On January 29, 2020 Syros Pharmaceuticals (NASDAQ: SYRS), a leader in the development of medicines that control the expression of genes, reported new preclinical data showing that inhibiting cyclin-dependent kinase 7 (CDK7) results in different transcriptional effects than inhibiting cyclin-dependent kinase 12 (CDK12), pointing to distinct therapeutic opportunities to benefit patients with difficult-to-treat cancers (Press release, Syros Pharmaceuticals, JAN 29, 2020, View Source [SID1234553664]). Building on its leadership in gene control, Syros also described new methods for identifying essential genes and transcriptional dependencies in cancer that could serve as potential drug targets. These data were presented at the 2020 Keystone Symposia Cancer Epigenetics: New Mechanisms and Therapeutic Opportunities.

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"Together, these presentations underscore our leadership in CDK inhibition and, more broadly, in the field of gene control," said Eric R. Olson, Ph.D., Syros’ Chief Scientific Officer. "Our understanding of how regulatory regions of the genome control the expression of genes is growing by leaps and bounds, bringing into reach a wide range of diseases that have long eluded effective treatment with other genomics-based approaches. Our platform allows us to elucidate those regulatory regions to pinpoint which genes to control, in which cells, for which patients, and how best to control the expression of those genes using oral molecules to maximize the chances of providing a profound benefit for patients."

CDK7 Inhibition and CDK12 Inhibition as Distinct Therapeutic Approaches
Syros scientists studied the transcriptional effects of selective CDK7 and CDK12 inhibition in an ovarian cancer cell line, marking the first reported direct comparison of these two approaches. CDK7 and CDK12 are members of the CDK family that have emerged as potentially important drug targets in cancer because of their roles in transcription, the process by which genes express proteins. The findings showed that, under the conditions tested, CDK7 and CDK12 inhibition had distinct effects despite decreasing expression of many of the same genes:

CDK7 decreased expression of more genes.
CDK12 inhibition preferentially decreased expression of genes with longer transcripts, a phenomenon that was not observed with CDK7 inhibition.
The DNA double-stranded break repair pathway is enriched for genes with longer transcripts that are preferentially downregulated by CDK12 inhibition.
CDK12 inhibition induced DNA damage, while CDK7 inhibition did not.
The results suggest that a selective CDK12 inhibitor presents distinct therapeutic opportunities from a selective CDK7 inhibitor, such as increasing the susceptibility of cancer to targeted therapies involved in DNA damage repair such as PARP1 inhibitors.

Syros has a highly selective and potent oral CDK7 inhibitor, SY-5609, currently in a Phase 1 trial in patients with advanced breast, colorectal, lung or ovarian cancer, or with solid tumors of any histology that harbor Rb pathway alterations. In addition to decreasing the expression of cancer-driving genes, CDK7 inhibition has also been shown to interfere with cancer’s ability to progress unchecked through the cell cycle. Syros also has a CDK12/13 inhibitor program in preclinical development in cancer.

Building on its Leadership in Gene Control
Syros scientists also presented on two new methods for identifying genes and transcriptional regulators upon which cancer cells are particularly dependent for their survival with the aim of identifying new drug targets.

By analyzing cancer cells with gene copy-number deletions, Syros scientists identified approximately 200 genes that represent dose-dependent transcriptional liabilities across several cancers, including general regulators of transcription that may be attractive drug targets in genetically defined tumor types. Since cancers with copy-number deletions may be more dependent on these regulators than non-cancerous cells, inhibiting them may kill cancer cells while sparing non-cancerous cells. Syros presented preclinical data on one of these transcriptional regulators, INTS11, showing that a glioblastoma cancer cell line with a 1p36-deletion, which is commonly associated with INTS11 copy-number loss, is more sensitive to decreased levels of INTS11 than a cell line without a 1p36-deletion.

In a separate presentation, Syros scientists presented data showing that its new computational model, PETCERF, outperforms earlier-generation models used to score individual enhancers to identify genes critical for a cancer cell’s survival. By integrating multiple variables and inputs related to the enhancer and gene regulatory landscapes into a machine learning model trained using CRISPR knock-out data, PETCERF was shown to identify genes in primary tumor samples that are essential to cancer cells.

Additionally, Dr. Olson will present tomorrow during an oral session on how Syros’ gene control platform has led to a pipeline of small-molecule drug candidates that control the expression of genes with the aim of providing much-needed new medicines for patients with a range of blood cancers and solid tumors.

On January 29, 2020 Bluestar Genomics, a company developing innovative, data-driven, epigenomic approaches to comprehensive disease analysis and diagnostics, reported the publication of a new study demonstrating the efficacy of their 5-hydroxymethylcytosine (5hmC) signal detection technology for its use in breast, lung, pancreatic, and prostate cancer (Press release, Bluestar Genomics, JAN 29, 2020, View Source [SID1234553663]). The study was published online in medRxiv. Results from the study provide further evidence that, using a single blood draw, Bluestar Genomics’ technology can non-invasively detect cancers and help identify the underlying biology of the disease using epigenetic markers.

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Breast, lung, pancreatic, and prostate cancer make up 41% of the cancer incidence in the United States. Early detection and a deep understanding of each cancer remain critical for implementing the highest quality of care. Tissue biopsy is invasive, and screening methods are limited for many forms of cancer and often fall short of capturing the complete genomic landscape. Bluestar Genomics uses liquid biopsy combined with 5hmC profiling to provide a detailed picture of the genomic landscape and identify potential biologic pathways that may be driving tumor progression.

"We have taken significant strides to strengthen our understanding of the underlying biology related to multiple forms of cancer and the tumor microenvironment," said Samuel Levy, Chief Executive Officer and Chief Scientific Officer, Bluestar Genomics. "In addition to early-stage cancer detection capabilities, our knowledge of 5hmC distribution across the genome can potentially yield new candidate biomarkers. With this information, we will create clinical tools that can revolutionize oncology screening and have a significant impact on patient outcomes."

Bluestar Genomics executed the study using multiple cell-free DNA samples to measure 5hmC profiles from patients with breast, lung, pancreatic, and prostate cancer. When used in conjunction with machine learning-based classification methods, their novel enrichment technology exhibited high performance in classifying these samples with Area Under the Curve (AUC) measures of 0.89, 0.84, 0.95 and 0.83, respectively. The majority of the breast and pancreatic cancer samples were stage 1 or stage 2, validating Bluestar Genomics’ potential to aid clinical decision making and detect cancer when treatment is most effective.

"There are significant limitations in screening for various cancers," said Kelly Bethel, MD, Chief Medical Officer, Bluestar Genomics. "Our research data outperforms screening PSA testing, the current standard of care screening blood test for prostate cancer. Detection of small early malignancies is challenging by usual imaging methods, and our platform technology also demonstrates the ability to detect the presence of malignant tumors smaller than 2cm. Overall, these findings suggest a clinical path toward early detection as part of a multi-cancer screening test."

These results were presented by Anna Bergamaschi, Ph.D., Principal Scientist, Bluestar Genomics at the PMWC 2020 Silicon Valley conference on January 23 at the Liquid Biopsy Showcase.

On January 29, 2020 The Janssen Pharmaceutical Companies of Johnson & Johnson reported that the European Commission (EC) has granted marketing authorisation for the expanded use of Erleada▼ (apalutamide) to include the treatment of adult men with metastatic hormone-sensitive prostate cancer (mHSPC) in combination with androgen deprivation therapy (ADT) (Press release, Janssen Pharmaceuticals, JAN 29, 2020, View Source [SID1234553661]).

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"Prostate cancer is the most prevalent form of cancer in men throughout Europe, and the expanded approval of apalutamide marks a significant advancement for those living with mHSPC," said Prof. Dr. med. Axel S. Merseburger, Chairman of the Department of Urology, Campus Lübeck, University Hospital Schleswig-Holstein, Kiel, Germany. "In prostate cancer treatment, our primary goal is always to delay progression of disease and prolong survival, to ensure the best possible outcomes for patients. Today’s news is therefore an encouraging development for patients within Europe, for whom the importance of an additional treatment option that can both delay progression and extend survival cannot be underestimated."

The EC approval is based on data from the Phase 3 TITAN study, which assessed the addition of apalutamide to ADT in a broad range of patients with mHSPC, regardless of disease volume, prior treatment with docetaxel or staging at initial diagnosis. The dual primary endpoints of the study were overall survival (OS) and radiographic progression-free survival (rPFS).2 Apalutamide plus ADT significantly improved OS compared to placebo plus ADT with a 33 percent reduction in the risk of death (HR=0.67; 95% CI, 0.51-0.89; p=0.0053).2 In both study arms, median OS was not reached.2 Apalutamide plus ADT also significantly improved rPFS compared to placebo plus ADT with a 52 percent reduction in risk of radiographic progression or death compared to placebo plus ADT (HR=0.48; 95% CI, 0.39-0.60; p<0.0001).2 The median rPFS was 22.1 months for placebo plus ADT and not reached for apalutamide plus ADT.2 The two-year OS rates, after a median follow up of 22.7 months, were 82 percent for apalutamide plus ADT compared to 74 percent for placebo plus ADT.2 These results were published in The New England Journal of Medicine.2,3

The safety profile observed in the TITAN study for apalutamide plus ADT was consistent with that described in previous studies. In the study, 42 percent of patients on apalutamide plus ADT experienced Grade 3/4 adverse events (AEs), compared to 41 percent of patients on placebo plus ADT.2 The most common Grade ≥3 AEs for apalutamide plus ADT versus placebo plus ADT were hypertension (8.4 percent vs. 9.1 percent) and skin rash (6.3 percent vs. 0.6 percent). Treatment discontinuation due to AEs was 8 percent in the apalutamide arm compared to 5 percent in the placebo arm.2

"We are delighted with the EC’s approval of the extended use of apalutamide, which makes an important treatment option potentially available to over 100,000 patients living with mHSPC across Europe," said Joaquín Casariego, M.D., Janssen Therapeutic Area Lead Oncology for Europe, Middle East & Africa, Janssen-Cilag S.A. "It is vital to fight cancer at this stage of the disease with an efficacious new line of treatment, to delay progression to the late and fatal mCRPC stage and, crucially, prolong survival. Janssen remains committed to transforming treatment outcomes for patients and improving lives throughout the prostate cancer journey."

"We continue to be encouraged by the clinical trial data for apalutamide, which demonstrates that the addition of apalutamide to ADT improves outcomes for a broad range of patients with mHSPC, compared to ADT alone," said Craig Tendler, M.D., Vice President, Clinical Development and Global Medical Affairs, Oncology at Janssen Research & Development, LLC. "This approval is welcome news for patients with mHSPC and highlights our focus of addressing areas of high unmet need across the prostate cancer disease continuum."

In Europe, apalutamide is also approved for use in adults with non-metastatic castration-resistant prostate cancer (nmCRPC) who are at high risk of developing metastatic disease.4

About the TITAN Study2,3
TITAN is a Phase 3 randomised, placebo-controlled, double-blind study in men with mHSPC regardless of extent of disease or prior docetaxel treatment history. The study included 1,052 patients in intention-to-treat (ITT) population in 23 countries across 260 sites in North America, Latin America, South America, Europe and Asia Pacific. Patients with mHSPC were randomised 1:1 and received either apalutamide (240 mg) plus continuous androgen deprivation therapy (ADT) (n=525), or placebo plus ADT (n=527). The recruitment period for the study spanned from December 2015 to July 2017. The study included a broad population of patients with mHSPC, including patients with both low- and high-volume disease, those who were newly diagnosed, or those who had received prior definitive local therapy or prior treatment with up to six cycles of docetaxel or up to six months of ADT for mHSPC. Participants were treated until disease progression or the occurrence of unacceptable treatment-related toxicity. An independent data-monitoring committee was commissioned by the sponsor to monitor safety and efficacy before unblinding and make study conduct recommendations. Dual primary endpoints of the study were OS and rPFS. Secondary endpoints included time to cytotoxic chemotherapy, time to pain progression, time to chronic opioid use and time to skeletal-related event. Exploratory endpoints included time to PSA progression, time to second progression-free survival and time to symptomatic progression. For additional study information, visit ClinicalTrials.gov.

About apalutamide
Apalutamide is an androgen receptor (AR) inhibitor indicated for use in Europe for the treatment of patients with non-metastatic castration-resistant prostate cancer (nmCRPC) who are at high risk of developing metastatic disease and metastatic hormone-sensitive prostate cancer (mHSPC).4 In the U.S. apalutamide is indicated for the treatment of nmCRPC and mHSPC.5

About Metastatic Hormone-Sensitive Prostate Cancer
Metastatic hormone-sensitive prostate cancer (mHSPC), also referred to as metastatic castration sensitive prostate cancer (mCSPC), refers to prostate cancer that still responds to androgen deprivation therapy (ADT) and has spread to other parts of the body.6 Patients with mHSPC tend to have a poor prognosis, with a median overall survival (OS) of less than five years, underscoring the need for new treatment options.7,8,9

On January 29, 2020 Starpharma (ASX: SPL, OTCQX: SPHRY) reported its Appendix 4C – Quarterly Cashflow Report for the period ended 31 December 2019 (Press release, Starpharma, JAN 29, 2020, View Source [SID1234553660]).

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Starpharma’s cash balance as at 31 December 2019 was $35.9 million, with net operating cash outflows for the quarter of $0.5 million, compared to $4.6 million last quarter. Receipts for the quarter included the $4.9 million R&D tax incentive refund received in December 2019. Product supply and royalty receipts for VivaGel BV totalled $0.9 million for the quarter.

The cash balance does not include the anticipated US$3 million milestone payment from AstraZeneca which is expected to be received during the March quarter.

Cash outflows for the quarter include the manufacture of VivaGel BV product to support the roll-out in multiple regions, including the UK, Eastern Europe and Asia. Cash outflows also included expenditure on Starpharma’s three DEP clinical programs, including several new sites across the DEP studies. Outflows also included expenditure on the dual strategy to achieve FDA approval through the formal review process, as well as preparation, including start-up activities, for a possible VivaGel BV treatment clinical trial.

Key recent events:

AstraZeneca commenced the phase 1 clinical trial of its first DEP product, AZD0466. The successful dosing of the first patient in this trial triggered a US$3 million milestone payment, which is expected to be received in the coming weeks.
DEP cabazitaxel trial progressed from phase 1 to phase 2 on positive results. The trial met its objective of evaluating safety, tolerability and preliminary efficacy data, and identifying a recommended phase 2 dose. The trial transitioned seamlessly into phase 2, with two new sites initiated and recruitment underway.
Patients continue to be recruited into the phase 2 trial for DEP docetaxel, with efficacy signals observed in a variety of tumour types including non-small cell lung cancer, prostate cancer, and several hard to treat tumours. Six sites in the UK are currently recruiting patients, including two new sites – the Christie and the Beatson (Glasgow).
Patients continue to be recruited into the dose escalation phase of the phase 1/2 trial for DEP The three leading cancer sites actively recruiting for this trial are the Christie, the Royal Marsden and Newcastle Freeman Hospital.
VivaGel BV was launched in the UK under the brand Betafem BV Gel.
Starpharma supplied product to Mundipharma to support the roll-out of VivaGel BV in Europe, including countries in Central and Eastern Europe, where launches are expected in the coming months.
Further regulatory approvals were granted in Asia. Advanced marketing activities are underway, and product has been delivered by Starpharma in preparation for launch.
Aspen continued to advance their marketing and promotional activities for Fleurstat BVgel in Australia, and preparations have progressed for the New Zealand launch, including product supply by Starpharma and training of sales representatives.
Starpharma progressed its dual strategy regarding FDA approval of VivaGel BV with ongoing support from a team of expert FDA consultants (regulatory, statistical, clinical, legal; several ex-FDA). This includes seeking formal review of some of the FDA’s initial conclusions, as well as preparation for a possible BV treatment trial.
VivaGel condom was granted marketing approval in Europe. LifeStyles has commenced marketing preparations ahead of the launch of the VivaGel condom under the brand name Absolute DUAL PROTECTION.
New DEP candidate, DEP gemcitabine, was advanced for development upon demonstrating significantly enhanced anti-tumour activity compared with Gemzar (gemcitabine), both alone and in combination with Nab‑paclitaxel (Abraxane), in a human pancreatic cancer model.
Several new DEP patents were filed covering DEP in combination with marketed anticancer agents and novel DEP
Dr Jackie Fairley, Starpharma CEO, commented: "It was a key milestone for Starpharma to see AstraZeneca treat its first patient with our partnered DEP product, AZD0466. AstraZeneca describes AZD0466 as having the potential to be a ‘best-in-class’ agent in this field due to its ability to target both Bcl2 and Bcl/xL. We will follow the progress of the AZD0466 trial, which is currently being conducted in multiple sites in the US, with interest. In our internal portfolio, we progressed DEP cabazitaxel into phase 2 on positive phase 1 results and we delivered excellent data on our new candidate, DEP gemcitabine. With four DEP products now in the clinic, and a pipeline of high-potential candidates, the DEP platform is generating a deep portfolio of valuable products".

"We also achieved key milestones for VivaGel BV, with the launch into the UK market. We continue to work closely with our partners to support the roll-out in Europe and Asia, as well as the New Zealand launch. In the last few months, several submissions have also been prepared and submitted for countries in other regions. During the next quarter we are focussed on accelerating our clinical trials, wherever possible, and working towards further regulatory approvals and launches for VivaGel BV," concluded Dr Fairley.

On January 29, 2020 PharmaMar (MSE:PHM) reported that it has received the upfront payment of $200 million from the agreement signed with Jazz Pharmaceuticals on 19 December 2019 (Press release, PharmaMar, JAN 29, 2020, View Source [SID1234553659]).

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This license agreement for the commercialization of lurbinectedin in the United State became effective with the expiration of the Hart-Scott-Rodino waiting period.

Under the terms of the agreement, PharmaMar is also eligible to receive, in the following months, potential regulatory milestone payments of up to $250 million upon the achievement of accelerated and/or full regulatory approval of lurbinectedin by FDA within certain timelines.

PharmaMar is also eligible to receive up to $550 million in potential commercial milestone payments, as well as incremental tiered royalties on future net sales of lurbinectedin ranging from the high teens up to 30%.

There is the potential for other regulatory milestones on FDA approval of other indications beyond relapsed small cell lung cancer.

About Lurbinectedin
Lurbinectedin (PM1183) is a synthetic compound currently under clinical investigation. It is a selective inhibitor of the oncogenic transcription programs on which many tumors are particularly dependent. Together with its effect on cancer cells, lurbinectedin inhibits oncogenic transcription in tumor-associated macrophages, downregulating the production of cytokines that are essential for the growth of the tumor. Transcriptional addiction is an acknowledged target in those diseases, many of them lacking other actionable targets.