PADCEV Injection Dosage

Generic name: ENFORTUMAB VEDOTIN 20mg in 2mL
Dosage form: injection, powder, lyophilized, for solution
Drug class: Miscellaneous antineoplastics

Medically reviewed by Drugs.com. Last updated on Dec 21, 2023.

Recommended Dosage

When given in combination with pembrolizumab, the recommended dose of PADCEV is 1.25 mg/kg (up to a maximum of 125 mg for patients ≥100 kg) administered as an intravenous infusion over 30 minutes on Days 1 and 8 of a 21-day cycle until disease progression or unacceptable toxicity. Refer to the pembrolizumab Prescribing Information for the recommended dosing information of pembrolizumab.

The recommended dose of PADCEV as a single agent is 1.25 mg/kg (up to a maximum of 125 mg for patients ≥100 kg) administered as an intravenous infusion over 30 minutes on Days 1, 8 and 15 of a 28-day cycle until disease progression or unacceptable toxicity.

Dose Modifications

Table 1. Dose Modifications
Adverse Reaction	Severity*	Dose Modification*
* Grade 1 is mild, Grade 2 is moderate, Grade 3 is severe, Grade 4 is life-threatening
Skin Reactions [see Boxed Warning, Warnings and Precautions (5.1)]	For persistent or recurrent Grade 2 skin reactions	Consider withholding until Grade ≤1, then resume treatment at the same dose level or dose reduce by one dose level.
	Grade 3 skin reactions	Withhold until Grade ≤1, then resume treatment at the same dose level or dose reduce by one dose level.
	Suspected SJS or TEN	Immediately withhold, consult a specialist to confirm the diagnosis. If not SJS/TEN, see Grade 2-4 skin reactions.
	Confirmed SJS or TEN; Grade 4 or recurrent Grade 3 skin reactions	Permanently discontinue.
Hyperglycemia [see Warnings and Precautions (5.2)]	Blood glucose >250 mg/dL	Withhold until elevated blood glucose has improved to ≤250 mg/dL, then resume treatment at the same dose level.
Pneumonitis/Interstitial Lung Disease (ILD) [see Warnings and Precautions (5.3)]	Grade 2	Withhold until Grade ≤1, then resume treatment at the same dose level or consider dose reduction by one dose level.
	Grade ≥3	Permanently discontinue.
Peripheral Neuropathy [see Warnings and Precautions (5.4)]	Grade 2	Withhold until Grade ≤1, then resume treatment at the same dose level (if first occurrence). For a recurrence, withhold until Grade ≤1, then resume treatment reduced by one dose level.
Peripheral Neuropathy [see Warnings and Precautions (5.4)]	Grade ≥3	Permanently discontinue.
Other nonhematologic toxicity [see Adverse Reactions (6)]	Grade 3	Withhold until Grade ≤1, then resume treatment at the same dose level or consider dose reduction by one dose level.
Other nonhematologic toxicity [see Adverse Reactions (6)]	Grade 4	Permanently discontinue.
Hematologic toxicity [see Adverse Reactions (6)]	Grade 3, or Grade 2 thrombocytopenia	Withhold until Grade ≤1, then resume treatment at the same dose level or consider dose reduction by one dose level.
Hematologic toxicity [see Adverse Reactions (6)]	Grade 4	Withhold until Grade ≤1, then reduce dose by one dose level or discontinue treatment.

Table 2. Recommended Dose Reduction Schedule
	Dose Level
Starting dose	1.25 mg/kg up to 125 mg
First dose reduction	1.0 mg/kg up to 100 mg
Second dose reduction	0.75 mg/kg up to 75 mg
Third dose reduction	0.5 mg/kg up to 50 mg

Instructions for Preparation and Administration

•: Administer PADCEV as an intravenous infusion only.
•: PADCEV is a hazardous drug. Follow applicable special handling and disposal procedures.1

Prior to administration, the PADCEV vial is reconstituted with Sterile Water for Injection (SWFI). The reconstituted solution is subsequently diluted in an intravenous infusion bag containing either 5% Dextrose Injection, USP, 0.9% Sodium Chloride Injection, USP, or Lactated Ringer’s Injection, USP.

Reconstitution in Single-dose Vial

1.

Follow procedures for proper handling and disposal of anticancer drugs.

2.

Use appropriate aseptic technique for reconstitution and preparation of dosing solutions.

3.

Calculate the recommended dose based on the patient’s weight to determine the number and strength (20 mg or 30 mg) of vials needed.

4.

Reconstitute each vial as follows and, if possible, direct the stream of SWFI along the walls of the vial and not directly onto the lyophilized powder:

a.: 20 mg vial: Add 2.3 mL of SWFI, resulting in 10 mg/mL PADCEV.
b.: 30 mg vial: Add 3.3 mL of SWFI, resulting in 10 mg/mL PADCEV.

5.

Slowly swirl each vial until the contents are completely dissolved. Allow the reconstituted vial(s) to settle for at least 1 minute until the bubbles are gone. DO NOT SHAKE THE VIAL. Do not expose to direct sunlight.

6.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. The reconstituted solution should be clear to slightly opalescent, colorless to light yellow and free of visible particles. Discard any vial with visible particles or discoloration.

7.

Based upon the calculated dose amount, the reconstituted solution from the vial(s) should be added to the infusion bag immediately. This product does not contain a preservative. If not used immediately, reconstituted vials may be stored for up to 24 hours in refrigeration at 2°C to 8°C (36°F to 46°F). DO NOT FREEZE. Discard unused vials with reconstituted solution beyond the recommended storage time.

Dilution in Infusion Bag

8.: Withdraw the calculated dose amount of reconstituted solution from the vial(s) and transfer into an infusion bag.
9.: Dilute PADCEV with either 5% Dextrose Injection, 0.9% Sodium Chloride Injection, or Lactated Ringer's Injection. The infusion bag size should allow enough diluent to achieve a final concentration of 0.3 mg/mL to 4 mg/mL PADCEV.
10.: Mix diluted solution by gentle inversion. DO NOT SHAKE THE BAG. Do not expose to direct sunlight.
11.: Visually inspect the infusion bag for any particulate matter or discoloration prior to use. The reconstituted solution should be clear to slightly opalescent, colorless to light yellow and free of visible particles. DO NOT USE the infusion bag if particulate matter or discoloration is observed.
12.: Discard any unused portion left in the single-dose vials.

Administration

13.: Immediately administer the infusion over 30 minutes through an intravenous line.
14.: If the infusion is not administered immediately, the prepared infusion bag should not be stored longer than 8 hours at 2°C to 8°C (36°F to 46°F). DO NOT FREEZE.

DO NOT administer PADCEV as an intravenous push or bolus.

DO NOT mix PADCEV with, or administer as an infusion with, other medicinal products.