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BRUKINSA (zanubrutinib) Logo

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SEQUOIA AND ALPINE: 2 GLOBAL PHASE 3 TRIALS IN CLL
FIRST LINE
SEQUOIA (STUDY 304):
DESIGNED TO EVALUATE SUPERIORITY OF BRUKINSA vs BR IN FIRST-LINE CLL1,2

A global Phase 3, randomized, open-label, multicenter trial conducted in patients with previously untreated CLL/SLL.
Trial was initiated in 2017.*

Cohort 2 rationale: Because patients with CLL/SLL whose tumors exhibit del(17p) have an unfavorable prognosis and respond poorly to standard chemoimmunotherapy, those with del(17p) mutations were assigned to receive BRUKINSA in this separate single-arm exploratory analysis.

*The primary endpoint was PFS per IRC in the ITT population in the BRUKINSA arm and the BR arm, with minimum 2-sided alpha of 0.05 for superiority.

Patients received bendamustine 90 mg/m2/day on the first 2 days of each cycle for 6 cycles, rituximab 375 mg/m2 for Cycle 1, and rituximab 500 mg/m2 for Cycles 2-6.

BID=twice daily; BR=bendamustine+rituximab; CLL=chronic lymphocytic leukemia; IRC=independent review committee; ITT=intent to treat; iWCLL=International Workshop on Chronic Lymphocytic Leukemia; ORR=overall response rate; PD=progressive disease; PFS=progression-free survival; SLL=small lymphocytic lymphoma.

SEE SEQUOIA EFFICACY DATA
BASELINE PATIENT CHARACTERISTICS IN A RANGE OF PATIENTS, INCLUDING THOSE WITH AND WITHOUT DEL(17p) MUTATIONS1-3

Patient Characteristics

Baseline Patient CharacteristicsCohort 1
Patients Without Del(17p)
Cohort 2
Patients Without Del(17p)
BRUKINSA
(n=241)
BR
(n=238)
BRUKINSA (n=111)
Median age, years70
(range: 66-75)
70
(range: 66-74)
70
(range: 66-74)
Age ≥65 years81%81%86%
Male64%61%71%
Caucasian92%87%95%
ECOG PS 26%8%13%
Binet stage C29%29%35%
Target lesion ≥5 cm29%31%40%
Unmutated IgHV, n/N (%)125/234 (53%)121/231 (52%)67/103 (60%)
Del(17p)1%0%99%
Del(11q)18%19%33%
TP53 mutation6%6%43%
Complex karyotype status
<3 abnormalities35%33%49%
≥3 abnormalities8%5%29%
≤5 abnormalities40%36%57%
≥5 abnormalities3%1%21%
Samples not yet evaluated58%63%23%

Comorbidities

Baseline Patient CharacteristicsCohort 1
Patients Without Del(17p)
Cohort 2
Patients Without Del(17p)
BRUKINSA
(n=241)
BR
(n=238)
BRUKINSA
(n=111)
History of cardiac disorders*27%29%29%
History of afib/flutter5%11%7%
Hypertension56%55%51%

*Cardiac disorders is a grouped term of 33 conditions that includes atrial fibrillation, myocardial ischemia, coronary artery disease, myocardial infarction, cardiac arrest, cardiac failure, acute coronary syndrome, angina pectoris, tachycardia, and bradycardia.

Afib=atrial fibrillation; BR=bendamustine+rituximab; ECOG PS=Eastern Cooperative Oncology Group performance status.

SECOND LINE
ALPINE (STUDY 305):
DESIGNED TO EVALUATE SUPERIORITY OF BRUKINSA vs IBRUTINIB IN SECOND-LINE CLL1,4

A global Phase 3, randomized, open-label, multicenter trial conducted in patients with relapsed/refractory CLL/SLL who received ≥1 prior systemic therapy.*

*Statistical analysis for PFS and ORR were initially conducted for noninferiority. When noninferiority was met, superiority was tested. Assessments were made by the investigators, with similar results by IRC.

Afib=atrial fibrillation; BID=twice daily; CLL=chronic lymphocytic leukemia; IRC=independent review committee; iWCLL=International Workshop on Chronic Lymphocytic Leukemia; ORR=overall response rate; PD=progressive disease; PFS=progression-free survival; QD=once daily; SLL=small lymphocytic lymphoma.

SEE ALPINE EFFICACY DATA
BRUKINSA WAS STUDIED IN A RANGE OF PATIENTS, INCLUDING THOSE WITH AND WITHOUT MUTATIONS ASSOCIATED WITH POOR PROGNOSIS4,5

Patient Characteristics

Baseline Patient Characteristics*BRUKINSA
(n=327)
Ibrutinib
(n=325)
Median age, years67
(range: 35-90)
68
(range: 35-89)
Age ≥65 years61%62%
Male65%71%
Caucasian80%82%
ECOG PS 22%4%
Binet stage C44%42%
Median prior lines of therapy1
(range: 1-6)
1
(range: 1-12)
Prior treatments
Anti-CD20 antibody84%83%
Alkylators (other than bendamustine)84%80%
Purine analogue54%52%
Bendamustine26%29%
PI3K/SYK inhibitor3%6%
BCL2 inhibitor2%3%
iMiD2%0.3%
Alemtuzumab0.6%0.3%
Chemoimmunotherapy80%76%
Del(17p) deleted/abnormal14%15%
Umutated IgHV73%74%
Del(11q) deleted/abnormal28%27%
TP53 mutation9%8%
Complex karyotype status
Yes17%22%
No47%40%
Missing36%39%

Comorbidities

Baseline Patient Characteristics*BRUKINSA
(n=327)
Ibrutinib
(n=325)
History of cardiac disorders28%29%
History of afib/flutter6%6%
Hypertension49%48%

*Values based on patients enrolled in the ITT population.

Complex karyotype is defined as having 3 or more abnormalities.

Cardiac disorders is a grouped term that includes atrial fibrillation, myocardial ischemia, coronary artery disease, myocardial infarction, arrhythmia, atrial flutter, cardiac failure, tachycardia, bradycardia, and cardiac aneurysm.

Afib=atrial fibrillation; ECOG PS=Eastern Cooperative Oncology Group performance status; iMiD=immunomodulatory drug; ITT=intent to treat.

LONG-TERM DATA
STUDY 003:
LONG-TERM DATA IN FIRST- AND SECOND-LINE CLL6,7

A global supportive Phase 1/2, open-label, single-arm trial that included patients with treatment-naïve or relapsed/refractory CLL/SLL and evaluated ~4 years of safety and ~3 years of efficacy data.*

The median follow-up in
Study 003 was 47 months

STUDY 003:
STUDIED IN A RANGE OF PATIENTS6
Baseline Patient CharacteristicsTN
(n=22)
R/R
(n=101)
Median age, years70
(range: 49-87)
66
(range: 24-87)
Age ≥75 years18%17%
Male82%73%
ECOG PS
041%48%
150%50%
29%3%
Median prior lines of therapy0
(0)
2
(range: 1-10)
Mutational status
Del(13q)44%46%
Del(11q)0%23%
Del(17p)17%16%
Trisomy 1217%15%
TP53 mutated38%31%
Del(17p) and TP53 mutated6%6%
IgHV unmutated40%73%

*Exploratory long-term analysis; all data are descriptive in nature.

BID=twice daily; CLL=chronic lymphocytic leukemia; ECOG PS=Eastern Cooperative Oncology Group performance status; IRC=independent review committee; iWCLL=International Workshop on Chronic Lymphocytic Leukemia; ORR=overall response rate; PFS=progression-free survival; QD=once daily; R/R=relapsed/refractory; SLL=small lymphocytic lymphoma; TN=treatment naïve.

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IMPORTANT SAFETY INFORMATION

What should I tell my healthcare provider before taking BRUKINSA?

Before taking BRUKINSA, tell your healthcare provider about all of your medical conditions, including if you:

  • have bleeding problems.
  • have had recent surgery or plan to have surgery. Your healthcare provider may stop BRUKINSA for any planned medical, surgical, or dental procedure.
  • have an infection.
  • have or had heart rhythm problems.
  • have high blood pressure.
  • have liver problems, including a history of hepatitis B virus (HBV) infection.
  • are pregnant or plan to become pregnant. BRUKINSA can harm your unborn baby. If you are able to become pregnant, your healthcare provider may do a pregnancy test before starting treatment with BRUKINSA.
    • Females should avoid getting pregnant during treatment and for 1 week after the last dose of BRUKINSA. You should use effective birth control (contraception) during treatment and for 1 week after the last dose of BRUKINSA.
    • Males should avoid getting female partners pregnant during treatment and for 1 week after the last dose of BRUKINSA. You should use effective birth control (contraception) during treatment and for 1 week after the last dose of BRUKINSA.
  • are breastfeeding or plan to breastfeed. It is not known if BRUKINSA passes into your breast milk. Do not breastfeed during treatment with BRUKINSA and for 2 weeks after the last dose of BRUKINSA.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Taking BRUKINSA with certain other medications may affect how BRUKINSA works and can cause side effects.

What are the possible side effects of BRUKINSA?

BRUKINSA may cause serious side effects, including:

  • Bleeding problems (hemorrhage). Bleeding problems are common with BRUKINSA, and can be serious and may lead to death. Your risk of bleeding may increase if you are also taking a blood thinner medicine. Tell your healthcare provider if you have any signs or symptoms of bleeding, including:
    • blood in your stools or black stools (looks like tar)
    • pink or brown urine
    • unexpected bleeding, or bleeding that is severe or you cannot control
    • vomit blood or vomit that looks like coffee grounds
    • cough up blood or blood clots
    • increased bruising
    • dizziness
    • weakness
    • confusion
    • change in speech
    • headache that lasts a long time
  • Infections that can be serious and may lead to death. Tell your healthcare provider right away if you have fever, chills, or flu-like symptoms.
  • Decrease in blood cell counts (white blood cells, platelets, and red blood cells). Your healthcare provider should do blood tests during treatment with BRUKINSA to check your blood counts.
  • Second primary cancers. New cancers have happened in people during treatment with BRUKINSA, including cancers of the skin or other organs. Your healthcare provider will check you for other cancers during treatment with BRUKINSA. Use sun protection when you are outside in sunlight.
  • Heart rhythm problems (atrial fibrillation, atrial flutter, and ventricular arrhythmias) that can be serious and may lead to death. Tell your healthcare provider if you have any of the following signs or symptoms:
    • your heartbeat is fast or irregular
    • feel lightheaded or dizzy
    • pass out (faint)
    • shortness of breath
    • chest discomfort

The most common side effects of BRUKINSA include:

  • decreased white blood cell count
  • decreased platelet count
  • upper respiratory tract infection
  • bleeding
  • muscle, bone, or joint pain

These are not all the possible side effects of BRUKINSA. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What is BRUKINSA?

BRUKINSA is a prescription medicine used to treat adults with:

  • Chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL).
  • Waldenström’s macroglobulinemia (WM).
  • Mantle cell lymphoma (MCL) who have received at least one prior treatment for their cancer.
  • Marginal zone lymphoma (MZL) when the disease has come back or did not respond to treatment and who have received at least one certain type of treatment.
  • Follicular lymphoma (FL), in combination with the medicine obinutuzumab, when the disease has come back or did not respond to treatment and who have received at least two prior treatments.

It is not known if BRUKINSA is safe and effective in children.

Please see full Prescribing Information including Patient Information.

References: 1. BRUKINSA. Package insert. BeiGene USA, Inc.; 2023. 2. Tam CS, Brown JR, Kahl BS, et al. Zanubrutinib versus bendamustine and rituximab in untreated chronic lymphocytic leukaemia and small lymphocytic lymphoma (SEQUOIA): a randomised, controlled, phase 3 trial. Lancet Oncol. 2022;23(8):1031-1043. 3. Data on file. BeiGene USA, Inc. 4. Brown JR, Eichhorst B, Hillmen P, et al. Zanubrutinib or ibrutinib in relapsed or refractory chronic lymphocytic leukemia. N Engl J Med. 2023;388(4):319-332. 5. Data on file. BeiGene USA, Inc. 6. Cull G, Burger JA, Opat S, et al. Zanubrutinib for treatment-naïve and relapsed/refractory chronic lymphocytic leukaemia: long-term follow-up of the phase I/II AU-003 study. Br J Haematol. 2022;196(5):1209-1218. 7. Tam C, Trotman J, Opat S, et al. Phase 1 study of the selective BTK inhibitor zanubrutinib in B-cell malignancies and safety and efficacy evaluation in CLL. Blood. 2019;134(11):851-859.

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