On February 7, 2024 HUTCHMED (China) Limited ("HUTCHMED") (Nasdaq/AIM:​HCM; HKEX:​13) reported that data from FRUTIGA, HUTCHMED’s Phase III trial of fruquintinib in combination with paclitaxel for the treatment of second-line advanced gastric cancer in China, were presented at the American Society of Clinical Oncology (ASCO) (Free ASCO Whitepaper) ("ASCO") Plenary Series Session on February 6, 2024 (Press release, Hutchison China MediTech, FEB 7, 2024, View Source [SID1234639910]). The full presentation can be found here. Fruquintinib is a selective oral inhibitor of vascular endothelial growth factor receptors ("VEGFR") -1, -2 and -3, which play a pivotal role in blocking tumor angiogenesis.

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The ASCO (Free ASCO Whitepaper) Plenary Series was established to feature practice-changing and clinically relevant studies on the latest advances in cancer care.1

The FRUTIGA trial (clinicaltrials.gov identifier NCT03223376) was a 1:1 randomized, double-blind, Phase III study conducted at 35 sites in China to evaluate fruquintinib combined with chemotherapy, paclitaxel, compared with paclitaxel monotherapy for second-line treatment of 703 patients with advanced gastric or gastro­esophageal junction adenocarcinoma. The dual primary endpoints were progression-free survival ("PFS") and overall survival ("OS"), and the study was declared positive as the PFS endpoint met statistical significance at a pre-defined alpha level.

Median PFS for patients who received fruquintinib plus paclitaxel was 5.6 months, compared to 2.7 months for those who received paclitaxel monotherapy, a statistically significant improvement (stratified hazard ratio ["HR"] = 0.569; p < 0.0001). The objective response rate ("ORR") was significantly higher in the fruquintinib combination group (42.5% vs. 22.4%).

There was an improvement in OS with median OS of 9.6 months vs. 8.4 months, however this was not statistically significant. There was an imbalance of patients receiving subsequent antitumor therapies across the two groups, with 52.7% in the fruquintinib plus paclitaxel group vs. 72.2% in the paclitaxel monotherapy group. Pre-specified sensitivity analyses showed that in patients without these subsequent antitumor therapies, OS improvement was statistically significant. Median OS for patients who received the combination therapy was 6.9 months compared to 4.8 months for those receiving the placebo, with a HR of 0.72 (p = 0.0422).

Fruquintinib demonstrated a statistically significant improvement in multiple other endpoints, including disease control rate ("DCR") at 77.2% vs. 56.3%, and duration of response ("DoR") at 5.5 vs. 3.7 months. The most common (at least 5%) grade 3 or above treatment-emergent adverse events were neutropenia (60.0% vs. 36.4%), leukopenia (42.9% vs. 23.5%), anemia (11.7% vs. 10.6%) and palmar-plantar erythrodysesthesia syndrome (8.9% vs. 4.9%). As such, fruquintinib plus paclitaxel was well-tolerated with a safety profile consistent with expectations.

The presentation concludes that fruquintinib plus paclitaxel could be a promising second-line treatment option for patients with advanced gastric or gastro­esophageal adenocarcinoma who have failed fluoropyrimidine- or platinum-containing chemotherapy.

Presentation title

Presenter & Lead author

Presentation details

Fruquintinib plus paclitaxel versus paclitaxel as second-line therapy for patients with advanced gastric or gastroesophageal junction adenocarcinoma (FRUTIGA): a randomized, multicenter, double-blind, placebo-controlled, phase 3 study

Rui-Hua Xu, MD, PhD

February ASCO (Free ASCO Whitepaper) Plenary Series Session

Abstract 438730

Tuesday, February 6, 2024
3 pm ET (8pm GMT, 4am HKT)

The New Drug Application ("NDA") for fruquintinib in combination with paclitaxel for the treatment of second-line advanced gastric or gastroesophageal junction adenocarcinoma in China was accepted for review by the China National Medical Products Administration in April 2023. Fruquintinib is approved in China and the United States for the treatment of certain patients with metastatic colorectal cancer ("mCRC").

About the ASCO (Free ASCO Whitepaper) Plenary Series

According to ASCO (Free ASCO Whitepaper), the ASCO (Free ASCO Whitepaper) Plenary Series was established to feature practice-changing and clinically relevant studies on the latest advances in cancer care. Up to two abstracts are presented in each session, and accompanied by a discussant presentation and a live question and answer session. It was developed by ASCO (Free ASCO Whitepaper) so that researchers and clinicians can stay current on cutting-edge research in oncology in between meetings, providing faster dissemination of practice-changing science to better help clinicians deliver the most up-to-date care and treatments to patients.

Abstracts at the ASCO (Free ASCO Whitepaper) Plenary Series are expected to address novel scientific questions, detail clinical observations, and contain primary scientific data in the form of a randomized phase II and III trial, or be original research studies that highlight novel and high-impact research with practice-changing implications. Presented studies are also expected to be placed in an oral presentation at the ASCO (Free ASCO Whitepaper) Annual Meeting.

About the Phase III FRUTIGA Trial

FRUTIGA is a randomized, double-blind, Phase III study in China to evaluate fruquintinib combined with paclitaxel compared with paclitaxel monotherapy, for second-line treatment of advanced gastric cancer. The study enrolled 703 patients. Its dual-primary endpoints were PFS and OS. The trial met the PFS endpoint at a statistically and clinically meaningful level. While there was an improvement in median OS, the OS endpoint was not statistically significant per the pre-specified statistical plan. Fruquintinib also demonstrated a statistically significant improvement in secondary endpoints including objective response rate (ORR), DCR and DoR. The safety profile of fruquintinib in FRUTIGA was consistent with previously reported studies. Additional details may be found at clinicaltrials.gov, using identifier NCT03223376.

About Gastric Cancer

Gastric cancer is a cancer that starts in the stomach. It is the fifth most common cancer worldwide in 2020. It was estimated to have caused approximately 770,000 deaths worldwide.2 In China, it was estimated that over 478,000 people were diagnosed with gastric cancer, and approximately 374,000 people died from gastric cancer.3

About Fruquintinib

Fruquintinib is a selective oral inhibitor of VEGFR-1, -2 and -3. VEGFR inhibitors play a pivotal role in inhibiting tumor angiogenesis. Fruquintinib was designed to have enhanced selectivity that limits off-target kinase activity, allowing for high drug exposure, sustained target inhibition, and flexibility for the potential use as part of combination therapy. Fruquintinib has demonstrated a manageable safety profile and is being investigated in combinations with other anti-cancer therapies.

About Fruquintinib Approval in China

Fruquintinib is approved for marketing in China, where it is co-marketed by HUTCHMED and Lilly under the brand name ELUNATE. It was included in the China National Reimbursement Drug List (NRDL) in January 2020. The approval was based on data from the FRESCO study, a Phase III pivotal registration trial of fruquintinib in 416 patients with mCRC in China, which were published in The Journal of the American Medical Association, JAMA. Since its launch in China, fruquintinib has benefited more than 80,000 colorectal cancer patients as of mid-2023.

About Fruquintinib Approval in the United States

Fruquintinib received approval in the United States in November 2023, where it is marketed by Takeda under the brand name FRUZAQLA. The approval was based on data from two large Phase III trials: the multi-regional FRESCO-2 trial, data from which were published in The Lancet, along with the FRESCO trial conducted in China. The trials investigated fruquintinib plus best supportive care versus placebo plus best supportive care in patients with previously treated mCRC. Both FRESCO and FRESCO-2 met their primary and key secondary efficacy endpoints and showed consistent benefit among a total of 734 patients treated with fruquintinib. Safety profiles were consistent across trials.

On February 7, 2024 Genprex, Inc. ("Genprex" or the "Company") (NASDAQ: GNPX), a clinical-stage gene therapy company focused on developing life-changing therapies for patients with cancer and diabetes, reported the expansion of its nonclinical programs into new indications through Sponsored Research Agreements and Material Transfer Agreements with multiple academic research collaborators to study TUSC2, the tumor suppressor gene used in Genprex’s lead drug candidate, REQORSA (quaratusugene ozeplasmid), and NPRL2, another tumor suppressor gene (Press release, Genprex, FEB 7, 2024, View Source [SID1234639909]). The new indications being evaluated include ALK-positive lung cancer and other additional programs that are not disclosed at this time.

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"We are developing a robust research program to expand the potential tumor targets, and even non-tumor targets, that we may include in future clinical trials for REQORSA," said Rodney Varner, Chairman, President and Chief Executive Officer at Genprex. "Research indicates that the TUSC2 gene used in REQORSA may benefit many types of cancers and potentially the treatment of other diseases. We are exploring opportunities to treat other cancers in which TUSC2 is often deleted or inactivated, and we are evaluating TUSC2 basic biology to better understand how to use our REQORSA treatment. Finally, we are also exploring the use of another tumor suppressor gene, NPRL2, in cancer treatment using our Oncoprex Nanoparticle Delivery System."

Genprex’s expanded nonclinical programs include these additional studies with TUSC2 and NPRL2:

TUSC2 in ALK-EML4 positive translocated lung cancer at the University of Michigan Rogel Cancer Center
TUSC2 in metabolism at Meharry Medical College in Nashville, Tennessee
NPRL2 in lung cancers with a major cancer research center in Houston, Texas
TUSC2 in ALK-EML4 positive translocated lung cancer at the University of Michigan Rogel Cancer Center’s Judith Tam ALK Lung Cancer Research Initiative:

ALK-EML4 positive translocated lung cancer is a subset of non-small cell lung cancer (NSCLC) that impacts young and relatively healthy individuals. Since the discovery of the ALK-EML4 translocation, there has been research into targeting and treating this malignancy, which has led to approval by the U.S. Food and Drug Administration (FDA) of various ALK-targeted therapies including crizotinib, alectinib and lorlatinib. Although these compounds provide significant benefit in treating ALK-EML4-driven malignancies initially, resistance ultimately develops. The 5-year survival rate of ALK-EML4 translocated lung cancers is 40.9%, which is higher than other types of lung cancer but we believe leaves substantial room for improvement.

TUSC2 is a tumor suppressor gene that is frequently deleted in lung cancer. In fact, approximately 82% of all NSCLCs lack or express decreased amounts of TUSC2 tumor suppressor protein. ALK translocations are found in approximately 5% of NSCLCs. Research collaborators at the Rogel Cancer Center’s Judith Tam ALK Lung Cancer Research Initiative are studying the combination of Genprex’s REQORSA, which uses the TUSC2 tumor suppressor gene, with various ALK inhibitors. An abstract submitted by these researchers was accepted for presentation at the 2024 AACR (Free AACR Whitepaper) Annual Meeting.

TUSC2 Control of Mitochondrial Metabolism at Meharry Medical College:

The TUSC2 gene is encoded in the cell’s DNA in the nucleus, but the TUSC2 protein resides in the inner membrane of the mitochondria. This suggests that TUSC2 protein may be one way in which the cell controls energy production, which largely occurs in the inner membrane of the mitochondria. In addition, mice lacking the TUSC2 gene in all cells, or TUSC2 knock-out mice, can exhibit a number of characteristics consistent with underlying metabolic abnormalities, including premature aging, aging-associated pathologies, and decreased survival. Thus, researchers at Meharry Medical College have been exploring TUSC2 effects on mitochondrial metabolism and have had their work accepted for presentation at the 2024 AACR (Free AACR Whitepaper) Annual Meeting.

NPRL2 in Lung Cancers

Following a presentation on NPRL2 at AACR (Free AACR Whitepaper) 2023, additional research has been performed to evaluate the use of lipid nanoparticles containing the tumor suppressor gene, NPRL2, in mouse xenografts with resistant cancers. This work, which validates Genprex’s ONCOPREX Nanoparticle Delivery System technology as a platform, has been selected for a presentation at the 2024 AACR (Free AACR Whitepaper) Annual Meeting.

Genprex’s ONCOPREX Nanoparticle Delivery System, is a novel non-viral approach that utilizes lipid nanoparticles to deliver tumor suppressor genes deleted during the course of cancer development. The platform allows for the intravenous delivery of various tumor suppressor genes, and potentially other genes, to achieve a therapeutic affect without the risk of toxicity often associated with viral delivery systems. Genprex believes this system allows for delivery of a number of cancer-fighting genes, alone or in combination with other cancer therapies, to combat multiple types of cancer.

About Reqorsa Therapy

REQORSA (quaratusugene ozeplasmid) for NSCLC and SCLC consists of the TUSC2 gene expressing plasmid encapsulated in non-viral nanoparticles made from lipid molecules (Genprex’s ONCOPREX Nanoparticle Delivery System) with a positive electrical charge. REQORSA is injected intravenously and specifically targets cancer cells, which generally have a negative electrical charge. REQORSA is designed to deliver the functioning TUSC2 gene to cancer cells while minimizing their uptake by normal tissue. REQORSA has a multimodal mechanism of action whereby it interrupts cell signaling pathways that cause replication and proliferation of cancer cells, re-establishes pathways for programmed cell death, or apoptosis, in cancer cells, and modulates the immune response against cancer cells.

Genprex’s strategy is to develop REQORSA in combination with currently approved therapies and believes that REQORSA’s unique attributes position it to provide treatments that improve on these current therapies for patients with NSCLC, SCLC, and possibly other cancers.

On February 7, 2024 Enlivex Therapeutics Ltd., (Nasdaq: ENLV, the "Company"), a clinical-stage macrophage reprogramming immunotherapy company, reported that the U.S. Patent and Trademark Office issued a new patent, number US 11,883,429, covering AllocetraTM, the Company’s immunotherapy product candidate (Press release, Enlivex Therapeutics, FEB 7, 2024, View Source [SID1234639908]). The new patent is expected to provide added intellectual property protection in the United States for the product’s composition and manufacturing method.

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On February 7, 2024 Cellectar Biosciences, Inc. (NASDAQ: CLRB), a late-stage clinical biopharmaceutical company focused on the discovery, development, and commercialization of drugs for the treatment of cancer, reported that James Caruso, president and chief executive officer of Cellectar, will present an overview of the company at the upcoming Oppenheimer 34th Annual Healthcare Life Sciences Conference being held virtually (Press release, Cellectar Biosciences, FEB 7, 2024, View Source [SID1234639907]). Details of the presentation are as follows:

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Date: Wednesday, February 14, 2024
Time: 2:00 – 2:30 pm Eastern Time
Webcast: Click HERE

A replay of the presentation will be available on Events section of the company’s investor relations website.

On February 7, 2024 Bristol Myers Squibb (NYSE: BMY) reported two regulatory acceptances for applications for neoadjuvant Opdivo (nivolumab) with chemotherapy followed by surgery and adjuvant Opdivo for the perioperative treatment of resectable stage IIA to IIIB non-small cell lung cancer (NSCLC) (Press release, Bristol-Myers Squibb, FEB 7, 2024, View Source [SID1234639906]). The U.S. Food and Drug Administration (FDA) accepted the supplemental Biologics Application (sBLA) and assigned a Prescription Drug User Fee Act (PDUFA) goal date of October 8, 2024. In late January, the European Medicines Agency (EMA) validated the type II variation application which confirms the submission is complete and begins the start of the EMA’s centralized review process.

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"Between 30% to 55% of non-small cell lung cancer patients who undergo surgery will experience disease recurrence. We are working to expand options that improve outcomes for patients with resectable disease, as part of our comprehensive approach to the treatment of multiple types of cancer, including and especially in earlier stages," said Abderrahim Oukessou, M.D., vice president, thoracic cancers global program lead, Bristol Myers Squibb. "With CheckMate -77T, we have evaluated the potential for neoadjuvant immunotherapy to induce pathological complete response and the role of perioperative Opdivo treatment in reducing the likelihood that the cancer will return and help make extended survival possible for patients. The acceptance of these applicationsunderscores our impactful progress in addressing unmet needs across several non-small cell lung cancer treatment settings and brings us one step closer to offering a new perioperative Opdivo-based regimen to patients who may benefit."

The submissions were based on results from the Phase 3 CheckMate -77T trial, which represents the company’s second positive Phase 3 randomized trial with an immunotherapy-based combination for the treatment of resectable NSCLC, showing statistically significant and clinically meaningful improvements in event-free survival (EFS), the study’s primary endpoint. The study also showed benefits in key secondary endpoints including pathologic complete response (pCR) and major pathologic response (MPR). Additionally, the perioperative regimen had a safety profile consistent with previously reported studies in NSCLC and no new safety signals were identified. The EFS, pCR and MPR results from CheckMate -77T were presented at the European Society of Medical Oncology (ESMO) (Free ESMO Whitepaper) Congress 2023. The study remains ongoing to assess another secondary endpoint of overall survival (OS).

Opdivo and Opdivo-based combinations have shown efficacy benefits in the neoadjuvant, adjuvant or perioperative settings across four cancers to date, including lung cancer, bladder cancer, esophageal/gastroesophageal junction cancer and melanoma.

About CheckMate -77T
CheckMate -77T is a Phase 3 randomized, double-blind, placebo-controlled, multi-center trial evaluating neoadjuvant Opdivo with chemotherapy followed by surgery and adjuvant Opdivo versus neoadjuvant chemotherapy and placebo followed by surgery and adjuvant placebo in 452 patients with resectable stage IIA to IIIB non-small cell lung cancer (NSCLC). The primary endpoint of the trial is event-free survival (EFS). Secondary endpoints include overall survival (OS), pathologic complete response (pCR) and major pathologic response (MPR).

About Lung Cancer
Lung cancer is the leading cause of cancer deaths globally. Non-small cell lung cancer (NSCLC) is one of the most common types of lung cancer, representing up to 84% of diagnoses. Non-metastatic cases account for the majority of NSCLC diagnoses (approximately 60%, with up to half of these being resectable), and the proportion is expected to grow over time with enhanced screening programs. While many non-metastatic NSCLC patients are cured by surgery, 30% to 55% develop recurrence and die of their disease despite resection, contributing to a need for treatment options administered before surgery (neoadjuvant) and/or after surgery (adjuvant) to improve long-term outcomes.