FAVLYXA

1 INDICATIONS AND USAGE FAVLYXA is indicated for the treatment of patients with: FAVLYXA is a nucleoside metabolic inhibitor indicated for the treatment of patients with: Adenocarcinoma of the Colon and Rectum ( 1.1 ) Adenocarcinoma of the Breast ( 1.2 ) Gastric Adenocarcinoma ( 1.3 ) Pancreatic Adenocarcinoma ( 1.4 ) 1.1 Adenocarcinoma of the Colon and Rectum 1.2 Adenocarcinoma of the Breast 1.3 Gastric Adenocarcinoma 1.4 Pancreatic Adenocarcinoma

2 DOSAGE AND ADMINISTRATION FAVLYXA is recommended for administration either as an intravenous bolus or as an intravenous infusion. ( 2.1 ) Adenocarcinoma of the Colon and Rectum In combination with leucovorin or as a component of a multidrug chemotherapy regimen that includes leucovorin (infusional regimen): 400 mg/m 2 for one dose, followed by 2,400 mg/m 2 to 3,000 mg/m 2 over 46 hours on day 1 of each 2-week cycle or In combination with leucovorin (bolus regimen): 500 mg/m 2 on days 1, 8, 15, 22, 29 and 36 of each 8-week cycle. ( 2.2 ) Adenocarcinoma of the Breast in combination with a cyclophosphamide-based multidrug regimen: 500 mg/m 2 or 600 mg/m 2 on days 1 and 8 of each 28-day cycle (bolus regimen). ( 2.2 ) Gastric Adenocarcinoma in combination with a platinum-containing multidrug regimen: 200 mg/m 2 to 1,000 mg/m 2 over 24 hours (infusional regimen). ( 2.2 ) Pancreatic Adenocarcinoma in combination with leucovorin or as a component of a multidrug chemotherapy regimen that includes leucovorin: 400 mg/m 2 on day 1, followed by 2,400 mg/m 2 over 46 hours every 2 weeks (infusional regimen). ( 2.2 ) Refer to Section 2.3 for dosage modifications due to adverse reactions. 2.1 Evaluation and Testing for DPD Deficiency Before Initiating FAVLYXA Prior to initiating FAVLYXA, test patients for genetic variants of the DPYD gene unless immediate treatment is necessary. An FDA-authorized test for the detection of the DPYD gene to identify patients at risk of serious adverse reactions with FAVLYXA is not currently available. Currently available tests used to identify DPYD variants may vary in accuracy and design (e.g., which DPYD variant(s) they identify). Avoid use of FAVLYXA in patients known to have certain homozygous or compound heterozygous DPYD variants that result in complete DPD deficiency . No FAVLYXA dose has been proven safe for patients with complete DPD deficiency. For patients with partial DPD deficiency, individualize the dosage and modify based on tolerability and intent of treatment [see Warnings and Precautions (5.1) ] . 2.2 Recommended Dosage FAVLYXA is recommended for administration either as an intravenous bolus or as an intravenous infusion. Dosage recommendations are in Table 1. Table 1: Recommended dosage of FAVLYXA Indication Recommended Dosage Duration of Treatment Adenocarcinoma of the Colon and Rectum In combination with leucovorin or as a component of a multidrug chemotherapy regimen that includes leucovorin 400 mg/m 2 for one dose, followed by 2,400 mg/m 2 to 3,000 mg/m 2 over 46 hours on day 1 of each 2-week cycle Until disease progression or unacceptable toxicity. In combination with leucovorin alone (bolus regimen) 500 mg/m 2 on days 1, 8, 15, 22, 29 and 36 of each 8-week cycle Until disease progression or unacceptable toxicity. Adenocarcinoma of the Breast In combination with cyclophosphamide-based multidrug regimen (bolus regimen) 500 mg/m 2 or 600 mg/m 2 on days 1 and 8 of each 28-day cycle Until disease progression or unacceptable toxicity or 6 cycles Gastric Adenocarcinoma In combination with a platinum-containing multidrug regimen 200 mg/m 2 to 1,000 mg/m 2 over 24 hours Frequency in each cycle and length of each cycle depend on dose of FAVLYXA and specific regimen Pancreatic Adenocarcinoma In combination with leucovorin or as a component of a multidrug chemotherapy regimen that includes leucovorin 400 mg/m 2 on day 1, followed by 2,400 mg/m 2 over 46 hours every 2 weeks Until disease progression or unacceptable toxicity. 2.3 Dosage Modifications for Adverse Reactions Withhold FAVLYXA for the following adverse reactions. Depending on the severity of the adverse reaction, either discontinue or resume FAVLYXA at a reduced dosage upon resolution or improvement to Grade 1: Grade 3 or 4 diarrhea [see Warnings and Precautions (5.5) ] Grade 2 or 3 palmar-plantar erythrodysesthesia (hand-foot syndrome) [see Warnings and Precautions (5.6) ] Grade 3 or 4 mucositis [see Warnings and Precautions (5.8) ] Gra …

3 DOSAGE FORMS AND STRENGTHS Injection: FAVLYXA contains 25 mg/mL fluorouracil as a colorless to light yellow clear solution and is available as: 250 mg/10 mL (25 mg/mL) in a single-dose vial. 2,500 mg/100 mL (25 mg/mL) in a multiple-dose vial. Injection: 250 mg/10 mL (25 mg/mL) in a single-dose vial. ( 3 ) 2,500 mg/100 mL (25 mg/mL) in a multiple-dose vial. ( 3 )

4 CONTRAINDICATIONS None. None. ( 4 )

6 ADVERSE REACTIONS The following adverse reactions are discussed in more detail in other sections of the labeling: Serious adverse reactions or death from Dihydropyrimidine Dehydrogenase (DPD) deficiency [see Warnings and Precautions (5.1) ] Cardiotoxicity [see Warnings and Precautions (5.2) ] Hyperammonemic encephalopathy [see Warnings and Precautions (5.3) ] Neurologic toxicity [see Warnings and Precautions (5.4) ] Diarrhea [see Warnings and Precautions (5.5) ] Palmar-plantar erythrodysesthesia (hand-foot syndrome) [see Warnings and Precautions (5.6) ] Myelosuppression [see Warnings and Precautions (5.7) ] Mucositis [see Warnings and Precautions (5.8) ] Increased risk of bleeding with concomitant use of warfarin [see Warnings and Precautions (5.9) ] To report SUSPECTED ADVERSE REACTIONS, contact Avyxa Pharma, LLC at 1-888-520-0954 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. 6.2 Postmarketing Experience The following adverse reactions have been identified during postapproval use of fluorouracil. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Hematologic: pancytopenia [see Warnings and Precautions (5.7) ] Gastrointestinal: gastrointestinal ulceration, nausea, vomiting Allergic Reactions: anaphylaxis and generalized allergic reactions Neurologic: nystagmus, headache Dermatologic: dry skin; fissuring; photosensitivity, as manifested by erythema or increased pigmentation of the skin; vein pigmentation Ophthalmic: lacrimal duct stenosis, visual changes, lacrimation, photophobia Psychiatric: euphoria Miscellaneous: thrombophlebitis, epistaxis, nail changes (including loss of nails)

7 DRUG INTERACTIONS 7.1 Effect of FAVLYXA on Other Drugs Vitamin K Antagonists Monitor INR and PT more frequently in patients receiving FAVLYXA and warfarin. Elevated INR and PT have been reported in patients taking fluorouracil concomitantly with warfarin.

8 USE IN SPECIFIC POPULATIONS Lactation: Advise not to breastfeed ( 8.2 ) Infertility: May impair fertility. ( 8.3 ) 8.1 Pregnancy Risk Summary Based on mechanism of action and animal reproduction studies, FAVLYXA can cause fetal harm when administered during pregnancy [see Clinical Pharmacology (12.1) ]. Available data from observational studies with intravenous administration of fluorouracil during pregnancy are insufficient to identify a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes. Administration of fluorouracil to rats and mice during selected periods of organogenesis, at doses lower than a human dose of 12 mg/kg, caused embryolethality and teratogenicity. Malformations included cleft palate and skeletal defects. In monkeys, maternal doses of fluorouracil higher than an approximate human dose of 12 mg/kg resulted in abortion (see Data). In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2–4% and 15–20%, respectively. Data Animal Data Malformations including cleft palate, skeletal defects and deformed appendages (paws and tails) were observed when fluorouracil was administered by intraperitoneal injection to mice at doses at or above 10 mg/kg (approximately 0.06 times a human dose of 12 mg/kg on a mg/m 2 basis) for 4 days during the period of organogenesis. Similar results were observed in hamsters administered fluorouracil intramuscularly at doses lower than those administered in commonly used clinical treatment regimens. In rats, administration of fluorouracil by intraperitoneal injection at doses greater than 15 mg/kg (approximately 0.2 times a human dose of 12 mg/kg on a mg/m 2 basis) for a single day during organogenesis resulted in delays in growth and malformations including micro-anophthalmos. In monkeys, administration of fluorouracil during organogenesis at doses approximately equal to a human dose of 12 mg/kg on a mg/m 2 basis resulted in abortion; at a 50% lower dose, resorptions and decreased fetal body weights were reported. 8.2 Lactation Risk Summary There are no data on the presence of fluorouracil or its metabolites in human milk, the effects on the breastfed child, or the effects on milk production. Because of the potential for serious adverse reactions in the breastfed child, advise patients not to breastfeed during treatment with FAVLYXA and for 1 week after the last dose. 8.3 Females and Males of Reproductive Potential FAVLYXA can cause fetal harm when administered to a pregnant woman [see Use in Specific Populations (8.1 ) ] . Pregnancy Testing Verify that females of reproductive potential are not pregnant prior to initiating FAVLYXA [see Warnings and Precautions (5.10) , Use in Specific Populations (8.1 , 8.3) ]. Contraception Females Advise females of reproductive potential to use effective contraception during treatment with FAVLYXA and for 6 months after the last dose. Males Based on genotoxicity findings, advise males with female partners of reproductive potential to use effective contraception during treatment with FAVLYXA and for 3 months after the last dose [see Nonclinical Toxicology (13.1) ]. Infertility Based on animal studies, FAVLYXA may impair fertility in females and males of reproductive potential [see Nonclinical Toxicology (13.1) ]. 8.4 Pediatric Use The safety and effectiveness of FAVLYXA in pediatric patients have not been established. 8.5 Geriatric Use Reported clinical experience has not identified differences in safety or effectiveness between the elderly and younger patients.

12.1 Mechanism of Action Fluorouracil is a nucleoside metabolic inhibitor that interferes with the synthesis of deoxyribonucleic acid (DNA) and to a lesser extent inhibits the formation of ribonucleic acid (RNA); these affect rapidly growing cells and may lead to cell death. Fluorouracil is converted to three main active metabolites: 5-fluoro-2′-deoxyuridine-5′-monophosphate (FdUMP), 5-fluorouridine-5′triphosphate (FUTP) and 5-fluoro-2′-deoxyuridine-5′-triphosphate (FdUTP). These metabolites have several effects including the inhibition of thymidylate synthase by FdUMP, incorporation of FUTP into RNA and incorporation of FdUTP into DNA.

11 DESCRIPTION FAVLYXA injection contains fluorouracil, a nucleoside metabolic inhibitor. Fluorouracil, a fluorinated pyrimidine, has a chemical name of 5-fluoro-2,4 (1 H ,3 H )-pyrimidinedione. Its structural formula is: Molecular formula: C 4 H 3 FN 2 O 2 Molecular weight: 130.08 g/mole FAVLYXA injection is a sterile, colorless to light yellow clear solution available in 250 mg/10 mL single-dose vials and 2,500 mg/100 mL multiple-dose vials for intravenous bolus or infusion administration. Each mL contains 25 mg fluorouracil in water for injection. Sodium hydroxide is added to adjust the pH to 8.6 to 9.4. structure

10 OVERDOSAGE Administer uridine triacetate within 96 hours following the end of FAVLYXA infusion for management of fluorouracil overdose.

16 HOW SUPPLIED/STORAGE AND HANDLING 16.1 How Supplied FAVLYXATM Injection is a sterile colorless to light yellow clear solution available in single-dose vials and multiple-dose vials, individually packaged in a carton as follows: Strength Carton Contains NDC 250 mg/10 mL (25 mg/mL) 2,500 mg/100 mL (25 mg/mL) One single-dose vial One multiple-dose vial 83831-143-01 83831-164-10 16.2 Storage Store at 20°C to 25°C (68°F to 77°F); excursions permitted from 15°C to 30°C (59°F to 86°F). [see USP Controlled Room Temperature]. Protect from light. Retain in carton until time of use. Fluorouracil is a hazardous drug. Follow applicable special handling and disposal procedures [see References (15) ] .