DailyMed Label: ALIQOPA

DailyMed Label: ALIQOPA

2023

DailyMed Prescription

ALIQOPA

copanlisib

Bayer HealthCare Pharmaceuticals Inc.

NDC: 50419-385

NDC: 50419-385

NDC: 50419-385

NDC: 50419-385

NDC: 50419-385

NDC: 50419-385

NDC: 50419-385

NDC: 50419-385

NDC: 50419-385

NDC: 50419-385

NDC: 50419-385

ALIQOPA (copanlisib) is a kinase inhibitor for intravenous infusion. The active pharmaceutical ingredient is copanlisib dihydrochloride which exists as a non-stoichiometric hydrate and has the molecular formula of C 23 H 28 N 8 O 4 2HCl and a molecular weight of 553.45 g/mol. The molecular formula and molecular weight are based on the anhydrous form. The chemical name is 2-amino-N-{7-methoxy-8-[3-(morpholin-4-yl)propoxy]-2,3-dihydroimidazo[1,2-c]quinazolin-5-yl}pyrimidine-5-carboxamide dihydrochloride. Copanlisib dihydrochloride has the following structural formula: ALIQOPA is supplied in single-dose vials as a sterile lyophilized solid for reconstitution and further dilution for intravenous infusion. The product is white to slightly yellowish. After reconstitution, the solution is colorless to slightly yellowish. Each vial contains 60 mg copanlisib free base (equivalent to 69.1 mg copanlisib dihydrochloride). After reconstitution, each mL contains 15 mg copanlisib free base (equivalent to 17.3 mg copanlisib dihydrochloride). Inactive ingredients: Each vial contains 5.8 mg citric acid anhydrous (might increase to 6.1 mg in case pH correction is necessary), 120 mg mannitol (bulking agent). Citric acid anhydrous acts as a buffering agent and may be used together with sodium hydroxide for pH adjustment. Chem structure

ALIQOPA is indicated for the treatment of adult patients with relapsed follicular lymphoma (FL) who have received at least two prior systemic therapies.   Accelerated approval was granted for this indication based on overall response rate [see Clinical Studies ( 14.1 )] . Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial. ALIQOPA is a kinase inhibitor indicated for the treatment of adult patients with relapsed follicular lymphoma (FL) who have received at least two prior systemic therapies ( 1 ). Accelerated approval was granted for this indication based on overall response rate. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial.

• Recommended dosage: 60 mg administered as a 1-hour intravenous infusion on Days 1, 8, and 15 of a 28-day treatment cycle on an intermittent schedule (three weeks on and one week off). Modify dosage for toxicity ( 2.1 , 2.4 ). • Reduce ALIQOPA dose to 45 mg in patients with moderate hepatic impairment (Child-Pugh B) or to 30 mg in patients with severe hepatic impairment (Child-Pugh C) ( 2.2 , 8.6 ). • See full prescribing information for important preparation and administration information ( 2.5 , 2.6 , 2.7 ). The recommended dose of ALIQOPA is 60 mg administered as a 1-hour intravenous infusion on Days 1, 8, and 15 of a 28-day treatment cycle on an intermittent schedule (three weeks on and one week off). Continue treatment until disease progression or unacceptable toxicity [see Warnings and Precautions ( 5 )] . Reduce ALIQOPA dose to 45 mg in patients with moderate hepatic impairment (Child-Pugh B). Reduce ALIQOPA dose to 30 mg in patients with severe hepatic impairment (Child-Pugh C) [see Use in Specific Populations ( 8.6 )]. Reduce ALIQOPA dose to 45 mg if a strong CYP3A inhibitor must be used. Concomitant use of ALIQOPA with strong CYP3A inhibitors increases copanlisib exposure (AUC) and may increase the risk for toxicity [see Drug Interactions ( 7.1 )] . Manage toxicities per Table 1 with dose reduction, treatment delay, or discontinuation of ALIQOPA. Discontinue ALIQOPA if life-threatening ALIQOPA-related toxicity occurs. Table 1: Dosage Modification and Toxicity Management a Toxicities Adverse Reaction Grade b Recommended Management Infections [see Warnings and Precautions ( 5.1 )]   Grade 3 or higher Withhold ALIQOPA until resolution. Suspected pneumocystis jiroveci pneumonia (PJP) infection of any grade Withhold ALIQOPA. If confirmed, treat infection until resolution, then resume ALIQOPA at previous dose with concomitant PJP prophylaxis. Cytomegalovirus (CMV) infection or viremia of any grade Withhold ALIQOPA until infection or viremia resolves, then resume at previous dose. Hyperglycemia [see Warnings and Precautions ( 5.2 )]   Pre-dose fasting blood glucose 160 mg/dL or more or random/non-fasting blood glucose of 200 mg/dL or more Withhold ALIQOPA until fasting glucose is 160 mg/dL or less, or a random/non-fasting blood glucose of 200 mg/dL or less. Pre-dose or post-dose blood glucose 500 mg/dL or more On first occurrence, withhold ALIQOPA until fasting blood glucose is 160 mg/dL or less, or a random/non-fasting blood glucose of 200 mg/dL or less. Then reduce ALIQOPA from 60 mg to 45 mg and maintain.     On subsequent occurrences, withhold ALIQOPA until fasting blood glucose is 160 mg/dL or less, or a random/non-fasting blood glucose of 200 mg/dL or less. Then reduce ALIQOPA from 45 mg to 30 mg and maintain. If persistent at 30 mg, discontinue ALIQOPA. Hypertension [see Warnings and Precautions ( 5.3 )]   Pre-dose blood pressure (BP) 150/90 or greater c Withhold ALIQOPA until BP is less than 150/90 based on two consecutive BP measurements at least 15 minutes apart. Post-dose BP 150/90 or greater c (non-life-threatening)  If anti-hypertensive treatment is not required, continue ALIQOPA at previous dose. If anti-hypertensive treatment is required, consider reduction of ALIQOPA from 60 mg to 45 mg or from 45 mg to 30 mg. Discontinue ALIQOPA if BP remains uncontrolled (BP greater than 150/90) despite anti-hypertensive treatment Post-dose elevated BP with life-threatening consequences Discontinue ALIQOPA. Non-infectious pneumonitis (NIP) [see Warnings and Precautions ( 5.4 )]   Grade 2 Withhold ALIQOPA and treat NIP. If NIP recovers to Grade 0 or 1, resume ALIQOPA at 45 mg. If Grade 2 NIP recurs, discontinue ALIQOPA. Grade 3 or higher Discontinue ALIQOPA. Neutropenia [see Warnings and Precautions ( 5.5 )] Absolute neutrophil count (ANC) 0.5 to 1.0 x 10 3 cells/mm 3 Maintain ALIQOPA dose. Monitor ANC at least weekly. ANC less than 0.5 x 10 3 cells/mm 3 Withhold ALIQOPA. Monitor ANC at least weekly until ANC 0.5 x 10 3 cells/mm 3 or greater, then resume ALIQOPA at previous dose. If ANC 0.5 x 10 3 cells/mm 3 or less recurs, then reduce ALIQOPA to 45 mg. Severe cutaneous reactions [see Warnings and Precautions ( 5.6 )] Grade 3 Withhold ALIQOPA until toxicity is resolved and reduce ALIQOPA from 60 mg to 45 mg or from 45 mg to 30 mg. Life-threatening Discontinue ALIQOPA. Thrombocytopenia [see Adverse Reactions ( 6.1 )] Less than 25 x 10 9 /L Withhold ALIQOPA; resume when platelet levels return to 75.0 x 10 9 /L or greater. If recovery occurs within 21 days, reduce ALIQOPA from 60 mg to 45 mg or from 45 mg to 30 mg. If recovery does not occur within 21 days, discontinue ALIQOPA. Other severe and non-life-threatening toxicities [see Adverse Reactions ( 6.1 )]   Grade 3 Withhold ALIQOPA until toxicity is resolved and reduce ALIQOPA from 60 mg to 45 mg or from 45 mg to 30 mg. a Ensure a minimum of 7 days between any two consecutive infusions. b National Cancer Institute-Common Terminology Criteria for Adverse Events (NCI-CTCAE) v4.03. c Both systolic of less than 150 mmHg and diastolic of less than 90 mmHg are required. For intravenous infusion only. Administer ALIQOPA as a single agent, following reconstitution and dilution. Mix only with sterile 0.9% Sodium Chloride Injection, USP solution. Do not mix or inject ALIQOPA with other drugs or other diluents. Reconstitute ALIQOPA with 4.4 mL of sterile 0.9% Sodium Chloride Injection, USP solution leading to a concentration of 15 mg/mL. • Withdraw 4.4 mL of sterile 0.9% Sodium Chloride Injection, USP solution by using a 5 mL sterile syringe with needle. • Inject the measured volume through the disinfected stopper surface into the vial of ALIQOPA. • Dissolve the lyophilized solid by gently shaking the injection vial for 30 seconds. • Allow to stand for one minute to let bubbles rise to the surface. • Check if any undissolved substance is still seen. If yes, repeat the gentle shaking and settling procedure. • Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. After reconstitution, the solution should be colorless to slightly yellowish. • Once the solution is free of visible particles, withdraw the reconstituted solution for further dilution. Further dilute the reconstituted solution in 100 mL sterile 0.9% Sodium Chloride Injection, USP solution for injection. With a sterile syringe, withdraw the required amount of the reconstituted solution for the desired dosage: 60 mg: Withdraw 4 mL of the reconstituted solution with a sterile syringe. 45 mg: Withdraw 3 mL of the reconstituted solution with a sterile syringe. 30 mg: Withdraw 2 mL of the reconstituted solution with a sterile syringe. Inject the contents of the syringe into the patient infusion bag of 100 mL sterile 0.9% Sodium Chloride Injection, USP solution. Mix the dose well by inverting. Discard any unused reconstituted or diluted solution appropriately. Use reconstituted and diluted ALIQOPA immediately or store the reconstituted solution in the vial or diluted solution in the infusion bag at 2°C to 8°C (36°F to 46°F) for up to 24 hours before use. Allow the product to adapt to room temperature before use following refrigeration. Avoid exposure of the diluted solution to direct sunlight.

For injection: 60 mg of copanlisib as a lyophilized solid in single-dose vial for reconstitution. For injection: 60 mg of copanlisib as a lyophilized solid in single-dose vial for reconstitution ( 3 ).

None. None ( 4 ).

• Infections: Monitor patients for signs and symptoms of infection. Withhold treatment for Grade 3 and higher infections until resolution ( 5.1 ). • Hyperglycemia: Start each infusion once optimal blood glucose control is achieved. Withhold treatment, reduce dose, or discontinue treatment depending on the severity and persistence of hyperglycemia ( 5.2 ). • Hypertension: Withhold treatment in patients until both the systolic blood pressure (BP) is less than 150 mmHg and the diastolic BP is less than 90 mmHg. Consider reducing dose if anti-hypertensive treatment is required. Discontinue in patients with BP that is uncontrolled or with life-threatening consequences ( 5.3 ). • Non-infectious pneumonitis (NIP): Treat NIP and reduce dose. Discontinue treatment if Grade 2 NIP recurs or in patients experiencing Grade 3 or higher NIP ( 5.4 ). • Neutropenia: Monitor blood counts at least weekly while under treatment. Withhold treatment until ANC ≥0.5 x 10 3 cells/mm 3 ( 5.5 ). • Severe Cutaneous Reactions: Withhold treatment, reduce dose, or discontinue treatment depending on the severity and persistence of severe cutaneous reactions ( 5.6 ). • Embryo-Fetal Toxicity: ALIQOPA can cause fetal harm. Advise patients of potential risk to a fetus and to use effective contraception ( 5.7 , 8.1 , 8.3 ). Serious, including fatal, infections occurred in 19% of 317 patients treated with ALIQOPA monotherapy. The most common serious infection was pneumonia [see Adverse Reactions ( 6.1 )] . Monitor patients for signs and symptoms of infection and withhold ALIQOPA for Grade 3 and higher infection [see Dosage and Administration ( 2.4 )] . Serious pneumocystis jiroveci pneumonia (PJP) occurred in 0.6% of 317 patients treated with ALIQOPA monotherapy [see Adverse Reactions ( 6.1 )]. Before initiating treatment with ALIQOPA, consider PJP prophylaxis for populations at risk. Withhold ALIQOPA in patients with suspected PJP infection of any grade. If confirmed, treat infection until resolution, then resume ALIQOPA at previous dose with concomitant PJP prophylaxis [see Dosage and Administration ( 2.4 )] . Grade 1 or 2 cytomegalovirus (CMV) reactivation or infection has occurred in 0.97% of patients treated with ALIQOPA monotherapy. Monitor for CMV infection during treatment with ALIQOPA in patients with a history of CMV infection. For clinical CMV infection or viremia, withhold ALIQOPA until infection or viremia resolves. If ALIQOPA is resumed, administer at the previous dose and monitor patients for CMV reactivation by PCR or antigen test at least monthly [see Dosage and Administration ( 2.4 )]. Grade 3 or 4 hyperglycemia (blood glucose 250 mg/dL or greater) occurred in 41% of 317 patients treated with ALIQOPA monotherapy [see Adverse Reactions ( 6.1 )] . Serious hyperglycemic events occurred in 2.8% of patients. Treatment with ALIQOPA may result in infusion-related hyperglycemia. Blood glucose levels typically peaked 5 to 8 hours post-infusion and subsequently declined to baseline levels for a majority of patients; blood glucose levels remained elevated in 17.7% of patients one day after ALIQOPA infusion. Of 155 patients with baseline HbA1c <5.7%, 16 (10%) patients had HbA1c >6.5% at the end of treatment. Of the twenty patients with diabetes mellitus treated in CHRONOS-1, seven developed Grade 4 hyperglycemia and two discontinued treatment. Patients with diabetes mellitus should only be treated with ALIQOPA following adequate glucose control and should be monitored closely. Achieve optimal blood glucose control before starting each ALIQOPA infusion. Withhold, reduce dose, or discontinue ALIQOPA depending on the severity and persistence of hyperglycemia [see Dosage and Administration ( 2.4 )] . Grade 3 hypertension (systolic 160 mmHg or greater or diastolic 100 mmHg or greater) occurred in 26% of 317 patients treated with ALIQOPA monotherapy [see Adverse Reactions ( 6.1 )] . Serious hypertensive events occurred in 0.9% of 317 patients. Treatment with ALIQOPA may result in infusion-related hypertension. The mean change of systolic and diastolic BP from baseline to 2 hours post-infusion on Cycle 1 Day 1 was 16.8 mmHg and 7.8 mmHg, respectively. The mean BP started decreasing approximately 2 hours post-infusion; BP remained elevated for 6 to 8 hours after the start of the ALIQOPA infusion. Optimal BP control should be achieved before starting each ALIQOPA infusion. Monitor BP pre- and post-infusion. Withhold, reduce dose, or discontinue ALIQOPA depending on the severity and persistence of hypertension [see Dosage and Administration ( 2.4 )] . Non-infectious pneumonitis occurred in 5% of 317 patients treated with ALIQOPA monotherapy [see Adverse Reactions ( 6.1 )]. Withhold ALIQOPA and conduct a diagnostic examination of a patient who is experiencing pulmonary symptoms such as cough, dyspnea, hypoxia, or interstitial infiltrates on radiologic exam. Patients with pneumonitis thought to be caused by ALIQOPA have been managed by withholding ALIQOPA and administration of systemic corticosteroids. Withhold, reduce dose, or discontinue ALIQOPA depending on the severity and persistence of non-infectious pneumonitis [see Dosage and Administration ( 2.4 )] . Grade 3 or 4 neutropenia occurred in 24% of 317 patients treated with ALIQOPA monotherapy. Serious neutropenic events occurred in 1.3% [see Adverse Reactions ( 6.1 )] . Monitor blood counts at least weekly during treatment with ALIQOPA. Withhold, reduce dose, or discontinue ALIQOPA depending on the severity and persistence of neutropenia [see Dosage and Administration ( 2.4 )] . Grade 3 and 4 cutaneous reactions occurred in 2.8% and 0.6% of 317 patients treated with ALIQOPA monotherapy, respectively [see Adverse Reactions ( 6.1 )]. Serious cutaneous reaction events were reported in 0.9%. The reported events included dermatitis exfoliative, exfoliative rash, pruritus, and rash (including maculo-papular rash). Withhold, reduce dose, or discontinue ALIQOPA depending on the severity and persistence of severe cutaneous reactions [see Dosage and Administration ( 2.4 )] . Based on findings in animals and its mechanism of action, ALIQOPA can cause fetal harm when administered to a pregnant woman. In animal reproduction studies, administration of copanlisib to pregnant rats during organogenesis caused embryo-fetal death and fetal abnormalities in rats at maternal doses as low as 0.75 mg/kg/day (4.5 mg/m 2 /day body surface area) corresponding to approximately 12% the recommended dose for patients. Advise pregnant women of the potential risk to a fetus. Advise females of reproductive potential and males with female partners of reproductive potential to use effective contraception during treatment and for one month after the last dose [see Use in Specific Populations ( 8.1 , 8.3 ) and Clinical Pharmacology ( 12.1 )] .

The following clinically significant adverse reactions are described elsewhere in the labeling.

• CYP3A Inducers: Avoid concomitant use with strong CYP3A inducers ( 7.1 ). • CYP3A Inhibitors: Reduce the ALIQOPA dose to 45 mg when concomitantly administered with strong CYP3A inhibitors ( 7.1 ). Table 4 lists the potential effects of coadministration of ALIQOPA with strong CYP3A inhibitors and inducers. Table 4: Drug Interactions with ALIQOPA that affect Copanlisib Concentrations Strong CYP3A inducers Clinical impact • Concomitant use of ALIQOPA with strong CYP3A inducers may decrease copanlisib AUC and C max [see Clinical Pharmacology ( 12.3 )] . Prevention management • Avoid concomitant use of ALIQOPA with strong CYP3A inducers Strong CYP3A inhibitors Clinical impact • Concomitant use of ALIQOPA with strong CYP3A inhibitors increases the copanlisib AUC [see Clinical Pharmacology ( 12.3 )] . • An increase in the copanlisib AUC may increase the risk of adverse reactions Prevention management • If concomitant use with strong CYP3A inhibitors cannot be avoided, reduce the ALIQOPA dose to 45 mg [see Dosage and Administration ( 2.3 )]

• Lactation: Advise not to breastfeed ( 8.2 ). Based on findings from animal studies and the mechanism of action, ALIQOPA can cause fetal harm when administered to a pregnant woman [see Clinical Pharmacology ( 12.1 )] . There are no available data in pregnant women to inform the drug-associated risk. In animal reproduction studies, administration of copanlisib to pregnant rats during organogenesis resulted in embryo-fetal death and fetal abnormalities at maternal doses approximately 12% of the recommended dose for patients (see Data) . Advise pregnant women of the potential risk to a fetus. Adverse outcomes in pregnancy occur regardless of the health of the mother or the use of medications. The background risk of major birth defects and miscarriage for the indicated population are unknown. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively. In an embryo-fetal development study in rats, pregnant animals received intravenous doses of copanlisib of 0, 0.75, or 3 mg/kg/day during the period of organogenesis. Administration of copanlisib at the dose of 3 mg/kg/day resulted in maternal toxicity and no live fetuses. Copanlisib administration at the dose of 0.75 mg/kg/day was maternally toxic and resulted in embryo-fetal death (increased resorptions, increased post-implantation loss, and decreased numbers of fetuses/dam). The dose of 0.75 mg/kg/day also resulted in increased incidence of fetal gross external (domed head, malformed eyeballs or eyeholes), soft tissue (hydrocephalus internus, ventricular septal defects, major vessel malformations), and skeletal (dysplastic forelimb bones, malformed ribs and vertebrae, and pelvis shift) abnormalities. The dose of 0.75 mg/kg/day (4.5 mg/m 2 body surface area) in rats is approximately 12% of the recommended dose for patients. Following administration of radiolabeled copanlisib to pregnant rats approximately 1.5% of the radioactivity (copanlisib and metabolites) reached the fetal compartment. There are no data on the presence of copanlisib and/or metabolites in human milk, the effects on the breastfed child, or on milk production. Following administration of radiolabeled copanlisib to lactating rats, approximately 2% of the radioactivity was secreted into milk; the milk to plasma ratio of radioactivity was 25-fold. Because of the potential for serious adverse reactions in a breastfed child from copanlisib, advise a lactating woman not to breastfeed during treatment with ALIQOPA and for 1 month after the last dose. ALIQOPA can cause fetal harm when administered to a pregnant woman [see Use in Specific Populations ( 8.1 )]. Conduct pregnancy testing prior to initiation of ALIQOPA treatment. Advise female patients of reproductive potential to use highly effective contraception (contraception with a failure rate <1% per year) during treatment with ALIQOPA and for one month after the last dose. Advise male patients with female partners of reproductive potential to use highly effective contraception during treatment with ALIQOPA and for one month after the last dose. There are no data on the effect of ALIQOPA on human fertility. Due to the mechanism of action of copanlisib, and findings in animal studies, adverse effects on reproduction, including fertility, are expected [see Nonclinical Toxicology ( 13.1 )] . Safety and effectiveness of ALIQOPA have not been established in pediatric patients. No dosage adjustment of ALIQOPA is necessary in patients ≥65 years of age. Of 168 patients with follicular lymphoma and other hematologic malignancies treated with ALIQOPA, 48% were age 65 or older while 16% were age 75 or older. No clinically relevant differences in efficacy were observed between elderly and younger patients. In patients ≥65 years of age, 30% experienced serious adverse reactions and 21% experienced adverse reactions leading to discontinuation. In the patients <65 years of age, 23% experienced serious adverse reactions and 11% experienced adverse reactions leading to discontinuation. Reduce ALIQOPA dose to 45 mg for patients with moderate hepatic impairment (Child-Pugh B). Reduce ALIQOPA dose to 30 mg for patients with severe hepatic impairment (Child-Pugh C) [see Dosage and Administration ( 2.2 )] . No dose adjustment is required for patients with mild hepatic impairment (total bilirubin ≤1 × upper limit of normal [ULN] and aspartate aminotransferase [AST] > ULN, or total bilirubin >1 to 1.5 × ULN and any AST) [see Clinical Pharmacology ( 12.3 )].

How Supplied ALIQOPA is contained in a colorless glass vial closed with bromobutyl stopper with a flanged closure. Each vial of ALIQOPA contains copanlisib as a lyophilized solid. NDC Strength Reconstituted Concentration 50419-385-01 60 mg (one single-dose vial per carton) 15 mg/mL Storage and Handling ALIQOPA vials must be refrigerated at 2°C to 8°C (36°F to 46°F).

Copanlisib is an inhibitor of phosphatidylinositol-3-kinase (PI3K) with inhibitory activity predominantly against PI3K-α and PI3K-δ isoforms expressed in malignant B cells. Copanlisib has been shown to induce tumor cell death by apoptosis and inhibition of proliferation of primary malignant B cell lines. Copanlisib inhibits several key cell-signaling pathways, including B-cell receptor (BCR) signaling, CXCR12 mediated chemotaxis of malignant B cells, and NFκB signaling in lymphoma cell lines. At 60 mg (or 0.8 mg/kg) of ALIQOPA dose, the elevation of plasma glucose was associated with higher copanlisib exposure. ALIQOPA does not cause a large mean increase in QTc interval > 20 milliseconds at the recommended dose. The effect of the recommended ALIQOPA dose of 60 mg on the QTc interval was evaluated in an open label, dedicated QT study of 25 patients with advanced cancer. A decrease in the change-from-baseline QTc (DQTc) was observed after the start of ALIQOPA administration, followed by an increase in DQTc between 12 and 24 hours post-treatment. The observed changes in DQTc are not likely due to direct inhibition of cardiac ion channels. The area under the plasma concentration-time curve (AUC) and maximum plasma concentration (C max ) of ALIQOPA increase dose-proportionally over 5 to 93 mg (0.08 to 1.55 times the approved recommended dose) absolute dose range and exhibit linear pharmacokinetics (PK). There is no time-dependency and no accumulation in the PK of copanlisib. The geometric mean (range) steady state copanlisib exposure at 0.8 mg/kg (approximately the approved recommended dose of 60 mg) are 463 (range: 105 to 1670; SD: 584) ng/mL for C max and 1570 (range: 536 to 3410; SD: 338) ng.hr/mL for AUC 0-25h . The in vitro human plasma protein binding of copanlisib is 84.2%. Albumin is the main binding protein. The in vitro mean blood-to-plasma ratio is 1.7 (range: 1.5 to 2.1). The geometric mean volume of distribution is 871 (range: 423 to 2150; SD: 479) L. The geometric mean terminal elimination half-life of copanlisib is 39.1 (range: 14.6 to 82.4; SD: 15.0) hours. The geometric mean clearance is 17.9 (range: 7.3 to 51.4; SD: 8.5) L/hr. Approximately >90% of copanlisib metabolism is mediated by CYP3A and <10% by CYP1A1. The M-1 metabolite accounts for 5% of total radioactivity AUC and its pharmacological activity is comparable to the parent compound copanlisib for the tested kinases PI3KαandPI3Kβ. Copanlisib is excreted approximately 50% as unchanged compound and 50% as metabolites in humans. Following a single intravenous dose of 12 mg (0.2 times the recommended approved dose) radiolabeled copanlisib, approximately 64% of the administered dose was recovered in feces and 22% in urine within 20 to 34 days. Unchanged copanlisib represented approximately 30% of the administered dose in feces and 15% in urine. Metabolites resulting from CYP450-mediated oxidation metabolism accounted for 41% of the administered dose. Age (20 to 90 years), gender, race (White, Asian, Hispanic, and Black), smoking status, body weight (41 to 130 kg), and mild, moderate, and severe renal impairment [CLcr ≥ 15 mL/min as estimated by Cockcroft-Gault (C-G) equation] had no clinically significant effect on the PK of copanlisib. The PK of copanlisib in patients with end stage renal disease (CLcr < 15 mL/min by C-G equation) with or without dialysis is unknown. Based on a population PK analysis in patients with cancer, mild hepatic impairment [total bilirubin ≤ 1 x ULN and AST > ULN, or total bilirubin > 1-1.5 x ULN and any AST] had no clinically relevant effect on the PK of copanlisib. In a dedicated PK study evaluating a single intravenous dose of 12 mg (0.2 times the recommended approved dose of 60 mg) of ALIQOPA in subjects with hepatic impairment, the geometric mean of total copanlisib C max and AUC increased 1.38-fold and 1.71-fold, respectively, in subjects with moderate hepatic impairment (Child-Pugh B) and 1.44-fold and 2.71-fold, respectively, in patients with severe hepatic impairment (Child‑Pugh C) as compared to normal hepatic function. The geometric mean unbound AUC of copanlisib increased 1.23-fold and 3.77-fold in patients with moderate and severe hepatic impairment, respectively. The geometric mean unbound Cmax of copanlisib did not increase in patients with moderate hepatic impairment, but increased 1.92-fold in patients with severe hepatic impairment. Effect of CYP3A and P-gp Inducers on Copanlisib Rifampin, a strong CYP3A and a P-glycoprotein (P-gp) transporter inducer, administered at a dose of 600 mg once daily for 12 days with a single intravenous dose of 60 mg ALIQOPA in patients with cancer resulted in a 60% decrease in the mean AUC and a 12% decrease in C max of copanlisib [see Drug Interactions ( 7.1 )] . Effect of CYP3A, P-gp and BCRP Inhibitors on Copanlisib Itraconazole, a strong CYP3A inhibitor and a P-gp and Breast Cancer Resistance Protein (BCRP) transporter inhibitor, administered at a dose of 200 mg once daily for 10 days increased the mean AUC of a single intravenous dose of 60 mg ALIQOPA by 53% (or 1.53-fold) with no effect on C max (1.03-fold) in patients with cancer [see Drug Interactions ( 7.1 )]. Effect of Copanlisib on Other Drugs Coadministration of a single intravenous dose of 60 mg ALIQOPA with a single 1000 mg dose of metformin, a clinically relevant substrate of multidrug and toxin extrusion protein (MATE) 2-K transporter, in healthy subjects increased the metformin AUC by 11% (or 1.11-fold) with no effect on Cmax (0.94-fold). Effect of Transporters on Copanlisib: Copanlisib is a substrate of P-gp and BCRP, but not a substrate for organic cation transporter (OCT) 1, OCT2, and OCT3, organic anion transporter (OAT) 1 and OAT3, organic anion-transporting polypeptide (OATP) 1B1 and OATP1B3, MATE1 or MATE2-K. Effect of Copanlisib on CYP and non-CYP Enzymes Copanlisib is not an inhibitor of the metabolism of drugs that are substrates of the major CYP isoforms (CYP1A2, 2A6, 2B6, 2C8, 2C9, 2C19, 2D6, 2E1, and 3A4) or uridine diphosphate-glucuronosyltransferase isoforms (UGT) or dihydropyrimidine dehydrogenase (DPD) at therapeutic 60 mg dose plasma concentrations. Copanlisib is not an inducer of CYP1A2, CYP2B6 and CYP3A. Effect of Copanlisib on Drug Transporter Substrates Copanlisib is not an inhibitor of P-gp, BCRP, multi-drug resistance-associated protein (MRP2), bile salt export pump (BSEP), OATP1B1, OATP1B3, OAT1, OAT3, OCT1, OCT2, and MATE1 at therapeutic 60 mg dose plasma concentrations. Copanlisib is an inhibitor of MATE2-K (IC 50 : 0.09 μM) at therapeutic 60 mg dose plasma concentrations.

Carcinogenicity studies have not been conducted with copanlisib. Copanlisib did not cause genetic damage in in vitro or in vivo assays. Fertility studies with copanlisib were not conducted; however, adverse findings in male and female reproductive systems were observed in the repeat dose toxicity studies. Findings in the male rats and/or dogs included effects on the testes (germinal epithelial degeneration, decreased weight, and/or tubular atrophy), epididymides (spermatic debris, decreased weight, and/or oligospermia/aspermia), and prostate (reduced secretion and/or decreased weight). Findings in female rats included effects on ovaries (hemorrhage, hemorrhagic cysts, and decreased weight), uterus (atrophy, decreased weight), vagina (mononuclear infiltration), and a dose-related reduction in the numbers of female rats in estrus.

Effect of CYP3A and P-gp Inducers on Copanlisib Rifampin, a strong CYP3A and a P-glycoprotein (P-gp) transporter inducer, administered at a dose of 600 mg once daily for 12 days with a single intravenous dose of 60 mg ALIQOPA in patients with cancer resulted in a 60% decrease in the mean AUC and a 12% decrease in C max of copanlisib [see Drug Interactions ( 7.1 )] . Effect of CYP3A, P-gp and BCRP Inhibitors on Copanlisib Itraconazole, a strong CYP3A inhibitor and a P-gp and Breast Cancer Resistance Protein (BCRP) transporter inhibitor, administered at a dose of 200 mg once daily for 10 days increased the mean AUC of a single intravenous dose of 60 mg ALIQOPA by 53% (or 1.53-fold) with no effect on C max (1.03-fold) in patients with cancer [see Drug Interactions ( 7.1 )]. Effect of Copanlisib on Other Drugs Coadministration of a single intravenous dose of 60 mg ALIQOPA with a single 1000 mg dose of metformin, a clinically relevant substrate of multidrug and toxin extrusion protein (MATE) 2-K transporter, in healthy subjects increased the metformin AUC by 11% (or 1.11-fold) with no effect on Cmax (0.94-fold).

PATIENT INFORMATION ALIQOPA™ (AL-ih-KO-pah) (copanlisib) for injection What is ALIQOPA? ALIQOPA is a prescription medicine used to treat adults with follicular lymphoma (FL) when the disease has come back after treatment with at least two prior medicines. It is not known if ALIQOPA is safe and effective in children. Before receiving ALIQOPA, tell your healthcare provider about all of your medical conditions, including if you: • have an infection • have a history of cytomegalovirus (CMV) infection • have lung or breathing problems • have high blood pressure (hypertension) • have diabetes or high blood sugar (hyperglycemia) • have liver problems • are pregnant or plan to become pregnant. ALIQOPA can harm your unborn baby. o Your healthcare provider will do a pregnancy test before starting treatment with ALIQOPA. o Females who are able to become pregnant should use effective birth control (contraception) during treatment with ALIQOPA and for 1 month after the last dose of ALIQOPA. Talk to your healthcare provider about birth control methods that may be right for you. Tell your healthcare provider right away if you become pregnant or think you are pregnant during treatment with ALIQOPA. o Males with female partners who are able to become pregnant should use effective birth control (contraception) during treatment with ALIQOPA and for 1 month after the last dose of ALIQOPA. • are breastfeeding or plan to breastfeed. It is not known if ALIQOPA passes into your breast milk. Do not breastfeed during treatment with ALIQOPA and for 1 month after the last dose of ALIQOPA. Talk to your healthcare provider about the best way to feed your child during treatment with ALIQOPA. Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Certain other medicines may affect how ALIQOPA works. How will I receive ALIQOPA? • ALIQOPA will be given to you by a healthcare provider as an intravenous (IV) injection into your vein over 1 hour. • You will receive your ALIQOPA treatment 1 time every week for 3 weeks and then stop for 1 week. This is 1 cycle of treatment. ALIQOPA is usually given on Day 1, Day 8, and Day 15 of a 28-day treatment cycle. • Your healthcare provider will decide how many treatment cycles you need. • Your healthcare provider may withhold treatment, decrease your dose, temporarily stop, or permanently stop treatment with ALIQOPA if you have certain side effects. What should I avoid while receiving ALIQOPA? • Avoid taking St. John’s Wort during treatment with ALIQOPA. • Avoid drinking grapefruit juice during treatment with ALIQOPA. What are the possible side effects of ALIQOPA? ALIQOPA can cause serious side effects, including: • Infections. ALIQOPA can cause serious infections that may lead to death. The most common serious infection was pneumonia. Tell your healthcare provider right away if you have a fever or any signs of an infection during treatment with ALIQOPA. • High blood sugar (hyperglycemia). High blood sugar is common following ALIQOPA infusion and can sometimes be serious. Tell your healthcare provider if you develop any symptoms of hyperglycemia during treatment with ALIQOPA, including: o being very hungry o headaches o being very thirsty o frequent urination • High blood pressure (hypertension). High blood pressure is common following ALIQOPA infusion and can sometimes be serious. Tell your healthcare provider if you develop any symptoms of hypertension during treatment with ALIQOPA, including: o dizziness o passing out o headache o feel like your heart is pounding • Lung or breathing problems. Your healthcare provider may do tests to check your lungs if you have breathing problems during treatment with ALIQOPA. Tell your healthcare provider right away if you develop new or worsening cough, shortness of breath, or difficulty breathing. • Low white blood cell count (neutropenia ). Neutropenia is common with ALIQOPA treatment and can sometimes be serious. Your healthcare provider will check your blood counts regularly during treatment with ALIQOPA. Tell your healthcare provider right away if you have a fever or any signs of infection during treatment with ALIQOPA. • Severe skin reactions. Skin peeling, rash, and itching are common with ALIQOPA and can sometimes be serious. Tell your healthcare provider if you develop skin peeling, itching, or rash during treatment with ALIQOPA. Your healthcare provider may withhold treatment, decrease your dose, or permanently stop treatment if you develop severe skin reactions during treatment with ALIQOPA. The most common side effects of ALIQOPA include: • diarrhea • decreased strength and tiredness • nausea • low platelet counts (thrombocytopenia) • lower respiratory tract infection These are not all of the possible side effects of ALIQOPA. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. General information about the safe and effective use of ALIQOPA Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. You can ask your healthcare provider or pharmacist for information about ALIQOPA that is written for health professionals. What are the ingredients in ALIQOPA? Active ingredient: copanlisib Inactive ingredients: citric acid anhydrous, mannitol Manufactured in Germany Manufactured for: Bayer HealthCare Pharmaceuticals Inc., Whippany, NJ 07981 USA © 2017 Bayer HealthCare Pharmaceuticals Inc. For more information, go to www.aliqopa.com or call 1-888-842-2937.   This Patient Information has been approved by the U.S. Food and Drug Administration Revised: September 2023

[The following is a representative example of Aliqopa labeling.] NDC 50419-385-01 Rx only Aliqopa (copanlisib) 60 mg* *Equivalent to 69.1 mg copanlisib dihydrochloride For intravenous infusion only. Must be reconstituted and diluted. Single dose vial - discard unused portion Aliqopa Carton