Merck Serono Expands Cilengitide Development Program

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1 Your contact Dr. Raphaela Farrenkopf Phone March 16, 2009, 9 a.m. CET Merck Serono Expands Cilengitide Development Program Study combining cilengitide and Erbitux in 1 st - line non-small cell lung cancer commences Cilengitide clinical development program now aimed at three cancer types Darmstadt, March 16, 2009 Merck Serono today announced the launch of its Phase II clinical study CERTO a, which will investigate the efficacy and safety of the novel combination of the investigational integrin inhibitor, cilengitide, and Erbitux (cetuximab), with cisplatin and either vinorelbine or gemcitabine, as 1 st -line treatment for patients with advanced non-small cell lung cancer (NSCLC). This study is a new addition to Merck Serono s global clinical development program that is evaluating cilengitide in a number of cancer types with high unmet medical need. The clinical program has been focusing on CENTRIC b so far a Phase III clinical trial in glioblastoma multiforme (GBM). It now also includes the recently started CORE c trial in GBM and ADVANTAGE d in squamous cell carcinoma of the head and neck (SCCHN). ADVANTAGE began enrolling patients in October Despite recent advances in NSCLC treatment, it remains a notoriously difficult-to-treat cancer with a poor prognosis, said Professor Johan F. Vansteenkiste from University Hospital Gasthuisberg, Leuven and Chair of the CERTO trial Steering Committee. The combination of the selective integrin inhibitor cilengitide and the targeted agent Erbitux plus platinum-based chemotherapy, is being studied in NSCLC in the CERTO trial. The Merck KGaA Page 1 of 6 Frankfurter Strasse 250 Head External Communications Media Relations Darmstadt Corporate Media Relations / Darmstadt Site Hotline +49 (0) Fax +49 (0) Fax +49 (0) media.relations@merck.de pressestelle@merck.de

2 results of this trial will hopefully lead the way to even better outcomes for lung cancer patients. In previous trials, cilengitide has already shown clinical activity in GBM in combination with chemoradiation and as a single agent, with only rare incidents of grade 3 or 4 related toxicity. Cilengitide is now being tested in combination with Erbitux and standard chemotherapy in NSCLC, said Dr. Frank T. Weber, Senior Vice President and Head of Medical Science and Innovation at Merck Serono. Combination is key for patients and these trials demonstrate our continued commitment to the development of novel anti-cancer therapies. Cilengitide, developed in Merck s own laboratories, is the first in a new class of investigational anti-cancer therapies called integrin inhibitors to reach Phase III development. Integrin inhibitors target integrins specific cell surface receptors that are improperly regulated in many tumor types and involved in cancer growth. Cilengitide is thought to work by targeting tumor cells directly and by preventing the formation of new blood vessels to the tumor, a process known as angiogenesis. 1 Cilengitide research program a. CERTO is an exploratory Phase II, multicenter, open-label, randomized, controlled study investigating two cilengitide regimens in combination with Erbitux and platinumbased chemotherapy (cisplatin/vinorelbine or cisplatin/gemcitabine) compared to Erbitux and platinum-based chemotherapy alone as 1 st -line treatment for patients with advanced NSCLC. b. CENTRIC is a Phase III, multicenter, open-label, controlled study to assess the efficacy and safety of cilengitide in combination with standard chemotherapy (temozolomide, or TMZ) plus radiotherapy versus standard chemotherapy plus radiotherapy alone, in a specific subgroup of newly diagnosed patients with GBM. Patients recruited into the CENTRIC trial will have their tumor tissue screened for methylation of the MGMT (methylguanine-dna methyltransferase) gene promoter. This Page 2 of 6

3 gene promoter acts as a controlling element in the expression of MGMT, an enzyme which reduces the efficacy of the chemotherapy. The CENTRIC trial is being conducted in collaboration with the European Organization for Research and Treatment of Cancer (EORTC) and the Canadian Brain Tumour Consortium (CBTC). c. CORE is an exploratory companion trial to CENTRIC evaluating cilengitide in GBM patients with unmethylated MGMT status. CORE is a Phase II, multicenter, open-label study investigating two cilengitide regimens in combination with standard treatment (temozolomide with concomitant radiation therapy, followed by temozolomide maintenance therapy). d. ADVANTAGE is an exploratory Phase II, open-label, randomized, controlled study of cilengitide investigating the combination of different regimens of cilengitide added to cisplatin, 5-FU and Erbitux in patients with recurrent/metastatic SCCHN. Burden of disease Combined, almost 1.9 million people worldwide die from cancers of the lung (1,351,000) 2, head and neck (387,000) 3, brain and central nervous system (142,000) 4 every year. Around 80% of lung cancer patients have NSCLC and first present with advanced disease, which is difficult to treat. 5-6 Only about 10% of patients are still alive after five years 5,7 About 40% of patients with head and neck cancer have recurrent and/or metastatic SCCHN 8. Median survival time for these patients is only around seven months. 9 GBM is the most aggressive form of primary brain tumor. Despite advances in imaging techniques and currently best available treatments, patients have nowadays a mortality within two years of more than 70%. 10 For more information on these studies, or to find a participating center and eligibility criteria, log on to Page 3 of 6

4 References 1. Tucker GC. Curr Oncol Rep. 2006;8: Global Cancer Facts & Figures 2007, American Cancer Society. 3. GLOBOCAN 2002 (www-dep.iarc.fr), accessed January Parkin M et al. CA Cancer J Clin 2005;55: D'Addario G & Felip E. Ann Oncol 2008;19 Suppl 2:ii Corner J et al. Thorax 2005;60(4): Sant M, et al. Ann Oncol 2003;14 Suppl 5:v Lefebvre J-L. Ann Oncol 2005;16 Suppl 6:vi7-vi Vermorken J, et al. ASCO 2007; Abstract No: Stupp et al., NEJM 2005; 352 (10): For more information on Erbitux and the investigational therapy cilengitide, please visit: About cilengitide Cilengitide is currently being developed by Merck KGaA. Cilengitide is the first in a new class of investigational anti-cancer therapies called integrin inhibitors to reach Phase III of development; it is currently being investigated for the treatment of glioblastoma, SCCHN and NSCLC. Integrin inhibitors are thought to work by targeting the tumor and its vasculature. Integrins are cell surface receptors that are improperly regulated in many cancer types. This lack of regulation enables them to enhance tumor growth, survival and invasiveness. Integrins are fundamental in the process of angiogenesis (blood vessel growth) a process that is essential for tumors as it enables them to grow past a finite size. In addition to the Merck-sponsored studies, the U.S. National Cancer Institute (NCI) is sponsoring a number of clinical trials under a Cooperative Research and Development Agreement (CRADA) with Merck KGaA for the development of cilengitide. About Erbitux Erbitux is a first-in-class and highly active IgG1 monoclonal antibody targeting the epidermal growth factor receptor (EGFR). As a monoclonal antibody, the mode of action of Erbitux is distinct from standard nonselective chemotherapy treatments in that it specifically targets and binds to the EGFR. This binding inhibits the activation of the receptor and the subsequent signal-transduction pathway, which results in reducing both the invasion of normal tissues by tumor cells and the spread of tumors to new sites. It is also believed to inhibit the ability of tumor cells to repair the damage caused by chemotherapy and radiotherapy and to inhibit the formation of new blood vessels inside tumors, which appears to lead to an overall suppression of tumor growth. The most commonly reported side effect with Erbitux is an acne-like skin rash that seems to be correlated with a good response to therapy. In approximately 5% of patients, hypersensitivity reactions may occur during treatment with Erbitux; about half of these reactions are severe. Page 4 of 6

5 Erbitux has already obtained market authorization in 76 countries. It has been approved for the treatment of colorectal cancer in 75 countries and for the treatment of squamous cell carcinoma of the head and neck (SCCHN) in 71 countries: December 2003 (Switzerland), February 2004 (USA), June 2004 (EU) and followed by other countries: for use in combination with irinotecan in patients with EGFR-expressing mcrc (metastatic colorectal cancer) who have failed prior irinotecan therapy. In addition, Erbitux is also approved for single-agent use in further countries. April 2006 (EU) and followed by other countries: for use in combination with radiotherapy for the treatment of locally advanced squamous cell carcinoma of the head and neck (SCCHN). In further countries, Erbitux is also approved as monotherapy in patients with recurrent and/or metastatic SCCHN who failed prior chemotherapy. July 2008 (EU): license was updated for the treatment of patients with epidermal growth factor receptor (EGFR) expressing, KRAS wild-type mcrc in combination with chemotherapy and as a single agent in patients who have failed oxaliplatin-and irinotecan-based therapy and who are intolerant to irinotecan. July 2008 (Japan): for use in combination with irinotecan in patients with EGFR-expressing mcrc who have failed prior irinotecan therapy In November 2008 (EU): license was updated for the use in combination with platinum-based chemotherapy in patients with recurrent and/or metastatic SCCHN Merck licensed the right to market Erbitux outside the US and Canada from ImClone Systems, a whollyowned subsidiary of Eli Lilly and Company, in In Japan, ImClone Systems, Bristol-Myers Squibb Company and Merck jointly develop and commercialize Erbitux. Merck has an ongoing commitment to the advancement of oncology treatment and is currently investigating novel therapies in highly targeted areas, such as the use of Erbitux in colorectal cancer, squamous cell carcinoma of the head and neck and nonsmall cell lung cancer. Merck has also acquired the rights for the cancer treatment UFT (tegafur-uracil) an oral chemotherapy administered with folinic acid (FA) for the first-line treatment of metastatic colorectal cancer. Merck is also investigating among other cancer treatments the use of Stimuvax (formerly referred to as BLP25 Liposome Vaccine) in the treatment of non-small cell lung cancer. The vaccine was granted fasttrack status in September 2004 by the FDA. Merck obtained the exclusive worldwide licensing rights from Oncothyreon Inc., Bellevue, Washington, USA. Page 5 of 6

6 About Merck Serono Merck Serono is the division for innovative prescription pharmaceuticals of Merck, a global pharmaceutical and chemical group. Headquartered in Geneva, Switzerland, Merck Serono discovers, develops, manufactures and markets innovative small molecules and biopharmaceuticals to help patients with unmet medical needs. Its North American business operates in the United States and Canada as EMD Serono. Merck Serono has leading brands serving patients with cancer (Erbitux ), multiple sclerosis (Rebif ), infertility (Gonal-f ), endocrine and cardiometabolic disorders (Glucophage, Concor, Saizen, Serostim ), as well as psoriasis (Raptiva ). With an annual R&D investment of around 1bn, Merck Serono is committed to growing its business in specialist-focused therapeutic areas including neurodegenerative diseases, oncology, fertility and endocrinology, as well as new areas potentially arising out of research and development in autoimmune and inflammatory diseases. For more information, please visit or About Merck All Merck Press Releases are distributed by at the same time they become available on the Merck Website. Please go to to register online, change your selection or discontinue this service. Merck is a global pharmaceutical and chemical company with total revenues of 7.6 billion in 2008, a history that began in 1668, and a future shaped by 32,800 employees in 59 countries. Its success is characterized by innovations from entrepreneurial employees. Merck's operating activities come under the umbrella of Merck KGaA, in which the Merck family holds an approximately 70% interest and free shareholders own the remaining approximately 30%. In 1917 the U.S. subsidiary Merck & Co. was expropriated and has been an independent company ever since. Page 6 of 6