Celgene Corporation (NASDAQ:CELG) today announced additional
results from RELEVANCE, a phase III, randomized, open-label,
international clinical study conducted in partnership with the
Lymphoma Academic Research Organisation (LYSARC), were presented at
the 54th Annual American Society of Clinical Oncology Scientific
Sessions (ASCO) in Chicago, Illinois on June 1-5, 2018.
This investigational study evaluated REVLIMID® (lenalidomide)
plus rituximab (R2), followed by R2 maintenance, an investigational
regimen, compared to the standard of care treatment of rituximab
plus chemotherapy (R-chemo: R-CHOP, R-bendamustine or R-CVP)
followed by rituximab maintenance in patients with previously
untreated follicular lymphoma. Investigators found that treatment
with a chemotherapy-free R2 regimen offered numerically similar
efficacy results for the primary endpoints of progression free
survival (PFS) and complete response or unconfirmed complete
response (CR/CRu) at 120 weeks with a different safety profile than
treatment with the conventional R-chemo standard. As previously
disclosed, the study did not achieve the primary endpoints of
superior PFS and CR/CRu.
"These findings provide important insight into the efficacy and
safety of a chemotherapy-free regimen in patients with previously
untreated follicular lymphoma and represent an important step
forward in understanding possible treatment options for these
patients," said Nathan Fowler, MD, Associate Professor, Department
of Lymphoma/Myeloma, University of Texas MD Anderson Cancer
Center.
The co-primary efficacy endpoints of the study were CR and CRu
at 120 weeks and PFS during the pre-planned analysis (final
analysis of CR/CRu and interim analysis of PFS). An analysis of the
findings found that 48% of patients in the R2 arm and 53% of those
receiving R-chemo maintained CR/Cru 120 weeks after randomization,
with a 3-year estimated interim PFS rate of 77% and 78%
respectively (P=0.48, HR (95% CI) 1.10 (0.85-1.43)). Preliminary
overall survival, one of the study’s secondary endpoints, showed a
3-year survival rate of 94% in both treatment arms. Other secondary
endpoints included number of patients with adverse events, time to
treatment failure, event-free survival, time to next anti-lymphoma
treatment, time to next chemotherapy treatment, overall response
rate at 120 weeks based on International Working Group (IWG) 1999
criteria, and health-related quality of life as measured by the
EORTC QLQ-C30.
The majority of patients in both arms completed treatment (69%
R2 and 71% R-chemo). The most common Grade 3/4 TEAEs in both arms
were neutropenia (32% R2 vs. 50% R-chemo), febrile neutropenia (2%
R2 vs. 7% R-chemo) and cutaneous events (7% R2 vs. 1% R-chemo).
SPMs were reported in 7% R2 and 10% R-chemo patients, and Grade 5
AEs were 1% in both treatment arms.
"We believe the findings of the RELEVANCE trial add further to
the understanding of the R2 regimen in patients with follicular
lymphoma," said Nadim Ahmed, President of Hematology and Oncology
for Celgene. "We now look forward to the results of our AUGMENT
study, which is evaluating this important regimen in previously
treated patients with indolent lymphomas. These studies support our
ongoing efforts to develop a portfolio of novel treatments for
lymphoma."
REVLIMID alone or in combination with rituximab is not approved
for use in follicular lymphoma in any country.
ABOUT RELEVANCE
RELEVANCE is the first multi-center, international, open-label,
randomized phase III clinical trial of the chemotherapy-free
combination immunotherapy R2 vs. R-chemo followed by rituximab
maintenance in previously untreated, advanced follicular lymphoma
patients. The study was conducted by Celgene in the US and Japan
and by LYSARC in the rest of the world at 136 centers in 10
countries and evaluated the safety and efficacy of REVLIMID plus
rituximab (R2) followed by R2 maintenance compared to the standard
of care treatment of rituximab plus chemotherapy (R-CHOP,
R-bendamustine or R-CVP) followed by rituximab maintenance.
The trial evaluated 1030 patients with advanced follicular
lymphoma who had not received prior treatment and were deemed to
require treatment per Groupe d'Etude des Lymphomes Folliculaires
(GELF) Criteria. Patients received treatment for 120 weeks and were
randomized to receive either R2 or R-chemo treatment. The median
age of the patients was 59 years.
The R2 arm received REVLIMID + Rituximab on the following dosing
schedules: REVLIMID 20-mg on days 2-22 every 28 days for up to 6
cycles. Patients with a complete response after 6 cycles then
received REVLIMID 10-mg on days 2-22 every 28 days for 12 cycles.
Patients with a partial response after 6 cycles continued to
receive REVLIMID 20 mg for 3-6 cycles until they achieved a CR/CRu,
at which time they then received REVLIMID 10 mg on days 2-22 of
every 28-day cycle for up to 9 or 6 cycles, respectively. Patients
who remained in partial response after the additional 6 cycles
received REVLIMID 10 mg for a total of 18 cycles. Rituximab 375
mg/m2 was administered on days 1, 8, 15 and 22 of cycle 1, day 1 of
cycles 2 to 6; 8 weeks later responding patients continue with 375
mg/m2 rituximab every 8 weeks for 12 cycles.
The R-chemo arm received ONE of the following: Rituximab – CHOP
(72%), Rituximab – CVP (5%), or Rituximab – Bendamustine (23%).
Seven to 8 weeks later, responding patients continued with 375
mg/m2 rituximab every 8 weeks for 12 cycles.
About REVLIMID®
REVLIMID® (lenalidomide) in combination with
dexamethasone (dex) is indicated for the treatment of patients with
multiple myeloma (MM)
REVLIMID is indicated as maintenance therapy in patients with
MM following autologous hematopoietic stem cell transplantation
(auto-HSCT)
REVLIMID® is indicated for the treatment of
patients with transfusion-dependent anemia due to low-or
intermediate-1–risk myelodysplastic syndromes (MDS) associated with
a deletion 5q cytogenetic abnormality with or without additional
cytogenetic abnormalities
REVLIMID® is indicated for the treatment of
patients with mantle cell lymphoma (MCL) whose disease has relapsed
or progressed after two prior therapies, one of which included
bortezomib
REVLIMID is not indicated and is not recommended for the
treatment of patients with chronic lymphocytic leukemia (CLL)
outside of controlled clinical trials
Important Safety Information
WARNING: EMBRYO-FETAL TOXICITY,
HEMATOLOGIC TOXICITY, and VENOUS and ARTERIAL
THROMBOEMBOLISM
Embryo-Fetal
Toxicity
Do not use REVLIMID during pregnancy.
Lenalidomide, a thalidomide analogue, caused limb abnormalities in
a developmental monkey study. Thalidomide is a known human
teratogen that causes severe life-threatening human birth defects.
If lenalidomide is used during pregnancy, it may cause birth
defects or embryo-fetal death. In females of reproductive
potential, obtain 2 negative pregnancy tests before starting
REVLIMID treatment. Females of reproductive potential must use 2
forms of contraception or continuously abstain from heterosexual
sex during and for 4 weeks after REVLIMID treatment. To avoid
embryo-fetal exposure to lenalidomide, REVLIMID is only available
through a restricted distribution program, the REVLIMID
REMS® program.
Information about the REVLIMID
REMS® program is available at
www.celgeneriskmanagement.com or by calling the
manufacturer’s toll-free number 1-888-423-5436.
Hematologic
Toxicity (Neutropenia and Thrombocytopenia)
REVLIMID can cause significant
neutropenia and thrombocytopenia. Eighty percent of patients with
del 5q MDS had to have a dose delay/reduction during the major
study. Thirty-four percent of patients had to have a second dose
delay/reduction. Grade 3 or 4 hematologic toxicity was seen in 80%
of patients enrolled in the study. Patients on therapy for del 5q
MDS should have their complete blood counts monitored weekly for
the first 8 weeks of therapy and at least monthly thereafter.
Patients may require dose interruption and/or reduction. Patients
may require use of blood product support and/or growth
factors.
Venous and
Arterial Thromboembolism
REVLIMID has demonstrated a
significantly increased risk of deep vein thrombosis (DVT) and
pulmonary embolism (PE), as well as risk of myocardial infarction
and stroke in patients with MM who were treated with REVLIMID and
dexamethasone therapy. Monitor for and advise patients about signs
and symptoms of thromboembolism. Advise patients to seek immediate
medical care if they develop symptoms such as shortness of breath,
chest pain, or arm or leg swelling. Thromboprophylaxis is
recommended and the choice of regimen should be based on an
assessment of the patient’s underlying risks.
CONTRAINDICATIONS
Pregnancy: REVLIMID can cause fetal harm when
administered to a pregnant female and is contraindicated in females
who are pregnant. If this drug is used during pregnancy or if the
patient becomes pregnant while taking this drug, the patient should
be apprised of the potential risk to the fetus
Severe Hypersensitivity Reactions: REVLIMID is
contraindicated in patients who have demonstrated severe
hypersensitivity (e.g., angioedema, Stevens-Johnson syndrome, toxic
epidermal necrolysis) to lenalidomide
WARNINGS AND PRECAUTIONS
Embryo-Fetal Toxicity: See Boxed WARNINGS
- Females of
Reproductive Potential: See Boxed WARNINGS
- Males:
Lenalidomide is present in the semen of patients receiving the
drug. Males must always use a latex or synthetic condom during any
sexual contact with females of reproductive potential while taking
REVLIMID and for up to 4 weeks after discontinuing REVLIMID, even
if they have undergone a successful vasectomy. Male patients taking
REVLIMID must not donate sperm
- Blood
Donation: Patients must not donate blood during treatment
with REVLIMID and for 4 weeks following discontinuation of the drug
because the blood might be given to a pregnant female patient whose
fetus must not be exposed to REVLIMID
REVLIMID REMS® Program: See Boxed WARNINGS:
Prescribers and pharmacies must be certified with the REVLIMID REMS
program by enrolling and complying with the REMS requirements;
pharmacies must only dispense to patients who are authorized to
receive REVLIMID. Patients must sign a Patient-Physician Agreement
Form and comply with REMS requirements; female patients of
reproductive potential who are not pregnant must comply with the
pregnancy testing and contraception requirements and males must
comply with contraception requirements
Hematologic Toxicity: REVLIMID can cause significant
neutropenia and thrombocytopenia. Monitor patients with neutropenia
for signs of infection. Advise patients to observe for bleeding or
bruising, especially with use of concomitant medications that may
increase risk of bleeding. MM: Patients taking REVLIMID/dex or
REVLIMID as maintenance therapy should have their complete blood
counts (CBC) assessed every 7 days for the first 2 cycles, on days
1 and 15 of cycle 3, and every 28 days thereafter. MDS: Patients on therapy for del 5q
MDS should have their complete blood counts monitored weekly for
the first 8 weeks of therapy and at least monthly thereafter.
Patients may require dose interruption and/or dose reduction.
Please see the Black Box WARNINGS for further information.
MCL: Patients taking
REVLIMID for MCL should have their CBCs monitored weekly for the
first cycle (28 days), every 2 weeks during cycles 2-4, and then
monthly thereafter. Patients may require dose interruption and/or
dose reduction
Venous and Arterial Thromboembolism: See Boxed WARNINGS:
Venous thromboembolic events (DVT and PE) and arterial thromboses
(MI and CVA) are increased in patients treated with REVLIMID.
Patients with known risk factors, including prior thrombosis, may
be at greater risk and actions should be taken to try to minimize
all modifiable factors (e.g., hyperlipidemia, hypertension,
smoking). Thromboprophylaxis is recommended and the regimen should
be based on patient’s underlying risks. ESAs and estrogens may
further increase the risk of thrombosis and their use should be
based on a benefit-risk decision
Increased Mortality in Patients with CLL: In a clinical
trial in the first-line treatment of patients with CLL, single
agent REVLIMID therapy increased the risk of death as compared to
single agent chlorambucil. Serious adverse cardiovascular
reactions, including atrial fibrillation, myocardial infarction,
and cardiac failure, occurred more frequently in the REVLIMID arm.
REVLIMID is not indicated and not recommended for use in CLL
outside of controlled clinical trials
Second Primary Malignancies (SPM): In clinical trials in
patients with MM receiving REVLIMID, an increase of hematologic
plus solid tumor SPM, notably AML and MDS, have been observed.
Monitor patients for the development of SPM. Take into account both
the potential benefit of REVLIMID and risk of SPM when considering
treatment
Increased Mortality with Pembrolizumab: In clinical
trials in patients with multiple myeloma, the addition of
pembrolizumab to a thalidomide analogue plus dexamethasone resulted
in increased mortality. Treatment of patients with multiple myeloma
with a PD-1 or PD-L1 blocking antibody in combination with a
thalidomide analogue plus dexamethasone is not recommended outside
of controlled clinical trials
Hepatotoxicity: Hepatic failure, including fatal cases,
has occurred in patients treated with REVLIMID/dex. Pre-existing
viral liver disease, elevated baseline liver enzymes, and
concomitant medications may be risk factors. Monitor liver enzymes
periodically. Stop REVLIMID upon elevation of liver enzymes. After
return to baseline values, treatment at a lower dose may be
considered
Severe Cutaneous Reactions Including Hypersensitivity
Reactions: Angioedema and severe cutaneous reactions including
Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN),
and drug reaction with eosinophilia and systemic symptoms (DRESS)
have been reported. DRESS may present with a cutaneous reaction
(such as rash, or exfoliative dermatitis), eosinophilia, fever,
and/or lymphadenopathy with systemic complications such as
hepatitis, nephritis, pneumonitis, myocarditis, and/or
pericarditis. These events can be fatal. Patients with a prior
history of Grade 4 rash associated with thalidomide treatment
should not receive REVLIMID. REVLIMID interruption or
discontinuation should be considered for Grade 2-3 skin rash.
REVLIMID must be discontinued for angioedema, Grade 4 rash,
exfoliative or bullous rash, or if SJS, TEN, or DRESS is suspected
and should not be resumed following discontinuation for these
reactions
Tumor Lysis Syndrome (TLS): Fatal instances of TLS have
been reported during treatment with lenalidomide. The patients at
risk of TLS are those with high tumor burden prior to treatment.
These patients should be monitored closely and appropriate
precautions taken
Tumor Flare Reaction (TFR): TFR has occurred during
investigational use of lenalidomide for CLL and lymphoma.
Monitoring and evaluation for TFR is recommended in patients with
MCL. Tumor flare may mimic the progression of disease (PD). In
patients with Grade 3 or 4 TFR, it is recommended to withhold
treatment with REVLIMID until TFR resolves to ≤Grade 1. REVLIMID
may be continued in patients with Grade 1 and 2 TFR without
interruption or modification, at the physician’s discretion
Impaired Stem Cell Mobilization: A decrease in the number
of CD34+ cells collected after treatment (>4 cycles) with
REVLIMID has been reported. Consider early referral to transplant
center to optimize timing of the stem cell collection
Thyroid Disorders: Both hypothyroidism and
hyperthyroidism have been reported. Measure thyroid function before
start of REVLIMID treatment and during therapy
Early Mortality in Patients with MCL: In another MCL
study, there was an increase in early deaths (within 20 weeks),
12.9% in the REVLIMID arm versus 7.1% in the control arm. Risk
factors for early deaths include high tumor burden, MIPI score at
diagnosis, and high WBC at baseline (≥10 x 109/L)
ADVERSE REACTIONS
Multiple Myeloma
- In newly diagnosed: The most
frequently reported Grade 3 or 4 reactions included neutropenia,
anemia, thrombocytopenia, pneumonia, asthenia, fatigue, back pain,
hypokalemia, rash, cataract, lymphopenia, dyspnea, DVT,
hyperglycemia, and leukopenia. The highest frequency of infections
occurred in Arm Rd Continuous (75%) compared to Arm MPT (56%).
There were more Grade 3 and 4 and serious adverse reactions of
infection in Arm Rd Continuous than either Arm MPT or Rd18
- The most common adverse reactions
reported in ≥20% (Arm Rd Continuous): diarrhea (46%), anemia (44%),
neutropenia (35%), fatigue (33%), back pain (32%), asthenia (28%),
insomnia (28%), rash (26%), decreased appetite (23%), cough (23%),
dyspnea (22%), pyrexia (21%), abdominal pain (21%), muscle spasms
(20%), and thrombocytopenia (20%)
- Maintenance Therapy Post
Auto-HSCT: The most frequently reported Grade 3 or 4 reactions
in ≥20% (REVLIMID arm) included neutropenia, thrombocytopenia, and
leukopenia. The serious adverse reactions of lung infection and
neutropenia (more than 4.5%) occurred in the REVLIMID arm
- The most frequently reported adverse
reactions in ≥20% (REVLIMID arm) across both maintenance studies
(Study 1, Study 2) were neutropenia (79%, 61%), thrombocytopenia
(72%, 24%), leukopenia (23%, 32%), anemia (21%, 9%), upper
respiratory tract infection (27%, 11%), bronchitis (5%, 47%),
nasopharyngitis (2%, 35%), cough (10%, 27%), gastroenteritis (0%,
23%), diarrhea (55%, 39%), rash (32%, 8%), fatigue (23%, 11%),
asthenia (0%, 30%), muscle spasm (0%, 33%), and pyrexia (8%,
21%)
- After at least one prior
therapy: The most common adverse reactions reported in ≥20%
(REVLIMID/dex vs dex/placebo): fatigue (44% vs 42%), neutropenia
(42% vs 6%), constipation (41% vs 21%), diarrhea (39% vs 27%),
muscle cramp (33% vs 21%), anemia (31% vs 24%), pyrexia (28% vs
23%), peripheral edema (26% vs 21%), nausea (26% vs 21%), back pain
(26% vs 19%), upper respiratory tract infection (25% vs 16%),
dyspnea (24% vs 17%), dizziness (23% vs 17%), thrombocytopenia (22%
vs 11%), rash (21% vs 9%), tremor (21% vs 7%), and weight decreased
(20% vs 15%)
Myelodysplastic
Syndromes
- Grade 3 and 4 adverse events reported
in ≥ 5% of patients with del 5q MDS were neutropenia (53%),
thrombocytopenia (50%), pneumonia (7%), rash (7%), anemia (6%),
leukopenia (5%), fatigue (5%), dyspnea (5%), and back pain
(5%)
- Adverse events reported in ≥15% of del
5q MDS patients (REVLIMID): thrombocytopenia (61.5%), neutropenia
(58.8%), diarrhea (49%), pruritus (42%), rash (36%), fatigue (31%),
constipation (24%), nausea (24%), nasopharyngitis (23%), arthralgia
(22%), pyrexia (21%), back pain (21%), peripheral edema (20%),
cough (20%), dizziness (20%), headache (20%), muscle cramp (18%),
dyspnea (17%), pharyngitis (16%), epistaxis (15%), asthenia (15%),
upper respiratory tract infection (15%)
Mantle Cell Lymphoma
- Grade 3 and 4 adverse events reported
in ≥5% of patients treated with REVLIMID in the MCL trial (N=134)
included neutropenia (43%), thrombocytopenia (28%), anemia (11%),
pneumonia (9%), leukopenia (7%), fatigue (7%), diarrhea (6%),
dyspnea (6%), and febrile neutropenia (6%)
- Adverse events reported in ≥15% of
patients treated with REVLIMID in the MCL trial included
neutropenia (49%), thrombocytopenia (36%), fatigue (34%), anemia
(31%), diarrhea (31%), nausea (30%), cough (28%), pyrexia (23%),
rash (22%), dyspnea (18%), pruritus (17%), peripheral edema (16%),
constipation (16%), and leukopenia (15%)
DRUG INTERACTIONS
Periodic monitoring of digoxin plasma levels is recommended due
to increased Cmax and AUC with concomitant REVLIMID therapy.
Patients taking concomitant therapies such as erythropoietin
stimulating agents or estrogen containing therapies may have an
increased risk of thrombosis. It is not known whether there is an
interaction between dex and warfarin. Close monitoring of PT and
INR is recommended in patients with MM taking concomitant
warfarin
USE IN SPECIFIC POPULATIONS
- PREGNANCY: See Boxed WARNINGS:
If pregnancy does occur during treatment, immediately discontinue
the drug and refer patient to an obstetrician/gynecologist
experienced in reproductive toxicity for further evaluation and
counseling. There is a REVLIMID pregnancy exposure registry that
monitors pregnancy outcomes in females exposed to REVLIMID during
pregnancy as well as female partners of male patients who are
exposed to REVLIMID. This registry is also used to understand the
root cause for the pregnancy. Report any suspected fetal exposure
to REVLIMID to the FDA via the MedWatch program at 1-800-FDA-1088
and also to Celgene Corporation at 1-888-423-5436
- LACTATION: There is no
information regarding the presence of lenalidomide in human milk,
the effects of REVLIMID on the breastfed infant, or the effects of
REVLIMID on milk production. Because many drugs are excreted in
human milk and because of the potential for adverse reactions in
breastfed infants from REVLIMID, advise female patients not to
breastfeed during treatment with REVLIMID
- PEDIATRIC USE: Safety and
effectiveness have not been established in pediatric patients
- RENAL IMPAIRMENT: Adjust the
starting dose of REVLIMID based on the creatinine clearance value
and in patients on dialysis
Please see full Prescribing Information, including
Boxed WARNINGS.
About Celgene
Celgene Corporation, headquartered in Summit, New Jersey, is an
integrated global biopharmaceutical company engaged primarily in
the discovery, development and commercialization of innovative
therapies for the treatment of cancer and inflammatory diseases
through next-generation solutions in protein homeostasis,
immuno-oncology, epigenetics, immunology and neuro-inflammation.
For more information, please visit www.celgene.com. Follow Celgene
on Social Media: @Celgene, Pinterest, LinkedIn, Facebook and
YouTube.
About LYSARC
The Lymphoma Academic Research Organisation (LYSARC), located in
Lyon, France, is an academic clinical research organization running
international clinical lymphoma trials in affiliation with the LYSA
and in collaboration with other renowned, international cooperative
groups. For more information, please visit www.lysarc.org.
About LYSA
The Lymphoma Study Association (LYSA), is a French association
leader in international clinical and translational research in
lymphoma, with a network of 130 centers in France, Switzerland,
Portugal and Belgium. For more information, please visit
www.lysa-lymphoma.org
Forward-Looking Statements
This press release contains forward-looking statements, which
are generally statements that are not historical facts.
Forward-looking statements can be identified by the words
"expects," "anticipates," "believes," "intends," "estimates,"
"plans," "will," "outlook" and similar expressions. Forward-looking
statements are based on management's current plans, estimates,
assumptions and projections, and speak only as of the date they are
made. We undertake no obligation to update any forward-looking
statement in light of new information or future events, except as
otherwise required by law. Forward-looking statements involve
inherent risks and uncertainties, most of which are difficult to
predict and are generally beyond our control. Actual results or
outcomes may differ materially from those implied by the
forward-looking statements as a result of the impact of a number of
factors, many of which are discussed in more detail in our Annual
Report on Form 10-K and our other reports filed with the Securities
and Exchange Commission.
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