Turalio risk evaluation and mitigation strategy for treatment of tenosynovial giant cell tumor: framework and experience

Future Oncol. 2022 Apr;18(13):1595-1607. doi: 10.2217/fon-2021-1475. Epub 2022 Feb 2.


For drugs with enhanced serious safety risks, Risk Evaluation and Mitigation Strategy (REMS) may be required. Pexidartinib is approved for treatment of adult symptomatic tenosynovial giant cell tumor (TGCT) associated with severe morbidity or functional limitations and not amenable to improvement with surgery. Its approval was conditional on its prescription via a mandatory REMS due to serious and potentially fatal liver injury seen in clinical trials. Turalio® REMS aims to mitigate this risk by ensuring provider education on pexidartinib use and required REMS components, prescriber adherence to baseline and periodic monitoring, and enrolling patients in a registry to further assess safe use and acute, chronic and irreversible hepatotoxicity. Through Turalio REMS, benefits of treating patients with pexidartinib may be preserved.

Keywords: Pexidartinib; REMS framework; Turalio REMS Program; elements to assure safe use; hepatotoxicity; knowledge, attitude and behavior assessment; liver adverse event reporting criteria; risk evaluation and mitigation strategy; risk minimization measures; tenosynovial giant cell tumor.

Plain language summary

For drugs with serious side effects, specific safety measures may be put in place to manage these serious side effects in the form of Risk Evaluation and Mitigation Strategy (REMS) programs. Pexidartinib (Turalio®) is approved for treatment of adults who have symptoms of severe tenosynovial giant cell tumor or have limitations in function that do not improve with surgery. Turalio® has an REMS program because liver injuries that can be serious or fatal were seen in Pexidartinib clinical trials. This program aims to decrease the seriousness of the liver injuries by assuring doctors and pharmacists are educated on how to use the drug, patients are advised of this potential risk and that baseline and periodic monitoring of patients are conducted.

Publication types

  • Review

MeSH terms

  • Adult
  • Aminopyridines / therapeutic use
  • Giant Cell Tumor of Tendon Sheath* / drug therapy
  • Humans
  • Pyrroles / therapeutic use
  • Risk Evaluation and Mitigation*
  • United States
  • United States Food and Drug Administration


  • Aminopyridines
  • Pyrroles
  • pexidartinib

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