Pivotal Phase III Data for BAVENCIO(R) (avelumab) Plus INLYTA(R) (axitinib) in Advanced Renal Cell Carcinoma Published in the New England Journal of Medicine

PR77469

DARMSTADT, Germany and NEW YORK, Feb. 17, 2019 /PRNewswire=KYODO JBN/ --

Not intended for US, Canada and UK-based media

- JAVELIN Renal 101 shows significant improvement in progression-free survival

  with a hazard ratio of 0.69 in patients regardless of PD-L1 expression

- US FDA has granted Priority Review to BAVENCIO plus INLYTA for patients with

  advanced renal cell carcinoma

- Data at 2019 Genitourinary Cancers Symposium reinforce consistency of PFS

  and ORR benefits across broad population of patients with advanced RCC,

  including all prognostic risk groups, and show increased time to progression

  on next-line therapy

Merck and Pfizer Inc. (NYSE: PFE) today announced the publication of results

from an interim analysis of the pivotal JAVELIN Renal 101 trial online in the

New England Journal of Medicine.1 The combination of BAVENCIO(R)(avelumab) and

INLYTA(R)(axitinib)* significantly extended median progression-free survival

(PFS) by more than five months compared with SUTENT(R)(sunitinib) as a

first-line treatment for patients with advanced renal cell carcinoma (RCC),

irrespective of PD-L1 expression (HR: 0.69 [95% CI: 0.56-0.84];

BAVENCIO+INLYTA: 13.8 months [95% CI: 11.1-NE]; SUTENT: 8.4 months [95% CI:

6.9-11.1]; p<0.001). Further, the objective response rate (ORR) was doubled

with BAVENCIO+INLYTA versus SUTENT in this population (51.4% [95% CI:

46.6-56.1] vs. 25.7% [95% CI: 21.7-30.0]). The study is continuing for the

other primary endpoint of overall survival (OS).

"There is a significant need for patients with advanced RCC to prolong the time

until the disease worsens beyond what tyrosine kinase inhibitors alone offer,"

said Robert J. Motzer, M.D., Jack and Dorothy Byrne Chair in Clinical Oncology,

Memorial Sloan Kettering Cancer Center, New York, US, and principal

investigator for JAVELIN Renal 101. "The magnitude and consistency of PFS and

response rates seen thus far across populations in the JAVELIN Renal 101 study

suggest that many different types of patients, including those with a favorable

prognosis, could potentially derive benefit from this particular combination."

Additional data presented today at the 2019 Genitourinary Cancers Symposium

reinforce the consistency of the PFS and ORR results across patient subgroups,

including patients with favorable, intermediate and poor prognoses as well as

those with PD-L1-positive or negative tumors. In subgroup analyses,

approximately two-thirds of patients with favorable risk (66% of patients using

the Memorial Sloan Kettering Cancer Center risk model and 68% with the

International Metastatic Renal Cell Carcinoma Database Consortium risk model)

achieved a complete or partial response with BAVENCIO+INLYTA. Median PFS for

these patients is not yet estimable. BAVENCIO+INLYTA also extended median PFS2,

defined as the time from randomization to disease progression on next-line

therapy (HR: 0.56 [95% CI: 0.42-0.74]; NE [95% CI: 19.9-NE] vs. 18.4 months

[95% CI: 15.7-23.6]) and increased median duration of response by more than

four months (95% CI: 2.9-5.1) in the overall population.

"In this study, the combination of avelumab plus axitinib not only prolonged

the initial response in treated patients compared to sunitinib, but for

patients who went on to subsequent therapy, reduced the risk of disease

progression or death on the next treatment," said Toni K. Choueiri, M.D.,

Director of the Lank Center for Genitourinary Oncology at Dana-Farber, Boston,

US,  senior and co-corresponding author of JAVELIN Renal 101, and presenter.

"Together with the progression-free survival results and objective response

rates, these findings show the potential of this combination regimen to be an

important new treatment option for patients with advanced RCC."

The Phase III JAVELIN Renal 101 study is evaluating the combination of

BAVENCIO+INLYTA compared with SUTENT in 886 patients with previously untreated

advanced RCC. BAVENCIO+INLYTA significantly reduced the risk of disease

progression or death by 39% in patients with PD-L1-positive (≥1%) tumors, a

primary endpoint (HR: 0.61 [95% CI: 0.47¨C0.79], p<0.001; median PFS: 13.8

months [95% CI: 11.1-NE] vs. 7.2 months [95% CI: 5.7-9.7]). In the overall

population, which was tested after achieving statistical significance for the

primary endpoint, the risk was reduced by 31%. The confirmed ORR in patients

with PD-L1-positive tumors was 55.2% (95% CI: 49.0-61.2) with BAVENCIO+INLYTA

vs. 25.5% (95% CI: 20.6-30.9) with SUTENT.

In the BAVENCIO+INLYTA arm, 20.8% of patients received subsequent anticancer

drug therapies, compared with 39.2% in the SUTENT arm. In the SUTENT arm, about

two-thirds (66.7%) of patients who received subsequent anticancer therapy were

known to have been treated with an anti¨CPD-1/PD-L1 agent.

Adverse events of grade 3 or higher during treatment (treatment-emergent

adverse events [TEAEs]) occurred in 71.2% of patients in the BAVENCIO+INLYTA

arm and 71.5% in the SUTENT arm; grade 3 or higher TEAEs that occurred in more

than 5% of patients receiving the combination were hypertension (25.6%),

diarrhea (6.7%), increased alanine aminotransferase level (6.0%) and hand¨Cfoot

syndrome (5.8%). In the combination arm, 9.0% of patients experienced grade 3

or higher immune-related adverse events. Grade 5 events occurred in three

patients in the BAVENCIO+INLYTA arm (myocarditis, necrotizing pancreatitis,

sudden death; n=1 each); and in one patient in the SUTENT arm (intestinal

perforation). There were fewer discontinuations due to adverse events that

occurred during treatment with BAVENCIO+INLYTA, compared with SUTENT (7.6% vs.

13.4%).

On February 11, 2019, the alliance announced that the US Food and Drug

Administration (FDA) accepted for Priority Review the supplemental Biologics

License Application (sBLA) for BAVENCIO in combination with INLYTA for patients

with advanced RCC. The application has been given a target action date in June

2019. A supplemental application for BAVENCIO+INLYTA in unresectable or

metastatic RCC was submitted in Japan on January 30, 2019. In December 2017,

the FDA granted Breakthrough Therapy Designation for BAVENCIO in combination

with INLYTA for treatment-naive patients with advanced RCC. Despite available

therapies, the outlook for patients with advanced RCC remains poor.2

*The combination of BAVENCIO and INLYTA is under clinical investigation for

advanced RCC, and there is no guarantee this combination will be approved for

advanced RCC by any health authority worldwide. In the US, INLYTA is approved

as monotherapy for the treatment of advanced RCC after failure of one prior

systemic therapy. INLYTA is also approved by the European Medicines Agency

(EMA) for use in the EU in adult patients with advanced RCC after failure of

prior treatment with SUTENT or a cytokine.

About Renal Cell Carcinoma

RCC is the most common form of kidney cancer, accounting for about 2% to 3% of

all cancers in adults.3,4 The most common type of RCC is clear cell carcinoma,

accounting for approximately 70% of all cases.3 In 2019, an estimated 73,820

new cases of kidney cancer will be diagnosed in the US, and approximately

14,770 people will die from the disease.5 Approximately 20% to 30% of patients

are first diagnosed at the metastatic stage.6 The five-year survival rate for

patients with metastatic RCC is approximately 12%.2

About the JAVELIN Clinical Development Program

The clinical development program for avelumab, known as JAVELIN, involves at

least 30 clinical programs and more than 9,000 patients evaluated across more

than 15 different tumor types. In addition to RCC, these tumor types include

breast, gastric/gastro-esophageal junction, and head and neck cancers, Merkel

cell carcinoma, non-small cell lung cancer, and urothelial carcinoma.

About BAVENCIO(R)(avelumab)

BAVENCIO is a human anti-programmed death ligand-1 (PD-L1) antibody. BAVENCIO

has been shown in preclinical models to engage both the adaptive and innate

immune functions. By blocking the interaction of PD-L1 with PD-1 receptors,

BAVENCIO has been shown to release the suppression of the T cell-mediated

antitumor immune response in preclinical models.7-9 BAVENCIO has also been

shown to induce NK cell-mediated direct tumor cell lysis via antibody-dependent

cell-mediated cytotoxicity (ADCC) in vitro.9-11 In November 2014, Merck  and

Pfizer announced a strategic alliance to co-develop and co-commercialize

BAVENCIO.

Approved Indications in the US

In the US, the FDA granted accelerated approval for BAVENCIO for the treatment

of (i) adults and pediatric patients 12 years and older with metastatic Merkel

cell carcinoma (mMCC) and (ii) patients with locally advanced or metastatic

urothelial carcinoma (mUC) who have disease progression during or following

platinum-containing chemotherapy, or have disease progression within 12 months

of neoadjuvant or adjuvant treatment with platinum-containing chemotherapy.

These indications are approved under accelerated approval based on tumor

response rate and duration of response. Continued approval for these

indications may be contingent upon verification and description of clinical

benefit in confirmatory trials.

BAVENCIO is currently approved for patients with MCC in more than 45 countries

globally, with the majority of these approvals in a broad indication that is

not limited to a specific line of treatment.

Important Safety Information from the US FDA-Approved Label

The warnings and precautions for BAVENCIO include immune-mediated adverse

reactions (such as pneumonitis, hepatitis, colitis, endocrinopathies, nephritis

and renal dysfunction, and other adverse reactions), infusion-related reactions

and embryo-fetal toxicity.

Common adverse reactions (reported in at least 20% of patients) in patients

treated with BAVENCIO for mMCC and patients with locally advanced or mUC

include fatigue, musculoskeletal pain, diarrhea, nausea, infusion-related

reaction, peripheral edema, decreased appetite/hypophagia, urinary tract

infection and rash.

About INLYTA(R)(axitinib)

INLYTA is an oral therapy that is designed to inhibit tyrosine kinases,

including vascular endothelial growth factor (VEGF) receptors 1, 2 and 3; these

receptors can influence tumor growth, vascular angiogenesis and progression of

cancer (the spread of tumors). In the US, INLYTA is approved for the treatment

of advanced renal cell carcinoma (RCC) after failure of one prior systemic

therapy. INLYTA is also approved by the European Medicines Agency (EMA) for use

in the EU in adult patients with advanced RCC after failure of prior treatment

with sunitinib or a cytokine.

INLYTA Important Safety Information from the US FDA-Approved Label

In the study of advanced RCC after failure of one prior systemic therapy, the

warnings and precautions for INLYTA include hypertension, including

hypertensive crisis, arterial and venous thrombotic events, hemorrhagic events,

cardiac failure, gastrointestinal perforation and fistula, hypothyroidism,

wound healing complications, reversible posterior leukoencephalopathy syndrome

(RPLS), proteinuria, liver enzyme elevation, hepatic impairment, and fetal harm

during pregnancy.

Common adverse events (reported in at least 20% of patients) in patients

receiving INLYTA were diarrhea, hypertension, fatigue, decreased appetite,

nausea, dysphonia, hand-foot syndrome, weight decreased, vomiting, asthenia,

and constipation.

For more information and full Prescribing Information, visit www.INLYTA.com.

About SUTENT(R)(sunitinib malate)

Sunitinib is a small molecule that inhibits multiple receptor tyrosine kinases,

some of which are implicated in tumor growth, pathologic angiogenesis, and

metastatic progression of cancer. Sunitinib was evaluated for its inhibitory

activity against a variety of kinases (>80 kinases) and was identified as an

inhibitor of platelet-derived growth factor receptors (PDGFR¦Á and PDGFR¦Â),

vascular endothelial growth factor receptors (VEGFR1, VEGFR2 and VEGFR3), stem

cell factor receptor (KIT), Fms-like tyrosine kinase-3 (FLT3), colony

stimulating factor receptor Type 1 (CSF-1R), and the glial cell-line derived

neurotrophic factor receptor (RET).

SUTENT is indicated in the US for the treatment of gastrointestinal stromal

tumor (GIST) after disease progression on or intolerance to imatinib mesylate;

the treatment of advanced RCC; the adjuvant treatment of adult patients at high

risk of recurrent RCC following nephrectomy; and the treatment of progressive,

well-differentiated pancreatic neuroendocrine tumors (pNET) in patients with

unresectable locally advanced or metastatic disease.

SUTENT Important Safety Information from the US FDA-Approved Label

Boxed Warning/Hepatotoxicity has been observed in clinical trials and

postmarketing experience. Hepatotoxicity may be severe, and in some cases

fatal. Monitor hepatic function and interrupt, reduce, or discontinue dosing as

recommended. Fatal liver failure has been observed. Monitor liver function

tests before initiation of treatment, during each cycle of treatment, and as

clinically indicated. Interrupt SUTENT for Grade 3 or 4 drug-related hepatic

adverse reactions and discontinue if there is no resolution. Do not restart

SUTENT if patients subsequently experience severe changes in liver function

tests or have signs and symptoms of liver failure.

Additional warnings and precautions for SUTENT include cardiovascular events,

QT prolongation and Torsades de Pointes, hypertension, hemorrhagic events,

tumor lysis syndrome (TLS), thrombotic microangiopathy (TMA), proteinuria,

dermatologic toxicities including erythema multiforme, Sevens-Johnson syndrome,

and toxic epidermal necrolysis, necrotizing fasciitis, thyroid dysfunction,

hypoglycemia, osteonecrosis of the jaw (ONJ), impaired wound healing, embryo

fetal toxicity and impaired reproductive potential, potential harm during

lactation, venous thromboembolic events, reversible posterior

leukoencephalopathy syndrome (RPLS), and pancreatic function.

Common adverse reactions (reported in at least 20% of patients) in patients

receiving SUTENT for treatment-naive metastatic RCC were diarrhea, fatigue,

nausea, anorexia, altered taste, mucositis/stomatitis, pain in extremity/limb

discomfort, vomiting, bleeding, all sites, hypertension, dyspepsia, arthralgia,

abdominal pain, rash, hand-foot syndrome, back pain, cough, asthenia, dyspnea,

skin discoloration/yellow skin, peripheral edema, headache, constipation, dry

skin, fever, and hair color changes.

Common adverse reactions (reported in at least 20% of patients) in patients

receiving SUTENT for adjuvant treatment of RCC, GIST or pNET - and more

commonly than in patients given placebo - were mucositis/stomatitis/oral

syndromes, diarrhea, fatigue, asthenia, hand-foot syndrome, hypertension,

altered taste, nausea, dyspepsia, abdominal pain, hypothyroidism/TSH increased,

rash, hair color changes, anorexia, skin discoloration, constipation, vomiting,

bleeding events, epistaxis, and dysgeusia.

For more information and full Prescribing Information, visit: www.SUTENT.com.

About Merck-Pfizer Alliance

Immuno-oncology is a top priority for Merck and Pfizer. The global strategic

alliance between Merck and Pfizer enables the companies to benefit from each

other's strengths and capabilities and further explore the therapeutic

potential of BAVENCIO, an anti-PD-L1 antibody initially discovered and

developed by Merck. The immuno-oncology alliance is jointly developing and

commercializing BAVENCIO. The alliance is focused on developing high-priority

international clinical programs to investigate BAVENCIO as a monotherapy as

well as combination regimens, and is striving to find new ways to treat cancer.

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About Merck

Merck, a leading science and technology company, operates across healthcare,

life science and performance materials. Around 51,000 employees work to make a

positive difference to millions of people's lives every day by creating more

joyful and sustainable ways to live. From advancing gene editing technologies

and discovering unique ways to treat the most challenging diseases to enabling

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generated sales of Euros 15.3 billion in 66 countries.

Scientific exploration and responsible entrepreneurship have been key to

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since its founding in 1668. The founding family remains the majority owner of

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and brand. The only exceptions are the United States and Canada, where the

business sectors of Merck operate as EMD Serono in healthcare, MilliporeSigma

in life science, and EMD Performance Materials.

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At Pfizer, we apply science and our global resources to bring therapies to

people that extend and significantly improve their lives. We strive to set the

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Pfizer Disclosure Notice

The information contained in this release is as of February 16, 2019. Pfizer

assumes no obligation to update forward-looking statements contained in this

release as the result of new information or future events or developments.

This release contains forward-looking information about BAVENCIO (avelumab),

including a potential new indication for BAVENCIO in combination with INLYTA

(axitinib) for the treatment of patients with advanced renal cell carcinoma,

the alliance between Merck KGaA, Darmstadt, Germany, and Pfizer involving

BAVENCIO and clinical development plans, including their potential benefits,

that involves substantial risks and uncertainties that could cause actual

results to differ materially from those expressed or implied by such

statements. Risks and uncertainties include, among other things, uncertainties

regarding the commercial success of BAVENCIO; the uncertainties inherent in

research and development, including the ability to meet anticipated clinical

endpoints, commencement and/or completion dates for our clinical trials,

regulatory submission dates, regulatory approval dates and/or launch dates, as

well as the possibility of unfavorable further analyses of existing clinical

data and uncertainties regarding whether the other primary endpoint of JAVELIN

Renal 101 will be met; risks associated with interim data; the risk that

clinical trial data are subject to differing interpretations and assessments by

regulatory authorities; whether regulatory authorities will be satisfied with

the design of and results from our clinical studies; whether and when any drug

applications may be filed for BAVENCIO  in combination with INLYTA for the

potential new indication in any other jurisdictions or in any jurisdictions for

any other potential indications for BAVENCIO or combination therapies; whether

and when the pending applications in the U.S. and Japan for BAVENCIO in

combination with INLYTA for the potential new indication may be approved and

whether and when regulatory authorities in any jurisdictions where any other

applications are pending or may be submitted for BAVENCIO or combination

therapies may approve any such applications, which will depend on myriad

factors, including making a determination as to whether the product's benefits

outweigh its known risks and determination of the product's efficacy, and, if

approved, whether they will be commercially successful; decisions by regulatory

authorities impacting labeling, manufacturing processes and/or other matters

that could affect the availability or commercial potential of BAVENCIO or

combination therapies, including BAVENCIO in combination with INLYTA for the

potential new indication; and competitive developments.

A further description of risks and uncertainties can be found in Pfizer's

Annual Report on Form 10-K for the fiscal year ended December 31, 2017, and in

its subsequent reports on Form 10-Q, including in the sections thereof

captioned "Risk Factors" and "Forward-Looking Information and Factors That May

Affect Future Results", as well as in its subsequent reports on Form 8-K, all

of which are filed with the U.S. Securities and Exchange Commission and

available at www.sec.gov and www.pfizer.com.

References

1. Motzer R, Penkov K, Haanen J, et al. Avelumab plus axitinib versus sunitinib

for advanced renal-cell carcinoma. NEJM. February 16, 2019.Published online

ahead of print.

2. National Cancer Institute: SEER Stat Fact Sheets: Kidney and renal pelvis.

Available from: http://seer.cancer.gov/statfacts/html/kidrp.html. Accessed

February 2019.

3. American Cancer Society. What is kidney cancer? Available from:

https://www.cancer.org/cancer/kidney-cancer/about.html. Accessed February 2019.

4. Escudier B, Porta C, Schmidinger M et al Renal cell carcinoma: ESMO clinical

practice guidelines for diagnosis, treatment and follow-up. Annal Oncol. 2014;

25(Suppl3):iii49-iii56.

5. American Cancer Society. Cancer facts and figures 2019. Available at:

https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2019/cancer-facts-and-figures-2019.pdf.

Accessed February 2019.

6. Ljungberg B, Campbell S and Cho H. The Epidemiology of Renal Cell Carcinoma.

Eur Urol. 2011;60:615-621.

7. Dolan DE, Gupta S. PD-1 pathway inhibitors: changing the landscape of cancer

immunotherapy. Cancer Control. 2014;21(3):231-237.

8. Dahan R, Sega E, Engelhardt J, Selby M, Korman AJ, Ravetch JV. Fc¦ÃRs

modulate the anti-tumor activity of antibodies targeting the PD-1/PD-L1 axis.

Cancer Cell. 2015;28(3):285-295.

9. Boyerinas B, Jochems C, Fantini M, et al. Antibody-dependent cellular

cytotoxicity activity of a novel anti-PD-L1 antibody avelumab (MSB0010718C) on

human tumor cells. Cancer Immunol Res. 2015;3(10):1148-1157.

10. Kohrt HE, Houot R, Marabelle A, et al. Combination strategies to enhance

antitumor ADCC. Immunotherapy. 2012;4(5):511-527.

11. Hamilton G, Rath B. Avelumab: combining immune checkpoint inhibition and

antibody-dependent cytotoxicity. Expert Opin Biol Ther. 2017;17(4):515-523.

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Contacts:

Merck

Media Relations:    +1-781-427 4351, noelle.piscitelli@emdserono.com;

Investor Relations: +49 6151 72 3321, investor.relations@merckgroup.com

Pfizer

Media Relations:    +1-212-733-6213, jessica.m.smith@pfizer.com;

Investor Relations: +1 212 733 8160, ryan.crowe@pfizer.com

  

SOURCE: Merck