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Monday, August 02 2021 - 16:00
AsiaNet
Servier Announces Positive Topline Data from the Global Phase 3 Study of TIBSOVO(R) (ivosidenib tablets) in Combination with Azacitidine in Patients with Previously Untreated IDH1-mutated Acute Myeloid Leukemia
PARIS and BOSTON, Aug. 2, 2021 /PRNewswire-AsiaNet/ --

- TIBSOVO is the first targeted therapy to show improved event-free survival 
and overall survival in combination with azacitidine compared to azacitidine 
monotherapy. 

- Safety profile consistent with previously published data in patients with 
IDH1-mutated acute myeloid leukemia.

- The study recently halted further enrollment due to compelling efficacy data 
for TIBSOVO.

Servier, a global pharmaceutical company, today announced the global Phase 3 
double blinded placebo controlled AGILE study of TIBSOVO (ivosidenib tablets) 
in combination with the chemotherapy azacitidine in adults with previously 
untreated IDH1-mutated acute myeloid leukemia (AML) met its primary endpoint of 
event-free survival (EFS)[1,2]. Treatment with TIBSOVO in combination with 
azacitidine compared to azacitidine in combination with placebo demonstrated a 
statistically significant improvement in EFS. Additionally, the trial met all 
of its key secondary endpoints, including complete remission rate (CR rate), 
overall survival (OS), CR and complete remission with partial hematologic 
recovery rate (CRh rate) and objective response rate (ORR). The safety profile 
of TIBSOVO in combination with azacitidine was consistent with previously 
published data. The study recently halted further enrollment based on the 
recommendation of the Independent Data Monitoring Committee (IDMC), as a 
difference of clinical importance was noted between the treatment groups.

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"The results of AGILE represent a major breakthrough and will be welcome news 
for patients dealing with previously untreated IDH1-mutated acute myeloid 
leukemia," said Claude Bertrand, Executive Vice President, R&D, Servier Group. 
"We look forward to sharing the findings from this study with the medical 
community and with regulatory authorities around the world."

A full analysis of the AGILE trial will be submitted for a presentation at a 
future medical congress. 

"Acute myeloid leukemia has a poor prognosis, especially for newly diagnosed 
patients who are not eligible for intensive chemotherapy," said Susan Pandya, 
M.D., Vice President Clinical Development, Servier Pharmaceuticals. "TIBSOVO 
monotherapy has been instrumental in transforming outcomes for adult patients 
with newly diagnosed or relapsed refractory AML harboring an IDH1 mutation. 
These promising results from the AGILE study support the added benefit of 
inhibiting the mutant IDH1 enzyme in combination with standard chemotherapy in 
the newly diagnosed intensive chemotherapy ineligible setting. We look forward 
to presenting the full results of the AGILE trial to show how TIBSOVO in 
combination with azacitidine may improve outcomes in previously untreated 
patients with IDH1-mutated acute myeloid leukemia."

TIBSOVO* is currently approved in the U.S. as monotherapy for the treatment of 
adults with IDH1-mutant relapsed or refractory acute myeloid leukemia (AML), 
and for adults with newly diagnosed IDH1-mutant AML who are greater than or 
equal to 75 years old or who have comorbidities that preclude the use of 
intensive induction chemotherapy. Recently, the U.S. Food and Drug 
Administration (FDA) accepted Servier's supplemental New Drug Application 
(sNDA) for TIBSOVO as a potential treatment for patients with previously 
treated IDH1-mutated cholangiocarcinoma. The sNDA was granted Priority Review 
by the FDA. 

About AGILE Phase 3 Trial 
The AGILE trial is a global, Phase 3, multicenter, double-blind, randomized, 
placebo-controlled clinical trial designed to evaluate the efficacy and safety 
of TIBSOVO in combination with azacitidine compared to placebo in combination 
with azacitidine, in newly diagnosed AML patients non eligible for intensive 
chemotherapy. The study's primary endpoint is event-free survival (EFS), 
defined as the time from randomization until treatment failure, relapse from 
remission, or death from any cause, whichever occurs first. Treatment failure 
is defined as failure to achieve complete remission (CR) by Week 24.

Other key secondary endpoints included complete remission rate (CR rate), 
defined as the proportion of participants who achieve a CR; overall survival 
(OS), defined as the time from date of randomization to the date of death due 
to any cause; CR and complete remission with partial hematologic recovery (CRh) 
rate, defined as the proportion of participants who achieve a CR or CRh; and 
objective response rate (ORR), defined as the rate of CR, CR with incomplete 
hematologic recovery (CRi) (including CR with incomplete platelet recovery 
[CRp]), partial remission (PR), and morphologic leukemia-free state (MLFS). 

About Acute Myeloid Leukemia 
Acute Myeloid Leukemia (AML) is a cancer of the blood and bone marrow marked by 
rapid disease progression and is the most common acute leukemia affecting 
adults with approximately 20,000 new cases in the U.S., and 43,000 cases in 
Europe each year[3,4]. The majority of patients with AML eventually relapse. 
Relapsed or refractory AML has a poor prognosis[5]. The five-year survival rate 
is approximately 27%[3]. For 6 to 10 percent of AML patients, the mutated IDH1 
enzyme blocks normal blood stem cell differentiation, contributing to the 
genesis of acute leukemia[6]. 

About Servier Pharmaceuticals 
Servier Pharmaceuticals LLC is a commercial-stage company with a passion for 
innovation and improving the lives of patients, their families and caregivers. 
A privately held company, Servier has the unique freedom to devote its time and 
energy toward putting those who require our treatment and care first, with 
future growth driven by innovation in areas of unmet medical need.

As a growing leader in oncology, Servier is committed to finding solutions that 
will address today's challenges. The company's oncology portfolio of innovative 
medicines is designed to bring more life-saving treatments to a greater number 
of patients, across the entire spectrum of disease and in a variety of tumor 
types.  

Servier believes co-creation is fundamental to driving innovation and is 
actively building alliances, acquisitions, licensing deals and partnerships 
that bring solutions and accelerate access to therapies. With our commercial 
expertise, global reach, scientific expertise and commitment to clinical 
excellence, Servier Pharmaceuticals is dedicated to bringing the promise of 
tomorrow to the patients that we serve.

More information: www.servier.us 
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About Servier Group 
Servier is a global pharmaceutical group governed by a Foundation. With a 
strong international presence in 150 countries and a total revenue of 4.7 
billion euros in 2020, Servier employs 22,500 people worldwide. Servier is an 
independent group that invests over 20% of its brand-name revenue in Research 
and Development every year. To accelerate therapeutic innovation for the 
benefit of patients, the Group is committed to open and collaborative 
innovation with academic partners, pharmaceutical groups, and biotech 
companies. It also integrates the patient's voice at the heart of its 
activities. 

A leader in cardiology, the ambition of the Servier Group is to become a 
renowned and innovative player in oncology. Its growth is based on a sustained 
commitment to cardiovascular and metabolic diseases, oncology, neuroscience and 
immuno-inflammatory diseases. To promote access to healthcare for all, the 
Servier Group also offers a range of quality generic drugs covering most 
pathologies.

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Press Contacts 
Servier Group (France and worldwide)
Sonia Marques
presse@servier.com 
+33 (0)1 55 72 40 21 / + 33 (0)7 84 28 76 13

Servier Pharmaceuticals (U.S.)
Megan Talon
megan.talon@servier.com 
+1 857-895-4334

Disclosures 
This release contains general information about the Servier Group and its 
entities (hereinafter "Servier and its Affiliates") and is intended for 
informational purposes only. The information is thought to be reliable; 
however, Servier and its Affiliates make no representation as to the 
completeness of the information contained herein or otherwise provided and 
accept no responsibility or liability, in contract, in tort, in negligence, or 
otherwise, should the information be found to be inaccurate or incomplete in 
any respect.

Servier and its Affiliates are not acting as an advisor to the recipient of 
this information, and the ultimate decision to proceed with any transaction 
rests solely with the recipient of this information. Therefore, prior to 
entering into any proposed transaction, the recipient of this information 
should determine, without reliance upon Servier or its Affiliates, the economic 
risks and merits, as well as the legal, tax, and accounting characterizations 
and consequences, of the transaction and that it is able to assume these risks. 

This statement also contains forward-looking statements that are subject to 
varying levels of uncertainty and risk. Investigational new drugs and 
indications are subject to further scientific and medical review and regulatory 
approval. They are not approved for use by the FDA.

Any reliance placed on this document is done entirely at the risk of the person 
placing such reliance. The information contained in this document is neither an 
offer to sell nor the solicitation of an offer to enter into a transaction.

The content of this document is a summary only, is not complete, and does not 
include all material information about Servier and its Affiliates, including 
potential conflicts of interest.

To the maximum extent permitted by applicable laws and regulations, Servier and 
its Affiliates disclaim all representations, warranties, conditions and 
guarantees, whether express, implied, statutory or of other kind, nor does it 
accept any duty to any person, in connection with this document. Without 
prejudice to the generality of the foregoing, Servier and its Affiliates do not 
warrant or represent that the information or opinions contained in this 
document is accurate or complete. 

To the maximum extent permitted by applicable laws and regulations, Servier and 
its Affiliates shall not be liable for any loss, damage or expense whatsoever, 
whether direct or indirect, howsoever arising, whether in contract, tort 
(including negligence), strict liability or otherwise, for direct, indirect, 
incidental, consequential, punitive or special damages arising out of or in 
connection with this document, including (without limitation) any course of 
action taken on the basis of the same.

The estimates, strategies, and views expressed in this document are based upon 
past or current data and information and are subject to change without notice. 

About TIBSOVO(R) (ivosidenib tablets)

TIBSOVO(R) is indicated for the treatment of acute myeloid leukemia (AML) with 
a susceptible isocitrate dehydrogenase-1 (IDH1) mutation as detected by an 
FDA-approved test in:

    -- Adult patients with newly-diagnosed AML who are greater than or equal to 
       75 years old or who have comorbidities that preclude use of intensive 
       induction chemotherapy. 
    -- Adult patients with relapsed or refractory AML.

IMPORTANT SAFETY INFORMATION

WARNING: DIFFERENTIATION SYNDROME

Patients treated with TIBSOVO have experienced symptoms of differentiation 
syndrome, which can be fatal if not treated. Symptoms may include fever, 
dyspnea, hypoxia, pulmonary infiltrates, pleural or pericardial effusions, 
rapid weight gain or peripheral edema, hypotension, and hepatic, renal, or 
multi-organ dysfunction. If differentiation syndrome is suspected, initiate 
corticosteroid therapy and hemodynamic monitoring until symptom resolution.

WARNINGS AND PRECAUTIONS

Differentiation Syndrome: See Boxed WARNING. In the clinical trial, 25% (7/28) 
of patients with newly diagnosed AML and 19% (34/179) of patients with relapsed 
or refractory AML treated with TIBSOVO experienced differentiation syndrome. 
Differentiation syndrome is associated with rapid proliferation and 
differentiation of myeloid cells and may be life-threatening or fatal if not 
treated. Symptoms of differentiation syndrome in patients treated with TIBSOVO 
included noninfectious leukocytosis, peripheral edema, pyrexia, dyspnea, 
pleural effusion, hypotension, hypoxia, pulmonary edema, pneumonitis, 
pericardial effusion, rash, fluid overload, tumor lysis syndrome, and 
creatinine increased. Of the 7 patients with newly diagnosed AML who 
experienced differentiation syndrome, 6 (86%) patients recovered. Of the 34 
patients with relapsed or refractory AML who experienced differentiation 
syndrome, 27 (79%) patients recovered after treatment or after dose 
interruption of TIBSOVO. Differentiation syndrome occurred as early as 1 day 
and up to 3 months after TIBSOVO initiation and has been observed with or 
without concomitant leukocytosis.

If differentiation syndrome is suspected, initiate dexamethasone 10 mg IV every 
12 hours (or an equivalent dose of an alternative oral or IV corticosteroid) 
and hemodynamic monitoring until improvement. If concomitant noninfectious 
leukocytosis is observed, initiate treatment with hydroxyurea or leukapheresis, 
as clinically indicated. Taper corticosteroids and hydroxyurea after resolution 
of symptoms and administer corticosteroids for a minimum of 3 days. Symptoms of 
differentiation syndrome may recur with premature discontinuation of 
corticosteroid and/or hydroxyurea treatment. If severe signs and/or symptoms 
persist for more than 48 hours after initiation of corticosteroids, interrupt 
TIBSOVO until signs and symptoms are no longer severe.

QTc Interval Prolongation: Patients treated with TIBSOVO can develop QT (QTc) 
prolongation and ventricular arrhythmias. One patient developed ventricular 
fibrillation attributed to TIBSOVO. Concomitant use of TIBSOVO with drugs known 
to prolong the QTc interval (e.g., anti-arrhythmic medicines, fluoroquinolones, 
triazole anti-fungals, 5-HT3 receptor antagonists) and CYP3A4 inhibitors may 
increase the risk of QTc interval prolongation. Conduct monitoring of 
electrocardiograms (ECGs) and electrolytes. In patients with congenital long 
QTc syndrome, congestive heart failure, or electrolyte abnormalities, or in 
those who are taking medications known to prolong the QTc interval, more 
frequent monitoring may be necessary.

Interrupt TIBSOVO if QTc increases to greater than 480 msec and less than 500 
msec. Interrupt and reduce TIBSOVO if QTc increases to greater than 500 msec. 
Permanently discontinue TIBSOVO in patients who develop QTc interval 
prolongation with signs or symptoms of life-threatening arrhythmia.

Guillain-Barre Syndrome: Guillain-Barre syndrome occurred in less than 1% 
(2/258) of AML patients treated with TIBSOVO in the clinical study. Monitor 
patients taking TIBSOVO for onset of new signs or symptoms of motor and/or 
sensory neuropathy such as unilateral or bilateral weakness, sensory 
alterations, paresthesias, or difficulty breathing. Permanently discontinue 
TIBSOVO in patients who are diagnosed with Guillain-Barre syndrome.

ADVERSE REACTIONS

-- The most common adverse reactions including laboratory abnormalities 
(greater than or equal to 20%) were hemoglobin decreased (60%), fatigue (43%), 
arthralgia (39%), calcium decreased (39%), sodium decreased (39%), leukocytosis 
(38%), diarrhea (37%), magnesium decreased (36%), edema (34%), nausea (33%), 
dyspnea (32%), uric acid increased (32%), potassium decreased (32%), alkaline 
phosphatase increased (30%), mucositis (28%), aspartate aminotransferase 
increased (27%), phosphatase decreased (25%), electrocardiogram QT prolonged 
(24%), rash (24%), creatinine increased (24%), cough (23%), decreased appetite 
(22%), myalgia (21%), constipation (20%), and pyrexia (20%). 

-- In patients with newly diagnosed AML, the most frequently reported Grade 
greater than or equal to 3 adverse reactions (greater than or equal to 5%) were 
fatigue (14%), differentiation syndrome (11%), electrocardiogram QT prolonged 
(11%), diarrhea (7%), nausea (7%), and leukocytosis (7%). Serious adverse 
reactions (greater than or equal to 5%) were differentiation syndrome (18%), 
electrocardiogram QT prolonged (7%), and fatigue (7%). There was one case of 
posterior reversible encephalopathy syndrome (PRES). 

-- In patients with relapsed or refractory AML, the most frequently reported 
Grade greater than or equal to 3 adverse reactions (greater than or equal to 
5%) were differentiation syndrome (13%), electrocardiogram QT prolonged (10%), 
dyspnea (9%), leukocytosis (8%), and tumor lysis syndrome (6%). Serious adverse 
reactions (greater than or equal to 5%) were differentiation syndrome (10%), 
leukocytosis (10%), and electrocardiogram QT prolonged (7%). There was one case 
of progressive multifocal leukoencephalopathy (PML).

DRUG INTERACTIONS

Strong or Moderate CYP3A4 Inhibitors: Reduce TIBSOVO dose with strong CYP3A4 
inhibitors. Monitor patients for increased risk of QTc interval prolongation. 
Strong CYP3A4 Inducers: Avoid concomitant use with TIBSOVO.
Sensitive CYP3A4 Substrates: Avoid concomitant use with TIBSOVO.
QTc Prolonging Drugs: Avoid concomitant use with TIBSOVO. If co-administration 
is unavoidable, monitor patients for increased risk of QTc interval 
prolongation.

LACTATION 
Because many drugs are excreted in human milk and because of the potential for 
adverse reactions in breastfed children, advise women not to breastfeed during 
treatment with TIBSOVO and for at least 1 month after the last dose.

Please see full Prescribing Information ( 
https://c212.net/c/link/?t=0&l=en&o=3245194-1&h=1549900327&u=https%3A%2F%2Fc212.net%2Fc%2Flink%2F%3Ft%3D0%26l%3Den%26o%3D3185619-1%26h%3D1440211408%26u%3Dhttps%253A%252F%252Fwww.tibsovopro.com%252Fpdf%252Fprescribinginformation.pdf%26a%3DPrescribing%2BInformation&a=Prescribing+Information 
), including Boxed WARNING.

References

1. Data on file. Servier. July 30, 2021 
2. ClinicalTrials.gov. Study of AG-120 (Ivosidenib) vs. Placebo in Combination 
With Azacitidine in Patients With Previously Untreated Acute Myeloid Leukemia 
With an IDH1 Mutation (AGILE). Available at: 
https://clinicaltrials.gov/ct2/show/NCT03173248. Last accessed: July 2021. 
3. National Cancer Institute Surveillance, Epidemiology, and End Results 
Program. Cancer Stat Facts: Acute Myeloid Leukemia (AML). 
https://seer.cancer.gov/statfacts/html/amyl.html. Last accessed: July 2021. 
4. American Cancer Society. Acute Myeloid Leukemia (AML). 
https://www.cancer.org/content/dam/CRC/PDF/Public/8674.00.pdf. Accessed July 
2021. 
5. Kumar C. Genetic Abnormalities and Challenges in the Treatment of Acute 
Myeloid Leukemia. Genes Cancer. 2011; 2:95-107. 
6. DiNardo CD, Stein EM, de Botton S, et al. Durable Remissions from Ivosidenib 
in IDH1-Mutated Relapsed or Refractory AML. N Engl J Med 2018;378:2386-98.

* Servier has an exclusive collaboration and license agreement with CStone for 
the development and commercialization of TIBSOVO (ivosidenib tablets) in 
Mainland China, Taiwan, Hong Kong, Macau and Singapore.

SOURCE  Servier Pharmaceuticals
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