Thermo Fisher Scientific collaborates with the University of Sheffield to advance oligonucleotide characterization and analytical workflows

On June 7, 2021 Thermo Fisher Scientific, the world leader in serving science, and the University of Sheffield, a leading institution with a global reputation for research excellence, reported that they have joined forces to develop advanced end-to-end workflows for the characterization and monitoring of complex oligonucleotide and mRNA products (Press release, Lifescience Newswire, JUN 7, 2021, View Source [SID1234583662]). This collaboration brings together the University of Sheffield’s extensive research expertise and Thermo Fisher’s cutting-edge sample preparation, liquid chromatography (LC), high resolution accurate mass (HRAM) mass spectrometry (MS) and data interpretation software technologies to enable the development of streamlined analytical workflows and robust fit-for-purpose processes.

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Thermo Fisher brings magnetic bead technology to this collaboration, providing access to sample preparation protocols that are simple to create and modify for optimal reliability and sample-to-sample consistency. These novel sample preparation techniques will be combined with the high-performing Thermo Scientific Orbitrap Exploris 240 Mass Spectrometers, which are designed to deliver quantitative precision and accuracy regardless of sample complexity, the depth of insight required or the presence of unknown compounds. For a complete workflow solution, the Thermo Scientific Dionex DNAPac RP Oligonucleotide Columns will enable high-resolution analysis of synthetic and modified oligonucleotides, while the Thermo Scientific BioPharma Finder Integrated Software will facilitate comprehensive interpretation and data visualization for more confident characterization of oligonucleotide and mRNA products.

"Recently we have witnessed a pressing need for more robust and accurate methods for the characterization and monitoring of oligonucleotide and mRNA products, to ensure generation of a rich level of information that can drive timely production of an ever-growing pipeline of novel vaccines and drug products," explained Eric Grumbach, director of pharma, biopharma vertical marketing, Thermo Fisher Scientific. "Our collaboration with the University of Sheffield will enable us to effectively meet this need through powerful analytical workflows and best practices. We will also optimize current approaches by streamlining sample preparation techniques for mRNA sequencing using nuclease digestion, ion-pairing chromatography and novel separation methods without ion-pairing."

"Having the right tools is essential for the reliable analysis and characterization of oligonucleotide and mRNA products," said Professor Mark Dickman, deputy faculty director of research and innovation, Engineering, University of Sheffield. "Our decades-long research experience and expertise combined with Thermo Fisher’s support and access to industry-leading technology gives us the means to further expand our testing capabilities in this rapidly evolving space, ultimately facilitating the discovery and development of cutting-edge therapeutics."

Thermo Fisher Scientific will showcase its newest products, software solutions and collaborations in a company-hosted virtual event, "Innovation Summit: Shaping the Future of LC-MS in Life Science Together," from June 8-10, 2021. Register here to learn more.

To find out more about Thermo Fisher’s complete workflow solutions, please visit Orbitrap Exploris 240 Mass Spectrometers, Thermo Scientific Dionex DNAPac RP Oligonucleotide Columns and BioPharma Finder Integrated Software.

Live from ASCO 2021 | Ascentage Pharma Delivers Oral Presentation Featuring Updated Data Demonstrating Promising Efficacy and Safety of Bcl-2 Inhibitor Lisaftoclax (APG-2575) in Patients with Relapsed or Refractory CLL/SLL

On June 7, 2021 Ascentage Pharma (6855.HK), a globally focused, clinical-stage biotechnology company engaged in developing novel therapies for cancers, chronic hepatitis B (CHB), and age-related diseases, reported updated results from the first-in-human study of the Bcl-2 inhibitor lisaftoclax (APG-2575) in patients with relapsed/refractory chronic lymphocytic leukemia/small lymphocytic lymphoma (R/R CLL/SLL) and other hematologic malignancies (Press release, Ascentage Pharma, JUN 7, 2021, View Source;ascentage-pharma-delivers-oral-presentation-featuring-updated-data-demonstrating-promising-efficacy-and-safety-of-bcl-2-inhibitor-lisaftoclax-apg-2575-in-patients-with-relapsed-or-refractory-cllsll-301307266.html [SID1234583678]). The findings were reported in an oral presentation at the 57th American Society of Clinical Oncology (ASCO) (Free ASCO Whitepaper) Annual Meeting.

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As one of the Chinese biotechnology companies that have been increasingly visible at international scientific congresses in recent years, Ascentage Pharma has entered the fourth year in which its clinical advances have been selected for presentations at the ASCO (Free ASCO Whitepaper) Annual Meeting. This year, results from four of the company’s clinical trials were selected for presentations at the meeting, and of these data, the two oral presentations have received widespread and avid interest from research and medical communities. Updated data on lisaftoclax have demonstrated favorable preliminary safety and efficacy, including an objective response rate (ORR) of 80% and a favorable tolerability profile, with manageable adverse events (AEs) in patients with R/R CLL/SLL. Moreover, no dose-limiting toxicity (DLT) was observed at the maximum tested dose of 1,200 mg. The maximum tolerated dose (MTD) has not been reached, and no laboratory or clinical tumor lysis syndrome (TLS) has been reported.

Dr. Asher Chanan-Khan, MD, of Mayo Clinic, and the Global Principal Investigator of this study, commented: "Lisaftoclax is a potent, selective Bcl-2 inhibitor which can both induce apoptosis and inhibit tumor cell growth. In this first-in-human study in the US and Australia, lisaftoclax showed a favorable safety profile and promising antitumor activity in patients with R/R CLL/SLL, and potential disease control in several other hematologic malignancies. In view of the preliminary safety and clinical activity observed in this Phase I study, we look forward to further evaluating the antitumor activity of lisaftoclax in individual hematologic malignancies and solid tumors."

"The initial objective response rate of 80%, together with a favorable safety profile and no TLS despite a daily dose ramp-up, demonstrated by lisaftoclax in patients with R/R CLL/SLL are particularly encouraging and once again support the best-in-class potential of lisaftoclax," said Dr. Yifan Zhai, Chief Medical Officer of Ascentage Pharma. "At this year’s ASCO (Free ASCO Whitepaper) Annual Meeting, we have announced results from multiple studies, including that of lisaftoclax, in two oral presentations and two poster presentations. I am very proud of these advances, which attest to Ascentage Pharma’s robust capabilities in global innovation. Moving forward, we will remain committed to our mission of addressing unmet clinical needs in China and around the world, and strive to accelerate our clinical programs in the hope of soon benefitting patients."

An overview of the four abstracts presented at the 2021 ASCO (Free ASCO Whitepaper) Annual Meeting:

Drug Candidate

Abstract Title

Abstract #

Format

Lisaftoclax

(APG-2575)

First-in-human study of lisaftoclax (APG-2575), a novel Bcl-2 inhibitor (Bcl-2i), in patients (pts) with relapsed/refractory (R/R) CLL and other hematologic malignancies (HMs)

7502

Oral

Presentation

Alrizomadlin

(APG-115)

Preliminary results of a phase II study of alrizomadlin (APG-115), a novel, small-molecule MDM2 inhibitor, in combination with pembrolizumab in patients (pts) with unresectable or metastatic melanoma or advanced solid tumors that have failed immuno-oncologic (I-O) drugs

2506

Oral

Presentation

Trial in progress: A phase I/II trial of novel MDM2 inhibitor alrizomadlin (APG-115), with or without platinum chemotherapy, in patients with p53 wild-type salivary gland carcinoma

TPS6094

Poster

Presentation

Pelcitoclax

(APG-1252)

Trial in progress: A multicenter phase Ib/II study of pelcitoclax (APG-1252) in combination with paclitaxel in patients with relapsed/refractory small-cell lung cancer (R/R SCLC)

TPS8589

Poster

Presentation

Highlights of the oral presentation on lisaftoclax at this year’s ASCO (Free ASCO Whitepaper) Annual Meeting:

First-in-human study of lisaftoclax (APG-2575), a novel Bcl-2 inhibitor (Bcl-2i), in patients (pts) with relapsed/refractory (R/R) CLL and other hematologic malignancies (HMs)

Abstract: #7502

This first-in-human global Phase I study assessed the safety, pharmacokinetics (PK), pharmacodynamics (PD), efficacy, and MTD/recommended Phase II dose (RP2D) of lisaftoclax in patients with R/R CLL and other HMs. Lisaftoclax was orally administered once daily in a 28-day cycle. Patients with CLL or intermediate-high TLS risk were initiated on a daily ramp-up schedule until the dose assigned before the study cycles.
As of April 15, 2021, 36 patients had been enrolled and treated with lisaftoclax at doses ranging from 20 to 1,200 mg, with a median of 2 (range: 1-13) prior lines of treatment. These patients had been diagnosed with R/R CLL/SLL (n=15), multiple myeloma (MM, n=6), follicular lymphoma (FL, n=5), Waldenström macroglobulinemia (WM, n=5); and either acute myeloid leukemia (AML), mantle cell lymphoma (MCL), diffuse large B-cell lymphoma (DLBCL), myelodysplastic syndromes (MDS), or hairy cell leukemia (HCL; n=1 each). These patients received a median of 6 cycles (range: 1-24) of treatment with lisaftoclax.
Lisaftoclax was well tolerated, with manageable AEs. No DLT was observed even at the maximum dose of 1,200 mg. The MTD has not been reached, and no laboratory or clinical TLS has been reported. Hematologic treatment-related adverse events (TRAEs) of any grade in more than 10% patients included neutropenia and anemia, while nonhematologic TRAEs included fatigue, diarrhea, constipation, and nausea.
In the 15 evaluable patients with R/R CLL/SLL, 7 (46.7%) each were assessed as Rai stage III-IV or intermediate-high per International Prognostic Index (IPI). Patients in this cohort received a median of 9 (range: 5-24) cycles of treatment, and 12 patients achieved partial responses (PRs), for an ORR of 80% and a median time to response of 2 (range: 2-8) treatment cycles.
Among 21 patients with R/R non CLL/SLL, who received a median of 3 (range: 1-13) prior lines of treatment, 20 were evaluable. Of these individuals, 1 with t (11;14)-mutant MM achieved minor response (MR) after 2 treatment cycles. A total of 10 (50%) patients in this cohort achieved stable disease (SD) or deeper responses.
The preliminary PK profile showed that exposures increased with lisaftoclax at doses ranging from 20 to 1,200 mg (average half-life: 4-5 hours). On BH3 profiling, lisaftoclax rapidly triggered changes in Bcl-2 complex in CLL/SLL patient samples, which were consistent with rapid clinical reductions in absolute lymphocyte counts (ALCs).
In conclusion, efficacy and safety data showed that the Bcl-2 inhibitor lisaftoclax offers a potential alternative treatment for patients with R/R CLL/SLL and other HMs, with a daily ramp-up schedule that may be more patient-friendly and a favorable preliminary safety profile.

CAPTIVATE Study Shows an IMBRUVICA® (ibrutinib) Plus VENCLEXTA®/VENCLYXTO® (venetoclax) Chemotherapy-Free Combination Has Potential to Provide Remission After Fixed-Duration Treatment for Chronic Lymphocytic Leukemia (CLL)

On June 7, 2021 AbbVie (NYSE: ABBV) reported new data from the Phase 2 CAPTIVATE (PCYC-1142) study investigating IMBRUVICA (ibrutinib) in combination with VENCLEXTA/VENCLYXTO (venetoclax), an all-oral, once-daily, chemotherapy-free, fixed-duration investigational combination, for patients with previously untreated chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) during an oral presentation at the virtual 2021 American Society of Clinical Oncology (ASCO) (Free ASCO Whitepaper) Annual Meeting (Abstract #7501) (Press release, AbbVie, JUN 7, 2021, View Source [SID1234583647]). The ibrutinib and venetoclax cohort met its primary endpoint of complete response (CR) rate of 56% (95% CI 48-64) among patients without del(17p), 70 years old or younger and with 27.9 months of follow up. This rate was higher than the 37% minimum meaningful rate study assumption (P<0.0001). The CR rate was consistent across all patients in the study including high-risk CLL patient groups. Furthermore, 24-month progression free survival (PFS) and overall survival (OS) were 95% and 98%, respectively.

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"We are encouraged by these promising results, which indicate ibrutinib and venetoclax combined has the potential to serve as an important chemotherapy-free, fixed-duration treatment option for people living with CLL," said Dr. Paolo Ghia, M.D., Ph.D., Professor of Medical Oncology at the Università Vita-Salute San Raffaele and CAPTIVATE steering committee member and investigator.

Ibrutinib plus venetoclax is an investigational fixed-duration combination. Patients received 3 cycles of ibrutinib lead-in followed by 12 cycles of ibrutinib + venetoclax (Ibr 420 mg/day PO; Ven ramp up to 400 mg/day PO). At 27.9 months median duration of follow-up in the fixed-duration cohort, complete response (CR) rate was 56% without del(17p), and CR, including complete response with incomplete marrow recovery (CRi), was 55% in the overall study population and was consistent across high-risk subgroups. Undetectable minimal residual disease (uMRD) was achieved in 77% of patients in peripheral blood and 60% of patients in bone marrow. The most common grade 3/4 adverse effects (AEs) were neutropenia (33%), hypertension (6%) and neutrophil count decreased (5%). AEs led to discontinuation of ibrutinib in 4% and venetoclax in 2% of patients. The safety profile of the combination was generally consistent with known AEs for each agent and no new safety signals were identified.

"Combining our novel therapies to deliver a new potential treatment is an example of AbbVie’s innovative approach to identify options for difficult-to-treat blood cancers, like CLL," said Mohamed Zaki, M.D., Ph.D., vice president and global head of oncology development, AbbVie. "We are proud to be leading in the development of this combination to continue raising the standards of care for the blood cancer community."

This data builds on previously reported results from the Minimal Residual Disease (MRD) cohort where undetectable uMRD was achieved in over two-thirds of patients with 12 cycles of ibrutinib plus venetoclax, and 30-month PFS rates were ≥95% irrespective of subsequent randomized treatment (Wierda, ASH (Free ASH Whitepaper) 2020).

CAPTIVATE data will also be presented at the European Hematology Association (EHA) (Free EHA Whitepaper)’s (EHA) (Free EHA Whitepaper) congress taking place from June 9-17, 2021. Additionally, there are other ongoing company-sponsored and investigator-initiated trials exploring the potential of ibrutinib and venetoclax in combination for CLL treatment, including the Phase 3 GLOW study. Results from the ongoing GLOW study, assessing the ibrutinib plus venetoclax combination in comparison to chlorambucil plus obinutuzumab for first-line treatment of patients with CLL or SLL (NCT03462719), will be presented at the upcoming EHA (Free EHA Whitepaper) congress.

About CLL
CLL is one of the two most common forms of leukemia in adults and is a type of cancer that can develop from cells in the bone marrow that later mature into certain white blood cells (called lymphocytes).1 While these cancer cells start in the bone marrow, they later spread into the blood. There are approximately 195,129 people with CLL living in the United States with more than 21,000 newly diagnosed patients in 2021.2,3 CLL is predominately a disease of the elderly, with a median age at diagnosis of 70 years and is more common among men than women.4

About the CAPTIVATE Study
The CAPTIVATE study fixed-duration cohort evaluated 159 patients between the ages of 18 and 70 years old with CLL/SLL. Patients received 3 cycles of ibrutinib lead-in followed by 12 cycles of ibrutinib + venetoclax (Ibr 420 mg/day PO; Ven ramp up to 400 mg/day PO). High-risk features included del(17p)/TP53 mutation, 17%; del(11q), 18%; complex karyotype, 19%; and unmutated IGHV, 56%. 147 (92%) and 149 (94%) patients completed planned treatment with ibrutinib and venetoclax respectively. Median time on study was 27.9 month (range, 0.8–33.2). FD cohort primary endpoint was CR rate, including CR with incomplete marrow recovery (CRi) in patients without del(17p). Key secondary endpoints were objective response rate (ORR), duration of response, uMRD rate (<10-4 by 8-color flow cytometry), PFS, OS, tumor lysis syndrome (TLS) risk category reduction based on tumor burden shifted to medium- or low-risk after ibrutinib lead-in therapy and AEs.

The CAPTIVATE study MRD cohort evaluated 164 patients between the ages of 18 and 70 years old with previously untreated CLL/SLL. Patients received 3 cycles of ibrutinib lead-in followed by 12 cycles of ibrutinib + venetoclax (Ibr 420 mg/day PO; Ven ramp-up to 400 mg/day PO). Patients with confirmed uMRD (defined as uMRD serially over ≥3 cycles, and in both PB and BM) after 12 cycles of ibrutinib + venetoclax were randomized 1:1 to receive double-blind treatment with placebo or ibrutinib during a 13th cycle of ibrutinib and venetoclax combined. Patients who did not meet the definition of confirmed uMRD were randomized 1:1 to receive open-label treatment with ibrutinib or continued ibrutinib + venetoclax. Primary endpoint was 1-year DFS rate in the confirmed uMRD patients randomized to placebo vs ibrutinib; DFS was defined as survival without progression or MRD relapse (which was defined as an MRD level of 10-2). Key secondary endpoints were rates of uMRD (<10-4 by 8-color flow cytometry), response per iwCLL, adverse events (AEs), as well as progression-free survival (PFS). The depth of response achieved with this regimen is reflected in the 30-month progression-free survival (PFS) rate of ~95% across all treated patients, including the subset receiving placebo after the fixed-duration treatment. The safety profile of the combination was generally consistent with known adverse events for ibrutinib and venetoclax individually and no new safety signals emerged.

About IMBRUVICA (Ibrutinib)
IMBRUVICA (ibrutinib) is a once-daily, first-in-class BTK inhibitor that is administered orally, and is jointly developed and commercialized by Pharmacyclics, LLC, an AbbVie Company, and Janssen Biotech, Inc. (Janssen). The BTK protein sends important signals that tell B cells to mature and produce antibodies. BTK signaling is needed by specific cancer cells to multiply and spread.5,6 By blocking BTK, IMBRUVICA may help move abnormal B cells out of their nourishing environments in the lymph nodes, bone marrow, and other organs.7

Since its launch in 2013, IMBRUVICA has received 11 FDA approvals across six disease areas: chronic lymphocytic leukemia (CLL) with or without 17p deletion (del17p); small lymphocytic lymphoma (SLL) with or without del17p; Waldenström macroglobulinemia; previously-treated patients with mantle cell lymphoma (MCL)*; previously-treated patients with marginal zone lymphoma (MZL) who require systemic therapy and have received at least one prior anti-CD20-based therapy* – and previously-treated patients with chronic graft-versus-host disease (cGVHD) after failure of one or more lines of systemic therapy.8

IMBRUVICA is now approved in more than 100 countries and has been used to treat more than 230,000 patients worldwide across its approved indications. IMBRUVICA is the only FDA-approved medicine in WM and cGVHD. IMBRUVICA has been granted four Breakthrough Therapy Designations from the U.S. FDA. This designation is intended to expedite the development and review of a potential new drug for serious or life-threatening diseases. IMBRUVICA was one of the first medicines to receive FDA approval via the Breakthrough Therapy Designation pathway.

Since 2019, the National Comprehensive Cancer Network (NCCN), a not-for-profit alliance of 28 leading cancer centers devoted to patient care, research, and education, recommends ibrutinib (IMBRUVICA) as a preferred regimen for the initial treatment of CLL/SLL and has Category 1 treatment status for treatment-naïve patients without deletion 17p. In January 2020, the NCCN Guidelines were updated to elevate IMBRUVICA with or without rituximab from other recommended regimens to a preferred regimen for the treatment of relapsed/refractory MCL, regardless of duration of response to prior chemoimmunotherapy. As of September 2020, the NCCN guidelines were updated to reflect IMBRUVICA with or without rituximab as the only Category 1 preferred regimen for both untreated and previously treated WM patients.

IMBRUVICA is being studied alone and in combination with other treatments in several blood and solid tumor cancers and other serious illnesses. IMBRUVICA is the most comprehensively studied BTK inhibitor, with more than 150 ongoing clinical trials. There are approximately 30 ongoing company-sponsored trials, 14 of which are in Phase 3, and more than 100 investigator-sponsored trials and external collaborations that are active around the world. For more information, visit www.IMBRUVICA.com

*Accelerated approval was granted for the MCL and MZL indications based on overall response rate. Continued approval for MCL and MZL may be contingent upon verification and description of clinical benefit in confirmatory trials.

Important Side Effect Information 8 Before taking IMBRUVICA, tell your healthcare provider about all of your medical conditions, including if you:

have had recent surgery or plan to have surgery. Your healthcare provider may stop IMBRUVICA for any planned medical, surgical, or dental procedure.
have bleeding problems.
have or had heart rhythm problems, smoke, or have a medical condition that increases your risk of heart disease, such as high blood pressure, high cholesterol, or diabetes.
have an infection.
have liver problems.
are pregnant or plan to become pregnant. IMBRUVICA can harm your unborn baby. If you are able to become pregnant, your healthcare provider will do a pregnancy test before starting treatment with IMBRUVICA. Tell your healthcare provider if you are pregnant or think you may be pregnant during treatment with IMBRUVICA.
Females who are able to become pregnant should use effective birth control (contraception) during treatment with IMBRUVICA and for 1 month after the last dose.
Males with female partners who are able to become pregnant should use effective birth control, such as condoms, during treatment with IMBRUVICA and for 1 month after the last dose.
are breastfeeding or plan to breastfeed. Do not breastfeed during treatment with IMBRUVICA and for 1 week after the last dose.
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Taking IMBRUVICA with certain other medicines may affect how IMBRUVICA works and can cause side effects.
How should I take IMBRUVICA?

Take IMBRUVICA exactly as your healthcare provider tells you to take it.
Take IMBRUVICA 1 time a day.
Swallow IMBRUVICA capsules or tablets whole with a glass of water.
Do not open, break or chew IMBRUVICA capsules.
Do not cut, crush or chew IMBRUVICA tablets.
Take IMBRUVICA at about the same time each day.
If you miss a dose of IMBRUVICA take it as soon as you remember on the same day. Take your next dose of IMBRUVICA at your regular time on the next day. Do not take extra doses of IMBRUVICA to make up for a missed dose.
If you take too much IMBRUVICA call your healthcare provider or go to the nearest hospital emergency room right away.
What should I avoid while taking IMBRUVICA?

You should not drink grapefruit juice, eat grapefruit, or eat Seville oranges (often used in marmalades) during treatment with IMBRUVICA. These products may increase the amount of IMBRUVICA in your blood.
What are the possible side effects of IMBRUVICA?
IMBRUVICA may cause serious side effects, including:

Bleeding problems (hemorrhage) are common during treatment with IMBRUVICA, and can also be serious and may lead to death. Your risk of bleeding may increase if you are also taking a blood thinner medicine. Tell your healthcare provider if you have any signs of bleeding, including: blood in your stools or black stools (looks like tar), pink or brown urine, unexpected bleeding, or bleeding that is severe or that you cannot control, vomit blood or vomit looks like coffee grounds, cough up blood or blood clots, increased bruising, dizziness, weakness, confusion, change in your speech, or a headache that lasts a long time or severe headache. 
Infections can happen during treatment with IMBRUVICA. These infections can be serious and may lead to death. Tell your healthcare provider right away if you have fever, chills, weakness, confusion, or other signs or symptoms of an infection during treatment with IMBRUVICA.
Decrease in blood cell counts. Decreased blood counts (white blood cells, platelets, and red blood cells) are common with IMBRUVICA, but can also be severe. Your healthcare provider should do monthly blood tests to check your blood counts.
Heart problems. Serious heart rhythm problems (ventricular arrhythmias, atrial fibrillation, and atrial flutter), heart failure, and death have happened in people treated with IMBRUVICA, especially in people who have an increased risk for heart disease, have an infection, or who have had heart rhythm problems in the past. Tell your healthcare provider if you get any symptoms of heart problems, such as feeling as if your heart is beating fast and irregular, lightheadedness, dizziness, shortness of breath, swelling of the feet, ankles, or legs, chest discomfort, or you faint. If you develop any of these symptoms, your healthcare provider may do a test to check your heart (ECG) and may change your IMBRUVICA dose.
High blood pressure (hypertension). New or worsening high blood pressure has happened in people treated with IMBRUVICA. Your healthcare provider may start you on blood pressure medicine or change current medicines to treat your blood pressure.
Second primary cancers. New cancers have happened during treatment with IMBRUVICA, including cancers of the skin or other organs.
Tumor lysis syndrome (TLS). TLS is caused by the fast breakdown of cancer cells. TLS can cause kidney failure and the need for dialysis treatment, abnormal heart rhythm, seizure, and sometimes death. Your healthcare provider may do blood tests to check you for TLS.
The most common side effects of IMBRUVICA in adults with B-cell malignancies (MCL, CLL/SLL, WM and MZL) include:

diarrhea
tiredness
muscle and bone pain
rash
bruising
The most common side effects of IMBRUVICA in adults with cGVHD include:

tiredness
bruising
diarrhea
mouth sores (stomatitis)
muscle spasms
nausea
pneumonia
Diarrhea is a common side effect in people who take IMBRUVICA. Drink plenty of fluids during treatment with IMBRUVICA to help reduce your risk of losing too much fluid (dehydration) due to diarrhea. Tell your healthcare provider if you have diarrhea that does not go away.
These are not all the possible side effects of IMBRUVICA. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

General information about the safe and effective use of IMBRUVICA 
Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use IMBRUVICA for a condition for which it was not prescribed. Do not give IMBRUVICA to other people, even if they have the same symptoms that you have. It may harm them. You can ask your pharmacist or healthcare provider for information about IMBRUVICA that is written for health professionals.

Please click here for full Prescribing Information.

About VENCLEXTA/VENCLYXTO (venetoclax)
VENCLEXTA/VENCLYXTO (venetoclax) is a first-in-class medicine that selectively binds and inhibits the B-cell lymphoma-2 (BCL-2) protein. In some blood cancers, BCL-2 prevents cancer cells from undergoing their natural death or self-destruction process, called apoptosis. VENCLXEXTA/VENCLYXTO targets the BCL-2 protein and works to help restore the process of apoptosis.
VENCLEXTA/VENCLYXTO is being developed by AbbVie and Roche. It is jointly commercialized by AbbVie and Genentech, a member of the Roche Group, in the U.S. and by AbbVie outside of the U.S. Together, the companies are committed to BCL-2 research and to studying venetoclax in clinical trials across several blood cancers. Venetoclax is approved in more than 80 countries, including the U.S.

Important Safety Information9
What is the most important information I should know about VENCLEXTA?
VENCLEXTA can cause serious side effects, including:
Tumor lysis syndrome (TLS). TLS is caused by the fast breakdown of cancer cells. TLS can cause kidney failure, the need for dialysis treatment, and may lead to death. Your healthcare provider will do tests to check your risk of getting TLS before you start taking VENCLEXTA. You will receive other medicines before starting and during treatment with VENCLEXTA to help reduce your risk of TLS. You may also need to receive intravenous (IV) fluids into your vein. Your healthcare provider will do blood tests to check for TLS when you first start treatment and during treatment with VENCLEXTA. It is important to keep your appointments for blood tests. Tell your healthcare provider right away if you have any symptoms of TLS during treatment with VENCLEXTA, including fever, chills, nausea, vomiting, confusion, shortness of breath, seizures, irregular heartbeat, dark or cloudy urine, unusual tiredness, or muscle or joint pain.

Drink plenty of water during treatment with VENCLEXTA to help reduce your risk of getting TLS.
Drink 6 to 8 glasses (about 56 ounces total) of water each day, starting 2 days before your first dose, on the day of your first dose of VENCLEXTA, and each time your dose is increased.

Your healthcare provider may delay, decrease your dose, or stop treatment with VENCLEXTA if you have side effects. When restarting VENCLEXTA after stopping for 1 week or longer, your healthcare provider may again check for your risk of TLS and change your dose.

Who should not take VENCLEXTA?
Certain medicines must not be taken when you first start taking VENCLEXTA and while your dose is being slowly increased because of the risk of increased TLS.

Tell your healthcare provider about all the medicines you take, including prescription and over-the counter medicines, vitamins, and herbal supplements. VENCLEXTA and other medicines may affect each other causing serious side effects.
Do not start new medicines during treatment with VENCLEXTA without first talking with your healthcare provider.
Before taking VENCLEXTA, tell your healthcare provider about all of your medical conditions, including if you:

have kidney or liver problems.
have problems with your body salts or electrolytes, such as potassium, phosphorus, or calcium.
have a history of high uric acid levels in your blood or gout.
are scheduled to receive a vaccine. You should not receive a "live vaccine" before, during, or after treatment with VENCLEXTA, until your healthcare provider tells you it is okay. If you are not sure about the type of immunization or vaccine, ask your healthcare provider. These vaccines may not be safe or may not work as well during treatment with VENCLEXTA.
are pregnant or plan to become pregnant. VENCLEXTA may harm your unborn baby. If you are able to become pregnant, your healthcare provider should do a pregnancy test before you start treatment with VENCLEXTA, and you should use effective birth control during treatment and for at least 30 days after the last dose of VENCLEXTA. If you become pregnant or think you are pregnant, tell your healthcare provider right away.
are breastfeeding or plan to breastfeed. It is not known if VENCLEXTA passes into your breast milk. Do not breastfeed during treatment with VENCLEXTA and for 1 week after the last dose.
What should I avoid while taking VENCLEXTA?
You should not drink grapefruit juice or eat grapefruit, Seville oranges (often used in marmalades), or starfruit while you are taking VENCLEXTA. These products may increase the amount of VENCLEXTA in your blood.

What are the possible side effects of VENCLEXTA?
VENCLEXTA can cause serious side effects, including:

Low white blood cell counts (neutropenia). Low white blood cell counts are common with VENCLEXTA, but can also be severe. Your healthcare provider will do blood tests to check your blood counts during treatment with VENCLEXTA and may pause dosing.
Infections. Death and serious infections such as pneumonia and blood infection (sepsis) have happened during treatment with VENCLEXTA. Your healthcare provider will closely monitor and treat you right away if you have a fever or any signs of infection during treatment with VENCLEXTA.
Tell your healthcare provider right away if you have a fever or any signs of an infection during treatment with VENCLEXTA.

The most common side effects of VENCLEXTA when used in combination with obinutuzumab or rituximab or alone in people with CLL or SLL include low white blood cell counts; low platelet counts; low red blood cell counts; diarrhea; nausea; upper respiratory tract infection; cough; muscle and joint pain; tiredness; and swelling of your arms, legs, hands, and feet.

The most common side effects of VENCLEXTA in combination with azacitidine or decitabine or low-dose cytarabine in people with AML include nausea; diarrhea; low platelet count; constipation; low white blood cell count; fever with low white blood cell count; tiredness; vomiting; swelling of arms, legs, hands, or feet; fever; infection in lungs; shortness of breath; bleeding; low red blood cell count; rash; stomach (abdominal) pain; infection in your blood; muscle and joint pain; dizziness; cough; sore throat; and low blood pressure.

VENCLEXTA may cause fertility problems in males. This may affect your ability to father a child. Talk to your healthcare provider if you have concerns about fertility.

These are not all the possible side effects of VENCLEXTA. Call your doctor for medical advice about side effects.

You are encouraged to report side effects of prescription drug to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

If you cannot afford your medication, contact genentech-access.com/patient/brands/venclexta for assistance.

The full U.S. prescribing information, including Medication Guide, for VENCLEXTA can be found  here . 

Indication and Important VENCLYXTO (venetoclax) EU Safety Information10
Indication
VENCLYXTO in combination with obinutuzumab is indicated for the treatment of adult patients with previously untreated chronic lymphocytic leukaemia (CLL).

VENCLYXTO in combination with rituximab is indicated for the treatment of adult patients with CLL who have received at least one prior therapy.

VENCLYXTO monotherapy is indicated for the treatment of CLL:

In the presence of 17p deletion or TP53 mutation in adult patients who are unsuitable for or have failed a B-cell receptor pathway inhibitor, or
In the absence of 17p deletion or TP53 mutation in adult patients who have failed both chemoimmunotherapy and a B-cell receptor pathway inhibitor.
Contraindications
Hypersensitivity to the active substance or to any of the excipients is contraindicated.  Concomitant use of strong CYP3A inhibitors at initiation and during the dose-titration phase due to increased risk for tumor lysis syndrome (TLS). Concomitant use of preparations containing St. John’s wort as VENCLYXTO efficacy may be reduced.

Special Warnings & Precautions for Use
TLS, including fatal events, has occurred in patients with previously treated CLL with high tumour burden when treated with VENCLYXTO. VENCLYXTO poses a risk for TLS in the initial 5-week dose-titration phase. Changes in electrolytes consistent with TLS that require prompt management can occur as early as 6 to 8 hours following the first dose of VENCLYXTO and at each dose increase. Patients should be assessed for risk and should receive appropriate prophylaxis, monitoring, and management for TLS.

Neutropenia (grade 3 or 4) has been reported and complete blood counts should be monitored throughout the treatment period. 

Serious infections including sepsis with fatal outcome have been reported. Monitoring of any signs and symptoms of infection is required.  Suspected infections should receive prompt treatment including antimicrobials and dose interruption or reduction as appropriate.  

Live vaccines should not be administered during treatment or thereafter until B-cell recovery.

Drug Interactions
CYP3A inhibitors may increase VENCLYXTO plasma concentrations. At initiation and dose-titration phase: Strong CYP3A inhibitors are contraindicated due to increased risk for TLS and moderate CYP3A inhibitors should be avoided. If moderate CYP3A inhibitors must be used, physicians should refer to the SmPC for dose adjustment recommendations. At steady daily dose:  moderate or strong CYP3A inhibitors must be used, physicians should refer to the VENCLYXTO summary of product characteristics (SmPC) for dose adjustment recommendations.

Avoid concomitant use of P-gp and BCRP inhibitors at initiation and during the dose titration phase.

CYP3A4 inducers may decrease VENCLYXTO plasma concentrations. Avoid coadministration with strong or moderate CYP3A inducers. These agents may decrease venetoclax plasma concentrations. 

Co-administration of bile acid sequestrants with VENCLYXTO is not recommended as this may reduce the absorption of VENCLYXTO.

Adverse Reactions
The most commonly occurring adverse reactions (>=20%) of any grade in patients receiving venetoclax in the combination studies with obinutuzumab or rituximab were neutropenia, diarrhoea, and upper respiratory tract infection.  In the monotherapy studies, the most common adverse reactions were neutropenia/neutrophil count decreased, diarrhoea, nausea, anaemia, fatigue, and upper respiratory tract infection.

The most frequently occurring serious adverse reactions (>=2%) in patients receiving venetoclax in combination with obinutuzumab or rituximab were pneumonia, sepsis, febrile neutropenia, and TLS.  In the monotherapy studies, the most frequently reported serious adverse reactions (>=2%) were pneumonia and febrile neutropenia.

Discontinuations due to adverse reactions occurred in 16% of patients treated with venetoclax in combination with obinutuzumab or rituximab in the CLL14 and Murano studies respectively.  In the monotherapy studies with venetoclax, 11% of patients discontinued due to adverse reactions. 

Dosage reductions due to adverse reactions occurred in 21% of patients treated with the combination of venetoclax and obinutuzumab in CLL14 and in 15% of patients treated with the combination of venetoclax and in Murano and in 14% of patients treated with venetoclax in the monotherapy studies.    The most common adverse reaction that led to dose interruptions was neutropenia. 

Specific Populations
Patients with reduced renal function (CrCl <80 mL/min) may require more intensive prophylaxis and monitoring to reduce the risk of TLS.  Safety in patients with severe renal impairment (CrCl <30 mL/min) or on dialysis has not been established, and a recommended dose for these patients has not been determined.

For patients with severe (Child-Pugh C) hepatic impairment, a dose reduction of at least 50% throughout treatment is recommended.

VENCLYXTO may cause embryo-fetal harm when administered to a pregnant woman. Advise nursing women to discontinue breastfeeding during treatment.
This is not a complete summary of all safety information. See VENCLYXTO full summary of product characteristics (SmPC) at View Source Globally, prescribing information varies; refer to the individual country product label for complete information.

About AbbVie in Oncology
At AbbVie, we are committed to transforming standards of care for multiple blood cancers while advancing a dynamic pipeline of investigational therapies across a range of cancer types. Our dedicated and experienced team joins forces with innovative partners to accelerate the delivery of potentially breakthrough medicines. We are evaluating more than 20 investigational medicines in over 300 clinical trials across some of the world’s most widespread and debilitating cancers. As we work to have a remarkable impact on people’s lives, we are committed to exploring solutions to help patients obtain access to our cancer medicines. For more information, please visit View Source

4SC to present results from the SENSITIZE study at the (virtual) 2021 ASCO Annual Meeting

On June 7, 2021 Prof. Dr. Jessica C. Hassel, Principle Investigator of the SENSITIZE study at the University Hospital Heidelberg, Germany, Department of Dermatology and National Center for Tumor Diseases, reported that presents a poster and associated slide presentation at the virtual 2021 ASCO (Free ASCO Whitepaper) Annual Meeting (Jun 4 – Jun 8, 2021) summarizing results from the Phase Ib part of the SENSITIZE study combining domatinostat with pembrolizumab in advanced melanoma patients refractory to prior checkpoint inhibitor therapy (Abstract #9545) (Press release, 4SC, JUN 7, 2021, View Source [SID1234583663]). The poster and slide presentation is available on the ASCO (Free ASCO Whitepaper) 2021 Virtual Meeting platform and will be available on the 4SC homepage after the conference.

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The SENSITIZE study (ClinicalTrials.gov identifier: NCT03278665) enrolled 40 patients suffering from unresectable or metastatic advanced-stage cutaneous melanoma who were refractory prior treatment with anti-PD-1 antibodies (checkpoint inhibitor) into this Phase Ib part of the study. Different dose levels and schedules for domatinostat were applied to evaluate safety and tolerability, and to define the Phase II dose and schedule. Tumor assessments for clinical activity were performed according to irRECIST criteria and sequential tumor biopsies were taken for translational research.

Conclusions from the data presented were:

Domatinostat (a selective class I HDAC inhibitor) in combination with pembrolizumab was safely administered at all dose levels tested up to 200 mg BID (twice daily)
Domatinostat 200 mg BID was determined as the Phase II dose and schedule in combination with pembrolizumab
Clinical activity was observed in this heavily-pretreated patient population, primary refractory to prior anti-PD-1 therapy (i.e. stable disease or progressive disease as best response to previous therapy), with a Disease Control Rate (DCR) of 34% (12/35) in patients with at least one post-baseline tumor assessment
Translational research results support the immune-modulating mode of action of domatinostat to synergize with checkpoint inhibition.
4SC would like to sincerely thank the patients who volunteered to participate in the SENSITIZE study and the investigators and staff members at the study sites who cared for them.

Prof. Jessica Hassel stated: „Metastatic Melanoma patients progressing on anti-PD1 therapy urgently need new treatment options especially if the melanoma is not BRAF mutated. The SENSITIZE study investigates an innovative combination therapy intending to overcome resistance to the anti-PD1 therapy. The phase Ib data of the HDAC inhibitor domatinostat in combination with the anti-PD1 antibody pembrolizumab in patients resistant to anti-PD1 therapy that I am presenting on behalf of my co-investigators of the study at the Annual ASCO (Free ASCO Whitepaper) meeting 2021 are encouraging. Several doses and schedules of domatinostat in this combination were safely administered and a Phase II dose defined. For the first time the immune-modulating features of domatinostat could be confirmed in patients, further supporting the scientific rationale for the combination with checkpoint inhibition. Approximately one third of these refractory melanoma patients achieved disease control, some of them for up to 2 years, which is remarkable and justifies further investigation of domatinostat in combination with anti-PD-1 therapies."

Jason Loveridge, Ph.D., CEO of 4SC: "SENSITIZE is the first clinical study of domatinostat in combination with checkpoint inhibition. The primary objective of the Phase Ib part of the study was to investigate the safety and tolerability of domatinostat, and to establish a Phase II dose and regime. This goal has been achieved and builds the basis for our ongoing clinical program in other indications in combination with checkpoint inhibition.

In terms of efficacy, a disease control rate of 34% is good, especially in such a difficult to treat population, where surprisingly, the analysis of patient tumor samples showed them to be inflamed, but immunosuppressed and populated by exhausted T-cells.

Overall, the SENSITIZE study data gives us plenty of encouragement for our ongoing clinical development program in Merkel Cell Carcinoma with the MERKLIN 1 and 2 studies in combination with avelumab where we expect to see less immunosuppressed tumors, and where the upregulation of antigen presentation by domatinostat is more likely to be a key contributor to clinical activity (of the combination) in this cancer type".

Related articles
30 September 2019, First domatinostat combination data from Phase Ib/II SENSITIZE study presented at ESMO (Free ESMO Whitepaper)

11 July 2019, 4SC AG: Positive safety review of Phase Ib/II SENSITIZE study of domatinostat + pembrolizumab in melanoma

8 April 2019, 4SC AG: Domatinostat’s mode of action in Merkel cell carcinoma

6 February 2019, First patient enrolled in Phase II study EMERGE of domatinostat (4SC-202) in gastrointestinal cancer

Live from ASCO 2021 | Ascentage Pharma Presents Updated Results of MDM2-p53 Inhibitor Alrizomadlin (APG-115) Demonstrating an ORR of 24.1% Including Complete Response in Combination with Pembrolizumab in Patients with Advanced Melanoma Resistant or Refractory to Prior Immuno-Oncologic Drugs

On June 7, 2021 Ascentage Pharma (6855.HK), a globally focused, clinical-stage biotechnology company engaged in developing novel therapies for cancers, chronic hepatitis B (CHB), and age-related diseases, reported in an oral presentation at the 57th American Society of Clinical Oncology (ASCO) (Free ASCO Whitepaper) Annual Meeting, updated results from a Phase II study of the MDM2-p53 inhibitor alrizomadlin (APG-115) in combination with pembrolizumab in patients with unresectable or metastatic melanoma or advanced solid tumors that have progressed on prior immuno-oncologic (IO) drugs (Press release, Ascentage Pharma, JUN 7, 2021, View Source;ascentage-pharma-presents-updated-results-of-mdm2-p53-inhibitor-alrizomadlin-apg-115-demonstrating-an-orr-of-24-1-including-complete-response-in-combination-with-pembrolizumab-in-patients-with-advanced-mel-301307261.html [SID1234583679]).

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As a leading Chinese biotechnology company with progressive visibility at international scientific congresses in recent years, Ascentage Pharma’s clinical study results have been selected for presentations at the ASCO (Free ASCO Whitepaper) Annual Meeting for the fourth year. This year, results from four of its studies clinical studies were selected for presentations at the meeting, including two oral presentations. The clinical study data from the on-going Phase II study of alrizomadlin have demonstrated a manageable safety profile and meaningful clinical antitumor activity, including one patient with a complete response (CR), an objective response rate (ORR) of 24.1% and a disease control rate (DCR) of 55.2% in the PD-1/PD-L1 inhibitor-resistant melanoma cohort. In addition, partial responses (PRs) were reported in enrolled patients with other tumor types.

"The clinical data of alrizomadlin presented in our oral presentation are encouraging, as they suggest clinical activity in hard-to-treat tumor types across multiple indications, including several without currently available standard of care, such as relapsed or refractory melanoma subtypes," said Dr. Anthony W. Tolcher, Founder and CEO of NEXT Oncology, Director of Clinical Research at Texas Oncology, and the Global Principal Investigator of the study. "Our data provide a clinical validation of the recently published paper in Nature Immunology demonstrating that alrizomadlin synergizes with immunotherapy by sustaining STAT5 stability and controlling T-cell-mediated antitumor immunity via the novel pathway of MDM2 inhibition. This seminal publication elucidates why patients who previously failed to respond to IO therapy may derive clinical benefit from the addition of alrizomadlin to the IO agent pembrolizumab."

"This study of alrizomadlin in combination with pembrolizumab offers a clinical validation of the therapeutic synergy between MDM2-p53 inhibitors and existing immuno-oncologic drugs and shows the potential as a new treatment option that could bring renewed hope for patients with solid tumors," said Dr. Yifan Zhai, Chief Medical Officer of Ascentage Pharma. "At this year’s ASCO (Free ASCO Whitepaper) Annual Meeting, we have announced results from multiple studies, including that of Alrizomadlin, in two oral presentations and two poster presentations. I am very proud of these advances, which attest to Ascentage Pharma’s robust capabilities in global innovation. Moving forward, we will remain committed to our mission of addressing unmet clinical needs in China and around the world, and strive to accelerate our clinical programs in the hope of soon benefitting patients."

An overview of the four abstracts presented at the 2021 ASCO (Free ASCO Whitepaper) Annual Meeting:

Drug Candidate

Abstract Title

Abstract #

Format

Lisaftoclax

(APG-2575)

First-in-human study of lisaftoclax (APG-2575), a novel Bcl-2 inhibitor (Bcl-2i), in patients (pts) with relapsed/refractory (R/R) CLL and other hematologic malignancies (HMs)

7502

Oral

Presentation

Alrizomadlin

(APG-115)

Preliminary results of a phase II study of alrizomadlin (APG-115), a novel, small-molecule MDM2 inhibitor, in combination with pembrolizumab in patients (pts) with unresectable or metastatic melanoma or advanced solid tumors that have failed immuno-oncologic (I-O) drugs

2506

Oral

Presentation

Trial in progress: A phase I/II trial of novel MDM2 inhibitor alrizomadlin (APG-115), with or without platinum chemotherapy, in patients with p53 wild-type salivary gland carcinoma

TPS6094

Poster

Presentation

Pelcitoclax

(APG-1252)

Trial in progress: A multicenter phase Ib/II study of pelcitoclax (APG-1252) in combination with paclitaxel in patients with relapsed/refractory small-cell lung cancer (R/R SCLC)

TPS8589

Poster

Presentation

Highlights of the oral presentation on alrizomadlin at this year’s ASCO (Free ASCO Whitepaper) Annual Meeting:

Preliminary results of a phase II study of alrizomadlin (APG-115), a novel, small-molecule MDM2 inhibitor, in combination with pembrolizumab in patients (pts) with unresectable or metastatic melanoma or advanced solid tumors that have failed immuno-oncologic (I-O) drugs

Abstract: #2506

This open-label, multicenter Phase II study in the US assessed the safety, tolerability, pharmacokinetics (PK), pharmacodynamics (PD), and antitumor activity of alrizomadlin in combination with pembrolizumab in patients with advanced solid tumors.
As of April 15, 2021, 102 patients had been enrolled in the Phase II part of the study and treated with alrizomadlin at the recommended Phase II dose (RP2D) of 150 mg every other day, in combination with pembrolizumab. This study has 6 cohorts, including patients with: PD-1/PD-L1 inhibitor-resistant melanoma, non-small cell lung cancer (NSCLC), and urothelial carcinoma; or malignant peripheral nerve sheath tumor (MPNST), liposarcoma, and ATM mutant solid tumors.
Antitumor Effects:
In the PD-1/PD-L1 inhibitor-resistant melanoma cohort (n=29), there was 1 confirmed partial response (PR) out of 7 patients with uveal (ocular) melanoma; 2 PRs (1 confirmed + 1 unconfirmed) out of 5 patients with mucosal melanoma; and 1 complete response (CR, confirmed) and 3 PRs (2 confirmed + 1 unconfirmed) out of 15 patients with cutaneous melanoma. The ORR and DCR in the melanoma cohort were 24.1% (7/29) and 55.2% (16/29), respectively.
In the MPNST cohort (n=6), 1 PR (unconfirmed).
In the liposarcoma cohort (n=16), 1 PR (unconfirmed) and 12 stable diseases (SDs), at a DCR of 81.2% (13/16).
In the PD-1/PD-L1 inhibitor-resistant NSCLC (n=15) and urothelial carcinoma (n=8 evaluable) cohorts, 1 patient in each cohort achieved confirmed PR.
Common treatment-related adverse events (TRAEs) observed in more than 10% of patients were nausea, thrombocytopenia, vomiting, fatigue, decreased appetite, diarrhea, neutropenia, and anemia.
In conclusion, alrizomadlin combined with pembrolizumab is well tolerated, and did not exhibit any overlapping toxicity. These preliminary results have established proof of concept clinically that the combination regimen has antitumor activity in patients with IO relapsed/refractory metastatic melanoma, (including uveal melanoma, mucosal melanoma, or cutaneous melanoma). In addition, this combination therapy also showed promising antitumor activity in patients with MPNST or liposarcoma for which pembrolizumab has no approved indications.