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Phase II Trial of Investigational Anetumab Ravtansine Does Not Meet Primary Endpoint in Second-Line Mesothelioma (for specialized target groups only)

On July 21, 2017 Bayer reported that a Phase II clinical trial evaluating its investigational oncology compound anetumab ravtansine (BAY 949343) as a monotherapy in patients with recurrent malignant pleural mesothelioma (MPM), who were previously treated, did not meet its primary endpoint of progression-free survival (Press release, Bayer, JUL 21, 2017, View Source [SID1234519851]). The safety and tolerability of anetumab ravtansine were consistent with earlier clinical findings. Detailed study results are expected to be presented at an upcoming medical meeting.

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"Malignant pleural mesothelioma is a very difficult-to-treat tumor, and we had hoped for a better outcome for patients," said Robert LaCaze, Executive Vice President and Head of the Oncology Strategic Business Unit at Bayer. "We would like to thank the patients and their caregivers, as well as the study investigators for their participation and contributions in this study. Based on the available data, we remain committed to further evaluating the utility and safety of anetumab ravtansine across multiple tumor types with significant unmet medical need."

Anetumab ravtansine is currently being investigated, as monotherapy and in combination, in additional studies, including a Phase Ib multi-indication study in six different types of advanced solid tumors, as well as a Phase Ib combination-study in patients with recurrent platinum-resistant ovarian cancer.

About the Phase II Study
The phase II clinical trial (NCT02610140) is a randomized, open-label, active-controlled, multicenter superiority study investigating anetumab ravtansine as second line treatment in patients with advanced or metastatic mesothelin-positive malignant pleural mesothelioma (MPM), whose disease had progressed after treatment with first-line platinum/pemetrexed-based chemotherapy. The trial randomized 248 patients in a 2:1 ratio to receive either anetumab ravtansine (6.5 mg/kg intravenously every three weeks) or vinorelbine (30 mg/m2 intravenously every week).

The primary endpoint of the study was progression-free survival. Secondary endpoints included overall survival, as well as other indicators of efficacy, such as patient-reported outcomes, objective tumor response rate, duration of response, disease control rate, and durable response rate. Safety and tolerability of patients were also continuously monitored.

About Mesothelioma
Malignant pleural mesothelioma (MPM) is a rare and deadly cancer affecting more than 25,000 people globally, with about 3,000 new cases being diagnosed in the US and more than 12,000 in Europe each year. It is commonly caused by occupational or environmental exposure to asbestos. The majority of patients with MPM are not diagnosed until the disease has progressed to an advanced stage, with the onset of the disease in many cases occurring 20 to 40 years after exposure. Due to its aggressive nature, the estimated median overall survival is approximately one year from diagnosis. Rapid deterioration and poor survival are hallmarks of MPM. In first line therapy, cisplatin/pemetrexed has become the standard of care but nearly all MPM-patients progress during or after first-line treatment. In the second-line setting, the lack of an accepted standard of care treatment underscores the substantial unmet need in the treatment of MPM.

About Anetumab Ravtansine (BAY 949343)
Anetumab ravtansine is an antibody-drug conjugate (ADC) that specifically targets mesothelin, a surface marker protein overexpressed in many cancers. After binding to mesothelin, anetumab ravtansine is taken up inside the tumor cells, where degrading enzymes release cytotoxic DM4, a maytansinoid tubulin inhibitor, which induces cell cycle arrest and apoptosis in dividing cells.

In a Phase I clinical trial in patients with advanced solid tumors, anetumab ravtansine demonstrated promising efficacy with durable responses in patients with malignant pleural mesothelioma (MPM), and a manageable safety profile. In addition to the Phase II clinical trial in MPM, anetumab ravtansine is currently being investigated in a variety of other mesothelin-positive tumors, including a Phase Ib multi-indication study in six different types of advanced solid tumors (NCT03102320), as well as a Phase Ib combination-study in patients with recurrent platinum-resistent ovarian cancer (NCT02751918).

Anetumab ravtansine is a compound developed by Bayer. In the development, the following collaborators were involved: The antibody was derived from the HuCAL technology platform of MorphoSys AG. In a 2008 license agreement with ImmunoGen, Inc., Bayer was granted exclusive rights for using their maytansinoid ADC technology to develop anti-tumor therapies targeting mesothelin. Both partners are entitled to milestone payments and royalties on commercial sales, if any.

CHMP recommends EU approval of Roche’s Gazyvaro for people with previously untreated advanced follicular lymphoma

On July 21, 2017 Roche (SIX: RO, ROG; OTCQX: RHHBY) reported that the EU Committee for Medicinal Products for Human Use (CHMP) has adopted a positive opinion for Gazyvaro (obinutuzumab) in combination with chemotherapy, followed by Gazyvaro maintenance in people achieving a response, as a new treatment option for previously untreated advanced follicular lymphoma (Press release, Hoffmann-La Roche, JUL 21, 2017, View Source [SID1234519844]). The CHMP’s recommendation is based on results from the phase III GALLIUM study. Follicular lymphoma, the most common type of indolent (slow-growing) non-Hodgkin lymphoma, is considered incurable, and most people relapse repeatedly.1,2 Based on this positive CHMP recommendation, a final decision regarding the approval of Gazyvaro is expected from the European Commission in the near future.

"As follicular lymphoma is considered incurable, better initial treatment options are needed to prevent the disease from returning for as long as possible," said Sandra Horning, MD, Chief Medical Officer and Head of Global Product Development. "MabThera has been the standard of care for the past 20 years. Based on the GALLIUM study, Gazyvaro-based therapy provides superior progression-free survival compared to MabThera-based therapy, setting a new benchmark for what can be achieved with initial therapy for follicular lymphoma."

The GALLIUM study is the first phase III study in previously untreated follicular lymphoma to show superior PFS over MabThera(rituximab)-based treatment, the current standard of care. Results showed that Gazyvaro-based treatment reduced the risk of disease progression or death (progression-free survival; PFS), as evaluated by investigator assessment, by 34 percent (HR=0.66; 95% CI 0.51-0.85, p=0.001) compared to MabThera-based treatment. As supported by an independent review committee (IRC), the risk of disease progression or death was reduced by 29 percent (HR=0.71; 95% CI 0.54-0.93, p=0.014) compared to MabThera/Rituxan-based treatment. Median PFS has not yet been reached in either treatment arm. Investigator assessment showed that at three years, 80.0 percent of patients who received Gazyvaro-based treatment were progression-free compared to 73.3 percent of patients who received MabThera-based treatment. Adverse events with either Gazyvaro or MabThera were consistent with those seen in previous studies.

About the GALLIUM study
GALLIUM (NCT01332968) is a global Phase III open-label, multi-centre, randomised two-arm study examining the efficacy and safety of Gazyvaro plus chemotherapy followed by Gazyvaro alone for up to two years, as compared head-to-head against MabThera plus chemotherapy followed by MabThera alone for up to two years or until disease progression (whichever occurs first). Chemotherapies (CHOP, CVP or bendamustine) were selected by each participating study site prior to beginning enrolment. GALLIUM included 1401 patients with previously untreated indolent non-Hodgkin lymphoma (iNHL), of which 1202 patients had follicular lymphoma. The primary endpoint of the study was investigator-assessed PFS in patients with follicular lymphoma, with secondary endpoints including PFS assessed by IRC, PFS in the overall study population (iNHL), response rate (overall response, ORR; and complete response, CR), overall survival (OS), and safety. The GALLIUM study is being conducted in cooperation with the NCRI (United Kingdom), GLSG (Germany), the East German Study Group Hematology and Oncology (OSHO; Germany).

About Gazyvaro (obinutuzumab)
Gazyvaro is an engineered monoclonal antibody designed to attach to CD20, a protein expressed on certain B cells, but not on stem cells or plasma cells. Gazyvaro is designed to attack and destroy targeted B-cells both directly and together with the body’s immune system.

Gazyvaro is marketed as Gazyva outside the EU and Switzerland. Gazyva/Gazyvaro is currently approved in more than 80 countries in combination with chlorambucil, for people with previously untreated chronic lymphocytic leukaemia (CLL), and in combination with bendamustine for people with certain types of previously treated follicular lymphoma. The approvals in CLL were based on the CLL11 study, showing significant improvements with 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 plus chlorambucil.

The approvals in certain types of previously treated follicular lymphoma were based on the phase III GADOLIN study, in people with follicular lymphoma who did not respond to or who progressed during or within six months of prior MabThera -based therapy, showing a significant improvement in PFS and overall survival (OS) with Gazyvaro-based therapy compared to bendamustine alone.

Additional combination studies investigating Gazyvaro with other approved or investigational medicines, including cancer immunotherapies and small molecule inhibitors, are underway across a range of blood cancers.

About Follicular Lymphoma
Follicular lymphoma is the most common indolent (slow-growing) form of non-Hodgkin lymphoma (NHL), accounting for about one in five cases of NHL.1 It is considered incurable and relapse is common. Every day, more than 50 people in Europe are diagnosed with this type of NHL2. It is estimated that more than 75,000 people are diagnosed with follicular lymphoma each year worldwide2.

CHMP recommends EU approval for Roche’s TECENTRIQ (atezolizumab) in a specific type of metastatic lung and two types of metastatic bladder cancer

On July 21, 2017 Roche (SIX: RO, ROG; OTCQX: RHHBY) reported that the EU Committee for Medicinal Products for Human Use (CHMP) has adopted a positive opinion for TECENTRIQ (atezolizumab) as a monotherapy for the treatment of adults with locally advanced or metastatic non-small cell lung cancer (NSCLC) after they have been previously treated with chemotherapy (Press release, Hoffmann-La Roche, JUL 21, 2017, View Source [SID1234519843]). People with EGFR activating mutations or ALK positive tumour mutations should also have received targeted therapy before receiving TECENTRIQ. This positive recommendation is based on results from the large randomised Phase III OAK study and the randomised Phase II POPLAR study. The CHMP has also adopted a positive opinion for the use of TECENTRIQ as a monotherapy for the treatment of adults with locally advanced or metastatic urothelial carcinoma (mUC) who have been previously treated with a platinum based chemotherapy or who are considered ineligible for cisplatin chemotherapy. This positive opinion is based on results from the randomised Phase III IMvigor211 study and cohorts 1 and 2 from the single-arm Phase II IMvigor210 study.

"This positive CHMP opinion represents great news for people living with either advanced lung or bladder cancer because, despite recent developments, long-term survival rates for people with these cancers are inferior to those with other common cancers," said Sandra Horning, MD, Roche’s Chief Medical Officer and Head of Global Product Development. "We are encouraged that the CHMP considered the totality of the data for TECENTRIQ including the importance of key clinical endpoints, such as long-term responses."
Based on this positive CHMP opinion, a final decision from the European Commisssion is expected in the near future. TECENTRIQ is already approved in the US and in a number of other countries for people with metastatic NSCLC; and for people with locally advanced or mUC and who are not eligible for cisplatin chemotherapy, or who have disease progression during or following platinum-containing therapy.
About the OAK study
OAK is a global, multicentre, open-label, randomised, controlled Phase III study that evaluated the efficacy and safety of TECENTRIQ compared with docetaxel. It enrolled 1225 patients with both squamous and non-squamous disease, regardless of the programmed death-ligand 1 (PD-L1) status of their tumours, and randomised them (1:1) to receive either TECENTRIQ administered intravenously at 1,200 mg every 3 weeks or docetaxel administered intravenously at 75 mg/m2 every 3 weeks. The co-primary endpoints were overall survival (OS) in the first 850 randomised patients (intention-to-treat population) and in a PD-L1-selected subgroup of this primary analysis population.
The OAK study showed that TECENTRIQ helped people in the overall study population live a median of 13.8 months – 4.2 months longer than those treated with docetaxel chemotherapy (median overall survival [OS]: 13.8 vs. 9.6 months; HR = 0.73, 95% CI: 0.62, 0.87).

CI=confidence interval; DOR=duration of response; IC=tumour-infiltrating immune cells; NE=not estimable; ORR=objective response rate; OS=overall survival; PFS=progression-free survival; RECIST=Response Evaluation Criteria in Solid Tumours v1.1; *All comers refers to the primary analysis population consisting of the first 850 randomised patients ǂStratified by PD-L1 expression in tumour infiltrating immune cells, the number of prior chemotherapy regimens, and histology ** Based on the stratified log-rank test
About the POPLAR study
A phase II, multi-centre, international, randomised, open-label, controlled study, POPLAR, was conducted in patients with locally advanced or metastatic NSCLC who progressed during or following a platinum-containing regimen, regardless of PD-L1 expression. The primary efficacy outcome was overall survival. A total of 287 patients were randomised 1:1 to receive either TECENTRIQ (1,200 mg by intravenous infusion every 3 weeks until loss of clinical benefit) or docetaxel (75 mg/m2 by intravenous infusion on day 1 of each 3-week cycle until disease progression). Randomisation was stratified by PD-L1 expression status on IC, by the number of prior chemotherapy regimens and by histology.
An updated analysis with a total of 200 deaths observed and a median survival follow-up of 22 months showed a median OS of 12.6 months in patients treated with TECENTRIQ, vs. 9.7 months in patients treated with docetaxel (HR of 0.69, 95% CI: 0.52, 0.92). ORR was 15.3% vs. 14.7% and median DOR was 18.6 months vs. 7.2 months for TECENTRIQ vs. docetaxel, respectively.
About non-small cell lung cancer
Lung cancer is the leading cause of cancer death globally. Each year 1.59 million people die as a result of the disease; this translates into more than 4,350 deaths worldwide every day. Lung cancer can be broadly divided into two major types: NSCLC and small cell lung cancer. NSCLC is the most prevalent type, accounting for around 85% of all cases.
About the IMvigor211 study
IMvigor211 is a Phase III study of TECENTRIQ compared to chemotherapy in people with advanced bladder cancer who were previously treated with a platinum-based chemotherapy. The study evaluated the efficacy and safety of TECENTRIQ compared to chemotherapy of physician choice (vinflunine, paclitaxel or docetaxel) administered every three weeks in 931 people with previously-treated mUC who progressed during or following a platinum-based regimen. The primary efficacy endpoint was OS and key secondary endpoints include objective response rate, progression-free survival, duration of response and safety. IMvigor211 study did not meet its primary endpoint of overall survival (OS) compared to chemotherapy. These data were presented in full at the EACR-AACR-SIC Special Conference 2017.
The primary efficacy endpoint, overall survival, was to be tested in a successive fashion (hierarchical testing) in study populations defined by PD-L1 expression. The first population tested was people with the highest levels of PD-L1 expression (IC2/3), followed by those with any observable level of PD-L1 expression (IC1/2/3), and followed by the overall study population (Intention-To-Treat; ITT). Per the pre-specified hierarchical testing order, the IC2/3 (≥5%) population was tested first, with an OS HR of 0.87 (95% CI: 0.63, 1.21; median OS of 11.1 vs. 10.6 months for TECENTRIQ and chemotherapy respectively). In the overall study population (intention-to-treat or ITT) people treated with TECENTRIQ achieved a mOS of 8.6 months (CI: 95%; 7.8, 9.6) compared to 8.0 months (CI: 95%; 7.2, 8.6) with chemotherapy (HR 0.85, 95% CI 0.73-0.99).
Statistical significance needed to be achieved for the study populations in the following order: IC2/3 (≥5%), IC1/2/3 (≥1%), and ITT group. However, because statistical significance was not achieved for OS in the IC2/3 population, results could not be evaluated for statistical significance in the IC1/2/3 and ITT populations and those analyses are considered descriptive in nature.
Overall Response Rates (ORR) were similar to those previously reported in the phase II IMvigor210 study and similar between the two study arms. The median duration of response (mDOR), a secondary endpoint, for those receiving TECENTRIQ was 21.7 months (95% CI: 13.0, 21.7) in the overall study population, compared to 7.4 months (95% CI: 6.1, 10.3) for those receiving chemotherapy. At the time of data cutoff, the majority (63%) of people who responded to treatment with TECENTRIQ continued to respond, compared to 21% of people treated with chemotherapy.
About the IMvigor210 study (Cohort 2)
In Cohort 2, the co-primary efficacy endpoints were confirmed ORR as assessed by an IRF using RECIST v1.1 and investigator-assessed ORR according to Modified RECIST (mRECIST) criteria. There were 310 patients treated with TECENTRIQ 1,200 mg by intravenous infusion every 3 weeks until loss of clinical benefit. The study met its co-primary endpoints in Cohort 2, demonstrating statistically significant ORRs per IRF-assessed RECIST v1.1 and investigator-assessed mRECIST compared to a pre-specified historical control response rate of 10%.
An analysis was also performed with a median duration of survival follow-up of 21.1 months for Cohort 2. The confirmed ORRs per IRF-RECIST v1.1 were 28.0% (95% CI: 19.5, 37.9) in patients with PD-L1 expression IC2/3 (≥ 5%), 19.3% (95% CI: 14.2, 25.4) in patients with PD-L1 expression IC1/2/3 (≥ 1%), and 15.8% (95% CI: 11.9, 20.4) in all comers. The confirmed ORR per investigator-assessed mRECIST was 29.0% (95% CI: 20.4, 38.9) in patients with PD-L1 expression ≥ 5%, 23.7% (95% CI: 18.1, 30.1) in patients with PD-L1 expression ≥ 1%, and 19.7% (95% CI: 15.4, 24.6) in all comers. The rate of complete response per IRF-RECIST v1.1 in the all comer population was 6.1% (95% CI: 3.7, 9.4). For Cohort 2, median DOR per IRF-RECIST v1.1 was not reached in any PD-L1 expression subgroup or in all comers, however was reached in patients with PD-L1 expression < 1% (13.3 months; 95% CI 4.2, NE). The OS rate at 12 month was 37% in all comers.
About the IMvigor210 study (Cohort 1)
The positive CHMP opinion for patients who are ineligible for cisplatin-based chemotherapy is based on results from Cohort 1, which consisted of 119 people with locally advanced or mUC who were ineligible for cisplatin-containing chemotherapy and were either previously untreated or had disease progression at least 12 months after neoadjuvant (before surgery) or adjuvant (after surgery) chemotherapy. The primary endpoint of the study was objective response rate (ORR).

CI=confidence interval; DOR=duration of response; IC= tumour-infiltrating immune cells; IRF= independent review facility; NE=not estimable; ORR=objective response rate; OS=overall survival; PFS=progression-free survival; RECIST=Response Evaluation Criteria in Solid Tumours v1.1.
Pooled Safety Profile
The safety of TECENTRIQ is based on pooled data in 2,160 patients with mUC and NSCLC. The most common adverse all grade reactions were fatigue (35.4%), decreased appetite (25.5%), nausea (22.9%), dyspnoea (21.8%), diarrhoea (18.6%), pyrexia (18.3%), rash (18.6%), vomiting (15.0%), arthralgia (14.2%), asthenia (13.8%) and pruritus (11.3%).
About metastatic urothelial carcinoma
Metastatic urothelial carcinoma (mUC) is associated with a poor prognosis and limited treatment options. It is a disease that has seen no major advances for more than 30 years outside of the US. UC is the ninth most common cancer worldwide, with 430,000 new cases diagnosed in 2012, and it results in approximately 145,000 deaths globally each year. Men are three times more likely to suffer from UC, compared with women, and the disease is three times more common in developed countries than in less developed countries.
About TECENTRIQ (atezolizumab)
TECENTRIQ is a monoclonal antibody designed to bind with a protein called PD-L1. TECENTRIQ is designed to bind to PD-L1 expressed on tumour cells and tumour-infiltrating immune cells, blocking its interactions with both PD-1 and B7.1 receptors. By inhibiting PD-L1, TECENTRIQ may enable the activation of T cells. TECENTRIQ has the potential to be used as a foundational combination partner with cancer immunotherapies, targeted medicines and various chemotherapies across a broad range of cancers
About Roche in cancer immunotherapy

Propanc Biopharma Receives Acceptance of Key Patent Application for Cancer Treatment in China

On July 20, 2017 Propanc Biopharma Inc. (OTCQB: PPCB) ("Propanc Biopharma" or "the Company"), a clinical stage biopharmaceutical company focusing on development of new and proprietary treatments for cancer patients suffering from solid tumors such as pancreatic, ovarian and colorectal cancers, reported that it received notification of acceptance for its lead patent application from the Chinese Patent Office (Press release, Propanc, JUL 20, 2017, View Source [SID1234519834]). The patent application provides broad coverage of a pharmaceutical composition of trypsinogen and chymotrypsinogen to treat certain cancers.

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The acceptance of this key patent application is a first in China, representing yet another significant milestone for the Company, as it progresses its lead product, PRP, towards First-In-Human studies. Given that China accounts for more than 20% of the world’s population, significant growth in this pharmaceutical market is anticipated due to greater healthcare coverage for a rising middle class. The Company is considering filing a divisional application with the Chinese Patent Office to pursue additional claims based off the initial accepted application.

"Acceptance of our first Chinese patent is a significant achievement for our Company, and indicates the strong growth of intellectual property portfolio worldwide," said James Nathanielsz, Propanc Biopharma’s Chief Executive Officer. "We continue to advance a number of different patent applications in key regions around the world. This provides a solid foundation for future licensing discussions. By having major regions and territories covered, it means we have greater flexibility selecting strategic partners, either by global reach, or local market penetration."

The Company’s key patent application has now been accepted, or granted, in Australia, Indonesia, Israel, Japan, China, New Zealand, Singapore, South Africa and the US.

The Company’s lead product, PRP, is a solution for once daily intravenous administration of a combination of two pancreatic proenzymes trypsinogen and chymotrypsinogen. Currently progressing towards First-In-Human studies, PRP aims to prevent tumor recurrence and metastasis from solid tumors. Eighty percent of all cancers are solid tumors and metastasis is the main cause of patient death from cancer. According to the World Health Organization, 8.2 million people died from cancer in 2012. Consequently, a report by IMS Health states innovative therapies are driving the global oncology market to meet demand, which is expected to reach $150 Billion by 2020. The Company’s initial target patient populations are pancreatic, ovarian and colorectal cancers, representing a combined market segment of $14 Billion predicted in 2020, by GBI Research.

CureVac to Receive Patent Claiming the Combination of mRNA Vaccines with Anti-PD-1 Antibodies

On July 20, 2017 – CureVac AG, a fully-integrated biopharmaceutical company pioneering the field of mRNA-based drugs, reported it has been granted a Notice of Allowance from the European Patent Office (EPO) for its patent application (EP 2958588) entitled, "Combination of Vaccination and Inhibition of the PD-1 Pathway"(Press release, CureVac, JUL 20, 2017, View Source [SID1234519946]).

The patent claims both composition of matter and methods of treatment for a vaccine/inhibitor combination comprising an mRNA vaccine and an anti-PD-1 antibody. Further, the patent covers a pharmaceutical composition and a kit of parts comprising such a vaccine/inhibitor combination, particularly for the prevention or treatment of tumor or cancer diseases and infectious diseases.

Dr. Franz-Werner Haas, Chief Corporate Officer of CureVac, stated, "We are convinced there is tremendous potential in combining mRNA-based vaccines with PD-1 checkpoint inhibitors for the treatment of a wide range of cancers and infectious diseases. Anti-PD-1 antibody therapy is becoming standard of care in several cancer indications, and combination approaches are now recognized as optimal for the development of mRNA cancer vaccines. Therefore, this patent adds considerable value to our company and our IP estate. Together with our extensive experience in the development of mRNA-based cancer vaccines this encourages us to advance and expand our RNActive Cancer Immunotherapy pipeline."

In total, CureVac holds a broad IP portfolio comprising more than 100 patent families covering different aspects of its mRNA platform enabling the use and production of mRNA across a wide range of treatment modalities and disease indications.