ASH Clinical News FINAL_ACN_3.14_FULL_ISSUE_DIGITAL | Page 129

RESONATE TM -2 FRONTLINE DATA RESONATE TM -2 was a multicenter, randomized 1:1, open-label, Phase 3 trial of IMBRUVICA® vs chlorambucil in frontline CLL/SLL patients ≥65 years (N=269) 2,3 Patients with 17p deletion were excluded 3 EXTENDED OVERALL SURVIVAL 2 PROLONGED PROGRESSION-FREE SURVIVAL 2,3 SECONDARY ENDPOINT: OS IMBRUVICA® vs CHLORAMBUCIL PRIMARY ENDPOINT: PFS IMBRUVICA® vs CHLORAMBUCIL 84% statistically significant reduction in risk of progression or death 2,3 Reduced risk of death by more than half Estimated PFS at 18 months 90 % IMBRUVICA® 100 56% Estimated survival rates at 24 months IMBRUVICA ® (95% CI: 89, 97) 90 80 70 95% Statistically significant reduction in risk of death HR=0.44 (95% CI: 0.21, 0.92) 60 50 40 30 41% of patients crossed over to IMBRUVICA® upon disease progression chlorambucil (95% CI: 77, 90) 84% Estimated PFS at 18 months 20 52 % Chlorambucil 10 HR=0.16 (95% CI: 0.09, 0.28); P<0.0001 0 0 3 6 9 12 • Median follow-up was 28 months 2 • Fewer deaths with IMBRUVICA® were observed; 11 (8.1%) in the IMBRUVICA® arm vs 21 (15.8%) in the chlorambucil arm 2 15 18 21 24 27 Months N at risk IMB 136 133 130 126 122 98 66 21 2 0 CLB 133 121 95 85 74 49 34 10 0 0 • Median follow-up was 18 months 3 • With IMBRUVICA®, median PFS was not reached vs 18.9 months (95% CI: 14.1, 22.0) with chlorambucil 2 • PFS and ORR (CR and PR) were assessed by an IRC according to the revised 2008 iwCLL criteria 3 RESONATE™-2 Adverse Reactions ≥15% • Diarrhea (42%) • Musculoskeletal pain (36%) • Cough (22%) • Rash (21%) • Bruising (19%) • Peripheral edema (19%) • Pyrexia (17%) • Dry eye (17%) • Arthralgia (16%) • Skin infection (15%) of therapy. If this drug is used during pregnancy or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to a fetus. Advise men to avoid fathering a child during the same time period. ADVERSE REACTIONS B-cell malignancies: The most common adverse reactions (≥20%) in patients with B-cell malignancies (MCL, CLL/SLL, WM and MZL) were thrombocytopenia (62%), neutropenia (61%), diarrhea (43%), anemia (41%), musculoskeletal pain (30%), rash (30%), bruising (30%), nausea (29%), fatigue (29%), hemorrhage (22%), and pyrexia (21%). The most common Grade 3 or 4 adverse reactions (≥5%) in patients with B-cell malignancies (MCL, CLL/SLL, WM and MZL) were neutropenia (39%), thrombocytopenia (16%), and pneumonia (10%). Approximately 6% (CLL/SLL), 14% (MCL), 11% (WM) and 10% (MZL) of patients had a dose reduction due to adverse reactions. Approximately 4%- 10% (CLL/SLL), 9% (MCL), and 9 % (WM [6%] and MZL [13%]) of patients discontinued due to adverse reactions. cGVHD: The most common adverse reactions (≥20%) in patients with cGVHD were fatigue (57%), bruising (40%), diarrhea (36%), thrombocytopenia (33%), muscle spasms (29%), stomatitis (29%), nausea (26%), hemorrhage (26%), anemia (24%), and pneumonia (21%). The most common Grade 3 or 4 adverse reactions (≥5%) reported in patients with cGVHD were fatigue (12%), diarrhea (10%), neutropenia (10%), pneumonia (10%), sepsis (10%), hypokalemia (7%), headache (5%), musculoskeletal pain (5%), and pyrexia (5%). To learn more, visit IMBRUVICAHCP.com Twenty-four percent of patients receiving IMBRUVICA ® in the cGVHD trial discontinued treatment due to adverse reactions. Adverse reactions leading to dose reduction occurred in 26% of patients. DRUG INTERACTIONS CYP3A Inducers: Avoid coadministration with strong CYP3A inducers. CYP3A Inhibitors: Dose adjustment may be recommended. SPECIFIC POPULATION S Hepatic Impairment (based on Child-Pugh criteria): Avoid use of IMBRUVICA ® in patients with moderate or severe baseline hepatic impairment. In patients with mild impairment, reduce IMBRUVICA ® dose. Please see the Brief Summary on the following pages. CI=confi dence interval, CLL=chronic lymphocytic leukemia, HR=hazard ratio, IRC=Independent Review Committee, iwCLL=International Workshop on CLL, OS=overall survival, PFS=progression-free survival, SLL=small lymphocytic lymphoma. References: 1. Data on fi le. Pharmacyclics LLC. 2. IMBRUVICA ® (ibrutinib) Prescribing Information. Pharmacyclics LLC 2017. 3. Burger JA, Tedeschi A, Barr PM, et al; for the RESONATE-2 Investigators. Ibrutinib as initial therapy for patients with chronic lymphocytic leukemia. N Engl J Med. 2015;373(25):2425-2437.