On December 12, 2017 Roche (SIX: RO, ROG; OTCQX: RHHBY) reported the first results from the pivotal phase III MURANO study evaluating Venclexta/Venclyxto (venetoclax) plus MabThera/Rituxan (rituximab) compared to bendamustine plus MabThera/Rituxan (BR) for the treatment of people with relapsed or refractory chronic lymphocytic leukaemia (CLL) (Press release, Hoffmann-La Roche, DEC 12, 2017, View Source [SID1234522580]). The results showed that a fixed duration of treatment with Venclexta/Venclyxto plus MabThera/Rituxan significantly reduced the risk of disease progression or death (progression-free survival; PFS, as assessed by investigator) by 83% compared with BR (HR=0.17; 95% CI 0.11-0.25; p<0.0001). No new safety signals were observed. Venclexta/Venclyxto is being developed by AbbVie and Roche. It is jointly commercialised by AbbVie and Genentech, a member of the Roche Group, in the United States and commercialised by AbbVie outside of the United States.

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"The MURANO study results indicate that Venclexta/Venclyxto plus MabThera/Rituxan has the potential to provide an important new chemotherapy-free option for people with previously treated chronic lymphocytic leukaemia," said Sandra Horning, MD, Roche’s Chief Medical Officer and Head of Global Product Development. "We are particularly encouraged by the magnitude of benefit observed across key efficacy measures compared to a current standard of care, and we look forward to discussing these results with health authorities."

Results from the study were featured in the official press programme of the 59th American Society of Hematology (ASH) (Free ASH Whitepaper) Annual Meeting in Atlanta on Monday, 11 December, and will be presented during the Late-Breaking Abstracts Session on Tuesday, 12 December, at 7.45am EST by John F. Seymour, MD, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia (Abstract #LBA-2).

Data from the MURANO study will be submitted to global health authorities, including the US Food and Drug Administration (FDA), which has granted Breakthrough Therapy Designation for Venclexta in combination with Rituxan for the treatment of relapsed or refractory CLL based on promising results from the phase Ib M13-365 study.

Venclexta was granted accelerated approval by the FDA in April 2016 for the treatment of people with CLL with 17p deletion, as detected by an FDA approved test, who have received at least one prior therapy. The MURANO study is part of the company’s commitment in the United States to convert the current accelerated approval of Venclexta to a full approval.

A robust clinical development programme for Venclexta/Venclyxto is ongoing, and additional results across multiple blood cancers including acute myeloid leukaemia (AML) and multiple myeloma (MM) were also presented at the ASH (Free ASH Whitepaper) Annual Meeting.

About the MURANO Study
MURANO (NCT02005471) is a phase III open-label, international, multicentre, randomised study evaluating the efficacy and safety of Venclexta/Venclyxto in combination with MabThera/Rituxan compared to bendamustine in combination with MabThera/Rituxan (BR). All treatments were of fixed duration. The study included 389 patients with relapsed or refractory chronic lymphocytic leukaemia (CLL) who had been previously treated with at least one, but not more than three, lines of therapy. Patients were randomly assigned in a 1:1 ratio to receive either Venclexta/Venclyxto plus MabThera/Rituxan (Arm A) or BR (Arm B). The primary endpoint of the study is investigator-assessed progression-free survival (PFS). Secondary endpoints include PFS assessed by independent review committee (IRC), overall response rate (ORR), complete response rate (with or without complete blood count recovery, CR/CRi), overall survival (OS), minimal residual disease (MRD) status, duration of response, event-free survival and time to next CLL treatment.

The results showed:

Patients in the study who received Venclexta/Venclyxto plus MabThera/Rituxan lived significantly longer without their disease worsening (PFS, as assessed by investigator) compared to those who received BR (HR=0.17; 95% CI, 0.11-0.25; p<0.0001; median PFS: not reached vs. 17.0 months, respectively).
At two years, 84.9% of patients in the Venclexta/Venclyxto plus MabThera/Rituxan arm had not experienced disease progression, compared to 36.3% of patients in the BR arm.
Consistent benefit was observed in all patient subgroups for Venclexta/Venclyxto plus MabThera/Rituxan compared to BR, including high-risk and low-risk groups.
IRC assessment was consistent; as assessed by IRC, Venclexta/Venclyxto plus MabThera/Rituxan reduced the risk of disease progression or death by 81% compared to BR (HR=0.19; 95% CI 0.13, 0.28; p<0.0001).
Clinical benefit observed for Venclexta/Venclyxto plus MabThera/Rituxan compared to BR was consistent across key secondary endpoints, including OS (HR=0.48, 95% CI 0.25-0.90; medians not yet reached), ORR as assessed by investigator (93.3% vs. 67.7%), CR/CRi as assessed by investigator (26.8% vs. 8.2%). These results were not statistically significant. In addition, higher rates of MRD-negativity at any time were observed with Venclexta/Venclyxto plus MabThera/Rituxan compared to BR (83.5% vs. 23.1%). MRD negativity was defined as less than one CLL cell in 10,000 leukocytes.
No new safety signals were observed with the treatment combination of Venclexta/Venclyxto plus MabThera/Rituxan. The most common Grade 3-4 adverse events with Venclexta/Venclyxto plus MabThera/Rituxan compared to BR, respectively, were low white blood cell count (57.7% vs. 38.8%), low red blood cell count (10.8% vs. 13.8%), low platelet count (5.7% vs. 10.1%), low white blood cell count with fever (3.6% vs. 9.6%), pneumonia (5.2% vs. 8.0%) and infusion reactions (1.5% vs. 5.3%).
About Venclexta/Venclyxto
Venclexta/Venclyxto is a small molecule designed to selectively bind and inhibit the BCL-2 protein, which plays an important role in a process called apoptosis (programmed cell death). Overexpression of the BCL-2 protein in CLL has been associated with resistance to certain therapies. It is believed that blocking BCL-2 may restore the signalling system that tells cells, including cancer cells, to self-destruct. Venclexta/Venclyxto is being developed by Roche and AbbVie. It is jointly commercialised by AbbVie and Genentech, a member of the Roche Group, in the United States and commercialised by AbbVie outside of the United States.

Together, the companies are committed to further research with Venclexta/Venclyxto, which is currently being evaluated in phase III clinical trials for the treatment of CLL, along with studies in several other types of cancers. In the United States, Venclexta has been granted four breakthrough therapy designations by the FDA: in combination with Rituxan for people with relapsed or refractory CLL, as a monotherapy for people with relapsed or refractory CLL with 17p deletion; in combination with hypomethylating agents (azacitidine or decitabine) for people with untreated acute myeloid leukaemia (AML) ineligible for intensive chemotherapy, and in combination with low-dose cytarabine (LDAC) for people with untreated AML ineligible for intensive chemotherapy.

About Chronic Lymphocytic Leukaemia
Chronic lymphocytic leukaemia (CLL) is the most common type of leukaemia in the Western world.1 CLL mainly affects men and the median age at diagnosis is about 70 years.2 Worldwide, the incidence of all leukaemias is estimated to be over 350,0001 and CLL is estimated to affect around one-third of all people newly diagnosed with leukaemia.3

About Roche in haematology
For more than 20 years, Roche has been developing medicines that redefine treatment in haematology. Today, we are investing more than ever in our effort to bring innovative treatment options to people with diseases of the blood. In addition to approved medicines MabThera /Rituxan (rituximab), Gazyva/Gazyvaro (obinutuzumab), and Venclexta / Venclyxto (venetoclax) in collaboration with AbbVie, Roche’s pipeline of investigational haematology medicines includes Tecentriq (atezolizumab), an anti-CD79b antibody drug conjugate (polatuzumab vedotin/RG7596) and a small molecule antagonist of MDM2 (idasanutlin/RG7388). Roche’s dedication to developing novel molecules in haematology expands beyond malignancy, with the development of Hemlibra (emicizumab), a bispecific monoclonal antibody for the treatment of haemophilia A.

On December 12, 2017 Immutep Limited (ASX: IMM; NASDAQ: IMMP) (Immutep or the Company), reported update on the Company’s two ongoing clinical trials with eftilagimod alpha (LAG-3Ig or IMP321). Immutep is pleased to advise that clinical studies of eftilagimod alpha are progressing well (Press release, Prima Biomed, DEC 12, 2017, View Source [SID1234522623]).
In line with previous guidance, the third cohort of TACTI-mel (Two ACTive Immunotherapeutics in melanoma), the Company’s Australian melanoma clinical trial, has now been fully recruited. The sixth and last patient of that cohort received their first treatment yesterday, bringing the total number of patients recruited for the trial to 18.

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The patients eligible to participate in the TACTI-mel Phase 1 clinical trial are those with unresectable or metastatic melanoma who have either had a suboptimal response or had disease progression with pembrolizumab (KEYTRUDA) monotherapy as a first-line of treatment. These patients are dosed with eftilagimod alpha in combination with pembrolizumab. To date, no dose limiting toxicity has been observed in any patient at any dose level. Data shows the combination to be safe and well tolerated. Data from all three cohorts is expected in H1 2018.

AIPAC (Active Immunotherapy PAClitaxel), the Company’s European clinical trial started recruitment of the randomized part of the study in January 2017. In addition to centres in Belgium and the Netherlands, competent authorities’ approvals have been received and patient recruitment has also now commenced in Poland, Hungary, United Kingdom and Germany, with France following in due course. In total, 29 out of 34 clinical sites have been activated with the outstanding site activations expected to occur in early 2018. The study is expected to be fully recruited by mid-2018.

As announced earlier in June, data from the open-label safety run-in cohort of 15 patients, who received 6mg and 30mg doses of eftilagimod alpha in combination with paclitaxel, were presented at the American Society of Clinical Oncology (ASCO) (Free ASCO Whitepaper) Annual Meeting in Chicago, IL, USA. Final results received in December 2017 confirm the data presented at ASCO (Free ASCO Whitepaper). Data shows that the combination of eftilagimod alpha plus weekly paclitaxel in patients with metastatic breast cancer is safe and well tolerated, leading to an overall response rate of 47% in the safety run-in. Pharmacodynamic parameters on primary and secondary target cells confirmed the proof of principle in patients.

Eftilagimod alpha Partnering Update
Immutep’s Chinese partner for eftilagimod alpha, EOC Pharma, an oncology focused affiliate of Eddingpharm, applied in the first quarter of 2017 for an Investigational New Drug (IND) in China, in preparation before starting clinical trials. Recent positive changes in the Chinese regulatory environment are likely to speed up development of eftilagimod alpha in China.

CYTLIMIC, the Japanese NEC spin off with which Immutep has a collaboration agreement, presented a poster at ASCO (Free ASCO Whitepaper) (View Source) which showed the results of their T-cell based therapeutic cancer vaccine with eftilagimod alpha as a vaccine adjuvant. A new material transfer agreement with CYTLIMIC regarding their purchase of additional vials of eftilagimod alpha from Immutep was concluded in September 2017.

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IMP761 Update
IMP761 is the first humanized antibody which acts as an agonist to one of the three immune checkpoint molecules targeted in oncology, namely CTLA-4, PD-1 and LAG-3. Consequently, Immutep is the first company to translate the vast amount of clinical data and biologic knowledge from oncology to the field of auto-immune diseases. The preclinical development of our agonist anti-LAG-3 antibody has now been successfully advanced following an extensive cross-reactivity study on a series of 30 FDA-approved human tissues sections, a prerequisite before entering the clinic.

On December 12, 2017 Palleon Pharmaceuticals, a company focused on developing Glycoimmune Checkpoint Inhibitors to treat cancer, reported an agreement with King’s College London to license intellectual property developed in the laboratory of Joy Burchell, Ph.D., Professor of Glyco-Oncology at the university. This agreement gives Palleon the exclusive rights to a patent portfolio that will facilitate the development of drugs that target Glycoimmune Checkpoints, a novel approach to overcoming resistance to first-generation immuno-oncology drugs.

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Professor Burchell has been a leader in the field of aberrant glycosylation in breast cancer for over 25 years. Earlier in her career she developed tools that demonstrated that more than 90% of breast cancers, and many other carcinomas, carry glycans that are different from those carried by proteins on normal cells. She was the first to show that a mucin known as MUC1 is present in the sera of breast cancer patients. This discovery enabled the development of the CA15.3 test, a serum assay used to measure the response to breast cancer treatment and to monitor recurrence of breast cancer. More recently, Professor Burchell has been investigating how aberrant glycosylation of MUC1 plays a significant role in immunosuppression and allows the cancer to thrive.

Jim Broderick, M.D., Chief Executive Officer and Founder of Palleon, commented, "Professor Burchell’s research is at the forefront of understanding how tumors use glycans to evade the immune system. We now know that tumor cells down-regulate a wide spectrum of immune cell types by cloaking themselves in certain glycan patterns, and that this mechanism of immunosuppression can be targeted by a new class of drugs. This licensing agreement strengthens Palleon’s position as the leader in this new approach to defeating cancer’s suppression of the human immune system."

Dr. Burchell added, "We have known about the alteration of glycans on the surface of malignant cells for decades. However, recent discoveries in the field of glycoscience have demonstrated the role of glycans in immunosuppression. Glycobiology is now emerging as a major axis of immunosuppression in cancer. We expect these findings to provide the foundation for developing immuno-oncology drugs that will have a significant impact on the lives of patients."

On December 12, 2017 Constellation Pharmaceuticals, Inc., a clinical-stage biopharmaceutical company developing tumor-targeted and immuno-oncology therapies based on its pioneering research in cancer epigenetics, reported that the first patient has been dosed in its Phase 1b/2 PROSTAR study of CPI-1205, a small-molecule inhibitor of EZH2, combined with enzalutamide or abiraterone/prednisone in patients with metastatic castration-resistant prostate cancer (mCRPC) (Press release, Constellation Pharmaceuticals, DEC 12, 2017, View Source [SID1234522670]).

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"The initiation of this combination study marks a significant milestone for the company as we execute on our goal to rapidly advance our pipeline of epigenetic therapeutics that have the potential to address difficult-to-treat cancers," said Adrian Senderowicz, M.D., senior vice president and chief medical officer of Constellation Pharmaceuticals. "Today’s announcement marks the first evaluation of CPI-1205 in solid tumors. We anticipate advancing CPI-1205 and other therapies from our EZH2 portfolio in additional solid tumor clinical trials in the future."

CPI-1205 is a potent, highly selective, first-generation small-molecule inhibitor of EZH2, a clinically-validated target in cancer. In multiple types of cancer, including mCRPC, EZH2 contributes to drug resistance over time by enhancing pro-tumor pathways, such as androgen receptor signaling. CPI-1205 has shown single-agent activity and synergistic activity with small-molecule androgen inhibitors in preclinical studies. CPI-1205 has also demonstrated single-agent clinical activity and a dose-dependent increase in exposure correlated to pharmacodynamic biomarkers during a clinical trial of CPI-1205 in selected lymphoma patients.

"There is a tremendous need for new, safe and effective medicines for advanced prostate cancer, especially for men with progressive mCRPC," said Mary-Ellen Taplin, M.D., Dana-Farber Cancer Institute and an investigator in the trial. "We look forward to learning how CPI-1205 may help overcome resistance mechanisms in mCRPC and extend response to therapy."

The Phase 1b portion of the PROSTAR study is designed to assess safety, pharmacokinetics, pharmacodynamics, as well as a recommended Phase 2 dose (RP2D) of CPI-1205 in combination with either enzalutamide (marketed as Xtandi by Astellas and Pfizer) or abiraterone acetate (marketed as Zytiga by Janssen), which are FDA-approved second-generation androgen inhibitors. The Phase 2 portion of the PROSTAR study will assess clinical activity and potential biomarkers to identify patient populations with higher clinical anti-tumor activity to CPI-1205.

About mCRPC

mCRPC is an advanced form of prostate cancer and is defined by disease progression despite treatment with androgen depletion therapy (ADT). mCRPC may present as one, or any combination of, a continuous rise in serum levels of prostate-specific antigen (PSA), progression of known metastases, or appearance of new metastases. Prognosis is associated with several factors, including the ability to perform certain daily activities and the presence of bone pain. Additional symptoms commonly include anemia (low healthy red blood cell levels), weight loss, fatigue, hypercoagulability (abnormal blood coagulation) and increased susceptibility to infection. mCRPC presents as a spectrum of disease ranging from patients without symptoms but rising PSA levels despite ADT, to patients with metastases and significant debilitation.

About CPI-1205

CPI-1205 is a therapeutic candidate from Constellation Pharmaceuticals’ EZH2 portfolio and is an inhibitor of Enhancer of Zeste Homolog 2 (EZH2). The function of EZH2 is to selectively suppress gene expression of several pro-cancer pathways that contribute to drug resistance.

On December 12, 2017 Geron Corporation (Nasdaq:GERN) reported four presentations related to imetelstat at the 59th American Society of Hematology (ASH) (Free ASH Whitepaper) Annual Meeting and Exposition held in Atlanta, Georgia from December 9-12, 2017 (Press release, Geron, DEC 12, 2017, View Source;p=RssLanding&cat=news&id=2322273 [SID1234522575]). Imetelstat is a telomerase inhibitor initially developed by Geron and exclusively licensed to Janssen Biotech, Inc. (Janssen) on a worldwide basis. The presentations are available on Geron’s website at www.geron.com/presentations.

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"We and our partner are pleased to have this first presentation of data from IMerge displaying an 8-week transfusion independence rate of 54% among the subset of patients who were naïve to lenalidomide and HMAs and who lacked del(5q), which suggests that imetelstat could offer lower risk MDS patients a much-needed treatment option," said John A. Scarlett, M.D., Geron’s President and Chief Executive Officer. "In addition, the non-clinical data presentations continue to support the potential use of imetelstat in multiple hematologic malignancies. We continue to be encouraged by the consistent interest in imetelstat by collaborators around the world."

Clinical Data Presentation

Title: Efficacy and Safety of Imetelstat in RBC Transfusion-Dependent (TD) IPSS Low/Int-1 MDS Relapsed/Refractory to Erythropoiesis-Stimulating Agents (ESA) (IMerge) (Abstract #4256)

This poster presentation described data from the first 32 patients enrolled in Part 1 of IMerge, the ongoing Phase 2/3 clinical trial of imetelstat in red blood cell (RBC) transfusion-dependent (TD) patients with lower risk MDS. TD is defined as an RBC transfusion requirement of ≥4 units over 8 weeks prior to entry into the trial. The primary efficacy endpoint is the rate of RBC transfusion-independence (TI) lasting at least 8 weeks, defined as the proportion of patients without any RBC transfusion during any consecutive 8 weeks since entry to the trial. Key secondary endpoints are the rate of 24-week TI and the rate of hematologic improvement-erythroid (HI-E), defined as a rise in hemoglobin of at least 1.5 g/dL above the pretreatment level for at least 8 weeks or a reduction of at least 4 units of RBC transfusions over 8 weeks compared with the prior RBC transfusion burden. IMerge is designed in two parts: Part 1 is a Phase 2, open-label, single-arm trial of imetelstat administered as a single agent by intravenous infusion, and Part 2 is designed to be a Phase 3, randomized, controlled trial.

Data as of October 2017 with a median follow-up of 66.1 weeks in Part 1 were presented. Part 2 has not yet begun.

Efficacy in the Overall Trial Population (n=32):

38% (12/32) of patients achieved ≥8-week RBC TI
Mean relative reduction in transfusion burden from baseline was 64%
16% (5/32) of patients achieved ≥24-week RBC TI, with the median TI duration exceeding one year in these patients
63% (20/32) of patients achieved an erythroid hematologic improvement (HI-E)
Efficacy in the Lenalidomide and HMA Naïve and Non-Del(5q) Subset (n=13):

54% (7/13) of patients achieved ≥8-week RBC TI
Mean relative reduction in transfusion burden from baseline was 71%
31% (4/13) of patients achieved ≥24-week RBC TI
69% (9/13) of patients achieved an HI-E
Safety Summary:

Cytopenias, particularly neutropenia and thrombocytopenia, were the most frequently reported adverse events which were predictable, manageable and reversible
Link to IMerge poster: Fenaux P, et al. ASH (Free ASH Whitepaper) 2017

Based on these data, Part 1 of IMerge is being expanded to enroll approximately 20 additional patients who are naïve to lenalidomide and HMA treatment and are non-del(5q) to increase the experience and confirm the benefit-risk profile of imetelstat in this refined target patient population. For more information about IMerge, please visit View Source

Non-Clinical Data Presentations

Data were presented from three non-clinical studies by academic scientists in collaboration with Janssen.

Title: Imetelstat, a Telomerase Inhibitor, Is Capable of Depleting Myelofibrosis Hematopoietic Stem Cells and Progenitor Cells (Abstract #1654)

This poster presentation described the effects of imetelstat on normal and myelofibrosis (MF) stem and progenitor cells in non-clinical models. The data showed that imetelstat inhibited the proliferation and differentiation of MF progenitor and stem cells in hematopoietic colony assays and xenograft models, but had minimal effects on normal hematopoietic stem and progenitor cells in such experiments. Imetelstat treatment of MF stem and progenitor cells reduced telomerase activity and induced apoptosis. These data provide further support that imetelstat may selectively inhibit the proliferation of and promote apoptosis in MF progenitor and stem cells, suppressing the malignant clones that drive the disease in patients.

Title: Telomerase Inhibition Impairs Self-Renewal of b-Catenin Activated Myeloproliferative Neoplasm Progenitors (Abstract #2860)

This poster presentation described the potential impact of imetelstat on leukemia stem cells in non-clinical models of chronic myeloid leukemia (CML) in blast crisis. The data suggest that imetelstat plus dasatinib, a standard treatment for CML, may inhibit self-renewal of blast crisis cells in vitro compared with normal bone marrow progenitors. In mouse xenograft models of blast crisis CML, imetelstat treatment reduced the number of leukemia progenitor cells detected in bone marrow and spleen, decreased spleen size, inhibited the self-renewal capacity and prolonged survival compared to controls. These data suggest that imetelstat may inhibit proliferation of malignant progenitors in CML.

Title: Integrated Molecular Analysis Identifies Replicative Stress as Sensitizer to Imetelstat Therapy in AML (Abstract #798)

This oral presentation described imetelstat’s activity in human acute myeloid leukemia (AML) patient-derived xenograft models. The preclinical data demonstrated that imetelstat prolonged overall survival of AML xenografts derived from 17 out of 30 individual patient samples compared to saline-treated controls. Molecular analysis showed that sustained responders were associated with gene signatures of replicative stress at baseline. The data also suggest that inducing replicative stress with standard induction chemotherapy may sensitize poorly responding samples to imetelstat. These data build on previously published preclinical work and further support potential application of imetelstat in the treatment of AML.

Webcast Investor Event

Management will be hosting a live webcast of an analyst and investor meeting on December 19, 2017 at 8:30 a.m. ET to discuss the imetelstat clinical data in MDS presented at ASH (Free ASH Whitepaper). The audio and slide presentation webcast will be accessible at www.geron.com on the Investor Relations pages, under Events. Following the live presentation, the webcast will be archived and available for replay at the same address for a period of 30 days.

About Imetelstat

Imetelstat (GRN163L; JNJ-63935937) is a potent and specific inhibitor of telomerase that is administered by intravenous infusion. This first-in-class compound, discovered by Geron, is a specially designed and modified short oligonucleotide, which targets and binds directly with high affinity to the active site of telomerase. Preliminary clinical data suggest imetelstat might have disease-modifying activity by inhibiting the progenitor cells of the malignant clones associated with hematologic malignancies in a relatively select manner. Most commonly reported adverse events in imetelstat clinical studies include fatigue, gastrointestinal symptoms and cytopenias. Imetelstat has not been approved for marketing by any regulatory authority.

About the Collaboration with Janssen

On November 13, 2014, Geron entered into an exclusive worldwide license and collaboration agreement with Janssen Biotech, Inc., to develop and commercialize imetelstat for oncology, including hematologic myeloid malignancies, and all other human therapeutics uses. Under the terms of the agreement, Geron received an upfront payment of $35 million and is eligible to receive additional payments up to a potential total of $900 million for the achievement of development, regulatory and commercial milestones, as well as royalties on worldwide net sales. All regulatory, development, manufacturing and promotional activities related to imetelstat are being managed through a joint governance structure, with Janssen responsible for these activities.