NORTH CHICAGO, Ill.,
Dec. 12, 2017 /PRNewswire/
-- AbbVie (NYSE: ABBV), a research and development based
global biopharmaceutical company, today announced the first
presentation of efficacy and safety results from MURANO, an
international, multicenter, open-label, randomized Phase 3 study of
VENCLEXTA™/VENCLYXTO™ (venetoclax) in combination with Rituxan®
(rituximab) compared with bendamustine in combination with
Rituxan in patients with relapsed or refractory (R/R) chronic
lymphocytic leukemia (CLL).
Investigator-assessed results showed that patients with R/R CLL
achieved significantly prolonged median progression-free survival
(PFS) with VENCLEXTA/VENCLYXTO in combination with Rituxan [median
PFS, not reached], compared with bendamustine in combination with
Rituxan [median PFS, 17.0 months; hazard ratio, 0.17; 95% CI,
0.11–0.25; P<0.0001].1 Twenty-four month PFS
estimates were 84.9 percent and 36.3 percent,
respectively.1 Independent Review Committee
(IRC)-assessed PFS showed similar results.1
Additionally, consistent improvement in PFS was observed across the
patient subgroups assessed in the trial, including patients with
17p deletion [hazard ratio 0.14; 95% CI, 0.06–0.33].1
VENCLEXTA/VENCLYXTO is being developed by AbbVie and Roche. It
is jointly commercialized by AbbVie and Genentech, a member of the
Roche Group, in the U.S. and by AbbVie outside of the
U.S.
At the time of the interim analysis, safety data were consistent
with the known safety profiles of the medicines.1
"The data from the MURANO trial represents the next evolution in
a potential treatment option for patients with relapsed/refractory
CLL, an indication for which we received Breakthrough Therapy
Designation," said Michael Severino,
M.D., executive vice president, research and development, and chief
scientific officer, AbbVie. "We are proud to present these findings
at the ASH annual meeting and are working closely with regulatory
authorities to bring this combination therapy to appropriate
patients as soon as possible."
The data also serves as the Phase 3 confirmatory study requested
by the U.S. Food and Drug Administration (FDA) when VENCLEXTA was
granted accelerated approval on April 11, 2016.2 Health
authority regulatory submissions of VENCLEXTA/VENCLYXTO in
combination with Rituxan are underway.
"This primary analysis of the MURANO trial showed a significant
improvement in PFS with VENCLEXTA/VENCLYXTO and Rituxan versus
bendamustine and Rituxan, with consistent results in all patient
subsets assessed," said John
Seymour, M.D., Peter MacCallum Cancer Centre & Royal
Melbourne Hospital in Australia
and lead investigator of the MURANO trial. "Based on the
efficacy and safety results of this trial, the VENCLEXTA/VENCLYXTO
and Rituxan combination has the potential to offer a new
chemotherapy-free regimen for patients with relapsed/refractory
CLL. We continue to monitor safety and efficacy in trial patients
to gain further data and information."
Design and Results of Phase 3 Study Presented at
ASH
A total of 389 patients with R/R CLL who had
received one to three prior therapies were enrolled in the
international, multicenter, open-label, randomized Phase 3 MURANO
study.1 The study was designed to evaluate the efficacy
and safety of VENCLEXTA/VENCLYXTO in combination
with Rituxan (194 patients; median age, 64.5 years) compared with
bendamustine in combination with Rituxan (195 patients; median age,
66.0 years).1
For patients receiving VENCLEXTA/VENCLYXTO in
combination with Rituxan, a 4-week or 5-week dose ramp-up of
VENCLEXTA/VENCLYXTO from 20 to 400 mg daily was used to mitigate
potential tumor lysis syndrome (TLS) risk.1 Beginning at
week 6, intravenous (IV) Rituxan was given monthly for six 28-day
cycles (375 mg/m2 first dose, then 500
mg/m2).1 Patients continued with
VENCLEXTA/VENCLYXTO 400 mg for a maximum of two years or until
disease progression, whichever was first.1 For patients
receiving bendamustine in combination with Rituxan, patients were
given bendamustine (70 mg/m2 IV) on days 1 and 2 of each
of six 28-day cycles in combination with Rituxan using the same
dosing schedule.1
The primary endpoint was investigator-assessed PFS, which was
determined using standard International Workshop on Chronic
Lymphocytic Leukemia (iwCLL) guidelines.3 Secondary
endpoints included Independent Review Committee (IRC)-assessed PFS,
as well as PFS in patients with 17p deletion, best overall response
(defined as complete response [CR], complete response with
incomplete marrow recovery [CRi], nodular partial response [nPR],
or partial response [PR]), overall survival (OS), event-free
survival, duration of response, time to next anti-CLL treatment,
and percentage of patients achieving minimal residual
disease (MRD)-negativity.3 As of May 8, 2017,
median follow-up was 23.8 months (range, 0-37.4
months).1
Study Results:1
Endpoint*
|
Investigator-Assessed
|
Independent Review
Committee
|
Progression-Free
Survival
|
VR:
84.9%
|
VR:
82.8%4
|
(24-month
estimate)
|
BR: 36.3%
|
BR:
37.4%4
|
|
|
|
Median PFS
|
VR: Not
reached
|
VR: Not
reached4
|
|
BR: 17.0
months
|
BR: 18.1
months4
|
|
|
|
|
|
|
HR (95%
CI)
|
HR=0.17
(0.11–0.25)
|
HR=0.19 (0.13-
0.28)
|
P-value
|
P
<0.0001
|
P
<0.0001
|
|
|
|
Overall
Response
|
VR: 93.3%
(181/194)
|
VR: 92.3%
(179/194)
|
(CR, CRi, PR,
nPR)
|
BR: 67.7%
(132/195)
|
BR: 72.3%
(141/195)
|
|
|
|
Difference (95%
CI)
|
25.6%
(17.9-33.3)
|
20.0%
(12.4-27.6)
|
|
|
|
Complete
Response
|
VR: 26.8%
(52/194)
|
VR: 8.2%
(16/194)
|
(CR/CRi)
|
BR: 8.2%
(16/195)
|
BR: 3.6%
(7/195)
|
|
|
|
Difference (95%
CI)
|
18.6%
|
4.7% (-0.3,
9.6)
|
P-value
|
|
P=NS
|
|
|
|
Partial
Response
|
VR: 66.5%
(129/194)
|
VR: 84.0%
(163/194)
|
(PR/nPR)
|
BR: 59.5%
(116/195)
|
BR: 68.7%
(134/195)
|
Overall
Survival
|
|
(OS)
|
|
|
|
Events
|
VR 7.7%
(15/194)4
|
|
BR 13.8%
(27/195)4
|
|
|
HR (95%
CI)
|
HR =0.48
(0.25-0.90)4
|
|
|
Peripheral blood
Minimal Residual Disease Negativity
|
VR: 83.5%
(162/194)
BR: 23.1% (45/195)
|
(MRD-)**
|
|
|
|
Difference (95%
CI)
|
60.4%
(52.3–68.6)
|
*Abbreviations: VR
(VENCLYXTO/VENCLEXTA+ Rituxan); BR (bendamustine + Rituxan); NS
(not significant)
|
** Best response
at any timepoint; MRD negativity was defined as less than 1 CLL
cell in 10,000 leukocytes
|
In the study, the adverse events (AEs) were consistent with the
known safety profile of VENCLEXTA/VENCLYXTO and Rituxan. Grade 3-4
neutropenia was higher in the VENCLEXTA/VENCLYXTO in
combination with Rituxan arm of the trial. 1 For
patients taking VENCLEXTA/VENCLYXTO in combination with
Rituxan and bendamustine in combination with Rituxan, there were 6
(3.1 percent) and 2 (1.1 percent) grade ≥3 TLS AEs reported in each
arm, respectively.1 For
VENCLEXTA/VENCLYXTO in combination with Rituxan versus
bendamustine in combination with Rituxan, respectively, Richter
transformation was confirmed in 6 and 5 patients, and AEs leading
to death were seen in 10 (5.2 percent) versus 11 (5.9 percent)
patients.1
Summary of Adverse Events (AEs):1
Adverse
Events*
|
Venetoclax in
combination with
rituximab (N= 194)
|
Bendamustine in
combination with
rituximab (N=195)
|
Number of
AEs
|
335
|
255
|
Grade 3-4 AEs
occurring in > 5
percent in either arm, n (%)
Neutropenia Anemia Thrombocytopenia Febrile neutropenia Pneumonia Infusion-related reaction
|
112 (57.7)
21 (10.8)
11 (5.7)
7 (3.6)
10 (5.2)
3 (1.5)
|
73 (38.8)
26 (13.8)
19 (10.1)
18 (9.6)
15 (8.0)
10 (5.3)
|
Serious AEs in
> 2 patients
in either arm, n (%)
Pneumonia
Influenza
Sepsis
Upper respiratory
tract infection
Lung
infection
Sinusitis
Appendicitis
Bronchitis
Pharyngitis
Respiratory tract
infection
|
16 (8.2)
3 (1.5)
1 (0.5)
3 (1.5)
3 (1.5)
2 (1.0)
2 (1.0)
0
0
2 (1.0)
|
15 (8.0)
2 (1.1)
4 (2.1)
2 (1.1)
0
1 (0.5)
0
2 (1.1)
2 (1.1)
0
|
Fatal AEs, n
(%)
|
10 (5.2)
|
11 (5.9)
|
*AE reporting
period: up to 90 days after end of bendamustine and rituximab
treatment (maximum six months); up to 28 days after end of
venetoclax and rituximab treatment (maximum two
years).
|
About VENCLEXTA™/VENCLYXTO™
VENCLEXTA/VENCLYXTO
is an oral B-cell lymphoma-2 (BCL-2) inhibitor that targets a
specific protein in the body called BCL-2.2,5
When you have CLL, BCL-2 may build up and prevent cancer cells from
self-destructing naturally.2,5
VENCLEXTA/VENCLYXTO targets BCL-2 in order to help restore the
process of apoptosis.2,5 Through apoptosis,
your body allows cancer cells and normal cells to
self-destruct.2,5
VENCLEXTA/VENCLYXTO is being developed by AbbVie and
Roche. It is jointly commercialized by AbbVie and Genentech, a
member of the Roche Group, in the U.S. and by AbbVie outside of the
U.S. Together, the companies are committed to BCL-2 research with
venetoclax, which is currently being evaluated in clinical trials
in several hematologic cancers.
VENCLEXTA/VENCLYXTO is currently approved in 49 nations,
including the U.S., and in the EU. AbbVie, in collaboration with
Roche and Genentech, is currently working with regulatory agencies
around the world to bring this medicine to eligible patients in
need.
About VENCLYXTO™ (venetoclax) Tablets (EU)
VENCLYXTO™
(venetoclax) is indicated in the European Union (EU) for the
treatment of chronic lymphocytic leukemia (CLL) in the presence of
17p deletion or TP53 mutation in adult patients who are unsuitable
for or have failed a B-cell receptor pathway inhibitor; and for the
treatment of CLL in the absence of 17p deletion or TP53 mutation in
adult patients who have failed both chemoimmunotherapy and a B-cell
receptor pathway inhibitor.5 It is also being evaluated
for the treatment of patients with various blood cancer
types. 1,6,7,8,9 The BCL-2 protein
prevents apoptosis (programmed cell death) of some cells, including
lymphocytes, and can be overexpressed in CLL cells.1
VENCLYXTO, which is given once-daily, is designed to selectively
inhibit the function of the BCL-2 protein.1
Important VENCLYXTO (venetoclax) EU Safety
Information
Contraindications
Hypersensitivity to
the active substance or to any of the excipients. Concomitant use
of strong CYP3A inhibitors at initiation and during the
dose-titration phase. Concomitant use of preparations containing
St. John's wort.
Special Warnings & Precautions for Use
Tumor
lysis syndrome (TLS), including fatal events, has occurred in
patients with previously treated CLL with high tumor burden when
treated with VENCLYXTO. VENCLYXTO poses a risk for TLS in the
initial 5-week dose-titration phase. Changes in electrolytes
consistent with TLS that require prompt management can occur as
early as 6 to 8 hours following the first dose of VENCLYXTO and at
each dose increase. Patients should be assessed for risk and should
receive appropriate prophylaxis for TLS. Blood chemistries should
be monitored and abnormalities managed promptly. More intensive
measures (including IV hydration, frequent monitoring and
hospitalization) should be employed as overall risk increases.
Neutropenia (grade 3 or 4) has been reported and complete blood
counts should be monitored throughout the treatment period.
Live vaccines should not be administered during treatment or
thereafter until B-cell recovery.
Drug Interactions
CYP3A inhibitors may increase
VENCLYXTO plasma concentrations. At initiation and dose-titration
phase: Strong CYP3A inhibitors are contraindicated due to increased
risk for TLS and moderate CYP3A inhibitors should be avoided. If
moderate CYP3A inhibitors must be used, physicians should refer to
the SmPC for dose adjustment recommendations. At steady daily dose:
If moderate or strong CYP3A inhibitors must be used, physicians
should refer to the SmPC for dose adjustment recommendations.
Avoid concomitant use of P-gp and BCRP inhibitors at initiation
and during the dose titration phase.
CYP3A4 inducers may decrease VENCLYXTO plasma
concentrations.
Avoid co-administration with strong or moderate CYP3A inducers.
These agents may decrease venetoclax plasma concentrations.
Co-administration of bile acid sequestrants with VENCLYXTO is
not recommended as this may reduce the absorption of VENCLYXTO.
Adverse Reactions
The most commonly occurring adverse
reactions (>=20%) of any grade were neutropenia/neutrophil count
decreased, diarrhea, nausea, anemia, upper respiratory tract
infection, fatigue, hyperphosphatemia, vomiting and
constipation.
The most frequently occurring adverse reactions (>=2%) were
pneumonia, febrile neutropenia and TLS.
Discontinuations due to adverse reactions occurred in 9.1% of
patients and dosage adjustments due to adverse reactions occurred
in 11.8% of patients.
Specific Populations
VENCLYXTO may cause embryo-fetal
harm when administered to a pregnant woman. Advise females of
reproductive potential to avoid pregnancy during treatment. Advise
nursing women to discontinue breastfeeding during treatment.
Safety in patients with severe renal impairment or on dialysis
has not been established, and a recommended dose has not been
determined. VENCLYXTO should be administered to patients with
severe renal impairment only if the benefit outweighs the risk.
Monitor closely for signs of toxicity due to increased risk of
TLS.
This is not a complete summary of all safety information. See
VENCLYXTO full summary of product characteristics (SmPC) at
www.ema.europa.eu. Globally, prescribing information varies; refer
to the individual country product label for complete
information.
About VENCLEXTA™ (venetoclax) tablets (US)
In
April 2016, the U.S. Food and Drug
Administration (FDA) granted accelerated approval of VENCLEXTA™
(venetoclax) tablets for the treatment of patients with CLL with
17p deletion, as detected by an FDA-approved test, who have
received at least one prior therapy.2 The FDA approved
this indication under accelerated approval based on overall
response rate, and continued approval may be contingent upon
verification and description of clinical benefit in a confirmatory
trial.
VENCLEXTA has been granted four Breakthrough Therapy
Designations from the FDA including for the combination treatment
of patients with untreated AML not eligible for standard induction
chemotherapy. This designation is intended to expedite the
development and review of therapies for serious or life-threatening
conditions.10 In January 2016, AbbVie
announced that the FDA granted priority review for the single agent
NDA application for VENCLEXTA.
In November 2017, AbbVie and
Genentech received the Prix Galien award for "Best Pharmaceutical
Product" for VENCLEXTA.11
What is VENCLEXTA™ (venetoclax)?
VENCLEXTA™
(venetoclax) is a prescription medicine used to treat people with
chronic lymphocytic leukemia (CLL) with 17p deletion who have
received at least one prior treatment.
VENCLEXTA was approved based on response rate. There is an
ongoing study to find out how VENCLEXTA works over a longer period
of time.
It is not known if VENCLEXTA is safe and effective in
children.
Important VENCLEXTA™ (venetoclax) US Safety
Information
What is the most important information I should know about
VENCLEXTA?
VENCLEXTA can cause serious side
effects, including:
Tumor lysis syndrome (TLS). TLS
is caused by the fast breakdown of cancer cells. TLS can cause
kidney failure, the need for dialysis treatment, and may lead to
death. Your doctor will do tests for TLS. It is important to keep
your appointments for blood tests. You will receive other medicines
before starting and during treatment with VENCLEXTA to help reduce
your risk of TLS. You may also need to receive intravenous (IV)
fluids into your vein. Tell your doctor right away if you have any
symptoms of TLS during treatment with VENCLEXTA, including fever,
chills, nausea, vomiting, confusion, shortness of breath, seizures,
irregular heartbeat, dark or cloudy urine, unusual tiredness, or
muscle or joint pain.
Drink plenty of water when taking VENCLEXTA to help reduce
your risk of getting TLS. Drink 6 to 8 glasses (about 56 ounces
total) of water each day, starting 2 days before your first dose,
on the day of your first dose of VENCLEXTA, and each time your dose
is increased.
Who should not take VENCLEXTA?
Certain medicines
must not be taken when you first start taking VENCLEXTA and while
your dose is being slowly increased.
- Tell your doctor about all the medicines you take,
including prescription and over-the-counter medicines, vitamins,
and herbal supplements. VENCLEXTA and other medicines may affect
each other, causing serious side effects.
- Do not start new medicines during treatment with VENCLEXTA
without first talking with your doctor.
What should I tell my doctor before taking
VENCLEXTA?
Before taking VENCLEXTA, tell your doctor
about all of your medical conditions, including if you:
- Have kidney or liver problems.
- Have problems with your body salts or electrolytes, such as
potassium, phosphorus, or calcium
- Have a history of high uric acid levels in your blood or
gout
- Are scheduled to receive a vaccine. You should not receive a
"live vaccine" before, during or after treatment with VENCLEXTA
until your doctor tells you it is okay. If you are not sure about
the type of immunization or vaccine, ask your doctor. These
vaccines may not be safe or may not work as well during treatment
with VENCLEXTA.
- Are pregnant or plan to become pregnant. VENCLEXTA may harm
your unborn baby. If you are able to become pregnant, your doctor
should do a pregnancy test before you start treatment with
VENCLEXTA, and you should use effective birth control during
treatment and for 30 days after the last dose of VENCLEXTA.
- Are breastfeeding or plan to breastfeed. It is not known if
VENCLEXTA passes into your breast milk. Do not breastfeed during
treatment with VENCLEXTA.
What should I avoid while taking VENCLEXTA?
You should
not drink grapefruit juice or eat grapefruit, Seville oranges (often used in marmalades), or
starfruit while you are taking VENCLEXTA. These products may
increase the amount of VENCLEXTA in your blood.
What are the possible side effects of VENCLEXTA?
VENCLEXTA can cause serious side effects, including:
- Low white blood cell count (neutropenia). Low white
blood cell counts are common with VENCLEXTA, but can also be
severe. Your doctor will do blood tests to check your blood counts
during treatment with VENCLEXTA. Tell your doctor right away if you
have a fever or any signs of an infection.
The most common side effects of VENCLEXTA include low
white blood cell count, diarrhea, nausea, low red blood cell count,
upper respiratory tract infection, low platelet count, and feeling
tired.
VENCLEXTA may cause fertility problems in males. This may affect
your ability to father a child. Talk to your doctor if you have
concerns about fertility.
These are not all the possible side effects of VENCLEXTA. Tell
your doctor if you have any side effect that bothers you or that
does not go away.
The full U.S. prescribing information for VENCLEXTA can be found
here. Globally, prescribing information varies; refer to the
individual country product label for complete information.
Patient Assistance
For those who qualify, patient
assistance options are available for people taking VENCLEXTA in the
U.S.
About AbbVie in Oncology
At AbbVie, we strive to
discover and develop medicines that deliver transformational
improvements in cancer treatment by uniquely combining our deep
knowledge in core areas of biology with cutting-edge technologies,
and by working together with our partners – scientists, clinical
experts, industry peers, advocates, and patients. We remain focused
on delivering these transformative advances in treatment across
some of the most debilitating and widespread cancers. We are also
committed to exploring solutions to help patients obtain access to
our cancer medicines. With the acquisitions of Pharmacyclics in
2015 and Stemcentrx in 2016, our research and development efforts,
and through collaborations, AbbVie's oncology portfolio now
consists of marketed medicines and a pipeline containing multiple
new molecules being evaluated worldwide in more than 200 clinical
trials and more than 20 different tumor types. For more
information, please visit http://abbvieoncology.com.
About AbbVie
AbbVie is a global, research-driven
biopharmaceutical company committed to developing innovative
advanced therapies for some of the world's most complex and
critical conditions. The company's mission is to use its expertise,
dedicated people and unique approach to innovation to markedly
improve treatments across four primary therapeutic areas:
immunology, oncology, virology and neuroscience. In more than
75 countries, AbbVie employees are working every day to advance
health solutions for people around the world. For more information
about AbbVie, please visit us at www.abbvie.com.
Follow @abbvie on
Twitter, Facebook or LinkedIn.
Forward-Looking Statements
Some statements in this
news release may be forward-looking statements for purposes of the
Private Securities Litigation Reform Act of 1995. The words
"believe," "expect," "anticipate," "project" and similar
expressions, among others, generally identify forward-looking
statements. AbbVie cautions that these forward-looking statements
are subject to risks and uncertainties that may cause actual
results to differ materially from those indicated in the
forward-looking statements. Such risks and uncertainties include,
but are not limited to, challenges to intellectual property,
competition from other products, difficulties inherent in the
research and development process, adverse litigation or government
action, and changes to laws and regulations applicable to our
industry.
Additional information about the economic, competitive,
governmental, technological and other factors that may affect
AbbVie's operations is set forth in Item 1A, "Risk Factors," of
AbbVie's 2016 Annual Report on Form 10-K, which has been filed with
the Securities and Exchange Commission. AbbVie undertakes no
obligation to release publicly any revisions to forward-looking
statements as a result of subsequent events or developments, except
as required by law.
References
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1 American
Society of Hematology 59th Annual Meeting and
Exposition; December 9-12, 2017; Atlanta, GA. (2017). LBA-2
Venetoclax Plus Rituximab Is Superior to Bendamustine Plus
Rituximab in Patients with Relapsed/ Refractory Chronic Lymphocytic
Leukemia - Results from Pre-Planned Interim Analysis of the
Randomized Phase 3 Murano Study.
https://ash.confex.com/ash/2017/webprogram/Paper109076.html.
Accessed November 2017.
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2
Venclexta (venetoclax) [Package Insert]. North Chicago, Ill.:
AbbVie Inc.
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3
Clinicaltrials.gov. NCT02005471: A Study of Venetoclax in
Combination With Rituximab Compared With Bendamustine in
Combination With Rituximab in Participants With Relapsed or
Refractory Chronic Lymphocytic Leukemia
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4 American
Society of Hematology 2017 Annual Meeting and Exposition. MURANO
Study Interim Analysis Results. Presentation. December 12,
2017.
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5
Venclyxto (venetoclax) Summary of Product Characteristics. December
2016.
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Clinicaltrials.gov. NCT01994837: A Phase 2 Study of ABT-199 in
subjects with Acute Myelogenous Leukemia (AML). Accessed October
2016.
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Clinicaltrials.gov. NCT01794520: Study evaluating ABT-199 in
subjects with relapsed or refractory Multiple Myeloma. Accessed
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Clinicaltrials.gov. NCT01328626: A Phase 1 study evaluating the
safety and pharmacokinetics of ABT-199 in subjects with relapsed or
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Accessed October 2016
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Clinicaltrials.gov. NCT01889186: A study of the efficacy of ABT-199
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10 U.S.
Food and Drug Administration. Fact Sheet: Breakthrough Therapies.
Available from:
https://www.fda.gov/RegulatoryInformation/LawsEnforcedbyFDA/SignificantAmendmentstotheFDCAct/FDASIA/ucm329491.htm.
Accessed November 2017
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11 Galien
Foundation. The Galien Foundation Honors Excellence in Scientific
Innovation and Humanitarian Efforts at 2017 Prix Galien Awards
Gala. Available from:
https://www.prnewswire.com/news-releases/the-galien-foundation-honors-excellence-in-scientific-innovation-and-humanitarian-efforts-at-2017-prix-galien-awards-gala-300543930.html.
Accessed November 2017.
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