On October 21, 2023 Astrazeneca reported that Positive results from the primary analysis of the DUO-E Phase III trial showed that Imfinzi (durvalumab) plus platinum-based chemotherapy, followed by either Imfinzi monotherapy or Imfinzi plus Lynparza (olaparib), both demonstrated a statistically significant and clinically meaningful improvement in progression-free survival (PFS) compared to chemotherapy alone in the overall trial population of patients with newly diagnosed advanced or recurrent endometrial cancer (Press release, AstraZeneca, OCT 21, 2023, View Source [SID1234636188]).

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These results will be presented today in a proffered paper session at the 2023 European Society for Medical Oncology (ESMO) (Free ESMO Whitepaper) Congress in Madrid, Spain (Presentation #LBA41) and simultaneously published online in the Journal of Clinical Oncology.

In the overall trial population, results showed that treatment with Imfinzi plus chemotherapy followed by Imfinzi plus Lynparza (Imfinzi plus Lynparza Arm) and treatment with Imfinzi plus chemotherapy followed by Imfinzi monotherapy (Imfinzi Arm) demonstrated a reduction in the risk of disease progression or death, by 45% (hazard ratio [HR] 0.55; 95% confidence interval [CI] 0.43-0.69; p<0.0001) and 29% (HR 0.71; 95% CI 0.57-0.89; p=0.003), respectively, versus chemotherapy alone (Control Arm). Median PFS was 15.1 months in the Imfinzi plus Lynparza Arm and 9.6 months in the Control Arm.

Mismatch repair (MMR) status is a biomarker of interest in endometrial cancer, therefore a prespecified exploratory subgroup analysis by MMR status was conducted in DUO-E. Results from the analysis of mismatch repair proficient (pMMR) patients showed a reduction in the risk of disease progression or death in both the Imfinzi plus Lynparza and the Imfinzi Arms, by 43% (HR 0.57; 95% CI 0.44-0.73) and 23% (HR 0.77; 95% CI 0.60-0.97), respectively, versus the Control Arm. Median PFS was 15 months in the Imfinzi plus Lynparza Arm and 9.7 months in the Control Arm.

Results from the analysis of mismatch repair deficient (dMMR) patients showed a similar reduction in the risk of disease progression or death in both the Imfinzi plus Lynparza and the Imfinzi Arms, by 59% (HR 0.41; 95% CI 0.21-0.75) and 58% (HR 0.42; 95% CI 0.22-0.80), respectively, versus the Control Arm.

Interim overall survival (OS) data showed a favourable trend for both treatment regimens in the overall population.

Shannon N. Westin, Professor of Gynecologic Oncology and Reproductive Medicine at The University of Texas MD Anderson Cancer Center, and principal investigator of the trial, said, "These findings showcase, for the first time, the potential of combining immunotherapy with a PARP inhibitor to deliver significant clinical improvements for these patients. These DUO-E data may offer oncologists novel avenues to enhance outcomes for endometrial cancer patients."

Susan Galbraith, Executive Vice President, Oncology R&D, AstraZeneca, said, "The treatment options for most patients with advanced endometrial cancer are limited, especially for those with mismatch repair proficiency, and have not changed for many years. We are delighted that these DUO-E data show meaningful clinical improvements for patients when Imfinzi and Lynparza are combined or when Imfinzi is added alone. We look forward to discussing these data with global regulatory authorities and bringing these important new treatment approaches to patients as soon as possible."

PD-L1 is a known biomarker for Imfinzi in other indications and a prespecified analysis based on PD-L1 status showed, in the PD-L1 positive population, that treatment reduced the risk of disease progression or death by 58% (HR 0.42; 95% CI 0.31-0.57) and 37% (HR 0.63; 95% CI 0.48-0.83) in the Imfinzi plus Lynparza and the Imfinzi Arms, respectively, versus the Control Arm. Median PFS was 20.8 months in the Imfinzi plus Lynparza Arm and 9.5 months in the Control Arm.

In the PD-L1 negative population, treatment reduced the risk of disease progression or death by 20% (HR 0.80; 95% CI 0.55-1.16) and 11% (HR 0.89; 95% CI 0.59-1.34) in the Imfinzi plus Lynparza and the Imfinzi Arms, respectively, versus the Control Arm.

The safety and tolerability profiles of both regimens (Imfinzi plus Lynparza Arm and Imfinzi Arm) were broadly consistent with those observed in prior clinical trials and the known profiles of the individual medicines.1,2

The most common adverse events (AEs) (affecting 20% or more of patients) reported in the Imfinzi plus Lynparza Arm during the overall study were anaemia (62%), nausea (55%), fatigue and asthenia (54%), alopecia (51%), neutropenia (42%), constipation (33%), thrombo-cytopenia (30%), diarrhoea (28%), vomiting (26%), peripheral neuropathy (25%), peripheral sensory neuropathy (25%), arthralgia (24%), decreased appetite (23%), leukopenia (20%) and urinary tract infection (20%).

The most common AEs reported in the Imfinzi Arm during the overall study were alopecia (50%), anaemia (48%), fatigue and asthenia (43%), nausea (41%), neutropenia (36%), diarrhoea (31%), arthralgia (30%), thrombo-cytopenia (28%), constipation (27%), peripheral neuropathy (26%), peripheral sensory neuropathy (26%) and vomiting (21%).

Notes

Endometrial cancer
Endometrial cancer is a highly heterogeneous disease that originates in the tissue lining of the uterus and is most common in women who have already been through the menopause, with the average age at diagnosis being over 60 years old.3-5 It is the 6th most common cancer in women worldwide.6 Incidence and mortality of endometrial cancer are expected to increase by approximately 46% and 62% respectively (from 417,400 cases and 97,400 deaths in 2020 to 608,130 cases and 157,813 deaths) in 2040.6,7

The majority of patients with endometrial cancer are diagnosed at an early stage of disease where the cancer is confined to the uterus. They are typically treated with surgery and/or radiation and the 5-year survival rate is high (approximately 95%). Patients with advanced disease (Stage III-IV) usually have a much poorer prognosis, with the 5-year survival rate falling to around 20-30%. The standard of care for advanced endometrial cancer has traditionally been limited to chemotherapy.5,8,9,10,11,12 There is a high unmet need for novel treatment options and strategies that can improve long-term outcomes in advanced or recurring endometrial cancer.10,13

DUO-E
The DUO-E trial (GOG 3041/ENGOT-EN10) is a three-arm, randomised, double-blind, placebo-controlled, multicentre Phase III trial of 1st-line Imfinzi (durvalumab) plus platinum-based chemotherapy (carboplatin and paclitaxel) followed by either Imfinzi monotherapy or Imfinzi plus Lynparza (olaparib) as maintenance therapy versus platinum-based chemotherapy alone as a treatment for patients with newly diagnosed advanced or recurrent endometrial cancer.

The DUO-E trial randomised 699 patients with newly diagnosed advanced or recurrent epithelial endometrial carcinoma to receive either Imfinzi (1120mg) or placebo, given every three weeks in addition to standard-of-care platinum-based chemotherapy. After 4-6 cycles of chemotherapy, patients (whose disease had not progressed) then received either Imfinzi (1500mg) or placebo every four weeks as maintenance, plus 300mg Lynparza (300mg BID [2x150mg tablets, twice a day]) or placebo until disease progression.

The dual primary endpoint was progression-free survival (PFS) of each treatment arm versus standard of care. Key secondary endpoints included overall survival (OS), safety and tolerability. Mismatch repair status, recurrence status and geographic location were stratification factors. Mismatch repair deficient (dMMR) status reflects an inability to correct DNA replication errors and therefore results in an increased risk of cancer, while mismatch repair proficient (pMMR) status indicates when DNA repair pathways remain intact and where the mismatch repair pathway is active and functional.14,15 The trial was sponsored independently by AstraZeneca and conducted in 253 study locations across 22 countries including the US, Europe, South America and Asia.

For more information about the trial please visit ClinicalTrials.gov.

Imfinzi
Imfinzi (durvalumab) is a human monoclonal antibody that binds to the PD-L1 protein and blocks the interaction of PD-L1 with the PD-1 and CD80 proteins, countering the tumour’s immune-evading tactics and releasing the inhibition of immune responses.

Imfinzi is the only approved immunotherapy and the global standard of care in the curative-intent setting of unresectable, Stage III non-small cell lung cancer (NSCLC) in patients whose disease has not progressed after chemoradiation therapy based on the PACIFIC Phase III trial. Imfinzi is also approved in the US, EU, Japan, China and many other countries around the world for the treatment of extensive-stage small cell lung cancer (SCLC) based on the CASPIAN Phase III trial. Additionally, Imfinzi is approved in combination with a short course of Imjudo (tremelimumab) and chemotherapy for the treatment of metastatic NSCLC in the US, EU and Japan based on the POSEIDON Phase III trial.

In addition to its indications in lung cancer, Imfinzi also is approved in combination with chemotherapy (gemcitabine plus cisplatin) in locally advanced or metastatic biliary tract cancer and in combination with Imjudo in unresectable hepatocellular carcinoma in the US, EU, Japan and several other countries based on the TOPAZ-1 and HIMALAYA Phase III trials, respectively. Imfinzi is approved in previously treated patients with advanced bladder cancer in a small number of countries.

Since the first approval in May 2017, more than 200,000 patients have been treated with Imfinzi.

As part of a broad development programme, Imfinzi is being tested as a single treatment and in combination with other anti-cancer treatments for patients with SCLC, NSCLC, bladder cancer, several gastrointestinal cancers and other solid tumours.

Lynparza
Lynparza (olaparib) is a first-in-class PARP inhibitor and the first targeted treatment to block DNA damage response (DDR) in cells/tumours harbouring a deficiency in homologous recombination-related (HRR) genes, such as those with mutations in BRCA1 and/or BRCA2, or those where deficiency is induced by other agents (such as new hormonal agents [NHAs]).

Inhibition of PARP with Lynparza leads to the trapping of PARP bound to DNA single-strand breaks, stalling of replication forks, their collapse and the generation of DNA double-strand breaks and cancer cell death.

Lynparza is currently approved in a number of countries across multiple tumour types including maintenance treatment of platinum-sensitive relapsed ovarian cancer and as both monotherapy and in combination with bevacizumab for the 1st-line maintenance treatment of BRCA-mutated (BRCAm) and homologous recombination repair deficient (HRD)-positive advanced ovarian cancer, respectively; for germline BRCA mutation (gBRCAm), HER2-negative metastatic breast cancer (in the EU and Japan, this includes locally advanced breast cancer); for gBRCAm, HER2-negative high-risk early breast cancer (in Japan, this includes all BRCAm HER2-negative high-risk early breast cancer); for gBRCAm metastatic pancreatic cancer; in combination with abiraterone for the treatment of metastatic castration-resistant prostate cancer (mCRPC) when chemotherapy is not clinically indicated (EU only) and for BRCAm mCRPC (US and Japan); and as monotherapy for HRR gene-mutated mCRPC in patients who have progressed on prior NHA treatment (BRCAm only in the EU and Japan). In China, Lynparza is approved for the treatment of BRCA-mutated mCRPC as well as 1st-line maintenance treatment with bevacizumab for HRD-positive advanced ovarian cancer.

Lynparza is being jointly developed and commercialised by AstraZeneca and MSD, both as a monotherapy and in combination with other potential medicines. Independently, the companies are developing and will commercialise Lynparza in combination with their respective PD-L1 and PD-1 medicines, Imfinzi (durvalumab) and Keytruda (pembrolizumab). Lynparza has been used to treat over 75,000 patients worldwide. Lynparza has a broad clinical trial development programme, and AstraZeneca and MSD are working together to understand how it may affect multiple PARP-dependent tumours as a monotherapy and in combination across multiple cancer types. Lynparza is the foundation of AstraZeneca’s industry-leading portfolio of potential new medicines targeting DDR mechanisms in cancer cells.

On October 21, 2023 Astrazeneca reported results from a prespecified exploratory analysis of the FLAURA2 Phase III trial showed Tagrisso (osimertinib) with the addition of chemotherapy demonstrated a 42% improvement in central nervous system (CNS) progression-free survival (PFS), compared to Tagrisso alone for patients with locally advanced or metastatic epidermal growth factor receptor-mutated (EGFRm) non-small cell lung cancer (NSCLC) and brain metastases at baseline, reprsenting 40% of patients in the trial, as assessed by blinded independent central review (BICR) (Press release, AstraZeneca, OCT 21, 2023, View Source [SID1234636187]).

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These results were presented today in an oral presentation at the European Society for Medical Oncology (ESMO) (Free ESMO Whitepaper) Congress in Madrid, Spain (abstract #LBA68).

In this group of patients, Tagrisso with the addition of chemotherapy reduced the risk of CNS disease progression or death by 42% compared to Tagrisso alone (based on a hazard ratio [HR] of 0.58; 95% confidence interval [CI] 0.33-1.01) as assessed by BICR. With two years of follow-up, 74% of patients treated with Tagrisso plus chemotherapy had not experienced CNS disease progression or death versus 54% of patients treated with Tagrisso monotherapy. Results also showed a higher proportion of patients demonstrated CNS complete response (CR) with Tagrisso plus chemotherapy (59%) versus Tagrisso alone (43%).

David Planchard, MD, PhD, thoracic oncologist at Gustave Roussy Institute of Oncology and principal investigator for the trial, said: "Osimertinib has a proven ability to cross the blood-brain barrier and improve outcomes for patients with lung cancer and central nervous system metastases, who often face a poorer prognosis than patients whose disease has not spread to the brain. In FLAURA2, the addition of chemotherapy to osimertinib led to a complete response and the disappearance of these tumours in the brain, in more than half of these patients."

Susan Galbraith, Executive Vice President, Oncology R&D, AstraZeneca, said: "In this trial, patients with brain metastases at baseline saw a meaningful benefit with the FLAURA2 regimen, offering hope for patients whose cancer has spread to the brain. These data build on the recent positive progression-free survival results from FLAURA2, further reinforcing Tagrisso as the backbone therapy in EGFR-mutated non-small cell lung cancer."

The safety profile of Tagrisso with the addition of chemotherapy was generally manageable and consistent with the established profiles of the individual medicines. Adverse event (AEs) rates were higher in the Tagrisso plus chemotherapy arm, driven by well-characterised chemotherapy-related AEs. Tagrisso discontinuation rates were low in both arms of the trial (11% for the Tagrisso plus chemotherapy arm and 6% for the monotherapy arm).

In the Tagrisso plus chemotherapy arm, patients remained on Tagrisso for a median duration of 22.3 months, while patients had a median exposure to platinum-based chemotherapy of 2.8 months and a median exposure to pemetrexed of 8.3 months.

Summary of results: FLAURA2 CNS efficacyi

Tagrisso plus chemotherapy

(n=118)

Tagrisso monotherapy

(n=104)

PFS HR (95% CI)

0.58 (0.33-1.01)

Median PFS (months; 95% CI)

30.2 (28.4-NCii)

27.6 (22.1-NC)

CNS objective response rate, n (%)

86 (73)

72 (69)

CR, n (%)

70 (59)

45 (43)

Median CNS duration of response (in months; 95% CI)

NRiii (23.8-NC)

26.2 (19.4-NC)

i The data cut-off date was 3 April, 2023.
ii NC, non-calculable
iii NR, not reached

Earlier this month, Tagrisso with the addition of chemotherapy was granted Priority Review by the Food and Drug Administration (FDA) for the 1st-line treatment of adult patients with locally advanced or metastatic EGFRm NSCLC based on positive PFS data from the FLAURA2 Phase III trial recently presented at the International Association for the Study of Lung Cancer 2023 World Conference on Lung Cancer. In August 2023, Tagrisso with the addition of chemotherapy also received Breakthrough Therapy Designation from the FDA in this setting.

Notes

Lung cancer
Lung cancer is the leading cause of cancer death among both men and women, accounting for about one-fifth of all cancer deaths.1 Lung cancer is broadly split into NSCLC and small cell lung cancer.2 The majority of all NSCLC patients are diagnosed with advanced disease.3

Patients with EGFRm NSCLC are particularly sensitive to treatment with an EGFR-tyrosine kinase inhibitor (EGFR-TKI) which blocks the cell-signalling pathways that drive the growth of tumour cells.4

FLAURA2
FLAURA2 is a randomised, open-label, multi-centre, global Phase III trial in the 1st-line treatment of patients with locally advanced (Stage IIIB-IIIC) or metastatic (Stage IV) EGFRm NSCLC. Patients were treated with Tagrisso 80mg once daily oral tablets in combination with chemotherapy (pemetrexed (500mg/m2) plus cisplatin (75mg/m2) or carboplatin (AUC5) every three weeks for four cycles, followed by Tagrisso with pemetrexed maintenance every three weeks.

The trial enrolled 557 patients in more than 150 centres across more than 20 countries, including in the US, Europe, South America and Asia. The primary endpoint is PFS. The trial is ongoing and will continue to assess the secondary endpoint of overall survival (OS).

Tagrisso
Tagrisso (osimertinib) is a third-generation, irreversible EGFR-TKI with proven clinical activity in NSCLC, including against CNS metastases. Tagrisso (40mg and 80mg once-daily oral tablets) has been used to treat nearly 700,000 patients across its indications worldwide and AstraZeneca continues to explore Tagrisso as a treatment for patients across multiple stages of EGFRm NSCLC.

Tagrisso is approved as monotherapy in more than 100 countries including in the US, EU, China and Japan. These include for 1st-line treatment of patients with locally advanced or metastatic EGFRm NSCLC, locally advanced or metastatic EGFR T790M mutation-positive NSCLC, and adjuvant treatment of early-stage (IB, II and IIIA) EGFRm NSCLC, where Tagrisso recently demonstrated a statistically significant and clinically meaningful OS benefit.

There is an extensive body of evidence supporting the use of Tagrisso in EGFRm NSCLC. Tagrisso is the only targeted therapy to improve survival in both early-stage disease in the ADAURA Phase III trial and late-stage disease in the FLAURA Phase III trial.

AstraZeneca also has several ongoing Phase III trials focused on earlier stages of lung cancer, including a trial in the Stage IA2-IA3 adjuvant resectable setting (ADAURA2), in the neoadjuvant setting (NeoADAURA), and in the Stage III locally advanced unresectable setting (LAURA).

The Company is also researching ways to address tumour mechanisms of resistance through the SAVANNAH and ORCHARD Phase II trials, and the SAFFRON Phase III trial, which test Tagrisso plus savolitinib, an oral, potent and highly selective MET TKI, as well as other potential new medicines.

On October 20, 2023 Hangzhou Sumgen Biotech Co., Ltd. (hereinafter referred to as "Sumgen Biotech") reported that it has received regulatory approval from the National Medical Products Administration (NMPA) to commence clinical trials for its proprietary novel ADC drug candidate SG2918 for injection, for the treatment of advanced malignant tumors (Press release, Sumgen Biotech, OCT 20, 2023, View Source;a=nav&id=355 [SID1234656271]). SG2918 is the first ADC candidate from Sumgen Biotech’s pipeline to be approved for clinical use, and it is first-in-class ADC approved for clinical trials.

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On October 20, 2023 BreakBio Corp., a biotech company dedicated to advancing innovative solutions in vaccine development for the treatment of cancer, reported that it has received Investigational New Drug (IND) approval from the U.S. Food and Drug Administration (FDA) for its investigational new personalized immunotherapy drug, BreakVax, on October 20, 2023 (Press release, Break Bio, OCT 20, 2023, View Source [SID1234644908]).

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This represents a significant milestone in the company’s commitment to addressing unmet medical needs and improving global health outcomes. This IND approval marks the culmination of extensive research and development by BreakBio Corp.’s dedicated team of oncologists, bioinformaticians, immunologists, and personalized cancer vaccine specialists.

BreakVax is a cutting-edge personalized peptide immunotherapy designed by mass spec, ML and manufactured per patient. Leveraging breakthrough technology and scientific expertise, BreakVax aims to provide a safe and effective treatment for solid cancers.

"We are thrilled to receive IND approval for BreakVax, as it underscores our unwavering dedication to advancing immunotherapies that have the potential to transform solid cancer treatments," said Roy de Souza, CEO of BreakBio Corp. "This milestone brings us one step closer to fulfilling our mission of improving survival rates, and aiming for cures for all solid cancers."

BreakBio Corp. remains committed to advancing BreakVax through the next stages of development, including our First In Human clinical trial in first indication (colorectal cancer) in 2024, with the ultimate goal of achieving the FDA’s Breakthrough Designation and making this personalized immunotherapy available to cancer patients who need it.

On October 20, 2023 BeiGene, Ltd. (Nasdaq: BGNE; HKEX: 06160; SSE: 688235), a global biotechnology company, reported the National Institute for Health and Care Excellence (NICE) of the United Kingdom (U.K.) has issued a final draft guidance (FDG) recommending BRUKINSA (zanubrutinib) for the treatment of eligible adult patients with (Press release, BeiGene, OCT 20, 2023, View Source [SID1234636171]):

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Untreated chronic lymphocytic leukemia (CLL) if there is a 17p deletion or TP53 mutation (high risk) or
Untreated CLL without a 17p deletion or TP53 mutation, and fludarabine-cyclophosphamide-rituximab (FCR) or bendamustine plus rituximab (BR) is unsuitable and
Relapsed or refractory CLL
"We are delighted that NICE has recognized the clinical and economic benefit of BRUKINSA for patients with CLL," said Dr. Robert Mulrooney, General Manager, U.K. & Ireland at BeiGene. "This follows the previous approval of BRUKINSA by NICE in July 2022 as the only cost-effective treatment for patients with Waldenstrom’s macroglobulinemia. Although we are a relatively new player in the U.K. market, we are rapidly establishing ourselves as a company that can make innovative cancer medicines accessible and affordable for U.K. patients."

As stated in the FDG, for the untreated CLL population that is high-risk or for whom FCR or BR is unsuitable and for the relapsed/refractory CLL population, zanubrutinib had lower incremental costs and more incremental quality adjusted life years compared with other BTK inhibitors. The committee considered that zanubrutinib is a cost-effective use of NHS resources in CLL.

"This decision represents a significant milestone for patients in England and Wales with CLL, the most common form of leukemia in adults," said Nick York, Patient Advocacy Healthcare Liaison Officer, U.K. Leukemia Care. "Despite continued treatment advances, many patients with CLL will relapse and need additional treatment options. Furthermore, a proportion of patients have a disease which is refractory to initial treatment."

BRUKINSA is the third BTKi for CLL to be recommended by NICE for routine commissioning.

"Zanubrutinib has demonstrated superior efficacy and a favorable safety profile in two global Phase 3 trials, SEQUOIA and ALPINE, in adult patients with CLL," said Dr. Talha Munir, consultant hematologist at Leeds Teaching Hospitals NHS Trust, Leeds, U.K.i,ii "The positive recommendation from NICE will allow patients with CLL in England and Wales to access this important new treatment option."

In addition, on October 9, 2023, BRUKINSA received approval by the Scottish Medicines Consortium for the treatment of adult patients with CLL in whom chemo-immunotherapy is unsuitable.

BRUKINSA is approved in more than 65 countries, including the U.S., China, EU, Great Britain, Canada, Australia, South Korea, and Switzerland, in selected indications and under development for additional indications globally. The global BRUKINSA development program includes more than 5,000 subjects enrolled to date in 29 countries and regions.

About Chronic Lymphocytic Leukemia (CLL)
A life-threatening cancer of adults, CLL is a type of mature B-cell malignancy in which abnormal leukemic B lymphocytes (a type of white blood cells) arise from the bone marrow and flood peripheral blood, bone marrow, and lymphoid tissues.iii,iv CLL is the most common type of leukemia in adults, accounting for about one-quarter of new cases of leukemia.iv,v Approximately 3,800 people in the U.K. are diagnosed with CLL every year.vi,vii

About BRUKINSA (zanubrutinib)
BRUKINSA is a small molecule inhibitor of Bruton’s tyrosine kinase (BTK) discovered by BeiGene scientists that is currently being evaluated globally in a broad clinical program as a monotherapy and in combination with other therapies to treat various B-cell malignancies. Because new BTK is continuously synthesized, BRUKINSA was specifically designed to deliver complete and sustained inhibition of the BTK protein by optimizing bioavailability, half-life, and selectivity. With differentiated pharmacokinetics compared to other approved BTK inhibitors, BRUKINSA has been demonstrated to inhibit the proliferation of malignant B cells within a number of disease relevant tissues.