FDA Approves Genentech’s Tecentriq in Combination With Avastin and Chemotherapy for the Initial Treatment of People With a Specific Type of Metastatic Lung Cancer

– Approval based on survival benefit of Tecentriq, in combination
with Avastin, paclitaxel and carboplatin (chemotherapy), in people with
metastatic non-squamous non-small cell lung cancer (NSCLC) with no EGFR
or ALK genomic tumor aberrations compared to Avastin plus chemotherapy –

SOUTH SAN FRANCISCO, Calif.–(BUSINESS WIRE)–Genentech, a member of the Roche Group (SIX: RO, ROG; OTCQX: RHHBY),
today announced that the U.S. Food and Drug Administration (FDA)
approved Tecentriq® (atezolizumab), in combination
with Avastin® (bevacizumab), paclitaxel and carboplatin
(chemotherapy), for the initial (first-line) treatment of people with
metastatic non-squamous non-small cell lung cancer (NSCLC) with no EGFR
or ALK genomic tumor aberrations.

“This Tecentriq regimen has demonstrated a significant survival benefit
in the initial treatment of metastatic non-squamous non-small cell lung
cancer,” said Sandra Horning, M.D., chief medical officer and head of
Global Product Development. “Today’s approval supports our combination
approach for Tecentriq in lung cancer and our vision to develop
medicines that improve outcomes for patients with this complex disease.”

This approval is based on results from the Phase III IMpower150 study,
which showed that Tecentriq in combination with Avastin and chemotherapy
helped people live significantly longer compared to Avastin and
chemotherapy (median overall survival [OS] = 19.2 versus 14.7 months;
hazard ratio [HR] = 0.78; 95 percent CI: 0.64-0.96; p=0.016) in the
intention-to-treat wild-type (ITT-WT) population. The safety profile of
the Tecentriq combination was consistent with that observed in previous

Genentech is working with the FDA on postmarketing commitments (PMCs) to
better understand and characterize the potential effects of
Tecentriq-related anti-drug antibodies (ADAs) and neutralizing
antibodies (NAbs) across all of our studies. An analysis of ADAs in the
IMpower150 study showed no impact on the efficacy of Tecentriq.

Tecentriq is also approved by the FDA to treat people with metastatic
NSCLC who have disease progression during or following
platinum-containing chemotherapy, and have progressed on an appropriate
FDA-approved targeted therapy if their tumor has EGFR or ALK genetic

For those who qualify, Genentech offers patient assistance programs for
people taking Tecentriq through Genentech Access Solutions. Doctors can
contact Genentech Access Solutions at (866) 422-2377. More information
is also available at http://www.Genentech-Access.com.

About the IMpower150 study

IMpower150 is a multicenter, open-label, randomized, controlled Phase
III study evaluating the efficacy and safety of Tecentriq in combination
with chemotherapy (carboplatin and paclitaxel) with or without Avastin
in people with Stage IV or recurrent metastatic non-squamous NSCLC who
had not been treated with chemotherapy for their advanced disease. It
enrolled 1,202 people, of whom 1,045 were in the ITT-WT subpopulation,
which excluded those people with EGFR and ALK mutations.

People were randomized (1:1:1) to receive:

  • Tecentriq plus carboplatin and paclitaxel (Arm A), or
  • Tecentriq and Avastin plus carboplatin and paclitaxel (Arm B), or
  • Avastin plus carboplatin and paclitaxel (Arm C, control arm).

The co-primary endpoints comparing Arms B and C were progression-free
survival (PFS) as determined by the independent review facility (IRF)
using Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST
v1.1) and OS and assessed in the ITT-WT subpopulation. Key secondary
endpoints included IRF-assessed PFS, OS and safety in the ITT population.

A summary of the ITT-WT data from the IMpower150 study that support this
approval is included below.

  • Tecentriq in combination with Avastin and chemotherapy helped people
    live significantly longer compared to Avastin and chemotherapy (median
    OS=19.2 versus 14.7 months; HR=0.78, 95 percent CI: 0.64-0.96;
  • In addition, Tecentriq in combination with Avastin and chemotherapy
    reduced risk of disease worsening or death (PFS) by 29 percent
    compared to Avastin and chemotherapy (HR=0.71, 95 percent CI:
    0.59-0.85, p=0.0002).
  • Tecentriq in combination with Avastin and chemotherapy shrank tumors
    (overall response rate; ORR) in 55 percent of people (95 percent CI:
    49-60) compared to 42 percent of people (95 percent CI: 37-48) on
    Avastin and chemotherapy

    • 4 percent of people receiving Tecentriq in combination with
      Avastin and chemotherapy experienced a complete response (CR), and
      51 percent of people experienced a partial response (PR).
  • The median duration of response (DoR) for people receiving Tecentriq
    in combination with Avastin and chemotherapy was 10.8 months (95
    percent CI: 8.4-13.9) compared to 6.5 months (95 percent CI: 5.6-7.6)
    for people on Avastin and chemotherapy.
  • The most common adverse reactions (≥20 percent) in people receiving
    Tecentriq in combination with Avastin and chemotherapy were fatigue
    and lack of energy (asthenia; 50 percent), hair loss (alopecia; 48
    percent), nausea (39 percent), diarrhea (32 percent), constipation (30
    percent), decreased appetite (29 percent), joint pain (arthralgia; 26
    percent), hypertension (25 percent) and pain from nerve damage
    (peripheral neuropathy; 24 percent).

About lung cancer

According to the American Cancer Society, it is estimated that more than
234,000 Americans will be diagnosed with lung cancer in 2018, and NSCLC
accounts for 85 percent of all lung cancers. It is estimated that
approximately 60 percent of lung cancer diagnoses in the United States
are made when the disease is in the advanced stages.

About Genentech Access Solutions

Access Solutions is part of Genentech’s commitment to helping people
access the Genentech medicines they are prescribed, regardless of their
ability to pay. The team of in-house specialists at Access Solutions is
dedicated to helping people navigate the access and reimbursement
process, and to providing assistance to eligible patients in the United
States who are uninsured or cannot afford the out-of-pocket costs for
their medicine. To date, the team has helped more than 1.5 million
patients access the medicines they need. Please contact Access Solutions
(866) 4ACCESS/(866) 422-2377 or visit http://www.Genentech-Access.com
for more information.

About Tecentriq® (atezolizumab)

Tecentriq is a monoclonal antibody designed to bind with a protein
called PD-L1. Tecentriq is designed to bind to PD-L1 expressed on tumor
cells and tumor-infiltrating immune cells, blocking its interactions
with both PD-1 and B7.1 receptors. By inhibiting PD-L1, Tecentriq may
enable the re-activation of T cells. Tecentriq may also affect normal

About Avastin® (bevacizumab)

Avastin is a prescription-only medicine that is a solution for
intravenous infusion. It is a biologic antibody designed to specifically
bind to a protein called vascular endothelial growth factor (VEGF) that
plays an important role throughout the lifecycle of the tumor to develop
and maintain blood vessels, a process known as angiogenesis. Avastin is
designed to interfere with the tumor blood supply by directly binding to
the VEGF protein to prevent interactions with receptors on blood vessel
cells. The tumor blood supply is thought to be critical to a tumor’s
ability to grow and spread in the body (metastasize).

Tecentriq U.S. Indication (pronounced ‘tē-SEN-trik’)

Tecentriq is a prescription medicine used to treat:

A type of bladder and urinary tract cancer called urothelial
Tecentriq may be used when your bladder cancer:

  • has spread or cannot be removed by surgery, and if you have any one
    of the following conditions

    • you are not able to take chemotherapy that contains a medicine
      called cisplatin, and your doctor has tested your cancer and found
      high levels of a specific protein on your cancer called programmed
      death-ligand 1 (PD-L1), or
    • you are not able to take chemotherapy that contains any platinum
      regardless of the levels of PD-L1 on your cancer, or
    • you have tried chemotherapy that contains platinum, and it did not
      work or is no longer working

The approval of Tecentriq in these patients is based on a study that
measured response rate and duration of response. There is an ongoing
study to confirm clinical benefit.

A type of lung cancer called non-small cell lung cancer (NSCLC).

  • Tecentriq may be used with bevacizumab and the chemotherapy
    medicines carboplatin and paclitaxel as your first treatment when your
    lung cancer:

    • has spread or grown, and
    • is a type of lung cancer called non-squamous NSCLC
    • your tumor does not have an abnormal “EGFR” or “ALK” gene
  • Tecentriq may be used when your lung cancer:

    • has spread or grown, and
    • you have tried chemotherapy that contains platinum, and it did not
      work or is no longer working
    • If your tumor has an abnormal EGFR or ALK gene, you should have
      also tried an FDA-approved therapy for tumors with these abnormal
      genes, and it did not work or is no longer working.

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

Patients should call or see their healthcare provider right away if
they get any symptoms of the following problems or these symptoms get

Tecentriq can cause serious side effects, including:

  • Lung problems (pneumonitis)–signs and symptoms of pneumonitis
    may include new or worsening cough, shortness of breath, and chest pain
  • Liver problems (hepatitis)–signs and symptoms of hepatitis may
    include yellowing of your skin or the whites of your eyes, severe
    nausea or vomiting, pain on the right side of your stomach area
    (abdomen), drowsiness, dark urine (tea colored), bleeding or bruising
    more easily than normal, and feeling less hungry than usual
  • Intestinal problems (colitis)–signs and symptoms of colitis may
    include diarrhea (loose stools) or more bowel movements than
    usual, blood or mucus in your stools or dark, tarry, sticky
    stools, and severe stomach area (abdomen) pain or tenderness
  • Hormone gland problems (especially the thyroid, adrenal glands,
    pancreas, and pituitary)
    –signs and symptoms that your hormone
    glands are not working properly may include headaches that will not go
    away or unusual headaches, extreme tiredness, weight gain or weight
    loss, dizziness or fainting, feeling more hungry or thirsty than
    usual, hair loss, changes in mood or behavior (such as decreased sex
    drive, irritability, or forgetfulness), feeling cold, constipation,
    your voice gets deeper, urinating more often than usual, nausea or
    vomiting, and stomach area (abdomen) pain
  • Problems in other organs–signs and symptoms may include severe
    muscle weakness, numbness or tingling in hands or feet, confusion,
    blurry vision, double vision, or other vision problems, changes in
    mood or behavior, extreme sensitivity to light, neck stiffness, eye
    pain or redness, skin blisters or peeling, chest pain, irregular
    heartbeat, shortness of breath, or swelling of the ankles
  • Severe infections–signs and symptoms of infection may include
    fever, cough, flu-like symptoms, pain when urinating, and frequent
    urination or back pain
  • Severe infusion reactions–signs and symptoms of infusion
    reactions may include chills or shaking, itching or rash, flushing,
    shortness of breath or wheezing, swelling of your face or lips,
    dizziness, fever, feeling like passing out, and back or neck pain

Getting medical treatment right away may help keep these problems
from becoming more serious.
A healthcare provider may treat patients
with corticosteroid or hormone replacement medicines. A healthcare
provider may delay or completely stop treatment with Tecentriq if
patients have severe side effects.

Before receiving Tecentriq, patients should tell their healthcare
provider about all of their medical conditions, including if they:

  • have immune system problems (such as Crohn’s disease, ulcerative
    colitis, or lupus); have had an organ transplant; have lung or
    breathing problems; have liver problems; have a condition that affects
    the nervous system (such as myasthenia gravis or Guillain-Barre
    syndrome); or are being treated for an infection
  • are pregnant or plan to become pregnant. Tecentriq can harm an unborn
    baby. Patients should tell their healthcare provider right away if
    they become pregnant or think they may be pregnant during treatment
    with Tecentriq. Females who are able to become pregnant:

    • A healthcare provider should do a pregnancy test before they start
      treatment with Tecentriq
    • They should use an effective method of birth control during their
      treatment and for at least 5 months after the last dose of
  • are breastfeeding or plan to breastfeed. It is not known if Tecentriq
    passes into the breast milk. Patients should not breastfeed during
    treatment and for at least 5 months after the last dose of Tecentriq

Patients should tell their healthcare provider about all the
medicines they take,
including prescription and over-the-counter
medicines, vitamins, and herbal supplements.

The most common side effects of Tecentriq when used alone include:

  • feeling tired
  • nausea
  • constipation
  • cough
  • shortness of breath
  • decreased appetite

The most common side effects of Tecentriq when used with bevacizumab,
paclitaxel, and carboplatin include:

  • feeling tired or weak
  • hair loss
  • nausea
  • diarrhea
  • constipation
  • decreased appetite
  • joint pain
  • high blood pressure
  • tingling or numbness in hands and feet

Tecentriq may cause fertility problems in females, which may affect the
ability to have children. Patients should talk to their healthcare
provider if they have concerns about fertility.

These are not all the possible side effects of Tecentriq. Patients
should ask their healthcare provider or pharmacist for more information.
Patients should call their doctor for medical advice about side effects.

Report side effects to the FDA at 1-800-FDA-1088 or http://www.fda.gov/medwatch.
Report side effects to Genentech at 1-888-835-2555.

Please visit http://www.Tecentriq.com
for the Tecentriq full Prescribing Information for additional Important
Safety Information.

Avastin Indications:

  • Metastatic colorectal cancer (mCRC) for first- or second-line
    treatment in combination with intravenous 5-fluorouracil–based
    chemotherapy. It is also approved to treat mCRC for second-line
    treatment, when used with fluoropyrimidine-based (combined with
    irinotecan or oxaliplatin) chemotherapy, after cancer progresses
    following a first-line treatment that includes Avastin.

    • Avastin is not approved for use after the primary treatment of
      colon cancer that has not spread to other parts of the body
  • Advanced nonsquamous non–small cell lung cancer (NSCLC) in
    combination with carboplatin and paclitaxel, in people who have not
    received chemotherapy for their advanced disease
  • Metastatic kidney cancer (mRCC) when used with interferon alfa
  • Glioblastoma (GBM) in adult patients whose cancer has
    progressed after prior treatment (recurrent or rGBM)
  • Advanced cervical cancer (CC) in combination with paclitaxel
    and cisplatin or paclitaxel and topotecan, is approved to treat
    persistent, recurrent, or metastatic cancer of the cervix
  • Ovarian cancer (OC). Avastin, in combination with carboplatin
    and paclitaxel, followed by Avastin alone, is used for the treatment
    of patients with advanced (Stage III or IV) epithelial ovarian,
    fallopian tube, or primary peritoneal cancer following initial surgery.

    in combination with paclitaxel, pegylated liposomal doxorubicin or
    topotecan, is approved to treat platinum-resistant recurrent
    epithelial ovarian, fallopian tube or primary peritoneal cancer (prOC)
    in women who received no more than two prior chemotherapy treatments.

    either in combination with carboplatin and paclitaxel or with
    carboplatin and gemcitabine, followed by Avastin alone, is approved
    for the treatment of patients with platinum-sensitive recurrent
    epithelial ovarian, fallopian tube, or primary peritoneal cancer (psOC)

Possible serious side effects

Everyone reacts differently to Avastin therapy. So, it’s important to
know what the side effects are. Although some people may have a
life-threatening side effect, most do not
. Their doctor will stop
treatment if any serious side effects occur. Patients should contact
their health care team if there are any signs of these side effects.

Most serious side effects (not common, but sometimes fatal):

  • GI perforation. A hole that
    develops in the stomach or intestine. Symptoms include pain in the
    abdomen, nausea, vomiting, constipation, or fever
  • Wounds that don’t heal. A cut made
    during surgery can be slow to heal or may not fully heal. Avastin
    should not be used for at least 28 days before or after surgery and
    until surgical wounds are fully healed
  • Serious bleeding. This includes
    vomiting or coughing up blood; bleeding in the stomach, brain, or
    spinal cord; nosebleeds; and vaginal bleeding. If a patient has
    recently coughed up blood or had serious bleeding, they should be sure
    to tell their doctor

Other possible serious side effects

  • Abnormal passage in the body. This type of passage—known as a
    fistula—is an irregular connection from one part of the body to
    another and can sometimes be fatal
  • Severe high blood pressure. Blood pressure that severely spikes
    or shows signs of affecting the brain. Blood pressure should be
    monitored every 2 to 3 weeks while on Avastin and after stopping
  • Kidney problems. These may be caused by too much protein in the
    urine and can sometimes be fatal
  • Infusion reactions. These were uncommon with the first dose
    (less than 3% of patients). 0.2% of patients had severe reactions.
    Infusion reactions include high blood pressure or severe high blood
    pressure that may lead to stroke, trouble breathing, decreased oxygen
    in red blood cells, a serious allergic reaction, chest pain, headache,
    tremors, and excessive sweating. The patient’s doctor or nurse will
    monitor for signs of infusion reactions
  • Severe stroke or heart problems. These may include blood clots,
    mini-stroke, heart attack, chest pain, and the heart may become too
    weak to pump blood to other parts of the body (congestive heart
    failure). These can sometimes be fatal
  • Nervous system and vision problems. Signs include headache,
    seizure, high blood pressure, sluggishness, confusion, and blindness

Side effects seen most often

In clinical studies across different types of cancer, some patients
experienced the following side effects:

  • High blood pressure
  • Too much protein in the urine
  • Nosebleeds
  • Rectal bleeding
  • Back pain
  • Headache
  • Taste change
  • Dry skin
  • Inflammation of the skin
  • Inflammation of the nose
  • Watery eyes

Avastin is not for everyone

Patients should talk to their doctor if they are:

  • Undergoing surgery. Avastin should not be used for 28 days
    before or after surgery and until surgical wounds are fully healed
  • Pregnant or think they are pregnant. Data have shown that
    Avastin may harm a woman’s unborn baby. Birth control should be used
    while patients are on Avastin. If Avastin is stopped, patients should
    keep using birth control for 6 months before trying to become pregnant
  • Planning to become pregnant. Taking Avastin could cause a
    woman’s ovaries to stop working and may impair her ability to have
  • Breastfeeding. Breastfeeding while on Avastin may harm the baby
    and is therefore not recommended during and for 6 months after taking

Patients should talk with their doctor if they have any questions about
their condition or treatment.

Report side effects to the FDA at (800) FDA-1088 or http://www.fda.gov/medwatch.
Report side effects to Genentech at (888) 835-2555.

For full Prescribing Information and Boxed WARNINGS on Avastin please

About Genentech in Personalized Cancer Immunotherapy

For more than 30 years, Genentech has been developing medicines with the
goal to redefine treatment in oncology. Today, we’re investing more than
ever to bring personalized cancer immunotherapy (PCI) to people with
cancer. The goal of PCI is to provide each person with a treatment
tailored to harness his or her own immune system to fight cancer.
Genentech is studying more than 20 investigational medicines, 10 of
which are in clinical trials. In every study we are evaluating
biomarkers to identify which people may be appropriate candidates for
our medicines. For more information visit http://www.gene.com/cancer-immunotherapy.

About Genentech in Lung Cancer

Lung cancer is a major area of focus and investment for Genentech, and
we are committed to developing new approaches, medicines and tests that
can help people with this deadly disease. Our goal is to provide an
effective treatment option for every person diagnosed with lung cancer.
We currently have four approved medicines to treat certain kinds of lung
cancer and more than 10 medicines being developed to target the most
common genetic drivers of lung cancer or to boost the immune system to
combat the disease.

About Genentech

Founded more than 40 years ago, Genentech is a leading biotechnology
company that discovers, develops, manufactures and commercializes
medicines to treat patients with serious and life-threatening medical
conditions. The company, a member of the Roche Group, has headquarters
in South San Francisco, California. For additional information about the
company, please visit http://www.gene.com.


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