Starpharma Signs Second Oncology Agreement With AstraZeneca

On June 3, 2019 Starpharma (ASX: SPL, OTCQX: SPHRY) reported a Development and Option Agreement with AstraZeneca (LON: AZN) to progress the development of a Dendrimer Enhanced Product (DEP) version of an undisclosed AstraZeneca major marketed oncology medicine (Press release, Starpharma, JUN 3, 2019, View Source [SID1234536835]). This is the second DEP commercial agreement Starpharma has signed with AstraZeneca, the first agreement being a multiproduct licence which covers novel oncology drug candidates such as AZD0466 (a Bcl2/xL inhibitor).

Schedule your 30 min Free 1stOncology Demo!
Discover why more than 1,500 members use 1stOncology™ to excel in:

Early/Late Stage Pipeline Development - Target Scouting - Clinical Biomarkers - Indication Selection & Expansion - BD&L Contacts - Conference Reports - Combinatorial Drug Settings - Companion Diagnostics - Drug Repositioning - First-in-class Analysis - Competitive Analysis - Deals & Licensing

                  Schedule Your 30 min Free Demo!

The agreement was signed during the 2019 ASCO (Free ASCO Whitepaper) (American Society of Clinical Oncology) meeting in Chicago. ASCO (Free ASCO Whitepaper) attracts more than 40,000 cancer doctors, scientists, investors, pharmaceutical and life science executives.

Under this agreement, Starpharma will conduct preclinical testing of the DEP version of the AstraZeneca oncology product. At any time from the signing of this agreement and for a defined period after the completion of this testing, AstraZeneca may exercise its option and licence the DEP drug candidate for clinical and commercial development. If AstraZeneca exercises the option, an option exercise fee of US$5 million is payable to Starpharma, as well as industry standard development and commercialisation milestones and escalating royalties on sales. Further details regarding the major oncology medicine involved, drug candidates, and terms of the agreement remain confidential at this time for competitive reasons.

In the event AstraZeneca does not exercise its option to licence the DEP drug candidate within the defined period, Starpharma has the option to license the rights to develop and commercialise this DEP drug either itself or through a sub-licensee with milestones and royalties paid to AstraZeneca upon commercialisation of the resultant DEP product.

Dr Jackie Fairley, Starpharma Chief Executive Officer, said: "We are delighted to sign a new commercial DEP agreement at ASCO (Free ASCO Whitepaper) with our long-standing partner, AstraZeneca. This agreement follows a successful research program under which we identified a promising DEP candidate with a number of potential benefits. This agreement represents the culmination of that work and this DEP product has the potential to provide significantly enhanced patient benefit. Unlike our first DEP agreement with AstraZeneca, which applies DEP to novel oncology drug candidates, this agreement is for an existing major AstraZeneca oncology medicine and provides further validation of the value of the DEP platform and its broad application to both new chemical entities and existing products."

Susan Galbraith, Senior Vice President, R&D Early Oncology, AstraZeneca, said: "Building on our long-standing and successful working relationship with Starpharma, this agreement will enable us to further evaluate the potential of the DEP technology with the aim of improving treatment outcomes for patients."

Starpharma’s DEP platform remains available for further partnerships. Licences are typically product specific and structured to allow for multiple partnered-DEP programs to run in parallel.

Clinical Benefit and Safety of LONSURF® (trifluridine/tipiracil) Reinforced by New Data Presented at the 2019 ASCO Annual Meeting

On June 3, 2019 Servier and Taiho Oncology, Inc. a subsidiary of Taiho Pharmaceutical Co., Ltd. (Japan), reported LONSURF (trifluridine/tipiracil, TAS-102) clinical data in metastatic gastric cancer (mGC), metastatic gastroesophageal junction adenocarcinoma (mGEJC) and metastatic colorectal cancer (mCRC) at the 2019 American Society of Clinical Oncology (ASCO) (Free ASCO Whitepaper) Annual Meeting in Chicago (Press release, Servier, JUN 3, 2019, View Source [SID1234536834]).

Schedule your 30 min Free 1stOncology Demo!
Discover why more than 1,500 members use 1stOncology™ to excel in:

Early/Late Stage Pipeline Development - Target Scouting - Clinical Biomarkers - Indication Selection & Expansion - BD&L Contacts - Conference Reports - Combinatorial Drug Settings - Companion Diagnostics - Drug Repositioning - First-in-class Analysis - Competitive Analysis - Deals & Licensing

                  Schedule Your 30 min Free Demo!

Patients over the age of 65 make up 60% of those with gastric cancer, with the average age of diagnosis being 68 years old.1 Therefore it is important to demonstrate the effectiveness of LONSURF for the treatment of gastric cancer for this population. To determine the efficacy and tolerability of LONSURF a subgroup analysis from the global Phase III trial TAGS was conducted. This study demonstrated that the safety and efficacy of LONSURF in patients 65 years and older who have a higher incidence of moderate renal impairment versus the placebo was comparable to the overall population included in TAGS. Additionally there were no reported treatment-related deaths among this sub-population, dose modification was more common but this did not lead to an increase in discontinuation compared to the overall population.2

"We are pleased to present further data from the global Phase III trial TAGS, the subgroup analyses reinforces the clinical benefit and safety profile of LONSURF for those aged over 65 years old with mGC and for patients with mGEJC," said Patrick Therasse, Head of Servier Research and Development Oncology. "Patients with mGC/mGEJC have no standard of care in the EU, and the data supports LONSURF as an effective and tolerable treatment option for those patients with advanced disease."

The abstracts presented at ASCO (Free ASCO Whitepaper) were:

A subgroup analysis from the Phase III TAGS trial in previously treated mGC and mGEJC patients demonstrates safety and efficacy of LONSURF in patients 65 and older who have a higher incidence of moderate renal impairment vs the overall population. (abstract #4037)
A subgroup analysis from the Phase III TAGS trial demonstrates a manageable safety profile and consistent efficacy in patients with previously treated mGEJC. (abstract #4038)
Health-related quality of life (HRQoL) data from the Phase III TAGS trial in previously treated mGC and mGEJC patients shows that treatment with LONSURF is associated with a trend toward a lower risk of QoL deterioration than placebo consistent across all symptoms and functional scales. (abstract #4043)
A pooled safety analysis of patients receiving at least one dose of LONSURF in the two Phase III trials, TAGS and RECOURSE studies demonstrates a consistent safety profile across patients with mGC/mGEJC or mCRC compared with placebo. (abstract #4039)
LONSURF is indicated in the European Union for the treatment of adult patients with metastatic colorectal cancer (CRC) who have been previously treated with, or are not considered candidates for, available therapies including fluoropyrimidine-, oxaliplatin- and irinotecan- based chemotherapies, anti-VEGF agents, and anti-EGFR agents. Applications for an additional indication in mGC including mGEJC for LONSURF are currently under review by health authorities in Australia, the European Union, Japan and Switzerland.

In February 2019, the U.S. Food and Drug Administration (FDA) approved LONSURF for the treatment of adult patients with metastatic gastric cancer (GC) or gastroesophageal junction adenocarcinoma previously treated with at least two prior lines of chemotherapy that included a fluoropyrimidine, a platinum, either a taxane or irinotecan, and if appropriate, HER2/neu-targeted therapy.

#ENDS#

About TAGS

TAGS (TAS-102 Gastric Study) is a Taiho-sponsored, global, randomized, double-blind, placebo controlled, Phase III study evaluating the efficacy and safety of LONSURF in 507 adult patients with previously treated mGC or mGEJC. The primary endpoint was overall survival (OS), and the key secondary endpoints included progression-free survival (PFS), safety and tolerability, as well as quality of life. LONSURF demonstrated statistically significant improvement in OS and PFS compared with placebo. The median OS improved from 3.6 months with placebo to 5.7 months with LONSURF, HR 0.69 (95% confidence interval [CI], 0·56-0·85; P=0.00058).

For more information on TAGS, please visit www.ClinicalTrials.gov (View Source). The ClinicalTrials.gov Identifier is NCT02500043.

About RECOURSE

The RECOURSE trial is a global, randomized, double-blind, placebo-controlled Phase III trial evaluating the efficacy and safety of LONSURF in patients with previously treated mCRC. The trial enrolled 800 patients in North America, Japan, Europe and Australia. Patients were randomized (2:1) to receive LONSURF (35 mg/m2) or placebo, plus BSC, twice daily. The study met its primary and secondary endpoints of OS and PFS versus placebo. The median OS improved from 5.3 months with placebo to 7.1 months with LONSURF, HR 0.68 (95% CI, 0.58 to 0.81; P<0.001).

About Metastatic Gastric Cancer

Gastric cancer, also known as stomach cancer, is a disease in which malignant cells form in the lining of the stomach. It is the fifth most common cancer worldwide and the third most common cause of cancer-related death (after lung and colorectal cancer), with an estimated 780,000 deaths annually.3 

When cancer spreads it is called advanced cancer. Locally advanced cancer is when the cancer has grown outside the organ it started in but hasn’t spread to other parts of the body. When the cancer spreads to other parts of the body, this is called metastatic cancer. In the last two decades, the proportion of patients with gastric cancer who present with metastases has risen to over 40%.4

Standard chemotherapy regimens for advanced gastric cancer include fluoropyrimidines, platinum derivatives, and taxanes (with ramucirumab), or irinotecan. The addition of trastuzumab to chemotherapy is standard of care for patients with HER2/neu-positive advanced gastric cancer. However, after failure of first- and second-line therapies, there are neither approved nor standard third-line treatments in the EU.

About Metastatic Colorectal Cancer

Colorectal cancer is the third most common cancer worldwide with approximately 1.8 million new diagnoses in 2018. Each year there are over 880,000 deaths making it the second biggest cancer killer worldwide (after lung cancer).5

Those with metastatic disease (where the cancer has spread from the primary site) the average five-year survival is approximately 11%.6 Standard chemotherapy regimens for advanced mCRC include fluoropyrimidines, oxaliplatin, irinotecan or targeted treatments, such as those that target vascular endothelial growth factors (VEGF) or endothelial growth factor receptors (EGFR).

Over the last decade, clinical outcomes for patients with mCRC have improved considerably due to the advent of novel treatment agents, predictive biomarkers, and a more strategic approach to the delivery of systemic therapies. Currently, the median overall survival for patients with mCRC being treated both in phase III trials and in large observational series or registries is 30 months – more than double that of 20 years ago.7,8,9

About LONSURF10

LONSURF consists of a thymidine-based nucleoside analog, trifluridine, and the thymidine phosphorylase (TP) inhibitor, tipiracil, which increases trifluridine exposure by inhibiting its metabolism by TP. Trifluridine is incorporated into DNA, resulting in DNA dysfunction and inhibition of cell proliferation.

In the EU, LONSURF is indicated for the treatment of adult patients with metastatic colorectal cancer (CRC) who have been previously treated with, or are not considered candidates for, available therapies including fluoropyrimidine-, oxaliplatin- and irinotecan-based chemotherapies, anti-VEGF agents, and anti-EGFR agents.

As of May 2019, LONSURF has been approved as a treatment for advanced mCRC in 67 countries and regions. In February 2019, LONSURF has been approved as a treatment for mGC/mGEJC in the United States.

LONSURF was discovered and developed by Taiho Pharmaceutical. In June 2015, Taiho Pharmaceutical and Servier entered into an exclusive license agreement for the co-development and commercialization of LONSURF in Europe and other countries outside of the United States, Canada, Mexico and Asia

Exicure to Present at LD Micro 9th Invitational Conference

On June 3, 2019 Exicure, Inc. (OTCQB: XCUR), the pioneer in gene regulatory and immunotherapeutic drugs utilizing spherical nucleic acid (SNA) constructs, reported that its CFO, David Snyder, will give a company presentation on Tuesday, June 4th, 2019 at 3:40-4:00 pm MDT at the LD Micro 9th Invitational Conference (Press release, Exicure, JUN 3, 2019, View Source [SID1234536833]). The presentation will be made at Luxe Sunset Boulevard Hotel in Los Angeles.

Schedule your 30 min Free 1stOncology Demo!
Discover why more than 1,500 members use 1stOncology™ to excel in:

Early/Late Stage Pipeline Development - Target Scouting - Clinical Biomarkers - Indication Selection & Expansion - BD&L Contacts - Conference Reports - Combinatorial Drug Settings - Companion Diagnostics - Drug Repositioning - First-in-class Analysis - Competitive Analysis - Deals & Licensing

                  Schedule Your 30 min Free Demo!

A live audio webcast will be available on the Investors section of Exicure’s website: www.exicuretx.com. The webcast will be archived for approximately 30 days following the event.

Epizyme Reports Updated Data from Phase 2 Trial of Tazemetostat for Epithelioid Sarcoma at 2019 ASCO Annual Meeting

On June 3, 2019 Epizyme, Inc. (Nasdaq: EPZM), a late-stage biopharmaceutical company developing novel epigenetic therapies, reported updated data on tazemetostat from the epithelioid sarcoma cohort of its ongoing Phase 2 study in patients with molecularly defined solid tumors (Press release, Epizyme, JUN 3, 2019, View Source [SID1234536832]). The data will be presented today in an oral presentation entitled "Safety and efficacy of tazemetostat, a first-in-class EZH2 inhibitor, in patients with epithelioid sarcoma" at the 2019 American Society of Clinical Oncology (ASCO) (Free ASCO Whitepaper) Annual Meeting by Silvia Stacchiotti, M.D., Fondazione IRCCS Istituto Nazionale Tumori, Milan, and an investigator in the Phase 2 clinical trial.

Schedule your 30 min Free 1stOncology Demo!
Discover why more than 1,500 members use 1stOncology™ to excel in:

Early/Late Stage Pipeline Development - Target Scouting - Clinical Biomarkers - Indication Selection & Expansion - BD&L Contacts - Conference Reports - Combinatorial Drug Settings - Companion Diagnostics - Drug Repositioning - First-in-class Analysis - Competitive Analysis - Deals & Licensing

                  Schedule Your 30 min Free Demo!

In July 2017, Epizyme completed enrollment of 62 patients in the epithelioid sarcoma cohort of its Phase 2 trial. Updated data reported today from that cohort are as of a September 17, 2018 cutoff date. Findings include that treatment with tazemetostat resulted in a 15% objective response rate (ORR) and a 26% disease control rate (DCR). The median duration of response (DOR) has not yet been reached. Among the 62 patients, tazemetostat continues to be generally well-tolerated with favorable safety.

"Today, there are limited effective and tolerable treatment options available for patients with epithelioid sarcoma, a rare and aggressive cancer that affects people in the prime of their lives," said Dr. Shefali Agarwal, chief medical officer of Epizyme. "We are pleased that the data presented today are consistent with what we have seen throughout our development of tazemetostat for epithelioid sarcoma, demonstrating meaningful clinical activity and good tolerability. Importantly, the totality of these data formed the foundation for our first NDA submission, which we just announced last week. If we are successful, tazemetostat would be the first FDA-approved EZH2 inhibitor. We are thankful to the patients, physicians and caregivers who have participated in our study and hope that tazemetostat may positively impact patients with this devastating cancer in the future."

Efficacy Data
The epithelioid sarcoma cohort in Epizyme’s Phase 2 study represents the largest prospective study of epithelioid sarcoma with any approved or investigational anticancer treatment to date. Epithelioid sarcoma is an ultra-rare and aggressive soft tissue sarcoma, characterized by a loss of the INI1 protein. It is most commonly diagnosed in young adults (20-40 years old) and is often fatal, with a median overall survival (OS) of less than one year in patients with metastatic disease.

The fully enrolled cohort includes 24 treatment-naive patients and 38 relapsed and/or refractory patients for a total of 62 adult and pediatric epithelioid sarcoma patients (at least 16 years of age). Patients enrolled were administered 800 mg of tazemetostat orally twice daily. The primary endpoint of the study is ORR, comprised of complete and partial responses as measured by RECIST 1.1. Secondary endpoints include DOR, DCR, OS and safety.

Updated findings are summarized below, based on a September 17, 2018 data cut-off date.


Key Efficacy Endpoint


Treatment-naive
(n=24)


Relapsed and/or
Refractory

(n=38)


Total
(n=62)

Objective Response Rate, n (%) 6 (25%) 3 (8%) 9 (15%)
Median Duration of Response, weeks
41.1
(34.1, not reached)


Not reached
(40.1, not reached)


Not reached
(34.1, not reached)

Disease Control Rate*, n (%)
(95% confidence interval)


10 (42%)
(22.1, 63.4)

6 (16%)
(6.0, 31.3)
16 (26%)
(15.5, 38.5)

Median Overall Survival, weeks
(95% confidence interval)

Not reached 47.4
(29.0, 68.1)


82.4
(47.4, not reached)

*Comprised of confirmed objective responses for any duration or disease stabilization of 32 weeks or more

Tazemetostat Safety Data
Favorable safety and tolerability have been observed with tazemetostat in this Phase 2 study cohort. The majority of treatment-emergent adverse events (TEAEs) were grade 1 or 2, with only 13 percent of patients experiencing grade 3 or higher treatment-related TEAEs. Reported TEAEs regardless of attribution with an incidence of 10% or greater were fatigue (39%), nausea (35%), cancer pain (32%), decreased appetite (26%), constipation (21%), vomiting (24%), cough and headache (18% each), diarrhea, weight decrease and anemia (16% each), dyspnea (13%) and plural effusion (11.% ). Two percent of patients were dose-reduced due to an adverse event and one patient discontinued treatment due to an adverse event in the Phase 2 cohort.

The safety data from the 62 epithelioid sarcoma patients in the study cohort are consistent with the overall safety observed to date in over 800 people in the tazemetostat clinical program.

Tazemetostat NDA Submission for Epithelioid Sarcoma
In May, Epizyme announced that it submitted the New Drug Application (NDA) for tazemetostat for the treatment of patients with metastatic or locally advanced epithelioid sarcoma not eligible for curative surgery to the US. Food and Drug Administration (FDA). The FDA has a 60-day filing review period to determine whether the NDA is complete and acceptable for filing.

About Epithelioid Sarcoma
Epithelioid sarcoma is an ultra-rare soft tissue sarcoma characterized by a loss of the protein INI1. Patients are most commonly diagnosed as young adults, between 20 and 40 years of age. Median overall survival from initial diagnosis is 30 months. Epithelioid sarcoma becomes more aggressive after recurrence or metastases, with a typical survival of less than one year for patients with metastatic disease.

About the Tazemetostat Clinical Trial Program
Tazemetostat, an oral, potent, first-in-class EZH2 inhibitor, is currently being studied as a monotherapy in ongoing clinical programs in patients with certain molecularly defined solid tumors, including epithelioid sarcoma and other INI1-negative tumors, and in patients with follicular lymphoma, both with and without EZH2 activating mutations. Multiple clinical studies are underway through collaborations assessing tazemetostat as a combination treatment for patients with diffuse large B-cell lymphoma. Epizyme also plans to conduct multiple additional clinical trials designed to evaluate the potential benefit of tazemetostat in earlier lines of therapy for follicular lymphoma, as well as new combinations and cancer indications.

Merck Presents Updated Results for Investigational Therapy Tepotinib Demonstrating Durable Clinical Response in Patients with Advanced NSCLC with METex14 Skipping Mutations

On June 3, 2019 Merck, a leading science and technology company, reported updated results from the potentially registrational Phase II VISION study, showing durable anti-tumor clinical activity for the investigational targeted therapy tepotinib* across different lines of treatment in advanced non-small cell lung cancer (NSCLC) patients harboring MET exon 14 skipping mutations detected by liquid biopsy (LBx) or tissue biopsy (TBx) (Press release, Merck & Co, JUN 3, 2019, View Source [SID1234536831]). Data were shared in an oral presentation today at the 2019 American Society of Clinical Oncology (ASCO) (Free ASCO Whitepaper) Annual Meeting in Chicago, IL, US.

Schedule your 30 min Free 1stOncology Demo!
Discover why more than 1,500 members use 1stOncology™ to excel in:

Early/Late Stage Pipeline Development - Target Scouting - Clinical Biomarkers - Indication Selection & Expansion - BD&L Contacts - Conference Reports - Combinatorial Drug Settings - Companion Diagnostics - Drug Repositioning - First-in-class Analysis - Competitive Analysis - Deals & Licensing

                  Schedule Your 30 min Free Demo!

"Tepotinib has been designed to potentially improve outcomes in aggressive tumors that have a poor prognosis and harbor these specific alterations," said Luciano Rossetti, Global Head of Research & Development for the Biopharma business of Merck. "Tepotinib is an important part of our strategic focus on precision medicine, and both the proportion of patients responding and the duration of anti-tumor clinical activity demonstrate the potential of this investigational therapy."

Discovered in-house at Merck, tepotinib is an investigational, highly potent and selective1 oral MET kinase inhibitor that is designed to inhibit the oncogenic signaling caused by MET (gene) alterations, including both MET exon 14 skipping mutations and MET amplifications, or MET protein overexpression. Alterations of the MET signaling pathway are found in various cancer types, including 3-5% of NSCLC cases, and correlate with aggressive tumor behavior and poor clinical prognosis.2-4

"Patients with this NSCLC molecular subtype lack treatment options that have the potential to significantly improve clinical outcomes," said Paul K. Paik, M.D., primary study investigator and Clinical Director, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center. "It is noteworthy to see data that are consistent with tepotinib’s previously reported efficacy findings in this patient population, and that also provide valuable new insight into its durable clinical activity across various treatment lines."

Results from the ongoing Phase II VISION study in 73 efficacy-evaluable patients with NSCLC with MET exon 14 skipping mutations identified by LBx or TBx demonstrate overall objective response rate (ORR) of 50.0% for LBx-identified patients as assessed by Independent Review Committee (IRC), and 55.3% as assessed by investigators. The ORR for TBx-identified patients was 45.1% and 54.9%, respectively. The overall median duration of response (DOR) was 12.4 months and 17.1 months among LBx-identified patients, as assessed by IRC and investigators, respectively, while among TBx-identified patients, 15.7 and 14.3 months were observed, respectively.

Most treatment-related adverse events (TRAEs) were Grade 1 and 2. No Grade 4 or 5 TRAEs were observed. Any grade TRAEs reported by ≥10% of 87 patients evaluable for safety were peripheral edema (48.3%), nausea (23.0%) diarrhea (20.7%) and increased blood creatinine (12.6%). Other relevant TRAEs of any grade include increased lipase (4.6%), fatigue (3.4%) and vomiting (3.4%). TRAEs led to permanent discontinuation in four patients (two patients due to peripheral edema, one due to interstitial lung disease, one due to diarrhea and nausea).

The use of both liquid and tissue biopsies to identify patients for the VISION trial is intended to support improved patient selection and is consistent with the company’s focus on patient-centric drug development.

Tepotinib is currently being investigated in NSCLC in two different settings: in NSCLC harboring MET alterations (MET exon 14 skipping mutations and MET amplifications) as monotherapy, as well as in combination with the tyrosine kinase inhibitor (TKI) osimertinib in epidermal growth factor receptor (EGFR) mutated MET amplified NSCLC having acquired resistance to prior EGFR TKI. Additional information on these clinical trials can be found at ClinicalTrials.gov using the identifiers NCT02864992 and NCT03940703, respectively. Merck is also actively assessing the potential of investigating tepotinib in combination with novel therapies for other tumor indications.

*Tepotinib is the recommended International Nonproprietary Name (INN) for the MET kinase inhibitor (MSC2156119J). Tepotinib is currently under clinical investigation and not approved for any use anywhere in the world.

Notes to Editors
Tepotinib oral session:

Title

Lead Author

Abstract #

Presentation
Date / Time
(CDT)

Location

Tepotinib

Oral Session

Phase II study of
tepotinib in
NSCLC patients with

METex14 mutations

P.K. Paik

9005

Mon, Jun 3, 8:00

AM – 11:00 AM
(9:24 AM – 9:36
AM lecture time)

Hall B1

About Non-Small Cell Lung Cancer
With 2 million cases diagnosed annually, lung cancer (including trachea, bronchus, and lung) is the most common type of cancer worldwide, and the leading cause of cancer-related death, with 1.7 million mortality cases worldwide.5 Alterations of the MET signaling pathway, including MET exon 14 skipping mutations and MET amplifications, occur in 3-5% of NSCLC cases.2-4

About Tepotinib
Tepotinib, discovered in-house at Merck, is an investigational oral MET inhibitor that is designed to inhibit the oncogenic MET receptor signaling caused by MET (gene) alterations, including both MET exon 14 skipping mutations and MET amplifications, or MET protein overexpression. It has been designed to have a highly selective mechanism of action, with the potential to improve outcomes in aggressive tumors that have a poor prognosis and harbor these specific alterations.

Tepotinib is currently being investigated in NSCLC and Merck is actively assessing the potential of investigating tepotinib in combination with novel therapies and in other tumor indications.

All Merck press releases are distributed by e-mail at the same time they become available on the Merck Website. Please go to www.merckgroup.com/subscribe to register online, change your selection or discontinue this service.