

Safety analysis of patients who received DANYELZA® with GM-CSF
DANYELZA can cause serious infusion reactions, including hypotension, bronchospasm, hypoxia, and stridor, as well as severe neurotoxicity, including pain1:
Any grade infusion-related reactions occurred in 94%−100% of patients
- — Any grade hypotension occurred in 89%−100% of patients
Any grade pain occurred in 94%−100% of patients
The most common ARs in Studies 201 and 12-230 (≥25% in either study)1
-
Infusion-related reaction
-
Pain
-
Tachycardia
-
Vomiting
-
Cough
-
Nausea
-
Diarrhea
-
Decreased appetite
-
Hypertension
-
Fatigue
-
Erythema multiforme
-
Peripheral neuropathy
-
Urticaria
-
Pyrexia
-
Headache
-
Injection site reaction
-
Edema
-
Anxiety
-
Localized edema
-
Irritability
Total DANYELZA exposure across Studies 201 and 12-2301,2
Of the 25 patients in Study 201, an ongoing multicenter trial, 12% were exposed to DANYELZA with GM-CSF for ≥6 months and 0% for >1 year
Of the 72 patients in Study 12-230, 32% were exposed to DANYELZA with GM-CSF for ≥6 months and 8% for >1 year
Adverse Reaction
All Grades
Grade 3 or 4
All Grades
Grade 3 or 4
System organ class/preferred term
%
%
%
%
General disorders and administration site conditions
Pain2
Infusion-related reaction3
Edema
Fatigue4
Pyrexia5
Injection site reaction
Localized edema
100%
100%
28%
28%
28%
N/A
N/A
68%
72%
0%
0%
0%
N/A
N/A
94%
94%
N/A
44%
11%
28%
25%
32%
2.8%
N/A
0%
0%
0%
0%
Respiratory, thoracic, and mediastinal disorders
Cough
Rhinorrhea
Oropharyngeal pain
60%
24%
N/A
0%
0%
N/A
57%
15%
15%
0%
0%
0%
Vascular disorders
Hypertension
44%
4%
28%
7%
Gastrointestinal disorders
Vomiting
Diarrhea
Nausea
Constipation
60%
56%
56%
N/A
4%
8%
0%
N/A
63%
50%
57%
15%
2.8%
4.2%
1.4%
0%
Skin and subcutaneous tissue disorders
Urticaria6
Erythema multiforme
Hyperhidrosis
Erythema
32%
N/A
N/A
N/A
4%
N/A
N/A
N/A
N/A
33%
17%
11%
N/A
0%
0%
0%
Cardiac disorders
Tachycardia7
Sinus tachycardia
84%
N/A
4%
N/A
N/A
44%
N/A
1.4%
Nervous system disorders
Peripheral neuropathy8
Headache
Depressed level of consciousness
Lethargy
32%
28%
24%
N/A
0%
8%
16%
N/A
25%
18%
N/A
14%
0%
0%
N/A
0%
Eye disorders
Neurological disorders of the eye9
24%
0%
19%
0%
Immune system disorders
Anaphylactic reaction
12%
12%
N/A
0%
Metabolism and nutrition disorders
Decreased appetite
16%
0%
53%
4.2%
Infections and infestations
Influenza
Rhinovirus infection
Upper respiratory tract infection
Enterovirus infection
12%
12%
12%
N/A
0%
0%
0%
N/A
N/A
14%
N/A
13%
N/A
0%
N/A
0%
Investigations
Weight decreased
Breath sounds abnormal
12%
N/A
0%
N/A
N/A
15%
N/A
0%
Psychiatric disorders
Anxiety
Irritability
12%
N/A
0%
N/A
26%
25%
0%
0%
Injury and procedural complications
Contusion
N/A
N/A
15%
0%
Adverse
Reaction
All Grades
Grade 3 or 4
All Grades
Grade 3 or 4
System organ class/preferred term
%
%
%
%
General disorders and administration site conditions
Pain2
Infusion-related reaction3
Edema
Fatigue4
Pyrexia5
Injection site reaction
Localized edema
100%
100%
28%
28%
28%
N/A
N/A
68%
72%
0%
0%
0%
N/A
N/A
94%
94%
N/A
44%
11%
28%
25%
2.8%
32%
N/A
0%
0%
0%
0%
Respiratory, thoracic, and mediastinal disorders
Cough
Rhinorrhea
Oropharyngeal pain
60%
24%
N/A
0%
0%
N/A
57%
15%
15%
0%
0%
0%
Vascular disorders
Hypertension
44%
4%
28%
7%
Gastrointestinal disorders
Vomiting
Diarrhea
Nausea
Constipation
60%
56%
56%
N/A
4%
8%
0%
N/A
63%
50%
57%
15%
2.8%
4.2%
1.4%
0%
Skin and subcutaneous tissue disorders
Urticaria6
Erythema multiforme
Hyperhidrosis
Erythema
32%
N/A
N/A
N/A
4%
N/A
N/A
N/A
N/A
33%
17%
11%
N/A
0%
0%
0%
Cardiac disorders
Tachycardia7
Sinus tachycardia
84%
N/A
4%
N/A
N/A
44%
N/A
1.4%
Nervous system disorders
Peripheral neuropathy8
Headache
Depressed level of consciousness
Lethargy
32%
28%
24%
N/A
0%
8%
16%
N/A
25%
18%
N/A
14%
0%
0%
N/A
0%
Eye disorders
Neurological disorders of the eye
24%
0%
19%
0%
Immune system disorders
Anaphylactic reaction
12%
12%
N/A
0%
Metabolism and nutrition disorders
Decreased appetite
16%
0%
53%
4.2%
Infections and infestations
Influenza
Rhinovirus infection
Upper respiratory tract infection
Enterovirus infection
12%
12%
12%
N/A
0%
0%
0%
N/A
N/A
14%
N/A
13%
N/A
0%
N/A
0%
Investigations
Weight decreased
Breath sounds abnormal
12%
N/A
0%
N/A
N/A
15%
N/A
0%
Psychiatric disorders
Anxiety
Irritability
12%
N/A
0%
N/A
26%
25%
0%
0%
Injury and procedural complications
Contusion
N/A
N/A
15%
0%
Adverse
Reaction
All Grades
Grade 3 or 4
All Grades
Grade 3 or 4
System organ class/preferred term
%
%
%
%
General disorders and administration site conditions
Pain2
Infusion-related reaction3
Edema
Fatigue4
Pyrexia5
Injection site reaction
Localized edema
100%
100%
28%
28%
28%
N/A
N/A
68%
72%
0%
0%
0%
N/A
N/A
94%
94%
N/A
44%
11%
28%
25%
32%
2.8%
N/A
0%
0%
0%
0%
Respiratory, thoracic, and mediastinal disorders
Cough
Oropharyngeal pain
Rhinorrhea
60%
24%
N/A
0%
0%
N/A
57%
15%
15%
0%
0%
0%
Vascular disorders
Hypertension
44%
4%
28%
7%
Gastrointestinal disorders
Vomiting
Diarrhea
Nausea
Constipation
60%
56%
56%
N/A
4%
8%
0%
N/A
63%
50%
57%
15%
2.8%
4.2%
1.4%
0%
Skin and subcutaneous tissue disorders
Urticaria6
Erythema multiforme
Hyperhidrosis
Erythema
32%
N/A
N/A
N/A
4%
N/A
N/A
N/A
N/A
33%
17%
11%
N/A
0%
0%
0%
Cardiac disorders
Tachycardia7
Sinus tachycardia
84%
N/A
4%
N/A
N/A
44%
N/A
1.4%
Nervous system disorders
Peripheral neuropathy8
Headache
Depressed level of consciousness
Lethargy
32%
28%
24%
N/A
0%
8%
16%
N/A
25%
18%
N/A
14%
0%
0%
N/A
0%
Eye disorders
Neurological disorders of the eye
24%
0%
19%
0%
Immune system disorders
Anaphylactic reaction
12%
12%
N/A
0%
Metabolism and nutrition disorders
Decreased appetite
16%
0%
53%
4.2%
Infections and infestations
Influenza
Rhinovirus infection
Upper respiratory tract infection
Enterovirus infection
12%
12%
12%
N/A
0%
0%
0%
N/A
N/A
14%
N/A
13%
N/A
0%
N/A
0%
Investigations
Weight decreased
Breath sounds abnormal
12%
N/A
0%
N/A
N/A
15%
N/A
0%
Psychiatric disorders
Anxiety
Decreased appetite
12%
N/A
0%
N/A
26%
25%
0%
0%
Injury and procedural complications
Contusion
N/A
N/A
15%
0%
Adverse reactions were graded using Common Terminology Criteria for Adverse Events version 4.0.
1All adverse reactions occurring in Cycles 1 and 2, and adverse reactions of Grade ≥3 severity occurring in subsequent cycles were reported. In the dose-finding phase, Grade 2 unexpected adverse reactions were also reported for Cycles 3 and later.
2Pain includes pain, abdominal pain, pain in extremity, bone pain, neck pain, back pain, non-cardiac chest pain, flank pain, and musculoskeletal pain.
3Infusion-related reaction includes hypotension, bronchospasm, flushing, wheezing, stridor, urticaria, dyspnea, pyrexia, infusion-related reaction, face edema, edema mouth, periorbital edema, lip swelling, swollen tongue, tongue edema, lip edema, respiratory tract edema, chills, hypoxia, pruritus, rash, rash maculo-papular, and rash erythematous occurring on the day of infusion or the day following an infusion.
4Fatigue includes fatigue and asthenia.
5Pyrexia not occurring on the day of infusion or the day following an infusion.
6Urticaria, not occurring on the day of infusion or the day following an infusion.
7Tachycardia includes sinus tachycardia and tachycardia.
8Peripheral neuropathy includes peripheral sensory neuropathy, paresthesia, neuralgia.
9Neurological disorders of the eye includes unequal pupils, blurred vision, and mydriasis.
N/A=not applicable.
Laboratory Abnormality
All Grades
%
Grade 3 or 4
%
All Grades
%
Grade 3 or 4
%
Chemistry
Decreased potassium
Decreased albumin
Increased alanine aminotransferase
Decreased sodium
Increased glucose
Decreased calcium
Decreased magnesium
Increased aspartate aminotransferase
Decreased phosphate
Decreased glucose
63%
50%
42%
29%
N/A
N/A
N/A
N/A
N/A
N/A
8%
0%
8%
0%
N/A
N/A
N/A
N/A
N/A
N/A
47%
68%
55%
38%
74%
64%
54%
49%
47%
29%
32%
7%
9%
6%
0%
8%
0%
4%
5%
8%
Hematology
Decreased lymphocytes
Decreased platelet count
Decreased neutrophils
Decreased hemoglobin
74%
65%
61%
48%
30%
17%
39%
4%
79%
71%
72%
76%
56%
40%
46%
42%
Laboratory Abnormality
All Grades
%
Grade 3 or 4
%
All Grades
Grade 3 or 4
%
%
%
%
Chemistry
Decreased potassium
Decreased albumin
Increased alanine aminotransferase
Decreased sodium
Increased glucose
Decreased calcium
Decreased magnesium
Increased aspartate aminotransferase
Decreased phosphate
Decreased glucose
63%
50%
42%
29%
N/A
N/A
N/A
N/A
N/A
N/A
8%
0%
8%
0%
N/A
N/A
N/A
N/A
N/A
N/A
47%
68%
55%
38%
74%
64%
54%
49%
47%
29%
32%
7%
9%
6%
0%
8%
0%
4%
5%
8%
Hematology
Decreased lymphocytes
Decreased platelet count
Decreased neutrophils
Decreased hemoglobin
74%
65%
61%
48%
30%
17%
39%
4%
79%
71%
72%
76%
56%
40%
46%
42%
Laboratory Abnormality
All Grades
Grade 3 or 4
All Grades
%
Grade 3 or 4
%
%
%
%
%
Chemistry
Decreased potassium
Decreased albumin
Increased alanine aminotransferase
Decreased sodium
Increased glucose
Decreased calcium
Decreased magnesium
Increased aspartate aminotransferase
Decreased phosphate
Decreased glucose
63%
50%
42%
29%
N/A
N/A
N/A
N/A
N/A
N/A
8%
0%
8%
0%
N/A
N/A
N/A
N/A
N/A
N/A
47%
68%
55%
38%
74%
64%
54%
49%
47%
29%
32%
7%
9%
6%
0%
8%
0%
4%
5%
8%
Hematology
Decreased lymphocytes
Decreased platelet count
Decreased neutrophils
Decreased hemoglobin
74%
65%
61%
48%
30%
17%
39%
4%
79%
71%
72%
76%
56%
40%
46%
42%
The table presents laboratory parameters with available grading according to Common Terminology Criteria for Adverse Events version 4.0. Baseline evaluation was the last non-missing value prior to first DANYELZA dosing. Each test incidence is based on the number of patients who had both a baseline value and at least 1 on-study laboratory measurement.
1Range: 23 to 24 patients.
2Range: 19 to 72 patients.
N/A=not applicable.


• Dose interruptions due to an AR occurred in 84% of patients. ARs requiring dosage interruption in >10% of patients included hypotension and bronchospasm1
*Serious ARs occurring in only 1 patient.
AR=adverse reaction.


*Serious ARs occurring in <5% of patients.
AR=adverse reaction; RPLS=reversible posterior leukoencephalopathy syndrome.
Infusion-related reactions
Grade 4, Grade 3 and not responding to medical intervention, or Grade 3-4 anaphylaxis
Neurological disorders of the eye
Grade 2-4 not resolving within 2 weeks or upon recurrence; any grade with subtotal or total vision loss
Pain
Grade 3 and unresponsive to maximum supportive measures
Prolonged urinary retention
Persisting following discontinuation of opioids
Reversible posterior leukoencephalopathy syndrome (RPLS)
All grades
Hypertension
Grade 4, or Grade 3 and not responding to medical intervention
Transverse myelitis
All grades
Other ARs
Grade 4, or Grade 3 not resolving to Grade ≤2 within 2 weeks
Peripheral neuropathy
Grade ≥2 motor neuropathy or Grade 3-4 sensory neuropathy
Infusion-related reactions
Grade 4, Grade 3 and not responding to medical intervention, or Grade 3-4 anaphylaxis
Pain
Grade 3 and unresponsive to maximum supportive measures
Reversible posterior leukoencephalopathy syndrome (RPLS)
All grades
Transverse myelitis
All grades
Peripheral neuropathy
Grade ≥2 motor neuropathy or Grade 3-4 sensory neuropathy
Neurological disorders of the eye
Grade 2-4 not resolving within 2 weeks or upon recurrence; any grade with subtotal or total vision loss
Prolonged urinary retention
Persisting following discontinuation of opioids
Hypertension
Grade 4, or Grade 3 and not responding to medical intervention
Other ARs
Grade 4, or Grade 3 not resolving to Grade ≤2 within 2 weeks
†Based on Common Terminology Criteria for Adverse Events (CTCAE) v5.0.
AR=adverse reaction.