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In adult patients with locally advanced unresectable or metastatic HER2-negative gastric/GEJ adenocarcinoma,

VYLOY dosing and administration aligns with fluoropyrimidine- and platinum-containing chemotherapy dosing schedule

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Prior to each infusion of VYLOY, it is recommended to premedicate patients with a combination of antiemetics (e.g., NK-1 receptor blockers and/or 5-HT3 receptor blockers, as well as other medicinal products as indicated), for the prevention of nausea and vomiting.1

 

VYLOY should be administered in combination with fluoropyrimidine- and platinum-containing chemotherapy.1

 

To help minimise potential adverse reactions, it is recommended that each infusion should be started at a slower rate than the initially calculated rate for the entire infusion, and gradually increased as tolerated during the course of the infusion.1

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VYLOY DOSING1

Loading dose:
(Cycle 1, Day 1): 800 mg/m2 intravenously
Maintenance dose:

  • 400 mg/m2 every 2 weeks or
  • 600 mg/m2 every 3 weeks
  • Cycle duration is determined based on the chemotherapy backbone
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VYLOY ADMINISTRATION1

2-hour minimum IV infusion (or longer if clinically indicated)
Refer to VYLOY infusion rates in the Summary of Product Characteristics for details.

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VYLOY ADMINISTRATION1

  • Every 2 weeks (with mFOLFOX6)
  • Every 3 weeks (with CAPOX)

VYLOY must not be administered as an intravenous push or bolus injection.1

Continue VYLOY treatment until disease progression or unacceptable toxicity.1
See the Summary of Product Characteristics for more specific information on dosing and administration.

VYLOY and your preferred chemotherapy regimen can be infused on the same day. If VYLOY and chemotherapy are administered on the same day, VYLOY must be administered first.1

Please see the Summary of Product Characteristics for more information on recommended regimens.

CAPOX=capecitabine/oxaliplatin; IV=intravenous; mFOLFOX6=modified folinic acid, fluorouracil, and oxaliplatin regimen; NK-1=neurokinin-1; 5-HT3=5-hydroxytryptamine type 3.

Recommended dosage and infusion rates1*

Treatment cycle VYLOY (zolbetuximab) dose  Rate of infusion 
Cycle 1 (loading dose) bottle

800 mg/m2
  • Administer at 100 mg/m2/hour for the first 30–60 minutes 
  • In the absence of adverse reactions after 30–60 minutes, the rate of the infusion can be escalated to 200–400 mg/m2/hour 
  • If an infusion-related reaction of Grade 2 occurs, pause the infusion until Grade ≤1 then resume at a reduced infusion rate for the remaining infusion 
  • Consider pre-medication for next infusion 
  • For grade 3 or 4 infusion-related reactions, immediately stop the infusion and permanently discontinue 
Cycle 2 onward (maintenance dose) 3-weekly dosing regimen bottle


600 mg/m2 

every 3 weeks
  • Administer at 75 mg/m2/hour for the first 30–60 minutes 
  • In the absence of adverse reactions after 30–60 minutes, the rate of infusion can be escalated to 150–300 mg/m2/hour 
  • If an infusion-related reaction of Grade 2 occurs, pause the infusion until Grade ≤1 then resume at a reduced infusion rate for the remaining infusion 
  • Consider pre-medication for next infusion 
  • For Grade 3 or 4 infusion-related reactions, immediately stop the infusion and permanently discontinue 
OR
Cycle 2 onward (maintenance dose) 2-weekly dosing regimen bottle


400 mg/m2

every 2 weeks
  • Administer at 50 mg/m2/hour for the first 30–60 minutes 
  • In the absence of adverse reactions after 30–60 minutes, the rate of infusion can be escalated to 100–200 mg/m2/hour 
  • If an infusion-related reaction of Grade 2 occurs, pause the infusion until Grade ≤1 then resume at a reduced infusion rate for the remaining infusion 
  • Consider pre-medication for next infusion
  • For Grade 3 or 4 infusion-related reactions, immediately stop the infusion and permanently discontinue
Infusion must be over a minimum of 2 hours through an IV line

Steps can be taken to mitigate nausea and vomiting in your patients:1

  • Proactive management of nausea and vomiting is required to support patient adherence

  • If a patient is experiencing nausea and/or vomiting prior to administration of VYLOY, the symptoms should be resolved to Grade ≤1 before administering the first infusion

  • During and after infusion: Monitor and manage using standard of care (including antiemetics or fluid replacement) as clinically indicated

Refer to the fluoropyrimidine- or platinum-containing chemotherapy Summary of Product Characteristics regarding the dosing information for chemotherapy.

 

∗Administer VYLOY (zolbetuximab) in combination with fluoropyrimidine- and platinum-containing chemotherapy.1 

 

IV=intravenous.

Dose modifications

No dose reduction for VYLOY is recommended. Adverse reactions for VYLOY are managed by infusion rate reduction, interruption, and/or discontinuation.1 For dose modification recommendations for hypersensitivity, infusion related reactions, nausea, and vomiting, please see Table 2 in the Summary of Product Characteristics.

Special populations

Elderly

  • No dose adjustment is required in patients ≥65 years of age

Renal impairment

  • No dose adjustment is required in patients with mild or moderate renal impairment. VYLOY has only been evaluated in a limited number of patients with severe renal impairment

Hepatic impairment

  • No dose adjustment is required in patients with mild hepatic impairment. VYLOY has only been evaluated in a limited number of patients with moderate hepatic impairment and has not been evaluated in patients with severe hepatic impairment

Paediatric population

  • The safety and efficacy of VYLOY in the paediatric population have not been established

Find resources designed for HCPs as they help patients throughout their treatment journey.

Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. Adverse events should also be reported to Astellas Pharma Ltd. on 0800 783 5018.

The above link will take you to a non-Astellas website. Astellas does not endorse or accept liability for sites controlled by third-parties.

Reference:

  1. VYLOY Summary of Product Characteristics.

MAT-GB-ZOL-2024-00092 | Date of preparation: January 2026

Indication

Important Safety Information

Indication

VYLOY, in combination with fluoropyrimidine- and platinum-containing chemotherapy, is indicated for the first-line treatment of adult patients with locally advanced unresectable or metastatic human epidermal growth factor receptor 2 (HER2)-negative gastric or gastro-oesophageal junction (GEJ) adenocarcinoma whose tumours are Claudin (CLDN) 18.2 positive.

SAFETY PROFILE

The safety of VYLOY was evaluated in two Phase 2 studies (FAST, ILUSTRO) and two Phase 3 studies (SPOTLIGHT, GLOW) in 631 patients who received at least one dose of VYLOY 800 mg/m2 as a loading dose followed by 600 mg/m2 subsequent doses every 3 weeks in combination with fluoropyrimidine- and platinum-containing chemotherapy. The median duration of exposure to zolbetuximab was 174 days (range: 1 to 1,791 days).

Serious adverse events occurred in 45% of patients treated with VYLOY and/or fluoropyrimidine- and platinum‑containing chemotherapy. The most common serious adverse reactions (≥2%) were vomiting (6.8%) and nausea (4.9%).

Adverse reactions observed during clinical studies

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Frequency categories are defined as follows: Very common (≥1/10); common (≥1/100 to <1/10); uncommon (≥1/1,000 to <1/100); rare (≥1/10,000 to <1/1,000); very rare (<1/10,000).

  • Thirty-seven percent of patients permanently discontinued VYLOY for adverse events; the most common adverse reactions (≥2%) leading to dose discontinuation were vomiting (5.4%) and nausea (4.3%).
  • Adverse events leading to dose interruption of VYLOY and/or fluoropyrimidine- and platinum‑containing chemotherapy occurred in 73% of patients; the most common adverse reactions (≥2%) leading to dose interruption were vomiting (29.3%), nausea (28.4%) and decreased appetite (3.6%).
  • The most common adverse reactions (≥2%) leading to dose rate reduction of the VYLOY and/or fluoropyrimidine- and platinum-containing chemotherapy infusion were nausea (9.7%) and vomiting (7.8%).

Contraindications

  • Hypersensitivity to the active substance or to any of the following excipients: Arginine, Phosphoric acid, Sucrose, Polysorbate 80

Interaction with other medicinal products and other forms of interaction

  • Zolbetuximab is not a cytokine modulator and there are no known effects of its mechanism of action on cytochrome P450 or drug transporters; therefore, no in vitro or in vivo drug-drug interaction or transporter studies have been conducted
  • Based on a Phase 2 study, co-administration of zolbetuximab with mFOLFOX6 did not show a clinically meaningful change in drug exposure of zolbetuximab, oxaliplatin or 5-fluorouracil (5-FU). Therefore, no dose adjustment is required for zolbetuximab and mFOLFOX6 when used in combination. This finding is also expected to be applicable to CAPOX, which contains oxaliplatin and capecitabine (a prodrug of 5-FU), therefore no dose adjustment is required for zolbetuximab and CAPOX when used in combination

Fertility, pregnancy and lactation

  • There are no data on the use of zolbetuximab in pregnant women. VYLOY should only be given to a pregnant woman if the benefit outweighs the potential risk

    - No adverse effects were observed in an animal reproductive and developmental study with intravenous administration of zolbetuximab to pregnant mice during organogenesis. Based on AUC, the doses administered in this study were up to approximately 1.8 times higher than human exposure at the recommended therapeutic dose of 600 mg/m2
  • There are no data on the presence of zolbetuximab in human milk, the effects on the breastfed child or the effects on milk production. Breastfeeding is not recommended during treatment with VYLOY

    - Because many drugs, including antibodies are excreted in human milk and because of the potential for serious adverse reactions in a breastfed child, breastfeeding is not recommended during treatment with VYLOY
  • The effect of VYLOY on male and female fertility is unknown

    - Studies to evaluate the effect of zolbetuximab on fertility have not been performed

Traceability

  • In order to improve the traceability of biological medicinal products, the name and the batch number of the administered product should be clearly recorded

WARNINGS AND PRECAUTIONS

 

HYPERSENSITIVITY REACTIONS

  • In the integrated safety analysis, all grade hypersensitivity reactions such as anaphylactic reaction and drug hypersensitivity occurred in the VYLOY + fluoropyrimidine- and platinum-containing chemotherapy arm [0.5% (3/631), 1.6% (10/631)] compared with the fluoropyrimidine- and platinum-containing chemotherapy + placebo arm [0.8% (5/611), 1.6% (10/611)]
  • The median time to first onset of anaphylactic reaction or drug hypersensitivity with VYLOY + fluoropyrimidine- and platinum-containing chemotherapy was 22 days or 113 days, respectively
  • Three patients (0.5%) permanently discontinued VYLOY due to anaphylactic reaction
  • Severe (Grade 3) anaphylactic reaction and drug hypersensitivity occurred at a similar frequency in the VYLOY + fluoropyrimidine- and platinum-containing chemotherapy arm [0.5% (3/631), 0.2% (1/631)] compared with the fluoropyrimidine- and platinum-containing chemotherapy + placebo arm [0.3% (2/611), 0.2% (1/611)]
  • Dose interruption of VYLOY was experienced due to drug hypersensitivity in six patients (1%). The infusion rate was reduced for VYLOY or fluoropyrimidine- and platinum-containing chemotherapy in one patient (0.2%) due to drug hypersensitivity

Special warnings and precautions for use

  • Monitor patients during and after infusion with VYLOY (at least 2 hours, or longer if clinically indicated) for hypersensitivity reactions with symptoms and signs that are highly suggestive of anaphylaxis (urticaria, repetitive cough, wheeze and throat tightness/change in voice)
  • If an anaphylactic reaction occurs, administration of VYLOY should be immediately and permanently discontinued and appropriate medical therapy administered
  • For any Grade 3 or 4 hypersensitivity reaction or hypersensitivity reaction with features of anaphylaxis, administration of VYLOY should be immediately and permanently discontinued and appropriate medical therapy instituted based on the type of reaction
  • For any Grade 2 hypersensitivity reaction, interrupt the VYLOY infusion until Grade ≤1, then resume the infusion at a reduced infusion rate for the remaining infusion. Pre-medicate the patient with antihistamines for the next infusion, and closely monitor the patient for symptoms and signs of a hypersensitivity reaction. The infusion rate may be gradually increased as tolerated

INFUSION-RELATED REACTION (IRR)

  • In the integrated safety analysis, all grade IRR occurred in the VYLOY + fluoropyrimidine- and platinum-containing chemotherapy arm at 3.2% (20/631) compared with fluoropyrimidine- and platinum-containing chemotherapy + placebo at 1.1% (7/611)
  • The median time to first onset of infusion-related reaction with VYLOY + fluoropyrimidine- and platinum-containing chemotherapy was 22 days
  • An IRR led to permanent discontinuation of VYLOY in 4 (0.6%) patients and dose interruption in 10 (1.6%) patients. The infusion rate was reduced for VYLOY or fluoropyrimidine- and platinum-containing chemotherapy in 2 patients (0.3%) due to an IRR
  • Severe (Grade 3) IRRs occurred more frequently in the VYLOY + fluoropyrimidine- and platinum-containing chemotherapy arm [0.5% (3/631)] compared with fluoropyrimidine- and platinum-containing chemotherapy + placebo [0% (0/611)]

Special warnings and precautions for use

  • Monitor patients for signs and symptoms of infusion-related reaction including nausea, vomiting, abdominal pain, salivary hypersecretion, pyrexia, chest discomfort, chills, back pain, cough and hypertension. These signs and symptoms are usually reversible with the interruption of the infusion
  • For Grade 3 or 4 IRRs, administration of VYLOY should be immediately and permanently discontinued and appropriate medical therapy instituted
  • For Grade 2 IRRs, interrupt the VYLOY infusion until Grade ≤1, then resume the infusion at a reduced infusion rate for the remaining infusion. Pre-medicate the patient with antihistamines for the next infusion, and closely monitor the patient for symptoms and signs of an IRR. The infusion rate may be gradually increased as tolerated

NAUSEA AND VOMITING

  • In the integrated safety analysis, all grade nausea and vomiting occurred more frequently in the VYLOY in combination with fluoropyrimidine- and platinum-containing chemotherapy arm [77.2% (487/631), 66.9% (422/631)] compared with the placebo in combination with fluoropyrimidine- and platinum-containing chemotherapy arm [58.9% (360/611), 36.8% (225/611)]
  • Severe (Grade 3) nausea and vomiting in the VYLOY in combination with fluoropyrimidine- and platinum-containing chemotherapy and placebo in combination with fluoropyrimidine- and platinum-containing chemotherapy arms occurred at the following freHYPERSENSITIVITY REACTIONSquencies: nausea [11.6% (73/631) and 4.7% (29/611)] and vomiting [13.6% (86/631) and 4.7% (29/611)]
  • The median time to first onset of nausea or vomiting with VYLOY in combination with fluoropyrimidine- and platinum-containing chemotherapy was 1 day or 1 day, respectively
  • Nausea led to permanent discontinuation of VYLOY in 27 (4.3%) patients and dose interruption in 179 (28.4%) patients. Vomiting led to permanent discontinuation of VYLOY in 34 (5.4%) patients and dose interruption in 185 (29.3%) patients. The infusion rate was reduced for VYLOY or fluoropyrimidine- and platinum-containing chemotherapy in 61 patients (9.7%) due to nausea and in 49 patients (7.8%) due to vomiting

Special warnings and precautions for use

  • Nausea and vomiting occurred more often during the first cycle of treatment but decreased in incidence with subsequent cycles of treatment
  • To prevent nausea and vomiting, pre-treatment with antiemetics is recommended prior to each infusion of VYLOY
  • During and after infusion, patients should be monitored and managed using standard of care, including antiemetics or fluid replacement, as clinically indicated
  • For Grade 4 vomiting, permanently discontinue treatment with VYLOY
  • For Grade 2 or 3 nausea or vomiting, interrupt the VYLOY infusion until Grade ≤1, then resume at a reduced infusion rate for the remaining infusion. For the next infusion, administer per the recommended infusion rates, and closely monitor the patient for symptoms and signs of nausea or vomiting. The infusion rate may be gradually increased as tolerated

 

Refer to the Summary of Product Characteristics for the full safety profile of VYLOY.