The CHMP reviews applications for all 27 member states in the
Multiple Myeloma (MM) is a rare blood cancer in which plasma cells, important components of the immune system, replicate uncontrollably and accumulate in the bone marrow and interfere with the production of normal blood cells. Multiple myeloma remains incurable and nearly all MM patients who achieve an initial response to treatment will relapse and require additional treatment options.
“Celgene is the first company in more than 40 years to deliver two oral
treatments for multiple myeloma,” said
The CHMP positive opinion was based on the results of the MM-003 study, a phase III, multi-centre, randomised (2:1), open-label study in 455 patients. The trial evaluated use of oral pomalidomide plus low-dose dexamethasone (n=302) compared with high-dose dexamethasone (n=153) in patients with relapsed and refractory multiple myeloma; according to the protocol, all patients were to have been treated with both bortezomib and lenalidomide prior to study entry. In the trial, progression-free survival (PFS), the primary endpoint, was significantly longer in patients who received pomalidomide plus low-dose dexamethasone (15.7 weeks) compared with those who received high-dose dexamethasone alone (8 weeks). Median overall survival, the secondary endpoint, was also significantly improved for pomalidomide plus low-dose dexamethasone arm, compared with high-dose dexamethasone only (due to patients still on therapy in the pomalidomide plus low-dose dexamethasone arm, the median has not yet been reached vs. 34 weeks in the high-dose dexamethasone arm).
The most commonly reported adverse reactions included anaemia, neutropenia, fatigue and thrombocytopenia. The most commonly reported Grade 3 or 4 adverse reactions included neutropenia, anaemia, thrombocytopenia and pneumonia.
Pomalidomide is an oral immunomodulatory agent currently approved in the U.S. under the brand name Pomalyst and is under review in other countries. In the U.S., POMALYST® (pomalidomide) is indicated for patients with multiple myeloma who have received at least two prior therapies including lenalidomide and bortezomib and have demonstrated disease progression on or within 60 days of completion of the last therapy. Approval in the U.S. is based on response rate in the MM-002 clinical trial. Clinical benefit, such as improvement in survival or symptoms, has not been verified in this study.
Important Safety Information based on approved U.S. Label
WARNING: EMBRYO-FETAL TOXICITY and VENOUS THROMBOEMBOLISM
POMALYST is only available through a restricted distribution program called POMALYST REMSTM.
WARNINGS AND PRECAUTIONS
POMALYST REMS Program
Because of the embryo-fetal risk, POMALYST is available only through a restricted distribution program under a Risk Evaluation and Mitigation Strategy (REMS) called “POMALYST REMS.” Prescribers and pharmacists must be certified with the program; patients must sign an agreement form and comply with the requirements. Further information about the POMALYST REMS program is available at [celgeneriskmanagement.com] or by telephone at 1-888-423-5436.
Venous Thromboembolism: Patients receiving POMALYST have developed venous thromboembolic events reported as serious adverse reactions. In the trial, all patients were required to receive prophylaxis or antithrombotic treatment. The rate of DVT or PE was 3%. Consider anticoagulation prophylaxis after an assessment of each patient’s underlying risk factors.
Hematologic Toxicity: Neutropenia of any grade was reported in 50% of patients and was the most frequently reported Grade 3/4 adverse event, followed by anemia and thrombocytopenia. Monitor patients for hematologic toxicities, especially neutropenia, with complete blood counts weekly for the first 8 weeks and monthly thereafter. Treatment is continued or modified for Grade 3 or 4 hematologic toxicities based upon clinical and laboratory findings. Dosing interruptions and/or modifications are recommended to manage neutropenia and thrombocytopenia.
Hypersensitivity Reactions: Patients with a prior history of serious hypersensitivity associated with thalidomide or lenalidomide were excluded from studies and may be at higher risk of hypersensitivity.
Dizziness and Confusional State: 18% of patients experienced dizziness and 12% of patients experienced a confusional state; 1% of patients experienced grade 3/4 dizziness, and 3% of patients experienced grade 3/4 confusional state. Instruct patients to avoid situations where dizziness or confusion may be a problem and not to take other medications that may cause dizziness or confusion without adequate medical advice.
Neuropathy: 18% of patients experienced neuropathy (approximately 9% peripheral neuropathy). There were no cases of grade 3 or higher neuropathy adverse reactions reported.
Risk of Second Primary Malignancies: Cases of acute myelogenous leukemia have been reported in patients receiving POMALYST as an investigational therapy outside of multiple myeloma.
In the clinical trial MM-002 of 219 patients who received POMALYST alone (n=107) or POMALYST + low-dose dexamethasone (low-dose dex) (n=112), all patients had at least one treatment-emergent adverse reaction.
No formal drug interaction studies have been conducted with POMALYST. Pomalidomide is primarily metabolized by CYP1A2 and CYP3A. Pomalidomide is also a substrate for P-glycoprotein (P-gp). Coadministration of POMALYST with drugs that are strong inhibitors or inducers of CYP1A2, CYP3A, or P-gp should be avoided. Cigarette smoking may reduce pomalidomide exposure due to CYP1A2 induction. Patients should be advised that smoking may reduce the efficacy of pomalidomide.
USE IN SPECIFIC POPULATIONS
Pregnancy: If pregnancy does occur during treatment, immediately
discontinue the drug and refer patient to an obstetrician/gynecologist
experienced in reproductive toxicity for further evaluation and
counseling. Report any suspected fetal exposure to POMALYST to the
Nursing Mothers: It is not known if pomalidomide is excreted in human milk. Pomalidomide was excreted in the milk of lactating rats. Because many drugs are excreted in human milk and because of the potential for adverse reactions in nursing infants from POMALYST, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Pediatric Use: Safety and effectiveness of POMALYST in patients under the age of 18 have not been established.
Geriatric Use: No dosage adjustment is required for POMALYST based on age. Patients greater than or equal to 65 years of age were more likely than patients less than or equal to 65 years of age to experience pneumonia.
Renal and Hepatic Impairment: Pomalidomide is metabolized in the liver. Pomalidomide and its metabolites are primarily excreted by the kidneys. The influence of renal and hepatic impairment on the safety, efficacy, and pharmacokinetics of pomalidomide has not been evaluated. Avoid POMALYST in patients with a serum creatinine >3.0 mg/dL. Avoid POMALYST in patients with serum bilirubin >2.0 mg/dL and AST/ALT >3.0 x ULN.
Please see full U.S. Prescribing Information, including Boxed WARNINGS, CONTRAINDICATIONS, WARNINGS AND PRECAUTIONS, and ADVERSE REACTIONS.
POMALYST (pomalidomide) is indicated for patients with multiple myeloma who have received at least two prior therapies including lenalidomide and bortezomib and have demonstrated disease progression on or within 60 days of completion of the last therapy. Approval is based on response rate in the MM-002 clinical trial. Clinical benefit, such as improvement in survival or symptoms, has not been verified.
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results or outcomes may differ materially from those implied by the
forward-looking statements as a result of the impact of a number of
factors, many of which are discussed in more detail in our Annual Report
on Form 10-K and our other reports filed with the