On December 14, 2015 BioLineRx Ltd. (NASDAQ/TASE:BLRX), a clinical-stage biopharmaceutical company dedicated to identifying, in-licensing and developing promising therapeutic candidates, reported the filing of regulatory submissions required to commence a Phase 2 trial for BL-8040 as a novel approach for mobilization and collection of bone marrow stem cells from the peripheral blood circulation (Press release, BioLineRx, DEC 14, 2015, View Source;p=RssLanding&cat=news&id=2122198 [SID:1234508562]). The trial is expected to commence shortly after receipt of regulatory approval, anticipated in the first quarter of 2016.

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The Phase 2 open-label study will be conducted as an investigator-initiated study in collaboration with Washington University School of Medicine, Division of Oncology and Hematology, and will enroll up to 24 donor/recipient pairs. The study submission was made following a meeting with the FDA in October 2015 to discuss the BL-8040 stem cell mobilization development program. The trial will evaluate the ability of BL-8040 to promote stem cell mobilization as a single agent in the allogeneic transplantation setting. Donors between 18 and 70 years of age and their HLA-matching recipients, diagnosed with advanced hematological malignancies that require stem cell transplantation, will be recruited to the study. On the donor side, the primary endpoint of the study is the ability of a single injection of BL-8040 to mobilize sufficient amounts of cells for transplantation following up to two leukapheresis collections. On the recipient side the study aims to evaluate the functionality and engraftment following transplantation of the BL-8040 collected graft.

The safety and tolerability of BL-8040 in the healthy donors will be evaluated. In addition, graft durability, the incidence of grade 2-4 acute graft versus host disease (GvHD), and other recipient related parameters will be evaluated in the patients who have undergone transplantation of hematopoietic cells mobilized with BL-8040.

Dr. Kinneret Savitsky, Chief Executive Officer of BioLineRx, stated, "Stem cell mobilization is used increasingly as a method of collecting hematopoietic stem cells for transplantation, forming part of the treatment regimen for certain types of hematological cancers, as well as for severe anemia or immune deficiency disorders. We have already completed a successful Phase 1 safety and efficacy study in healthy volunteers, supporting BL-8040 as one-day, single-dose collection regimen, with the capacity to rapidly mobilize substantial amounts of stem cells, representing a significant improvement upon the current standard of care. Following a productive meeting with the FDA regarding the development program for BL-8040 as a stem cell mobilizer for allogeneic transplantation, and in light of the fact that there are no approved drugs for stem cell mobilization to support allogeneic transplant, we are looking forward to shortly commencing yet another Phase 2 trial for our lead oncology platform."

"In parallel, BL-8040 is also undergoing a Phase 2 study for treating relapsed and refractory acute myeloid leukemia patients, and has recently initiated a Phase 2b study as an AML consolidation treatment and a Phase 1/2 study as a novel treatment for hMDS and AA, two bone marrow failure conditions. In addition, as we recently announced, we are also performing an extensive evaluation of BL-8040’s potential in the immuno-oncology space, as a combination treatment with immune checkpoint inhibitors," added Dr. Savitsky.

About BL-8040
BL-8040 is a clinical-stage drug candidate for the treatment of acute myeloid leukemia, as well as other hematological indications. It is a short peptide that functions as a high-affinity antagonist for CXCR4, a chemokine receptor that is directly involved in tumor progression, angiogenesis (growth of new blood vessels in the tumor), metastasis (spread of the disease to other organs or organ parts) and cell survival. CXCR4 is over-expressed in more than 70% of human cancers and its expression often correlates with disease severity. BL-8040 is currently in the midst of a Phase 2 study for relapsed/refractory acute myeloid leukemia (AML) and has recently initiated a Phase 2b study as an AML consolidation treatment and a Phase 1/2 study in hMDS and AA,. In addition, in a Phase 1/2, open-label, dose escalation, safety and efficacy clinical trial in 18 multiple myeloma patients, BL-8040, when combined with G-CSF, demonstrated an excellent safety profile at all doses tested and was highly effective in the mobilization of hematopoietic stem cells and white blood cells from the bone marrow to the peripheral blood. Additionally, in a Phase 1 stem-cell mobilization study in healthy volunteers, BL-8040 as a single agent was safe and well tolerated at all doses tested and resulted in efficient stem-cell mobilization and collection in all study participants. Importantly, the results of this study support the use of BL-8040 as one-day, single-dose collection regimen, which is a significant improvement upon the current standard of care.

BL-8040 effectively mobilizes cancer cells from the bone marrow and may therefore sensitize these cells to chemo- and bio-based anti-cancer therapy. Importantly, BL-8040 has also demonstrated a direct anti-cancer effect by inducing apoptosis. Pre-clinical studies show that BL-8040 inhibits the growth of various tumor types including multiple myeloma, non-Hodgkin’s lymphoma, leukemia, non-small cell lung carcinoma, neuroblastoma and melanoma. BL-8040 also significantly and preferentially stimulated apoptotic cell death of malignant cells (multiple myeloma, non-Hodgkin’s lymphoma and leukemia). Significant synergistic and/or additive tumor cell killing activity has been observed in vitro and in vivo when tumor cells were treated with BL-8040 together with Rituximab, Bortezomib, Imatinib, Cytarabine and the FLT-3 inhibitor AC-220 (in NHL, MM, CML, AML, and AML-FLT3-ITD models, respectively). BL-8040 was licensed by BioLineRx from Biokine Therapeutics and was previously developed under the name BKT-140.

On December 14, 2015 Celsion Corporation (NASDAQ: CLSN) reported the presentation of results from its ongoing Phase I/II US DIGNITY Study of ThermoDox in combination with mild hyperthermia in patients with recurrent chest wall (RCW) breast cancer (Press release, Celsion, DEC 14, 2015, View Source [SID:1234508564]). The data, which demonstrated a combined local response rate of 61.9% among evaluable patients treated with ThermoDox, were presented on Saturday, December 12, 2015 at the San Antonio Breast Cancer Symposium during a poster session titled New Drugs and Treatment Strategies. Celsion Corporation is a fully-integrated oncology company focused on the development of a portfolio of innovative cancer treatments, including directed chemotherapies, immunotherapies and RNA- or DNA-based therapies for the treatment of cancer and other difficult-to-treat diseases.

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"Results from this study are very encouraging and suggest that ThermoDox combined with superficial hyperthermia offers a promising and well tolerated treatment option for patients with recurrent chest wall disease from breast cancer, a highly refractory form of breast cancer associated with poor quality of life and limited treatment options," said Hope Rugo, M.D., Clinical Professor, Department of Medicine and Director, Breast Oncology Clinical Trials Program at the University of California, San Francisco, and lead investigator of the study. "These findings underscore the potential for this therapy to serve as a much needed treatment for these patients, and further define the importance of advancing development of ThermoDox in this indication," Dr. Rugo added.

In the Phase I/II trials, which were designed to evaluate the safety and anti-tumor activity of ThermoDox in combination with mild hyperthermia in RCW breast cancer, a total of 28 patients were treated at doses of either 40 or 50 mg/m2. In addition to a local response rate of 61.9% among evaluable patients, a combined local response rate was observed in 46.4% of the intent-to-treat population (13/28), notably consisting of five patients demonstrating a durable local response lasting greater than three months, including four complete responses (CR) and one partial response (PR). Patients dosed at 40 mg/m2 displayed a comparable response rate and a more favorable safety profile to that of patients receiving 50 mg/m2. As a result, 40 mg/m2 will be the recommended dose for future clinical trials in this indication.

"ThermoDox in RCW breast cancer continues to yield striking response data in this vulnerable patient population, further validating our commitment to expanding this program, including the initiation of the Euro-DIGNITY Trial, a multi-center study designed to evaluate ThermoDox’s potential to locally control chest wall lesions in earlier-stage patients," said Michael H. Tardugno, Celsion’s chairman, president and CEO. "Additionally, we remain committed to providing patients who are suffering from this aggressive form of breast cancer with access to ThermoDox, and are continuing to work closely with myTomorrows to ensure the success of our Early Access Program in Europe for ThermoDox in RCW breast cancer."

The Company anticipates completion of the Phase II US DIGNITY trial by year-end, and plans to initiate a 70 patient Phase II study in Europe and Israel in less advanced, less heavily pretreated patients as part of the Euro-DIGNITY Trial. The Euro-DIGNITY Trial will evaluate ThermoDox plus radiation and hyperthermia in RCW breast cancer patients and is designed to support a registration filing in Europe. This study will be initiated throughout Europe and Israel and with assistance from MedLogics Corporation, an Italian-based hyperthermia device company. In addition, Celsion has a license and distribution agreement with myTomorrows to implement an Early Access Program (EAP) for ThermoDox in all countries of the European Union territory plus Switzerland for the treatment of patients with RCW breast cancer. The EAP provides physicians with access to products in later stage development demonstrating evidence of clinical benefit, with an acceptable safety profile and a quality manufacturing process in place.

The poster presentation is available on Celsion’s website at View Source

On December 14, 2015 Corcept Therapeutics Incorporated (NASDAQ: CORT), a pharmaceutical company engaged in the discovery, development and commercialization of drugs that treat severe metabolic, oncologic and psychiatric disorders by modulating activity at the glucocorticoid receptor (GR), reported initial efficacy data from its Phase 1/2 trial of mifepristone in combination with the chemotherapy drug eribulin to treat patients with GR-positive, metastatic, triple-negative breast cancer (TNBC) (Press release, Corcept Therapeutics, DEC 14, 2015, http://www.corcept.com/news_events/view/pr_1450104306 [SID:1234508565]). The data were presented at the 2015 San Antonio Breast Cancer Symposium (SABCS) on Saturday, December 12th, 2015.

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Trial Design and Objective

Corcept is investigating whether the addition of mifepristone, the active ingredient in Corcept’s approved medication, Korlym, will enhance the effect of eribulin in patients whose TNBC tumors express GR, one of the receptors to which Korlym binds.

The trial is being conducted in two parts. In the first phase, researchers determined the maximum tolerated combined dose of mifepristone and eribulin. This dose — 300 mg of mifepristone daily with 1.1 mg/m2 of eribulin taken on days one and eight of a three week cycle — is now being administered to patients in the trial’s second, efficacy phase, which will enroll 20 patients with GR-positive, metastatic TNBC. This phase of the trial is ongoing.

Initial Efficacy Results

At SABCS, the trial’s investigators presented efficacy data from the 15 patients enrolled to-date with GR-positive TNBC who have been treated with the recommended dose (two patients from the trial’s first phase and 13 from its second). As determined using the Response Evaluation Criteria in Solid Tumors (RECIST), initial efficacy results in this group were as follows: one patient exhibited a partial response (defined as a 30 percent or greater reduction in tumor size), seven had stable disease and five had progressive disease. Two patients were too early in their treatment to be assessed.

The combination of mifepristone and eribulin has been well-tolerated. Most adverse events have been disease-related and of mild or moderate severity, with the most common being neutropenia, fatigue, hypokalemia, nausea, hair loss and neuropathy. Neutropenia has been manageable with the administration of growth factor. No patient has suffered a serious adverse event. Pharmacokinetic data show no interaction between eribulin and mifepristone.

"We are pleased that the combination of mifepristone and eribulin appears to be active in these very ill patients," said Robert S. Fishman, MD, Corcept’s Chief Medical Officer. "Our oncology program is based on the hypothesis that GR modulators such as mifepristone can enhance the efficacy of a variety of chemotherapeutic agents in GR-positive disease. We very much look forward to completing the trial. If the final results are sufficiently positive, we plan to initiate a Phase 3 trial of this treatment regimen next year."

Corcept’s trial builds on pre-clinical and clinical research performed by investigators at Corcept and at the University of Chicago showing that modulation of activity at GR enhances the effect of chemotherapy in the treatment of TNBC. At the 2013 SABC, University of Chicago researchers presented positive results of a trial in which six patients with metastatic, GR-positive TNBC received a combination of nab-paclitaxel and mifepristone

About Triple-Negative Breast Cancer

TNBC is a form of breast cancer in which the three receptors that fuel most breast cancer growth — estrogen, progesterone and HER-2 — are not present. Because the tumor cells lack these receptors, treatments that target estrogen, progesterone and HER-2 are ineffective. Approximately 40,000 women are diagnosed with triple-negative breast cancer each year. It is estimated that more than 75 percent of these women’s tumor cells express GR. There is no FDA-approved treatment and neither a targeted treatment nor an approved standard chemotherapy regimen for relapsed triple-negative breast cancer patients exists.

Corcept has licensed patents from the University of Chicago covering the use of GR antagonists in combination with chemotherapy to treat TNBC and castration-resistant prostate cancer.

About Korlym (mifepristone)

Korlym modulates the effects of excess cortisol in patients with Cushing’s syndrome. Since 2012, Corcept has marketed Korlym as a once-daily oral treatment of hyperglycemia secondary to endogenous Cushing’s syndrome in adult patients with glucose intolerance or diabetes mellitus type 2 who have failed surgery or are not candidates for surgery. Korlym was the first FDA-approved treatment for that illness, and the FDA has designated Korlym as an Orphan Drug for that indication.

On December 14, 2015 Chugai Pharmaceutical Co., Ltd. (TOKYO: 4519) reported that Genentech Inc., a member of the Roche Group, obtained approval from the U.S. Food and Drug Administration (FDA), for the anti-cancer agent, alectinib hydrochloride (brand name: Alecensa) for the indication of "anaplastic lymphoma kinase (ALK) positive, metastatic non-small cell lung cancer (NSCLC) who have progressed on or those intolerant to crizotinib (Press release, Chugai, DEC 13, 2015, View Source [SID:1234508554])."

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"Alecensa was created by Chugai and in July 2014, Japan became the first country in the World to receive approval. We believe that the FDA’s priority review of Alecensa will bring fresh hope for patients in the US living with this disease." said Chugai’s Director and Executive Vice President, Dr. Yutaka Tanaka. "We are extremely pleased that Alecensa can contribute to the treatment of patients with ALK positive NSCLC."

Alecensa was granted Breakthrough Therapy Designation by FDA in June 2013 for patients with ALK positive NSCLC who have progressed on crizotinib. And FDA also granted priority review for Alecensa in September 2015.

The FDA’s Accelerated Approval Program allows conditional approval of a medicine that fills an unmet medical need for a serious condition based on early evidence suggesting clinical benefit. The indication for Alecensa is approved under accelerated approval based on tumour response rate and duration of response (DOR). Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial.

ALEX is a global, randomized phase III study comparing Alecensa to crizotinib as an initial treatment for people with advanced ALK-positive NSCLC. This study is part of the company’s commitment to convert the current accelerated approval in people with ALK-positive, metastatic NSCLC who have progressed on or are intolerant to crizotinib to a full approval as an initial treatment.

Alecensa is a highly selective ALK inhibitor created by Chugai. It has been reported that 2 to 5 percent of patients with NSCLC express a chromosomal rearrangement which leads to fusion of the ALK gene with another gene1. ALK kinase signaling is constantly active in cells with such fusion genes, resulting in uncontrolled growth of tumor cells and transforming the cells into tumor cells2, 3. Alecensa exerts its anti-tumor effect by selectively inhibiting ALK kinase activity to inhibit tumor cell proliferation and induce cell death4. In addition, Alecensa is not recognized by the transporter proteins in the blood brain barrier that actively pump molecules out of the brain. Alectinib is active in the central nervous system and has proven activity against brain metastases.

In Europe, Roche filed the NDA to the European Medicines Agency for the approval of "ALK fusion gene positive unresectable, recurrent/advanced NSCLC" in September 2015. Chugai has out-licensed the rights of Alecensa to Roche in overseas countries including Europe and the US.

In Japan, Alecensa capsule 20mg, 40mg and 150mg is available to patients with "ALK fusion gene positive unresectable, recurrent/advanced NSCLC" and is marketed by Chugai.

1) Biomarker committee of The Japan Lung Cancer Society, Guidelines for ALK gene tests in lung cancer patients
2) Soda et al., Nature. 448: 561-566 (2007)
3) Takeuchi et al., Clin Cancer Res. 15: 3143-3149 (2009)
4) Sakamoto et al., Cancer Cell. 19: 679-690 (2011)

Overview of two pivotal clinical phase I/II trials based on the U.S. approval

The NP28761 study is a phase I/II North American, single arm, open-label, multicentre trial evaluating the safety and efficacy of Alecensa in 87 people with ALK positive NSCLC whose disease progressed on crizotinib. (Data cut-off: October 24, 2014)
The NP28673 study is a phase I/II global, single arm, open-label, multicentre trial evaluating the safety and efficacy of Alecensa in 138 people with ALK positive NSCLC whose disease progressed on crizotinib. (Data cut-off: primary data cut-off including safety: August 18, 2014, updated IRC data cut-off: January 8, 2015)
People in the phase II studies received 600 mg of Alecensa orally twice daily. In both trials, the primary endpoint was ORR according to Response Evaluation Criteria in Solid Tumours (RECIST v1.1), and evaluated by an Independent Review Committee (IRC). Secondary endpoints included DOR and efficacy against disease that had spread to the CNS (CNS ORR and CNS DOR).

The most common Grade 3 or higher adverse events in the pooled analysis of both studies were an increase in muscle enzymes (creatine phosphokinase; 4.6 percent), shortness of breath (dyspnea; 3.6 percent), increased liver enzymes (aspartate transaminase; 3.6 percent, and alanine transaminase; 4.8 percent), evidence of liver dysfunction (hyperbilirubinemia; 2.4 percent), increased blood glucose (hyperglycemia; 2 percent), decreased levels of minerals (hypokalemia; 4 percent, hypophosphatemia; 2.8 percent, and hyponatremia; 2 percent), decreased red blood cells (anemia; 2 percent) and decreased white blood cells (lymphopenia; 4.6 percent).

On December 13, 2015 Roche (SIX: RO, ROG; OTCQX: RHHBY) reported that the US Food and Drug Administration (FDA) granted accelerated approval to Alecensa (alectinib) for the treatment of people with anaplastic lymphoma kinase (ALK)-positive, metastatic non-small cell lung cancer (NSCLC) who have progressed on or are intolerant to crizotinib (Press release, Hoffmann-La Roche , DEC 13, 2015, View Source [SID:1234508556]). In the pivotal studies, Alecensa shrank tumours in up to 44 percent of people with ALK-positive NSCLC who progressed on crizotinib (objective response rate [ORR] of 38 percent [95 percent CI 28-49] and 44 percent [95 percent CI 36-53]).

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In a subset of people with tumours that spread to the brain or other parts of the central nervous system (CNS), Alecensa shrank CNS tumours in about 60 percent of people (CNS ORR of 61 percent [95 percent CI 46-74]).

"Alecensa is now approved as a new option for people with ALK-positive NSCLC who progress on or are intolerant to crizotinib," said Sandra Horning, M.D., Chief Medical Officer and Head of Global Product Development. "Sixty percent of people enrolled in our studies had tumours that had spread to their central nervous systems, and Alecensa shrank tumours in many people in a subset of patients with CNS disease."

Possible serious side effects with Alecensa include liver problems, lung problems, slow heartbeat, muscle pain, tenderness and weakness. The most common side effects of Alecensa include tiredness, constipation and swelling in the hands, feet, ankles and eyelids.

The FDA’s Accelerated Approval Program allows conditional approval of a medicine that fills an unmet medical need for a serious condition based on early evidence suggesting clinical benefit. The indication for Alecensa is approved under accelerated approval based on tumour response rate and duration of response (DOR). Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trials.

In addition, Alecensa is being studied for use as an initial (first-line) treatment for people with advanced ALK-positive NSCLC. ALEX is a global, randomised phase III study comparing Alecensa to crizotinib as an initial treatment for people with advanced NSCLC whose tumours were characterised as ALK-positive by a companion VENTANA ALK (D5F3) CDx Assay immunohistochemistry (IHC) test developed by Roche Diagnostics. This study is part of the company’s commitment to convert the current accelerated approval in people with ALK-positive, metastatic NSCLC who have progressed on or are intolerant to crizotinib to a full approval as an initial treatment.

About NP28761 (Study 1) and NP28673 (Study 2)
Study 1 is a phase II North American, single-arm, open-label, multicentre trial evaluating the safety and efficacy of Alecensa (600 mg orally twice daily) in 87 people with ALK-positive NSCLC whose disease progressed on crizotinib. Study 2 is a phase I/II global, single-arm, open-label, multicentre trial evaluating the safety and efficacy of Alecensa (600 mg orally twice daily) in 138 people with ALK-positive NSCLC whose disease progressed on crizotinib. People in the phase II studies received 600 mg of Alecensa orally twice daily. In both trials, the primary endpoint was ORR according to Response Evaluation Criteria in Solid Tumours (RECIST v1.1), as evaluated by an Independent Review Committee (IRC). Secondary endpoints included DOR and efficacy against disease that had spread to the CNS (CNS ORR and CNS DOR). A summary of the efficacy and safety data from both studies that support this approval is included below.

The most common Grade 3 or higher adverse events in the pooled analysis of both studies were an increase in muscle enzymes (creatine phosphokinase; 4.6 percent), shortness of breath (dyspnea; 3.6 percent), increased liver enzymes (aspartate transaminase; 3.6 percent, and alanine transaminase; 4.8 percent), evidence of liver dysfunction (hyperbilirubinemia; 2.4 percent), increased blood glucose (hyperglycemia; 2 percent), decreased levels of minerals (hypokalemia; 4 percent, hypophosphatemia; 2.8 percent, and hyponatremia; 2 percent), decreased red blood cells (anemia; 2 percent) and decreased white blood cells (lymphopenia; 4.6 percent).

About Alecensa
Alecensa (RG7853/AF-802/RO5424802/CH5424802) is an investigational oral medicine created at Chugai and is being developed for people with NSCLC whose tumours are identified as ALK+. ALK+ NSCLC is often found in younger people who have a light or non-smoking history. It is almost always found in people with a specific type of NSCLC called adenocarcinoma.

Early studies with Alecensa have shown activity on brain metastases, indicating that the drug may be taken up in the brain. The brain is protected by the Blood-Brain Barrier, a network of tightly joined cells that line the inside of the blood vessels in the brain and spinal cord. One of the ways the Blood-Brain Barrier prevents molecules from affecting the brain is to actively eject them from the barrier through a process known as ‘active efflux’. The active efflux system does not recognise Alecensa, which means that it may travel into and throughout brain tissue.

The Global phase III studies of Alecensa include a companion test developed by Roche. Alecensa is marketed in Japan by Chugai Pharmaceutical, a member of the Roche Group.