Bristol Myers Squibb (NYSE: BMY) today announced the
presentation of data across its oncology portfolio and pipeline at
the 2025 American Society of Clinical Oncology (ASCO®) Annual
Meeting to be held May 30-June 3 in Chicago, Illinois. Data from
more than 80 company-sponsored studies, investigator-sponsored
studies, and collaborations showcase results spanning more than 20
cancer types.
“Bristol Myers Squibb is advancing novel approaches to address
high unmet needs in cancer and at this year’s ASCO meeting, we are
highlighting data across a range of assets, including our targeted
therapy pipeline, and new data that support the use of our
portfolio in earlier lines of treatment, enhancing or improving
patient outcomes,” said Samit Hirawat, M.D., executive vice
president, chief medical officer, head of development, Bristol
Myers Squibb. “We are a company that has redefined the cancer care
landscape and we are leveraging our deep expertise, combined with
innovative technologies and modalities, to deliver new medicines
and breakthrough advances for patients.”
Key data to be presented by Bristol Myers Squibb and its
collaborators at ASCO include:
Highlighting our leading portfolio with long-term survival
data and intervention earlier in the treatment of disease
- Results from the independent Phase 3 randomized NIVOPOSTOP
(GORTEC 2018-01) study evaluating adjuvant nivolumab added to
radio-chemotherapy in patients with resected head and neck squamous
cell carcinoma (HNSCC) at high risk of relapse will be presented
during the plenary session of the meeting
- Late-breaking 5-year analysis of overall survival (OS), a key
secondary endpoint, in the Phase 3 CheckMate -816 study of Opdivo®
(nivolumab) in combination with chemotherapy as a neoadjuvant
treatment for resectable (tumors ≥4 cm or node positive) non-small
cell lung cancer (NSCLC) compared to chemotherapy alone
- Late-breaking data highlighting updated survival results and an
exploratory biomarker analysis from the Phase 3 CheckMate -77T
study evaluating the perioperative treatment with neoadjuvant
Opdivo in combination with chemotherapy followed by surgery and
adjuvant single-agent Opdivo for certain patients with resectable
NSCLC
- 5-year OS results from the Phase 3 CheckMate -577 study
evaluating adjuvant Opdivo in adult patients with completely
resected esophageal or gastroesophageal junction cancer who have
residual disease following neoadjuvant chemoradiotherapy (CRT)
- First disclosure of OS results and updated duration of response
(DoR) data from the Phase 3 COMMANDS study evaluating the benefit
of Reblozyl® (luspatercept-aamt) vs. epoetin alfa (EA) for
transfusion independence (TI) in erythropoiesis stimulating agent
(ESA)-naive patients with very low-, low-, or intermediate-risk
myelodysplastic syndromes (MDS)
Advancing our oncology pipeline
- Updated safety and efficacy results from the first-in-human
Phase 1/2 CA240-0007 study evaluating BMS-986504, a potential
first-in-class MTA-cooperative PRMT5 inhibitor, in heavily
pretreated patients with advanced, unresectable or metastatic solid
tumors with homozygous MTAP deletions
- OS, progression free survival (PFS) and overall response rate
(ORR) data from the Phase 2 KRYSTAL-7 study evaluating first-line
KRAZATI® (adagrasib) plus pembrolizumab for the treatment of
advanced/metastatic KRASG12C-mutated NSCLC, regardless of PD-L1
status
- Results from two Phase 1 studies of EGFR x HER3 bispecific
antibody-drug conjugate, iza-bren (BL-B01D1), in patients with
locally advanced or metastatic small cell lung cancer (SCLC) and in
patients with locally advanced or metastatic NSCLC with driver
genomic alterations (GA) outside of classic EGFR mutations
Furthering the science of cell therapy
- Analysis of cytokine release syndrome (CRS) and immune effector
cell-associated neurotoxicity syndrome (ICANS) timing in over 1,500
patients treated with Breyanzi® (lisocabtagene maraleucel;
liso-cel) in clinical trials and real-world experience across
indications of B-cell non-Hodgkin lymphoma providing a more precise
window into the onset and duration of CRS/ICANS for patient
management after CAR T cell treatment
- Assessment of normal plasma cell biomarkers after arlocabtagene
autoleucel (arlo-cel) treatment in patients with ≥3L relapsed or
refractory multiple myeloma suggesting preservation of the humoral
immune system when targeting the GPRC5D antigen
Summary of Presentations: Select Bristol Myers Squibb
studies at the 2025 ASCO Annual Meeting include: (all times
in Central Time)
Abstract Title
Author
Presentation Type/#
Session Title
Session Date/Time (CDT)
Bladder Cancer
Nivolumab plus ipilimumab (NIVO+IPI) vs
gemcitabine-carboplatin (gem-carbo) chemotherapy for previously
untreated unresectable or metastatic urothelial carcinoma (mUC):
final results for cisplatin-ineligible patients from the CheckMate
901 trial
Michiel S. van der Heijden
Oral
Abstract #4500
Genitourinary Cancer—Kidney and
Bladder
Sunday, June 1, 2025
9:45 AM – 12:45 PM
Chronic Lymphocytic Leukemia
(CLL)
Propensity score (PS) comparison between
lisocabtagene maraleucel (liso-cel) plus ibrutinib combination
therapy (combo) and liso-cel monotherapy (mono) cohorts from
TRANSCEND CLL
William Wierda
Poster
Abstract #7037
Hematologic Malignancies—Lymphoma and
Chronic Lymphocytic Leukemia
Sunday, June 1, 2025
9:00 AM – 12:00 PM
Comparison of outcomes for patients (pts)
with R/R chronic lymphocytic leukemia (CLL)/small lymphocytic
lymphoma (SLL) previously treated with Bruton tyrosine kinase
inhibitor (BTKi) and venetoclax from the TRANSCEND CLL 004 study
versus a matched cohort of real-world (RW) pts
William Wierda
Poster
Abstract #7039
Hematologic Malignancies—Lymphoma and
Chronic Lymphocytic Leukemia
Sunday, June 1, 2025
9:00 AM – 12:00 PM
Colorectal Cancer (CRC)
Nivolumab (NIVO) plus ipilimumab (IPI) vs
chemotherapy (chemo) or NIVO monotherapy for microsatellite
instability-high/mismatch repair-deficient (MSI-H/dMMR) metastatic
colorectal cancer (mCRC): expanded analyses from CheckMate 8HW
Heinz-Josef Lenz
Oral
Abstract #3501
Gastrointestinal Cancer–Colorectal and
Anal
Friday, May 30, 2025
2:45 PM – 5:45 PM
Esophageal Cancer (EC) and
Gastrointestinal Cancer (GC)
Adjuvant nivolumab in resected esophageal
or gastroesophageal junction cancer (EC/GEJC) following neoadjuvant
chemoradiotherapy (CRT): final analysis of overall survival (OS)
from CheckMate 577
Ronan J. Kelly
Oral
Abstract #4000
Gastrointestinal Cancer—Gastroesophageal,
Pancreatic, and Hepatobiliary
Saturday, May 31, 2025
3:00 PM – 6:00 PM
Hepatocellular Carcinoma (HCC)
Real-world outcomes of first-line
therapies for unresectable hepatocellular carcinoma in the
United States
Masafumi
Ikeda
Poster
Abstract #4079
Gastrointestinal Cancer—Gastroesophageal,
Pancreatic, and Hepatobiliary
Saturday, May 31, 2025
9:00 AM – 12:00 PM
Melanoma
Randomized dose evaluation of nivolumab +
relatlimab (NIVO + RELA) in patients (pts) with advanced
melanoma: results from RELATIVITY-020
Georgina V. Long
Poster
Abstract #9526
Melanoma/Skin Cancers,
Advanced/Metastatic Disease
Sunday, June 1, 2025
9:00 AM – 12:00 PM
Real-world comparison of survival with
nivolumab (NIVO) + relatlimab (RELA) vs NIVO + ipilimumab (IPI) in
advanced melanoma
Michael A. Postow
Poster
Abstract #9527
Melanoma/Skin Cancers;
Advanced/Metastatic Disease
Sunday, June 1, 2025
9:00 AM – 12:00 PM
Efficacy and safety of first-line (1L)
nivolumab plus relatlimab (NIVO + RELA) versus NIVO plus ipilimumab
(NIVO + IPI) in advanced melanoma: an updated indirect treatment
comparison (ITC) with 4-year follow-up data
Dirk Schadendorf
Poster
Abstract #9554
Melanoma/Skin Cancers,
Advanced/Metastatic Disease
Sunday, June 1, 2025
9:00 AM – 12:00 PM
RELATIVITY-020: Intracranial (IC) activity
of nivolumab + relatlimab (NIVO + RELA) in patients (pts) with
PD-(L)1 refractory melanoma with melanoma brain metastases
(MBM)
Hussein A. Tawbi
Poster
Abstract #9525
Melanoma/Skin Cancers,
Advanced/Metastatic Disease
Sunday, June 1, 2025
9:00 AM – 12:00 PM
Multiple Myeloma (MM)
Assessment of normal plasma cell
biomarkers after arlocabtagene autoleucel (arlo-cel) treatment in
patients with ≥3L relapsed refractory multiple myeloma (MM)
Kristina Jordahl
Poster
Abstract #7530
Hematologic Malignancies—Plasma Cell
Dyscrasia
Sunday, June 1, 2025
9:00 AM – 12:00 PM
QUINTESSENTIAL-2: A phase 3 study
comparing efficacy and safety of arlocabtagene autoleucel
(arlo-cel) versus standard regimens in adult patients with relapsed
or refractory multiple myeloma (RRMM) refractory to
lenalidomide
Rakesh Popat
Poster
Abstract # TPS7564
Hematologic Malignancies—Plasma Cell
Dyscrasia
Sunday, June 1, 2025
9:00 AM – 12:00 PM
QUINTESSENTIAL: A multicenter phase 2
study evaluating the efficacy and safety of arlocabtagene
autoleucel (arlo-cel) in triple- and quad-class exposed patients
with relapsed or refractory multiple myeloma (RRMM)
Krina Patel
Poster
Abstract # TPS7563
Hematologic Malignancies—Plasma Cell
Dyscrasia
Sunday, June 1, 2025
9:00 AM – 12:00 PM
Iberdomide, bortezomib, and dexamethasone
(IberVd) in transplant-ineligible (TNE) newly diagnosed multiple
myeloma (NDMM): updated results from the CC-220-MM-001 trial
Darrell White
Poster
Abstract #7532
Hematologic Malignancies—Plasma Cell
Dyscrasia
Sunday, June 1, 2025
9:00 AM – 12:00 PM
Myelodysplastic Syndromes (MDS)
Overall survival (OS) and duration of
response for transfusion independence (TI) in erythropoiesis
stimulating agent (ESA)–naive patients (pts) with very low-, low-,
or intermediate-risk myelodysplastic syndromes (MDS) treated with
luspatercept (LUSPA) vs epoetin alfa (EA) in the COMMANDS trial
Guillermo Garcia-Manero
Rapid Oral
Abstract #6512
Hematologic Malignancies—Leukemia,
Myelodysplastic Syndromes, and Allotransplant
Friday, May 30, 2025
1:00 PM – 2:30 PM
Real-world (RW) outcomes of patients (pts)
with lower-risk myelodysplastic syndrome (LR-MDS) receiving
first-line (1L) luspatercept (LUSPA) or 1L
erythropoiesis-stimulating agents (ESA) in the US
Idoroenyi Amanam
Poster
Abstract #6570
Hematologic Malignancies—Leukemia,
Myelodysplastic Syndromes, and Allotransplant
Sunday, June 1, 2025
9:00 AM – 12:00 PM
Non-Hodgkin Lymphoma (includes DLBCL,
LBCL, FL, MCL, etc.)
Matching-adjusted indirect comparison
(MAIC) of lisocabtagene maraleucel (liso-cel) versus axicabtagene
ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel) for treatment
of third-line or later (3L+) R/R follicular lymphoma (FL): update
with 24 months of liso-cel follow-up (FU)
Alexander P. Boardman
Publication Only
Abstract # e19049
Publication Only: Hematologic
Malignancies—Lymphoma and Chronic Lymphocytic Leukemia
Thursday, May 22, 2025
Optimizing post–chimeric antigen receptor
(CAR) T cell monitoring: evidence across lisocabtagene maraleucel
(liso-cel) pivotal clinical trials and real-world experience
Manali Kamdar
Poster
Abstract #7026
Hematologic Malignancies—Lymphoma and
Chronic Lymphocytic Leukemia
Sunday, June 1, 2025
9:00 AM – 12:00 PM
Postmarketing safety profile of chimeric
antigen receptor (CAR) T cell therapies in diffuse large B-cell
lymphoma (DLBCL): analysis of real-world (RW) AE reporting from the
FDA Adverse Event Reporting System (FAERS)
Matthew Lunning
Poster
Abstract #7028
Hematologic Malignancies—Lymphoma and
Chronic Lymphocytic Leukemia
Sunday, June 1, 2025
9:00 AM – 12:00 PM
Non-Small Cell Lung Cancer (NSCLC),
Small Cell Lung Cancer (SCLC) and Thoracic Cancers
NIVOPOSTOP (GORTEC 2018-01): A phase III
randomized trial of adjuvant nivolumab added to radio-chemotherapy
in patients with resected head and neck squamous cell carcinoma at
high risk of relapse
Jean Bourhis
Oral
Abstract #LBA2
Plenary Session
Sunday, June 1, 2025
1:00 PM – 4:00 PM
Perioperative nivolumab (NIVO) vs placebo
(PBO) in patients with resectable non–small cell lung cancer
(NSCLC): updated survival and biomarker analyses from CheckMate
77T
Tina Cascone
Rapid Oral
Abstract # LBA8010
Lung Cancer—Non-Small Cell
Local-Regional/Small Cell/Other Thoracic Cancers
Sunday, June 1, 2025
4:30 PM – 6:00 PM
Overall survival with neoadjuvant
nivolumab (NIVO) + chemotherapy (chemo) in patients with resectable
NSCLC in CheckMate 816
Patrick M. Forde
Oral
Abstract # LBA8000
Lung Cancer—Non-Small Cell
Local-Regional/Small Cell/Other Thoracic Cancers
Monday, June 2, 2025
3:00 PM – 6:00 PM
First-line adagrasib (ADA) with
pembrolizumab (PEMBRO) in patients (pts) with advanced/metastatic
KRASG12C-mutated non-small cell lung cancer (NSCLC) from the phase
2 portion of the KRYSTAL-7 study
Pasi A. Jänne
Oral
Abstract #8500
Lung Cancer—Non-Small Cell Metastatic
Sunday, June 1, 2025
8:00 AM – 11:00 AM
Phase I study of iza-bren (BL-B01D1), an
EGFR x HER3 Bispecific Antibody-drug Conjugate (ADC), in Patients
with Locally Advanced or Metastatic Small Cell Lung Cancer
(SCLC)
Yan Huang
Oral
Abstract #3002
Developmental Therapeutics—Molecularly
Targeted Agents and Tumor Biology
Friday,
May 30, 2025
2:45 PM – 5:45 PM
Unraveling relatlimab (RELA)-specific
biology: Biomarker analyses in patients (pts) with metastatic
non-small cell lung cancer (mNSCLC) treated with 1L nivolumab
(NIVO) + RELA high-dose (HD) and platinum-doublet chemotherapy
(PDCT)
Martin Reck
Poster
Abstract #8527
Lung Cancer—Non-Small Cell Metastatic
Saturday, May 31, 2025
1:30 PM – 4:30 PM
Phase I study of iza-bren (BL-B01D1), an
EGFR x HER3 Bispecific Antibody-drug Conjugate (ADC), in Patients
with Locally Advanced or Metastatic Non-Small Cell Lung Cancer
(NSCLC) with Driver Genomic Alterations (GA) outside of Classic
EGFR Mutations
Yunpeng Yang
Oral
Abstract #3001
Developmental Therapeutics—Molecularly
Targeted Agents and Tumor Biology
Friday, May 30, 2025
2:45 PM – 5:45 PM
Pan-Tumor
BMS-986504 in patients (pts) with advanced
solid tumors with homozygous MTAP deletion (MTAP-del): clinical
update and first report of pharmacokinetics (PK) and
pharmacodynamic (PD) analyses from CA240-0007
Kathryn C. Arbour
Rapid Oral
Abstract #3011
Developmental Therapeutics— Molecularly
Targeted Agents and Tumor Biology
Monday, June 2, 2025
8:00 AM – 9:30 AM
Zanzalintinib (zanza) + nivolumab (nivo) ±
relatlimab (rela) in patients (pts) with advanced solid tumors:
results from two dose-escalation cohorts of the phase 1b STELLAR
002 study
Benjamin Garmezy
Poster
Abstract #3101
Developmental Therapeutics—Molecularly
Targeted Agents and Tumor Biology
Monday, June 2, 2025
1:30 PM – 4:30 PM
BMS-986504 in patients (pts) with advanced
solid tumors with homozygous MTAP deletion (MTAP-del): Clinical
update and first report of pharmacokinetics (PK) and
pharmacodynamic (PD) analyses from CA240-0007
Kathryn Arbour
Rapid Oral
Abstract #3011
Developmental Therapeutics— Molecularly
Targeted Agents and Tumor Biology
Monday, June 2, 2025
8:00 AM – 9:30 AM
Experiences and preferences of cancer
survivors across the immunotherapy journey
Shelley Fuld Nasso
Poster
Abstract #1635
Care Delivery/Models of Care
Sunday, June 1, 2025
9:00 AM – 12:00 PM
Prostate Cancer
A phase 3 trial of the androgen receptor
ligand-directed degrader (AR LDD), BMS-986365, versus
investigator’s choice in patients with metastatic
castration-resistant prostate cancer (CA071-1000 - rechARge)
Kim Nguyen Chi
Poster (TiP)
Abstract # TPS5119
Genitourinary Cancer—Prostate, Testicular,
and Penile
Monday, June 2, 2025
9:00 AM – 12:00 PM
Renal Cell Carcinoma (RCC)
Zanzalintinib (zanza) + nivolumab (nivo) ±
relatlimab (rela) in patients (pts) with previously untreated clear
cell renal cell carcinoma (ccRCC): results from an expansion cohort
of the phase 1b STELLAR-002 study
Jad Chahoud
Rapid Oral
Abstract #4515
Genitourinary Cancer—Kidney and
Bladder
Saturday, May 31, 2025
1:15 PM – 2:45 PM
Baseline radiological tumor burden to
sub-stratify IMDC risk groups in metastatic renal cell carcinoma
treated with first-line therapy: A post hoc analysis from a
randomized phase III trial
Rashad Nawfal
Poster
Abstract #4544
Genitourinary Cancer—Kidney and
Bladder
Monday, June 2, 2025
9:00 AM – 12:00 PM
An integrative analysis of circulating and
tumor microenvironment (TME) determinants of patient response in
the Checkmate 9ER (CM 9ER) trial of nivolumab and cabozantinib
(NIVO+CABO) in advanced renal cell carcinoma (aRCC)
David A. Braun
Clinical Science Symposium
Abstract #4511
Biomarkers in Kidney Cancer: Are We There
Yet?
Saturday, May 31, 2025
4:30 PM – 6:00 PM
Nivolumab plus ipilimumab vs sunitinib for
first-line treatment of advanced renal cell carcinoma: final
analysis from the phase 3 CheckMate 214 trial
Toni K. Choueiri
Oral
Abstract #4505
Genitourinary Cancer—Kidney and
Bladder
Sunday, June 1, 2025
9:45 AM – 12:45 PM
OPDIVO
INDICATIONS
OPDIVO® (nivolumab), as a single agent, is indicated for the
treatment of adult and pediatric patients 12 years and older with
unresectable or metastatic melanoma.
OPDIVO® (nivolumab), in combination with YERVOY® (ipilimumab),
is indicated for the treatment of adult and pediatric patients 12
years and older with unresectable or metastatic melanoma.
OPDIVO® is indicated for the adjuvant treatment of adult and
pediatric patients 12 years and older with completely resected
Stage IIB, Stage IIC, Stage III, or Stage IV melanoma.
OPDIVO® (nivolumab), in combination with platinum-doublet
chemotherapy, is indicated as neoadjuvant treatment of adult
patients with resectable (tumors ≥4 cm or node positive) non-small
cell lung cancer (NSCLC).
OPDIVO® (nivolumab) in combination with platinum-doublet
chemotherapy, is indicated for neoadjuvant treatment of adult
patients with resectable (tumors ≥4 cm or node positive) non-small
cell lung cancer (NSCLC) and no known epidermal growth factor
receptor (EGFR) mutations or anaplastic lymphoma kinase (ALK)
rearrangements, followed by single-agent OPDIVO® as adjuvant
treatment after surgery.
OPDIVO® (nivolumab), in combination with YERVOY® (ipilimumab),
is indicated for the first-line treatment of adult patients with
metastatic non-small cell lung cancer (NSCLC) whose tumors express
PD-L1 (≥1%) as determined by an FDA-approved test, with no EGFR or
ALK genomic tumor aberrations.
OPDIVO® (nivolumab), in combination with YERVOY® (ipilimumab)
and 2 cycles of platinum-doublet chemotherapy, is indicated for the
first-line treatment of adult patients with metastatic or recurrent
non-small cell lung cancer (NSCLC), with no EGFR or ALK genomic
tumor aberrations.
OPDIVO® (nivolumab) is indicated for the treatment of adult
patients with metastatic non-small cell lung cancer (NSCLC) with
progression on or after platinum-based chemotherapy. Patients with
EGFR or ALK genomic tumor aberrations should have disease
progression on FDA-approved therapy for these aberrations prior to
receiving OPDIVO.
OPDIVO® (nivolumab), in combination with YERVOY® (ipilimumab),
is indicated for the first-line treatment of adult patients with
unresectable malignant pleural mesothelioma (MPM).
OPDIVO® (nivolumab), in combination with YERVOY® (ipilimumab),
is indicated for the first-line treatment of adult patients with
intermediate or poor risk advanced renal cell carcinoma (RCC).
OPDIVO® (nivolumab), in combination with cabozantinib, is
indicated for the first-line treatment of adult patients with
advanced renal cell carcinoma (RCC).
OPDIVO® (nivolumab) is indicated for the treatment of adult
patients with advanced renal cell carcinoma (RCC) who have received
prior anti-angiogenic therapy.
OPDIVO® (nivolumab) is indicated for the treatment of adult
patients with classical Hodgkin lymphoma (cHL) that has relapsed or
progressed after autologous hematopoietic stem cell transplantation
(HSCT) and brentuximab vedotin or after 3 or more lines of systemic
therapy that includes autologous HSCT. This indication is approved
under accelerated approval based on overall response rate.
Continued approval for this indication may be contingent upon
verification and description of clinical benefit in confirmatory
trials.
OPDIVO® (nivolumab) is indicated for the treatment of adult
patients with recurrent or metastatic squamous cell carcinoma of
the head and neck (SCCHN) with disease progression on or after
platinum-based therapy.
OPDIVO® (nivolumab) is indicated for the treatment of adult
patients with locally advanced or metastatic urothelial carcinoma
who have disease progression during or following
platinum-containing chemotherapy or have disease progression within
12 months of neoadjuvant or adjuvant treatment with
platinum-containing chemotherapy.
OPDIVO® (nivolumab), as a single agent, is indicated for the
adjuvant treatment of adult patients with urothelial carcinoma (UC)
who are at high risk of recurrence after undergoing radical
resection of UC.
OPDIVO® (nivolumab), in combination with cisplatin and
gemcitabine, is indicated as first-line treatment for adult
patients with unresectable or metastatic urothelial carcinoma.
OPDIVO® (nivolumab), in combination with YERVOY® (ipilimumab),
is indicated for the treatment of adult and pediatric patients 12
years and older with unresectable or metastatic microsatellite
instability-high (MSI-H) or mismatch repair deficient (dMMR)
colorectal cancer (CRC).
OPDIVO® (nivolumab), as a single agent, is indicated for the
treatment of adult and pediatric patients 12 years and older with
metastatic microsatellite instability-high (MSI-H) or mismatch
repair deficient (dMMR) colorectal cancer (CRC) that has progressed
following treatment with a fluoropyrimidine, oxaliplatin, and
irinotecan.
OPDIVO® (nivolumab), in combination with YERVOY® (ipilimumab),
is indicated for the first-line treatment of adult patients with
unresectable or metastatic hepatocellular carcinoma (HCC).
OPDIVO® (nivolumab), in combination with YERVOY® (ipilimumab),
is indicated for the treatment of adult patients with unresectable
or metastatic hepatocellular carcinoma (HCC) who have been
previously treated with sorafenib.
OPDIVO® (nivolumab) is indicated for the treatment of adult
patients with unresectable advanced, recurrent or metastatic
esophageal squamous cell carcinoma (ESCC) after prior
fluoropyrimidine- and platinum-based chemotherapy.
OPDIVO® (nivolumab) is indicated for the adjuvant treatment of
completely resected esophageal or gastroesophageal junction cancer
with residual pathologic disease in adult patients who have
received neoadjuvant chemoradiotherapy (CRT).
OPDIVO® (nivolumab), in combination with fluoropyrimidine- and
platinum-containing chemotherapy, is indicated for the first-line
treatment of adult patients with unresectable advanced or
metastatic esophageal squamous cell carcinoma (ESCC).
OPDIVO® (nivolumab), in combination with YERVOY® (ipilimumab),
is indicated for the first-line treatment of adult patients with
unresectable advanced or metastatic esophageal squamous cell
carcinoma (ESCC).
OPDIVO® (nivolumab), in combination with fluoropyrimidine- and
platinum-containing chemotherapy, is indicated for the treatment of
adult patients with advanced or metastatic gastric cancer,
gastroesophageal junction cancer, and esophageal
adenocarcinoma.
IMPORTANT SAFETY
INFORMATION
Severe and Fatal Immune-Mediated Adverse Reactions
Immune-mediated adverse reactions listed herein may not include
all possible severe and fatal immune-mediated adverse
reactions.
Immune-mediated adverse reactions, which may be severe or fatal,
can occur in any organ system or tissue. While immune-mediated
adverse reactions usually manifest during treatment, they can also
occur after discontinuation of OPDIVO or YERVOY. Early
identification and management are essential to ensure safe use of
OPDIVO and YERVOY. Monitor for signs and symptoms that may be
clinical manifestations of underlying immune-mediated adverse
reactions. Evaluate clinical chemistries including liver enzymes,
creatinine, adrenocorticotropic hormone (ACTH) level, and thyroid
function at baseline and periodically during treatment with OPDIVO
and before each dose of YERVOY. In cases of suspected
immune-mediated adverse reactions, initiate appropriate workup to
exclude alternative etiologies, including infection. Institute
medical management promptly, including specialty consultation as
appropriate.
Withhold or permanently discontinue OPDIVO and YERVOY depending
on severity (please see section 2 Dosage and Administration in the
accompanying Full Prescribing Information). In general, if OPDIVO
or YERVOY interruption or discontinuation is required, administer
systemic corticosteroid therapy (1 to 2 mg/kg/day prednisone or
equivalent) until improvement to Grade 1 or less. Upon improvement
to Grade 1 or less, initiate corticosteroid taper and continue to
taper over at least 1 month. Consider administration of other
systemic immunosuppressants in patients whose immune-mediated
adverse reactions are not controlled with corticosteroid therapy.
Toxicity management guidelines for adverse reactions that do not
necessarily require systemic steroids (e.g., endocrinopathies and
dermatologic reactions) are discussed below.
Immune-Mediated Pneumonitis
OPDIVO and YERVOY can cause immune-mediated pneumonitis. The
incidence of pneumonitis is higher in patients who have received
prior thoracic radiation. In patients receiving OPDIVO monotherapy,
immune- mediated pneumonitis occurred in 3.1% (61/1994) of
patients, including Grade 4 (<0.1%), Grade 3 (0.9%), and Grade 2
(2.1%). In patients receiving OPDIVO 1 mg/kg with YERVOY 3 mg/kg
every 3 weeks, immune- mediated pneumonitis occurred in 7% (31/456)
of patients, including Grade 4 (0.2%), Grade 3 (2.0%), and Grade 2
(4.4%). In patients receiving OPDIVO 3 mg/kg with YERVOY 1 mg/kg
every 3 weeks, immune- mediated pneumonitis occurred in 3.9%
(26/666) of patients, including Grade 3 (1.4%) and Grade 2 (2.6%).
In NSCLC patients receiving OPDIVO 3 mg/kg every 2 weeks with
YERVOY 1 mg/kg every 6 weeks, immune- mediated pneumonitis occurred
in 9% (50/576) of patients, including Grade 4 (0.5%), Grade 3
(3.5%), and Grade 2 (4.0%). Four patients (0.7%) died due to
pneumonitis.
In Checkmate 205 and 039, pneumonitis, including interstitial
lung disease, occurred in 6.0% (16/266) of patients receiving
OPDIVO. Immune-mediated pneumonitis occurred in 4.9% (13/266) of
patients receiving OPDIVO, including Grade 3 (n=1) and Grade 2
(n=12).
Immune-Mediated Colitis
OPDIVO and YERVOY can cause immune-mediated colitis, which may
be fatal. A common symptom included in the definition of colitis
was diarrhea. Cytomegalovirus (CMV) infection/reactivation has been
reported in patients with corticosteroid-refractory immune-mediated
colitis. In cases of corticosteroid-refractory colitis, consider
repeating infectious workup to exclude alternative etiologies. In
patients receiving OPDIVO monotherapy, immune-mediated colitis
occurred in 2.9% (58/1994) of patients, including Grade 3 (1.7%)
and Grade 2 (1%). In patients receiving OPDIVO 1 mg/kg with YERVOY
3 mg/kg every 3 weeks, immune-mediated colitis occurred in 25%
(115/456) of patients, including Grade 4 (0.4%), Grade 3 (14%) and
Grade 2 (8%). In patients receiving OPDIVO 3 mg/kg with YERVOY 1
mg/kg every 3 weeks, immune-mediated colitis occurred in 9%
(60/666) of patients, including Grade 3 (4.4%) and Grade 2
(3.7%).
Immune-Mediated Hepatitis and
Hepatotoxicity
OPDIVO and YERVOY can cause immune-mediated hepatitis. In
patients receiving OPDIVO monotherapy, immune-mediated hepatitis
occurred in 1.8% (35/1994) of patients, including Grade 4 (0.2%),
Grade 3 (1.3%), and Grade 2 (0.4%). In patients receiving OPDIVO 1
mg/kg with YERVOY 3 mg/kg every 3 weeks, immune- mediated hepatitis
occurred in 15% (70/456) of patients, including Grade 4 (2.4%),
Grade 3 (11%), and Grade 2 (1.8%). In patients receiving OPDIVO 3
mg/kg with YERVOY 1 mg/kg every 3 weeks, immune-mediated hepatitis
occurred in 7% (48/666) of patients, including Grade 4 (1.2%),
Grade 3 (4.9%), and Grade 2 (0.4%).
OPDIVO in combination with cabozantinib can cause hepatic
toxicity with higher frequencies of Grade 3 and 4 ALT and AST
elevations compared to OPDIVO alone. Consider more frequent
monitoring of liver enzymes as compared to when the drugs are
administered as single agents. In patients receiving OPDIVO and
cabozantinib, Grades 3 and 4 increased ALT or AST were seen in 11%
of patients.
Immune-Mediated
Endocrinopathies
OPDIVO and YERVOY can cause primary or secondary adrenal
insufficiency, immune-mediated hypophysitis, immune-mediated
thyroid disorders, and Type 1 diabetes mellitus, which can present
with diabetic ketoacidosis. Withhold OPDIVO and YERVOY depending on
severity (please see section 2 Dosage and Administration in the
accompanying Full Prescribing Information). For Grade 2 or higher
adrenal insufficiency, initiate symptomatic treatment, including
hormone replacement as clinically indicated. Hypophysitis can
present with acute symptoms associated with mass effect such as
headache, photophobia, or visual field defects. Hypophysitis can
cause hypopituitarism; initiate hormone replacement as clinically
indicated. Thyroiditis can present with or without endocrinopathy.
Hypothyroidism can follow hyperthyroidism; initiate hormone
replacement or medical management as clinically indicated. Monitor
patients for hyperglycemia or other signs and symptoms of diabetes;
initiate treatment with insulin as clinically indicated.
In patients receiving OPDIVO monotherapy, adrenal insufficiency
occurred in 1% (20/1994), including Grade 3 (0.4%) and Grade 2
(0.6%). In patients receiving OPDIVO 1 mg/kg with YERVOY 3 mg/kg
every 3 weeks, adrenal insufficiency occurred in 8% (35/456) of
patients, including Grade 4 (0.2%), Grade 3 (2.4%), and Grade 2
(4.2%). In patients receiving OPDIVO 3 mg/kg with YERVOY 1 mg/kg
every 3 weeks, adrenal insufficiency occurred in 7% (48/666) of
patients, including Grade 4 (0.3%), Grade 3 (2.5%), and Grade 2
(4.1%). In patients receiving OPDIVO and cabozantinib, adrenal
insufficiency occurred in 4.7% (15/320) of patients, including
Grade 3 (2.2%) and Grade 2 (1.9%).
In patients receiving OPDIVO monotherapy, hypophysitis occurred
in 0.6% (12/1994) of patients, including Grade 3 (0.2%) and Grade 2
(0.3%). In patients receiving OPDIVO 1 mg/kg with YERVOY 3 mg/kg
every 3 weeks, hypophysitis occurred in 9% (42/456) of patients,
including Grade 3 (2.4%) and Grade 2 (6%). In patients receiving
OPDIVO 3 mg/kg with YERVOY 1 mg/kg every 3 weeks, hypophysitis
occurred in 4.4% (29/666) of patients, including Grade 4 (0.3%),
Grade 3 (2.4%), and Grade 2 (0.9%).
In patients receiving OPDIVO monotherapy, thyroiditis occurred
in 0.6% (12/1994) of patients, including Grade 2 (0.2%). In
patients receiving OPDIVO 3 mg/kg with YERVOY 1 mg/kg every 3
weeks, thyroiditis occurred in 2.7% (22/666) of patients, including
Grade 3 (4.5%) and Grade 2 (2.2%).
In patients receiving OPDIVO monotherapy, hyperthyroidism
occurred in 2.7% (54/1994) of patients, including Grade 3
(<0.1%) and Grade 2 (1.2%). In patients receiving OPDIVO 1 mg/kg
with YERVOY 3 mg/kg every 3 weeks, hyperthyroidism occurred in 9%
(42/456) of patients, including Grade 3 (0.9%) and Grade 2 (4.2%).
In patients receiving OPDIVO 3 mg/kg with YERVOY 1 mg/kg every 3
weeks, hyperthyroidism occurred in 12% (80/666) of patients,
including Grade 3 (0.6%) and Grade 2 (4.5%).
In patients receiving OPDIVO monotherapy, hypothyroidism
occurred in 8% (163/1994) of patients, including Grade 3 (0.2%) and
Grade 2 (4.8%). In patients receiving OPDIVO 1 mg/kg with YERVOY 3
mg/kg every 3 weeks, hypothyroidism occurred in 20% (91/456) of
patients, including Grade 3 (0.4%) and Grade 2 (11%). In patients
receiving OPDIVO 3 mg/kg with YERVOY 1 mg/kg every 3 weeks,
hypothyroidism occurred in 18% (122/666) of patients, including
Grade 3 (0.6%) and Grade 2 (11%).
In patients receiving OPDIVO monotherapy, diabetes occurred in
0.9% (17/1994) of patients, including Grade 3 (0.4%) and Grade 2
(0.3%), and 2 cases of diabetic ketoacidosis. In patients receiving
OPDIVO 3 mg/kg with YERVOY 1 mg/kg every 3 weeks, diabetes occurred
in 2.7% (15/666) of patients, including Grade 4 (0.6%), Grade 3
(0.3%), and Grade 2 (0.9%).
Immune-Mediated Nephritis with Renal Dysfunction
OPDIVO and YERVOY can cause immune-mediated nephritis. In
patients receiving OPDIVO monotherapy, immune-mediated nephritis
and renal dysfunction occurred in 1.2% (23/1994) of patients,
including Grade 4 (<0.1%), Grade 3 (0.5%), and Grade 2 (0.6%).
In patients receiving OPDIVO 3 mg/kg with YERVOY 1 mg/kg every 3
weeks, immune-mediated nephritis with renal dysfunction occurred in
4.1% (27/666) of patients, including Grade 4 (0.6%), Grade 3
(1.1%), and Grade 2 (2.2%).
Immune-Mediated Dermatologic Adverse
Reactions
OPDIVO can cause immune-mediated rash or dermatitis. Exfoliative
dermatitis, including Stevens-Johnson syndrome (SJS), toxic
epidermal necrolysis (TEN), and drug rash with eosinophilia and
systemic symptoms (DRESS) has occurred with PD-1/PD-L1 blocking
antibodies. Topical emollients and/or topical corticosteroids may
be adequate to treat mild to moderate non-exfoliative rashes.
YERVOY can cause immune-mediated rash or dermatitis, including
bullous and exfoliative dermatitis, SJS, TEN, and DRESS. Topical
emollients and/or topical corticosteroids may be adequate to treat
mild to moderate non-bullous/exfoliative rashes.
Withhold or permanently discontinue OPDIVO and YERVOY depending
on severity (please see section 2 Dosage and Administration in the
accompanying Full Prescribing Information).
In patients receiving OPDIVO monotherapy, immune-mediated rash
occurred in 9% (171/1994) of patients, including Grade 3 (1.1%) and
Grade 2 (2.2%). In patients receiving OPDIVO 1 mg/kg with YERVOY 3
mg/kg every 3 weeks, immune-mediated rash occurred in 28% (127/456)
of patients, including Grade 3 (4.8%) and Grade 2 (10%). In
patients receiving OPDIVO 3 mg/kg with YERVOY 1 mg/kg every 3
weeks, immune-mediated rash occurred in 16% (108/666) of patients,
including Grade 3 (3.5%) and Grade 2 (4.2%).
Other Immune-Mediated Adverse
Reactions
The following clinically significant immune-mediated adverse
reactions occurred at an incidence of <1% (unless otherwise
noted) in patients who received OPDIVO monotherapy or OPDIVO in
combination with YERVOY or were reported with the use of other
PD-1/PD-L1 blocking antibodies. Severe or fatal cases have been
reported for some of these adverse reactions: cardiac/vascular:
myocarditis, pericarditis, vasculitis; nervous system: meningitis,
encephalitis, myelitis and demyelination, myasthenic
syndrome/myasthenia gravis (including exacerbation), Guillain-Barré
syndrome, nerve paresis, autoimmune neuropathy; ocular: uveitis,
iritis, and other ocular inflammatory toxicities can occur;
gastrointestinal: pancreatitis to include increases in serum
amylase and lipase levels, gastritis, duodenitis; musculoskeletal
and connective tissue: myositis/polymyositis, rhabdomyolysis, and
associated sequelae including renal failure, arthritis, polymyalgia
rheumatica; endocrine: hypoparathyroidism; other
(hematologic/immune): hemolytic anemia, aplastic anemia,
hemophagocytic lymphohistiocytosis (HLH), systemic inflammatory
response syndrome, histiocytic necrotizing lymphadenitis (Kikuchi
lymphadenitis), sarcoidosis, immune thrombocytopenic purpura, solid
organ transplant rejection, other transplant (including corneal
graft) rejection.
In addition to the immune-mediated adverse reactions listed
above, across clinical trials of YERVOY monotherapy or in
combination with OPDIVO, the following clinically significant
immune-mediated adverse reactions, some with fatal outcome,
occurred in <1% of patients unless otherwise specified: nervous
system: autoimmune neuropathy (2%), myasthenic syndrome/myasthenia
gravis, motor dysfunction; cardiovascular: angiopathy, temporal
arteritis; ocular: blepharitis, episcleritis, orbital myositis,
scleritis; gastrointestinal: pancreatitis (1.3%); other
(hematologic/immune): conjunctivitis, cytopenias (2.5%),
eosinophilia (2.1%), erythema multiforme, hypersensitivity
vasculitis, neurosensory hypoacusis, psoriasis.
Some ocular IMAR cases can be associated with retinal
detachment. Various grades of visual impairment, including
blindness, can occur. If uveitis occurs in combination with other
immune-mediated adverse reactions, consider a
Vogt-Koyanagi-Harada–like syndrome, which has been observed in
patients receiving OPDIVO and YERVOY, as this may require treatment
with systemic corticosteroids to reduce the risk of permanent
vision loss.
Infusion-Related Reactions
OPDIVO and YERVOY can cause severe infusion-related reactions.
Discontinue OPDIVO and YERVOY in patients with severe (Grade 3) or
life-threatening (Grade 4) infusion-related reactions. Interrupt or
slow the rate of infusion in patients with mild (Grade 1) or
moderate (Grade 2) infusion-related reactions. In patients
receiving OPDIVO monotherapy as a 60-minute infusion,
infusion-related reactions occurred in 6.4% (127/1994) of patients.
In a separate trial in which patients received OPDIVO monotherapy
as a 60-minute infusion or a 30- minute infusion, infusion-related
reactions occurred in 2.2% (8/368) and 2.7% (10/369) of patients,
respectively. Additionally, 0.5% (2/368) and 1.4% (5/369) of
patients, respectively, experienced adverse reactions within 48
hours of infusion that led to dose delay, permanent discontinuation
or withholding of OPDIVO. In melanoma patients receiving OPDIVO 1
mg/kg with YERVOY 3 mg/kg every 3 weeks, infusion-related reactions
occurred in 2.5% (10/407) of patients. In HCC patients receiving
OPDIVO 1 mg/kg with YERVOY 3 mg/kg every 3 weeks, infusion-related
reactions occurred in 8% (4/49) of patients. In RCC patients
receiving OPDIVO 3 mg/kg with YERVOY 1 mg/kg every 3 weeks,
infusion-related reactions occurred in 5.1% (28/547) of patients.
In MSI- H/dMMR mCRC patients receiving OPDIVO 3 mg/kg with YERVOY 1
mg/kg every 3 weeks, infusion-related reactions occurred in 4.2%
(5/119) of patients. In MPM patients receiving OPDIVO 3 mg/kg every
2 weeks with YERVOY 1 mg/kg every 6 weeks, infusion-related
reactions occurred in 12% (37/300) of patients.
Complications of Allogeneic Hematopoietic Stem Cell
Transplantation
Fatal and other serious complications can occur in patients who
receive allogeneic hematopoietic stem cell transplantation (HSCT)
before or after being treated with OPDIVO or YERVOY.
Transplant-related complications include hyperacute
graft-versus-host disease (GVHD), acute GVHD, chronic GVHD, hepatic
veno-occlusive disease (VOD) after reduced intensity conditioning,
and steroid-requiring febrile syndrome (without an identified
infectious cause). These complications may occur despite
intervening therapy between OPDIVO or YERVOY and allogeneic
HSCT.
Follow patients closely for evidence of transplant-related
complications and intervene promptly. Consider the benefit versus
risks of treatment with OPDIVO and YERVOY prior to or after an
allogeneic HSCT.
Embryo-Fetal Toxicity
Based on its mechanism of action and findings from animal
studies, OPDIVO and YERVOY can cause fetal harm when administered
to a pregnant woman. The effects of YERVOY are likely to be greater
during the second and third trimesters of pregnancy. Advise
pregnant women of the potential risk to a fetus. Advise females of
reproductive potential to use effective contraception during
treatment with OPDIVO and YERVOY and for at least 5 months after
the last dose.
Increased Mortality in Patients with Multiple Myeloma when
OPDIVO is Added to a Thalidomide Analogue and Dexamethasone
In randomized clinical trials in patients with multiple myeloma,
the addition of OPDIVO 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.
Lactation
There are no data on the presence of OPDIVO or YERVOY in human
milk, the effects on the breastfed child, or the effects on milk
production. Because of the potential for serious adverse reactions
in breastfed children, advise women not to breastfeed during
treatment and for 5 months after the last dose.
Serious Adverse Reactions
In Checkmate 037, serious adverse reactions occurred in 41% of
patients receiving OPDIVO (n=268). Grade 3 and 4 adverse reactions
occurred in 42% of patients receiving OPDIVO. The most frequent
Grade 3 and 4 adverse drug reactions reported in 2% to <5% of
patients receiving OPDIVO were abdominal pain, hyponatremia,
increased aspartate aminotransferase, and increased lipase. In
Checkmate 066, serious adverse reactions occurred in 36% of
patients receiving OPDIVO (n=206). Grade 3 and 4 adverse reactions
occurred in 41% of patients receiving OPDIVO. The most frequent
Grade 3 and 4 adverse reactions reported in ≥2% of patients
receiving OPDIVO were gamma-glutamyltransferase increase (3.9%) and
diarrhea (3.4%). In Checkmate 067, serious adverse reactions (74%
and 44%), adverse reactions leading to permanent discontinuation
(47% and 18%) or to dosing delays (58% and 36%), and Grade 3 or 4
adverse reactions (72% and 51%) all occurred more frequently in the
OPDIVO plus YERVOY arm (n=313) relative to the OPDIVO arm (n=313).
The most frequent (≥10%) serious adverse reactions in the OPDIVO
plus YERVOY arm and the OPDIVO arm, respectively, were diarrhea
(13% and 2.2%), colitis (10% and 1.9%), and pyrexia (10% and 1.0%).
In Checkmate 238, serious adverse reactions occurred in 18% of
patients receiving OPDIVO (n=452). Grade 3 or 4 adverse reactions
occurred in 25% of OPDIVO-treated patients (n=452). The most
frequent Grade 3 and 4 adverse reactions reported in ≥2% of
OPDIVO-treated patients were diarrhea and increased lipase and
amylase. In Checkmate 816, serious adverse reactions occurred in
30% of patients (n=176) who were treated with OPDIVO in combination
with platinum-doublet chemotherapy. Serious adverse reactions in
>2% included pneumonia and vomiting. No fatal adverse reactions
occurred in patients who received OPDIVO in combination with
platinum-doublet chemotherapy. In Checkmate 77T, serious adverse
reactions occurred in 21% of patients who received OPDIVO in
combination with platinum-doublet chemotherapy as neoadjuvant
treatment (n=228). The most frequent (≥2%) serious adverse
reactions was pneumonia. Fatal adverse reactions occurred in 2.2%
of patients, due to cerebrovascular accident, COVID-19 infection,
hemoptysis, pneumonia, and pneumonitis (0.4% each). In the adjuvant
phase of Checkmate 77T, 22% of patients experienced serious adverse
reactions (n=142). The most frequent serious adverse reaction was
pneumonitis/ILD (2.8%). One fatal adverse reaction due to COVID-19
occurred. In Checkmate 227, serious adverse reactions occurred in
58% of patients (n=576). The most frequent (≥2%) serious adverse
reactions were pneumonia, diarrhea/colitis, pneumonitis, hepatitis,
pulmonary embolism, adrenal insufficiency, and hypophysitis. Fatal
adverse reactions occurred in 1.7% of patients; these included
events of pneumonitis (4 patients), myocarditis, acute kidney
injury, shock, hyperglycemia, multi-system organ failure, and renal
failure. In Checkmate 9LA, serious adverse reactions occurred in
57% of patients (n=358). The most frequent (>2%) serious adverse
reactions were pneumonia, diarrhea, febrile neutropenia, anemia,
acute kidney injury, musculoskeletal pain, dyspnea, pneumonitis,
and respiratory failure. Fatal adverse reactions occurred in 7 (2%)
patients, and included hepatic toxicity, acute renal failure,
sepsis, pneumonitis, diarrhea with hypokalemia, and massive
hemoptysis in the setting of thrombocytopenia. In Checkmate 017 and
057, serious adverse reactions occurred in 46% of patients
receiving OPDIVO (n=418). The most frequent serious adverse
reactions reported in ≥2% of patients receiving OPDIVO were
pneumonia, pulmonary embolism, dyspnea, pyrexia, pleural effusion,
pneumonitis, and respiratory failure. In Checkmate 057, fatal
adverse reactions occurred; these included events of infection (7
patients, including one case of Pneumocystis jirovecii pneumonia),
pulmonary embolism (4 patients), and limbic encephalitis (1
patient). In Checkmate 743, serious adverse reactions occurred in
54% of patients receiving OPDIVO plus YERVOY. The most frequent
serious adverse reactions reported in ≥2% of patients were
pneumonia, pyrexia, diarrhea, pneumonitis, pleural effusion,
dyspnea, acute kidney injury, infusion-related reaction,
musculoskeletal pain, and pulmonary embolism. Fatal adverse
reactions occurred in 4 (1.3%) patients and included pneumonitis,
acute heart failure, sepsis, and encephalitis. In Checkmate 214,
serious adverse reactions occurred in 59% of patients receiving
OPDIVO plus YERVOY (n=547). The most frequent serious adverse
reactions reported in ≥2% of patients were diarrhea, pyrexia,
pneumonia, pneumonitis, hypophysitis, acute kidney injury, dyspnea,
adrenal insufficiency, and colitis. In Checkmate 9ER, serious
adverse reactions occurred in 48% of patients receiving OPDIVO and
cabozantinib (n=320). The most frequent serious adverse reactions
reported in ≥2% of patients were diarrhea, pneumonia, pneumonitis,
pulmonary embolism, urinary tract infection, and hyponatremia.
Fatal intestinal perforations occurred in 3 (0.9%) patients. In
Checkmate 025, serious adverse reactions occurred in 47% of
patients receiving OPDIVO (n=406). The most frequent serious
adverse reactions reported in ≥2% of patients were acute kidney
injury, pleural effusion, pneumonia, diarrhea, and hypercalcemia.
In Checkmate 205 and 039, adverse reactions leading to
discontinuation occurred in 7% and dose delays due to adverse
reactions occurred in 34% of patients (n=266). Serious adverse
reactions occurred in 26% of patients. The most frequent serious
adverse reactions reported in ≥1% of patients were pneumonia,
infusion-related reaction, pyrexia, colitis or diarrhea, pleural
effusion, pneumonitis, and rash. Eleven patients died from causes
other than disease progression: 3 from adverse reactions within 30
days of the last OPDIVO dose, 2 from infection 8 to 9 months after
completing OPDIVO, and 6 from complications of allogeneic HSCT. In
Checkmate 141, serious adverse reactions occurred in 49% of
patients receiving OPDIVO (n=236). The most frequent serious
adverse reactions reported in ≥2% of patients receiving OPDIVO were
pneumonia, dyspnea, respiratory failure, respiratory tract
infection, and sepsis. In Checkmate 275, serious adverse reactions
occurred in 54% of patients receiving OPDIVO (n=270). The most
frequent serious adverse reactions reported in ≥2% of patients
receiving OPDIVO were urinary tract infection, sepsis, diarrhea,
small intestine obstruction, and general physical health
deterioration. In Checkmate 274, serious adverse reactions occurred
in 30% of patients receiving OPDIVO (n=351). The most frequent
serious adverse reaction reported in ≥2% of patients receiving
OPDIVO was urinary tract infection. Fatal adverse reactions
occurred in 1% of patients; these included events of pneumonitis
(0.6%). In Checkmate 901, serious adverse reactions occurred in 48%
of patients receiving OPDIVO in combination with chemotherapy. The
most frequent serious adverse reactions reporting in ≥2% of
patients who received OPDIVO with chemotherapy were urinary tract
infection (4.9%), acute kidney injury (4.3%), anemia (3%),
pulmonary embolism (2.6%), sepsis (2.3%), and platelet count
decreased (2.3%). Fatal adverse reactions occurred in 3.6% of
patients who received OPDIVO in combination with chemotherapy;
these included sepsis (1%). OPDIVO and/or chemotherapy were
discontinued in 30% of patients and were delayed in 67% of patients
for an adverse reaction. In Checkmate 8HW, serious adverse
reactions occurred in 46% of patients receiving OPDIVO in
combination with ipilimumab. The most frequent serious adverse
reactions reported in ≥1% of patients who received OPDIVO with
ipilimumab were adrenal insufficiency (2.8%), hypophysitis (2.8%),
diarrhea (2.0%), abdominal pain (2.0%), small intestinal
obstruction (2.0%), pneumonia (1.7%), acute kidney injury (1.4%),
immune mediated enterocolitis (1.4%), pneumonitis (1.4%), colitis
(1.1%), large intestinal obstruction (1.1%), and urinary tract
infection (1.1%). Fatal adverse reactions occurred in 2 (0.6%)
patients who received OPDIVO in combination with ipilimumab; these
included myocarditis and pneumonitis (1 each). In Checkmate 8HW,
serious adverse reactions occurred in 39% of patients receiving
OPDIVO alone. The most frequent serious adverse reactions reported
in >1% of patients who received OPDIVO as a single agent were
intestinal obstruction (2.3%), acute kidney injury (1.7%), COVID-19
(1.7%), abdominal pain (1.4%), diarrhea (1.4%), ileus (1.4%),
subileus (1.4%), pulmonary embolism (1.4%), adrenal insufficiency
(1.1%) and pneumonia (1.1%). Fatal adverse reactions occurring in 3
(0.9%) patients who received OPDIVO as a single agent; these
included pneumonitis (n=2) and myasthenia gravis. In Checkmate 9DW,
serious adverse reactions occurred in 53% of patients receiving
OPDIVO with YERVOY (n=332). The most frequent non liver-related
serious adverse reactions reported in ≥2% of patients who received
OPDIVO with YERVOY were diarrhea/colitis (4.5%), gastrointestinal
hemorrhage (3%), and rash (2.4%). Liver-related serious adverse
reactions occurred in 17% of patients receiving OPDIVO with YERVOY,
including Grade 3-4 events in 16% of patients. The most frequently
reported all grade liver-related serious adverse reactions
occurring in ≥1% of patients who received OPDIVO with YERVOY were
immune-mediated hepatitis (3%), increased AST/ALT (3%), hepatic
failure (2.4%), ascites (2.4%), and hepatotoxicity (1.2%). Fatal
adverse reactions occurred in 12 (3.6%) patients who received
OPDIVO with YERVOY; these included 4 (1.2%) patients who died due
to immune-mediated or autoimmune hepatitis and 4 (1.2%) patients
who died of hepatic failure. In Checkmate 040, serious adverse
reactions occurred in 59% of patients receiving OPDIVO with YERVOY
(n=49). Serious adverse reactions reported in ≥4% of patients were
pyrexia, diarrhea, anemia, increased AST, adrenal insufficiency,
ascites, esophageal varices hemorrhage, hyponatremia, increased
blood bilirubin, and pneumonitis. In Attraction-3, serious adverse
reactions occurred in 38% of patients receiving OPDIVO (n=209).
Serious adverse reactions reported in ≥2% of patients who received
OPDIVO were pneumonia, esophageal fistula, interstitial lung
disease, and pyrexia. The following fatal adverse reactions
occurred in patients who received OPDIVO: interstitial lung disease
or pneumonitis (1.4%), pneumonia (1.0%), septic shock (0.5%),
esophageal fistula (0.5%), gastrointestinal hemorrhage (0.5%),
pulmonary embolism (0.5%), and sudden death (0.5%). In Checkmate
577, serious adverse reactions occurred in 33% of patients
receiving OPDIVO (n=532). A serious adverse reaction reported in
≥2% of patients who received OPDIVO was pneumonitis. A fatal
reaction of myocardial infarction occurred in one patient who
received OPDIVO. In Checkmate 648, serious adverse reactions
occurred in 62% of patients receiving OPDIVO in combination with
chemotherapy (n=310). The most frequent serious adverse reactions
reported in ≥2% of patients who received OPDIVO with chemotherapy
were pneumonia (11%), dysphagia (7%), esophageal stenosis (2.9%),
acute kidney injury (2.9%), and pyrexia (2.3%). Fatal adverse
reactions occurred in 5 (1.6%) patients who received OPDIVO in
combination with chemotherapy; these included pneumonitis,
pneumatosis intestinalis, pneumonia, and acute kidney injury. In
Checkmate 648, serious adverse reactions occurred in 69% of
patients receiving OPDIVO in combination with YERVOY (n=322). The
most frequent serious adverse reactions reported in ≥2% who
received OPDIVO in combination with YERVOY were pneumonia (10%),
pyrexia (4.3%), pneumonitis (4.0%), aspiration pneumonia (3.7%),
dysphagia (3.7%), hepatic function abnormal (2.8%), decreased
appetite (2.8%), adrenal insufficiency (2.5%), and dehydration
(2.5%). Fatal adverse reactions occurred in 5 (1.6%) patients who
received OPDIVO in combination with YERVOY; these included
pneumonitis, interstitial lung disease, pulmonary embolism, and
acute respiratory distress syndrome. In Checkmate 649, serious
adverse reactions occurred in 52% of patients treated with OPDIVO
in combination with chemotherapy (n=782). The most frequent serious
adverse reactions reported in ≥2% of patients treated with OPDIVO
in combination with chemotherapy were vomiting (3.7%), pneumonia
(3.6%), anemia (3.6%), pyrexia (2.8%), diarrhea (2.7%), febrile
neutropenia (2.6%), and pneumonitis (2.4%). Fatal adverse reactions
occurred in 16 (2.0%) patients who were treated with OPDIVO in
combination with chemotherapy; these included pneumonitis (4
patients), febrile neutropenia (2 patients), stroke (2 patients),
gastrointestinal toxicity, intestinal mucositis, septic shock,
pneumonia, infection, gastrointestinal bleeding, mesenteric vessel
thrombosis, and disseminated intravascular coagulation. In
Checkmate 76K, serious adverse reactions occurred in 18% of
patients receiving OPDIVO (n=524). Adverse reactions which resulted
in permanent discontinuation of OPDIVO in >1% of patients
included arthralgia (1.7%), rash (1.7%), and diarrhea (1.1%). A
fatal adverse reaction occurred in 1 (0.2%) patient (heart failure
and acute kidney injury). The most frequent Grade 3-4 lab
abnormalities reported in ≥1% of OPDIVO-treated patients were
increased lipase (2.9%), increased AST (2.2%), increased ALT
(2.1%), lymphopenia (1.1%), and decreased potassium (1.0%).
Common Adverse Reactions
In Checkmate 037, the most common adverse reaction (≥20%)
reported with OPDIVO (n=268) was rash (21%). In Checkmate 066, the
most common adverse reactions (≥20%) reported with OPDIVO (n=206)
vs dacarbazine (n=205) were fatigue (49% vs 39%), musculoskeletal
pain (32% vs 25%), rash (28% vs 12%), and pruritus (23% vs 12%). In
Checkmate 067, the most common (≥20%) adverse reactions in the
OPDIVO plus YERVOY arm (n=313) were fatigue (62%), diarrhea (54%),
rash (53%), nausea (44%), pyrexia (40%), pruritus (39%),
musculoskeletal pain (32%), vomiting (31%), decreased appetite
(29%), cough (27%), headache (26%), dyspnea (24%), upper
respiratory tract infection (23%), arthralgia (21%), and increased
transaminases (25%). In Checkmate 067, the most common (≥20%)
adverse reactions in the OPDIVO arm (n=313) were fatigue (59%),
rash (40%), musculoskeletal pain (42%), diarrhea (36%), nausea
(30%), cough (28%), pruritus (27%), upper respiratory tract
infection (22%), decreased appetite (22%), headache (22%),
constipation (21%), arthralgia (21%), and vomiting (20%). In
Checkmate 238, the most common adverse reactions (≥20%) reported in
OPDIVO-treated patients (n=452) vs ipilimumab-treated patients
(n=453) were fatigue (57% vs 55%), diarrhea (37% vs 55%), rash (35%
vs 47%), musculoskeletal pain (32% vs 27%), pruritus (28% vs 37%),
headache (23% vs 31%), nausea (23% vs 28%), upper respiratory
infection (22% vs 15%), and abdominal pain (21% vs 23%). The most
common immune-mediated adverse reactions were rash (16%),
diarrhea/colitis (6%), and hepatitis (3%). In Checkmate 816, the
most common (>20%) adverse reactions in the OPDIVO plus
chemotherapy arm (n=176) were nausea (38%), constipation (34%),
fatigue (26%), decreased appetite (20%), and rash (20%). In
Checkmate 77T, the most common adverse reactions (reported in ≥20%)
in patients receiving OPDIVO in combination with chemotherapy (n=
228) were anemia (39.5%), constipation (32.0%), nausea (28.9%),
fatigue (28.1%), alopecia (25.9%), and cough (21.9%). In Checkmate
227, the most common (≥20%) adverse reactions were fatigue (44%),
rash (34%), decreased appetite (31%), musculoskeletal pain (27%),
diarrhea/colitis (26%), dyspnea (26%), cough (23%), hepatitis
(21%), nausea (21%), and pruritus (21%). In Checkmate 9LA, the most
common (>20%) adverse reactions were fatigue (49%),
musculoskeletal pain (39%), nausea (32%), diarrhea (31%), rash
(30%), decreased appetite (28%), constipation (21%), and pruritus
(21%). In Checkmate 017 and 057, the most common adverse reactions
(≥20%) in patients receiving OPDIVO (n=418) were fatigue,
musculoskeletal pain, cough, dyspnea, and decreased appetite. In
Checkmate 743, the most common adverse reactions (≥20%) in patients
receiving OPDIVO plus YERVOY were fatigue (43%), musculoskeletal
pain (38%), rash (34%), diarrhea (32%), dyspnea (27%), nausea
(24%), decreased appetite (24%), cough (23%), and pruritus (21%).
In Checkmate 214, the most common adverse reactions (≥20%) reported
in patients treated with OPDIVO plus YERVOY (n=547) were fatigue
(58%), rash (39%), diarrhea (38%), musculoskeletal pain (37%),
pruritus (33%), nausea (30%), cough (28%), pyrexia (25%),
arthralgia (23%), decreased appetite (21%), dyspnea (20%), and
vomiting (20%). In Checkmate 9ER, the most common adverse reactions
(≥20%) in patients receiving OPDIVO and cabozantinib (n=320) were
diarrhea (64%), fatigue (51%), hepatotoxicity (44%), palmar-plantar
erythrodysaesthesia syndrome (40%), stomatitis (37%), rash (36%),
hypertension (36%), hypothyroidism (34%), musculoskeletal pain
(33%), decreased appetite (28%), nausea (27%), dysgeusia (24%),
abdominal pain (22%), cough (20%) and upper respiratory tract
infection (20%). In Checkmate 025, the most common adverse
reactions (≥20%) reported in patients receiving OPDIVO (n=406) vs
everolimus (n=397) were fatigue (56% vs 57%), cough (34% vs 38%),
nausea (28% vs 29%), rash (28% vs 36%), dyspnea (27% vs 31%),
diarrhea (25% vs 32%), constipation (23% vs 18%), decreased
appetite (23% vs 30%), back pain (21% vs 16%), and arthralgia (20%
vs 14%). In Checkmate 205 and 039, the most common adverse
reactions (≥20%) reported in patients receiving OPDIVO (n=266) were
upper respiratory tract infection (44%), fatigue (39%), cough
(36%), diarrhea (33%), pyrexia (29%), musculoskeletal pain (26%),
rash (24%), nausea (20%) and pruritus (20%). In Checkmate 141, the
most common adverse reactions (≥10%) in patients receiving OPDIVO
(n=236) were cough (14%) and dyspnea (14%) at a higher incidence
than investigator’s choice. In Checkmate 275, the most common
adverse reactions (≥20%) reported in patients receiving OPDIVO
(n=270) were fatigue (46%), musculoskeletal pain (30%), nausea
(22%), and decreased appetite (22%). In Checkmate 274, the most
common adverse reactions (≥20%) reported in patients receiving
OPDIVO (n=351) were rash (36%), fatigue (36%), diarrhea (30%),
pruritus (30%), musculoskeletal pain (28%), and urinary tract
infection (22%).In Checkmate 901, the most common adverse reactions
(≥20%) were nausea, fatigue, musculoskeletal pain, constipation,
decreased appetite, rash, vomiting, and peripheral neuropathy. In
Checkmate 8HW, the most common adverse reactions reported in ≥20%
of patients treated with OPDIVO in combination with ipilimumab were
fatigue, diarrhea, pruritus, abdominal pain, musculoskeletal pain,
and nausea. In Checkmate 8HW the most common adverse reaction
reported in ≥20% of patients treated with OPDIVO as a single agent,
were fatigue, diarrhea, abdominal pain, pruritus, and
musculoskeletal pain. In Checkmate 9DW, the most common adverse
reactions (≥20%) in patients receiving OPDIVO with YERVOY (n=332)
were rash (36%), pruritus (34%), fatigue (33%), and diarrhea (25%).
In Checkmate 040, the most common adverse reactions (≥20%) in
patients receiving OPDIVO with YERVOY (n=49), were rash (53%),
pruritus (53%), musculoskeletal pain (41%), diarrhea (39%), cough
(37%), decreased appetite (35%), fatigue (27%), pyrexia (27%),
abdominal pain (22%), headache (22%), nausea (20%), dizziness
(20%), hypothyroidism (20%), and weight decreased (20%). In
Attraction-3, the most common adverse reactions (≥20%) in OPDIVO-
treated patients (n=209) were rash (22%) and decreased appetite
(21%). In Checkmate 577, the most common adverse reactions (≥20%)
in patients receiving OPDIVO (n=532) were fatigue (34%), diarrhea
(29%), nausea (23%), rash (21%), musculoskeletal pain (21%), and
cough (20%). In Checkmate 648, the most common adverse reactions
(≥20%) in patients treated with OPDIVO in combination with
chemotherapy (n=310) were nausea (65%), decreased appetite (51%),
fatigue (47%), constipation (44%), stomatitis (44%), diarrhea
(29%), and vomiting (23%). In Checkmate 648, the most common
adverse reactions reported in ≥20% of patients treated with OPDIVO
in combination with YERVOY were rash (31%), fatigue (28%), pyrexia
(23%), nausea (22%), diarrhea (22%), and constipation (20%). In
Checkmate 649, the most common adverse reactions (≥20%) in patients
treated with OPDIVO in combination with chemotherapy (n=782) were
peripheral neuropathy (53%), nausea (48%), fatigue (44%), diarrhea
(39%), vomiting (31%), decreased appetite (29%), abdominal pain
(27%), constipation (25%), and musculoskeletal pain (20%). In
Checkmate 76K, the most common adverse reactions (≥20%) reported
with OPDIVO (n=524) were fatigue (36%), musculoskeletal pain (30%),
rash (28%), diarrhea (23%) and pruritis (20%).
Surgery Related Adverse Reactions
In Checkmate 77T, 5.3% (n=12) of the OPDIVO-treated patients who
received neoadjuvant treatment, did not receive surgery due to
adverse reactions. The adverse reactions that led to cancellation
of surgery in OPDIVO- treated patients were cerebrovascular
accident, pneumonia, and colitis/diarrhea (2 patients each) and
acute coronary syndrome, myocarditis, hemoptysis, pneumonitis,
COVID-19, and myositis (1 patient each).
Please see U.S. Full Prescribing Information for OPDIVO and
YERVOY.
Clinical Trials and Patient Populations
Checkmate 9DW-hepatocellular carcinoma, in combination with
YERVOY; Checkmate 227-previously untreated metastatic non-small
cell lung cancer, in combination with YERVOY; Checkmate
9LA-previously untreated recurrent or metastatic non-small cell
lung cancer in combination with YERVOY and 2 cycles of
platinum-doublet chemotherapy by histology; Checkmate
649-previously untreated advanced or metastatic gastric cancer,
gastroesophageal junction and esophageal adenocarcinoma; Checkmate
040-hepatocellular carcinoma, in combination with YERVOY, after
prior treatment with sorafenib; Checkmate 577-adjuvant treatment of
esophageal or gastroesophageal junction cancer; Checkmate
238-adjuvant treatment of patients with completely resected Stage
III or Stage IV melanoma; Checkmate 76K-adjuvant treatment of
patients 12 years of age and older with completely resected Stage
IIB or Stage IIC melanoma; Checkmate 274-adjuvant treatment of
urothelial carcinoma; Checkmate 275-previously treated advanced or
metastatic urothelial carcinoma; 8HW: Previously Checkmate
142-MSI-H or dMMR metastatic colorectal cancer in combination with
YERVOY; 8HW: Previously Checkmate 142-MSI-H or dMMR metastatic
colorectal cancer, as a single agent; Attraction-3-esophageal
squamous cell carcinoma; Checkmate 648-previously untreated,
unresectable advanced recurrent or metastatic esophageal squamous
cell carcinoma in combination with chemotherapy; Checkmate
648-previously untreated, unresectable advanced recurrent or
metastatic esophageal squamous cell carcinoma combination with
YERVOY; Checkmate 743-previously untreated unresectable malignant
pleural mesothelioma, in combination with YERVOY; Checkmate
037-previously treated metastatic melanoma; Checkmate
066-previously untreated metastatic melanoma; Checkmate
067-previously untreated metastatic melanoma, as a single agent or
in combination with YERVOY; Checkmate 017-second-line treatment of
metastatic squamous non-small cell lung cancer; Checkmate
057-second-line treatment of metastatic non- squamous non-small
cell lung cancer; Checkmate 816-neoadjuvant non-small cell lung
cancer, in combination with platinum-doublet chemotherapy;
Checkmate 77T-Neoadjuvant treatment with platinum-doublet
chemotherapy for non-small cell lung cancer followed by
single-agent OPDIVO as adjuvant treatment after surgery; Checkmate
901-Adult patients with unresectable or metastatic urothelial
carcinoma; Checkmate 141-recurrent or metastatic squamous cell
carcinoma of the head and neck; Checkmate 025-previously treated
renal cell carcinoma; Checkmate 214-previously untreated renal cell
carcinoma, in combination with YERVOY; Checkmate 9ER-previously
untreated renal cell carcinoma, in combination with cabozantinib;
Checkmate 205/039-classical Hodgkin lymphoma
BREYANZI
INDICATIONS
BREYANZI is a CD19-directed genetically modified autologous T
cell immunotherapy indicated for the treatment of:
- adult patients with large B-cell lymphoma (LBCL), including
diffuse large B-cell lymphoma (DLBCL) not otherwise specified
(including DLBCL arising from indolent lymphoma), high-grade B cell
lymphoma, primary mediastinal large B-cell lymphoma, and follicular
lymphoma grade 3B, who have:
- refractory disease to first-line chemoimmunotherapy or relapse
within 12 months of first-line chemoimmunotherapy; or
- refractory disease to first-line chemoimmunotherapy or relapse
after first-line chemoimmunotherapy and are not eligible for
hematopoietic stem cell transplantation (HSCT) due to comorbidities
or age.
Limitations of Use: BREYANZI is not
indicated for the treatment of patients with primary central
nervous system lymphoma.
BREYANZI is a CD19-directed genetically modified autologous T
cell immunotherapy indicated for the treatment of:
- adult patients with relapsed or refractory chronic lymphocytic
leukemia (CLL) or small lymphocytic lymphoma (SLL) who have
received at least 2 prior lines of therapy, including a Bruton
tyrosine kinase (BTK) inhibitor and a B-cell lymphoma 2 (BCL-2)
inhibitor. This indication is approved under accelerated approval
based on response rate and duration of response. Continued approval
for this indication may be contingent upon verification and
description of clinical benefit in confirmatory trial(s).
BREYANZI is a CD19-directed genetically modified autologous T
cell immunotherapy indicated for the treatment of:
- adult patients with relapsed or refractory follicular lymphoma
(FL) who have received 2 or more prior lines of systemic therapy.
This indication is approved under accelerated approval based on
response rate and duration of response. Continued approval for this
indication may be contingent upon verification and description of
clinical benefit in confirmatory trial(s).
BREYANZI is a CD19-directed genetically modified autologous T
cell immunotherapy indicated for the treatment of:
- adult patients with relapsed or refractory mantle cell lymphoma
(MCL) who have received at least 2 prior lines of systemic therapy,
including a Bruton tyrosine kinase (BTK) inhibitor.
Important Safety Information
WARNING: CYTOKINE RELEASE SYNDROME,
NEUROLOGIC TOXICITIES, AND SECONDARY HEMATOLOGICAL
MALIGNANCIES
- Cytokine Release Syndrome (CRS), including fatal or
life-threatening reactions, occurred in patients receiving
BREYANZI. Do not administer BREYANZI to patients with active
infection or inflammatory disorders. Treat severe or
life-threatening CRS with tocilizumab with or without
corticosteroids.
- Neurologic toxicities, including fatal or life-threatening
reactions, occurred in patients receiving BREYANZI, including
concurrently with CRS, after CRS resolution, or in the absence of
CRS. Monitor for neurologic events after treatment with BREYANZI.
Provide supportive care and/or corticosteroids as needed.
- T cell malignancies have occurred following treatment of
hematologic malignancies with BCMA- and CD19-directed genetically
modified autologous T cell immunotherapies, including
BREYANZI.
- BREYANZI is available only through a restricted program
under a Risk Evaluation and Mitigation Strategy (REMS) called the
BREYANZI REMS.
Cytokine Release Syndrome
Cytokine release syndrome (CRS), including fatal or
life-threatening reactions, occurred following treatment with
BREYANZI. In clinical trials of BREYANZI, which enrolled a total of
702 patients with non-Hodgkin lymphoma (NHL), CRS occurred in 54%
of patients, including ≥ Grade 3 CRS in 3.2% of patients. The
median time to onset was 5 days (range: 1 to 63 days). CRS resolved
in 98% of patients with a median duration of 5 days (range: 1 to 37
days). One patient had fatal CRS and 5 patients had ongoing CRS at
the time of death. The most common manifestations of CRS (≥10%)
were fever, hypotension, tachycardia, chills, hypoxia, and
headache.
Serious events that may be associated with CRS include cardiac
arrhythmias (including atrial fibrillation and ventricular
tachycardia), cardiac arrest, cardiac failure, diffuse alveolar
damage, renal insufficiency, capillary leak syndrome, hypotension,
hypoxia, and hemophagocytic lymphohistiocytosis/macrophage
activation syndrome (HLH/MAS).
Ensure that 2 doses of tocilizumab are available prior to
infusion of BREYANZI.
Neurologic Toxicities
Neurologic toxicities that were fatal or life-threatening,
including immune effector cell-associated neurotoxicity syndrome
(ICANS), occurred following treatment with BREYANZI. Serious events
including cerebral edema and seizures occurred with BREYANZI. Fatal
and serious cases of leukoencephalopathy, some attributable to
fludarabine, also occurred.
In clinical trials of BREYANZI, CAR T cell-associated neurologic
toxicities occurred in 31% of patients, including ≥ Grade 3 cases
in 10% of patients. The median time to onset of neurotoxicity was 8
days (range: 1 to 63 days). Neurologic toxicities resolved in 88%
of patients with a median duration of 7 days (range: 1 to 119
days). Of patients developing neurotoxicity, 82% also developed
CRS.
The most common neurologic toxicities (≥5%) included
encephalopathy, tremor, aphasia, headache, dizziness, and
delirium.
CRS and Neurologic Toxicities Monitoring
Monitor patients daily for at least 7 days following BREYANZI
infusion at a REMS-certified healthcare facility for signs and
symptoms of CRS and neurologic toxicities and assess for other
causes of neurological symptoms. Monitor patients for signs and
symptoms of CRS and neurologic toxicities for at least 4 weeks
after infusion and treat promptly. At the first sign of CRS,
institute treatment with supportive care, tocilizumab, or
tocilizumab and corticosteroids as indicated. Manage neurologic
toxicity with supportive care and/or corticosteroid as needed.
Counsel patients to seek immediate medical attention should signs
or symptoms of CRS or neurologic toxicity occur at any time.
BREYANZI REMS
Because of the risk of CRS and neurologic toxicities, BREYANZI
is available only through a restricted program under a Risk
Evaluation and Mitigation Strategy (REMS) called the BREYANZI REMS.
The required components of the BREYANZI REMS are:
- Healthcare facilities that dispense and administer BREYANZI
must be enrolled and comply with the REMS requirements.
- Certified healthcare facilities must have on-site, immediate
access to tocilizumab.
- Ensure that a minimum of 2 doses of tocilizumab are available
for each patient for infusion within 2 hours after BREYANZI
infusion, if needed for treatment of CRS.
Further information is available at www.BreyanziREMS.com, or
contact Bristol Myers Squibb at 1-866-340-7332.
Hypersensitivity Reactions
Allergic reactions may occur with the infusion of BREYANZI.
Serious hypersensitivity reactions, including anaphylaxis, may be
due to dimethyl sulfoxide (DMSO).
Serious Infections
Severe infections, including life-threatening or fatal
infections, have occurred in patients after BREYANZI infusion. In
clinical trials of BREYANZI, infections of any grade occurred in
34% of patients, with Grade 3 or higher infections occurring in 12%
of all patients. Grade 3 or higher infections with an unspecified
pathogen occurred in 7%, bacterial infections in 3.7%, viral
infections in 2%, and fungal infections in 0.7% of patients. One
patient who received 4 prior lines of therapy developed a fatal
case of John Cunningham (JC) virus progressive multifocal
leukoencephalopathy 4 months after treatment with BREYANZI. One
patient who received 3 prior lines of therapy developed a fatal
case of cryptococcal meningoencephalitis 35 days after treatment
with BREYANZI.
Febrile neutropenia developed after BREYANZI infusion in 8% of
patients. Febrile neutropenia may be concurrent with CRS. In the
event of febrile neutropenia, evaluate for infection and manage
with broad- spectrum antibiotics, fluids, and other supportive care
as medically indicated.
Monitor patients for signs and symptoms of infection before and
after BREYANZI administration and treat appropriately. Administer
prophylactic antimicrobials according to standard institutional
guidelines. Avoid administration of BREYANZI in patients with
clinically significant, active systemic infections.
Viral reactivation: Hepatitis B virus (HBV) reactivation, in
some cases resulting in fulminant hepatitis, hepatic failure, and
death, can occur in patients treated with drugs directed against B
cells. In clinical trials of BREYANZI, 35 of 38 patients with a
prior history of HBV were treated with concurrent antiviral
suppressive therapy. Perform screening for HBV, HCV, and HIV in
accordance with clinical guidelines before collection of cells for
manufacturing. In patients with prior history of HBV, consider
concurrent antiviral suppressive therapy to prevent HBV
reactivation per standard guidelines.
Prolonged Cytopenias
Patients may exhibit cytopenias not resolved for several weeks
following lymphodepleting chemotherapy and BREYANZI infusion. In
clinical trials of BREYANZI, Grade 3 or higher cytopenias persisted
at Day 29 following BREYANZI infusion in 35% of patients, and
included thrombocytopenia in 25%, neutropenia in 22%, and anemia in
6% of patients. Monitor complete blood counts prior to and after
BREYANZI administration.
Hypogammaglobulinemia
B-cell aplasia and hypogammaglobulinemia can occur in patients
receiving BREYANZI. In clinical trials of BREYANZI,
hypogammaglobulinemia was reported as an adverse reaction in 10% of
patients.
Hypogammaglobulinemia, either as an adverse reaction or
laboratory IgG level below 500 mg/dL after infusion, was reported
in 30% of patients. Monitor immunoglobulin levels after treatment
with BREYANZI and manage using infection precautions, antibiotic
prophylaxis, and immunoglobulin replacement as clinically
indicated.
Live vaccines: The safety of immunization with live viral
vaccines during or following BREYANZI treatment has not been
studied. Vaccination with live virus vaccines is not recommended
for at least 6 weeks prior to the start of lymphodepleting
chemotherapy, during BREYANZI treatment, and until immune recovery
following treatment with BREYANZI.
Secondary Malignancies
Patients treated with BREYANZI may develop secondary
malignancies. T cell malignancies have occurred following treatment
of hematologic malignancies with BCMA- and CD19-directed
genetically modified autologous T cell immunotherapies, including
BREYANZI. Mature T cell malignancies, including CAR-positive
tumors, may present as soon as weeks following infusion, and may
include fatal outcomes. Monitor lifelong for secondary
malignancies. In the event that a secondary malignancy occurs,
contact Bristol Myers Squibb at 1-888-805-4555 for reporting and to
obtain instructions on collection of patient samples for
testing.
Effects on Ability to Drive and Use Machines
Due to the potential for neurologic events, including altered
mental status or seizures, patients receiving BREYANZI are at risk
for developing altered or decreased consciousness or impaired
coordination in the 8 weeks following BREYANZI administration.
Advise patients to refrain from driving and engaging in hazardous
occupations or activities, such as operating heavy or potentially
dangerous machinery, for at least 8 weeks.
Immune Effector Cell-Associated Hemophagocytic
Lymphohistiocytosis-Like Syndrome (IEC-HS)
Immune Effector Cell-Associated Hemophagocytic
Lymphohistiocytosis-Like Syndrome (IEC-HS), including fatal or
life-threatening reactions, occurred following treatment with
BREYANZI. Three of 89 (3%) safety evaluable patients with R/R
CLL/SLL developed IEC-HS. Time to onset of IEC-HS ranged from 7 to
18 days. Two of the 3 patients developed IEC-HS in the setting of
ongoing CRS and 1 in the setting of ongoing neurotoxicity. IEC-HS
was fatal in 2 of 3 patients. One patient had fatal IEC-HS and one
had ongoing IEC-HS at time of death. IEC-HS is a life-threatening
condition with a high mortality rate if not recognized and treated
early. Treatment of IEC-HS should be administered per current
practice guidelines.
Adverse Reactions
The most common adverse reactions (incidence ≥30%) in LBCL are
fever, cytokine release syndrome, fatigue, musculoskeletal pain,
and nausea. The most common Grade 3-4 laboratory abnormalities
include lymphocyte count decrease, neutrophil count decrease,
platelet count decrease, and hemoglobin decrease.
The most common adverse reactions (incidence ≥30%) in CLL/SLL
are cytokine release syndrome, encephalopathy, fatigue,
musculoskeletal pain, nausea, edema, and diarrhea. The most common
Grade 3-4 laboratory abnormalities include neutrophil count
decrease, white blood cell decrease, hemoglobin decrease, platelet
count decrease, and lymphocyte count decrease.
The most common adverse reaction (incidence ≥30%) in FL is
cytokine release syndrome. The most common Grade 3-4 laboratory
abnormalities include lymphocyte count decrease, neutrophil count
decrease, and white blood cell decrease.
The most common adverse reactions (incidence ≥30%) in MCL are
cytokine release syndrome, fatigue, musculoskeletal pain, and
encephalopathy. The most common Grade 3-4 laboratory abnormalities
include neutrophil count decrease, white blood cell decrease, and
platelet count decrease.
Please see full Prescribing Information, including Boxed
WARNINGS and Medication Guide.
REBLOZYL
REBLOZYL® (luspatercept-aamt) is indicated for the treatment of
anemia without previous erythropoiesis stimulating agent use
(ESA-naïve) in adult patients with very low- to intermediate-risk
myelodysplastic syndromes (MDS) who may require regular red blood
cell (RBC) transfusions.
REBLOZYL® (luspatercept-aamt) is indicated for the treatment of
anemia failing an erythropoiesis stimulating agent and requiring 2
or more red blood cell (RBC) units over 8 weeks in adult patients
with very low- to intermediate-risk myelodysplastic syndromes with
ring sideroblasts (MDS-RS) or with
myelodysplastic/myeloproliferative neoplasm with ring sideroblasts
and thrombocytosis (MDS/MPN-RS-T).
REBLOZYL is not indicated for use as a substitute for RBC
transfusions in patients who require immediate correction of
anemia.
Important Safety Information
WARNINGS AND PRECAUTIONS
Thrombosis/Thromboembolism
In adult patients with beta thalassemia, thromboembolic events
(TEE) were reported in 8/223 (3.6%) of REBLOZYL-treated patients.
TEEs included deep vein thrombosis, pulmonary embolus, portal vein
thrombosis, and ischemic stroke. Patients with known risk factors
for thromboembolism (splenectomy or concomitant use of hormone
replacement therapy) may be at further increased risk of
thromboembolic conditions. Consider thromboprophylaxis in patients
at increased risk of TEE. Monitor patients for signs and symptoms
of thromboembolic events and institute treatment promptly.
Hypertension
Hypertension was reported in 11.4% (63/554) of REBLOZYL-treated
patients. Across clinical studies, the incidence of Grade 3 to 4
hypertension ranged from 2% to 9.6%. In ESA-refractory or
-intolerant adult patients with MDS with normal baseline blood
pressure, 26 (30%) patients developed systolic blood pressure (SBP)
≥130 mm Hg and 23 (16%) patients developed diastolic blood pressure
(DBP) ≥80 mm Hg. In ESA-naïve adult patients with MDS with normal
baseline blood pressure, 23 (36%) patients developed SBP ≥140 mm Hg
and 11 (6%) patients developed DBP ≥80 mm Hg. Monitor blood
pressure prior to each administration. Manage new or exacerbations
of preexisting hypertension using anti-hypertensive agents.
Embryo-Fetal Toxicity
REBLOZYL may cause fetal harm when administered to a pregnant
woman. REBLOZYL caused increased post-implantation loss, decreased
litter size, and an increased incidence of skeletal variations in
pregnant rat and rabbit studies. Advise pregnant women of the
potential risk to a fetus. Advise females of reproductive potential
to use effective contraception during treatment and for at least 3
months after the final dose.
ADVERSE REACTIONS
ESA-naïve adult patients with Myelodysplastic Syndromes
Grade ≥3 (≥2%) adverse reactions included hypertension and dyspnea.
The most common (≥10%) all-grade adverse reactions included
diarrhea, fatigue, hypertension, peripheral edema, nausea, and
dyspnea.
ESA-refractory or -intolerant adult patients with
Myelodysplastic Syndromes Grade ≥3 (≥2%) adverse reactions
included fatigue, hypertension, syncope and musculoskeletal pain. A
fatal adverse reaction occurred in 5 (2.1%) patients.
The most common (≥10%) adverse reactions included fatigue,
musculoskeletal pain, dizziness, diarrhea, nausea, hypersensitivity
reactions, hypertension, headache, upper respiratory tract
infection, bronchitis, and urinary tract infection.
LACTATION
It is not known whether REBLOZYL is excreted into human milk or
absorbed systemically after ingestion by a nursing infant. REBLOZYL
was detected in milk of lactating rats. When a drug is present in
animal milk, it is likely that the drug will be present in human
milk. Because many drugs are excreted in human milk, and because of
the unknown effects of REBLOZYL in infants, a decision should be
made whether to discontinue nursing or to discontinue treatment.
Because of the potential for serious adverse reactions in the
breastfed child, breastfeeding is not recommended during treatment
and for 3 months after the last dose.
DRUG ABUSE POTENTIAL
Abuse: Abuse of REBLOZYL may be seen in athletes for the effects
on erythropoiesis. Misuse of drugs that increase erythropoiesis,
such as REBLOZYL, by healthy persons may lead to polycythemia,
which may be associated with life-threatening cardiovascular
complications.
Please see U.S. Full Prescribing Information for REBLOZYL.
KRAZATI
INDICATIONS
KRAZATI, as a single-agent, is indicated for the treatment of
adult patients with KRAS G12C-mutated locally advanced or
metastatic non-small cell lung cancer (NSCLC) as determined by an
FDA-approved test, who have received at least one prior systemic
therapy.
KRAZATI in combination with cetuximab is indicated for the
treatment of adult patients with KRAS G12C- mutated locally
advanced or metastatic colorectal cancer (CRC), as determined by an
FDA-approved test, who have received prior treatment with
fluoropyrimidine-, oxaliplatin-, and irinotecan-based
chemotherapy.
These indications are approved under accelerated approval based
on objective response rate (ORR) and duration of response (DOR).
Continued approval for these indications may be contingent upon
verification and description of a clinical benefit in confirmatory
trials.
IMPORTANT SAFETY
INFORMATION
WARNINGS AND PRECAUTIONS
Gastrointestinal Adverse Reactions
- KRAZATI can cause severe gastrointestinal adverse
reactions
- Monitor and manage patients using supportive care, including
antidiarrheals, antiemetics, or fluid replacement, as indicated.
Withhold, reduce the dose, or permanently discontinue KRAZATI based
on severity
QTc Interval Prolongation
- KRAZATI can cause QTc interval prolongation, which can increase
the risk for ventricular tachyarrhythmias (eg, torsades de pointes)
or sudden death
- Avoid concomitant use of KRAZATI with other products with a
known potential to prolong the QTc interval.
- Avoid use of KRAZATI in patients with congenital long QT
syndrome and in patients with concurrent QTc prolongation
- Monitor ECGs and electrolytes, particularly potassium and
magnesium, prior to starting KRAZATI, during concomitant use, and
as clinically indicated in patients with congestive heart failure,
bradyarrhythmias, electrolyte abnormalities, and in patients who
are unable to avoid concomitant medications that are known to
prolong the QT interval. Correct electrolyte abnormalities.
Withhold, reduce the dose, or permanently discontinue KRAZATI,
depending on severity
Hepatotoxicity
- KRAZATI can cause hepatotoxicity, which may lead to
drug-induced liver injury and hepatitis
- Monitor liver laboratory tests (AST, ALT, alkaline phosphatase,
and total bilirubin) prior to the start of KRAZATI, and monthly for
3 months or as clinically indicated, with more frequent testing in
patients who develop transaminase elevations. Reduce the dose,
withhold, or permanently discontinue KRAZATI based on severity
Interstitial Lung Disease/Pneumonitis
- KRAZATI can cause interstitial lung disease (ILD)/pneumonitis,
which can be fatal
- Monitor patients for new or worsening respiratory symptoms
indicative of ILD/pneumonitis (eg, dyspnea, cough, fever) during
treatment with KRAZATI. Withhold KRAZATI in patients with suspected
ILD/pneumonitis and permanently discontinue KRAZATI if no other
potential causes of ILD/pneumonitis are identified
ADVERSE REACTIONS
- Serious adverse reactions occurred in 57% of 116 patients who
received adagrasib in NSCLC patients. The most common adverse
reactions in NSCLC patients (≥20%) were diarrhea, nausea, fatigue,
vomiting, musculoskeletal pain, hepatotoxicity, renal impairment,
dyspnea, edema, decreased appetite, cough, pneumonia, dizziness,
constipation, abdominal pain, and QTc interval prolongation
- Serious adverse reactions occurred in 30% of 94 patients who
received adagrasib in combination with cetuximab. The most common
adverse reactions in CRC patients (≥20%) were rash, nausea,
diarrhea, vomiting, fatigue, musculoskeletal pain, hepatotoxicity,
headache, dry skin, abdominal pain, decreased appetite, edema,
anemia, dizziness, cough, constipation, and peripheral
neuropathy
DRUG INTERACTIONS
- Strong CYP3A4 Inducers: Avoid concomitant use.
- Strong CYP3A4 Inhibitors: Avoid concomitant use until adagrasib
concentrations have reached steady state (after ~8 days).
- Sensitive CYP3A4 Substrates: Avoid concomitant use with
sensitive CYP3A4 substrates.
- Sensitive CYP2C9 or CYP2D6 Substrates or P-gp Substrates: Avoid
concomitant use with sensitive CYP2C9 or CYP2D6 substrates or P-gp
substrates where minimal concentration changes may lead to serious
adverse reactions.
- Drugs That Prolong QT Interval: Avoid concomitant use with
KRAZATI.
Please see Drug Interactions Section of the Full Prescribing
Information for additional information.
USE IN SPECIFIC POPULATIONS
Females and Males of Reproductive Potential
- Infertility: Based on findings from animal studies, KRAZATI may
impair fertility in females and males of reproductive
potential
Lactation
Please see Full Prescribing Information.
Bristol Myers Squibb: Creating a Better
Future for People with Cancer
Bristol Myers Squibb is inspired by a single vision —
transforming patients’ lives through science. The goal of the
company’s cancer research is to deliver medicines that offer each
patient a better, healthier life and to make cure a possibility.
Building on a legacy across a broad range of cancers that have
changed survival expectations for many, Bristol Myers Squibb
researchers are exploring new frontiers in personalized medicine
and, through innovative digital platforms, are turning data into
insights that sharpen their focus. Deep understanding of causal
human biology, cutting-edge capabilities and differentiated
research platforms uniquely position the company to approach cancer
from every angle.
Cancer can have a relentless grasp on many parts of a patient’s
life, and Bristol Myers Squibb is committed to taking actions to
address all aspects of care, from diagnosis to survivorship. As a
leader in cancer care, Bristol Myers Squibb is working to empower
all people with cancer to have a better future.
About Bristol Myers Squibb’s Patient
Access Support
Bristol Myers Squibb remains committed to providing assistance
so that cancer patients who need our medicines can access them and
expedite time to therapy.
BMS Access Support®, the Bristol Myers Squibb patient access and
reimbursement program, is designed to help appropriate patients
initiate and maintain access to BMS medicines during their
treatment journey. BMS Access Support offers benefit investigation,
prior authorization assistance, as well as co-pay assistance for
eligible, commercially insured patients. More information about our
access and reimbursement support can be obtained by calling BMS
Access Support at 1-800-861-0048 or by visiting
www.bmsaccesssupport.com.
About the Bristol Myers Squibb and Ono
Pharmaceutical Collaboration
In 2011, through a collaboration agreement with Ono
Pharmaceutical Co., Bristol Myers Squibb expanded its territorial
rights to develop and commercialize Opdivo globally, except in
Japan, South Korea and Taiwan, where Ono had retained all rights to
the compound at the time. On July 23, 2014, Ono and Bristol Myers
Squibb further expanded the companies’ strategic collaboration
agreement to jointly develop and commercialize multiple
immunotherapies – as single agents and combination regimens – for
patients with cancer in Japan, South Korea and Taiwan.
About Bristol Myers
Squibb
Bristol Myers Squibb is a global biopharmaceutical company whose
mission is to discover, develop and deliver innovative medicines
that help patients prevail over serious diseases. For more
information about Bristol Myers Squibb, visit us at BMS.com or
follow us on LinkedIn, X, YouTube, Facebook and Instagram.
Cautionary Statement Regarding
Forward-Looking Statements
This press release contains “forward-looking statements” within
the meaning of the Private Securities Litigation Reform Act of 1995
regarding, among other things, the research, development and
commercialization of pharmaceutical products. All statements that
are not statements of historical facts are, or may be deemed to be,
forward-looking statements. Such forward-looking statements are
based on current expectations and projections about our future
financial results, goals, plans and objectives and involve inherent
risks, assumptions and uncertainties, including internal or
external factors that could delay, divert or change any of them in
the next several years, that are difficult to predict, may be
beyond our control and could cause our future financial results,
goals, plans and objectives to differ materially from those
expressed in, or implied by, the statements. These risks,
assumptions, uncertainties and other factors include, among others,
that future study results may not be consistent with the results to
date, that the treatments and combination treatments described in
this release may not receive regulatory approval for the
indications described in this release, any marketing approvals, if
granted, may have significant limitations on their use, and, if
approved, whether the such treatments and combination treatments
will be commercially successful. No forward-looking statement can
be guaranteed. Forward-looking statements in this press release
should be evaluated together with the many risks and uncertainties
that affect Bristol Myers Squibb’s business and market,
particularly those identified in the cautionary statement and risk
factors discussion in Bristol Myers Squibb’s Annual Report on Form
10-K for the year ended December 31, 2024, as updated by our
subsequent Quarterly Reports on Form 10-Q, Current Reports on Form
8-K and other filings with the Securities and Exchange Commission.
The forward-looking statements included in this document are made
only as of the date of this document and except as otherwise
required by applicable law, Bristol Myers Squibb undertakes no
obligation to publicly update or revise any forward-looking
statement, whether as a result of new information, future events,
changed circumstances or otherwise.
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