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Analysis From Two Institutions Shows Strong Tumor Response, Overall Survival Potential of Delcath Investigational PHP Therapy

On February 21, 2017 Delcath Systems, Inc. (NASDAQ:DCTH), an interventional oncology company focused on the treatment of primary and metastatic liver cancers, reporteded that a retrospective, multicenter study demonstrated that 45.7 percent of patients with ocular melanoma that metastasized to the liver who underwent percutaneous hepatic perfusion (PHP) using investigational Melphalan/HDS experienced a complete or partial response (Press release, Delcath Systems, FEB 21, 2017, View Source [SID1234517777]). The study further showed that among those who responded to treatment, overall survival was projected to be more than three years.

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The findings were reported at the Regional Cancer Therapies 12th International Symposium in an oral presentation titled, "Percutaneous Hepatic Perfusion for Unresectable Metastatic Ocular Melanoma to the Liver: A Multi-Institutional Report of Outcomes." The analysis was conducted by teams from Moffitt Cancer Center in Tampa, Fla., and the University Hospital Southampton in the United Kingdom. The presentation was led by Dr. Alexandra Gangi of the Moffitt Cancer Center.

The analysis reviewed outcomes of 49 patients treated between 2008 and 2016 with Melphalan/HDS at either the Moffitt Cancer Center or the University Hospital Southampton. Patients underwent a total of 115 PHP treatments. The median number of treatments per patient was two, with patients receiving one-to-six treatments. PHP is a minimally invasive procedure that isolates the liver from the body’s circulatory system, so that a high dose of chemotherapy (melphalan hydrochloride) may be infused directly into the liver. Blood from the liver is then filtered to remove the chemotherapeutic agent thereby minimizing systemic exposure.

Hepatic response to PHP was evaluable in 46 patients, among whom 45.7 percent showed complete or partial response, and 37.0 percent had stable disease. Median overall survival was not reached, but was projected to be 657 days (1.8 years). Among patients with a complete or partial response, overall survival was projected to be 1,207 days (3.4 years). Most common side effects following treatment were anemia, thrombocytopenia and neutropenia.

"Patients diagnosed with metastatic ocular melanoma to the liver have an average of 6-8 months of survival. This retrospective analysis reported a much longer survival after Melphalan/HDS , and provided an interesting long-term look at patient outcomes after treatment with Delcath Melphalan/HDS," said Dr. Jennifer K. Simpson, President & CEO of Delcath. "The projected 657-day median OS and 1,207 day median OS in those with a partial or complete response is very impressive, and we believe speaks to the potential of the system to provide meaningful durable response."

PHP with Melphalan/HDS was developed by Delcath Systems as a targeted, whole organ therapy for the liver. It is commercially available as a device in Europe, where it is marketed as CHEMOSAT. The system has not been approved by the U.S. Food and Drug Administration, and is undergoing Phase 3 clinical testing in the U.S. as an investigational product.

TG Therapeutics, Inc. Announces Publication of Clinical Data from the Phase 1/2 Trial of TG-1101 (ublituximab) Monotherapy in the British Journal of Haematology

On February 21, 2017 TG Therapeutics, Inc. (NASDAQ:TGTX) reported the publication of clinical data from a Phase 1/2 trial of TG-1101 (ublituximab), the Company’s novel glycoengineered anti-CD20 monoclonal antibody, in patients with B-cell non-Hodgkin Lymphoma (NHL) or Chronic Lymphocytic Leukemia (CLL) previously exposed to rituximab (Press release, TG Therapeutics, FEB 21, 2017, View Source [SID1234517775]). The data demonstrates single agent TG-1101 to be well tolerated with the most common adverse event observed being grade 1/2 infusion related reactions (IRR), with no grade 3/4 IRRs. TG-1101 monotherapy was active, with a 45% overall response rate (ORR) observed among heavily pretreated patients with NHL and CLL, including those who were refractory to prior anti-CD20 based therapy. These data are described further in the manuscript titled, "A phase 1/2 trial of ublituximab, a novel, glycoengineered anti-CD20 monoclonal antibody, in patients with B-cell non-Hodgkin lymphoma or chronic lymphocytic leukaemia previously exposed to rituximab," which was published online today in the British Journal of Haematology. The online version of the article can be accessed at View Source

"We want to thank Dr. Owen O’Connor, and the team from Columbia Presbyterian Medical Center and the Center for Lymphoid Malignancies for their work on this Phase 1/2 trial of single agent TG-1101 and congratulate them on the publication of these data. Since the inception of our Company, we have been focused on developing best-in-class agents with the goal of building novel combination therapies. This single agent data illustrates that TG-1101 is a safe and highly-active anti-CD20 monoclonal antibody on top of which additional treatments can be layered. The safety profile, speed of infusion, and response rates observed, with single agent TG-1101, especially in rituximab-refractory patients, serve as a foundation for our belief that TG-1101 is a best-in-class anti-CD20 monoclonal antibody," stated Michael S. Weiss, Executive Chairman and Chief Executive Officer of TG Therapeutics. Mr. Weiss continued, "These Phase 1/2 data, as well as the combination data of TG-1101 plus ibrutinib published in the British Journal of Haematology late last year, further support our Phase 3 GENUINE trial of TG-1101 in combination with ibrutinib and we look forward to presenting top-line data from this study in the first half of this year."

"The addition of an anti-CD20 monoclonal antibody to other treatments, whether chemo-based or novel targeted therapies, has demonstrated to be an impactful way to enhance responses for patients with NHL and CLL. Acquired resistance to rituximab is a significant clinical issue for which many patients need an alternative effective agent to overcome the resistance. We are highly encouraged by the results we have seen in the clinic with ublituximab and believe the drug’s safety profile, as well as shortened infusion times as compared to other anti-CD20s, can provide meaningful benefit to patients," stated Dr. Owen A. O’Connor, Professor of Medicine and Experimental Therapeutics, Director Lymphoid Malignancies at Columbia Presbyterian Medical Center.

Pfizer Announces Acceptance of Regulatory Submission for Inotuzumab Ozogamicin by the U.S. Food and Drug Administration

On February 21, 2017 Pfizer Inc. (NYSE:PFE) reported that a Biologics License Application (BLA) for inotuzumab ozogamicin has been accepted for filing and granted Priority Review by the U.S. Food and Drug Administration (FDA) (Press release, Pfizer, FEB 21, 2017, View Source [SID1234517774]). Inotuzumab ozogamicin is being evaluated for the treatment of adult patients with relapsed or refractory B-cell precursor acute lymphoblastic leukemia (ALL).

Inotuzumab ozogamicin received Breakthrough Therapy designation from the FDA in October 2015 for ALL. Priority Review status accelerates FDA review time from 10 months to a goal of six months from the day of acceptance of filing, and is given to drugs that may offer major advances in treatment or may provide a treatment for which no adequate therapy exists. The Prescription Drug User Fee Act (PDUFA) goal date for a decision by the FDA is in August 2017.

"ALL that has recurred after, or is refractory to, first-line therapy is a rapidly progressing and deadly disease," said Mace Rothenberg, MD, chief development officer, Oncology, Pfizer Global Product Development. "Based on the positive results of the INO-VATE 1022 Phase 3 trial, we believe inotuzumab ozogamicin, if approved, represents a new treatment option for adult patients with relapsed or refractory B-cell precursor ALL."

In addition, a Marketing Authorization Application (MAA) for inotuzumab ozogamicin in the same patient population is currently under review by the European Medicines Agency (EMA).

The submissions are based on results from the Phase 3 INO-VATE 1022 trial, which enrolled 326 adult patients with relapsed or refractory B-cell ALL and compared inotuzumab ozogamicin to standard of care chemotherapy. The INO-VATE 1022 study had two independent primary endpoints, complete response with or without hematologic remission (CR/CRi) and overall survival (OS). Results from the trial were published in The New England Journal of Medicine in June 2016.

About Acute Lymphoblastic Leukemia (ALL)

Acute lymphoblastic leukemia (ALL) is an aggressive type of leukemia with a poor prognosis in adults.1 The current foundational treatment is intensive, long-term chemotherapy.2 In 2017, it is estimated that 5,970 cases of ALL will be diagnosed in the United States, with about 2 in 5 cases occurring in adults.3 Approximately 20 to 40 percent of newly diagnosed adults with ALL are cured with current treatment regimens.4 For patients with relapsed or refractory adult ALL, the five-year overall survival rate is less than 10 percent.5

About Inotuzumab Ozogamicin

Inotuzumab ozogamicin is an investigational antibody-drug conjugate (ADC) comprised of a monoclonal antibody (mAb) targeting CD22, a cell surface antigen expressed on approximately 90 percent of B-cell malignancies, linked to a cytotoxic agent.6 When inotuzumab ozogamicin binds to the CD22 antigen on B-cells, it is internalized into the cell, where the cytotoxic agent calicheamicin is released to destroy the cell.7 The most common adverse events (AEs) observed in clinical trials for inotuzumab ozogamicin were cytopenias, including febrile neutropenia. Common nonhematologic treatment-emergent AEs with inotuzumab ozogamicin included nausea, headache and pyrexia. Additionally, veno-occlusive liver disease (VOD) was observed more frequently in patients treated with inotuzumab ozogamicin, especially those who went on to receive hematopoietic stem cell transplantation.

Inotuzumab ozogamicin originates from a collaboration between Pfizer and Celltech, now UCB. Pfizer has sole responsibility for all manufacturing and clinical development activities for this molecule.

Roche receives EU approval of Alecensa (alectinib) for people with previously treated ALK-positive non-small cell lung cancer

On February 21, 2017 Roche (SIX: RO, ROG; OTCQX: RHHBY) reported that the European Commission has granted a conditional marketing authorisation for Alecensa (alectinib) as monotherapy for the treatment of adult patients with anaplastic lymphoma kinase (ALK)-positive advanced non-small cell lung cancer (NSCLC) previously treated with crizotinib (Press release, Hoffmann-La Roche, FEB 21, 2017, View Source [SID1234517773]). Most people with ALK-positive NSCLC develop resistance to the current standard of care within one year of treatment, and approximately 60% will develop metastases in the central nervous system (CNS).1,2

"Every year, an estimated 75,000 people are diagnosed with ALK-positive NSCLC worldwide," said Sandra Horning, MD, Chief Medical Officer and Head of Global Product Development. "Development of resistance to the current standard of care underlines the need for alternative treatments. Today’s approval provides the promise of a new treatment option for people in Europe with this devastating disease."

The conditional approval is based primarily on data from the pivotal phase II NP28673 and NP28761 studies, which showed that Alecensa shrank tumours in up to 52.2% (95% CI: 39.7%, 64.6%) of people with advanced ALK-positive NSCLC whose disease had progressed following treatment with crizotinib (overall response rate; ORR).2,3 The studies also showed that Alecensa extended the time that people lived without their disease worsening or death (progression-free survival, PFS) by up to 8.9 months (95% CI: 5.6, 12.8).2,3 In addition, a pooled analysis of the two studies showed that Alecensa shrank CNS tumours that were measurable in 64% of patients (95% CI: 49.2%, 77.1%), and 22% (n=-29) achieved a complete response of their measurable and non-measurable CNS tumours.4

Conditional approval is granted to a medicinal product that fulfils an unmet medical need where the benefit of immediate availability outweighs the risk of less comprehensive data than normally required. Under the provisions of the conditional approval, Roche will provide additional data on first-line Alecensa in ALK inhibitor naïve ALK-positive NSCLC patients from an ongoing phase III study ALEX, comparing Alecensa to crizotinib.5 The ALEX study is expected to report data in the first half of 2017.

Alecensa is already approved for ALK-positive NSCLC in eight countries in the crizotinib failure setting, and also in Japan for people whose tumours were advanced, recurrent or could not be removed completely through surgery (unresectable).6 In addition to ALEX, Alecensa is also being explored as a first-line treatment option with the phase III J-ALEX study comparing Alecensa to crizotinib in Japanese patients.5,7 Results from the J-ALEX study were presented at the 2016 American Society of Clinical Oncology (ASCO) (Free ASCO Whitepaper) Annual Meeting and showed that Alecensa reduced the risk of disease worsening or death (PFS) by 66% (hazard ratio [HR]=0.34, 99% CI: 0.17-0.70, p<0.0001) compared to crizotinib in this specific form of lung cancer.7

Each year lung cancer causes 1.59 million deaths worldwide, more than any other cancer.8 NSCLC is the most common type of lung cancer, and is the leading cause of cancer-related deaths in Europe and across the world, accounting for approximately 85% of lung cancer cases.9 ALK-positive NSCLC occurs in approximately 5% of patients with advanced NSCLC, translating to about 75,000 patients being diagnosed with the disease annually.9,10 It is almost always found in people with a specific type of NSCLC called adenocarcinoma, and is more common in light or non-smokers.11

About the NP28673 study2
NP28673 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.
The study showed by assessment of an independent review committee an ORR of 50.8% (95% CI: 41.6%, 60.0%), as measured by RECIST criteria.
An investigator assessment also showed tumours shrank in 51.4% of people who received Alecensa (95% CI: 42.8%, 60.0%)

In addition, the people whose tumours shrank in response to Alecensa continued to respond for a median of 15.2 months (95% CI: 11.2, 24.9) (duration of response, DOR)

The median PFS for people who received Alecensa was 8.9 months (95% CI: 5.6, 12.8)
Alecensa demonstrated a safety profile consistent with that observed in previous studies.
The following events were reported in ≥2% of patients: dyspnoea (4%); anaemia (3%); fatigue, INR increased, pulmonary embolism and hyperbilirubinemia (each 2%).

About the NP28761 study3
NP28761 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.
The study showed by assessment of an independent review committee an ORR of 52.2% (95% CI: 39.7%, 64.6%) as measured by RECIST criteria.
An investigator assessment showed tumours shrank in 52.9% of people who received Alecensa (95% CI: 41.9%, 63.7%).

In addition, the people whose tumours shrank in response to Alecensa continued to respond for a median of 14.9 months (95% CI: 6.9, NE) (DOR).

The median PFS for people who received Alecensa was 8.0 months (95% CI: 6.3, 12.6).
Alecensa demonstrated a safety profile consistent with that observed in previous studies.
The most common (occurring in at least 2% of people) Grade 3 or higher adverse events were an increase in muscle enzymes (increased blood levels of creatine phosphokinase; 8%), increased liver enzymes (alanine aminotransferase; 6%, and aspartate aminotransferase; 5%), shortness of breath (dyspnoea; 3%), elevated levels of triglyceride (hypertriglyceridaemia), decreased potassium level (hypokalaemia) low levels of phosphate in the blood (hypophosphatemia; 3%), partial blood thickening (thromboplastin; 2%) time prolonged.

About Alecensa
Alecensa (RG7853/AF-802/RO5424802/CH5424802) is an oral medicine created at Chugai Kamakura
Research Laboratories and is being developed for people with NSCLC whose tumours are identified as ALK-positive. ALK-positive NSCLC is often found in younger people who have a light or non-smoking history.11 It is almost always found in people with a specific type of NSCLC called adenocarcinoma.11 Alecensa is currently approved in the United States, Kuwait, Israel, Hong Kong, Canada, South Korea, Switzerland and India for the treatment of advanced (metastatic) ALK-positive NSCLC whose disease has worsened after, or who could not tolerate treatment with, crizotinib and in Japan for ALK positive NSCLC patients.5

In a pooled analysis of CNS endpoints from studies NP28673 and NP28761, Alecensa demonstrated activity in brain metastases, indicating that the drug may be taken up in the brain.4 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.12 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’.13 The active efflux system does not recognise Alecensa, which means that it may travel into and throughout brain tissue.2,3

The global phase III ALEX study of Alecensa includes a companion test developed by Roche Diagnostics. Alecensa is marketed in Japan by Chugai Pharmaceutical, a member of the Roche Group.

Chi-Med Initiates a Phase II Study of Savolitinib in Pulmonary Sarcomatoid Carcinoma

February 20, 2017: Hutchison China MediTech Limited ("Chi-Med") (AIM/Nasdaq: HCM) today announces that a Phase II study of savolitinib has been initiated in locally advanced or metastatic pulmonary sarcomatoid carcinoma ("PSC") in China. Savolitinib is a highly selective and potent oral c-Met inhibitor with global first-in-class potential. The first drug dose was administered on February 10, 2017.

This Phase II study is a multi-center, single-arm, open-label study to evaluate the efficacy and safety of savolitinib as a monotherapy in treating locally advanced or metastatic PSC patients harboring mesenchymal epithelial transition ("Met") gene alterations. The primary endpoint is objective response rate (ORR), with secondary endpoints including progression free survival (PFS), disease control rate (DCR), duration of response (DoR), overall survival (OS) and safety. Additional details about this study can be found at clinicaltrials.gov, using identifier NCT02897479.

About PSC and Met gene alterations

PSC is a rare subset of poorly differentiated non-small cell lung cancer ("NSCLC"). Containing a component with sarcoma-like (spindle and/or giant cell) features, PSC accounts for approximately 0.4% of all cases of lung cancer in the US, according to the Surveillance, Epidemiology and End Results database. These tumors are highly aggressive with outcomes significantly worse than other forms of NSCLC, and are more resistant to conventional chemotherapies[1],[2]. There is no approved targeted therapy for this fatal disease.

The sarcomatoid component of some PSC tumors is believed to derive from carcinoma cells through the activation of Met. Met gene exon 14 skipping has been reported as one of the major genetic alterations in PSC, acting as a negative control in Met signaling. This genetic alteration has been found in approximately 20-30% of PSC patients[3]. As such, a highly selective c-Met inhibitor may provide clinically meaningful benefit to patients with PSC.

About Savolitinib

Savolitinib is a potential global first-in-class inhibitor of c-Met (also known as mesenchymal epithelial transition factor) receptor tyrosine kinase, an enzyme which has been shown to function abnormally in many types of solid tumors. It was developed as a potent and highly selective oral inhibitor specifically designed to address issues observed in the clinic with first-generation c-Met inhibitors, including renal toxicity.