Announcement • May 15
Beone Medicines Ltd. Announces FDA Approval of Beqalzi for Relapsed or Refractory Mantle Cell Lymphoma
BeOne Medicines Ltd. announced that the U.S. Food and Drug Administration has granted accelerated approval to BEQALZI (sonrotoclax), a foundational, next-generation BCL2 inhibitor, for the treatment of adult patients with relapsed or refractory mantle cell lymphoma after at least two lines of systemic therapy, including a Bruton’s tyrosine kinase inhibitor. BEQALZI was designed to enhance BCL2 inhibition—with greater potency, selectivity, and a pharmacologic profile with potential to improve efficacy, tolerability, and convenience over others in the class. The accelerated approval of BEQALZI is supported by efficacy and safety data from the Phase 1/2 study, BGB-11417-201, which was presented at the 67th American Society of Hematology Annual Meeting & Exposition. The study included an independent review of efficacy data and demonstrated: Overall response rate (ORR): 52% (95% CI, 42-62); Complete response (CR) rate: 16% (95% CI, 9.1-24.0); Median time to response (TTR): 1.9 months; Median duration of response (DOR): 15.8 months (95% CI, 7.4 months-NE) at a median response follow-up of 11.9 months (has yet to reach full maturity); Safety: treatment with sonrotoclax monotherapy was generally well tolerated. Continued approval for this indication is contingent upon confirmation of clinical benefit in the confirmatory CELESTIAL-RRMCL trial, which is underway. The U.S. FDA granted Breakthrough Therapy Designation for sonrotoclax in this indication, as well as Fast Track Designation and Orphan Drug Designation. BEQALZI is also approved in China for the treatment of relapsed or refractory mantle cell lymphoma, as well as adult patients with chronic lymphocytic leukemia/small lymphocytic lymphoma who have previously received at least one systemic therapy, including a Bruton’s tyrosine kinase inhibitor. Data from the Phase 1/2 study of sonrotoclax in relapsed or refractory mantle cell lymphoma is also under review by the European Medicines Agency and other regulatory agencies. The U.S. FDA also granted sonrotoclax Fast Track Designation for Waldenström macroglobulinemia, as well as Orphan Drug Designation for the treatment of adult patients with Waldenström macroglobulinemia, multiple myeloma, acute myeloid leukemia, and myelodysplastic syndrome. Sonrotoclax is currently being studied in combination with other therapeutics, including zanubrutinib, as a potential treatment for chronic lymphocytic leukemia, with updated data expected to be presented at the 2026 American Society of Clinical Oncology Annual Meeting. BEQALZI (sonrotoclax) is a foundational, next-generation and potentially best-in-class B-cell lymphoma 2 inhibitor with a unique pharmacokinetic and pharmacodynamic profile. Preclinical and clinical studies in early drug development have shown that sonrotoclax is a highly potent and specific BCL2 inhibitor with a short half-life and no drug accumulation. Sonrotoclax has shown promising clinical activity across a range of B-cell malignancies, including chronic lymphocytic leukemia, and is in development as a monotherapy and in combination with other therapeutics, including zanubrutinib. To date, more than 2,200 patients have been enrolled across the broad sonrotoclax global development program. BEQALZI (sonrotoclax) is a BCL-2 inhibitor indicated for the treatment of adult patients with relapsed or refractory mantle cell lymphoma after at least two lines of systemic therapy, including a Bruton’s tyrosine kinase inhibitor. This indication is approved under accelerated approval based on response rate and duration of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial(s). BEQALZI is contraindicated with strong CYP3A inhibitors at initiation and during the ramp-up phase due to the potential for an increased risk of tumor lysis syndrome. BEQALZI can cause rapid tumor reduction and changes in blood chemistries consistent with tumor lysis syndrome, which may be serious or life-threatening and require prompt management. Tumor lysis syndrome may occur as early as 4 hours after the first dose, with dose increases, or upon reinitiation following treatment interruption. Laboratory or clinical tumor lysis syndrome occurred in 7% of patients who followed the recommended dose ramp-up. Assess all patients for tumor lysis syndrome risk and initiate prophylaxis, including adequate hydration and antihyperuricemics. For patients at high risk of tumor lysis syndrome, consider hospitalization with intravenous hydration and employ frequent monitoring. Monitor blood chemistries closely and manage abnormalities promptly. Interrupt BEQALZI for tumor lysis syndrome; upon reinitiation, follow dose modification guidance in the Prescribing Information. BEQALZI can cause fatal or serious infections. Serious infections occurred in 14% of patients; Grade 3-4 occurred in 17% (fatal: 2.6%). The most common Grade 3 or greater infection was pneumonia (10%). Monitor for signs and symptoms of infection and treat appropriately. Consider prophylactic antimicrobials and immunoglobulins. Interrupt, reduce dose, or permanently discontinue BEQALZI based on severity. BEQALZI can cause serious or severe cytopenias, including neutropenia. Grade 3 or 4 decreases in neutrophils occurred in 18% of patients (Grade 4: 6%); febrile neutropenia occurred in 1.7% of all patients. Monitor complete blood counts throughout treatment. Interrupt treatment, reduce the dose, or permanently discontinue BEQALZI based on severity. BEQALZI can cause fetal harm when administered to pregnant women. Advise patients of the potential risk to a fetus. Verify pregnancy status prior to initiation. Advise females to use effective contraception and males with female partners of reproductive potential to use effective contraception during treatment and for 1 week after the last dose. The most common adverse reactions (=15%) are pneumonia (16%) and fatigue (16%). The most common Grade 3-4 laboratory abnormalities (=15%) are decreases in lymphocytes (29%) and neutrophils (18%). Concomitant use of strong or moderate CYP3A inhibitors increases BEQALZI exposure. Avoid use of strong CYP3A inhibitors during BEQALZI initiation and ramp-up. Avoid use of moderate CYP3A inhibitors at the 1 mg and 2 mg doses; for all other doses, reduce the BEQALZI dose with concomitant use. Concomitant use of strong or moderate CYP3A inducers decreases BEQALZI exposure. Avoid use. Advise women not to breastfeed during treatment with BEQALZI and for 1 week after the last dose.