision, rash, epistaxis, extremity pain, back pain, peripheral edema, and dizziness. More than 20% of patients taking it for cholangiocarcinoma experience (https://www.pemazyre.com/pdf/prescribing-information.pdf) hyper- or hypophosphatemia, decreased appetite, nausea, vomiting, diarrhea, dysgeusia, abdominal pain, constipation, nail toxicity, alopecia, stomatitis, dry skin, dry mouth, dry eye, arthralgia, and back pain.

Nursing Considerations

Avoid concurrent use of CYP3A inducers and inhibitors. Reduce the pemigatinib dose if a CYP3A inhibitor is unavoidable.

Ensure patients adhere to comprehensive ophthalmologic examinations (https://www.pemazyre.com/pdf/prescribing-information.pdf), including optical coherence tomography, prior to initiation and every two months for the first six months, every three months for the duration of treatment, and urgently as needed if they develop new visual symptoms.

Monitor patients for hyperphosphatemia (https://www.pemazyre.com/pdf/prescribing-information.pdf). For serum phosphate levels greater than 5.5 mg/dl, educate them about following a low-phosphate diet. For phosphate levels greater than 7 mg/dl, consult the provider for phosphate-lowering therapy and, depending on severity, withholding, reducing, or permanently discontinuing pemigatinib.

Verify pregnancy status of patients of reproductive potential prior to initiating therapy.

Patient Education

Special Considerations

The clinical trials demonstrated no difference (https://www.pemazyre.com/pdf/prescribing-information.pdf) in safety or effectiveness in adult patients of different ages, races, or ethnicities. Safety and effectiveness have not been established in pediatric patients.

Safe Handling

Pemigatinib is considered a hazardous drug (https://www.pemazyre.com/pdf/prescribing-information.pdf) because it can cause embryo-fetal toxicity.

Patient Assistance

Visit IncyteCARES (https://hcp.incytecares.com/oncology-hematology/pemazyre/home.aspx) or call 866-708-8806.


Copyright © 2023 by the Oncology Nursing Society. User has permission to print one copy for personal or unit-based educational use. Contact pubpermissions@ons.org for quantity reprints or permission to adapt, excerpt, post online, or reuse ONS Voice content for any other purpose.