On April 1, 2020 Mevion Medical Systems reported that it has delivered the synchrocyclotron accelerator for the MEVION S250i Proton Therapy System to Huntsman Cancer Institute (HCI) at the University of Utah (U of U) on March 28, 2020 (Press release, Mevion Medical Systems, APR 1, 2020, View Source [SID1234556075]). The 15-ton accelerator, the world’s smallest, was driven up the side of the Red Butte Canyon and was lowered by a crane into the proton facility the same day.

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"With the arrival of the accelerator, we are on track to provide proton therapy to our patients later this year," said Dennis Shrieve, M.D, Ph.D., radiation oncologist at HCI and professor and chair of radiation oncology at the U of U.

The system, now under installation, features Mevion’s industry leading HYPERSCAN Pencil Beam Scanning (PBS) technology. HYPERSCAN improves on existing scanning capabilities to deliver more conformal fields of therapeutic radiation to tumors faster, with more precision, and is the most advanced pencil beam scanning available. HCI, Utah’s only National Cancer Institute-designated Comprehensive Cancer Center, has been closely tracking and considering proton therapy for over a decade. Recent technological advances by Mevion made it the right time to add this powerful cancer-fighting tool to their cancer center. HCI will also integrate* Siemen’s SOMATOM Definition Edge CT on rails to provide precise image-guided proton therapy (IGPT).

"Proton therapy is especially effective in delivering targeted radiation while preserving healthy tissues. Patients with tumors close to critical organs along with pediatric cancer patients can benefit the most from this advanced treatment," said Bill Salter, Ph.D., director of radiation oncology at HCI and professor and chief of the division of medical physics at the U of U. "The HYPERSCAN system will be a powerful new addition to Huntsman Cancer Institute’s already formidable suite of treatment tools."

By reducing the size and complexity of a proton therapy system, Mevion has allowed hospitals to offer proton therapy without the enormous expenditures and space requirements needed by other single-room or multi-room proton systems. Today, more cancer centers are considering providing compact proton therapy to their patients because of the technology Mevion has advanced.

"We are honored to provide Utah with the first proton therapy center in the Mountain West," said Tina Yu, Ph.D., chief executive officer of Mevion Medical Systems. "HCI is a nationally recognized research center and treatment hospital and we look forward to building our partnership to advance the science and application of proton therapy."

On April 1, 2020 Castle Biosciences, Inc. (Nasdaq: CSTL), a skin cancer diagnostics company providing personalized genomic information to improve cancer treatment decisions, reported the publication of a systematic review and meta-analysis of four study cohorts demonstrating that the DecisionDx-Melanoma test is an independent, significant predictor of recurrence and metastatic risk in patients with invasive cutaneous melanoma (Press release, Castle Biosciences, APR 1, 2020, View Source [SID1234556074]).

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The article titled, "Molecular risk prediction in cutaneous melanoma: a meta-analysis of the 31-gene expression profile prognostic test in 1,479 patients," appeared in the Journal of the American Academy of Dermatology (JAAD).

"This systematic review and meta-analysis are important because they further demonstrate the strength and consistency of the DecisionDx-Melanoma test as a significant, independent predictor of recurrence and metastasis in patients with Stage I-III melanoma, across these unique study cohorts," said lead author Bradley Greenhaw, M.D., Dermatology Center of North Mississippi, Tupelo, Mississippi. "The meta-analysis shows the value of using the DecisionDx-Melanoma gene expression profile test in combination with American Joint Committee on Cancer (AJCC) staging to optimize melanoma prognostication."

Systematic Review and Meta-Analysis Background:

This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)1.

Multiple published archival and prospective studies have described the prognostic capability, performance and clinical utility of the DecisionDx-Melanoma test to assess recurrence risk and inform patient management decisions on sentinel lymph node recommendations, follow up, surveillance imaging and referrals for patients with cutaneous melanoma.

This systematic review and meta-analysis were performed to evaluate the cumulative prognostic effect of the test across multiple cohorts with a focus on differences in recurrence and distant metastasis between patients with a DecisionDx-Melanoma Class 1A (lowest risk) and Class 2B (highest risk) test result. Four study cohorts, which included a total of 1,479 non-overlapping patients with Stage I-III melanoma, were included in the analysis.

Systematic Review and Meta-Analysis Results:

The DecisionDx-Melanoma test was found to be a consistent, independent and significant predictor of recurrence and metastatic risk in the meta-analysis across four study cohorts, achieving the highest Strength of Recommendation Taxonomy (SORT) level for a prognostic biomarker (Level 1 evidence).
The DecisionDx-Melanoma risk assessment is independent from other clinical factors (age, Breslow tumor thickness, ulceration and node status) and improves upon risk assessment performed with staging factors alone.
For melanoma recurrence, multivariate analysis showed that patients with DecisionDx-Melanoma Class 2B tumors are 2.90 times more likely (Hazard Ratio) to experience a recurrence than patients with Class 1A tumors (p<0.0001).
For distant metastasis, patients with Class 2B tumors are 2.75 times more likely to experience a distant metastasis than patients with Class 1A tumors (p<0.0001).
Despite differences in populations and study design, heterogeneity among the four studies was not significant.
The SORT system is used by the American Academy of Dermatology (AAD) and other organizations to evaluate the quality, quantity and consistency of evidence supporting tests such as DecisionDx-Melanoma. The SORT scale evaluates both the quality of the evidence (Level 1, 2 or 3) and strength of the recommendation (A, B or C).

About DecisionDx-Melanoma

DecisionDx-Melanoma is a gene expression profile test that uses an individual patient’s tumor biology to predict individual risk of cutaneous melanoma metastasis or recurrence, as well as sentinel lymph node positivity, independent of traditional staging factors, and has been studied in more than 5,700 patient samples. Using tissue from the primary melanoma, the test measures the expression of 31 genes. The test has been validated in four archival risk of recurrence studies of 901 patients and six prospective risk of recurrence studies including more than 1600 patients. Prediction of the likelihood of sentinel lymph node positivity has also been validated in two prospective multicenter studies that included more than 3,000 patients. Impact on patient management plans for one of every two patients tested has been demonstrated in four multicenter and single-center studies including more than 560 patients. The consistent performance and accuracy demonstrated in these studies provides confidence in disease management plans that incorporate DecisionDx-Melanoma test results. Since its commercial launch in 2015, through December 31, 2019, DecisionDx-Melanoma has been ordered 51,967 times for use in patients with cutaneous melanoma.

More information about the test and disease can be found at www.SkinMelanoma.com.

On April 1, 2020 Trovagene, Inc. (Nasdaq: TROV), a clinical-stage, oncology therapeutics company developing onvansertib for the treatment of various cancers including colorectal, prostate and leukemia, reported that its Phase 1b/2 clinical trial of onvansertib in combination with standard-of-care FOLFIRI/Avastin (bevacizumab) for second-line treatment of patients with KRAS-mutated mCRC, will be featured in a presentation at the 2020 American Society of Clinical Oncology (ASCO) (Free ASCO Whitepaper) Annual Meeting to be held from May 29 – June 2 (Press release, Trovagene, APR 1, 2020, View Source [SID1234556073]).

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There is a significant, unmet medical need to develop a safe and effective second-line treatment option for patients with KRAS-mutated mCRC. Currently available treatments have limited efficacy with only a 4% response rate and a median of 5.5 months progression-free survival (PFS). Other compounds currently in clinical development that target KRAS-mutated cancers have shown minimal activity in mCRC.

Data presented at the ASCO (Free ASCO Whitepaper)-GI meeting in late January showed the effectiveness of onvansertib against all prevalent KRAS mutations associated with mCRC by quantitative decreases in the plasma KRAS mutation levels in treated patients within the first cycle of treatment. Subsequent radiographic scans performed at 8 and 16 weeks confirmed efficacy by measurable shrinkage of tumors in all patients.

"We are excited to have our abstract accepted for presentation at the prestigious ASCO (Free ASCO Whitepaper) annual meeting," said Dr. Thomas Adams, Chief Executive Officer and Chairman of Trovagene. "Despite more than 30 years of intensive efforts, anti-KRAS therapies have remained elusive, and currently there are no drugs effectively targeting a broad spectrum of KRAS mutations. We believe onvansertib has the potential to provide a substantially improved treatment option for second-line treatment of patients with KRAS-mutated mCRC."

About the Phase 1b/2 Trial of Onvansertib in Metastatic KRAS-mutated Colorectal Cancer

The trial, A Phase 1b/2 Study of Onvansertib (PCM-075) in Combination with FOLFIRI and Bevacizumab for Second‑Line Treatment of Metastatic Colorectal Cancer in Patients with a KRAS Mutation (NCT03829410), will evaluate the safety and efficacy of onvansertib in combination with standard-of-care FOLFIRI and Avastin (bevacizumab). Up to 44 patients, with a confirmed KRAS mutation, metastatic and unresectable disease, who have failed or are intolerant of treatment with FOLFOX (fluoropyrimidine and oxaliplatin) with or without Avastin (bevacizumab), will be enrolled. The trial is being conducted at two prestigious cancer centers: USC Norris Comprehensive Cancer Center and The Mayo Cancer Center.

About Onvansertib

Onvansertib is a first-in-class, third-generation, oral and highly-selective adenosine triphosphate (ATP) competitive inhibitor of the serine/threonine polo-like-kinase 1 (PLK1) enzyme, which is over-expressed in multiple cancers including leukemias, lymphomas and solid tumors. Onvansertib targets the PLK1 isoform only (not PLK2 or PLK3), is orally administered and has a 24-hour half-life with only mild-to-moderate side effects reported. Trovagene believes that targeting only PLK1 and having a favorable safety and tolerability profile, along with an improved dose/scheduling regimen will significantly improve on the outcome observed in previous studies with a former panPLK inhibitor in AML.

Onvansertib has demonstrated synergy in preclinical studies with numerous chemotherapies and targeted therapeutics used to treat leukemias, lymphomas and solid tumor cancers, including irinotecan, FLT3 and HDAC inhibitors, taxanes and cytotoxins. Trovagene believes the combination of onvansertib with other compounds has the potential to improve clinical efficacy in acute myeloid leukemia (AML), metastatic castration-resistant prostate cancer (mCRPC), non-Hodgkin lymphoma (NHL), colorectal cancer and triple-negative breast cancer (TNBC), as well as other types of cancer.

Trovagene has three ongoing clinical trials of onvansertib: A Phase 2 trial of onvansertib in combination with Zytiga (abiraterone acetate)/prednisone in patients with mCRPC who are showing signs of early progressive disease (rise in PSA but minimally symptomatic or asymptomatic) while currently receiving Zytiga (NCT03414034); a Phase 1b/2 Study of onvansertib in combination with FOLFIRI and Avastin for second-line treatment in patients with mCRC with a KRAS mutation (NCT03829410); and a Phase 1b/2 clinical trial of onvansertib in combination with low-dose cytarabine or decitabine in patients with relapsed or refractory AML (NCT03303339). Onvansertib has been granted orphan drug designation by the FDA in the U.S. and by the EC in the European Union for the treatment of patients with AML.

Trovagene licensed onvansertib (also known as NMS-1286937 and PCM-075) from Nerviano Medical Sciences (NMS), the largest oncology-focused research and development company in Italy, and a leader in protein kinase drug development. NMS has an excellent track record of licensing innovative drugs to pharma/biotech companies, including Array (recently acquired by Pfizer), Ignyta (acquired by Roche) and Genentech.

On April 1, 2020 Sysmex reported The "Prospective Study to Assess the Feasibility and Clinical Utility of Comprehensive Genomic Profiling at the Time of Initial Treatment in Patients with Solid Tumors" (the "Study"), which uses the OncoGuide NCC Oncopanel System1 (the "System", generic name: mutation analysis set for cancer genome profiling) developed through collaboration between the National Cancer Center (Location: Tokyo, Japan; President: Hitoshi Nakagama) and Sysmex Corporation (HQ: Kobe, Japan; Chairman and CEO: Hisashi Ietsugu), has been applied as Advanced Medical Care2 on April 1, 2020 (Press release, Sysmex, APR 1, 2020, View Source [SID1234556072]). The start date of this test will be announced on the website as soon as preparations at the National Cancer Center are completed. (View Source)

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The System analyzes genetic alterations in cancer-specific genes in patients with solid tumors and provides the cancer genomic profile of the tumor to help determine the treatment strategy, including accurate diagnosis and the selection of anti-cancer drugs. Currently, the System is covered by the National Health Insurance (NHI) in patients who have already undergone the standard treatment. Personalized genomic medicine based on cancer genomic profiling from an early phase at the time of initial treatment could provide the patients with more opportunities for appropriate treatment, including matched therapy. However, the feasibility and clinical utility of the System at the time of initial treatment remains unclear.

On April 1, 2020, the "Prospective Study to Assess the Feasibility and Clinical Utility of Comprehensive Genomic Profiling at the Time of Initial Treatment in Patients with Solid Tumors" has been applied as Advanced Medical Care. The National Cancer Center will announce the start date of this test at the National Cancer Center Hospital on its website as soon as the National Cancer Center is ready. (View Source).

The Study will include patients with six types of advanced or recurrent solid tumors, which could be treated with medication, including non-small-cell lung cancer, gastric cancer, colon cancer, breast cancer, pancreatic cancer, and biliary tract cancer (a total of 200 cases). We will evaluate whether personalized genomic medicine based on cancer genome profiling by the System at the time of initial treatment results in more opportunities of matched therapies compared to after standard treatment.

All collected samples will be analyzed at the Innovation Genome Center (Kawasaki Office) of RIKEN GENESIS Co., Ltd. (HQ: Tokyo, Japan; President and CEO: Naoto Kondo), a Sysmex subsidiary which provides lab assay services for gene analysis.

The National Cancer Center, Sysmex and RIKEN GENESIS will contribute to the implementation and development of personalized genomic medicine in Japan by providing high-value testing and diagnostic technologies for cancer patients.

Product Overview

Generic name: Gene mutation analysis set (for use in cancer genome profiling)

Name: OncoGuide NCC Oncopanel System (medical equipment production sales authorization number: 23000BZX00398000)

Target institutions: Medical institutions that have in place diagnostic systems appropriate for cancer genome profiling Target market: Japan

References

Press release dated December 25, 2018: "Sysmex Receives Manufacturing and Marketing Approval to Use the OncoGuide NCC Oncopanel System in Cancer Genome Profiling" View Source

Press release dated May 31, 2019: "The OncoGuide NCC Oncopanel System Receives Insurance Coverage for Use in Cancer Genome Profiling" View Source

Terminology
1 OncoGuide NCC Oncopanel System:
On December 25, 2018, Sysmex received manufacturing and marketing approval for the System as Japan’s first system for cancer genome profiling. This was also the first such system to be covered under the NHI, as of June 1, 2019.
The NHI coverage for D006-19 cancer genome profiling using the System includes patients with solid tumors for which no standard treatment exists and patients with solid tumors confirmed to have advanced locally or metastasized (including patients for which treatment is expected to conclude). Coverage is limited to cases in which the attending physician determines the potential for applying chemotherapy following this testing is high based on chemotherapy guidelines from related societies and the patient’s general status and organ function. The objective of Advanced Medical Care is to assess utility at the time of initial treatment.

2 Advanced Medical Care:
Refers to advanced healthcare technologies that have been approved by Japan’s Minister of Health, Labour and Welfare but are not yet covered by healthcare insurance. Based on a Fundamental Accord in December 2004 between the Minister of Health, Labour and Welfare; the Cabinet Officer Minister of State in Charge of Special Missions (regulatory reform, industrial revitalization); the minister in charge of administrative reform; and the Minister in charge of Special Zones for Structural Reform and Regional revitalization, this system was approved in combination with healthcare insurance coverage from the perspective of ensuring the safety of patients in Japan, preventing patient burdens from increasing, expanding patient choices, and increasing convenience.

On April 1, 2020 Zymeworks Inc. (NYSE: ZYME), a clinical-stage biopharmaceutical company developing multifunctional biotherapeutics, reported that its partner, BeiGene, Ltd., has dosed the first patient in a two-arm Phase 1b/2 trial evaluating Zymeworks’ HER2-targeted bispecific antibody ZW25 in combination with chemotherapy as a first-line treatment for patients with metastatic HER2-positive breast cancer and in combination with chemotherapy and BeiGene’s PD-1-targeted antibody tislelizumab as a first-line treatment for patients with metastatic HER2-positive gastroesophageal adenocarcinoma (GEA) (Press release, Zymeworks, APR 1, 2020, View Source [SID1234556071]). Zymeworks will receive a payment under its collaboration with BeiGene as a result of the achievement of this development milestone.

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"To date, ZW25 has demonstrated promising activity in late-stage, treatment-refractory HER2-expressing tumors. This new clinical trial provides a unique opportunity to evaluate the additional potential benefit of ZW25 in first-line metastatic breast tumors which have not developed resistance to multiple HER2-targeted therapeutics," said Diana Hausman, M.D., Chief Medical Officer at Zymeworks. "In addition, the GEA arm of this trial complements our ongoing Phase 2 trial of ZW25 plus chemotherapy in first-line GEA, and we are excited to examine possible synergies between ZW25 and BeiGene’s PD-1 inhibitor tislelizumab. We look forward to the results of these trials, which have the potential to further expand the population of patients who may benefit from ZW25."

"Through this collaboration with Zymeworks, our broad development program for tislelizumab is expanding into HER2-expressing tumors as a potential first-line treatment," said Lai Wang, Ph.D., Senior Vice President, Head of Global Research and APAC Clinical Development at BeiGene. "ZW25 has demonstrated appealing clinical activity against HER2-positive tumors, and we are excited to gain additional understanding of its use as a monotherapy and in combinations as well."

This Phase 1b/2 clinical trial is a multicenter, open-label, two-arm study (NCT04276493). Arm one of the trial will evaluate the safety, tolerability, and preliminary antitumor activity of ZW25 in combination with docetaxel in patients with metastatic HER2-positive breast cancer. The second arm of the trial will evaluate the safety, tolerability, and preliminary antitumor activity of ZW25 in combination with tislelizumab and chemotherapy in patients with HER2-positive GEA, including gastric and gastroesophageal junction (GEJ) adenocarcinomas.

An ongoing Phase 1 trial is evaluating the safety and antitumor activity of ZW25 as a single agent and in combination with chemotherapy in HER2-expressing cancers that have progressed after prior standard of care treatments, including HER2-targeted agents (Phase 1: NCT02892123). ZW25 is also being evaluated in a Phase 2 trial in first-line HER2-positive GEA in combination with standard of care chemotherapy (Phase 2: NCT03929666) as well as in combination with the oral CDK4/6 inhibitor palbociclib (Ibrance, Pfizer) and fulvestrant in advanced HER2-positive, HR-positive breast cancer (Phase 2: NCT04224272). Zymeworks, in collaboration with BeiGene, also plans to initiate registration-enabling studies of ZW25 in patients with previously treated HER2-positive biliary tract cancer and develop ZW25 as a potential first-line treatment for patients with HER2-positive GEA.

About ZW25

ZW25 is being evaluated in multiple Phase 1 and Phase 2 clinical trials globally. It is a bispecific antibody, based on Zymeworks’ Azymetric platform, that can simultaneously bind two non-overlapping epitopes of HER2, known as biparatopic binding. This unique design results in multiple mechanisms of action including dual HER2 signal blockade, increased binding and removal of HER2 protein from the cell surface, and potent effector function leading to encouraging antitumor activity in patients. Zymeworks is developing ZW25 as a targeted treatment option for patients with solid tumors that express HER2. The FDA has granted two Fast Track Designations to ZW25, one as a single agent for refractory biliary tract cancer and one in combination with standard of care chemotherapy, for first-line GEA. ZW25 has also received Orphan Drug Designations for the treatment of biliary tract, gastric, and ovarian cancers.

About the Zymeworks-BeiGene Collaboration

In November 2018, Zymeworks and BeiGene entered into license and collaboration agreement in which BeiGene was granted an exclusive license for the research, development and commercialization of ZW25 and ZW49 in Asia (excluding Japan), Australia, and New Zealand. The companies are collaborating on joint global development for selected indications, with the goal of developing ZW25 and ZW49 worldwide across multiple HER2-expressing cancers and lines of therapy.