TURALIO® Risk Evaluation and Mitigation Strategy (tREMS) program: 5-year retrospective hepatic safety assessment.

Aims: To assess hepatic safety data of pexidartinib in adult patients with tenosynovial giant cell tumor (TGCT) from the retrospective 5-year evaluation of the TURALIO® Risk Evaluation and Mitigation Strategy (tREMS) Program.

Patients & methods: We analyzed data collected from healthcare professionals, patients, pharmacies, and distributors who participated in the tREMS Program from August 2019 to June 2024.

Results: For the current reporting period, June 2022 to June 2024, of the 524 patients enrolled in the tREMS with ≥ 1 dispense of pexidartinib, 24 (4.6%) had adverse events or laboratory abnormalities suggestive of serious and potentially fatal liver injury, with a total of 45/735 (6.1%) patients over 5 years. One (0.2%) patient in the current period had confirmed vanishing bile duct syndrome (VBDS) and was recovering at last follow-up. Another patient from the previous reporting period had unconfirmed VBDS and was alive with unknown recovery status at last follow-up. For the current reporting period and cumulative 5-year tREMS assessment, the reported frequency and pattern of liver injury were consistent with the phase 3 ENLIVEN trial.

Conclusions: The tREMS Program effectively mitigates the risk of hepatotoxicity through careful monitoring and early intervention. Pexidartinib remains a viable treatment option for TGCT when managed according to recommended guidelines.