HIGHLIGHTS OF PRESCRIBING INFORMATION Dose

FULL PRESCRIBING INFORMATION: CONTENTS* (Continued)121314CLINICAL PHARMACOLOGY12.1 Mechanism of Action12.3 PharmacokineticsNONCLINICAL TOXICOLOGY13.1 Carcinogenesis, Mutagenesis, Impairment of FertilityCLINICAL STUDIES14.1 Metastatic Breast Cancer14.2 Non-Small Cell Lung Cancer14.3 Adenocarcinoma of the PancreasFULL PRESCRIBING INFORMATIONABRAXANE for Injectable Suspension (paclitaxel protein-bound particles forinjectable suspension) (albumin-bound)WARNING: SEVERE MYELOSUPPRESSION Do not administer ABRAXANE therapy to patients with baseline neutrophilcounts of less than 1,500 cells/mm3 [see Contraindications (4)]. Monitor for neutropenia, which may be severe and result in infection or sepsis[see Warnings and Precautions (5.1, 5.3)]. Perform frequent complete blood cell counts on all patients receivingABRAXANE [see Warnings and Precautions (5.1, 5.3)].1INDICATIONS AND USAGE1.1Metastatic Breast CancerABRAXANE is indicated for the treatment of breast cancer after failure of combinationchemotherapy for metastatic disease or relapse within 6 months of adjuvantchemotherapy. Prior therapy should have included an anthracycline unless clinicallycontraindicated.1.2Non-Small Cell Lung CancerABRAXANE is indicated for the first-line treatment of locally advanced or metastatic nonsmall cell lung cancer, in combination with carboplatin, in patients who are not candidatesfor curative surgery or radiation therapy.1.3Adenocarcinoma of the PancreasABRAXANE is indicated for the first-line treatment of patients with metastaticadenocarcinoma of the pancreas, in combination with gemcitabine.2151617REFERENCESHOW SUPPLIED/STORAGE AND HANDLINGPATIENT COUNSELING INFORMATION*Sections or subsections omitted from the full prescribing information are not listed.Closely monitor the infusion site for extravasation or drug infiltration during administration.Limiting the infusion of ABRAXANE to 30 minutes may reduce the risk of infusion-relatedreactions [see Adverse Reactions (6.2)].Consider premedication in patients who have had prior hypersensitivity reactions toABRAXANE. Do not re-challenge patients who experience a severe hypersensitivityreaction to ABRAXANE [see Contraindications (4) and Warnings and Precautions (5.5)].2.2Recommended Dosage for Metastatic Breast CancerAfter failure of combination chemotherapy for metastatic breast cancer or relapse within6 months of adjuvant chemotherapy, the recommended regimen for ABRAXANE is260 mg/m2 administered intravenously over 30 minutes every 3 weeks.2.3Recommended Dosage for Non-Small Cell Lung CancerThe recommended dose of ABRAXANE is 100 mg/m2 administered as an intravenousinfusion over 30 minutes on Days 1, 8, and 15 of each 21-day cycle. Administercarboplatin on Day 1 of each 21-day cycle immediately after ABRAXANE [see ClinicalStudies (14.2)].2.4Recommended Dosage for Adenocarcinoma of the PancreasThe recommended dose of ABRAXANE is 125 mg/m2 administered as an intravenousinfusion over 30-40 minutes on Days 1, 8, and 15 of each 28-day cycle. Administergemcitabine immediately after ABRAXANE on Days 1, 8, and 15 of each 28-day cycle [seeClinical Studies (14.3)].2.5Dosage Modifications for Hepatic ImpairmentFor patients with moderate or severe hepatic impairment, reduce the starting dose ofABRAXANE as shown in Table 1.DOSAGE AND ADMINISTRATION2.1Important Administration InstructionsDO NOT SUBSTITUTE FOR OR WITH OTHER PACLITAXEL FORMULATIONS. ABRAXANEhas different dosage and administration instructions from other paclitaxelproducts.Table 1:Recommendations for Starting Dose in Patients with Moderate and Severe Hepatic ImpairmentAST LevelsBilirubinLevelsABRAXANE Dose aMBCNSCLC cAdenocarcinoma of Pancreas c2b2bModerate 10 x ULNAND 1.5 to 3 x ULN200 mg/m80 mg/mnot recommended80 mg/m2 bnot recommendedSevere 10 x ULNAND 3 to 5 x ULN200 mg/m2 b 10 x ULNOR 5 x ULNnot recommendednot recommendednot recommendedAST Aspartate Aminotransferase; MBC Metastatic Breast Cancer; NSCLC Non-Small Cell Lung Cancer; ULN Upper limit of normal.a Dosage recommendations are for the first course of therapy. The need for further dose adjustments in subsequent courses should be based on individual tolerance.b A dose increase to 260 mg/m2 for patients with metastatic breast cancer or 100 mg/m2 for patients with non-small cell lung cancer in subsequent courses should be considered if the patienttolerates the reduced dose for two cycles.c Patients with bilirubin levels above the upper limit of normal were excluded from clinical trials for pancreatic or lung cancer.2.6Dosage Modifications for Adverse ReactionsMetastatic Breast CancerPatients who experience severe neutropenia (neutrophils less than 500 cells/mm3 for aweek or longer) or severe sensory neuropathy during ABRAXANE therapy should havedosage reduced to 220 mg/m2 for subsequent courses of ABRAXANE. For recurrence ofsevere neutropenia or severe sensory neuropathy, additional dose reduction should bemade to 180 mg/m2. For Grade 3 sensory neuropathy hold treatment until resolution toGrade 1 or 2, followed by a dose reduction for all subsequent courses of ABRAXANE [seeContraindications (4), Warnings and Precautions (5.1, 5.2) and Adverse Reactions (6.1)].Non-Small Cell Lung Cancer Do not administer ABRAXANE on Day 1 of a cycle until absolute neutrophil count (ANC)is at least 1500 cells/mm3 and platelet count is at least 100,000 cells/mm3 [seeContraindications (4), Warnings and Precautions (5.1) and Adverse Reactions (6.1)]. In patients who develop severe neutropenia or thrombocytopenia withhold treatmentuntil counts recover to an absolute neutrophil count of at least 1500 cells/mm3 andplatelet count of at least 100,000 cells/mm3 on Day 1 or to an absolute neutrophilcount of at least 500 cells/mm3 and platelet count of at least 50,000 cells/mm3 onDays 8 or 15 of the cycle. Upon resumption of dosing, permanently reduce ABRAXANEand carboplatin doses as outlined in Table 2. Withhold ABRAXANE for Grade 3-4 peripheral neuropathy. Resume ABRAXANE andcarboplatin at reduced doses (see Table 2) when peripheral neuropathy improves toGrade 1 or completely resolves [see Warnings and Precautions (5.2) and AdverseReactions (6.1)].

ABRAXANE for Injectable Suspension (paclitaxel protein-bound particles for injectable suspension) (albumin-bound)Table 2:Permanent Dose Reductions for Hematologic and Neurologic Adverse Reactions in NSCLCAdverse ReactionOccurrenceWeeklyABRAXANE Dose(mg/m2)Every 3-WeekCarboplatin Dose(AUC mg min/mL)First754.5Second503Neutropenic Fever (ANC less than 500/mm3 with fever 38 C)ORDelay of next cycle by more than 7 days for ANC less than 1500/mm3ORANC less than 500/mm3 for more than 7 daysThirdDiscontinue TreatmentFirstSecondFirstSecondThirdPlatelet count less than 50,000/mm3Severe sensory Neuropathy – Grade 3 or 4754.5Discontinue Treatment75504.53Discontinue TreatmentAdenocarcinoma of the PancreasDose level reductions for patients with adenocarcinoma of the pancreas, as referenced in Tables 4 and 5, are provided in Table 3.Table 3:Dose Level Reductions for Patients with Adenocarcinoma of the PancreasABRAXANE (mg/m2)12510075DiscontinueDose LevelFull dose1st dose reduction2nd dose reductionIf additional dose reduction requiredGemcitabine (mg/m2)1000800600DiscontinueRecommended dose modifications for neutropenia and thrombocytopenia for patients with adenocarcinoma of the pancreas are provided in Table 4.Table 4:Dose Recommendation and Modifications for Neutropenia and/or Thrombocytopenia at the Start of a Cycle or within a Cycle for Patients with Adenocarcinoma ofthe PancreasANC (cells/mm3) 1500OR500 to 1000OR 500ORDay 15: If Day 8 doses were reduced or given without modification:500 to 1000OR 500ORDay 15: If Day 8 doses were withheld: 1000OR500 to 1000OR 500ORANC Absolute Neutrophil CountCycle DayDay 1Day 8Platelet count (cells/mm3) 100,00050,000 to 75,000 50,000ABRAXANE / GemcitabineDelay doses until recoveryReduce 1 dose levelWithhold doses50,000 to 75,000 50,000Reduce 1 dose level from Day 8Withhold doses 75,00050,000 to 75,000 50,000Reduce 1 dose level from Day 1Reduce 2 dose levels from Day 1Withhold dosesRecommended dose modifications for other adverse reactions in patients with adenocarcinoma of the pancreas are provided in Table 5.Table 5:Dose Modifications for Other Adverse Reactions in Patients with Adenocarcinoma of the PancreasAdverse ReactionFebrile Neutropenia:Grade 3 or 4Peripheral Neuropathy:Grade 3 or 4Cutaneous Toxicity:Grade 2 or 3Gastrointestinal Toxicity:Grade 3 mucositis or diarrhea2.7Preparation for Intravenous AdministrationABRAXANE is a cytotoxic drug. Follow applicable special handling and disposalprocedures.1 The use of gloves is recommended. If ABRAXANE (lyophilized cake orreconstituted suspension) contacts the skin, wash the skin immediately and thoroughlywith soap and water. Following topical exposure to paclitaxel, events may include tingling,burning, and redness. If ABRAXANE contacts mucous membranes, the membranes shouldbe flushed thoroughly with water.ABRAXANEGemcitabineWithhold until fever resolves and ANC 1500; resume at next lower dose levelWithhold until improves to Grade 1;resume at next lower dose levelNo dose reductionReduce to next lower dose level; discontinue treatment if toxicity persistsWithhold until improves to Grade 1;resume at next lower dose levelABRAXANE is supplied as a sterile lyophilized powder for reconstitution before use.Read the entire preparation instructions prior to reconstitution.

ABRAXANE for Injectable Suspension (paclitaxel protein-bound particles for injectablesuspension (albumin-bound)ABRAXANE for Injectable Suspension (paclitaxel protein-bound particles for injectablesuspension (albumin-bound)4CONTRAINDICATIONS1. Aseptically, reconstitute each vial by injecting 20 mL of 0.9% Sodium ChlorideInjection, USP.ABRAXANE is contraindicated in patients with:2. Slowly inject the 20 mL of 0.9% Sodium Chloride Injection, USP, over a minimumof 1 minute, using the sterile syringe to direct the solution flow onto the INSIDEWALL OF THE VIAL. Baseline neutrophil counts of 1,500 cells/mm3 [see Warnings and Precautions (5.1)] A history of severe hypersensitivity reactions to ABRAXANE [see Warnings andPrecautions (5.5)]5WARNINGS AND PRECAUTIONS5.1Severe MyelosuppressionSevere myelosuppression (primarily neutropenia) is dose-dependent and a dose-limitingtoxicity of ABRAXANE. In clinical studies, Grade 3-4 neutropenia occurred in 34% ofpatients with metastatic breast cancer (MBC), 47% of patients with non-small cell lungcancer (NSCLC), and 38% of patients with pancreatic cancer.Monitor for severe neutropenia and thrombocytopenia by performing complete blood cellcounts frequently, including prior to dosing on Day 1 (for MBC) and Days 1, 8, and 15 (forNSCLC and for pancreatic cancer). Do not administer ABRAXANE to patients with baselineabsolute neutrophil counts (ANC) of less than 1,500 cells/mm3 [see Contraindications (4)].3. DO NOT INJECT the 0.9% Sodium Chloride Injection, USP, directly onto thelyophilized cake as this will result in foaming.4. Once the injection is complete, allow the vial to sit for a minimum of 5 minutesto ensure proper wetting of the lyophilized cake/powder.5. Gently swirl and/or invert the vial slowly for at least 2 minutes until completedissolution of any cake/powder occurs. Avoid generation of foam.6. If foaming or clumping occurs, stand solution for at least 15 minutes until foamsubsides.Each mL of the reconstituted formulation will contain 5 mg/mL paclitaxel.The reconstituted suspension should be milky and homogenous without visibleparticulates. If particulates or settling are visible, the vial should be gently inverted againto ensure complete resuspension prior to use. Discard the reconstituted suspension ifprecipitates are observed. Discard any unused portion.Calculate the exact total dosing volume of 5 mg/mL suspension required for the patientand slowly withdraw the dosing volume of the reconstituted suspension from the vial(s)into a syringe: Dosing volume (mL) Total dose (mg)/5 (mg/mL).Inject the appropriate amount of reconstituted ABRAXANE into an empty, sterileintravenous bag [plasticized polyvinyl chloride (PVC) containers, PVC or non-PVC typeintravenous bag]. The use of specialized DEHP-free solution containers or administrationsets is not necessary to prepare or administer ABRAXANE infusions. The use ofmedical devices containing silicone oil as a lubricant (i.e., syringes and intravenousbags) to reconstitute and administer ABRAXANE may result in the formation ofproteinaceous strands.Visually inspect the reconstituted ABRAXANE suspension in the intravenous bag prior toadministration. Discard the reconstituted suspension if proteinaceous strands, particulatematter, or discoloration are observed.2.8StabilityUnopened vials of ABRAXANE are stable until the date indicated on the package whenstored between 20ºC to 25ºC (68ºF to 77ºF) in the original package. Neither freezing norrefrigeration adversely affects the stability of the product.Stability of Reconstituted Suspension in the VialReconstituted ABRAXANE in the vial should be used immediately, but may be refrigeratedat 2ºC to 8ºC (36ºF to 46ºF) for a maximum of 24 hours if necessary. If not usedimmediately, each vial of reconstituted suspension should be replaced in the originalcarton to protect it from bright light. Discard any unused portion.Stability of Reconstituted Suspension in the Infusion BagThe suspension for infusion when prepared as recommended in an infusion bag shouldbe used immediately, but may be refrigerated at 2 C to 8 C (36 F to 46 F) and protectedfrom bright light for a maximum of 24 hours.In the case of severe neutropenia ( 500 cells/mm3 for seven days or more) during acourse of ABRAXANE therapy, reduce the dose of ABRAXANE in subsequent courses inpatients with either MBC or NSCLC.In patients with MBC, resume treatment with every-3-week cycles of ABRAXANE after ANCrecovers to a level 1,500 cells/mm3 and platelets recover to a level 100,000 cells/mm3.In patients with NSCLC, resume treatment if recommended at permanently reduced dosesfor both weekly ABRAXANE and every-3-week carboplatin after ANC recovers to at least1500 cells/mm3 and platelet count of at least 100,000 cells/mm3 on Day 1 or to an ANCof at least 500 cells/mm3 and platelet count of at least 50,000 cells/mm3 on Days 8 or 15of the cycle [see Dosage and Administration (2.6)].In patients with adenocarcinoma of the pancreas, withhold ABRAXANE and gemcitabine ifthe ANC is less than 500 cells/mm3 or platelets are less than 50,000 cells/mm3 and delayinitiation of the next cycle if the ANC is less than 1500 cells/mm3 or platelet count is lessthan 100,000 cells/mm3 on Day 1 of the cycle. Resume treatment with appropriate dosereduction if recommended [see Dosage and Administration (2.6)].5.2Severe NeuropathySensory neuropathy is dose- and schedule-dependent [see Adverse Reactions (6.1)].If Grade 3 sensory neuropathy develops, withhold ABRAXANE treatment until resolutionto Grade 1 or 2 for metastatic breast cancer or until resolution to Grade 1 for NSCLC andpancreatic cancer followed by a dose reduction for all subsequent courses of ABRAXANE[see Dosage and Administration (2.6)].5.3SepsisSepsis occurred in 5% of patients with or without neutropenia who received ABRAXANEin combination with gemcitabine. Biliary obstruction or presence of biliary stent were riskfactors for severe or fatal sepsis.If a patient becomes febrile (regardless of ANC) initiate treatment with broad spectrumantibiotics. For febrile neutropenia, interrupt ABRAXANE and gemcitabine until feverresolves and ANC 1500, then resume treatment at reduced dose levels [see Dosageand Administration (2.6)].5.4PneumonitisPneumonitis, including some cases that were fatal, occurred in 4% of patients receivingABRAXANE in combination with gemcitabine.Monitor patients for signs and symptoms of pneumonitis and interrupt ABRAXANE andgemcitabine during evaluation of suspected pneumonitis. After ruling out infectiousetiology and upon making a diagnosis of pneumonitis, permanently discontinue treatmentwith ABRAXANE and gemcitabine.5.5Severe HypersensitivitySevere and sometimes fatal hypersensitivity reactions, including anaphylactic reactions,have been reported. Do not rechallenge patients who experience a severe hypersensitivityreaction to ABRAXANE with this drug [see Contraindications (4)].Cross-hypersensitivity between ABRAXANE and other taxane products has been reportedand may include severe reactions such as anaphylaxis. Closely monitor patients with aprevious history of hypersensitivity to other taxanes during initiation of ABRAXANE therapy.The total combined refrigerated storage time of reconstituted ABRAXANE in the vial andin the infusion bag is 24 hours. This may be followed by storage in the infusion bagat ambient temperature (approximately 25 C) and lighting conditions for a maximumof 4 hours.5.6Discard any unused portion.ABRAXANE is not recommended in patients who have total bilirubin 5 x ULN or AST 10 x ULN. In addition, ABRAXANE is not recommended in patients with metastaticadenocarcinoma of the pancreas who have moderate to severe hepatic impairment (totalbilirubin 1.5 x ULN and AST 10 x ULN). Reduce the starting dose for patients withmoderate or severe hepatic impairment [see Dosage and Administration (2.5), Use inSpecific Populations (8.7), Clinical Pharmacology (12.3)].3DOSAGE FORMS AND STRENGTHSFor injectable suspension, for intravenous use: white to yellow, sterile lyophilized powdercontaining 100 mg of paclitaxel formulated as albumin-bound particles in single-dose vialfor reconstitution.Use in Patients with Hepatic ImpairmentThe exposure and toxicity of paclitaxel can be increased in patients with hepaticimpairment. Closely monitor patients with hepatic impairment for severemyelosuppression.

ABRAXANE for Injectable Suspension (paclitaxel protein-bound particles for injectablesuspension (albumin-bound)ABRAXANE for Injectable Suspension (paclitaxel protein-bound particles for injectablesuspension (albumin-bound)5.7Albumin (Human)ABRAXANE contains albumin (human), a derivative of human blood. Based on effectivedonor screening and product manufacturing processes, it carries a remote risk fortransmission of viral diseases. A theoretical risk for transmission of Creutzfeldt-JakobDisease (CJD) also is considered extremely remote. No cases of transmission of viraldiseases or CJD have ever been identified for albumin.Table 6:5.8Embryo-Fetal ToxicityBased on mechanism of action and findings in animals, ABRAXANE can cause fetal harmwhen administered to a pregnant woman. In animal reproduction studies, administrationof paclitaxel formulated as albumin-bound particles to rats during pregnancy at doseslower than the maximum recommended human dose, based on body surface area,caused embryo-fetal toxicities, including intrauterine mortality, increased resorptions,reduced numbers of live fetuses, and malformations.Bone MarrowNeutropenia8082 2.0 x 109/L922 0.5 x 109/LThrombocytopenia23 100 x 109/L 1 1 50 x 109/LAnemia 11 g/dL3325 8 g/dL1 1Infections2420Febrile Neutropenia21Neutropenic Sepsis 1 1Bleeding22Hypersensitivity ReactionbAll41202SeverecCardiovascularVital Sign Changes During AdministrationBradycardia 1 1Hypotension5534Severe Cardiovascular EventscAbnormal ECGAll Patients6052Patients with Normal Baseline3530RespiratoryCough76Dyspnea129Sensory NeuropathyAny Symptoms7156102Severe SymptomscMyalgia / ArthralgiaAny Symptoms444984Severe SymptomscAstheniaAny Symptoms473983Severe SymptomscFluid Retention/EdemaAny Symptoms1080 1Severe SymptomscGastrointestinalNauseaAny Symptoms30223 1Severe SymptomscVomitingAny Symptoms181041Severe SymptomscDiarrheaAny Symptoms2715 11Severe SymptomscMucositisAny Symptoms76 10Severe SymptomscAlopecia9094Hepatic (Patients with Normal Baseline)Bilirubin Elevations77Alkaline Phosphatase Elevations3631AST (SGOT) Elevations3932Injection Site Reaction 11a Paclitaxel injection patients received premedication.b Includes treatment-related events related to hypersensitivity (e.g., flushing, dyspnea, chestpain, hypotension) that began on a day of dosing.c Severe events are defined as at least Grade 3 toxicity.Advise females of reproductive potential of the potential risk to a fetus. Advise females ofreproductive potential to use effective contraception and avoid becoming pregnant duringtreatment with ABRAXANE and for at least six months after the last dose of ABRAXANE[see Use in Specific Populations (8.1, 8.3), Clinical Pharmacology (12.1)].Based on findings from genetic toxicity and animal reproduction studies, advise malepatients with female partners of reproductive potential to use effective contraception andavoid fathering a child during treatment with ABRAXANE and for at least three monthsafter the last dose of ABRAXANE [see Use in Specific Populations (8.1, 8.3), NonclinicalToxicology (13.1)].6ADVERSE REACTIONSBecause clinical trials are conducted under widely varying conditions, adverse reactionrates observed in the clinical trials of a drug cannot be directly compared to rates in theclinical trials of another drug and may not reflect the rates observed in practice.The most common adverse reactions ( 20%) with single-agent use of ABRAXANE inmetastatic breast cancer are alopecia, neutropenia, sensory neuropathy, abnormal ECG,fatigue/asthenia, myalgia/arthralgia, AST elevation, alkaline phosphatase elevation,anemia, nausea, infections, and diarrhea [see Adverse Reactions (6.1)].The most common adverse reactions ( 20%) of ABRAXANE in combination withcarboplatin for non-small cell lung cancer are anemia, neutropenia, thrombocytopenia,alopecia, peripheral neuropathy, nausea, and fatigue [see Adverse Reactions (6.1)]. Themost common serious adverse reactions of ABRAXANE in combination with carboplatinfor non-small cell lung cancer are anemia (4%) and pneumonia (3%). The most commonadverse reactions resulting in permanent discontinuation of ABRAXANE are neutropenia(3%), thrombocytopenia (3%), and peripheral neuropathy (1%). The most commonadverse reactions resulting in dose reduction of ABRAXANE are neutropenia (24%),thrombocytopenia (13%), and anemia (6%). The most common adverse reactions leadingto withholding or delay in ABRAXANE dosing are neutropenia (41%), thrombocytopenia(30%), and anemia (16%).In a randomized open-label trial of ABRAXANE in combination with gemcitabine forpancreatic adenocarcinoma [see Clinical Studies (14.3)], the most common ( 20%)selected (with a 5% higher incidence) adverse reactions of ABRAXANE are neutropenia,fatigue, peripheral neuropathy, nausea, alopecia, peripheral edema, diarrhea, pyrexia,vomiting, decreased appetite, rash, and dehydration [see Adverse Reactions (6.1)]. Themost common serious adverse reactions of ABRAXANE (with a 1% higher incidence) arepyrexia (6%), dehydration (5%), pneumonia (4%), and vomiting (4%). The most commonadverse reactions resulting in pe

HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use ABRAXANE safely and effectively. See full prescribing information for ABRAXANE. ABRAXANE for Injectable Suspension (paclitaxel protein-bound particles for injectable suspension) (albumi