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ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS

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1 NAME OF THE MEDICINAL PRODUCT CEA-Scan 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Kit for the preparation of 99mTc labelled CEA-Scan. Each 3 mL vial contains 1.25 mg arcitumomab (IMMU-4 Fab anti-CEA monoclonal antibody fragments: consisting mainly of Fab’, but also containing F(ab )2 at ≤ 5% of total protein, with H and L chain fragments), buffered to pH 5-7, 0.29 mg stannous chloride, sodium chloride, potassium sodium tartrate, sodium acetate, sucrose, argon. 3. PHARMACEUTICAL FORM Powder for injection. 4. CLINICAL PARTICULARS 4.1 Indications After reconstitution with sodium pertechnetate [99mTc] solution, CEA-Scan is indicated only in patients with histologically-demonstrated carcinoma of the colon or rectum for imaging of recurrence and/or metastases. CEA-Scan is employed, in the above mentioned patients, as an adjunct to standard non-invasive imaging techniques, such as ultrasonography or CT scan, in the following situations: ¥ Patients with evidence of recurrence and/or metastatic carcinoma of the colon or rectum, who are

undergoing an evaluation for extent of disease, such as prior to surgical resection and/or other therapy. ¥ Patients with suspected recurrence and/or metastatic carcinoma of the colon or rectum in association

with rising levels of carcinoembryonic antigen (CEA). 4.2 Posology and Method of Administration CEA-Scan is reconstituted with sodium pertechnetate [99mTc] solution prior to use, and diluted to a total volume of 5-10 mL with isotonic sodium chloride injection. The recommended adult dose is a single dose of 1 mg of Fab fragment labelled with 750-1000 MBq of 99mTc. The radiolabelled solution (5-10 mL) should be administered as a intravenous injection over approximately 30 seconds. Immunoscintigraphy, using planar and SPECT techniques, should be performed preferably at two to five hours after injection. Readministration is discussed in section 4.4.10.

4.3 Contraindications Patients with known allergies or hypersensitivity to mouse proteins. Pregnancy.

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4.4 Special Warnings and Special Precautions for Use 4.4.1 Use of Radiopharmaceutical Agents • Radiopharmaceutical agents should be used only by qualified personnel with appropriate government

authorization for the use and manipulation of radionuclides. • This radiopharmaceutical may be received, used and administered only by authorized persons in

designated clinical settings. Its receipt, storage, use, transfer and disposal are subject to the regulations and/or appropriate licenses of local competent official organizations.

• Radiopharmaceuticals should be prepared by the user in a manner which satisfies both radiation safety

and pharmaceutical quality requirements. Appropriate aseptic precautions should be taken, complying with the requirements of Good Manufacturing Practices (GMP) for pharmaceuticals.

4.4.2 Reconstitution Immediately prior to use, contents of the vials are reconstituted to prepare CEA-Scan [99mTc]. The contents of the vials are not to be administered directly to patients. 4.4.3 Recommended Imaging Protocol A whole-body planar scan at 2-5 h post-injection can be used to localize sites of colorectal cancer. Planar imaging of the pelvis, abdomen, thorax, and head at 2-5 h post-injection with 500 k counts per view should be made. Image acquisition in analogue and/or digital word-mode and a 128 x 128 matrix is recommended. Single-photon emission computed tomography (SPECT) of the pelvis and abdomen at 2-5 h post-injection should also be employed. SPECT acquisition parameters recommended are: 60 projections in a 360o step-and-shoot technique, 30 s per view in a 64 x 64 matrix. Data processing by filtered backprojection and reconstruction in three planes (transaxial, coronal, and sagittal) is recommended. Variations in this protocol (e.g., additional SPECT of the head) can be performed, depending on the clinical problem. If late imaging is performed (18-24 h), intestinal and gall bladder activity may interfere with true tumor imaging. Therefore, such late images should be compared to those made at earlier times (2-5 h). Due to excretion of the labeled fragment by the urine, the patient should urinate prior to imaging in order to decrease bladder activity. 4.4.4 Tumor Specificity CEA-Scan is not specific for colorectal carcinomas, since CEA is expressed by other carcinomas. These include various carcinomas of the digestive system (e.g., oesophageal, gastric, pancreatic, and bile duct tumors), medullary thyroid cancer, and carcinomas of the lung, breast, ovary, endometrium and cervix.

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4.4.5 False Positives Among a study of patients with at least one known site of colorectal cancer recurrence or spread, 1 of 122 patients (0.8%) was classified as false-positive. In a study of patients with no other radiological evidence of colorectal cancer, but with clinical or biochemical evidence of recurrence or spread, 11 of 88 patients (12.5%) were classified as false-positive. Areas of potential false-positive readings, particularly with planar imaging, are near the major bloodpool organs (heart, major vessels, etc.) at very early imaging times (1-3 h post-injection), near the sites of antibody fragment metabolism (kidneys and urinary bladder), and in the intestines at late imaging times (18-24 h post-injection). Accordingly, imaging is recommended at early times, such as 2-5 hours after injection. There is a potential for false-positive results at late (18-24 h) imaging times due to intestinal and gall bladder imaging. If, however, later imaging is needed for comparison to earlier results, then normal activity in the bowel can be recognized by seeing movement of the site of activity in the intestine from the early to the late imaging sessions, suggesting nonspecific localization. With regard to imaging of tumor near the kidneys or urinary bladder, voiding of urine before the study should decrease bladder activity, and careful SPECT imaging near the kidneys and bladder is recommended. 4.4.6 Hot, Rimmed, and Cold Lesions Only hot or rimmed lesions should be considered as positive for tumor, unless other corroborative evidence supports the interpretation of a cold lesion as a site of cancer. Lesions that are rimmed or cold usually fill in as hot or rimmed, respectively, with time. Often, large lesions, due to poor vascularization, will appear to be cold. Of the cold lesions classified as positive for tumor in the studies analyzed, all were confirmed as cancer (18 lesions), indicating that cold lesions in a group of patients with a high suspicion or risk of cancer recurrence or spread have a high probability of being malignant. 4.4.7 Imaging Performance of CEA-Scan CEA-Scan images colorectal cancers, including tumor deposits less than 1 cm in diameter. It has a 98% positive predictive value for recurrence/metastases of colorectal cancer when both CT and CEA-Scan are positive for a lesion, and a negative predictive value of 75% when both tests are negative for a region. • Liver: CEA-Scan provides complementary information to CT when colorectal cancer has resulted in

secondaries in the liver. • Extrahepatic Abdomen and Pelvis: CEA-Scan is significantly more sensitive than CT for locating the

spread of colorectal cancer in the extrahepatic abdomen and pelvis. • Bone and Brain: Conventional diagnostic techniques other than CEA-Scan should be used to identify

possible bone and brain dissemination of colorectal cancer. 4.4.8 Hypersensitivity Anaphylactic and other hypersensitivity reactions are possible whenever mouse protein materials are administered to patients. Appropriate cardiopulmonary resuscitation facilities and trained personnel should be available for immediate use in the event of an adverse reaction.

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4.4.9 Human Anti-mouse antibody (HAMA) HAMA has been observed before and after single administration of CEA-Scan (see Undesirable Effects). HAMA to fragment was observed to develop in ≤ 1% of patients receiving CEA-Scan. In addition, patients who have previously received murine monoclonal antibody products are more likely to have HAMA. In subjects with HAMA, there may be a greater chance of allergic or hypersensitivity reactions and diminished efficacy in tumor imaging. 4.4.10 Readministration Clinical data reflecting safety and efficacy of multiple injections is only available in 22 patient. In patients whose sera do not contain human anti-mouse antibody (HAMA) in an appropriate assay, readministration may be performed at intervals of not less than three months. The overall radiation dose received by the patient over time should also be taken into account. 4.4.11 Subjects under 21 years of age Studies have not been performed in young patients. 4.4.12 Renal or hepatic disease Formal studies have not been performed in patients with renal or hepatic impairment. However, due to the low dose of protein administered and the short half-life of 99mTc, dosage adjustment is probably not necessary. 4.5 Interactions with Other Medicaments and Other Forms of Interaction Formal drug interaction studies have not been performed, but no drug interactions have been described to date. 4.6 Pregnancy and Lactation 4.6.1 Women of Childbearing Potential When it is necessary to administer radioactive medicinal products to women of childbearing potential, information should always be sought about pregnancy. Any women who has missed a period should be assumed to be pregnant until proven otherwise. When uncertainty exists, it is important that radiation exposure should be the minimum consistent with achieving the desired clinical information. Alternative techniques which do not involve ionizing radiation should be considered. 4.6.2 Pregnancy Radionuclide procedures carried out on pregnant women also involve radiation doses to the fetus. CEA-Scan is contraindicated in pregnancy. Administration of 740 MBq CEA-Scan will give an estimated absorbed dose of 4.1 mGy to an embryo or fetus at an early stage. 4.6.3 Lactation Before administering a radioactive medicinal product to a mother who is breast feeding, consideration should be given as to whether the investigation could be reasonably delayed until the mother has ceased breast feeding and as to whether the most appropriate choice of radiopharmaceutical has been made, bearing in mind the secretion of activity in breast milk. If the administration is considered necessary, breast feeding should be interrupted and the expressed feeds discarded. It is usual to advise that breast feeding can be

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restarted when the level in the milk will not result in a radiation dose to the child greater than 1 mSv. Due to the short six-hour, half-life of 99mTc, a dose of less than 1 mSv in mother’s milk can be expected 24 hours after the administration of CEA-Scan [99mTc]. 4.7 Effects on the Ability to Drive and Use Machines No known effect. 4.8 Undesirable Effects 1. The following minor, self-limiting adverse effects have been reported: 1) Transient eosinophilia; 2) nausea; 3) bursitis; 4) urticaria; 5) generalized itching; 6) headache; 7) upset stomach; and 8) fever. 2. There has been a single report, out of a total of over 500 patients receiving the product to date, of an apparent grand mal epileptic seizure that was "possibly related" to CEA-Scan infusion. 3. HAMA: The presence of HAMA and human anti-mouse fragment have been reported in patients before and after receiving CEA-Scan (≤1% of patients develop HAMA to the antibody fragment). While no hypersensitivity reactions to CEA-Scan have been observed to date, it is possible that such reactions could occur, resulting in hypersensitivity reactions, anaphylactic shock, serum sickness or death. For each patient, exposure to ionizing radiation must be justifiable on the basis of likely benefit. The activity administered must be such that the resulting radiation dose is as low as reasonably achievable bearing in mind the need to obtain the intended diagnostic result. Exposure to ionizing radiation is linked with cancer induction and a potential for development of hereditary defects. For diagnostic nuclear medicine investigations, the current evidence suggests that the adverse effects will occur with low frequency because of the low radiation doses incurred. For most diagnostic investigations using a nuclear medicine procedure, the radiation dose delivered (effective dose/EDE) is less than 20 mSV. Higher doses may be justified in some clinical circumstances. 4.9 Overdose Intravenous administration of intact IgG and F(ab )2 of IMMU-4 in therapeutic doses of up to 25 mg has not shown any serious adverse reactions. Fab fragments have been demonstrated to be less immunogenic than intact IgG or F(ab )2 fragments. In the unlikely event of the administration of a radiation overdose with CEA-Scan, the absorbed dose to the patient may be reduced by increased oral or intravenous intake of fluids to promote excretion of the radiolabel. 5. PHARMACOLOGICAL PROPERTIES 5.1 Pharmacodynamic Properties Pharmacotherapeutic group: Diagnostic Radiopharmaceutical for Tumour Detection, ATC V09I A01. At the concentrations and activities used for diagnostic procedures, CEA-Scan [99mTc] does not appear to exert any pharmacodynamic effects. CEA-Scan [99mTc] is not specific for colorectal carcinoma, since CEA is expressed by other carcinomas (see Section 4.4.4). 5.2 Pharmacokinetic Properties

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Pharmacokinetic studies were performed after the intravenous administration of the product. At one hour after infusion, the blood level was 63% of baseline, 23% at five hours, and 7% of baseline at 24 hours. The distribution half-life was approximately one hour; the elimination half-life was 13 ± 4 hours with 28% of the radiolabel excreted in urine over the first 24 hours after administration. 5.3 Preclinical Safety-Data Only very limited preclinical studies have been performed with either the labelled or unlabelled agent. These revealed no remarkable findings. It should be noted, however, that these studies did not assess mutagenicity, carcinogenicity, or potential effects on reproductive activity. 5.4 Radiation Dosimetry For this product, the effective dose equivalent resulting from an administered activity of 750 MBq is typically 9.8 mSv for a 70 kg individual. Technetium [99mTc] disintegrates with the emission of gamma radiation with an energy of 140 keV and a half life of 6 hours to technetium [99Tc] which can be regarded as quasi stable.

Radiation dosimetry for individual organs revealed a generally low level of activity. As might be expected for a small molecular-sized antibody fragment, it was highest in the kidney. The values were calculated according to Medical Internal Radiation Dosimetry (MIRD). Data represent the mean of ten patients, with the exception of kidney (nine patients), ovary (eight patients), and testes (two patients).

Summary of Normal Organ Dosimetry (µGy/MBq)

CEA-Scan [99mTc]

Organ Mean ± SD

Bladder Kidney Spleen Liver Red Marrow Lung Ovary Total Body Testes

16.6 100.3 15.9 10.4 9.9 7.7 7.7 4.6 4.5

3.6 31.7 4.5 2.9 2.0 1.9 1.5 0.8 0.6

Effective dose equivalent 13.1 µSv/MBq

Effective dose 9.1 µSv/MBq 6. PHARMACEUTICAL PARTICULARS 6.1 List of Excipients Stannous chloride, dihydrate Sodium Chloride Acetic Acid, Glacial

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Hydrochloric Acid Potassium Sodium Tartrate, Tetrahydrate Sodium Acetate, Trihydrate Sucrose Argon 6.2 Incompatibilities Not known. 6.3 Shelf Life The expiratory date for this kit stored at 2-8°C is 24 months from the day of manufacture. Following reconstitution and radiolabelling, the material can be held at room temperature (15-25°C) and must be used within four hours following reconstitution. 6.4 Special Precautions for Storage Store labelling kit at 2-8°C. 6.5 Nature and Contents of Container Materials included: One vial prepared so as to contain 1.25 mg lyophilized CEA-Scan monoclonal antibody fragment. Vials comply with the requirements for glass type I. The vial is closed with a bromobutyl rubber stopper with a blue flip-off seal. 6.6 Instructions for Use/Handling-Disposal Read complete directions thoroughly before starting the preparation procedure. All procedures should be conducted using aseptic technique and standard precautions for handling radionuclides. 6.6.1 Method of Preparation and Quality Contol 6.6.1.1 Method of Preparation 1. Obtain 925-1110 MBq/mL sodium-pertechnetate [99mTc] (from any commercial source) in sodium saline injection. 2. Resuspend the lyophilized material by injecting the 925-1110 MBq of [99mTc] sodium-pertechnetate in a shielded vial of CEA-Scan. 3. Swirl and shake the vial for approximately 30 seconds making sure all sodium-pertechnetate [99mTc] is in contact with the antibody. Allow the labelling reaction to proceed for at least five minutes. Add 1 mL of isotonic sodium chloride injection in order to facilitate easy removal. Assay the product in a suitable dose calibrator. 4. Based on the activity measured in the activity calibrator, withdraw a sufficient amount of the product to provide the desired activity (750-1000 MBq of 99mTc, see Dosage and Administration). CEA-Scan [99mTc]

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can be used after five minutes and should be used within four hours after preparation. CEA-Scan [99mTc] can be stored at room temperature after formulation. 5. Prior to administration, the solution should be inspected visually for particulate matter and discoloration. If either are present, the product should be discarded. 6.6.1.2 Quality Control 1. After radiolabelling the antibody, dilute a 10 µl sample with 1.5 mL saline. Determine the radiochemical purity by Instant Thin Layer Chromatography on silica gel impregnated glass fiber strips, 1 × 9 cm using acetone as the solvent. When the solvent front is within 1 cm of the top of the strip, remove it, cut it in half and place each into a glass tube. Count each tube in a gamma scintillation counter, dose calibrator or radiochromatogram analyzer. Calculate the percent free technetium as follows: % Free Technetium = Activity in top half of strip × 100 Total Activity The radiolabeled product should not contain more than 10% free technetium. 6.6.2 Disposal After use, the container should be disposed of as radioactive waste. 7. MARKETING AUTHORIZATION HOLDER Immunomedics B.V. Westerduinweg 3, 1755 ZG Petten, The Netherlands 8. MARKETING AUTHORIZATION NUMBER 9. DATE OF FIRST AUTHORIZATION/RENEWAL OF THE AUTHORIZATION 10. DATE OF REVISION OF THE TEXT

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ANNEX II MANUFACTURING AUTHORISATION(S) AND CONDITIONS

OF THE MARKETING AUTHORISATION

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A. HOLDER(S) OF THE MANUFACTURING AUTHORISATION(S) Manufacturer of the active substance: Immunomedics, Inc. 5 Bruce Street Newark, New Jersey 07103 USA. Manufacturer of the finished medicinal product: Pharmacia, Inc. Oncology Division 4272 Balloon Park Road, N.E. Albuquerque, New Mexico 87109-5801 USA. Manufacturer responsible for importation and batch release in the EEA: Mallinckrodt Medical B.V. Westerduinweg 3 1755 Petten The Netherlands. Manufacturing Authorisation issued on 12 November 1991, by Ministerie van Welzijn, Volksgezondheid en Cultuur, Postbus 5406, 2280 HK Rijswijk, the Netherlands. B. CONDITIONS OR RESTRICTIONS REGARDING SUPPLY AND USE Medicinal product subject to non-renewable restricted medical prescription. C. SPECIFIC OBLIGATIONS OF THE MARKETING AUTHORISATION HOLDER C.1 Post-authorisation commitments The company, after having been consulted (letter dated 21 May 1996) agreed to submit to the EMEA, within the defined time-frame, the information requested by the CPMP. Chemical, pharmaceutical and biological aspects: • The proposed limits in the specifications for the intermediates and the finished product, including those limits proposed to control the relative intensity of peak 4 corresponding to Fab’ and relative intensity of H and L chains (45%) as measured by the quantitative SDS-PAGE, have to be reviewed and revised on a six-monthly basis or after three full scale production batches or lots (whichever is greater on a batch or lot basis) with a view to tightening them. A progress report will have to be submitted to the EMEA on 22 November 1996.

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Clinical aspects: The results of the additional clinical studies, set out below, to evaluate safety and efficacy following multiple administration of CEA-SCAN, will be submitted to the EMEA by 31 December 1998: • Evaluation of CEA-SCAN for staging of primary operable colorectal cancer patients - followed by prediction of recurrence in patients with Dukes’ B2, C and/or D disease. These patients will be tested before surgery and then those with complete resection will be followed after surgery with CEA-SCAN performed every 4-6 months or whenever CT is done. CEA-SCAN will be administered to patients so long as the HAMA fragment assay is ≤ 250 ng/ml (50 patients). • Follow-up of patients who had complete resection of metastatic colorectal cancer diagnosed by CEA-SCAN. These patients will be readministered CEA-SCAN every 4-6 months or whenever CT is done as long as the HAMA fragment assay is ≤ 250 ng/ml (50 patients). • Follow-up of patients who have unconfirmed positive lesions by CEA-SCAN which are negative by other diagnostic modalities. This study is to determine if these lesions are confirmed as positive over time. CEA-SCAN will be readministered every 6 months so long as the HAMA fragment assay is ≤ 250 ng/ml and the patient remains clinically free of disease (50 patients). C.2 Batch release testing protocol Pursuant to Article 4 of Council Directive 89/342/EEC of 3 May 1989 on immunological medicinal products, this product is subject to batch release, to be carried out by the competent National Control Authority. The batch release testing protocol was agreed by the Committee as follows: • National Control Authority involved:

National Institute for Biological Standards and Control (NIBSC), in the UK. • Product to be tested: CEA-SCAN. • List of tests to be performed: - Potency (by immunoreactivity assay) (85% ± 10%) - Radiolabelling assay (>75% as Fab’-SH) - IEF - SDS-PAGE • Proposed duration of the Batch Release Procedure:

For the next two years or for at least ten full scale production batches or lots of Intermediate and Finished Product, with yearly reports. Depending of the consistency of the results obtained, extension of this procedure could be envisaged after discussion within the Biotechnology Working Party. Distribution on the market for the next two years or for at least ten full scale production batches or lots (whichever is greater on a batch or lot basis), is conditional to a positive batch release certificate.

• The Batch Release certificates as well as the yearly report should be provided to the EMEA, the

European Commission and the Company.

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ANNEX III LABELLING AND USER PACKAGE LEAFLET

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A. LABELLING

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Container Package Label CEA-ScanArcitumomab Kit for the Preparation of 99mTc arcitumomab For Intravenous Use PACKAGE CONTAINS One vial, arcitumomab powder for injection Each vial contains 1.25 mg of arcitumomab, buffered to pH 5-7, 0.29 mg stannous chloride, sodium chloride, potassium sodium tartrate, sodium acetate, sucrose, argon Store at 2-8°C Batch # xxxx Do not freeze Expiration Date 00/00/00 Marketing Authorization # xxxx Medicinal Product subject to medical prescription. Keep out of the reach of children. Dispose of as radioactive waste in accordance with local law. IMMUNOMEDICS, B.V. Westerduinweg 3 1755 ZG Petten The Netherlands

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Vial Label CEA-Scan - arcitumomab Contains 1.25 mg lyophilized arcitumomab, 0.29 mg stannous chloride and stabilizers. For Intravenous Use only. Rehydrate with sterile, non-pyrogenic 99mTc Na pertechnetate. Store at 2-8°C Batch # xxxx Do not freeze Expiration Date 00/00/00 Marketing authorization # xxxx IMMUNOMEDICS, B.V. Westerduinweg 3 1755 ZG Petten The Netherlands

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B. USER PACKAGE LEAFLET

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PACKAGE LEAFLET Please read this leaflet carefully. It does not contain all the information about your medicine that you may need to know, so please refer to the Summary of Product Characteristics or ask your doctor or nurse if you have any questions. This leaflet only applies to CEA-Scan. NAME OF YOUR MEDICINE CEA-Scan is the trade name of your medicine. It is also called arcitumomab. COMPOSITION: WHAT YOUR MEDICINE CONTAINS Each 3-mL vial (glass container) contains 1.25 mg of arcitumomab, buffered to pH 5-7, 0.29 mg stannous chloride, sodium chloride, potassium sodium tartrate, sodium acetate, sucrose, argon. An antibody is a natural substance made by the body which binds to foreign substances to help remove them from your body. You produce many different kinds of antibodies. CEA-Scan arcitumomab is a special kind of antibody which binds to the surface of certain kinds of tumour cells. It is produced in mice and purified so that it can be used in humans. When it is combined to the radioactive technetium isotope and injected, it finds certain tumours and attaches to them. This helps your doctor make a diagnosis and evaluate the extent of your illness. The doctor does this by using a special imaging camera that reveals areas of radioactivity. PHARMACEUTICAL FORM: WHAT CEA-Scan CONSISTS OF Powder for injection. THERAPEUTIC GROUP: HOW CEA-Scan WORKS CEA-Scan is used to determine the presence of tumours in the body derived from the colon or rectum. Shortly after mixing the CEA-Scan with the radioactive technetium isotope, the doctor will inject it into your vein. Two to five hours later you will be placed on a special table and pictures will be taken with standard nuclear cameras to see where the tumour(s) are located. Before undergoing the scanning procedure, you should empty your bladder by urinating. You may be asked to come back the next day for some additional pictures to be taken. NAME AND ADDRESS OF THE MARKETING AUTHORIZATION HOLDER AND MANUFACTURER Marketing Authorization Holder Manufacturer Responsible for Importation into EU Immunomedics, B.V. Mallinckrodt Medical, B.V. Westerduinweg 3 Westerduinweg 3 1755 ZG Petten 1755 ZG Petten The Netherlands The Netherlands INDICATIONS: WHEN CEA-Scan IS USED CEA-Scan is an antibody fragment which is linked to a radioactive substance called technetium. CEA-Scan is used in patients with tumours of the colon or rectum that have been diagnosed after examination under the microscope. The antibody is able to bind to the surface of certain kinds of tumours producing a tumour marker, carcinoembryonic antigen (CEA). When the radioactive antibody binds to the tumour, your doctor can determine where it is located by using a special imaging camera that reveals areas of radioactivity. The

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doctor can also determine how much disease there is and if it has spread to other areas of the body. This will help the doctor determine whether to operate or what other kind of treatment to use. CONTRAINDICATIONS: WHEN YOU SHOULD NOT USE CEA-Scan If you know that you are allergic to any protein which comes from a mouse, tell your doctor. You should then not be given CEA-Scan, unless your doctor takes certain precautions and believes that the potential benefit exceeds any risk. You should not be given CEA-Scan if you are pregnant. INTERACTIONS WITH OTHER MEDICATIONS AND OTHER FORMS OF INTERACTION No interactions have been described to date. SPECIAL WARNINGS: THINGS YOU SHOULD KNOW BEFORE YOU ARE GIVEN CEA-Scan It is possible to have a serious allergic reaction to CEA-Scan. Therefore, your doctor should keep you under close observation for a short time after he has given you this drug. If you have ever received CEA-Scan or another product made from a mouse antibody, your doctor should take a sample of blood for testing to be sure that you have not developed an allergy to it. If you are breast feeding, you should stop breast feeding your baby for at least 24 hours after you have been given CEA-Scan. If the prepared solution of CEA-Scan appears discolored or contains particles, it should not be used. DOSAGE: THE AMOUNT OF MEDICINE GIVEN You will receive a single dose of 1 mg of CEA-Scan. It will contain the radioactive technetium isotope in an amount called 750-1000 Mbq. METHOD AND ROUTE OF ADMINISTRATION: HOW THE INJECTION IS GIVEN TO YOU Your doctor will prepare the CEA-Scan and the radioactive isotope technetium in a volume of 5-10 ml. One mg of CEA-Scan will be labelled with 750-1000 MBq of technetium. This material will then be injected into your vein. This dose of radioactivity is safe and will be gone from the body in about 24 hours. FREQUENCY OF ADMINISTRATION: HOW OFTEN YOU WILL BE GIVEN CEA- SCAN CEA-Scan is prepared for a single injection. If your doctor decides to give it to you again after several weeks or several months, your blood should be tested first to see if you have developed an allergy to CEA-Scan. UNDESIRABLE EFFECTS Some side effects, although not common, have been reported. These include nausea, upset stomach, headache, itching, fever, a rough patch on the skin, a small increase in the number of certain white blood cells called eosinophils (but without any apparent symptoms). If you experience any of these or any other unwanted effect after you are given this drug, tell your doctor.

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OVERDOSE Intravenous administration of intact IgG and F(ab )2 of IMMU-4 in therapeutic doses of up to 25 mg has not shown any serious adverse reactions. Fab fragments have been demonstrated to be less immunogenic than intact IgG or F(ab )2 fragments. In the unlikely event of the administration of a radiation overdose with CEA-Scan, the absorbed dose to the patient may be reduced by increased oral or intravenous intake of fluids to promote excretion of the radiolabel. SHELF LIFE: HOW LONG CEA-Scan CAN BE KEPT, AND HOW IT IS STORED CEA-Scan is stored by the hospital in a refrigerator and given to your doctor when he needs it. The hospital can keep the medicine for 2 years at 2-8°C after it is made. The expiration date is printed on the vial. The product should not be used after this date. Following reconstitution and radiolabelling, the material can be held at room temperature (15-25°C) and must be used within four hours following reconstitution. INSTRUCTIONS FOR USE/HANDLING Read complete directions thoroughly before starting the preparation procedure. All procedures should be conducted using aseptic technique and standard precautions for handling radionuclides. Use of Radiopharmaceutical Agents • Radiopharmaceutical agents should be used only by qualified personnel with appropriate government

authorization for the use and manipulation of radionuclides. • This radiopharmaceutical may be received, used and administered only by authorized persons in

designated clinical settings. Its receipt, storage, use, transfer and disposal are subject to the regulations and/or appropriate licenses of local competent official organizations.

• Radiopharmaceuticals should be prepared by the user in a manner which satisfies both radiation safety

and pharmaceutical quality requirements. Appropriate aseptic precautions should be taken, complying with the requirements of Good Manufacturing Practices (GMP) for pharmaceuticals.

• After use, the container should be disposed of as radioactive waste. METHOD OF PREPARATION AND QUALITY CONTOL Method of Preparation 1. Obtain 925-1110 MBq/mL sodium-pertechnetate [99mTc] (from any commercial source) in sodium saline

injection. 2. Resuspend the lyophilized material by injecting the 925-1110 MBq of [99mTc] sodium-pertechnetate in a

shielded vial of CEA-Scan. 3. Swirl and shake the vial for approximately 30 seconds making sure all sodium-pertechnetate [99mTc] is in

contact with the antibody. Allow the labelling reaction to proceed for at least five minutes. Add 1 mL

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of isotonic sodium chloride injection in order to facilitate easy removal. Assay the product in a suitable dose calibrator.

4. Based on the activity measured in the activity calibrator, withdraw a sufficient amount of the product to

provide the desired activity (750-1000 MBq of 99mTc, see Dosage and Administration). CEA-Scan [99mTc] can be used after five minutes and should be used within four hours after preparation. CEA-Scan [99mTc] can be stored at room temperature after formulation.

5. Prior to administration, the solution should be inspected visually for particulate matter and discoloration.

If either are present, the product should be discarded. Quality Control After radiolabelling the antibody, dilute a 10 µl sample with 1.5 mL saline. Determine the radiochemical purity by Instant Thin Layer Chromatography on silica gel impregnated glass fiber strips, 1 × 9 cm using acetone as the solvent. When the solvent front is within 1 cm of the top of the strip, remove it, cut it in half and place each into a glass tube. Count each tube in a gamma scintillation counter, dose calibrator or radiochromatogram analyzer. Calculate the percent free technetium as follows:

% Free Technetium = Activity in top half of strip × 100 Total Activity

The radiolabeled product should not contain more than 10% free technetium. DATE ON WHICH THE PACKAGE LEAFLET WAS LAST REVISED:

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OTHER INFORMATION For any information about this product, please contact the local representative of the Marketing Authorisation holder. ÖSTERREICH Alser Straße 25 1080 Vienna Tel. 43.1.43.95.65

ITALIA : Casella Postale 10370 20110 Milan Tel 39.2.66.32.11

BELGIQUE / BELGIE / LUXEMBOURG : Rue de la Pépinière 1, boîte 3 Boomwekerijstraat 1. bus 3 1000 Brussels Tel. 32.2.511.8086

NEDERLAND : Westerdiunweg 3 1755 ZG Petten Tel. 31.224.567890

DANMARK : Arhusgade 108E DL2100- Copenhagen-O Tel. : 45.35.433077

PORTUGAL : Avda. de San Pablo, 28 28820 Coslada (Madrid) Tel. 34.1.669.72.78

SUOMI : Rajatorpantie 41 B 01640 Vantaa Tel. 358.0852.01785

ESPAÑA: Avda. de San Pablo, 28 28820 Coslada (Madrid) Tel. 34.1.669.72.78

FRANCE : 26, rue Gustave-Madiot B.P.3 91923 Bondoufle Cedex Tel. 33.1.69.11.83.60

SVERIGE: P.O. Box 397 58104 Linkoping

DEUTSCHLAND : Josef-Dietzgen-Straße 1 D-53771 HENNEF/SIEG 1 UNITED KINGDOM / IRELAND : 3, Granitefield Rochestown Avenue Dun Laoghaire, County Dublin Dublin Tel 353.1.285.3659

UNITED KINGDOM / IRELAND : 11, North Portway Close Round Spinney Northampton NN3 4RQ tel. 44.1.604.646132

119 Kifissias Ave. 15124 Athens Tel. 30.1.61.27.100 Tel. 30.1.61.27.101

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