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Indication
IDHIFA® (enasidenib) is indicated for the treatment of adult patients with relapsed or refractory acute myeloid leukemia with an isocitrate dehydrogenase-2 mutation as detected by an FDA-approved test.

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EFFICACY

IDHIFA® Clinical Trial Design

FDA approval of IDHIFA® was based on results from

THE FIRST PIVOTAL TRIAL EXCLUSIVELY IN R/R AML WITH AN IDH2 MUTATION

IDHIFA® was studied in an open-label, single-arm, multicenter, clinical trial of patients who had R/R AML with an IDH2 mutation who were assigned a starting dose of 100 mg daily until disease progression or unacceptable toxicity. Dose reductions were allowed to manage adverse events. The efficacy analysis included 199 patients; the safety analysis included 214 patients.

FDA approval of IDHIFA® was based on results from the first pivotal trial exclusively in r/r AML with an IDH2 mutation
FDA approval of IDHIFA® was based on results from the first pivotal trial exclusively in r/r AML with an IDH2 mutation

*Patients were defined as transfusion independent if they received no RBC or platelet transfusions within any 56-day post-baseline period.

Selected Baseline Characteristics

The Trial Included a Difficult-to-Treat Patient Population

SELECTED BASELINE CHARACTERISTICS

Selected baseline characteristics
Selected baseline characteristics

aOne patient had missing baseline ECOG PS.
bFor 3 patients with different mutations detected in bone marrow compared to blood, the result of blood is reported.
cPatients were defined as transfusion dependent at baseline if they received any RBC or platelet transfusions within the 8-week baseline period.
dIncludes intensive and/or nonintensive therapies.
ECOG PS, Eastern Cooperative Oncology Group performance status.

ADDITIONAL BASELINE HEMATOLOGIC PARAMETERS1

Additional Baseline Hematologic parameters
Additional Baseline Hematologic parameters

Baseline measurements not available for all patients in cycle 1.

IDHIFA® CLINICAL BROCHURE

Response Rates in This Challenging Clinical Setting

IDHIFA® ACHIEVED DURABLE AND CLINICALLY MEANINGFUL RESPONSES

RATE OF COMPLETE RESPONSE (CR) AND CR WITH PARTIAL HEMATOLOGIC RECOVERY (CRh)

Rate of complete response (CR) and CR with partial hematologic recovery (CRh)
Rate of complete response (CR) and CR with partial hematologic recovery (CRh)

a<5% of blasts in the bone marrow, no evidence of disease, and full recovery of peripheral blood counts (platelets >100,000/μL and ANC >1,000/μL).
b<5% of blasts in the bone marrow, no evidence of disease, and partial recovery of peripheral blood counts (platelets >50,000/μL and ANC >500/μL).
cTime since first response of CR or CRh to relapse or death, whichever is earlier.
CI, confidence interval; NA, not available.

ADDITIONAL OUTCOMES FOR PATIENTS WHO HAD R/R AML WITH AN IDH2 MUTATION

BEST OBJECTIVE RESPONSE1

Additional outcomes for patients who had R/R AML with an IDH2 mutation. Best Objective Response
Additional outcomes for patients who had R/R AML with an IDH2 mutation. Best Objective Response

aPercentages are based on the number of subjects in each group.1
MLFS, morphologic leukemia-free state for subjects with AML; PR, partial response.

WITH IDHIFA®, RESPONSES DEEPENED OVER TIME FOR SOME PATIENTS ACHIEVING CR/CRh

MEDIAN TIME TO FIRST AND BEST RESPONSE

With IDHIFA®, responses deepened over time for some patients achieving CR/CRh. Median time to first and best response.
With IDHIFA®, responses deepened over time for some patients achieving CR/CRh. Median time to first and best response.

Transfusion Independence

ACHIEVING TRANSFUSION INDEPENDENCE IS CLINICALLY MEANINGFUL

Achieving transfusion independence is clinically meaningful
Achieving transfusion independence is clinically meaningful

aPatients were defined as transfusion independent if they received no RBC or platelet transfusions within any 56-day post-baseline period.

ADDITIONAL DATA FOR TRANSFUSION STATUS IN PATIENTS WHO HAD R/R AML WITH AN IDH2 MUTATION1

TRANSFUSION STATUS BY RESPONSE TYPE (N=199)

Transfusion status by response type (N=199) Chart
Transfusion status by response type (N=199) Chart

TD, transfusion dependent; TI, transfusion independent.

  1. Data on file, Celgene Corporation. Summit, New Jersey.

WARNING: DIFFERENTIATION SYNDROME

Patients treated with IDHIFA have experienced symptoms of differentiation syndrome, which can be fatal if not treated. Symptoms may include fever, dyspnea, acute respiratory distress, pulmonary infiltrates, pleural or pericardial effusions, rapid weight gain or peripheral edema, lymphadenopathy, bone pain, 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: See Boxed WARNING. In the clinical trial, 14% of patients treated with IDHIFA experienced differentiation syndrome, which may be life-threatening or fatal if not treated. Differentiation syndrome has been observed with and without concomitant hyperleukocytosis, in as early as 1 day and up to 5 months after IDHIFA initiation. Symptoms in patients treated with IDHIFA included acute respiratory distress represented by dyspnea and/or hypoxia and need for supplemental oxygen; pulmonary infiltrates and pleural effusion; renal impairment; fever; lymphadenopathy; bone pain; peripheral edema with rapid weight gain; and pericardial effusion. Hepatic, renal, and multi-organ dysfunction have also been observed. If differentiation syndrome is suspected, initiate systemic corticosteroids and hemodynamic monitoring until improvement. Taper corticosteroids only after resolution of symptoms. Differentiation syndrome symptoms may recur with premature discontinuation of corticosteroids. If severe pulmonary symptoms requiring intubation or ventilator support and/or renal dysfunction persist for more than 48 hours after initiation of corticosteroids, interrupt IDHIFA until signs and symptoms are no longer severe. Hospitalization for close observation and monitoring of patients with pulmonary and/or renal manifestation is recommended.

Embryo-Fetal Toxicity: Based on animal embryo-fetal toxicity studies, IDHIFA can cause embryo-fetal harm when administered to a pregnant woman. Advise females of reproductive potential and males with female partners of reproductive potential to use effective non-hormonal contraception during treatment with IDHIFA and for 2 months after the last dose. Advise pregnant women of the potential risk to the fetus.

ADVERSE REACTIONS

  • The most common adverse reactions (≥20%) included total bilirubin increased (81%), calcium decreased (74%), nausea (50%), diarrhea (43%), potassium decreased (41%), vomiting (34%), decreased appetite (34%), and phosphorus decreased (27%)
  • The most frequently reported ≥Grade 3 adverse reactions (≥5%) included total bilirubin increased (15%), potassium decreased (15%), phosphorus decreased (8%), calcium decreased (8%), diarrhea (8%), differentiation syndrome (7%), non-infectious leukocytosis (6%), tumor lysis syndrome (6%), and nausea (5%)
  • Serious adverse reactions were reported in 77.1% of patients. The most frequent serious adverse reactions (≥2%) were leukocytosis (10%), diarrhea (6%), nausea (5%), vomiting (3%), decreased appetite (3%), tumor lysis syndrome (5%), and differentiation syndrome (8%). Differentiation syndrome events characterized as serious included pyrexia, renal failure acute, hypoxia, respiratory failure, and multi-organ failure

DRUG INTERACTIONS

Certain CYP1A2 CYP2C19 Substrates

Avoid concomitant use with IDHIFA unless otherwise recommended in the Prescribing Information for CYP1A2, CYP2C19 substrates where minimal concentration changes may lead to serious adverse reactions. Consider reducing the frequency of caffeine intake from various food and beverages in a 24-hour period while taking IDHIFA because IDHIFA may increase the effect of caffeine in patients who are sensitive to it. Enasidenib is a CYP1A2, CYP2C19 inhibitor. Concomitant use of IDHIFA increases the exposure of CYP1A2, CYP2C19 substrates, which may increase the risk of adverse reactions related to the substrates.

Certain CYP3A substrates

Avoid concomitant use with IDHIFA unless otherwise recommended in the Prescribing Information for CYP3A substrates where minimal concentration changes may lead to reduced efficacy. Do not administer IDHIFA with anti-fungal agents that are substrates of CYP3A due to expected loss of antifungal efficacy. Co-administration of IDHIFA may decrease the concentrations of hormonal contraceptives. Consider alternative methods of contraception in patients receiving IDHIFA. Enasidenib is a CYP3A inducer. Concomitant use of IDHIFA decreases the exposure of CYP3A substrates, which may reduce the efficacy of the substrates.

Certain OATP1B1, OATP1B3, and BCRP Substrates

Avoid coadministration of IDHIFA with OATP1B1, OATP1B3, and BCRP substrates, for which minimal concentration changes may lead to serious toxicities. If coadministration cannot be avoided, decrease the OATP1B1, OATP1B3, and BCRP substrates dosage(s) in accordance with the respective Prescribing Information. Enasidenib is an OATP1B1, OATP1B3, and BCRP transporter inhibitor. Concomitant use of IDHIFA increases the exposure of OATP1B1, OATP1B3, and BCRP, which may increase the risk of adverse reactions related to these substrates.

Certain P-glycoprotein (P-gp) Substrates

When coadministered with IDHIFA, follow recommended P-gp substrates Prescribing Information and monitor more frequently for adverse reactions related to these substrates. Enasidenib is a P-gp transporter inhibitor. Concomitant use of IDHIFA increases the exposure of P-gp substrates, which may increase the risk of adverse reactions related to the substrates.

LACTATION

Because of the potential for adverse reactions in the breastfed child, advise women not to breastfeed during treatment with IDHIFA and for 2 months after the last dose.

  1. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Acute Myeloid Leukemia V.1.2024. © National Comprehensive Cancer Network, Inc. 2024. All rights reserved. Accessed March 4, 2024. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.
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  6. Data on file, Celgene Corporation. Summit, New Jersey.
  1. Data on file, Celgene Corporation. Summit, New Jersey.
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03/24  2018-US-2300021