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Lrg-1 antagonists: Direct effect upon cancer cells

Summary
The formation of new blood vessels by angiogenesis is a key feature of number of diseases including Age-related Macular Degeneration (AMD), Proliferative Diabetic Retinopathy (PDR), atherosclerosis, rheumatoid arthritis and cancer (Press release, UCLB, FEB 4, 2016, View Source [SID:1234508995]). Vascular Endothelial Growth Factors (VEGFs) and their receptors have been previously identified as targets for therapy of these diseases but their success in human therapy is limited with adverse side effects upon long term use.
Researchers at UCL Institute of Ophthalmology have now identified a novel protein Lrg1 which acts in the pathogenic angiogenesis pathway. An antibody therapy has been developed against Lrg1 and is currently in pre-clinical development.

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The Technology and its Advantages
Researchers at UCL Institute of Ophthalmology have identified Lrg1 (leucine-rich alpha-2-glycoprotein-1) as a player in angiogenesis, tumour development, migration and aberrant scaring. Lrg1 is a secreted glycoprotein that stimulates angiogenesis by modulating the activity of TGFß. UCL researchers showed that antibodies against Lrg1 block lesion formation in the mouse model of laser-induced choroidal neovascularisation (CNV) (Wang et al., 2013, Nature, 499(7458):306-11). Significantly, in the mouse model of oxygen-induced retinopathy they observed that Lrg1 is involved specifically in the development of pathological vascular tufts, but not the normal vessel growth that occurs during the revascularisation phase. Collectively, these data revealed that Lrg1 is required for pathological angiogenesis, identifying Lrg1 as a therapeutic target for diseases such as wet AMD and cancer, in which aberrant blood vessel growth occurs.

The team developed a series of monoclonal antibodies against Lrg1. The lead candidate has been humanised and de-immunised and funding has been secured to develop the CMC process to GMP standards, perform pre-clinical toxicology studies and Phase IIa trial.

Targeting Lrg1 offers an alternative over currently used anti-VEGFs. These compounds have efficacy in wet AMD, diabetic retinopathy and cancer, but there is a significant fraction of patients who either fail to respond to VEGF blockade or who become refractory. The currently used VEGF blockers are known to have adverse effects in ocular indications, most likely because VEGF has a homeostatic role in neuronal cells, and this may limit long-term drug administration. In cancer, systemic administration of Avastin is associated with an increased risk of cardiovascular events, haemorrhage and stroke.

Market Opportunity
Currently the anti-angiogenic therapeutic market is dominated by the anti-VEGFs, in particular Avastin, Lucentis and Eylea.
Although Wet AMD, which results from the abnormal growth of blood vessels accounts for only 10-15% of all AMD cases, it is responsible for more than 80% of AMD-related vision loss. Datamonitor Healthcare estimates that sales of drugs for wet AMD across the US and five major EU markets (France, Germany, Italy, Spain, and the UK) will reach almost $5.8bn by 2023.
Diabetic retinopathy is the leading cause of blindness in adults of working age affecting 11.5M people in the seven major markets in 2010. According to Grand View Research Inc, global DR market is expected to reach $10.11bn by 2022.
Global cancer prevalence is driven by the aging population and even though cancer is not a single, homogenous disease, TGFß has been implicated in many cancer types – making this therapeutic approach suitable for many cancer indications. The global market for cancer is expected to reach $147bn by 2018, according to a report by the IMS Institute for Healthcare Informatics.
Collectively these three main indications for which Lrg1 antagonists could be used can be estimated to achieve ca. $160bn market potential.

8-K – Current report

On February 3, 2016 Advaxis, Inc. (NASDAQ: ADXS), a clinical stage biotechnology company developing cancer immunotherapies, reported that it has entered into a co-development and commercialization agreement with Especificos Stendhal SA de CV ("Stendhal"), for Advaxis’ lead Lm Technology immunotherapy, axalimogene filolisbac (ADXS-HPV), in HPV-associated cancers (Filing, 8-K, Advaxis, FEB 4, 2016, View Source [SID:1234508970]). Stendhal is a privately held Latin American specialty pharmaceutical company that partners with leading drug companies to deliver effective solutions for life-threatening diseases in Latin American markets.

Under the terms of the Agreement, Stendhal will pay $10 million toward the expenses of AIM2CERV, a planned global Phase 3 clinical trial in women with high-risk, locally advanced cervical cancer. This payment covers a significant portion of the total planned study costs. Stendhal will also work with Advaxis to complete the clinical trial of axalimogene filolisbac in Mexico, Brazil, Colombia, and other investigational sites in Latin American countries. Additionally, Stendhal will manage the regulatory approval process, promotion, commercialization and market access for axalimogene filolisbac in these markets. Advaxis and Stendhal will share profits on a pre-determined basis.

Stendhal has a long history of partnering with leading pharmaceutical companies to bring therapies for HIV, infectious disease, and neurologic and cardiovascular disease to its Latin American markets. This new partnership with Advaxis will expand its growing portfolio in oncology and is one of the first of its kind in Latin America to make cancer immunotherapies available in the region.

HPV-related cancer is a looming public health issue in Latin America. According to the World Health Organization, cervical cancer mortality rates are three times higher in Latin America and the Caribbean than in North America. More than 83,000 women are diagnosed annually and, without intervention, mortality is projected to increase to 45 percent by 2030. HPV is also prevalent in 90.4 percent of anal cancer in Latin America and the Caribbean.

"We’re pleased to announce our agreement with Stendhal, which enables us to greatly expand the clinical program for, and the potential impact of, axalimogene filolisbac in HPV-related cancers," said Daniel J. O’Connor, President and Chief Executive Officer of Advaxis. "We now have the potential to address an important unmet medical need in an area of the world where the rate of HPV-associated cancers is unfortunately extremely high."

"Our mission is to bring new treatments to Latin America and ensure that patients have access to therapies that have the potential to save their lives. Women throughout our region are facing increasing rates of HPV and the burden of cervical cancer," said Carlos Arenas, Chief Executive Officer of Stendhal. "It is through partnerships such as this one that we can alter the course of disease and address the health inequalities many in Latin America face."

About Cervical Cancer

Cervical cancer is the fourth most common cancer in women worldwide. In the U.S., nearly 13,000 new cases are diagnosed annually and approximately 4,100 deaths are reported because of cervical cancer. According to the WHO/ICO Information Centre on HPV and Cervical Cancer, about 3.9 percent of women in the U.S. are estimated to harbor high-risk cervical HPV infection at a given time, and 71.7 percent of invasive cervical cancers are attributed to high-risk HPV strains.

About Anal Cancer

Anal cancer is a fairly rare form of cancer in the United States, but the number of new anal cancer cases has been rising for years. The risk of being diagnosed with anal cancer in one’s lifetime is about 1 in 500. According to the American Cancer Society, approximately 7,270 new cases of anal cancer were diagnosed and about 1,010 people died of the disease in 2014.

HPV-Associated Head and Neck Cancers

More than 90 percent of head and neck squamous cell oropharyngeal cancers originate from the mucosal linings of the oral cavity, pharynx, or larynx. Currently, 60 to 80 percent of these cancers are caused by HPV. Head and neck cancers are treated by surgical removal of the cancer and lymph nodes, often followed by radiation and chemotherapy based on the extent of the disease. While patients may achieve good long-term survival, standard treatments can change their physical appearance and are associated with significant short and long-term toxicities which may interfere with salivary gland function, taste, smell, and the ability to swallow.

The incidence of HPV-associated head and neck cancers has been increasing at an epidemic rate, while head and neck cancers from other causes have been decreasing. According to the WHO, approximately 15 to 20 percent of the 400,000 new cases of head and neck cancer are HPV-related. In the US, there are about 12,000 new cases of HPV-associated head and neck cancer per year and it affects men about 3 times more frequently than women. HPV-associated head and neck cancer is growing fastest in developed countries like the U.S.

About Axalimogene Filolisbac

Axalimogene filolisbac (ADXS-HPV) is Advaxis’ lead Lm Technology immunotherapy candidate for the treatment of HPV-associated cancers and is in clinical trials for three potential indications: invasive cervical cancer, head and neck cancer, and anal cancer. In a completed randomized Phase 2 study in recurrent/refractory cervical cancer, axalimogene filolisbac showed apparent prolonged survival, objective tumor responses, and a manageable safety profile alone or in combination with chemotherapy, supporting further development of the company’s Lm Technology. Axalimogene filolisbac has Orphan Drug Designation in the U.S. for the treatment of anal cancer.

RIBOXX PHARMACEUTICALS and TOLLYS S.A.S Announce an Exclusive License Agreement for Treatment of Toll-like 3 Positive Cancers

On February 4, 2016 RIBOXX PHARMACEUTICALS, a biotech company developing Toll-like-receptor (TLR) and RIG-I-like-Receptor (RLR) ligands, and TOLLYS SAS, a biotech company developing new therapeutic strategies in cancer, reported that they have signed a license agreement that grants TOLLYS exclusive global development and commercialization rights to a new drug development program, which RIBOXX will refer to as APOXXIM (Press release, Riboxx Pharmaceuticals, FEB 4, 2016, View Source [SID:1234508983]).

Under the terms of the license agreement, TOLLYS will assume sole responsibility for global development and commercialization of APOXXIM product candidate. Riboxx will be responsible for manufacturing and supply of APOXXIM to TOLLYS.

APOXXIM is a Toll-like Receptor 3 (TLR3)-ligand that eliminates cancer cells by activating the TLR3 pathway. APOXXIM displays unique physico-chemical and biological properties, as well as optimal biodisponibility with increased stability to degradation in body fluids such as human plasma. APOXXIM is manufactured with the unique patented cGMP TENPORA-Process of Riboxx.

Jacques Rohayem, CEO and CSO of RIBOXX PHARMACEUTICALS declared: "We are very thrilled to start this collaboration with TOLLYS, a company with a very strong scientific expertise in cancer therapy. This collaboration expands the portfolio of Riboxx drug development programs such as RIBOXXIM, RIBOXXOL and QUADROXXIM, mainly focusing on cancer immunotherapy."

Jacques-François Martin, President of TOLLYS declared: "TOLLYS is very pleased to start this collaboration towards the development of a new and unique therapeutic strategy in cancer. The potential of TLR3-Ligands such as APOXXIM to treat cancer has been extensively studied in the past decades by scientists at TOLLYS, with a particular focus on TLR3-positive cancers".

About RIBOXX PHARMACEUTICALS
RIBOXX PHARMACEUTICALS is a biotech company developing proprietary Toll-like-receptor (TLR) ligands and RIG-I-like-Receptor (RLR) ligands for applications in cancer immunotherapy. RIBOXX IP portfolio includes 17 PCT patent families so far, with 8 PCT patents granted in EU and/or Japan.

About TOLLYS SAS
TOLLYS SAS is a biotech company developing drugs targeting TLR3-positive cancer cells. TOLLYS SAS has a strong expertise in the design and development of anti-cancer strategies through activation of TLR3-pathway.

OncoGenex Announces Reduction in Force to Extend Cash Runway and Align Operations with Clinical Development Priorities

On February 4, 2016 OncoGenex Pharmaceuticals, Inc. (NASDAQ: OGXI) reported that it is implementing a plan to reduce operating expenses, including a workforce reduction of approximately 27% (Press release, OncoGenex Pharmaceuticals, FEB 4, 2016, View Source [SID:1234508980]). The Company expects cost savings associated with the reduction of employees and consultants, together with the elimination of certain planned expenditures not required for the completion of ongoing trials, will extend cash runway into the third quarter of 2017.

OncoGenex will remain focused on executing clinical development plans in order to reach several near-term milestones for both the custirsen and apatorsen programs.

As of December 31, 2015, the Company’s cash, cash equivalents and short-term investments were $55.2 million. Based on current expectations, the Company believes that resources will be sufficient to fund currently planned operations into the third quarter of 2017. Depending on timing of enrollment or event-driven final analyses, the expected timing of key milestones and activities are as follows:

Custirsen
Announcing AFFINITY trial results, the phase 3 trial evaluating a survival benefit for custirsen in combination with cabazitaxel as second-line chemotherapy in approximately 630 patients with castrate-resistant prostate cancer. The final analysis for the intent-to-treat population is expected in the third quarter of 2016.
Announcing ENSPIRIT trial results, the phase 3 trial evaluating a survival benefit for custirsen in combination with docetaxel as second-line chemotherapy in approximately 700 patients with non-small cell lung cancer. The final survival analysis is expected in the first half of 2017.
Apatorsen
Announcing Borealis-2 trial results, an investigator-sponsored, randomized phase 2 trial evaluating apatorsen in combination with docetaxel treatment compared to docetaxel treatment alone in patients with advanced or metastatic bladder cancer. Final results are expected in the second half of 2016.
Announcing Spruce trial results for the overall survival endpoint, the investigator-sponsored, randomized, placebo-controlled phase 2 trial evaluating apatorsen treatment with carboplatin and pemetrexed chemotherapy in patients with previously untreated advanced non-squamous NSCLC. Results are expected in the second half of 2016.
Preparing an investigational new drug application for FDA submission of apatorsen for intravesical administration in combination with Bacillus Calmette-Guerin (BCG) treatment in patients with non-muscle invasive bladder cancer.

Phase 3 Study of BLINCYTO® (Blinatumomab) Met Primary Endpoint Of Overall Survival In Patients With B-Cell Precursor Acute Lymphoblastic Leukemia

On February 4, 2016 Amgen (NASDAQ:AMGN) reported that the results of a prespecified interim analysis showed that the primary endpoint of improved overall survival was met in the Phase 3 TOWER study (Press release, Amgen, FEB 4, 2016, View Source [SID:1234508978]). The randomized, open-label TOWER study evaluated the efficacy of BLINCYTO (blinatumomab) versus standard of care (SOC) in adult patients with Philadelphia chromosome-negative relapsed or refractory B-cell precursor acute lymphoblastic leukemia (ALL). The independent data monitoring committee recommended, and Amgen has accepted, that the study end early for efficacy.

The BLINCYTO adverse events observed in the TOWER study were consistent with the known safety profile of BLINCYTO. Secondary endpoints are currently being evaluated. These interim data will be submitted to a future medical conference and for publication.

"The FDA’s breakthrough therapy designation and accelerated approval of BLINCYTO underscore the dire prognosis for these patients. This is the first study to demonstrate an overall survival benefit for these patients with an immunotherapy, and this is a tremendously rare achievement in relapsed and refractory ALL," said Sean E. Harper, M.D., executive vice president of Research and Development at Amgen. "We will work with regulatory authorities towards a full approval for BLINCYTO in this population."

About TOWER Study

The TOWER study was a Phase 3, randomized, open-label study investigating the efficacy of the BiTE antibody BLINCYTO versus SOC chemotherapy in adult subjects with Philadelphia chromosome-negative relapsed or refractory B-cell precursor ALL. Patients were randomized in a 2:1 ratio to receive BLINCYTO or treatment with investigator choice of one of four protocol defined SOC chemotherapy regimens. The primary endpoint was OS. Click here to read about the trial on ClinicalTrials.gov.

About ALL

ALL is an aggressive cancer of the blood and bone marrow, the spongy tissue inside bones where blood cells are made. The disease progresses rapidly and affects immature blood cells. Patients with ALL have abnormal white blood cells (lymphocytes) that crowd out healthy white blood cells, red blood cells and platelets, leading to infection, anemia (fatigue), easy bleeding and other serious side effects.

About BLINCYTO (blinatumomab)

BLINCYTO is a bispecific CD19-directed CD3 T cell engager (BiTE) antibody construct that binds specifically to CD19 expressed on the surface of cells of B-lineage origin and CD3 expressed on the surface of T cells.

BiTE antibody constructs are a type of immunotherapy being investigated for fighting cancer by helping the body’s immune system to detect and target malignant cells. The modified antibodies are designed to engage two different targets simultaneously, thereby juxtaposing T cells (a type of white blood cell capable of killing other cells perceived as threats) to cancer cells. BiTE antibody constructs help place the T cells within reach of the targeted cell, with the intent of allowing T cells to inject toxins and trigger the cancer cell to die (apoptosis). BiTE antibody constructs are currently being investigated for their potential to treat a wide variety of cancers.

BLINCYTO was granted breakthrough therapy and priority review designations by the U.S. Food and Drug Administration, and is now approved in the U.S. for the treatment of Philadelphia chromosome-negative relapsed or refractory B-cell precursor ALL. This indication is approved under accelerated approval. Continued approval for this indication may be contingent upon verification of clinical benefit in subsequent trials.

About BiTE Technology

Bispecific T cell engager (BiTE) antibody constructs are a type of immunotherapy being investigated for fighting cancer by helping the body’s immune system to detect and target malignant cells. The modified antibodies are designed to engage two different targets simultaneously, thereby juxtaposing T cells (a type of white blood cell capable of killing other cells perceived as threats) to cancer cells. BiTE antibody constructs help place the T cells within reach of the targeted cell, with the intent of allowing T cells to inject toxins and trigger the cancer cell to die (apoptosis). BiTE antibody constructs are currently being investigated for their potential to treat a wide variety of cancers. For more information, visit www.biteantibodies.com.

BLINCYTO U.S. Product Safety Information

Important Safety Information Regarding BLINCYTO (blinatumomab) U.S. Indication

This safety information is specific to the current U.S. approved indication.

WARNING: CYTOKINE RELEASE SYNDROME and NEUROLOGICAL TOXICITIES

Cytokine Release Syndrome (CRS), which may be life-threatening or fatal, occurred in patients receiving BLINCYTO. Interrupt or discontinue BLINCYTO as recommended.
Neurological toxicities, which may be severe, life-threatening or fatal, occurred in patients receiving BLINCYTO. Interrupt or discontinue BLINCYTO as recommended.
Contraindications
BLINCYTO is contraindicated in patients with a known hypersensitivity to blinatumomab or to any component of the product formulation.

Warnings and Precautions

Cytokine Release Syndrome (CRS): Life-threatening or fatal CRS occurred in patients receiving BLINCYTO. Infusion reactions have occurred and may be clinically indistinguishable from manifestations of CRS. Closely monitor patients for signs and symptoms of serious events such as pyrexia, headache, nausea, asthenia, hypotension, increased alanine aminotransferase (ALT), increased aspartate aminotransferase (AST), increased total bilirubin (TBILI), disseminated intravascular coagulation (DIC), capillary leak syndrome (CLS), and hemophagocytic lymphohistiocytosis/macrophage activation syndrome (HLH/MAS). Interrupt or discontinue BLINCYTO as outlined in the Prescribing Information (PI).

Neurological Toxicities: Approximately 50% of patients receiving BLINCYTO in clinical trials experienced neurological toxicities. Severe, life-threatening, or fatal neurological toxicities occurred in approximately 15% of patients, including encephalopathy, convulsions, speech disorders, disturbances in consciousness, confusion and disorientation, and coordination and balance disorders. The median time to onset of any neurological toxicity was 7 days. Monitor patients for signs or symptoms and interrupt or discontinue BLINCYTO as outlined in the PI.

Infections: Approximately 25% of patients receiving BLINCYTO experienced serious infections, some of which were life-threatening or fatal. Administer prophylactic antibiotics and employ surveillance testing as appropriate during treatment. Monitor patients for signs or symptoms of infection and treat appropriately, including interruption or discontinuation of BLINCYTO as needed.

Tumor Lysis Syndrome (TLS): Life-threatening or fatal TLS has been observed. Preventive measures, including pretreatment nontoxic cytoreduction and on treatment hydration, should be used during BLINCYTO treatment. Monitor patients for signs and symptoms of TLS and interrupt or discontinue BLINCYTO as needed to manage these events.

Neutropenia and Febrile Neutropenia, including life-threatening cases, have been observed. Monitor appropriate laboratory parameters during BLINCYTO infusion and interrupt BLINCYTO if prolonged neutropenia occurs.

Effects on Ability to Drive and Use Machines: Due to the possibility of neurological events, including seizures, patients receiving BLINCYTO are at risk for loss of consciousness, and should be advised against driving and engaging in hazardous occupations or activities such as operating heavy or potentially dangerous machinery while BLINCYTO is being administered.

Elevated Liver Enzymes: Transient elevations in liver enzymes have been associated with BLINCYTO treatment. The majority of these events were observed in the setting of CRS. The median time to onset was 15 days. Grade 3 or greater elevations in liver enzymes occurred in 6% of patients outside the setting of CRS and resulted in treatment discontinuation in less than 1% of patients. Monitor ALT, AST, gamma-glutamyl transferase (GGT), and TBILI prior to the start of and during BLINCYTO treatment. BLINCYTO treatment should be interrupted if transaminases rise to > 5 times the upper limit of normal (ULN) or if TBILI rises to > 3 times ULN.

Leukoencephalopathy: Although the clinical significance is unknown, cranial magnetic resonance imaging (MRI) changes showing leukoencephalopathy have been observed in patients receiving BLINCYTO, especially in patients previously treated with cranial irradiation and anti-leukemic chemotherapy. Preparation and administration errors have occurred with BLINCYTO treatment. Follow instructions for preparation (including admixing) and administration in the PI strictly to minimize medication errors (including underdose and overdose).

Adverse Reactions

The most commonly reported adverse reactions (≥ 20%) in clinical trials were pyrexia (62%), headache (36%), peripheral edema (25%), febrile neutropenia (25%), nausea (25%), hypokalemia (23%), rash (21%), tremor (20%), diarrhea (20%) and constipation (20%).

Serious adverse reactions were reported in 65% of patients. The most common serious adverse reactions (≥ 2%) included febrile neutropenia, pyrexia, pneumonia, sepsis, neutropenia, device-related infection, tremor, encephalopathy, infection, overdose, confusion, Staphylococcal bacteremia, and headache.

U.S. Dosage and Administration Guidelines

BLINCYTO is administered as a continuous intravenous infusion at a constant flow rate using an infusion pump which should be programmable, lockable, non-elastomeric, and have an alarm. It is very important that the instructions for preparation (including admixing) and administration provided in the full Prescribing Information are strictly followed to minimize medication errors (including underdose and overdose). Please see full U.S. Prescribing Information and medication guide for BLINCYTO at www.BLINCYTO.com.