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Table 2 Glasdegib dose reduction in case of non-hematological toxicities

From: Rationale and design of the 2 by 2 factorial design GnG-trial: a randomized phase-III study to compare two schedules of gemtuzumab ozogamicin as adjunct to intensive induction therapy and to compare double-blinded intensive postremission therapy with or without glasdegib in older patients with newly diagnosed AML

Toxicity Glasdegib dosage modification
Non-hematologic toxicities grade ≥3 according to CTCAE criteria (excluding QTc prolongation, muscle spasms, and myalgias).
First episode
Second episode
Third episode
Interrupt medication until toxicity recovers to grade ≤1, then:
Dose level decrease 1 (DLD1): 75 mg
DLD2: 50 mg
Discontinue medication permanently
Renal toxicity, where serum creatinine or BUN are ≥2 × ULN or serum bicarbonate level is < 20 mmol/L.
First episode
Second episode
Third episode
Interrupt medication until toxicity recovers tograde ≤1 then:
Discontinue medication permanently
Electrocardiogram QT corrected (QTc) prolongation grade 1. Continue at the same level.
QTc prolongation grade 2 and 3. Interrupt and resume when QTc returns to ≤470 ms:
- Within 7 days, dosing as before
- Within 14 days, DLD1
Discontinue medication permanently, in case of no return to ≤470 ms after 14 days,
QTc prolongation grade 4 or repetitive grade 3 or grade 2 after DLD1. Discontinue medication permanently
  1. Toxicity is graded according to CTCAE criteria. Once the Glasdegib dose has been reduced, all subsequent cycles should be administered at that dose level, unless further dose reduction is required. Dose re-escalation is not allowed. Nausea, vomiting, or diarrhea must persist until next therapy cycle at grade ≥3 to require dose modification
  2. Abbreviations: CTCAE Common Terminology Criteria for Adverse Events, QTc QT corrected, DLD1 dose level decrease 1: 75 mg, DLD2 dose level decrease 2: 50 mg, ULN upper limit normal