Celgene International Sàrl (NASDAQ: CELG) announced clinical data
from an investigational study of patients with multiple myeloma who were
younger than 65 years old and received either lenalidomide (REVLIMID),
melphalan and prednisone (MPR) or melphalan plus autologous stem cell
transplant (MEL200) following an induction treatment of lenalidomide
plus low-dose dexamethasone (Rd) were presented at the American Society
of Clinical Oncology annual meeting.
In the study, 402 patients received four 28-day cycles of Rd as an
induction therapy. Patients were then randomized to receive either six
28-day courses of MPR or tandem autologous stem cell transplant
(MEL200). Upon completion of this regimen, patients were randomized to
either continuous lenalidomide or no continuous therapy until relapse.
Following the Rd induction phase, 86% (318/370) of patients achieved a
partial response (PR) or better and 37% (137/370) achieved at least a
very good partial response (VGPR). After randomization, 55% of those who
received at least three cycles of MPR (64/117) achieved at least a VGPR,
with 13% (15/117) achieving a complete response (CR). Fifty-three
percent of patients who received the first of the tandem autologous stem
cell transplant (MEL200) (65/122) achieved at least a VGPR, with 16%
(20/122) (p=0.82) achieving a CR.
Progression-free survival was the primary endpoint of the trial. At a
median follow-up of 14 months the 1-year progression free survival rate
was 91% for both the MPR and autologous stem cell transplant (MEL200)
arms (p=0.77). Additionally, the 1-year overall survival rate for the
MPR arm was 97% compared to 98% (p=0.27) for the MEL200 arm.
In the study, the most common grade 3 or 4 adverse events were
neutropenia (Rd 9%, MPR 48%, MEL200 84%), thrombocytopenia (Rd 3%, MPR
8%, MEL200 84%), infection (Rd 5%, MPR 0%, MEL200 17%) and
gastrointestinal events (MPR 0%, MEL200 22%).
These data are from an investigational study. REVLIMID is not approved
as a treatment for patients newly diagnosed with multiple myeloma.
About REVLIMID®
REVLIMID is an IMiDs compound. REVLIMID and other IMiDs continue to be
evaluated in over 100 clinical trials. The IMiDs pipeline is covered by
a comprehensive intellectual property estate of issued and pending
patent applications in the US, EU and other regions, including
composition-of- matter and use patents.
REVLIMID is approved in combination with dexamethasone for the treatment
of patients with multiple myeloma who have received at least one prior
therapy in nearly 50 countries, encompassing Europe, the Americas, the
Middle-East and Asia, and in combination with dexamethasone for the
treatment of patients whose disease has progressed after one therapy in
Australia and New Zealand.
REVLIMID is also approved in the United States, Canada and several Latin
American countries, as well as Malaysia and Israel, for
transfusion-dependent anemia due to low- or intermediate-1-risk MDS
associated with a deletion 5q cytogenetic abnormality with or without
additional cytogenetic abnormalities. Marketing Authorization
Applications are currently being evaluated in a number of other
countries.
REVLIMID
(lenalidomide) in combination with dexamethasone is
indicated for the treatment of multiple myeloma patients who have
received at least one prior therapy.
REVLIMID (lenalidomide) is indicated for patients with
transfusion-dependent anemia due to low- or intermediate-1–risk MDS
associated with a deletion 5q cytogenetic abnormality with or without
additional cytogenetic abnormalities.
Important Safety Information
WARNINGS:
1. POTENTIAL FOR HUMAN BIRTH DEFECTS.
Lenalidomide is an analogue of thalidomide. Thalidomide is a known
human teratogen that causes severe life-threatening human birth defects.
If lenalidomide is taken during pregnancy, it may cause birth defects or
death to an unborn baby. Females should be advised to avoid pregnancy
while taking REVLIMID® (lenalidomide).
Male Patients:
It is not known whether lenalidomide is present
in the semen of patients receiving the drug.
Therefore, males
receiving REVLIMID® (lenalidomide) must always use a latex condom
during any sexual contact with females of childbearing potential even if
they have undergone a successful vasectomy.
Special Prescribing Requirements
Because of this potential toxicity and to avoid fetal exposure to
REVLIMID® (lenalidomide), REVLIMID® (lenalidomide) is only available
under a special restricted distribution program. In the U.S., this
program is called "RevAssist®”. Under this program, only prescribers and
pharmacists registered with the program can prescribe and dispense the
product. In addition, REVLIMID® (lenalidomide) must only be dispensed to
patients who are registered and meet all the conditions of the
RevAssist® program.
2. HEMATOLOGIC TOXICITY (NEUTROPENIA AND THROMBOCYTOPENIA).
This drug is associated with significant neutropenia and
thrombocytopenia.
Eighty percent of patients with del 5q
myelodysplastic syndromes had to have a dose delay/reduction during the
major study. Thirty-four percent of patients had to have a second dose
delay/reduction. Grade 3 or 4 hematologic toxicity was seen in 80% of
patients enrolled in the study. Patients on therapy for del 5q
myelodysplastic syndromes should have their complete blood counts
monitored weekly for the first 8 weeks of therapy and at least monthly
thereafter. Patients may require dose interruption and/or reduction.
Patients may require use of blood product support and/or growth factors.
(see DOSAGE and ADMINISTRATION)
3. DEEP VENOUS THROMBOSIS AND PULMONARY EMBOLISM.
This drug has demonstrated a significantly increased risk of deep
venous thrombosis (DVT) and pulmonary embolism (PE) in patients with
multiple myeloma who were treated with REVLIMID® (lenalidomide)
combination therapy. Patients and physicians are advised to be observant
for the signs and symptoms of thromboembolism. Patients should be
instructed to seek medical care if they develop symptoms such as
shortness of breath, chest pain, or arm or leg swelling. It is not known
whether prophylactic anticoagulation or antiplatelet therapy prescribed
in conjunction with REVLIMID® (lenalidomide) may lessen the potential
for venous thromboembolic events. The decision to take prophylactic
measures should be done carefully after an assessment of an individual
patient’s underlying risk factors.
You can get the information about REVLIMID® (lenalidomide) and the
RevAssist® program on the Internet at www.REVLIMID.com
or by calling the manufacturer’s toll-free number at 1-888-423-5436.
ADDITIONAL WARNINGS: HEMATOLOGIC TOXICITY
Multiple Myeloma
-
In the pooled multiple myeloma studies, Grade 3 and 4 hematologic
toxicities were more frequent in patients treated with the combination
of REVLIMID® (lenalidomide) and dexamethasone than in patients treated
with dexamethasone alone.
-
Patients on therapy should have their complete blood counts
monitored every 2 weeks for the first 12 weeks and then monthly
thereafter.
-
Patients may require dose interruption and/or dose reduction.
CONTRAINDICATIONS:
Pregnancy Category X:
-
Lenalidomide is contraindicated in pregnant women and women capable of
becoming pregnant. When there is no alternative, females of
childbearing potential may be treated with lenalidomide provided
adequate precautions are taken to avoid pregnancy.
Hypersensitivity:
-
REVLIMID® (lenalidomide) is contraindicated in any patients who have
demonstrated hypersensitivity to the drug or its components.
PRECAUTIONS:
Angioedema, Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
-
Angioedema and serious dermatologic reactions including
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)
have been reported. These events can be fatal. Patients with a prior
history of Grade 4 rash associated with thalidomide treatment should
not receive REVLIMID® (lenalidomide). REVLIMID® (lenalidomide)
interruption or discontinuation should be considered for Grade 2-3
skin rash. REVLIMID® (lenalidomide) must be discontinued for
angioedema, Grade 4 rash, exfoliative or bullous rash, or if SJS or
TEN is suspected, and should not be resumed following discontinuation
for these reactions.
Tumor Lysis Syndrome
-
Lenalidomide has antineoplastic activity and therefore the
complications of tumor lysis syndrome may occur. The patients at risk
of tumor lysis syndrome are those with high tumor burden prior to
treatment. These patients should be monitored closely and appropriate
precautions taken.
Renal impairment:
-
Since lenalidomide is primarily excreted unchanged by the kidney,
adjustments to the starting dose of REVLIMID® (lenalidomide) are
recommended to provide appropriate drug exposure in patients with
moderate or severe (CLcr < 60 mL/min) renal impairment and in patients
on dialysis.
-
Because elderly patients are more likely to have decreased renal
function, care should be taken in dose selection, and it would be
prudent to monitor renal function.
Nursing mothers: It is not known whether REVLIMID® (lenalidomide)
is excreted in human milk.
-
Because of the potential for adverse reactions in nursing infants, a
decision should be made whether to discontinue nursing or the drug,
taking into account the importance of the drug to the mother.
ADVERSE REACTIONS:
Multiple Myeloma
-
In the REVLIMID® (lenalidomide)/dexamethasone treatment group, 151
patients (45%) underwent at least one dose interruption with or
without a dose reduction of REVLIMID® (lenalidomide) compared to 21%
in the placebo/dexamethasone treatment group.
-
Of these patients who had one dose interruption with or without a dose
reduction, 50% in the REVLIMID® (lenalidomide)/dexamethasone treatment
group underwent at least one additional dose interruption with or
without a dose reduction compared to 21% in the placebo/dexamethasone
treatment group.
-
Most adverse events and Grade 3/4 adverse events were more frequent in
MM patients who received the combination of REVLIMID®
(lenalidomide)/dexamethasone compared to placebo/dexamethasone.
Other adverse events reported in multiple myeloma patients (REVLIMID®
(lenalidomide)/dexamethasone vs dexamethasone/placebo): constipation
(39% vs 19%), fatigue (38% vs 37%), insomnia (32% vs 37%), muscle cramp
(30% vs 21%), diarrhea (29% vs 25%), neutropenia (28% vs 5%), anemia
(24% vs 17%), asthenia (23% vs 25%), pyrexia (23% vs 19%), nausea (22%
vs 19%), headache (21% vs 21%), peripheral edema (21% vs 19%), dizziness
(21% vs 15%), dyspnea (20% vs 15%), tremor (20% vs 7%), decreased weight
(18% vs 14%), thrombocytopenia (17% vs 10%), rash (16% vs 8%), back pain
(15% vs 14%), hyperglycemia (15% vs 14%), and muscle weakness (15% vs
15%).
Myelodysplastic Syndromes
-
Thrombocytopenia (61.5%; 91/148) and neutropenia (58.8%; 87/148) were
the most frequently reported adverse events observed in the del 5q MDS
population.
Other adverse reactions reported in del 5q MDS patients (REVLIMID®
(lenalidomide)): diarrhea (49%), pruritus (42%), rash (36%), fatigue
(31%), constipation (24%), nausea (24%), nasopharyngitis (23%),
arthralgia (22%), pyrexia (21%), back pain (21%), peripheral edema
(20%), cough (20%), dizziness (20%), headache (20%), muscle cramp (18%),
dyspnea (17%), and pharyngitis (16%).
DOSAGE AND ADMINISTRATION:
-
Dosing is continued or modified based upon clinical and laboratory
findings. Dosing modifications are recommended to manage Grade 3 or 4
neutropenia or thrombocytopenia or other Grade 3 or 4 toxicity judged
to be related to REVLIMID® (lenalidomide).
-
For other Grade 3 or 4 toxicities judged to be related to
REVLIMID®(lenalidomide), hold treatment and restart at next lower dose
level when toxicity has resolved to less than or equal to Grade 2.
Please see full Prescribing Information, including Boxed WARNINGS,
CONTRAINDICATIONS, PRECAUTIONS, and ADVERSE REACTIONS.
About Multiple Myeloma
Multiple myeloma (also known as myeloma or plasma cell myeloma) is a
cancer of the blood in which malignant plasma cells are overproduced in
the bone marrow. Plasma cells are white blood cells that help produce
antibodies called immunoglobulins that fight infection and disease.
However, most patients with multiple myeloma have cells that produce a
form of immunoglobulin called paraprotein (or M protein) that does not
benefit the body. In addition, the malignant plasma cells replace normal
plasma cells and other white blood cells important to the immune system.
Multiple myeloma cells can also attach to other tissues of the body,
such as bone, and produce tumors. The cause of the disease remains
unknown.
About Celgene International Sàrl
Celgene International Sàrl, located in Boudry, in the Canton of
Neuchâtel, Switzerland, is a wholly owned subsidiary and international
headquarters of Celgene Corporation. Celgene Corporation, headquartered
in Summit, New Jersey, is an integrated global pharmaceutical company
engaged primarily in the discovery, development and commercialization of
innovative therapies for the treatment of cancer and inflammatory
diseases through gene and protein regulation. For more information,
please visit the Company's website at www.celgene.com.
This release contains certain forward-looking statements which
involve known and unknown risks, delays, uncertainties and other factors
not under the Company’s control. The Company’s actual results,
performance, or achievements could be materially different from those
projected by these forward-looking statements.
The factors that
could cause actual results, performance, or achievements to differ from
the forward-looking statements are discussed in the Company’s filings
with the Securities and Exchange Commission, such as the Company’s Form
10-K, 10-Q and 8-K reports.
Given these risks and uncertainties,
you are cautioned not to place undue reliance on the forward-looking
statements.
