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Saturday, December 11 2021 - 23:05
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Phase 3 Data Demonstrate TIBSOVO(R) (ivosidenib tablets) in Combination with Azacitidine Significantly Improves Event-Free Survival and Overall Survival in Patients with Previously Untreated IDH1-mutated Acute Myeloid Leukemia
PARIS and BOSTON, Dec. 11, 2021 /PRNewswire-AsiaNet/--

-- TIBSOVO in combination with azacitidine compared to placebo plus azacitidine 
also demonstrated significant improvements in complete remission rate, complete 
remission and complete remission with partial hematologic recovery rate and 
objective response rate

-- Safety profile was favorable and consistent with previously published data

-- Data from the Phase 3 AGILE trial of patients with previously untreated 
IDH1-mutated acute myeloid leukemia will be presented in an oral session on 
Monday, December 13, 2021, and featured in the official press program of the 
63rd American Society of Hematology Annual Meeting

Servier, a growing leader in oncology committed to bringing the promise of 
tomorrow to the patients we serve, today announced Phase 3 data demonstrating 
that TIBSOVO(R) (ivosidenib tablets) in combination with the chemotherapy 
azacitidine significantly improved event-free survival (EFS) and overall 
survival (OS) compared to azacitidine plus placebo in adults with previously 
untreated IDH1-mutated acute myeloid leukemia (AML) who are not candidates for 
intensive chemotherapy.  These data from the global AGILE study will be 
presented in an oral session on Monday, December 13, 2021 from 2:45 - 4:15 PM 
ET, Abstract #697 and featured in the official press program during the 63rd 
American Society of Hematology Annual Meeting and Exposition.

Logo - https://mma.prnewswire.com/media/1389607/Servier_Logo.jpg 

Treatment with TIBSOVO in combination with azacitidine demonstrated a 
statistically significant improvement in EFS (hazard ratio [HR] = 0.33, 95% CI 
0.16, 0.69, 1-sided P = 0.0011 (1,2)). In addition, the combination of TIBSOVO 
with azacitidine showed a statistically significant improvement in OS (HR = 
0.44 [95% CI 0.27, 0.73]; 1-sided P = 0.0005), with a median OS of 24.0 months 
in the ivosidenib + azacitidine arm vs 7.9 months in the placebo + azacitidine 
arm.

"These significant findings from the AGILE Phase 3 study for TIBSOVO bolster 
our growing body of evidence supporting the rationale to target IDH1 mutations 
early in blood cancers like acute myeloid leukemia," said Susan Pandya, M.D., 
Vice President Clinical Development & Head of Cancer Metabolism Global 
Development Oncology & Immuno-Oncology, Servier Pharmaceuticals. "Up to 10 
percent of patients with AML have mutations in the IDH1 enzyme, and current 
treatment options are limited, especially for those who are newly diagnosed and 
are not eligible for intensive chemotherapy."

Additional Study Results
Investigators reported on results of key secondary endpoints of the AGILE trial 
including:

    -- Complete remission (CR) rate was 47.2% (n=34/72) for TIBSOVO in 
       combination with azacitidine vs. 14.9% (n=11/74) for placebo plus 
       azacitidine (p < 0.0001). 

    -- CR + complete remission with partial hematologic recovery rate (CR + 
       CRh rate) was 52.8% (n=38/72) for TIBSOVO in combination with 
       azacitidine vs. 17.6% (n=13/74) for placebo plus azacitidine 
       (p < 0.0001). 

    -- Objective response rate (ORR) was 62.5% (n=45/72) for TIBSOVO in 
       combination with azacitidine vs. 18.9% (n=14/74) for placebo plus 
       azacitidine (p < 0.0001).

"We are excited about the potential to bring a new treatment option to patients 
with previously untreated IDH1-mutated AML. This further extends the 
significant clinical benefit for patients with acute myeloid leukemia and IDH1 
mutations," said Patrick Therasse, M.D., Ph.D., Vice President, Head of Late 
Stage and Life Cycle Management in Oncology and Immuno-Oncology Therapeutic 
Area, Servier Group.

 Acute myeloid leukemia is a rapidly progressing type of cancer, and the 
prognosis is often poor," said Stephane De Botton, M.D. Ph.D., Principle 
Investigator and Head of Multidisciplinary Hematology Committee at the Institut 
Gustave Roussy, Villejuif, France. "Our goal with treatment is to prolong 
overall survival, and the impressive clinical benefit following treatment with 
TIBSOVO in combination with azacitidine is incredibly promising for these 
patients with previously untreated IDH1-mutated acute myeloid leukemia."

Common all-grade adverse events (AEs) occurring in more than 20 percent of 
patients receiving TIBSOVO in combination with azacitidine vs. placebo plus 
azacitidine were nausea (42.3% vs. 38.4%), vomiting (40.8% vs 26.0%), diarrhea 
(35.2% vs 35.6%), pyrexia (33.8% vs 39.7%), anemia (31.0% vs 28.8%), febrile 
neutropenia (28.2% vs 34.2%), thrombocytopenia (28.2% vs 20.5%), neutropenia 
(28.2% vs 16.4%), constipation (26.8% vs 52.1%) and pneumonia (23.9% vs 31.5%).

The AGILE study has halted further enrollment due to compelling efficacy data 
for TIBSOVO.

Servier is in discussions with regulatory health authorities regarding 
submissions to expand the currently approved indications for TIBSOVO.

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 > or = 75 years old 
or who have comorbidities that preclude the use of intensive induction 
chemotherapy. Recently, TIBSOVO was approved as a first and only targeted 
therapy for patients with previously treated IDH1-mutated cholangiocarcinoma. 

About NCT03173248 AGILE Phase 3 AML 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 with placebo in combination 
with azacitidine, in adults with previously untreated IDH1-mutated acute 
myeloid leukemia (AML) who are not candidates for intensive chemotherapy (> or 
= 75 years old or who have comorbidities that preclude the use of intensive 
induction chemotherapy). The study's primary endpoint is 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 
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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 is an isocitrate dehydrogenase-1 (IDH1) inhibitor indicated for the 
treatment of adult patients with a susceptible IDH1 mutation as detected by an 
FDA-approved test with:

Acute Myeloid Leukemia (AML)

    -- Newly-diagnosed AML who are > or = 75 years old or who have 
       comorbidities that preclude use of intensive induction chemotherapy. 

    -- Relapsed or refractory AML.

Locally Advanced or Metastatic Cholangiocarcinoma

    -- Locally advanced or metastatic cholangiocarcinoma who have been 
       previously treated.

IMPORTANT SAFETY INFORMATION

WARNING: DIFFERENTIATION SYNDROME IN AML
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 in AML: 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. Concomitant use of TIBSOVO with drugs 
known to prolong the QTc interval (e.g., anti-arrhythmic medicines, 
fluoroquinolones, triazole anti fungals, 5 HT(3) 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 can develop in patients 
treated with TIBSOVO. 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

    -- In patients with AML, the most common adverse reactions including 
       laboratory abnormalities (> or = 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 > or = 3 adverse reactions (> or = 5%) were fatigue (14%), 
       differentiation syndrome (11%), electrocardiogram QT prolonged (11%), 
       diarrhea (7%), nausea (7%), and leukocytosis (7%). Serious adverse 
       reactions (> or = 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 > or = 3 adverse reactions (> or = 5%) were 
       differentiation syndrome (13%), electrocardiogram QT prolonged (10%), 
       dyspnea (9%), leukocytosis (8%), and tumor lysis syndrome (6%). 
       Serious adverse reactions (> or = 5%) were differentiation syndrome 
       (10%), leukocytosis (10%), and electrocardiogram QT prolonged (7%). 
       There was one case of progressive multifocal leukoencephalopathy 
       (PML). 

    -- In patients with cholangiocarcinoma, the most common adverse reactions 
       (> or = 15%) were fatigue (43%), nausea (41%), abdominal pain (35%), 
       diarrhea (35%), cough (27%), decreased appetite (24%), ascites (23%), 
       vomiting (23%), anemia (18%), and rash (15%). The most common 
       laboratory abnormalities (> or = 10%) were hemoglobin decreased (40%), 
       aspartate aminotransferase increased (34%), and bilirubin increased 
       (30%).

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=3385587-1&h=1176338700&u=https%3A%2F%2Fwww.tibsovopro.com%2Fpdf%2Fprescribinginformation.pdf&a=Full+Prescribing+Information 
), including BOXED WARNING for AML patients.

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. 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. 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 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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