On June 13, 2020 Genentech, a member of the Roche Group (SIX: RO, ROG; OTCQX: RHHBY), reported positive results from the Phase III VIALE-A study, evaluating Venclexta (venetoclax) in combination with azacitidine in people with previously untreated acute myeloid leukemia (AML) who were ineligible for intensive induction chemotherapy (Press release, Genentech, JUN 13, 2020, View Source [SID1234561084]). VIALE-A results were featured in the 25th European Hematology Association (EHA) (Free EHA Whitepaper) Virtual Congress Press Briefing on Saturday, June 13, 2020 at 8:30 AM CEST and will be presented at the congress during the Late-breaking Oral Session (abstract #LB2601) on Sunday, June 14, 2020.
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"The significant survival benefits observed in the VIALE-A study reinforce the potential utility of this Venclexta-based combination for people with this aggressive disease."
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"We are very pleased to present these important results from people with acute myeloid leukemia, especially those who are unable to tolerate intensive chemotherapy and therefore have limited treatment options," said Levi Garraway, M.D., Ph.D., chief medical officer and head of Global Product Development. "The significant survival benefits observed in the VIALE-A study reinforce the potential utility of this Venclexta-based combination for people with this aggressive disease."
Results from the VIALE-A study showed that the Venclexta combination reduced the risk of death (overall survival [OS]) by 34% compared to azacitidine alone (median OS=14.7 months vs. 9.6 months; HR: 0.66, 95% CI: 0.52–0.85, p<0.001) in people with previously untreated AML. The Venclexta plus azacitidine combination also led to higher rates of composite complete remission (CR + CR with incomplete blood count recovery [CR + CRi]) at 66.4% compared to 28.3% with azacitidine alone (p<0.001).
Safety for Venclexta plus azacitidine appeared consistent with the known safety profile of these medicines and no unexpected safety signals were identified with the combination. Notable Grade 3 or higher adverse events in the Venclexta plus azacitidine and azacitidine alone arms included low platelet count (thrombocytopenia; 45% vs. 38%), low white blood cell count (neutropenia; 42% vs. 29%; leukopenia; 21% vs. 12%), low white blood cell count with fever (febrile neutropenia; 42% vs. 19%) and low red blood cell count (anemia; 26% vs. 20%).
The study also met its secondary endpoint of CR and CR with partial hematologic recovery (CR + CRh), with the combination showing a CR + CRh of 64.7% compared to 22.8% with azacitidine alone.
Data from the VIALE-A study has been shared with health authorities globally including the U.S. Food and Drug Administration (FDA). Venclexta has previously been granted accelerated approval by the FDA in combination with azacitidine, or decitabine, or low-dose cytarabine for the treatment of people with newly diagnosed AML who are aged 75 years or older, or for those ineligible for intensive induction chemotherapy due to coexisting medical conditions. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory studies. VIALE-A is part of Venclexta’s ongoing development program to convert the current accelerated approval of Venclexta, granted by the FDA in previously untreated AML, to a full approval. Venclexta has also been granted five Breakthrough Therapy Designations by the FDA, including two for previously untreated AML.
Venclexta is being developed by AbbVie and Genentech, a member of the Roche Group. It is jointly commercialized by the companies in the United States and commercialized by AbbVie outside of the United States.
About the VIALE-A Study
VIALE-A (NCT02993523) is a Phase III, randomized, double-blind, placebo-controlled multicenter study evaluating the efficacy and safety of Venclexta (venetoclax) plus azacitidine, a hypomethylating agent, compared to placebo plus azacitidine, in 433 people with previously untreated acute myeloid leukemia who are ineligible for intensive chemotherapy. Two-thirds of patients received 400 mg Venclexta daily, in combination with azacitidine, and the remaining patients received placebo tablets in combination with azacitidine. Patients enrolled in the study had a range of mutational subtypes, including IDH1/2 and FLT3. The primary endpoints of the study are overall survival (OS) and rate of complete remission (CR) and CR with incomplete blood count recovery (CRi). OS was the sole primary endpoint in the United States (U.S.) and U.S. reference countries, and OS and CR + CRi were co-primary endpoints in China, Japan, the European Union (EU) and EU reference countries. Secondary endpoints include CR and CR with partial hematologic recovery (CRh), event-free survival, transfusion independence and patient-reported outcomes.
Venclexta plus azacitidine
(n=286)
Azacitidine plus placebo
(n=145)
Median OS
14.7 months
9.6 months
Hazard ratio: 0.66, 95% CI: 0.52–0.85, p<0.001
CR + CRi
66.4%
28.3%
p<0.001
CR + CRh
64.7%
22.8%
p<0.001
CR + CRi rates in molecular subgroups
IDH1/2
75%
11%
p<0.001
FLT3
72%
36%
p=0.021
NPM1
67%
24%
p=0.012
TP53
55%
0%
p<0.001
About AML
Acute myeloid leukemia (AML) is the most common type of aggressive leukemia in adults, which has the lowest survival rate for all types of leukemia. In 2020, it is estimated there will be nearly 20,000 new cases of AML diagnosed in the United States. Many AML patients older than age 60 are unable to tolerate intensive induction chemotherapy treatment.
About Venclexta
Venclexta is a first-in-class targeted medicine designed to selectively bind and inhibit the B-cell lymphoma-2 (BCL-2) protein. In some blood cancers and other tumors, BCL-2 builds up and prevents cancer cells from dying or self-destructing, a process called apoptosis. Venclexta blocks the BCL-2 protein and works to help restore the process of apoptosis.
Venclexta is being developed by AbbVie and Genentech, a member of the Roche Group. It is jointly commercialized by the companies in the United States and commercialized by AbbVie outside of the United States. Together, the companies are committed to research with Venclexta, which is currently being studied in clinical trials across several types of blood and other cancers.
In the United States, Venclexta has been granted five Breakthrough Therapy Designations by the U.S. Food and Drug Administration: one for previously untreated chronic lymphocytic leukemia (CLL), two for relapsed or refractory CLL and two for previously untreated acute myeloid leukemia.
Venclexta Indications
Venclexta is a prescription medicine used:
To treat adults with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL).
In combination with azacitidine, or decitabine, or low-dose cytarabine to treat adults with newly-diagnosed acute myeloid leukemia (AML) who:
‒ Are 75 years of age or older, or
‒ Have other medical conditions that prevent the use of standard chemotherapy.
‒ Venclexta was approved based on response rates. Continued approval for this use may depend on the results of an ongoing study to find out how Venclexta works over a longer period of time.
It is not known if Venclexta is safe and effective in children.
Important Safety Information
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. The patient’s doctor will do tests to check their risk of getting TLS before they start taking Venclexta. The patient will receive other medicines before starting and during treatment with Venclexta to help reduce the risk of TLS. The patient may also need to receive intravenous (IV) fluids through their vein.
The patient’s doctor will do blood tests to check for TLS when the patient first starts treatment and during treatment with Venclexta. It is important for patients to keep appointments for blood tests. Patients should tell their doctor right away if they 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.
Patients should drink plenty of water during treatment with Venclexta to help reduce the risk of getting TLS.
Patients should drink 6 to 8 glasses (about 56 ounces total) of water each day, starting 2 days before the first dose, on the day of the first dose of Venclexta, and each time a dose is increased.
The patient’s doctor may delay, decrease the dose, or stop treatment with Venclexta if the patient has side effects.
Certain medicines must not be taken when the patient first starts taking Venclexta and while the dose is being slowly increased because of the risk of increased tumor lysis syndrome.
Patients must tell their doctor about all the medicines they take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Venclexta and other medicines may affect each other, causing serious side effects.
Patients must not start new medicines during treatment with Venclexta without first talking with their doctor.
Before taking Venclexta, patients must tell their doctor about all of their medical conditions, including if they:
Have kidney or liver problems.
Have problems with body salts or electrolytes, such as potassium, phosphorus, or calcium.
Have a history of high uric acid levels in the blood or gout.
Are scheduled to receive a vaccine. The patient should not receive a "live vaccine" before, during, or after treatment with Venclexta, until the patient’s doctor tells them it is okay. If the patient is not sure about the type of immunization or vaccine, the patient should ask their doctor. 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 an unborn baby. If the patient is able to become pregnant, the patient’s doctor should do a pregnancy test before the patient starts treatment with Venclexta, and the patient should use effective birth control during treatment and for at least 30 days after the last dose of Venclexta. If the patient becomes pregnant or thinks they are pregnant, the patient should tell their doctor right away.
Are breastfeeding or plan to breastfeed. It is not known if Venclexta passes into the patient’s breast milk. Patients should not breastfeed during treatment with Venclexta.
What to avoid while taking Venclexta:
Patients should not drink grapefruit juice, eat grapefruit, Seville oranges (often used in marmalades), or starfruit while they are taking Venclexta. These products may increase the amount of Venclexta in the patient’s blood.
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. The patient’s doctor will do blood tests to check their blood counts during treatment with Venclexta.
Infections. Death and serious infections such as pneumonia and blood infection (sepsis) have happened during treatment with Venclexta. The patient’s doctor will closely monitor and treat the patient right away if they have a fever or any signs of infection during treatment with Venclexta.
Patients should tell their doctor right away if they 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 low white blood cell counts; nausea; diarrhea; low platelet counts; constipation; fever with low white blood cell counts; low red blood cell counts; infection in blood; rash; dizziness; low blood pressure; fever; swelling of arms, legs, hands, and feet; vomiting; tiredness; shortness of breath; bleeding; infection in lung; stomach (abdominal) pain; pain in muscles or back; cough; and sore throat.
Venclexta may cause fertility problems in males. This may affect the ability to father a child. Patients should talk to their doctor if they have concerns about fertility.
These are not all the possible side effects of Venclexta. For more information, patients should ask their doctor or pharmacist.
Report side effects to the FDA at 1-800-FDA-1088 or View Source Report side effects to Genentech at 1-888-835-2555.
Please visit View Source for the Venclexta full Prescribing Information, including Patient Information, for additional Important Safety Information.
About Genentech in Hematology
For more than 20 years, Genentech has been developing medicines with the goal to redefine treatment in hematology. Today, we’re investing more than ever in our effort to bring innovative treatment options to people with diseases of the blood. For more information visit View Source