On July 20, 2020 Zai Lab Limited (NASDAQ: ZLAB) and Deciphera Pharmaceuticals, Inc. (NASDAQ:DCPH) reported that the China National Medical Products Administration (NMPA) has accepted its New Drug Application (NDA) for ripretinib for the treatment of adult patients with advanced gastrointestinal stromal tumor (GIST) who have received prior treatment with 3 or more kinase inhibitors, including imatinib (Press release, Zai Laboratory, JUL 20, 2020, View Source [SID1234562114]). Ripretinib was recently granted full approval by the U.S. Food and Drug Administration (FDA) for the treatment of fourth-line GIST. Ripretinib is also approved by Health Canada for the treatment of adult patients with advanced GIST who have received prior treatment with imatinib, sunitinib, and regorafenib and by the Australian Therapeutic Goods Administration for the treatment of adult patients with advanced GIST who have received prior treatment with 3 or more kinase inhibitors, including imatinib.
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"There is a significant unmet medical need for patients with GIST in China, especially for those who are refractory to prior therapies. Based on the recent full U.S. FDA approval and compelling clinical data from the INVICTUS trial1, we believe ripretinib has the potential to alter the treatment landscape for GIST patients in China," said Dr. Samantha Du, Founder, Chairperson and Chief Executive Officer of Zai Lab. "We look forward to working closely with the NMPA to make a profound impact on the way GIST is treated in China."
"The earlier than expected acceptance of the ripretinib NDA in China underscores its potential and follows the recent FDA approval in the U.S.," said Steve Hoerter, President and Chief Executive Officer of Deciphera. "The magnitude of the unmet need for GIST patients in China is striking, with over 30,000 Chinese patients reportedly diagnosed each year. We look forward to our continued collaboration with Zai as we work to bring ripretinib to patients who are waiting for an additional treatment option."
INVICTUS is a Phase 3 randomized, double-blind, placebo-controlled, international, multicenter clinical study designed to evaluate the safety, tolerability, and efficacy of ripretinib compared to placebo in 129 patients with advanced GIST whose previous therapies have included imatinib, sunitinib, and regorafenib. Patients were randomized 2:1 to either 150 mg of ripretinib or placebo once daily. The primary efficacy endpoint was progression-free survival (PFS) as determined by independent radiologic review using modified Response Evaluation Criteria in Solid Tumors (RECIST). As previously reported, the median PFS in the study was 6.3 months compared to 1.0 month in the placebo arm, with significantly reduced the risk of disease progression or death of 85% (hazard ratio of 0.15, p<0.0001). Secondary endpoints as
determined by independent radiologic review using modified RECIST included Objective Response Rate (ORR) and Overall Survival (OS). Ripretinib demonstrated an ORR of 9.4% compared with 0% for placebo (p=0.0504). Ripretinib also demonstrated a median OS of 15.1 months compared to 6.6 months in the placebo arm and reduced the risk of death by 64% (hazard ratio of 0.36).
The most common adverse reactions (≥20%) were alopecia, fatigue, nausea, abdominal pain, constipation, myalgia, diarrhea, decreased appetite, palmar-plantar erythrodysesthesia syndrome, and vomiting. Adverse reactions resulting in permanent discontinuation occurred in 8% of patients, dosage interruptions due to an adverse reaction occurred in 24% of patients and dose reductions due to an adverse reaction occurred in 7% of patients who received ripretinib.
Note: (1) NDA submission is supported by strong results from the INVICTUS pivotal Phase 3 study showing clinically meaningful improvement in both progression-free survival and overall survival.
About Ripretinib
Ripretinib is a switch-control tyrosine kinase inhibitor that was engineered to broadly inhibit KIT and PDGFRα mutated kinases by using a unique dual mechanism of action that regulates the kinase switch pocket and activation loop. Ripretinib inhibits primary and secondary KIT mutations in exons 9, 11, 13, 14, 17, and 18, involved in GIST, as well as the primary exon 17 D816V mutation involved in systemic mastocytosis, or SM. Ripretinib also inhibits primary PDGFRα mutations in exons 12, 14, and 18, including the exon 18 D842V mutation, involved in a subset of GIST.
Ripretinib is approved by the U.S. FDA under the brand name QINLOCK for the treatment of adult patients with advanced GIST who have received prior treatment with 3 or more kinase inhibitors, including imatinib. Ripretinib is also approved by Health Canada under the brand name QINLOCK for the treatment of adult patients with advanced GIST who have received prior treatment with imatinib, sunitinib, and regorafenib and by the Australian Therapeutic Goods Administration under the brand name QINLOCK for the treatment of adult patients with advanced GIST who have received prior treatment with 3 or more kinase inhibitors, including imatinib.
Deciphera Pharmaceuticals is developing ripretinib for the treatment of KIT and/or PDGFRα-driven cancers, including GIST, SM, and other cancers.
Zai Lab has an exclusive license agreement with Deciphera for the development and commercialization of ripretinib in Greater China, including mainland China, Hong Kong, Macau and Taiwan.