NORTH CHICAGO, Ill.,
June 13, 2020 /PRNewswire/ -- AbbVie
(NYSE: ABBV), a research-based global biopharmaceutical company,
today announced the positive results from the VIALE-A (M15-656)
trial, which demonstrated that previously-untreated patients with
acute myeloid leukemia (AML) who were ineligible for intensive
chemotherapy treated with venetoclax (VENCLEXTA® or VENCLYXTO®)
plus azacitidine achieved a 34 percent reduction in the risk of
death compared to azacitidine in combination with placebo (Hazard
Ratio [HR]=0.66 [95 percent CI 0.52-.85],
p=0.001).1 Patients receiving the venetoclax
combination achieved improved median overall survival (OS) (14.7
months versus 9.6 months in the placebo arm), and 66.4 percent of
patients treated with venetoclax plus azacitidine had a composite
complete remission (CR + CRi) compared to 28.3 percent treated with
azacitidine plus placebo.
The data set was presented for the first time as late-breaking
data during the virtual 25th European Hematology Association (EHA)
Annual Congress (abstract #LB2601).
"Patients living with AML may be too sick to endure
chemotherapy, and they face one of the most aggressive types of
blood cancer," said Neil Gallagher,
M.D., Ph.D., chief medical officer, AbbVie. "The positive results
from the VIALE-A study underscore the significant impact venetoclax
plus azacitidine can have on improved survival and complete
response in a previously-untreated patient population."
The randomized, double-blind, placebo-controlled, Phase 3
VIALE-A trial evaluated the efficacy and safety of venetoclax
in combination with azacitidine in patients with AML who are
ineligible for standard induction therapy. The study met its
primary endpoints of statistically significant improvement of OS
and composite complete remission rate (CR + CRi). OS was the sole
primary endpoint in the U.S. and U.S. reference countries, and OS
and CR + CRi were co-primary endpoints in China, Japan,
the European Union (EU) and EU reference countries.
"AML is a challenging blood cancer marked by low survival rates
– especially among older patients who are not eligible for
intensive induction chemotherapy – which leaves them with few
treatment options," said Courtney D.
DiNardo, M.D., MSCE, Department of Leukemia, Division of
Cancer Medicine at MD Anderson and the lead study investigator.
"The VIALE-A results provide further insights in venetoclax to
significantly extend overall survival and achieve better response
rates than azacitidine alone. Venetoclax in combination with
azacitidine is an effective therapeutic approach for
previously-untreated AML in patients who cannot withstand
chemotherapy."
The study also met secondary endpoints, with the venetoclax
combination arm resulting in a CR rate of 36.7 percent, a CR with
partial hematologic recovery (CRh) rate of 64.7 percent and a
composite complete remission rate (CR + CRi) of 66.4 percent,
compared to 17.9 percent CR, 22.8 percent CRh and 28.3 percent CR +
CRi in the placebo arm.
The observed safety profile is generally consistent with the
known safety profiles of venetoclax combined with azacitidine and
the known safety profiles of the two medications alone. The most
common (occurring in >10 percent of patients) grade 3/4 adverse
events in patients receiving venetoclax plus azacitidine were
thrombocytopenia (45 percent), neutropenia (42 percent), febrile
neutropenia (42 percent), anemia (26 percent), leukopenia (21
percent), pneumonia (20 percent) and hypokalemia (11 percent).
AML is the most common acute leukemia in the
world.2 An estimated 160,000 people are currently
living with the disease globally with an incidence rate of 103 new
cases per 100,000 people.2 It is also among the most
difficult blood cancers to treat.3 Despite advances
in available therapies and care, the five-year survival rate for
patients diagnosed with AML remains approximately 28
percent.4 AML typically worsens quickly, and due to
age and comorbidities, not all patients can tolerate intensive
induction chemotherapy.5
In November 2018, AbbVie received
accelerated approval in the U.S. for venetoclax in combination with
azacitidine, decitabine, or low-dose cytarabine (LDAC) for the
treatment of newly-diagnosed AML in adults who are age 75 years or
older, or who have comorbidities that preclude use of intensive
induction chemotherapy. Approval was also granted in Mexico, Israel, Puerto
Rico, Peru, Brazil, Russia, Argentina, Guatemala, Uruguay, Lebanon, Bahrain, Kazakhstan, Panama, Saudi
Arabia, Taiwan,
Australia, Qatar, United Arab
Emirates and Belarus.
Venetoclax 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.
About the VIALE-A (M15-656) Phase 3 Trial
A total of 433 treatment-naïve, intensive chemotherapy ineligible
AML patients were randomized in the double-blind,
placebo-controlled Phase 3 VIALE-A trial. The trial was designed to
evaluate the efficacy and safety of venetoclax in combination with
azacitidine (n=286) compared with placebo in combination with
azacitidine (n=145).6
About VENCLEXTA®/VENCLYXTO® (venetoclax)
VENCLEXTA®/VENCLYXTO® (venetoclax) is a first-in-class medicine
that selectively binds and inhibits the B-cell lymphoma-2 (BCL-2)
protein. In some blood cancers, BCL-2 prevents cancer cells from
undergoing their natural death or self-destruction process, called
apoptosis. VENCLEXTA/VENCLYXTO targets the BCL-2 protein and works
to help restore the process of apoptosis.
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 and to
studying venetoclax in clinical trials across several blood and
other cancers. VENCLEXTA/VENCLYXTO is approved in more than 50
countries, including the U.S.
Uses and Important VENCLEXTA® (venetoclax) U.S. Safety
Information7
Uses
VENCLEXTA is a prescription medicine used:
- to treat adults with chronic lymphocytic leukemia (CLL) or
small lymphocytic lymphoma (SLL).
- in combination with azacitidine, or decitabine, or low-dose
cytarabine to treat adults with newly-diagnosed acute myeloid
leukemia (AML) who:
-
- are 75 years of age or older, or
- have other medical conditions that prevent the use of standard
chemotherapy.
This indication is approved under accelerated approval based on
response rates. Continued approval for this indication may be
contingent upon verification and description of clinical benefit in
confirmatory trials
It is not known if VENCLEXTA is safe and effective in
children.
Important 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 healthcare
provider will do tests to check your risk of getting TLS before you
start taking VENCLEXTA. 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. Your healthcare provider will do blood tests to
check for TLS when you first start treatment and during treatment
with VENCLEXTA. It is important to keep your appointments for blood
tests. Tell your healthcare provider 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 during treatment with 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.
Your healthcare provider may delay, decrease your dose, or stop
treatment with VENCLEXTA if you have side effects.
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
because of the risk of increased TLS.
- Tell your healthcare provider 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 healthcare provider.
Before taking VENCLEXTA, tell your healthcare provider 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 healthcare provider tells you it is okay. If you are not
sure about the type of immunization or vaccine, ask your healthcare
provider. 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
healthcare provider should do a pregnancy test before you start
treatment with VENCLEXTA, and you should use effective birth
control during treatment and for at least 30 days after the last
dose of VENCLEXTA. If you become pregnant or think you are
pregnant, tell your healthcare provider right away.
- 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 counts (neutropenia). Low white
blood cell counts are common with VENCLEXTA, but can also be
severe. Your healthcare provider will do blood tests to check your
blood counts during treatment with VENCLEXTA.
- Infections. Death and serious infections such as
pneumonia and blood infection (sepsis) have happened during
treatment with VENCLEXTA. Your healthcare provider will closely
monitor and treat you right away if you have a fever or any signs
of infection during treatment with VENCLEXTA.
Tell your healthcare provider right away if you have a fever or
any signs of an infection during treatment with VENCLEXTA.
The most common side effects of VENCLEXTA when used in
combination with obinutuzumab or rituximab or alone in people with
CLL or SLL include low white blood cell counts; low
platelet counts; low red blood cell counts; diarrhea; nausea; upper
respiratory tract infection; cough; muscle and joint pain;
tiredness; and swelling of your arms, legs, hands, and feet.
The most common side effects of VENCLEXTA in combination with
azacitidine or decitabine or low-dose cytarabine in people with AML
include low white blood cell counts; nausea; diarrhea; low
platelet counts; constipation; fever with low white blood cell
counts; low red blood cell counts; infection in blood; rash;
dizziness; low blood pressure; fever; swelling of your arms, legs,
hands, and feet; vomiting; tiredness; shortness of breath;
bleeding; infection in lung; stomach (abdominal) pain; pain in
muscles or back; cough; and sore throat.
VENCLEXTA may cause fertility problems in males. This may affect
your ability to father a child. Talk to your healthcare provider if
you have concerns about fertility.
These are not all the possible side effects of VENCLEXTA. For
more information, ask your healthcare provider or pharmacist.
You are encouraged to report negative side effects of
prescription drugs to the FDA.
Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
If you cannot afford your medication,
contact www.medicineassistancetool.org for
assistance.
The full U.S. prescribing information, including Medication
Guide, for VENCLEXTA can be
found here.
Indication and Important VENCLYXTO (venetoclax) EU Safety
Information8
Indication
Venclyxto in combination with obinutuzumab is indicated for the
treatment of adult patients with previously untreated chronic
lymphocytic leukaemia (CLL).
Venclyxto in combination with rituximab is indicated for the
treatment of adult patients with CLL who have received at least one
prior therapy.
Venclyxto monotherapy is indicated for the treatment of 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, or
- In the absence of 17p deletion or TP53 mutation in adult
patients who have failed both chemoimmunotherapy and a B-cell
receptor pathway inhibitor.
Contraindications
Hypersensitivity to the active substance or to any of the
excipients is contraindicated. Concomitant use of strong
CYP3A inhibitors at initiation and during the dose-titration phase
due to increased risk for tumor lysis syndrome (TLS). Concomitant
use of preparations containing St. John's wort as
VENCLYXTO efficacy may be reduced.
Special Warnings & Precautions for Use
TLS, including fatal events, has occurred in patients with
previously treated CLL with high tumour 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, monitoring, and management for TLS.
Neutropenia (grade 3 or 4) has been reported and complete blood
counts should be monitored throughout the treatment
period.
Serious infections including sepsis with fatal outcome have been
reported. Monitoring of any signs and symptoms of infection is
required. Suspected infections should receive prompt
treatment including antimicrobials and dose interruption or
reduction as appropriate.
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: moderate or strong
CYP3A inhibitors must be used, physicians should refer to the
VENCLYXTO summary of product characteristics (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 coadministration 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 in patients receiving venetoclax in the combination studies
with obinutuzumab or rituximab were neutropenia, diarrhoea, and
upper respiratory tract infection. In the monotherapy
studies, the most common adverse reactions were
neutropenia/neutrophil count decreased, diarrhoea, nausea, anaemia,
fatigue, and upper respiratory tract infection.
The most frequently occurring serious adverse reactions
(>=2%) in patients receiving venetoclax in combination with
obinutuzumab or rituximab were pneumonia, sepsis, febrile
neutropenia, and TLS. In the monotherapy studies, the most
frequently reported serious adverse reactions (>=2%) were
pneumonia and febrile neutropenia.
Discontinuations due to adverse reactions occurred in 16% of
patients treated with venetoclax in combination with obinutuzumab
or rituximab in the CLL14 and Murano studies respectively. In
the monotherapy studies with venetoclax, 11% of patients
discontinued due to adverse reactions.
Dosage reductions due to adverse reactions occurred in 21% of
patients treated with the combination of venetoclax and
obinutuzumab in CLL14 and in 15% of patients treated with the
combination of venetoclax and in Murano and in 14% of patients
treated with venetoclax in the monotherapy studies. The most
common adverse reaction that led to dose interruptions was
neutropenia.
Specific Populations
Patients with reduced renal function (CrCl <80 mL/min) may
require more intensive prophylaxis and monitoring to reduce the
risk of TLS. Safety in patients with severe renal impairment
(CrCl <30 mL/min) or on dialysis has not been established, and a
recommended dose for these patients has not been determined.
For patients with severe (Child-Pugh C) hepatic
impairment, a dose reduction of at least 50% throughout treatment
is recommended.
VENCLYXTO may cause embryo-fetal harm when administered to a
pregnant woman. Advise nursing women to discontinue breastfeeding
during treatment.
This is not a complete summary of all safety information. See
VENCLYXTO full summary of product characteristics (SmPC)
at https://www.ema.europa.eu/en/documents/product-information/venclyxto-epar-product-information_en.pdf.
Globally, prescribing information varies; refer to the
individual country product label for complete information.
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. AbbVie's
oncology portfolio now consists of marketed medicines and a
pipeline containing multiple new molecules being evaluated
worldwide in more than 300 clinical trials and more than 20
different tumor types. For more information, please
visit http://www.abbvie.com/oncology.
About AbbVie
AbbVie's mission is to discover and deliver innovative medicines
that solve serious health issues today and address the medical
challenges of tomorrow. We strive to have a remarkable impact on
people's lives across several key therapeutic areas: immunology,
oncology, neuroscience, eye care, virology, women's health and
gastroenterology, in addition to products and services across its
Allergan Aesthetics portfolio. For more information about AbbVie,
please visit us at www.abbvie.com. Follow @abbvie on
Twitter, Facebook, Instagram, YouTube and
LinkedIn.
Forward-Looking Statements
Some statements in this news release are, or may be considered,
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, competition from
other products, challenges to intellectual property, 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 2019 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.
1 DiNardo, C.D., Jonas, B.A., et al. A
Randomized, Double-Blind, Placebo-Controlled Study of Venetoclax
With Azacitidine Vs. Azacitidine In Treatment-Naïve Patients with
Acute Myeloid Leukemia Ineligible For Intensive Therapy: The Phase
3 VIALE-A Trial. (2020).
https://library.ehaweb.org/eha/2020/eha25th/303390/courtney.dinardo.a.randomized.double-blind.placebo-controlled.study.of.html?f=menu%3D6%2Abrowseby%3D8%2Asortby%3D2%2Amedia%3D3%2Ace_id%3D1766%2Aces_id%3D27014%2Amarker%3D794%2Afeatured%3D16775
2 Puty, T.C., Sarraf, J.S., Do Carmo Almeida, T.C. et
al. Evaluation of the impact of single-nucleotide polymorphisms on
treatment response, survival and toxicity with cytarabine and
anthracyclines in patients with acute myeloid leukaemia: a
systematic review protocol. Syst Rev 8, 109 (2019).
3 American Cancer Society (2018). Typical Treatment
of Most Types of Acute Myeloid Leukemia (Except Acute Promyelocytic
M3). https://www.cancer.org/cancer/acute-myeloid-leukemia/treating/typical-treatment-of-aml.html.
4 National Cancer Institute (2018). Acute Myeloid
Leukemia - SEER Stat Fact
Sheets. https://seer.cancer.gov/statfacts/html/amyl.html.
5 Pettit, K and Odenike, O. Defining and Treating
Older Adults with Acute Myeloid Leukemia Who Are Ineligible for
Intensive Therapies. Front Oncol. 2015; 5:250.
6 ClinicalTrials.gov (2019). NCT02993523: A Study
of Venetoclax in Combination With Azacitidine Versus Azacitidine in
Treatment Naïve Subjects With Acute Myeloid Leukemia Who Are
Ineligible for Standard Induction Therapy.
https://clinicaltrials.gov/ct2/show/NCT02993523.
7 VENCLEXTA (venetoclax) [Package Insert].
North Chicago, IL.: AbbVie
Inc.
8 Summary of Product Characteristics for VENCLYXTO
(venetoclax). Ludwigshafen, Germany: AbbVie Deutschland GmbH
& Co. KG.
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