DOSAGE & ADMINISTRATION SECTION.

2 DOSAGE AND ADMINISTRATION oSelect patients for the treatment of HR-positive, HER2-negative advanced or metastatic breast cancer with TRUQAP based on the presence of one or more of the following genetic alterations in tumor tissue: PIK3CA/AKT1/PTEN. (2.1)oSelect patients for the treatment of mAPMN/S prostate cancer with TRUQAP based on PTEN deficiency in tumor tissue. (2.1)oRecommended Dosage: 400 mg orally twice daily, with or without food, for days followed by days off. (2.3). oSelect patients for the treatment of HR-positive, HER2-negative advanced or metastatic breast cancer with TRUQAP based on the presence of one or more of the following genetic alterations in tumor tissue: PIK3CA/AKT1/PTEN. (2.1). oSelect patients for the treatment of mAPMN/S prostate cancer with TRUQAP based on PTEN deficiency in tumor tissue. (2.1). oRecommended Dosage: 400 mg orally twice daily, with or without food, for days followed by days off. (2.3). 2.1 Patient Selection Select patients for the treatment of HR-positive, HER2-negative advanced or metastatic breast cancer with TRUQAP, based on the presence of one or more of the following genetic alterations in tumor tissue: PIK3CA/AKT1/PTEN [see Clinical Studies (14)].Select patients for the treatment of metastatic androgen pathway modulation-naive or -sensitive (mAPMN/S) prostate cancer with TRUQAP based on PTEN deficiency in tumor tissue [see Clinical Studies (14)].Information on FDA-authorized tests for patient selection for the detection of PIK3CA, AKT1, and PTEN alterations or PTEN deficiency are available at: http://www.fda.gov/CompanionDiagnostics. 2.2 Recommended Evaluation Before Initiating TRUQAP Evaluate fasting blood glucose (FG) and hemoglobin A1C (HbA1C) prior to starting TRUQAP and at regular intervals during treatment [see Warnings and Precautions (5.1)].. 2.3 Recommended Dosage The HR positive, HER2 negative locally advanced or metastatic breast cancerThe recommended dosage of TRUQAP, in combination with fulvestrant, is 400 mg orally twice daily (approximately 12 hours apart) with or without food, for days followed by days off. Continue TRUQAP until disease progression or unacceptable toxicity.For premenopausal and perimenopausal women, administer luteinizing hormone releasing hormone (LHRH) agonist according to current clinical practice standards. For men, consider administering LHRH agonist according to current clinical practice standards.PTEN-deficient metastatic androgen pathway modulation-naive or -sensitive (mAPMN/S) prostate cancerThe recommended dosage of TRUQAP, in combination with abiraterone and prednisone, is 400 mg orally twice daily (approximately 12 hours apart) with or without food, for days followed by days off. Continue TRUQAP until disease progression or unacceptable toxicity.Patients with mAPMN/S prostate cancer should also receive gonadotropin-releasing hormone (GnRH) analog concurrently or should have had bilateral orchiectomy. Refer to the Prescribing Information of the individual therapeutic agents used in combination with TRUQAP for dosing and administration information.. 2.4 Administration TRUQAP dosing schedule for each week is provided in Table 1.Table 1: TRUQAP Dosing Schedule for Each WeekDay12345No dosing on day 5, and 767Morning2 200 mg2 200 mg2 200 mg2 200 mgEvening2 200 mg2 200 mg2 200 mg2 200 mgSwallow TRUQAP tablets whole. Do not chew, crush, or split tablets prior to swallowing. Do not take tablets that are broken, cracked, or otherwise not intact.If patient misses dose within hours of the scheduled time, instruct the patient to take the missed dose. If patient misses dose more than hours of the scheduled time, instruct the patient to skip the dose and take the next dose at its usual scheduled time.If patient vomits dose, instruct the patient not to take an additional dose and take the next dose at its usual scheduled time.. 2.5 Dosage Modification for Adverse Reactions The recommended dose reductions for adverse reactions are listed in Table 2. Permanently discontinue TRUQAP if unable to tolerate the second dose reduction.Table 2: Recommended Dose Reductions of TRUQAP for Adverse ReactionsTRUQAPDose and ScheduleFirst dose reduction320 mg twice daily for days followed by days offSecond dose reduction200 mg twice daily for days followed by days offThe recommended dosage modifications for adverse reactions are provided in Table 3.Table 3: Recommended Dosage Modifications of TRUQAP for Adverse ReactionsAdverse Reaction SeveritySeverity grading according to Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0. TRUQAP Dosage ModificationHyperglycemiaFor the management of suspected or confirmed diabetic ketoacidosis (DKA) see Warnings and Precautions (5.1). (Fasting Glucose [FG])[see Warnings and Precautions (5.1)]FG ULN-160 mg/dL or FG ULN-8.9 mmol/L or HbA1C 7%Consider initiation or intensification of oral anti-diabetic treatment.FG 161-250 mg/dL orFG 9-13.9 mmol/LWithhold TRUQAP until FG decrease <= 160 mg/dL (or <= 8.9 mmol/L).If recovery occurs in <= 28 days, resume TRUQAP at same dose.If recovery occurs in 28 days, resume TRUQAP at one lower dose.FG 251-500 mg/dL or FG 14-27.8 mmol/LWithhold TRUQAP until FG decrease <= 160 mg/dL (or <= 8.9 mmol/L).If recovery occurs in <= 28 days, resume TRUQAP at one lower dose.If recovery occurs in 28 days, permanently discontinue TRUQAP.FG 500 mg/dL or FG 27.8 mmol/Lorlife-threatening sequelae of hyperglycemia at any FG levelWithhold TRUQAP. For life-threatening sequelae of hyperglycemia or if FG persists at >= 500 mg/dL after 24 hours, permanently discontinue TRUQAP. If FG <= 500 mg/dL (or <= 27.8 mmol/L) within 24 hours, then follow the guidance in the table for the relevant grade.Diarrhea [see Warnings and Precautions (5.2)]Grade 2Withhold TRUQAP until recovery to <= Grade 1.If recovery occurs in <= 28 days, resume TRUQAP at same dose or one lower dose as clinically indicated.If recovery occurs in 28 days, resume at one lower dose as clinically indicated.For recurrence, reduce TRUQAP by one lower dose.Grade 3Withhold TRUQAP until recovery to <= Grade 1. If recovery occurs in <= 28 days, resume TRUQAP at same dose or one lower dose as clinically indicated.If recovery occurs in 28 days, permanently discontinue TRUQAP.Grade 4Permanently discontinue TRUQAP.Cutaneous Adverse Reactions [see Warnings and Precautions (5.3)]Grade 2Withhold TRUQAP until recovery to <= Grade 1.Resume TRUQAP at the same dose.Persistent or recurrent: reduce TRUQAP by one lower dose.Grade 3Withhold TRUQAP until recovery to <= Grade 1.If recovery occurs in <= 28 days, resume TRUQAP at same dose.If recovery occurs in 28 days, resume TRUQAP at one lower dose.For recurrent Grade 3, permanently discontinue TRUQAP.Grade 4Permanently discontinue TRUQAP.Other Adverse Reactions [see Adverse Reactions (6.1)]Grade 2Withhold TRUQAP until recovery to <= Grade 1.Resume TRUQAP at the same dose.Grade 3Withhold TRUQAP until recovery to <= Grade 1. If recovery occurs in <= 28 days, resume TRUQAP at same dose.If recovery occurs in 28 days, resume TRUQAP at one lower dose.Grade 4Permanently discontinue TRUQAP.. 2.6 Dosage Modifications for Strong and Moderate CYP3A Inhibitors Avoid concomitant use with strong CYP3A inhibitors. If concomitant use with strong CYP3A inhibitor cannot be avoided, reduce the dosage of TRUQAP to 320 mg orally twice daily for days followed by days off [see Drug Interactions (7.1)]. When concomitantly used with moderate CYP3A inhibitor, reduce the dosage of TRUQAP to 320 mg orally twice daily for days followed by days off. After discontinuation of strong or moderate CYP3A inhibitor, resume the TRUQAP dosage (after to half-lives of the inhibitor) that was taken prior to initiating the strong or moderate CYP3A inhibitor.

ADVERSE REACTIONS SECTION.

6 ADVERSE REACTIONS The following adverse reactions are also discussed in greater details in other sections of the labeling:oHyperglycemia [see Warnings and Precautions (5.1)]oDiarrhea [see Warnings and Precautions (5.2)]oCutaneous Adverse Reactions [see Warnings and Precautions (5.3)]. oHyperglycemia [see Warnings and Precautions (5.1)]. oDiarrhea [see Warnings and Precautions (5.2)]. oCutaneous Adverse Reactions [see Warnings and Precautions (5.3)]. Most common adverse reactions (incidence >=20%), including laboratory abnormalities, in patients with: oHR-positive, HER2-negative breast cancer were diarrhea, cutaneous adverse reactions, increased random glucose, decreased lymphocytes, decreased hemoglobin, increased fasting glucose, nausea, fatigue, decreased leukocytes, increased triglycerides, decreased neutrophils, increased creatinine, vomiting and stomatitis. (6.1)oPTEN-deficient mAPMN/S prostate cancer were increased fasting glucose, decreased hemoglobin, decreased lymphocytes, cutaneous adverse reactions, diarrhea, decreased potassium, increased creatinine, increased non-fasting glucose, increased alanine aminotransferase, increased triglycerides, increased aspartate aminotransferase, decreased sodium, and fatigue. (6.1)To report SUSPECTED ADVERSE REACTIONS, contact AstraZeneca at 1-800-236-9933 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. oHR-positive, HER2-negative breast cancer were diarrhea, cutaneous adverse reactions, increased random glucose, decreased lymphocytes, decreased hemoglobin, increased fasting glucose, nausea, fatigue, decreased leukocytes, increased triglycerides, decreased neutrophils, increased creatinine, vomiting and stomatitis. (6.1). oPTEN-deficient mAPMN/S prostate cancer were increased fasting glucose, decreased hemoglobin, decreased lymphocytes, cutaneous adverse reactions, diarrhea, decreased potassium, increased creatinine, increased non-fasting glucose, increased alanine aminotransferase, increased triglycerides, increased aspartate aminotransferase, decreased sodium, and fatigue. (6.1). 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.The safety population described in WARNINGS and PRECAUTIONS reflects exposure to TRUQAP 400 mg orally, twice day for days followed by days off, in combination with fulvestrant, in 355 patients with metastatic breast cancer in CAPItello-291 until disease progression or unacceptable toxicity. Among the 355 patients who received TRUQAP in combination with fulvestrant, 52% were exposed for months or longer, and 27% were exposed for greater than one year. In this safety population, the most common (>= 20%) adverse reactions including laboratory abnormalities were diarrhea (72%), cutaneous adverse reactions (58%), increased random glucose (57%), decreased lymphocytes (47%), decreased hemoglobin (45%), increased fasting glucose (37%), nausea and fatigue (35% each), decreased leukocytes (32%), increased triglycerides (27%), decreased neutrophils (23%), increased creatinine (22%), vomiting (21%), and stomatitis (20%).The safety population described in WARNINGS and PRECAUTIONS also reflects exposure to TRUQAP 400 mg orally, twice day for days followed by days off, in combination with abiraterone, in 503 patients with mAPMN/S prostate cancer with PTEN deficiency in CAPItello-281 until disease progression or unacceptable toxicity.CAPItello-291The safety of TRUQAP was evaluated in CAPItello-291, clinical trial including 288 adult patients (155 patients in TRUQAP with fulvestrant arm and 133 patients in placebo with fulvestrant arm) whose breast cancer had one or more PIK3CA/AKT1/PTEN-alterations [see Clinical Studies (14)]. Among patients who received TRUQAP, 61% were exposed for months or longer and 30% were exposed for greater than one year.Of the 155 patients who received TRUQAP with fulvestrant, the median age was 58 years (range 36 to 84); female (99%); White (48%), Asian (31%), Black (1.3%), American Indian/Alaska Native (0.6%), and other races (19%).Serious adverse reactions occurred in 18% of patients receiving TRUQAP with fulvestrant. The most common serious adverse reactions (>= 1%) were cutaneous adverse reaction (3.9%), diarrhea and pneumonia (2.6% each), vomiting and pyrexia (1.9% each), hyperglycemia, hypersensitivity, fatigue, renal injury and second malignancy (1.3% each).Fatal adverse reactions occurred in 1.3% of patients who received TRUQAP with fulvestrant, including sepsis (0.6%), and acute myocardial infarction (0.6%). Permanent TRUQAP discontinuation due to an adverse reaction occurred in 10% of patients. The most common adverse reaction (>= 2%) leading to permanent discontinuation of TRUQAP was cutaneous adverse reactions (6%). Dosage interruptions of TRUQAP due to an adverse reaction occurred in 39% of patients. Adverse reactions leading to dosage interruption in >= 2% of patients included cutaneous adverse reactions (14%), diarrhea (10%), pyrexia (4.5%), vomiting and nausea (3.2% each), and fatigue (2.6%).Dose reductions of TRUQAP due to adverse reactions occurred in 21% of patients receiving TRUQAP with fulvestrant. Adverse reactions leading to TRUQAP dose reductions in >= 2% of patients were diarrhea and cutaneous adverse reactions (8% each).The most common (>= 20%) adverse reactions including laboratory abnormalities were diarrhea (77%), increased random glucose (58%), cutaneous adverse reaction (56%), decreased lymphocytes (49%), decreased hemoglobin (47%), fatigue (38%), increased fasting glucose (37%), nausea and decreased leukocytes (35% each), increased triglycerides (30%), stomatitis (25%), decreased neutrophils (25%), and vomiting (21%). Adverse reactions and laboratory abnormalities are listed in Table and Table 5, respectively.Table 4: Adverse Reactions >= 10% in Patients who Received TRUQAP with Fulvestrant [with Difference Between Arms of >= 3%] in CAPItello-291 Adverse Reaction TRUQAP with FulvestrantN=155Placebo with FulvestrantN=133All Grades%Grade or 4%All Grades%Grade or 4%Gastrointestinal Disorders Diarrhea 7712190.8Nausea 351.3140.8StomatitisIncludes other related terms. 251.950Vomiting 211.970.8Skin and Subcutaneous Tissue Disorders Cutaneous adverse reactionsCutaneous adverse reaction includes butterfly rash, dermatitis, allergic dermatitis, dry skin, eczema, erythema multiforme, hand dermatitis, palmar-plantar erythrodysesthesia syndrome, pruritus, rash, erythematous rash, maculo-papular rash, papular rash, skin discoloration, skin fissures, skin reaction, skin ulcer, urticaria, purpura, erythema and drug eruption. 5615160.8General Disorders and Administration Site Conditions Fatigue 381.9271.5Metabolism and Nutrition Disorders Decreased appetite 17080.8Nervous System Disorders Headache 170130.8Infections and Infestations Urinary tract infection 140.650Renal and Urinary disordersRenal injuryRenal injury includes acute kidney injury, renal failure, renal impairment, glomerular filtration rate decreased, increased creatinine and proteinuria. 112.61.50.8Clinically relevant adverse reactions occurring in 10% of patients treated with TRUQAP included anemia, pyrexia, dysgeusia, dyspepsia, pneumonia, decreased weight, hypersensitivity (including anaphylactic reaction).Table 5: Laboratory Abnormalities (>= 10%) That Worsened from Baseline in Patients who Received TRUQAP with Fulvestrant [With Difference Between Arms >=3%] in CAPItello-291Laboratory Abnormality TRUQAP with FulvestrantThe denominator used to calculate the rate varied from 129 to 155 based on the number of patients with baseline value and at least one post-treatment value.Placebo with FulvestrantThe denominator used to calculate the rate varied from 109 to 131 based on the number of patients with baseline value and at least one post-treatment value. All Grades (%) Grade or (%)All Grades(%)Grade or 4(%)Glucose MetabolismIncreased random glucose589170Increased fasting glucose370.6290HematologyDecreased lymphocytes4911142.3Decreased hemoglobin472222.3Decreased leukocytes350.6230Decreased neutrophils251.9160.8Decreased platelets121.960.8Other CategoriesIncreased triglycerides300.7220.9Increased alanine aminotransferase232.6130Electrolytes/RenalDecreased corrected calcium190.680Increased creatinine191.34.60.8Decreased potassium174.580CAPItello-281The safety of TRUQAP was evaluated in CAPItello-281, clinical trial including 1006 adult patients (503 patients in TRUQAP with abiraterone and prednisone/prednisolone arm and 503 patients in placebo with abiraterone and prednisone/prednisolone arm) with mAPMN/S prostate cancer with PTEN deficiency [see Clinical Studies (14)]. Among the 503 patients who received TRUQAP, 74% were exposed for months or longer, 58% were exposed for 12 months or longer, and 35% were exposed for more than years.Serious adverse reactions occurred in 47% of patients who received TRUQAP with abiraterone and prednisone. The most common serious adverse reactions (>= 2%) were pneumonia (7%), cutaneous adverse reactions (5%), hyperglycemia (5%), hemorrhage (3.4%), urinary tract infection (3.2%), ischemic cerebro /cardiovascular events (3.2%), acute kidney injury (2.2%), and hypokalemia (2.2%).Fatal adverse reactions occurred in 8% of patients who received TRUQAP with abiraterone and prednisone, including sepsis (1.2%), ischemic cerebro-/cardiovascular events (1%), hemorrhage (0.6%), pneumonia (0.4%), and diabetic ketoacidosis (0.2%).Dosage interruptions of TRUQAP due to an adverse reaction occurred in 65% of patients. Adverse reactions leading to dosage interruption in >= 2% of patients included cutaneous adverse reactions (22%), hyperglycemia (15%), diarrhea (13%), pneumonia (4%), hypokalemia (3.4%), fatigue (3.2%), pyrexia (3.2%), vomiting (2.6%), urinary tract infection (2.4%), nausea (2%) and anemia (2%).Permanent TRUQAP discontinuation due to an adverse reaction occurred in 20% of patients. The most common adverse reactions (>= 2%) leading to treatment discontinuation were cutaneous adverse reactions (8%) and hyperglycemia (2.4%).Dose reductions of TRUQAP due to adverse reactions occurred in 32% patients. Adverse reactions leading to TRUQAP dose reductions in >= 2% of patients were cutaneous adverse reactions (12%), hyperglycemia (9%), diarrhea (5%), and fatigue (2%).The most common (>= 20%) adverse reactions including laboratory abnormalities were increased fasting glucose, decreased hemoglobin, decreased lymphocytes, cutaneous adverse reactions, diarrhea, decreased potassium, increased creatinine, increased non-fasting glucose, increased alanine aminotransferase, increased triglycerides, increased aspartate aminotransferase, decreased sodium, and fatigue.Adverse reactions and laboratory abnormalities are listed in Table and Table 7, respectively.Table 6: Adverse Reactions >= 10% in Patients who Received TRUQAP plus Abiraterone [with Difference Between Arms of >= 5% (All Grades) or >=2% (Grade or 4)] in CAPItello-281Adverse ReactionTRUQAP plus AbirateroneN=503Placebo plus AbirateroneN=503All Grades%Grade or 4%All Grades%Grade or 4%Gastrointestinal DisordersDiarrhea53690.4Nausea130.650.2Skin and Subcutaneous Tissue Disorders Cutaneous adverse reactionsCutaneous adverse reaction includes brachioradial pruritus, dermatitis, dermatitis acneiform, dermatitis allergic, dermatitis atopic, dermatitis exfoliative, dermatitis exfoliative generalized, drug eruption, dry skin, eczema, eczema asteatotic, eczema nummular, erythema, erythema ab igne, erythema multiforme, exfoliative rash, eye pruritus, eyelids pruritus, genital erythema, mucocutaneous rash, palmar-plantar erythrodysesthesia syndrome, pruritus, pruritus allergic, pruritus genital, purpura, rash, rash erythematous, rash macular, rash maculo-papular, rash papular, rash pruritic, rash pustular, skin exfoliation, skin fissures, skin ulcer, stoma site rash, urticaria, and urticaria papular. 5317160.4General Disorders and Administration Site Conditions FatigueIncludes other related terms. 261.2191.2Pyrexia 111.23.20Infections and InfestationsUrinary tract infection 164.2121.8Pneumonia 11662.4Metabolism and Nutrition Disorders Decreased appetite1014.20Clinically relevant adverse reactions occurring in 10% of patients treated with TRUQAP included vomiting, stomatitis, decreased weight, dyspepsia, dysgeusia, hypersensitivity, and diabetic ketoacidosis.Table 7: Selected Laboratory Abnormalities (>= 10%) in Patients who Received TRUQAP plus Abiraterone With Difference Between Arms >= 5% (All Grades) or >=2% (Grade or 4) in CAPItello-281Laboratory AbnormalityTRUQAP plus AbirateroneThe denominator used to calculate the rate varied from 472 to 500 based on the number of patients with baseline value and at least one post-treatment valuePlacebo plus AbirateroneThe denominator used to calculate the rate varied from 485 to 500 based on the number of patients with baseline value and at least one post-treatment value. All Grades (%) Grade or (%)All Grades(%)Grade or 4(%)ChemistryIncreased fasting glucose7014503Decreased potassium51193610Increased creatinine497243Increased non-fasting glucose4923312.3Increased triglycerides373322.6Increased alanine aminotransferase389366Increased aspartate aminotransferase367374Decreased sodium305233.6HematologyDecreased hemoglobin618463.2Decreased lymphocytes5817369. All Grades. (%). Grade or 4. (%). All Grades. (%). Grade or 4. (%).

CLINICAL PHARMACOLOGY SECTION.

12 CLINICAL PHARMACOLOGY 12.1 Mechanism of Action Capivasertib is an inhibitor of all isoforms of serine/threonine kinase AKT (AKT1, AKT2 and AKT3) and inhibits phosphorylation of downstream AKT substrates. AKT activation in tumors is result of activation of upstream signaling pathways, mutations in AKT1, loss of phosphatase and tensin homolog (PTEN) function and mutations in the catalytic subunit alpha of phosphatidylinositol 3-kinase (PIK3CA).In vitro, capivasertib reduced growth of breast cancer cell lines including those with relevant PIK3CA or AKT1 mutations or PTEN alteration. In vivo, capivasertib alone and in combination with fulvestrant inhibited tumor growth of mouse xenograft models including estrogen receptor positive breast cancer models with alterations in PIK3CA, AKT1, and PTEN.In vitro, capivasertib reduced growth of AR-positive PTEN deficient prostate cancer cell lines. In vivo, capivasertib inhibited tumor growth in mouse xenograft models bearing PTEN-deficient prostate cancer cells and demonstrated increased antitumor activity when used in combination with abiraterone.. 12.2 Pharmacodynamics Exposure-Response Relationships The exposure-response relationship and time course of pharmacodynamic response for the effectiveness of capivasertib have not been fully characterized. An exposure-response relationship was observed where increased capivasertib exposure was associated with increased incidence of diarrhea (CTCAE Grades or 4) at doses of 80 to 800 mg (0.2 to times the approved recommended dosage).Cardiac ElectrophysiologyAt the recommended TRUQAP dose, mean increase in the QTc interval 20 ms was not observed.. 12.3 Pharmacokinetics Capivasertib pharmacokinetic parameters are presented as the geometric mean [geometric coefficient of variation (%CV)], unless otherwise specified. The capivasertib steady-state AUC is 7,356 h.ng/mL (38%) and Cmax is 1,247 ng/mL (28%). Steady-state concentrations are predicted to be attained on the 3rd and 4th dosing day of each week, starting week 2. Capivasertib plasma concentrations are approximately 0.2% to 5.1% of the steady state Cmax during the off-dosing days. Capivasertib AUC and Cmax are proportional with dose over range of 80 to 800 mg (0.2 to times the approved recommended dosage).AbsorptionTmax is approximately 1-2 hours. The absolute bioavailability is 29%.Effect of FoodNo clinically meaningful differences in capivasertib pharmacokinetics were observed following administration of TRUQAP with high-fat meal (approximately 1,000 kcal; fat 60%) or low-fat meal (approximately 400 kcal; fat 26%). DistributionThe steady state oral volume of distribution is 1,847 (36%). Capivasertib plasma protein binding is 78% and the plasma-to-blood ratio is 0.71.EliminationThe half-life is 8.3 hours, and the steady-state oral clearance is 50 L/h (37% CV). Renal clearance was 21% of total clearance.MetabolismCapivasertib is primarily metabolized by CYP3A4 and UGT2B7. ExcretionFollowing single radiolabeled oral dose of 400 mg, the mean total recovery was 45% from urine and 50% from feces. Specific PopulationsNo clinically significant differences in capivasertib pharmacokinetics were observed based on race/ethnicity (including White, Asian, Black, American Indian or Alaskan Native, and Native Hawaiian or Other Pacific Islander), sex (88% females), body weight (32 to 150 kg), age (26 to 87 years), mild hepatic impairment (bilirubin <= ULN and AST ULN or bilirubin 1 to 1.5x ULN), or mild to moderate renal impairment (CLcr 30 to 89 mL/min). The effect of moderate (bilirubin 1.5 to 3x ULN and any AST) hepatic impairment is not fully characterized. TRUQAP has not been studied in patients with severe (bilirubin 3x ULN and any AST) hepatic impairment or severe renal impairment (CLcr 15 to 29 mL/min). Drug Interaction StudiesClinical Studies and Model-Informed ApproachesEffect of Strong and Moderate CYP3A Inhibitors on Capivasertib: Itraconazole (strong CYP3A4 inhibitor) is predicted to increase capivasertib AUC by up to 1.7-fold and Cmax by up to 1.4-fold. Erythromycin and verapamil (moderate CYP3A inhibitors) are predicted to increase capivasertib AUC by up to 1.5-fold and Cmax by up to 1.3-fold. Effect of Strong and Moderate CYP3A Inducers on Capivasertib: Rifampicin (strong CYP3A4 inducer) is predicted to decrease capivasertib AUC by 70% and Cmax by 60%.Efavirenz (moderate CYP3A4 inducer) is predicted to decrease capivasertib AUC by 60% and Cmax by 50%.Effect of UGT2B7 Inhibitors on Capivasertib: Probenecid (UGT2B7 inhibitor) is not predicted to have clinically meaningful effect on capivasertib pharmacokinetics.Effect of Acid Reducing Agents on Capivasertib: Rabeprazole (gastric acid reducing agent) did not have clinically meaningful effect on capivasertib pharmacokinetics.Effect of Capivasertib on CYP3A Substrates: Concomitant use of TRUQAP increased midazolam (CYP3A substrate) AUC by 1.8-fold on day and by 1.2-fold on day 7. Effect of Capivasertib on CYP2D6 Substrates: TRUQAP is predicted to increase desipramine (CYP2D6 substrate) AUC by up to 2.1-fold on day 4.Effect of Capivasertib on CYP2C9 Substrates: Concomitant use of TRUQAP with warfarin (CYP2C9 substrate) is not predicted to have clinically meaningful effect on warfarin pharmacokinetics. Effect of Capivasertib on UGT1A1 Substrates: TRUQAP is predicted to increase raltegravir (UGT1A1 substrate) AUC by up to 1.7-fold on day 4.In-Vitro StudiesCYP450 Enzymes: Capivasertib induces CYP1A2.Transporter Systems: Capivasertib inhibits BCRP, OATP1B1, OATP1B3, OAT3, MATE1, MATE2-K, and OCT2.

CLINICAL STUDIES SECTION.

14 CLINICAL STUDIES 14.1 Metastatic HR-Positive, HER2-Negative Breast Cancer The efficacy of TRUQAP with fulvestrant was evaluated in CAPItello-291 (NCT04305496), randomized, double-blind, placebo-controlled, multicenter trial that enrolled 708 adult patients with locally advanced (inoperable) or metastatic HR-positive, HER2-negative (defined as IHC or 1+, or IHC 2+/ISH-) breast cancer of which 289 patients had tumors with eligible PIK3CA/AKT1/PTEN-alterations. Eligible PIK3CA/AKT1 activating mutations or PTEN loss of function alterations were identified in the majority of FFPE tumor specimens using FoundationOne(R)CDx next-generation sequencing (n=686). All patients were required to have progression on an aromatase inhibitor (AI) based treatment in the metastatic setting or recurrence on or within 12 months of completing (neo)adjuvant treatment with an AI. Patients could have received up to two prior lines of endocrine therapy and up to line of chemotherapy for locally advanced (inoperable) or metastatic disease. Patients were excluded if they had clinically significant abnormalities of glucose metabolism (defined as patients with diabetes mellitus Type 1, Type requiring insulin treatment, or HbA1c >=8%). Patients were randomized (1:1) to receive either 400 mg of TRUQAP (n=355) or placebo (n=353), given orally twice daily for days followed by days off treatment each week of 28-day treatment cycle. Fulvestrant 500 mg intramuscular injection was administered on cycle days and 15, and then at day of each subsequent 28-day cycle. Patients were treated until disease progression, or unacceptable toxicity. Randomization was stratified by presence of liver metastases (yes vs. no), prior treatment with CDK4/6 inhibitors (yes vs. no) and geographical region (region 1: US, Canada, Western Europe, Australia, and Israel vs region 2: Latin America, Eastern Europe and Russia vs Region 3: Asia). The major efficacy outcomes were investigator-assessed progression-free survival (PFS) in the overall population, and in the population of patients whose tumors have PIK3CA/AKT1/PTEN-alterations evaluated according to Response Evaluation Criteria in Solid Tumors (RECIST), version 1.1. Additional efficacy outcome measures were overall survival (OS), investigator assessed objective response rate (ORR) and duration of response (DoR). Of the 289 patients whose tumors were PIK3CA/AKT1/PTEN-altered, the median age was 59 years (range 34 to 90); female (99%); White (52%), Asian (29%), Black (1%), American Indian/Alaska Native (0.7%), other races (17%) and 9% were Hispanic/Latino. Eastern Cooperative Oncology Group (ECOG) performance status was (66%) or (34%), and 18% were premenopausal or perimenopausal. Seventy-six percent of patients had an alteration in PIK3CA, 13% had an alteration in AKT1, and 17% had an alteration in PTEN. All patients received prior endocrine-based therapy (100% AI based treatment and 44% received tamoxifen). Seventy-one percent of patients were previously treated with CDK4/6 inhibitor and 18% received prior chemotherapy for locally advanced (inoperable) or metastatic disease.A statistically significant difference in PFS was observed in the overall population and the population of patients whose tumors have PIK3CA/AKT1/PTEN-alteration. An exploratory analysis of PFS in the 313 (44%) patients whose tumors did not have PIK3CA/AKT1/PTEN-alteration showed HR of 0.79 (95% CI: 0.61, 1.02), indicating that the difference in the overall population was primarily attributed to the results seen in the population of patients whose tumors have PIK3CA/AKT1/PTEN-alteration. Efficacy results for PIK3CA/AKT1/PTEN-altered subgroup are presented in Table and Figure 1. Results from the blinded independent review committee (BICR) assessment were consistent with the investigator assessed PFS results. Overall survival results were immature at the time of the PFS analysis (30% of the patients died).Table 9: Efficacy Results for CAPItello-291 (Patients with PIK3CA/AKT1/PTEN-Altered Tumors)TRUQAP with fulvestrantN=155Placebo with fulvestrantN=134Investigator-Assessed Progression-Free Survival (PFS) Number of events (%)121 (78%)115 (86%) Median, months (95%CI)7.3 (5.5, 9.0)3.1 (2.0, 3.7) Hazard ratio (95% CI) Stratified Cox proportional hazards model stratified by presence of liver metastases (yes vs no), and prior use of CDK4/6 inhibitors (yes vs no).0.50 (0.38, 0.65) p-value Stratified log-rank test stratified by presence of liver metastases (yes vs no), and prior use of CDK4/6 inhibitors (yes vs no).<0.0001Investigator-Assessed Confirmed Objective Response Rate (ORR) Patients with measurable disease 132124 ORR (95% CI)26% (19, 34)8% (4, 14) Complete response rate2.3%0 Partial response rate23%8% Median DoR, months (95%CI)10.2 (7.7, NC NC not calculable)8.6 (3.8, 9.2)Figure 1: Kaplan-Meier Plot of Progression-Free Survival in CAPItello-291 (Investigator Assessment, Patients with PIK3CA/AKT1/PTEN-Altered Tumors). Number of events (%). Median, months (95%CI). Hazard ratio (95% CI) Stratified Cox proportional hazards model stratified by presence of liver metastases (yes vs no), and prior use of CDK4/6 inhibitors (yes vs no).. p-value Stratified log-rank test stratified by presence of liver metastases (yes vs no), and prior use of CDK4/6 inhibitors (yes vs no).. Patients with measurable disease. ORR (95% CI). Complete response rate. Partial response rate. Median DoR, months (95%CI). figure1. 14.2 PTEN-Deficient Metastatic Androgen Pathway Modulation-Naive or -Sensitive (mAPMN/S) Prostate Cancer The efficacy of TRUQAP with abiraterone was evaluated in CAPItello-281 (NCT04305496), randomized, double-blind, placebo-controlled, multicenter trial that enrolled 1012 adult patients with newly diagnosed, PTEN-deficient mAPMN/S prostate cancer (previously referred to as metastatic hormone-sensitive prostate cancer or mHSPC). Tumor PTEN deficiency status (>= 90% of viable malignant cells with no specific cytoplasmic staining) was prospectively determined using central testing with the immunohistochemistry based VENTANA PTEN (SP218) RxDx Assay. The only allowable prior systemic therapy was up to 93 days of androgen deprivation therapy (ADT) and/or abiraterone. Patients were excluded if they had clinically significant abnormalities of glucose metabolism (defined as patients with diabetes mellitus Type or Type requiring insulin treatment, or HbA1c >= 8%.Patients were randomized (1:1) to receive capivasertib 400 mg orally twice daily for days followed by days off treatment each week, in combination with abiraterone 1000 mg orally daily (N=507) compared with placebo plus abiraterone (N=505) until disease progression, death, withdrawal of consent, or unacceptable toxicity. Patients were required to receive either prednisone or prednisolone mg daily, and gonadotropin-releasing hormone (GnRH) analog or prior orchiectomy. Randomization was stratified by combination of volume of disease and visceral metastases (high-volume disease with visceral metastases vs. high-volume disease without visceral metastases vs. low-volume disease), and geographical region (Western Europe, Australia, North America, Latin America, Eastern Europe, Asia).The major efficacy outcome was investigator-assessed radiographic progression-free survival (rPFS). Overall survival (OS) was an additional efficacy outcome measure.Of the 1012 patients enrolled, the median age was 68 years (range 42 to 88); 52% were White, 37% Asian, 4% American Indian or Alaska Native, 4% Not reported, 1% Black, 1% Missing and 0.4% Other; 13% were Hispanic or Latino, 86% Not Hispanic or Latino, 1% Missing; and baseline Eastern Cooperative Oncology Group (ECOG) performance status was (64%), (36%). Seventy-four percent of patients had high volume disease including 19% with visceral metastases and 55% without visceral metastases. Type diabetes mellitus was reported in 14% of patients. Ninety-nine percent of patients received previous hormonal therapy including 98% with ADT and 11% with abiraterone.The study demonstrated statistically significant reduction in the risk of investigator-assessed radiographic progression (rPFS) for patients receiving TRUQAP in combination with abiraterone compared to patients receiving placebo in combination with abiraterone. Results from the blinded independent review committee (BICR) assessment were consistent with the investigator-assessed rPFS results.Efficacy results are presented in Table 10 and Figure 2. Overall survival results were immature at the time of the rPFS analysis (26% of the patients died).Table 10: Efficacy Results in CAPItello 281TRUQAP plus Abiraterone(N=507)Placebo plus Abiraterone(N=505)Investigator-Assessed Radiographic Progression-Free Survival (rPFS)Number of events (%)183 (36)215 (43)Median, months (95% CI) 33.2 (25.8, 44.2)25.7 (22.0, 29.9)Hazard ratio (95% CI) Stratified Cox proportional hazards model stratified by volume of disease/visceral metastases, geographic location0.81 (0.66, 0.98)p-value Two-sided p-value based on stratified log-rank test stratified by volume of disease/visceral metastases, geographic location0.034Figure 2: Kaplan-Meier Plot of Radiographic Progression-Free Survival in CAPItello 281. figure2.

DRUG INTERACTIONS SECTION.

7 DRUG INTERACTIONS oStrong CYP3A Inhibitors: Avoid concomitant use. If concomitant use cannot be avoided, reduce TRUQAP dose. (2.6, 7.1)oModerate CYP3A Inhibitors: Reduce TRUQAP dose. (2.6, 7.1)oStrong and Moderate CYP3A Inducers: Avoid concomitant use. (7.1). oStrong CYP3A Inhibitors: Avoid concomitant use. If concomitant use cannot be avoided, reduce TRUQAP dose. (2.6, 7.1). oModerate CYP3A Inhibitors: Reduce TRUQAP dose. (2.6, 7.1). oStrong and Moderate CYP3A Inducers: Avoid concomitant use. (7.1). 7.1 Effects of Other Drugs on TRUQAP Table describes drug interactions where concomitant use of another drug affects TRUQAP.Table 8: Drug Interactions with TRUQAPStrong CYP3A InhibitorsClinical ImpactoCapivasertib is CYP3A substrate. Strong CYP3A inhibitors increase capivasertib exposure [see Clinical Pharmacology (12.3)], which may increase the risk of TRUQAP adverse reactions.Prevention or ManagementoAvoid concomitant use with strong CYP3A inhibitor. If concomitant use cannot be avoided, reduce the dose of TRUQAP and monitor patients for adverse reactions [see Dosage and Administration (2.5)].Moderate CYP3A InhibitorsClinical ImpactoCapivasertib is CYP3A substrate. Moderate CYP3A inhibitors increase capivasertib exposure [see Clinical Pharmacology (12.3)], which may increase the risk of TRUQAP adverse reactions.Prevention or ManagementoWhen concomitantly used with moderate CYP3A inhibitor, reduce the dose of TRUQAP and monitor patients for adverse reactions [see Dosage and Administration (2.5)].Strong and Moderate CYP3A InducersClinical ImpactoCapivasertib is CYP3A substrate. Strong and moderate CYP3A inducers decrease capivasertib exposure [see Clinical Pharmacology (12.3)], which may reduce the effectiveness of TRUQAP. Prevention or ManagementoAvoid concomitant use of TRUQAP with strong or moderate CYP3A inducers.. oCapivasertib is CYP3A substrate. Strong CYP3A inhibitors increase capivasertib exposure [see Clinical Pharmacology (12.3)], which may increase the risk of TRUQAP adverse reactions.. oAvoid concomitant use with strong CYP3A inhibitor. If concomitant use cannot be avoided, reduce the dose of TRUQAP and monitor patients for adverse reactions [see Dosage and Administration (2.5)].. oCapivasertib is CYP3A substrate. Moderate CYP3A inhibitors increase capivasertib exposure [see Clinical Pharmacology (12.3)], which may increase the risk of TRUQAP adverse reactions.. oWhen concomitantly used with moderate CYP3A inhibitor, reduce the dose of TRUQAP and monitor patients for adverse reactions [see Dosage and Administration (2.5)].. oCapivasertib is CYP3A substrate. Strong and moderate CYP3A inducers decrease capivasertib exposure [see Clinical Pharmacology (12.3)], which may reduce the effectiveness of TRUQAP. oAvoid concomitant use of TRUQAP with strong or moderate CYP3A inducers.

INFORMATION FOR PATIENTS SECTION.

17 PATIENT COUNSELING INFORMATION Advise the patient to read the FDA-approved patient labeling (Patient Information). HyperglycemiaAdvise patients that TRUQAP can cause hyperglycemia and that they will need to monitor their fasting blood glucose and HbA1C periodically during therapy. Advise patients to withhold TRUQAP in clinical situations known to increase the risk of severe hyperglycemia or ketoacidosis (e.g., suspected serious infection or acute illness). Advise patients to contact their healthcare provider immediately for signs and symptoms of hyperglycemia (e.g., excessive thirst, urinating more often, blurred vision, mental confusion, difficulty breathing, or increased appetite with weight loss) or ketoacidosis [see Warnings and Precautions (5.1)].DiarrheaAdvise patients that TRUQAP can cause diarrhea and to start antidiarrheal treatment, increase oral fluids, and notify their healthcare provider if diarrhea occurs while taking TRUQAP [see Warnings and Precautions (5.2)].Cutaneous Adverse ReactionsAdvise patients that TRUQAP can cause cutaneous adverse reactions and to contact their healthcare provider immediately to report new or worsening rash, erythematous and exfoliative skin reactions [see Warnings and Precautions (5.3)].Embryo-Fetal ToxicityoAdvise females to inform their healthcare provider of known or suspected pregnancy [see Warnings and Precautions (5.4) and Use in Specific Populations (8.1)]. Advise pregnant women and females of reproductive potential of the potential risk to fetus.oAdvise females of reproductive potential to use effective contraception during treatment with TRUQAP and for month after the last dose [see Use in Specific Population (8.3)].oAdvise male patients with female partners of reproductive potential to use effective contraception during treatment with TRUQAP and for months after the last dose [see Use in Specific Populations (8.3)].oRefer to the Full Prescribing Information of fulvestrant or abiraterone for pregnancy and contraception information.LactationAdvise women to not breastfeed during treatment with TRUQAP [see Use in Specific Populations (8.2)]. Refer to the Full Prescribing Information of fulvestrant for lactation information.Dosing InstructionsInstruct patients to take TRUQAP times each day, at about the same times each day, for four days on and days off, with or without food. Swallow the tablet(s) whole with water. Tablets should not be chewed, crushed, or split prior to swallowing. [see Dosage and Administration (2.3)]. Instruct patients that if the dose is missed, it can be taken within hours after the time it is usually taken. If more than hours has passed, skip the dose. Take the next dose at the usual time.Instruct patients that if they vomit after taking the dose, an additional dose should not be taken. The next dose of TRUQAP should be taken at the usual time [see Dosage and Administration (2.3)].Drug InteractionsAdvise patients to inform their healthcare providers of all concomitant medications, including prescription medicines, over-the-counter medications, vitamins, and herbal products [see Drug Interactions (7.1)].Grapefruit may interact with TRUQAP. Patients should not consume grapefruit products while taking TRUQAP.Distributed by: AstraZeneca Pharmaceuticals LPWilmington, DE 19850TRUQAP is registered trademark of the AstraZeneca group of companies.(C)AstraZeneca 2026. oAdvise females to inform their healthcare provider of known or suspected pregnancy [see Warnings and Precautions (5.4) and Use in Specific Populations (8.1)]. Advise pregnant women and females of reproductive potential of the potential risk to fetus.. oAdvise females of reproductive potential to use effective contraception during treatment with TRUQAP and for month after the last dose [see Use in Specific Population (8.3)].. oAdvise male patients with female partners of reproductive potential to use effective contraception during treatment with TRUQAP and for months after the last dose [see Use in Specific Populations (8.3)].. oRefer to the Full Prescribing Information of fulvestrant or abiraterone for pregnancy and contraception information.

WARNINGS AND PRECAUTIONS SECTION.

5 WARNINGS AND PRECAUTIONS oHyperglycemia: TRUQAP can cause severe hyperglycemia, including diabetic ketoacidosis and fatal outcomes. Evaluate blood glucose levels and hemoglobin A1C prior to starting and at regular intervals during treatment. Withhold, reduce dose, or permanently discontinue TRUQAP based on severity. (2.2, 2.5, 5.1) oDiarrhea: TRUQAP caused diarrhea in most patients. Advise patients to increase oral fluids, start antidiarrheal treatment, and consult with healthcare provider if diarrhea occurs while taking TRUQAP. Withhold, reduce dose, or permanently discontinue TRUQAP based on severity. (2.5, 5.2)oCutaneous Adverse Reactions: Monitor for signs and symptoms of cutaneous adverse reactions. Withhold, reduce dose, or permanently discontinue TRUQAP based on severity. (2.5, 5.3)oEmbryo-Fetal Toxicity: TRUQAP can cause fetal harm. Advise patients of potential risk to fetus and to use effective contraception. Refer to the Full Prescribing Information of fulvestrant for pregnancy and contraception information. (5.4, 8.1, 8.3). oHyperglycemia: TRUQAP can cause severe hyperglycemia, including diabetic ketoacidosis and fatal outcomes. Evaluate blood glucose levels and hemoglobin A1C prior to starting and at regular intervals during treatment. Withhold, reduce dose, or permanently discontinue TRUQAP based on severity. (2.2, 2.5, 5.1) oDiarrhea: TRUQAP caused diarrhea in most patients. Advise patients to increase oral fluids, start antidiarrheal treatment, and consult with healthcare provider if diarrhea occurs while taking TRUQAP. Withhold, reduce dose, or permanently discontinue TRUQAP based on severity. (2.5, 5.2). oCutaneous Adverse Reactions: Monitor for signs and symptoms of cutaneous adverse reactions. Withhold, reduce dose, or permanently discontinue TRUQAP based on severity. (2.5, 5.3). oEmbryo-Fetal Toxicity: TRUQAP can cause fetal harm. Advise patients of potential risk to fetus and to use effective contraception. Refer to the Full Prescribing Information of fulvestrant for pregnancy and contraception information. (5.4, 8.1, 8.3). 5.1 Hyperglycemia TRUQAP can cause severe hyperglycemia, including diabetic ketoacidosis and fatal outcomes. Withhold TRUQAP in clinical situations known to increase the risk of severe hyperglycemia or ketoacidosis (e.g., suspected serious infection or acute illness). Before initiating treatment with TRUQAP, test fasting glucose levels (FPG or FBG), HbA1C levels, and optimize fasting glucose.After initiating treatment with TRUQAP, monitor or self-monitor fasting glucose levels on Day or of the dosing week during weeks 1, 2, 4, and 8; then monthly while on treatment with TRUQAP; and as clinically indicated. Monitor HbA1C levels every months during treatment with TRUQAP and as clinically indicated and manage changes as appropriate. Patients with history of well-controlled Type diabetes mellitus may require intensified anti-hyperglycemic treatment and require close monitoring of fasting glucose levels.For patients who experience hyperglycemia during treatment with TRUQAP, monitor fasting glucose at least twice weekly, on days on and off TRUQAP, until fasting glucose decreases to baseline levels. During treatment with anti-diabetic medications, monitor fasting glucose at least once week for months, followed by once every weeks, or as clinically indicated.Consider consultation with healthcare practitioner with expertise in the treatment of hyperglycemia and initiation of fasting glucose monitoring at home for patients who have risk factors for hyperglycemia or who experience hyperglycemia. Advise patients of the signs and symptoms of hyperglycemia and counsel patients on lifestyle changes.Withhold TRUQAP immediately when ketoacidosis is suspected. If ketoacidosis is confirmed, permanently discontinue TRUQAP.The safety of TRUQAP has not been established in patients with Type diabetes or Type diabetes that is uncontrolled or requiring insulin at baseline as these patients were excluded from clinical studies [see Clinical Studies (14.1,14.2)].Based on the severity of the hyperglycemia, withhold, reduce dose, or permanently discontinue TRUQAP [see Dosage and Administration (2.5)]. CAPItello 291Increased fasting glucose from baseline occurred in 37% of patients treated with TRUQAP, including 11% of patients with Grade (FG 160 to 250 mg/dL), 2% with Grade (FG 250 to 500 mg/dL), and 1.1% with Grade (FG 500 mg/dL) events. The median time to first occurrence of hyperglycemia was 15 days (range: to 367). Dose reduction for hyperglycemia was required in 0.6% of patients and permanent discontinuation was required in 0.6% of patients. Diabetic metabolic decompensation occurred in 0.6% of patients, including diabetic ketoacidosis in 0.3%.In CAPItello-291, 12% (43/355) of patients who received TRUQAP had an anti-hyperglycemic medication regimen either initiated or changed during the study, including treatment with insulin in 4.8% (17/355) of patients. CAPItello 281Increased fasting glucose from baseline occurred in 69% of patients treated with TRUQAP, including 25% of patients with Grade (FG 160 to 250 mg/dL), 12% with Grade (FG 250 to 500 mg/dL), and 1.2% of patients with Grade (FG 500 mg/dL) events.The median time to first occurrence of hyperglycemia was 71 days (range: to 1454). Dose reduction for hyperglycemia was required in 8.7% of patients and permanent discontinuation was required in 2.4% of patients.Diabetic ketoacidosis occurred in 1.2% of patients.In CAPItello 281, 41% (204/503) of patients who received TRUQAP had an anti-hyperglycemic medication regimen either initiated or changed during the study, including treatment with insulin in 16% (81/503) of patients.. 5.2 Diarrhea TRUQAP can cause severe diarrhea associated with dehydration.Monitor patients for signs and symptoms of diarrhea. Advise patients to increase oral fluids and start antidiarrheal treatment at the first sign of diarrhea while taking TRUQAP. Withhold, reduce dose, or permanently discontinue TRUQAP based on severity [see Dosage and Administration (2.5)].CAPItello-291Diarrhea occurred in 72% of patients. Grade or diarrhea occurred in 9% of patients. The median time to first occurrence was days (range to 519). In the 257 patients with diarrhea, 59% required anti-diarrheal medications to manage symptoms. Dose reductions were required in 8% of patients, and 2% of patients permanently discontinued TRUQAP due to diarrhea. In patients with Grade >= diarrhea (n=93) with at least grade improvement (n=89), median time to improvement from the first event was days (range: to 154). CAPItello 281In CAPItello 281, diarrhea of any grade occurred in 264 (52%) patients, Grade occurred in 31 (6%) patients and Grade occurred in (0.2%) patient. The median time to first occurrence was 12 days (range: to 48). In the study, dose reductions were required in 26 (5%) patients and (1.2%) patients discontinued TRUQAP due to diarrhea. In the 264 patients with diarrhea, anti-diarrheal medication was required in 64% (170/264) of patients to manage diarrhea symptoms.. 5.3 Cutaneous Adverse Reactions TRUQAP can cause cutaneous adverse reactions, which can be severe, including erythema multiforme (EM), palmar-plantar erythrodysesthesia, and drug reaction with eosinophilia and systemic symptoms (DRESS).Monitor patients for signs and symptoms of cutaneous adverse reactions. Early consultation with dermatologist is recommended. Withhold, reduce dose, or permanently discontinue TRUQAP based on severity [see Dosage and Administration (2.5)]. CAPItello 291Cutaneous adverse reactions occurred in 58% of patients. Grade or cutaneous adverse reactions occurred in 17% of patients receiving TRUQAP. EM occurred in 1.7% of patients, and DRESS occurred in 0.3% of patients. Dose reduction was required in 7% of patients and 7% of patients permanently discontinued TRUQAP due to cutaneous adverse reactions.The median time to onset of cutaneous adverse reactions was 13 days (range to 575 days). Among the 204 patients with cutaneous adverse reactions, 44% (90/204) required corticosteroid treatment. Of these, 37% (76/204) were treated with topical corticosteroids and 19% (39/204) with systemic corticosteroids. In patients with Grade >= cutaneous adverse reaction (n=116) with at least grade improvement (n=104), median time to improvement from the first event was 12 days (range to 544).CAPItello 281Cutaneous adverse reactions occurred in 53% of patients. Grade cutaneous adverse reactions occurred in 84 (17%) patients and Grade occurred in (0.2%) patient. In the study, dose reduction was required in 58 (12%) patients and 38 (8%) patients discontinued TRUQAP due to rash. The median time to onset of rash was 13 days (range: 11 to 63 days). Among the 265 patients with cutaneous adverse reactions, 80% (212/265) required treatment and 91% (242/265) recovered in the study. Of these, 54% (115/212) were treated with topical corticosteroids and 25% (54/212) with systemic corticosteroids. 5.4 Embryo-Fetal Toxicity Based on findings from animals and mechanism of action, TRUQAP can cause fetal harm when administered to pregnant woman [see Clinical Pharmacology (12.1)]. In an animal reproduction study, oral administration of capivasertib to pregnant rats during the period of organogenesis caused adverse developmental outcomes, including embryo-fetal mortality, and reduced fetal weights at maternal exposures 0.7 times the human exposure (AUC) at the recommended dosage of 400 mg twice daily. Advise pregnant women and females of reproductive potential of the potential risk to fetus. Advise females of reproductive potential to use effective contraception during treatment with TRUQAP and for month after the last dose. Advise male patients with female partners of reproductive potential to use effective contraception during treatment with TRUQAP and for months after the last dose [see Use in Specific Populations (8.1, 8.3)]. TRUQAP is used in combination with fulvestrant or abiraterone. Refer to the Full Prescribing Information of fulvestrant or abiraterone for pregnancy and contraception information.

PATIENT COUNSELING INFORMATION.

Patient Package Insert PATIENT INFORMATIONTRUQAP(R) (TRUE-cap)(capivasertib)tabletsWhat is TRUQAPTRUQAP is prescription medicine used in combination with:othe medicine fulvestrant to treat adults who have hormone receptor (HR)-positive, human epidermal growth factor receptor (HER2)-negative breast cancer that is advanced or that has spread to other parts of the body (metastatic), with an abnormal PIK3CA, AKT1, or PTEN gene, and whose disease has progressed on or after endocrine therapy. Your healthcare provider will test your cancer for an abnormal PIK3CA, AKT1, or PTEN gene to make sure that TRUQAP is right for you.othe medicines abiraterone and prednisone to treat adults who have PTEN-deficient prostate cancer that has spread to other parts of the body (metastatic). Your healthcare provider will test your prostate cancer to see if it has PTEN deficiency to make sure that TRUQAP is right for you.It is not known if TRUQAP is safe and effective in children.Do not take TRUQAP if you:Have had severe allergic reaction to TRUQAP or are allergic to any of the ingredients of TRUQAP. See the end of this leaflet for list of the ingredients in TRUQAP. Before you take TRUQAP, tell your healthcare provider about all of your medical conditions, including if you:ohave history of high levels of sugar in your blood or diabetes. ohave history of rash or other skin disorders. ohave liver problems.ohave any current infection.oare pregnant or plan to become pregnant. TRUQAP can harm your unborn baby. Females who are able to become pregnant:oYour healthcare provider will check to see if you are pregnant before you start treatment with TRUQAP. oYou should use effective birth control during treatment with TRUQAP and for month after the last dose. Talk to your healthcare provider about birth control methods that may be right for you during this time. oIf you become pregnant or think you are pregnant, tell your healthcare provider right away. Males with female partners who are able to become pregnant should use effective birth control during your treatment with TRUQAP and for months after the last dose. If your female partner becomes pregnant, tell your healthcare provider right away. oare breastfeeding or plan to breastfeed. Do not breastfeed during treatment with TRUQAP. Talk to your healthcare provider about the best way to feed your baby during treatment with TRUQAP. Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. TRUQAP may affect the way other medicines work, and other medicines may affect how TRUQAP works. Know the medicines you take. Keep list of them to show your healthcare provider or pharmacist when you get new medicine.How should take TRUQAPoTake TRUQAP exactly as your healthcare provider tells you.oDo not change your dose or stop taking TRUQAP unless your healthcare provider tells you.oTake TRUQAP times each day (about 12 hours apart) in the morning and evening, at about the same times each day.oTake TRUQAP for days in row, followed by days not taking TRUQAP each week. oTake TRUQAP with or without food. oSwallow TRUQAP tablets whole with water. Do not chew, crush, or split the tablets. oDo not take any tablets that are broken, cracked, or that look damaged.oIf you miss dose of TRUQAP, you may still take it within hours from the time you usually take it. If it has been more than hours after you usually take your dose, skip that dose. Take the next dose at your usual time. Do not take doses at the same time to make up for missed dose. oIf you vomit after taking dose of TRUQAP, do not take an additional dose. Take your next dose at your usual time.oFor women who have not reached menopause or are just starting menopause, your healthcare provider will prescribe medicine called luteinizing hormone-releasing hormone (LHRH) agonist to take with TRUQAP and fulvestrant. For men, your healthcare provider may prescribe LHRH agonist to take with TRUQAP and fulvestrant.oFor men who have not had surgery to remove both testicles (bilateral orchiectomy), your healthcare provider will prescribe gonadotropin-releasing hormone (GnRH) to take with TRUQAP along with abiraterone and prednisone.What are the possible side effects of TRUQAPTRUQAP may cause severe side effects, including:oHigh blood sugar levels (hyperglycemia). Hyperglycemia is common with TRUQAP and can be severe. Hyperglycemia has happened in people with and without history of diabetes. Untreated severe hyperglycemia can lead to condition called diabetic ketoacidosis that can happen in people treated with TRUQAP. Diabetic ketoacidosis is serious condition that requires treatment in hospital and that can lead to death. Your healthcare provider will monitor your blood sugar levels before you start and during treatment with TRUQAP. It is not known if TRUQAP is safe in people with type diabetes or people who use insulin to treat their diabetes. Your healthcare provider will monitor your blood sugar levels more often if you have history of diabetes. If you have fever, chills, infection, serious injury, or new illness, tell your healthcare provider before taking your next dose. Tell your healthcare provider right away if you develop symptoms of hyperglycemia, including:oexcessive thirstodry mouthomore frequent urination than usual or bigger amount of urine than normaloblurred visionoincreased appetite with weight lossostomach area (abdominal) painounusual tirednessoconfusion onauseaovomitingofruity odor on breathodry or flushed skinodifficulty breathingosleepinessoDiarrhea. Diarrhea can be severe during treatment with TRUQAP. Severe diarrhea can lead to the loss of too much body water (dehydration). Tell your healthcare provider if you develop any signs of diarrhea, including loose or watery stool. Your healthcare provider will tell you to drink more fluids or take medicines to treat diarrhea.oSkin reactions. Skin reactions can be severe during treatment with TRUQAP. Tell your healthcare provider or get medical help right away if you get new or worsening rash, reddening of the skin, fever, blistering of the lips, eyes or mouth, blisters on the skin, skin peeling, or dry skin.Your healthcare provider may tell you to decrease your dose, temporarily stop your treatment, or completely stop your treatment with TRUQAP if you get certain serious side effects.The most common side effects of TRUQAP when used in combination with fulvestrant include:odiarrheaoskin reactionsonauseaotirednessovomitingomouth soresochanges in certain blood testsThe most common side effects of TRUQAP when used in combination with abiraterone and prednisone include: skin reactions diarrheatirednesschanges in certain blood testsThese are not all of the possible side effects of TRUQAP. Call your healthcare provider for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088. What should avoid while taking TRUQAPoYou should not drink grapefruit juice or eat grapefruit during treatment with TRUQAP.How should store TRUQAPoStore TRUQAP in original packaging at room temperature between 68F to 77F (20C to 25C).Throw away (discard) TRUQAP after 45 days if the tablets are not kept in the original packaging. TRUQAP comes in child resistant packaging. Keep TRUQAP and all medicines out of the reach of children. General information about the safe and effective use of TRUQAP.Medicines are sometimes prescribed for purposes other than those listed in Patient Information leaflet. Do not use TRUQAP for condition for which it was not prescribed. Do not give TRUQAP to other people, even if they have the same symptoms you have. It may harm them. You can ask your pharmacist or healthcare provider for information about TRUQAP that is written for health professionals.What are the ingredients in TRUQAPActive ingredient: capivasertib.Inactive ingredients: copovidone, croscarmellose sodium, dibasic calcium phosphate, hypromellose, iron oxide black, iron oxide red, iron oxide yellow, magnesium stearate, medium chain triglycerides, microcrystalline cellulose, polydextrose, polyethylene glycol 3350, and titanium dioxideDistributed by: AstraZeneca Pharmaceuticals LPWilmington, DE 19850 TRUQAP is registered trademark of the AstraZeneca group of companies.(C)AstraZeneca 2026For more information, go to https://www.TRUQAP.com or call 1-800-236-9933. If you still have questions, contact your healthcare provider.This Patient Information has been approved by the U.S. Food and Drug Administration. Revised: 06/2026. othe medicine fulvestrant to treat adults who have hormone receptor (HR)-positive, human epidermal growth factor receptor (HER2)-negative breast cancer that is advanced or that has spread to other parts of the body (metastatic), with an abnormal PIK3CA, AKT1, or PTEN gene, and whose disease has progressed on or after endocrine therapy. Your healthcare provider will test your cancer for an abnormal PIK3CA, AKT1, or PTEN gene to make sure that TRUQAP is right for you.. othe medicines abiraterone and prednisone to treat adults who have PTEN-deficient prostate cancer that has spread to other parts of the body (metastatic). Your healthcare provider will test your prostate cancer to see if it has PTEN deficiency to make sure that TRUQAP is right for you.. ohave history of high levels of sugar in your blood or diabetes. ohave history of rash or other skin disorders. ohave liver problems.. ohave any current infection.. oare pregnant or plan to become pregnant. TRUQAP can harm your unborn baby.. Females who are able to become pregnant:. oYour healthcare provider will check to see if you are pregnant before you start treatment with TRUQAP. oYou should use effective birth control during treatment with TRUQAP and for month after the last dose. Talk to your healthcare provider about birth control methods that may be right for you during this time. oIf you become pregnant or think you are pregnant, tell your healthcare provider right away.. Males with female partners who are able to become pregnant should use effective birth control during your treatment with TRUQAP and for months after the last dose. If your female partner becomes pregnant, tell your healthcare provider right away. oare breastfeeding or plan to breastfeed. Do not breastfeed during treatment with TRUQAP. Talk to your healthcare provider about the best way to feed your baby during treatment with TRUQAP. oTake TRUQAP exactly as your healthcare provider tells you.. oDo not change your dose or stop taking TRUQAP unless your healthcare provider tells you.. oTake TRUQAP times each day (about 12 hours apart) in the morning and evening, at about the same times each day.. oTake TRUQAP for days in row, followed by days not taking TRUQAP each week. oTake TRUQAP with or without food. oSwallow TRUQAP tablets whole with water. Do not chew, crush, or split the tablets. oDo not take any tablets that are broken, cracked, or that look damaged.. oIf you miss dose of TRUQAP, you may still take it within hours from the time you usually take it. If it has been more than hours after you usually take your dose, skip that dose. Take the next dose at your usual time. Do not take doses at the same time to make up for missed dose. oIf you vomit after taking dose of TRUQAP, do not take an additional dose. Take your next dose at your usual time.. oFor women who have not reached menopause or are just starting menopause, your healthcare provider will prescribe medicine called luteinizing hormone-releasing hormone (LHRH) agonist to take with TRUQAP and fulvestrant. For men, your healthcare provider may prescribe LHRH agonist to take with TRUQAP and fulvestrant.. oFor men who have not had surgery to remove both testicles (bilateral orchiectomy), your healthcare provider will prescribe gonadotropin-releasing hormone (GnRH) to take with TRUQAP along with abiraterone and prednisone.. oHigh blood sugar levels (hyperglycemia). Hyperglycemia is common with TRUQAP and can be severe. Hyperglycemia has happened in people with and without history of diabetes. Untreated severe hyperglycemia can lead to condition called diabetic ketoacidosis that can happen in people treated with TRUQAP. Diabetic ketoacidosis is serious condition that requires treatment in hospital and that can lead to death. Your healthcare provider will monitor your blood sugar levels before you start and during treatment with TRUQAP. It is not known if TRUQAP is safe in people with type diabetes or people who use insulin to treat their diabetes. Your healthcare provider will monitor your blood sugar levels more often if you have history of diabetes. If you have fever, chills, infection, serious injury, or new illness, tell your healthcare provider before taking your next dose. Tell your healthcare provider right away if you develop symptoms of hyperglycemia, including:. oexcessive thirst. odry mouth. omore frequent urination than usual or bigger amount of urine than normal. oblurred vision. oincreased appetite with weight loss. ostomach area (abdominal) pain. ounusual tiredness. oconfusion onausea. ovomiting. ofruity odor on breath. odry or flushed skin. odifficulty breathing. osleepiness. oDiarrhea. Diarrhea can be severe during treatment with TRUQAP. Severe diarrhea can lead to the loss of too much body water (dehydration). Tell your healthcare provider if you develop any signs of diarrhea, including loose or watery stool. Your healthcare provider will tell you to drink more fluids or take medicines to treat diarrhea.. oSkin reactions. Skin reactions can be severe during treatment with TRUQAP. Tell your healthcare provider or get medical help right away if you get new or worsening rash, reddening of the skin, fever, blistering of the lips, eyes or mouth, blisters on the skin, skin peeling, or dry skin.. odiarrhea. oskin reactions. onausea. otiredness. ovomiting. omouth sores. ochanges in certain blood tests. skin reactions diarrhea. skin reactions diarrhea. tiredness. changes in certain blood tests. oYou should not drink grapefruit juice or eat grapefruit during treatment with TRUQAP.. oStore TRUQAP in original packaging at room temperature between 68F to 77F (20C to 25C).. TRUQAP comes in child resistant packaging.

PHARMACOKINETICS SECTION.

12.3 Pharmacokinetics Capivasertib pharmacokinetic parameters are presented as the geometric mean [geometric coefficient of variation (%CV)], unless otherwise specified. The capivasertib steady-state AUC is 7,356 h.ng/mL (38%) and Cmax is 1,247 ng/mL (28%). Steady-state concentrations are predicted to be attained on the 3rd and 4th dosing day of each week, starting week 2. Capivasertib plasma concentrations are approximately 0.2% to 5.1% of the steady state Cmax during the off-dosing days. Capivasertib AUC and Cmax are proportional with dose over range of 80 to 800 mg (0.2 to times the approved recommended dosage).AbsorptionTmax is approximately 1-2 hours. The absolute bioavailability is 29%.Effect of FoodNo clinically meaningful differences in capivasertib pharmacokinetics were observed following administration of TRUQAP with high-fat meal (approximately 1,000 kcal; fat 60%) or low-fat meal (approximately 400 kcal; fat 26%). DistributionThe steady state oral volume of distribution is 1,847 (36%). Capivasertib plasma protein binding is 78% and the plasma-to-blood ratio is 0.71.EliminationThe half-life is 8.3 hours, and the steady-state oral clearance is 50 L/h (37% CV). Renal clearance was 21% of total clearance.MetabolismCapivasertib is primarily metabolized by CYP3A4 and UGT2B7. ExcretionFollowing single radiolabeled oral dose of 400 mg, the mean total recovery was 45% from urine and 50% from feces. Specific PopulationsNo clinically significant differences in capivasertib pharmacokinetics were observed based on race/ethnicity (including White, Asian, Black, American Indian or Alaskan Native, and Native Hawaiian or Other Pacific Islander), sex (88% females), body weight (32 to 150 kg), age (26 to 87 years), mild hepatic impairment (bilirubin <= ULN and AST ULN or bilirubin 1 to 1.5x ULN), or mild to moderate renal impairment (CLcr 30 to 89 mL/min). The effect of moderate (bilirubin 1.5 to 3x ULN and any AST) hepatic impairment is not fully characterized. TRUQAP has not been studied in patients with severe (bilirubin 3x ULN and any AST) hepatic impairment or severe renal impairment (CLcr 15 to 29 mL/min). Drug Interaction StudiesClinical Studies and Model-Informed ApproachesEffect of Strong and Moderate CYP3A Inhibitors on Capivasertib: Itraconazole (strong CYP3A4 inhibitor) is predicted to increase capivasertib AUC by up to 1.7-fold and Cmax by up to 1.4-fold. Erythromycin and verapamil (moderate CYP3A inhibitors) are predicted to increase capivasertib AUC by up to 1.5-fold and Cmax by up to 1.3-fold. Effect of Strong and Moderate CYP3A Inducers on Capivasertib: Rifampicin (strong CYP3A4 inducer) is predicted to decrease capivasertib AUC by 70% and Cmax by 60%.Efavirenz (moderate CYP3A4 inducer) is predicted to decrease capivasertib AUC by 60% and Cmax by 50%.Effect of UGT2B7 Inhibitors on Capivasertib: Probenecid (UGT2B7 inhibitor) is not predicted to have clinically meaningful effect on capivasertib pharmacokinetics.Effect of Acid Reducing Agents on Capivasertib: Rabeprazole (gastric acid reducing agent) did not have clinically meaningful effect on capivasertib pharmacokinetics.Effect of Capivasertib on CYP3A Substrates: Concomitant use of TRUQAP increased midazolam (CYP3A substrate) AUC by 1.8-fold on day and by 1.2-fold on day 7. Effect of Capivasertib on CYP2D6 Substrates: TRUQAP is predicted to increase desipramine (CYP2D6 substrate) AUC by up to 2.1-fold on day 4.Effect of Capivasertib on CYP2C9 Substrates: Concomitant use of TRUQAP with warfarin (CYP2C9 substrate) is not predicted to have clinically meaningful effect on warfarin pharmacokinetics. Effect of Capivasertib on UGT1A1 Substrates: TRUQAP is predicted to increase raltegravir (UGT1A1 substrate) AUC by up to 1.7-fold on day 4.In-Vitro StudiesCYP450 Enzymes: Capivasertib induces CYP1A2.Transporter Systems: Capivasertib inhibits BCRP, OATP1B1, OATP1B3, OAT3, MATE1, MATE2-K, and OCT2.

USE IN SPECIFIC POPULATIONS SECTION.

8 USE IN SPECIFIC POPULATIONS Lactation: Advise not to breastfeed. (8.2). 8.1 Pregnancy Risk SummaryTRUQAP is used in combination with fulvestrant. Refer to the Full Prescribing Information of fulvestrant for pregnancy information.Based on findings in animals and mechanism of action, TRUQAP can cause fetal harm when administered to pregnant woman [see Clinical Pharmacology (12.1)]. There are no available data on the use of TRUQAP in pregnant women. In an animal reproduction study, oral administration of capivasertib to pregnant rats during the period of organogenesis caused adverse developmental outcomes, including embryo-fetal mortality and reduced fetal weights at maternal exposures 0.7 times the human exposure (AUC) at the recommended dose of 400 mg twice daily (see Data). Advise pregnant women and females of reproductive potential of the potential risk to fetus.The background risk of major birth defects and miscarriage for the indicated population is unknown. In the U.S. general population, the estimated background risk of major birth defects is 2% to 4% and of miscarriage is 15% to 20% of clinically recognized pregnancies in the U.S. general population.DataAnimal DataIn an embryo-fetal development study, pregnant rats received oral doses of capivasertib up to 150 mg/kg/day during the period of organogenesis. Administration of capivasertib resulted in maternal toxicities (reduced body weight gain and food consumption, increased blood glucose) and adverse developmental outcomes, including embryo-fetal deaths (post-implantation loss), reduced fetal weights, and minor fetal visceral variations at dose of 150 mg/kg/day (0.7 times the human exposure at the recommended dose of 400 mg twice daily based on AUC).In pre- and post-natal assessment, pregnant rats received oral doses of capivasertib up to 150 mg/kg/day from gestation day through at least lactation day 6. Administration of 150 mg/kg/day resulted in reduced litter and pup weights.. 8.2 Lactation Risk SummaryTRUQAP is used in combination with fulvestrant. Refer to the Full Prescribing Information of fulvestrant for lactation information. There are no data on the presence of capivasertib or its metabolites in human milk or their effects on milk production or the breastfed child. Capivasertib was detected in the plasma of suckling rat pups (see Data). Because of the potential for serious adverse reactions in breastfed child, advise women not to breastfeed during treatment with TRUQAP. DataAnimal DataIn pre- and post-natal assessment, when capivasertib was administered to maternal rats during the lactation period, capivasertib was detected in plasma of suckling rat pups on lactation day to [see Use in Specific Populations (8.1)]. Plasma concentrations in pups were up to 0.6% of concentrations in maternal plasma in the 150 mg/kg/day group.. 8.3 Females and Males of Reproductive Potential TRUQAP is used in combination with fulvestrant or abiraterone. Refer to the Full Prescribing Information of fulvestrant or abiraterone for contraception and infertility information.TRUQAP can cause fetal harm when administered to pregnant women [see Use in Specific Populations (8.1)].Pregnancy TestingVerify pregnancy status of females of reproductive potential prior to initiating TRUQAP [see Use in Specific Populations (8.1)].ContraceptionFemalesAdvise females of reproductive potential to use effective contraception during treatment with TRUQAP and for month after the last dose.MalesAdvise male patients with female partners of reproductive potential to use effective contraception during treatment with TRUQAP and for months after the last dose.. 8.4 Pediatric Use The safety and effectiveness of TRUQAP have not been established in pediatric patients.. 8.5 Geriatric Use Of the 355 patients who received TRUQAP in CAPItello-291, 115 (32%) patients were >= 65 years of age and 24 (7%) patients were >= 75 years of age. No overall differences in the efficacy of TRUQAP were observed between patients >= 65 years of age and younger patients. Analysis of the safety of TRUQAP comparing patients >= 65 years of age to younger patients suggest higher incidence of Grade to adverse reactions (57% versus 36%), dosage reductions (30% versus 15%), dose interruptions (57% versus 30%), and permanent discontinuations (23% versus 8%), respectively.Of the 503 patients who received TRUQAP in CAPItello-281, 331 (66%) patients were >= 65 years of age and 85 (17%) patients were >= 75 years of age. No overall differences in the efficacy of TRUQAP were observed between patients >= 65 years of age and younger patients. Analysis of the safety of TRUQAP comparing patients >= 65 years of age to younger patients suggest higher incidence of Grade to adverse reactions (77% versus 60%), dosage reductions (36% versus 24%), dose interruptions (72% versus 53%), and permanent discontinuations (27% versus 7%), respectively. The differences in Grade or adverse reactions between patients >= 65 years of age and younger patients was primarily driven by an increased incidence of hyperglycemia and hypokalemia.. 8.6 Renal Impairment No dosage modification is recommended for patients with mild to moderate (creatinine clearance (CLcr) 30 to 89 mL/min) renal impairment [see Clinical Pharmacology (12.3)]. TRUQAP has not been studied in patients with severe (CLcr 15 to 29 mL/min) renal impairment.. 8.7 Hepatic Impairment No dosage modification is recommended for patients with mild hepatic impairment (bilirubin <= upper limit of normal (ULN) and AST ULN or bilirubin 1 to 1.5x ULN and any AST) [see Clinical Pharmacology (12.3)]. Monitor patients with moderate (bilirubin 1.5 to 3x ULN and any AST) hepatic impairment for adverse reactions due to potential increased capivasertib exposure [see Warnings and Precautions (5.1, 5.2, 5.3)]. TRUQAP has not been studied in patients with severe (bilirubin 3x ULN and any AST) hepatic impairment.