On December 7, 2015 ARIAD Pharmaceuticals, Inc. (NASDAQ:ARIA) reported the initiation of a randomized Phase 3 trial of Iclusig (ponatinib) in second-line patients with chronic myeloid leukemia (CML) in the chronic phase (CP) (Press release, Ariad, DEC 7, 2015, View Source;p=RssLanding&cat=news&id=2120512 [SID:1234508447]). The OPTIC-2L (Optimizing Ponatinib Treatment In CML, Second Line) trial is designed to investigate the efficacy and safety of ponatinib, administered at two starting doses, compared with nilotinib, in patients who are resistant to front-line treatment with imatinib. The primary endpoint of the OPTIC-2L study, now open for patient enrollment, is major molecular response (MMR) by 12 months. Approximately 600 patients are expected to be enrolled at clinical sites in Europe, Asia, Latin America and Canada.

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"Physicians treating CML patients will be extremely interested in the outcome of this clinical trial in which ponatinib — at two different doses — will be compared to nilotinib in patients resistant to imatinib," stated Dr. D. Selleslag, Department of Hematology, St-Jan Bruges-Ostend Hospital in Belgium. "By comparing ponatinib to nilotinib in the second-line setting, we will garner valuable, randomized clinical data to better understand the potential utilization of ponatinib in this broad patient population."

Major Design Features of the Trial

This study is designed to demonstrate superiority of ponatinib over nilotinib and will enroll patients with CP-CML who have become resistant to imatinib and have received no other tyrosine kinase inhibitor. These patients will be randomized to receive once-daily administration of ponatinib at a starting dose of either 30 mg (cohort A) or 15 mg (cohort B), or 400 mg of nilotinib administered twice daily (cohort C). Patients will be randomized in a ratio of 1:2:1 respectively. Upon reaching MMR, patients in cohort A will have their daily dose of ponatinib reduced to 15 mg and patients in cohort B will have their dose reduced to 10 mg.

The primary endpoint of the trial is MMR by 12 months for each cohort. Secondary endpoints include rate of vascular occlusive events in each cohort, rates of adverse events and rates of serious adverse events.

"The OPTIC-2L trial is the first direct randomized comparison of ponatinib to an approved BCR-ABL tyrosine kinase inhibitor following imatinib therapy. We expect this trial to provide important head-to-head data regarding the efficacy and safety of treating patients with ponatinib versus nilotinib in the second-line," said Frank G. Haluska, M.D., Ph.D., senior vice president of clinical research and development and chief medical officer at ARIAD. "The trial will examine lower ponatinib starting and maintenance doses than presently approved, along with a direct comparison to nilotinib, from which we may be able to obtain regulatory authorizations that would provide patients with more treatment options in an earlier line of therapy."

Patients will be enrolled at up to 90 cancer centers in Europe, Asia, Latin America and Canada. For more information about the trial, patients and physicians should call the U.S. toll-free number 855-552-7423, the EU toll-free number 800 00027423, or the international number +1 617-503-7423 or email ARIAD at [email protected].

About Iclusig (ponatinib) tablets

Iclusig is approved in the U.S., EU, Australia, Switzerland, Israel and Canada.

In the U.S., Iclusig is a kinase inhibitor indicated for the:

Treatment of adult patients with T315I-positive chronic myeloid leukemia (chronic phase, accelerated phase, or blast phase) or T315I-positive Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL).
Treatment of adult patients with chronic phase, accelerated phase, or blast phase chronic myeloid leukemia or Ph+ ALL for whom no other tyrosine kinase inhibitor (TKI) therapy is indicated.
These indications are based upon response rate. There are no trials verifying an improvement in disease-related symptoms or increased survival with Iclusig.

IMPORTANT SAFETY INFORMATION, INCLUDING THE BOXED WARNING

WARNING: VASCULAR OCCLUSION, HEART FAILURE, and HEPATOTOXICITY

See full prescribing information for complete boxed warning

Vascular Occlusion: Arterial and venous thrombosis and occlusions have occurred in at least 27% of Iclusig treated patients, including fatal myocardial infarction, stroke, stenosis of large arterial vessels of the brain, severe peripheral vascular disease, and the need for urgent revascularization procedures. Patients with and without cardiovascular risk factors, including patients less than 50 years old, experienced these events. Monitor for evidence of thromboembolism and vascular occlusion. Interrupt or stop Iclusig immediately for vascular occlusion. A benefit risk consideration should guide a decision to restart Iclusig therapy.
Heart Failure, including fatalities, occurred in 8% of Iclusig-treated patients. Monitor cardiac function. Interrupt or stop Iclusig for new or worsening heart failure.

Hepatotoxicity, liver failure and death have occurred in Iclusig-treated patients. Monitor hepatic function. Interrupt Iclusig if hepatotoxicity is suspected.

Vascular Occlusion: Arterial and venous thrombosis and occlusions, including fatal myocardial infarction, stroke, stenosis of large arterial vessels of the brain, severe peripheral vascular disease, and the need for urgent revascularization procedures have occurred in at least 27% of Iclusig-treated patients from the phase 1 and phase 2 trials. Iclusig can also cause recurrent or multi-site vascular occlusion. Overall, 20% of Iclusig-treated patients experienced an arterial occlusion and thrombosis event of any grade. Fatal and life-threatening vascular occlusion has occurred within 2 weeks of starting Iclusig treatment and in patients treated with average daily dose intensities as low as 15 mg per day. The median time to onset of the first vascular occlusion event was 5 months. Patients with and without cardiovascular risk factors have experienced vascular occlusion although these events were more frequent with increasing age and in patients with prior history of ischemia, hypertension, diabetes, or hyperlipidemia. Interrupt or stop Iclusig immediately in patients who develop vascular occlusion events.

Heart Failure: Fatal and serious heart failure or left ventricular dysfunction occurred in 5% of Iclusig-treated patients (22/449). Eight percent of patients (35/449) experienced any grade of heart failure or left ventricular dysfunction. Monitor patients for signs or symptoms consistent with heart failure and treat as clinically indicated, including interruption of Iclusig. Consider discontinuation of Iclusig in patients who develop serious heart failure.

Hepatotoxicity: Iclusig can cause hepatotoxicity, including liver failure and death. Fulminant hepatic failure leading to death occurred in an Iclusig-treated patient within one week of starting Iclusig. Two additional fatal cases of acute liver failure also occurred. The fatal cases occurred in patients with blast phase CML (BP-CML) or Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL). Severe hepatotoxicity occurred in all disease cohorts. Iclusig treatment may result in elevation in ALT, AST, or both. Monitor liver function tests at baseline, then at least monthly or as clinically indicated. Interrupt, reduce or discontinue Iclusig as clinically indicated.

Hypertension: Treatment-emergent hypertension (defined as systolic BP≥140 mm Hg or diastolic BP≥90 mm Hg on at least one occasion) occurred in 67% of patients (300/449). Eight patients treated with Iclusig (2%) experienced treatment-emergent symptomatic hypertension as a serious adverse reaction, including one patient (<1%) with hypertensive crisis. Patients may require urgent clinical intervention for hypertension associated with confusion, headache, chest pain, or shortness of breath. In 131 patients with Stage 1 hypertension at baseline, 61% (80/131) developed Stage 2 hypertension. Monitor and manage blood pressure elevations during Iclusig use and treat hypertension to normalize blood pressure. Interrupt, dose reduce, or stop Iclusig if hypertension is not medically controlled. In the event of significant worsening, labile or treatment-resistant hypertension, interrupt treatment and consider evaluating for renal artery stenosis.

Pancreatitis: Clinical pancreatitis occurred in 6% (28/449) of patients (5% Grade 3) treated with Iclusig. Pancreatitis resulted in discontinuation or treatment interruption in 6% of patients (25/449). The incidence of treatment-emergent lipase elevation was 41%. Check serum lipase every 2 weeks for the first 2 months and then monthly thereafter or as clinically indicated. Consider additional serum lipase monitoring in patients with a history of pancreatitis or alcohol abuse. Dose interruption or reduction may be required. In cases where lipase elevations are accompanied by abdominal symptoms, interrupt treatment with Iclusig and evaluate patients for pancreatitis. Do not consider restarting Iclusig until patients have complete resolution of symptoms and lipase levels are less than 1.5 x ULN.

Neuropathy: Peripheral and cranial neuropathy have occurred in Iclusig-treated patients. Overall, 13% (59/449) of Iclusig-treated patients experienced a peripheral neuropathy event of any grade (2%, grade 3/4). In clinical trials, the most common peripheral neuropathies reported were peripheral neuropathy (4%, 18/449), paresthesia (4%, 17/449), hypoesthesia (2%, 11/449), and hyperesthesia (1%, 5/449). Cranial neuropathy developed in 1% (6/449) of Iclusig-treated patients (<1% grade 3/4). Of the patients who developed neuropathy, 31% (20/65) developed neuropathy during the first month of treatment. Monitor patients for symptoms of neuropathy, such as hypoesthesia, hyperesthesia, paresthesia, discomfort, a burning sensation, neuropathic pain or weakness. Consider interrupting Iclusig and evaluate if neuropathy is suspected.

Ocular Toxicity: Serious ocular toxicities leading to blindness or blurred vision have occurred in Iclusig-treated patients. Retinal toxicities including macular edema, retinal vein occlusion, and retinal hemorrhage occurred in 3% of Iclusig-treated patients. Conjunctival or corneal irritation, dry eye, or eye pain occurred in 13% of patients. Visual blurring occurred in 6% of the patients. Other ocular toxicities include cataracts, glaucoma, iritis, iridocyclitis, and ulcerative keratitis. Conduct comprehensive eye exams at baseline and periodically during treatment.

Hemorrhage: Serious bleeding events, including fatalities, occurred in 5% (22/449) of patients treated with Iclusig. Hemorrhagic events occurred in 24% of patients. The incidence of serious bleeding events was higher in patients with accelerated phase CML (AP-CML), BP-CML, and Ph+ ALL. Most hemorrhagic events, but not all occurred in patients with grade 4 thrombocytopenia. Interrupt Iclusig for serious or severe hemorrhage and evaluate.

Fluid Retention: Serious fluid retention events occurred in 3% (13/449) of patients treated with Iclusig. One instance of brain edema was fatal. In total, fluid retention occurred in 23% of the patients. The most common fluid retention events were peripheral edema (16%), pleural effusion (7%), and pericardial effusion (3%). Monitor patients for fluid retention and manage patients as clinically indicated. Interrupt, reduce, or discontinue Iclusig as clinically indicated.

Cardiac Arrhythmias: Symptomatic bradyarrhythmias that led to a requirement for pacemaker implantation occurred in 1% (3/449) of Iclusig-treated patients. Advise patients to report signs and symptoms suggestive of slow heart rate (fainting, dizziness, or chest pain). Supraventricular tachyarrhythmias occurred in 5% (25/449) of Iclusig-treated patients. Atrial fibrillation was the most common supraventricular tachyarrhythmia and occurred in 20 patients. For 13 patients, the event led to hospitalization. Advise patients to report signs and symptoms of rapid heart rate (palpitations, dizziness). Interrupt Iclusig and evaluate.

Myelosuppression: Severe (grade 3 or 4) myelosuppression occurred in 48% (215/449) of patients treated with Iclusig. The incidence of these events was greater in patients with AP-CML, BP-CML and Ph+ ALL than in patients with CP-CML. Obtain complete blood counts every 2 weeks for the first 3 months and then monthly or as clinically indicated, and adjust the dose as recommended.

Tumor Lysis Syndrome: Two patients (<1%) with advanced disease (AP-CML, BP-CML, or Ph+ ALL) treated with Iclusig developed serious tumor lysis syndrome. Hyperuricemia occurred in 7% (30/449) of patients overall; the majority had CP-CML (19 patients). Due to the potential for tumor lysis syndrome in patients with advanced disease, ensure adequate hydration and treat high uric acid levels prior to initiating therapy with Iclusig.

Compromised Wound Healing and Gastrointestinal Perforation: Since Iclusig may compromise wound healing, interrupt Iclusig for at least 1 week prior to major surgery. Serious gastrointestinal perforation (fistula) occurred in one patient 38 days post-cholecystectomy.

Embryo-Fetal Toxicity: Iclusig can cause fetal harm. If Iclusig is used during pregnancy, or if the patient becomes pregnant while taking Iclusig, the patient should be apprised of the potential hazard to the fetus. Advise women to avoid pregnancy while taking Iclusig.

Most common non-hematologic adverse reactions: (≥20%) were hypertension, rash, abdominal pain, fatigue, headache, dry skin, constipation, arthralgia, nausea, and pyrexia. Hematologic adverse reactions included thrombocytopenia, anemia, neutropenia, lymphopenia, and leukopenia.

Please see the full U.S. Prescribing Information for Iclusig, including the Boxed Warning, for additional important safety information.

On December 7, 2015 Kite Pharma, Inc. (Nasdaq:KITE) reported that it has initiated a phase 1/2 clinical study of KTE-C19 (ZUMA-4) for the treatment of pediatric and young adult patients with r/r ALL (Press release, Kite Pharma, DEC 7, 2015, View Source [SID:1234508442]). KTE-C19 is an investigational therapy in which a patient’s T cells are genetically modified to express a chimeric antigen receptor designed to target the antigen CD19, a protein expressed on the cell surface of B cell lymphomas and leukemias.

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"With the commencement of ZUMA-4, Kite has achieved its goal of initiating four company-sponsored trials this year for its lead product candidate, KTE-C19," said David Chang, M.D., Ph.D., Kite’s Executive Vice President, Research and Development, and Chief Medical Officer. "Our ZUMA trials are investigating critical needs in non-Hodgkin lymphoma (NHL) and ALL in patients with advanced, relapsed or refractory disease who have few or no other treatment options."

"We are enthusiastic about the possibility that KTE-C19 could safely put children and young adults who have persistent ALL despite multiple prior standard therapies into complete remissions," said internationally recognized leukemia expert Leonard S. Sender, M.D., Medical Director and Division Chief, and ZUMA-4 trial investigator, at Children’s Hospital of Orange Country. "Kite has done an outstanding job advancing immunotherapy for testing in multiple multi-center trials, and we are thrilled to offer this trial to our young patients and their families."

ZUMA-4 will proceed as a single-arm, open-label, multi-center study in patients with ALL whose disease is refractory to or has relapsed following standard chemotherapy or hematopoietic stem cell transplantation. The phase 1 portion of ZUMA-4 will assess the safety of KTE-C19, and the phase 2 portion will assess efficacy and safety. The study will target to enroll a total of 75 patients. Additional details about this study will be available on ClinicalTrials.gov.

On December 7, 2015 Roche (SIX: RO, ROG; OTCQX: RHHBY) reported follow-up results from the pivotal phase III GADOLIN study in people with indolent non-Hodgkin lymphoma (iNHL) who relapsed during or within six months after treatment with a MabThera/Rituxan (rituximab)-based regimen (Press release, Hoffmann-La Roche , DEC 7, 2015, View Source [SID:1234508440]). In a subgroup analysis of people with follicular lymphoma, the most common type of iNHL, treatment with Gazyva/Gazyvaro (obinutuzumab) plus bendamustine provided significantly greater depth of remission at end of induction compared to bendamustine alone, as measured by minimal residual disease (MRD)-negativity (82% vs 43%, respectively; p<0.0001)1. MRD assessment was an exploratory analysis.

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"Building on the significant progression-free survival benefit previously reported in the GADOLIN study, these follow-up data show that Gazyva/Gazyvaro-based treatment achieves significant rates of deep remission, known as minimal residual disease negativity, at the end of induction treatment," said Sandra Horning, MD, Roche’s Chief Medical Officer and Head of Global Product Development. "This achievement is particularly impressive in this difficult-to-treat patient population with follicular lymphoma, for whom treatment options are limited."

An additional analysis of the overall study population in the GADOLIN trial showed that a greater proportion of patients in the Gazyva/Gazyvaro arm reported a meaningful improvement in health-related quality of life (HRQoL) compared to those treated with bendamustine alone. HRQoL was a secondary endpoint in the study. This finding suggests that increased progression-free survival (PFS) does not appear to come at the expense of an increase in treatment-related toxicity that adversely impacts a patient’s quality of life.

Data from the GADOLIN MRD subgroup analysis will be presented in a poster session today, Monday December 7 by Dr. Kirsten Mundt, Senior Scientist, Roche at the 57th American Society of Hematology (ASH) (Free ASH Whitepaper), in Orlando, Florida. Data from the GADOLIN HRQoL analysis was also presented on Saturday, December 5, during a poster session by Dr. Peter Trask, Principal Scientist, Genentech and Professor Bruce Cheson from the Georgetown University Hospital, Washington DC, USA.

The FDA has accepted for priority review a supplemental Biologics License Application (sBLA) for Gazyva/Gazyvaro in the treatment of people with follicular lymphoma who relapsed after or are refractory to a MabThera/Rituxan-containing regimen. Marketing applications have also been submitted to other global regulatory authorities, including the EMA, for approval consideration in the treatment of people with follicular lymphoma who did not respond or who progressed during or up to six months after treatment with MabThera/Rituxan or a MabThera/Rituxan-containing regimen.

About the GADOLIN study
GADOLIN is a phase III open-label, multicentre, randomised two-arm study evaluating Gazyva/Gazyvaro plus bendamustine followed by Gazyva/Gazyvaro alone for up to two years, compared to bendamustine alone. GADOLIN included 413 patients with iNHL whose disease progressed during or within six months of prior MabThera/Rituxan-based therapy. The primary endpoint of the study is progression-free survival (PFS) as assessed by an independent review committee (IRC), with secondary endpoints including PFS as assessed by investigator review, response rate (RR), best response and overall survival (OS). GADOLIN data presented at the annual meeting of the American Society of Clinical Oncology (ASCO) (Free ASCO Whitepaper) in June this year showed the median PFS (mPFS) was not reached in the Gazyva/Gazyvaro-based treatment group versus 14.9 months with bendamustine alone (HR=0.55, p=0.0001) as assessed by IRC. The median PFS with Gazyva/Gazyvaro-based treatment was more than double that with bendamustine alone (29.2 months versus 14.0 months (HR=0.52, p<0.0001) as assessed by investigator review. No unexpected safety signals were identified in the Gazyva/Gazyvaro-based treatment arm. Grade 3-4 adverse events that occurred in at least two percent of patients in the Gazyva/Gazyvaro-treated group or bendamustine alone group included low white blood cell count (33% versus 26.3%), low blood platelet count (10.8% versus 16.2%), infusion-related reactions (10.8% versus 5.6%), low red blood cell count (7.7% versus 10.1%), low white blood cell count with fever (4.6% versus 3.5%), nausea (1% versus 3%), fatigue (1.5% versus 2.5%), diarrhoea (1% versus 2.5%), vomiting (2.1% versus 1%), respectively.

The MRD data from the subgroup analysis of people with follicular lymphoma will be presented at a poster presentation today, Monday 7 December, from 6:00-8:00 PM ET [Abstract #3978].

About Gazyva/Gazyvaro (obinutuzumab)
Gazyva/Gazyvaro is an engineered monoclonal antibody designed to attach to CD20, a protein found only on B-cells. Gazyva/Gazyvaro is designed to attack and destroy targeted B-cells both directly and together with the body’s immune system. Gazyva/Gazyvaro is currently approved in more than 60 countries in combination with chlorambucil, for people with previously untreated chronic lymphocytic leukaemia. The approval was based on the CLL11 study, showing significant improvements with Gazyva/Gazyvaro plus chlorambucil across multiple clinical endpoints, including PFS, overall response rate (ORR), complete response rate (CR), and minimal residual disease (MRD) when compared head-to-head with MabThera/Rituxan plus chlorambucil. Gazyva is marketed as Gazyvaro in the EU and Switzerland.

Gazyva/Gazyvaro is being studied in a large clinical programme, including the Phase III GOYA and GALLIUM studies. GOYA is comparing Gazyva/Gazyvaro head-to-head with MabThera/Rituxan plus CHOP chemotherapy in first line diffuse large B-cell lymphoma (DLBCL) and GALLIUM is comparing Gazyva/Gazyvaro plus chemotherapy followed by Gazyva/Gazyvaro maintenance head-to-head with MabThera/Rituxan plus chemotherapy followed by MabThera/Rituxan maintenance in first line indolent non-Hodgkin Lymphoma (iNHL). Additional combination studies investigating Gazyva/Gazyvaro with other approved or investigational medicines, including cancer immunotherapies and small molecule inhibitors, are planned or underway across a range of blood cancers.

About non-Hodgkin lymphoma
There are two main types of lymphoma: Hodgkin lymphoma and non-Hodgkin lymphoma (NHL). NHL represents approximately 85 percent of all lymphomas diagnosed2. Approximately 200,000 people die each year from NHL worldwide and approximately one person is newly diagnosed every 90 seconds2. There are more than 60 different types of NHL that fall under two subsets, aggressive and indolent (slow growing). The most common type of indolent NHL is follicular lymphoma (FL), found in about 25 percent of all NHL patients3. Most cases of NHL start in B-lymphocytes, cells that are part of the body’s immune system and help to defend the body against infections. B-cell lymphoma develops when these cells become cancerous and begin to multiply and collect in the lymphatic system such as in lymph nodes, lymphatic tissues or the spleen.

On December 7, 2015 Nemucore Medical Innovations, Inc., a privately held, clinical-stage biopharmaceutical company dedicated to the development of therapies targeting multi-drug resistant cancers with a special emphasis on highly lethal women’s cancers, reported the completion of an option agreement with Cancer Research Technology Ltd (CRT), the commercial arm of Cancer Research UK, for the exclusive license of worldwide commercial rights to GSK1070916 (now designated NMI-900 by Nemucore), a potent Aurora B/C kinase inhibitor targeting a broad range of cancers (Press release, Cancer Research Technology, DEC 7, 2015, View Source [SID1234523201]).

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"We are thrilled to be able to build on the excellent foundational clinical research conducted by Cancer Research UK, and continue the development of this innovative and very promising anticancer therapeutic," said Timothy P. Coleman, Ph.D., Chairman, Chief Executive Officer and President of Nemucore. "Based on its unique properties and pharmaceutical profile, we believe NMI-900 has best-in-class potential as a breakout therapy for treating women’s and other cancers associated with high mortality rates that have already been demonstrated to be intractable to conventional therapeutics."

NMI-900 is a potent ATP-competitive inhibitor of Aurora B kinase that has demonstrated high affinity for Aurora B, a significantly slower dissociation rate compared to its peers, potent anti-proliferative activity in multiple cancer cell lines, and minimal effects on non-proliferating normal human cells. In 2014, Cancer Research UK’s Centre for Drug Development successfully completed a Phase 1/2a trial of NMI-900. In this trial, NMI-900 elicited response in 61% of patients with no remaining standard therapies available to them across a wide variety of advanced and/or metastatic solid tumors. NMI-900 was well tolerated, with the most prevalent adverse event presenting as predictable and treatable neutropenia. NMI-900 was developed by Cancer Research UK’s Centre for Drug Development in partnership with GSK, under the Clinical Development Partnerships (CDP) initiative. This initiative, a joint effort launched by Cancer Research UK and Cancer Research Technology Ltd, provides a simple route for companies to progress oncology agents that would not otherwise be developed, and increase the number of clinical trials being undertaken for the treatment of cancer.

Dr. Keith Blundy, CEO of Cancer Research Technology commented, "We’re very pleased that Nemucore plans to take this promising new drug candidate and develop it through more clinical trials so that it has a greater chance of reaching patients who are in urgent need of new treatment options, sooner. The drug forms part of our Clinical Development Partnerships initiative, and is one of twelve drugs on the scheme that are moving out of the lab into clinical trials – something that wouldn’t have been possible otherwise."

Nemucore expects to initiate a Phase 2b clinical trial of NMI-900 in patients with advanced, platinum-resistant ovarian cancer in mid-2016 based on the supportive preclinical and early clinical trial results. As part of their clinical development and commercial strategy, the Company is concurrently developing a companion diagnostic with the Medical Prognosis Institute to identify patients most likely to respond to NMI-900. Nemucore expects to investigate the efficacy of NMI-900 in the treatment of EGF receptor-positive non-small cell lung cancer (NSCLC), myelodysplastic syndrome (MDS) and other difficult-to-treat cancers in the future.