FDA approves new treatment for advanced pancreatic cancer

On October 22, 2015 The U.S. Food and Drug Administration reported it approved Onivyde (irinotecan liposome injection), in combination with fluorouracil and leucovorin, to treat patients with advanced (metastatic) pancreatic cancer who have been previously treated with gemcitabine-based chemotherapy (Press release, , OCT 22, 2015, View Source [SID:1234507767]).
According to the National Cancer Institute, there will be 48,960 new cases of pancreatic cancer diagnosed in the U.S. in 2015, and nearly the same number of deaths caused by the disease (40,560). Pancreatic cancer can be difficult to diagnose early and treatment options are limited, especially when the disease has spread to other parts of the body (metastatic disease) and surgery to remove the tumor is not possible.

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"Many FDA staff who review drug applications are clinicians as well, so it’s especially rewarding when we are able to expedite access to new treatments for patients with unmet needs," said Richard Pazdur, M.D., director of the Office of Hematology and Oncology Products in the FDA’s Center for Drug Evaluation and Research. "By using the Priority Review designation for the application for Onivyde, patients will have earlier access to a drug that helps extend survival."

The FDA granted Priority Review and orphan drug designations for Onivyde. Priority review status is granted to applications for drugs that, if approved, would be a significant improvement in safety or effectiveness in the treatment of a serious condition. Orphan drug designation provides incentives such as tax credits, user fee waivers, and eligibility for orphan drug exclusivity to assist and encourage the development of drugs for rare diseases.

The effectiveness of Onivyde was demonstrated in a three-arm, randomized, open label study of 417 patients with metastatic pancreatic adenocarcinoma whose cancer had grown after receiving the chemotherapeutic drug gemcitabine or a gemcitabine-based therapy. The study was designed to determine whether patients receiving Onivyde plus fluorouracil/leucovorin or Onivyde alone lived longer than those receiving fluorouracil/leucovorin. Patients treated with Onivyde plus fluorouracil/leucovorin lived an average of 6.1 months, compared to 4.2 months for those treated with only fluorouracil/leucovorin. There was no survival improvement for those who received only Onivyde compared to those who received fluorouracil/leucovorin.

In addition, patients receiving Onivyde plus fluorouracil/leucovorin had a delay in the amount of time to tumor growth compared to those who received fluorouracil/leucovorin. The average time for those receiving Onivyde plus fluorouracil/leucovorin was 3.1 months compared to 1.5 months for those receiving fluorouracil/leucovorin.

The safety of Onivyde was evaluated in 398 patients who received either Onivyde with fluorouracil/leucovorin, Onivyde alone or fluorouracil/leucovorin. The most common side effects of treatment with Onivyde included diarrhea, fatigue, vomiting, nausea, decreased appetite, inflammation in the mouth (stomatitis) and fever (pyrexia). Onivyde was also found to result in low counts of infection-fighting cells (lymphopenia and neutropenia). Death due to sepsis following neutropenia has been reported in patients treated with Onivyde.

The labeling for Onivyde includes a boxed warning to alert health care professionals about the risks of severe neutropenia and diarrhea. Onivyde is not approved for use as a single agent for the treatment of patients with metastatic pancreatic cancer.

Onivyde is marketed by Merrimack Pharmaceuticals Inc. of Cambridge, Massachusetts.

Knowledge-Based Software Can Significantly Expedite Creation of High-Quality Radiotherapy Treatment Plans for Precise Tumor Targeting

On October 22, 2015 Varian Medical Systems reported that studies presented earlier this week at the 2015 annual meeting of the American Society for Radiation Oncology (ASTRO) confirmed that knowledge-based treatment planning software can dramatically improve the speed and quality of cancer care (Press release, Varian Medical Systems, OCT 22, 2015, View Source [SID:1234507766]). One award-winning study by a team using RapidPlan software from Varian Medical Systems (NYSE: VAR) showed that radiotherapy treatment planning for cervical cancer can be done in minutes rather than hours, with superior quality.

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In a presentation that was named among the "Best of ASTRO" and won the Basic/ Translational Science Abstract Award in the physics category, Nan Li, PhD, postdoctoral fellow at the University of California, San Diego (UCSD), and her team1 reported on their use of a RapidPlan model that was based on a refined sample of 86 previously-treated cervical cancer cases. They found that treatment planning time for intensity-modulated radiation therapy took an average of 6.85 minutes.[1] According to Kevin Moore, PhD, senior author on the study, UCSD dosimetrists estimate that manual GYN planning would require anywhere from 2-6 hours of optimization. "The use of knowledge-based planning represents a considerable time savings and reduced personnel costs," he said.

RapidPlan also improved plan quality compared to conventionally generated plans by minimizing the impact on normal surrounding tissues. "With both dramatic efficiency gains and improved normal tissue sparing, the final automated planning module was validated as both a clinical trial quality control system and a valuable tool for high-quality clinical planning in cervical cancer," observed Li.

Moore and his physician colleagues from UCSD also described work where stereotactic radiosurgery (SRS) treatment plans created using automated knowledge-based planning algorithms that they developed were set against manually-created clinical plans in a blinded comparison study.[2]

"In a clear majority of the cases, automated SRS planning demonstrated superior or equivalent plan quality to existing manual planning processes," Moore said. "Further refinement of algorithms to balance the complex clinical tradeoffs for high-priority organs-at-risk . . . will likely improve this technique further."

Researchers from Duke University evaluated a "rapid learning approach" in which clinicians "train" the RapidPlan tool by establishing a base knowledge model and continuously evaluate and update this knowledge model using subsequent cases. In their research on pelvic cancer cases, Jackie Wu, PhD, professor of radiation oncology, and her colleagues compared the RapidPlan rapid learning approach to the batch training method: knowledge modeling based on a static set of training cases.[3]

"The rapid learning approach is able to learn knowledge models for multiple cancer types in the pelvic region with comparable accuracy to the batch training method and with improved efficiency," Dr. Wu said. "This approach will facilitate the implementation of the knowledge based radiation therapy planning in clinics."

Knowledge-based planning enables clinicians to extract information from past clinical experience and use it to generate mathematical models that expedite the creation of new treatment plans. The software helps the planner quickly generate a new treatment plan that achieves the physician’s tumor coverage and normal tissue sparing goals, greatly reducing the need for time-consuming, manual trial-and-error processes while still optimizing quality.

"Varian’s RapidPlan software is a very robust knowledge-based planning solution that was developed to help clinical teams enhance quality, consistency, and efficiency in radiotherapy treatment planning," said Kolleen Kennedy, president of Varian Oncology Systems. "We are gratified to see research being conducted and presented, affirming the value of this tool for enhancing access to quality cancer treatment around the world. With the publication in the Lancet, last month, of a special report on the need to expand global access to radiotherapy, Varian is pleased to be offering tools like RapidPlan designed to improve utilization of radiotherapy around the world." [4]

OPKO Health Expands Portfolio of Tests for Inherited Forms of Cancer

On October 22, 2015 OPKO Health, Inc. (NYSE:OPK) reported that its GeneDx business unit has expanded its inherited cancer panel offerings and genetic tests to include four additional genes (Press release, Opko Health, OCT 22, 2015, View Source [SID:1234507759]).

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The four genes are POLD1, POLE, SCG5/GREM1, and SMARCA4. Three of the genes, POLD1, POLE and SCG5/GREM1, are associated with colon polyposis, colon cancer and endometrial cancer; while SMARCA4 is associated with an increased risk of a rare form of ovarian cancer. With the addition of these genes to the inherited cancer testing portfolio, it is possible to more effectively identify patients at risk. Once abnormalities are identified, patients can work with their healthcare providers to understand their specific cancer risk and what they can do to manage that risk.

"The addition of these four genes to the genetic tests now available from GeneDx can help in the diagnosis of rare syndromes associated with increased risk of colorectal, endometrial, ovarian and other cancers," said Marc. D. Grodman, M.D., CEO of BioReference Laboratories Inc., a subsidiary of OPKO.

The new gene panels and tests are available now for physicians to order from the GeneDx website. For more information, please visit www.genedx.com or email us at [email protected].

Roche delivers strong sales growth in the first nine months of 2015

On October 22, 2015 Roche reported strong sales growth in the first nine months of 2015 (Press release, Hoffmann-La Roche , OCT 22, 2015, View Source [SID:1234507757]).

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Group sales increased 6% at constant exchange rates1, 2% in Swiss francs

Pharmaceuticals Division sales up 6%, driven by strong growth of HER2-positive breast cancer medicines, as well as Avastin and Esbriet

Diagnostics Division sales increased 6%, driven by Professional Diagnostics, Molecular Diagnostics and Tissue Diagnostics

Full-year outlook raised

Positive phase III data presented on ocrelizumab, the first medicine for relapsing and for primary progressive forms of multiple sclerosis (MS)

Launch of cobas EGFR Mutation Test v2, the first liquid biopsy PCR test from Roche

For the seventh year running, Roche ranked most sustainable healthcare company in the Dow Jones Sustainability Indices (DJSI)

Commenting on the Group’s first nine months, Roche CEO Severin Schwan said: "With sales continuing to grow strongly, we are raising our outlook for the full year. I am very pleased about the positive newsflow coming from our product pipeline. This includes data on our cancer immunotherapy medicine atezolizumab in bladder and lung cancer and, in particular, strong data on ocrelizumab in both relapsing and primary progressive forms of MS. These medicines have the potential to make a big difference to people living with these terrible diseases."

Group demonstrated continued strong growth

Sales of the Roche Group increased 6% to CHF 35.5 billion in the first nine months. Growth was driven by all regions in the Pharmaceuticals Division and Professional Diagnostics’ sales.

The Swiss franc strengthened considerably against the euro during the first nine months of 2015, whilst weakening against the US dollar. The Japanese yen continued to weaken against the Swiss franc, as did Latin American and most European currencies. Overall, there was a negative currency impact of four percentage points on sales growth.

The DJSI again recognised Roche as the most sustainable company in the healthcare industry for the seventh consecutive year. Roche scored highest in the management of environmental and social topics, and with more than 100 new business partnerships established last year, DJSI also noted Roche’s strong culture of collaboration, broad approach to innovation, and commitment to furthering patient access to healthcare.

HER2 franchise, Avastin and Esbriet driving growth in the Pharmaceuticals Division

In Pharmaceuticals, the oncology and immunology products drove the division’s sales for the first nine months. Sales of the HER2-positive breast cancer medicines, Herceptin, Perjeta and Kadcyla, grew 19%. The outlook for this franchise was further strengthened in July after the European Commission approved Perjeta combination therapy for use before surgery. Avastin (+9%) and MabThera/Rituxan (+5%) also recorded continued strong growth.

In immunology, Actemra/RoActemra (+22%), which is used mainly to treat rheumatoid arthritis, and Xolair (+25%), which is now used in the treatment of chronic hives as well as asthma, grew again significantly. Sales of anti-viral medicine Valcyte and oral chemotherapy Xeloda declined as these medicines are no longer patent protected. Sales of hepatitis medicine Pegasys and eye treatment Lucentis dropped as a result of increased competition.

Strong demand for Esbriet, a treatment for idiopathic pulmonary fibrosis (IPF), a fatal lung disease, continued throughout the third quarter and sales totalled CHF 386 million in the first nine months. In September, additional data were presented from a pooled analysis of three phase III studies that suggested a reduction in treatment-emergent risk of death for IPF patients on Esbriet for more than two years.2 In the same month, Esbriet received approval in Switzerland.

Recently, key milestones were achieved for Roche’s Cotellic (cobimetinib) for use in combination with Zelboraf in advanced melanoma. The company announced final phase III data showing a significant increase in overall survival, and in September, the Committee for Medicinal Products for Human Use (CHMP) recommended EU approval for Cotellic plus Zelboraf for the treatment of patients with BRAF V600 mutation-positive metastatic melanoma. This combination therapy was approved in Switzerland in August and a US FDA decision is anticipated by the end of the year.

Laboratory business main growth contributor in Diagnostics Division
Sales of the Diagnostics Division increased 6%, driven primarily by immunodiagnostic products from the Professional Diagnostics business area (+7%). The Molecular and Tissue Diagnostics business areas also performed well, with sales up 10% and 12%, respectively. Sales in Diabetes Care declined 3% due to ongoing challenging market conditions.

With four instruments and four test approvals and launches this year, the Diagnostics Division further broadened its industry leading product portfolio. Roche recently launched the cobas EGFR Mutation Test v2 that utilises plasma and/or tumour tissue for non-small cell lung cancer diagnosis and treatment monitoring.

Significant clinical data released at key medical meetings
At this year’s European Cancer Congress (ECC), results were presented from several clinical studies that are supporting regulatory discussions on alectinib, atezolizumab and Cotellic, plus data on earlier-stage cancer immunotherapies. Roche is studying more than 20 medicines in cancer immunotherapy, eight of which are in clinical trials.

At the congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), Roche presented positive phase III data for ocrelizumab in people with relapsing forms of MS and in primary progressive MS. Ocrelizumab is the first medicine to show a clinically meaningful impact on the progression of disability in people with primary progressive MS (PPMS) in a pivotal phase III trial. In this study, the proportion of patients with adverse events and serious adverse events was similar in the ocrelizumab and placebo groups. In two studies in people with the most common form of the disease, relapsing MS, ocrelizumab was superior to high-dose interferon beta-1a in reducing key markers of MS activity over the two-year controlled treatment period: annualised relapse rate, disability progression, and areas of MS-related inflammation and brain injury. The proportion of patients with adverse events and serious adverse events was similar in the ocrelizumab and interferon beta-1a groups. Roche will submit these data to global health authorities in 2016 to seek approval of ocrelizumab for relapsing forms of MS and PPMS.

In September, the US FDA granted Breakthrough Therapy Designation for ACE910 to prevent bleeding episodes in hemophilia A patients aged 12 and older. This is now the ninth Breakthrough Therapy Designation granted for a Roche medicine.

Raised outlook for 2015
Based on the strong performance recorded in the first nine months of 2015, Roche now expects sales growth in the mid-single digit range, at constant exchange rates. Core earnings per share are targeted to grow ahead of sales at constant exchange rates3. Roche expects to further increase its dividend in Swiss francs.

Lilly Reports Third-Quarter 2015 Results, Revises 2015 Financial Guidance

On October 22, 2015 Eli Lilly and Company (NYSE: LLY) reported financial results for the third quarter of 2015 (Press release, Eli Lilly, OCT 22, 2015, View Source [SID:1234507756]).

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Certain financial information for 2015 and 2014 is presented on both a reported and a non-GAAP basis. Some numbers in this press release may not add due to rounding. Reported results were prepared in accordance with generally accepted accounting principles (GAAP) and include all revenue and expenses recognized during the period. Non-GAAP measures exclude the items described in the reconciliation tables later in the release. Non-GAAP measures in 2014 include the results of Novartis Animal Health as if the acquisition and the financing for the acquisition had occurred as of January 1, 2014. Non-GAAP financial measures for all periods presented also exclude amortization of intangibles primarily associated with costs of marketed products acquired or licensed from third parties. The company’s 2015 financial guidance is also being provided on both a reported and a non-GAAP basis. The non-GAAP measures are presented to provide additional insights into the underlying trends in the company’s business.

"We are pleased with our strong third-quarter results, which reflect the ongoing actions we are taking to grow revenue and increase productivity while we are replenishing and advancing our pipeline with an array of new, innovative therapies," said John C. Lechleiter, Ph.D., Lilly’s chairman, president and chief executive officer. "Despite headwinds from foreign exchange rates, we are benefiting from recent launches as well as our acquisition of Novartis Animal Health earlier this year."

"This quarter, we had higher sales volume for several key products, including recently launched Cyramza and Trulicity. We also launched several new products in various global markets, including Synjardy in the U.S. for type 2 diabetes. Promising pipeline momentum continued with encouraging news for baricitinib and abemaciclib, while Jardiance reported positive cardiovascular outcomes. Finally, we continued to create new collaborations and pursue smaller-scale acquisitions to bolster our pipeline and our product portfolio."

Looking forward, Lechleiter noted that Lilly could have a regulatory submission and/or decision for multiple potential new medicines in the next 18 months – reinforcing the company’s confidence in its innovation-based strategy and in its ability to grow revenue and expand margins over the balance of this decade.

Key Events Over the Last Three Months

Commercial

The company launched Basaglar, a basal insulin product, in Japan, the UK, Germany and other European markets. Basaglar is part of the Boehringer Ingelheim and Eli Lilly and Company Diabetes Alliance.
The company launched Trulicity in Japan as a treatment for type 2 diabetes.

Regulatory

The U.S. Food and Drug Administration (FDA) approved Synjardy (empagliflozin and metformin hydrochloride) tablets and the product was launched in the U.S. for the treatment of adults with type 2 diabetes. Synjardy is part of the Boehringer Ingelheim and Eli Lilly and Company Diabetes Alliance.

The FDA granted Breakthrough Therapy Designation to abemaciclib for patients with refractory hormone-receptor-positive advanced or metastatic breast cancer. Breakthrough Therapy Designation is designed to expedite the development and review of potential medicines that are intended to treat a serious condition, and preliminary clinical evidence indicates that the treatment may demonstrate substantial improvement over available therapy on a clinically significant endpoint.

Clinical

The company and Boehringer Ingelheim announced positive results from a long-term clinical trial investigating cardiovascular (CV) outcomes for Jardiance in adults with type 2 diabetes at high risk for CV events. Jardiance is the only diabetes medicine to have demonstrated a significant reduction in both cardiovascular risk and cardiovascular death in a dedicated outcomes trial.

The company will terminate the Phase III trials of evacetrapib for the treatment of high-risk atherosclerotic cardiovascular disease due to insufficient efficacy.

The company and Incyte Corporation announced positive top-line results for baricitinib, an investigational medicine for patients with moderately-to-severely active rheumatoid arthritis.

The third Phase III study evaluating safety and efficacy of baricitinib met its primary objective of demonstrating non-inferiority of baricitinib monotherapy to methotrexate monotherapy based on ACR20 response rate after 24 weeks of treatment. Additionally, baricitinib was superior to methotrexate based on ACR20 response.

The fourth Phase III study of baricitinib met its primary objective of demonstrating superiority compared to placebo after 12 weeks of treatment based on ACR20 response rate. Baricitinib was also superior to adalimumab in improving signs and symptoms of rheumatoid arthritis as measured by ACR20 response and improvement in the DAS28-hsCRP score after 12 weeks of treatment.

Business Development/Other

The company announced external innovation agreements with:

AstraZeneca to expand their existing immuno-oncology collaboration exploring novel combination therapies for the treatment of patients with solid tumors. The company and AstraZeneca will evaluate the safety and efficacy of a range of additional combinations across the companies’ complementary portfolios.

ImaginAb Inc. to conduct preclinical research studying potential novel T-cell-based immuno-oncology therapies.

Innovent Biologics, Inc. to expand their collaboration to support the development and potential commercialization of up to three anti-PD-1 based bispecific antibodies for cancer treatments over the next decade, both inside and outside of China.

The company acquired worldwide rights from Locemia Solutions to a Phase III intranasal glucagon, a potential treatment for severe hypoglycemia in people with diabetes treated with insulin.

Bristol-Myers Squibb transferred its Erbitux commercialization rights to Lilly in North America.

The company entered into a settlement agreement to resolve patent litigation with Sanofi regarding the company’s insulin glargine product, Basaglar. As a part of the agreement, Lilly and its alliance partner, Boehringer Ingelheim, will have the ability to launch Basaglar in the U.S. on December 15, 2016. Under the terms of the agreement, Sanofi granted Lilly a royalty-bearing license so Lilly can manufacture and sell Basaglar in the Kwikpen device globally.

The U.S. District Court for the Southern District of Indiana ruled that the Alimta vitamin regimen patent would be infringed by the generic challengers’ proposed products. The patent provides intellectual property protection for Alimta until May 2022.
The Japan Patent Office issued a notice of closure in the trial regarding the validity of Lilly’s vitamin regimen patent for Alimta. We expect a written decision upholding the patent validity in the coming weeks. This is the first of two decisions pending. If the patents are ultimately upheld through all challenges and appeals, they would provide intellectual property protection for Alimta in Japan until June 2021.

The company plans to add 30,000 square feet and approximately 50 new jobs to its research and development presence at the Alexandria Center for Life Science in New York, New York. Upon completion in 2016, this space will include a translational immuno-oncology hub and a Lilly "portal," which will provide local academic scientists with opportunities for collaborative access to cutting-edge drug discovery capabilities.

Third-Quarter Reported Results

In the third quarter of 2015, worldwide revenue was $4.960 billion, an increase of 2 percent compared with the third quarter of 2014. The revenue growth included an increase of 12 percent due to increased volume, largely offset by decreases of 8 percent due to the unfavorable impact of foreign exchange rates and 2 percent due to lower prices. The 12 percent increase in volume was primarily due to the inclusion of revenue from Novartis Animal Health and increased volume for several products, including the U.S. Evista authorized generic, Cyramza and Trulicity. These worldwide volume increases were partially offset by lower demand for Cymbalta due to the U.S. patent expiration in December 2013. Revenue in the U.S. increased 14 percent to $2.538 billion, due primarily to higher volume, partially offset by lower prices. The U.S. price decrease was driven by a lower price for the Evista authorized generic, which more than offset higher prices for other products. Revenue outside the U.S. decreased 9 percent to $2.422 billion, driven by the unfavorable impact of foreign exchange rates, partially offset by the inclusion of revenue from Novartis Animal Health and increased volumes for the majority of pharmaceutical products.

Gross margin increased 3 percent to $3.723 billion in the third quarter of 2015, as the favorable impact of foreign exchange rates on cost of sales, including the impact on international inventories sold, the inclusion of Novartis Animal Health and increased contribution from recently launched products were largely offset by the unfavorable impact of foreign exchange rates on revenue. Gross margin as a percent of revenue was 75.1 percent, an increase of 1.1 percentage points compared with the third quarter of 2014. The increase in gross margin percent was primarily due to the favorable impact of foreign exchange rates on international inventories sold, partially offset by the inclusion of Novartis Animal Health.

Operating expenses in the third quarter of 2015, defined as the sum of research and development and marketing, selling and administrative expenses, were $2.719 billion, a decline of 7 percent compared with the third quarter of 2014. Research and development expenses decreased 8 percent to $1.143 billion, or 23.1 percent of revenue, driven primarily by a 2014 charge associated with the termination of tabalumab development, and to a lesser extent foreign exchange rates, partially offset by the inclusion of Novartis Animal Health. Marketing, selling and administrative expenses decreased 6 percent to $1.576 billion, due to a 2014 charge associated with the Branded Prescription Drug Fee and foreign exchange rates, partially offset by the inclusion of Novartis Animal Health and expenses related to new product launches.

There were no acquired in-process research and development charges in the third quarter of 2015. In the third quarter of 2014, the company recognized acquired in-process research and development charges totaling $95.0 million related to collaboration agreements with Immunocore Limited and AstraZeneca.

In the third quarter of 2015, the company recognized asset impairment, restructuring and other special charges of $42.4 million. The charges primarily relate to integration costs for Novartis Animal Health and severance costs. In the third quarter of 2014, the company recognized asset impairment, restructuring and other special charges of $36.3 million, primarily severance, associated with cost-containment efforts and costs related to the then pending acquisition of Novartis Animal Health.

Operating income in the third quarter of 2015 was $961.3 million, an increase of 71 percent compared with the third quarter of 2014, driven by higher gross margin, lower operating expenses and lower acquired in-process research and development charges.

Other income (expense) was income of $86.5 million in the third quarter of 2015, compared with income of $93.5 million in the third quarter of 2014. Other income during the third quarter of 2015 was driven by net gains on investments. Other income during the third quarter of 2014 was driven primarily by net gains on investments and income from milestones earned.

The effective tax rate was 23.7 percent in the third quarter of 2015, compared with 23.6 percent in the third quarter of 2014. The 2015 effective tax rate reflects the impact of an increased percentage of forecasted earnings in higher taxed jurisdictions. The 2014 effective tax rate reflects the impact of a $119.0 million nondeductible charge associated with the U.S. Branded Prescription Drug Fee. Neither period includes the benefit of certain expired U.S. tax provisions, including the R&D tax credit.

In the third quarter of 2015, net income and earnings per share both increased 60 percent to $799.7 million, and $0.75, respectively, compared with $500.6 million and $0.47, respectively, in the third quarter of 2014. The increases in net income and earnings per share were driven by higher operating income.

Third-Quarter 2015 Non-GAAP Measures

On a non-GAAP basis, worldwide revenue was $4.960 billion in the third quarter of 2015, a decline of 4 percent compared with the third quarter of 2014. The revenue decline included decreases of 8 percent due to the unfavorable impact of foreign exchange rates and 2 percent due to lower prices, largely offset by an increase of 7 percent due to increased volume. The increase in volume was primarily due to the U.S. Evista authorized generic, as well as Cyramza and Trulicity, partially offset by lower demand for Cymbalta. U.S. revenue increased 11 percent to $2.538 billion, due primarily to higher volume, partially offset by lower prices. The U.S. price decrease was driven by a lower price for the Evista authorized generic, which more than offset higher prices for other products. Revenue outside the U.S. decreased 15 percent to $2.422 billion, driven by the unfavorable impact of foreign exchange rates, partially offset by increased volumes for the majority of pharmaceutical products.

Gross margin remained relatively flat at $3.861 billion in the third quarter of 2015, as the favorable impact of foreign exchange rates on cost of sales, including the impact on international inventories sold, and increased contribution from recently launched products were offset by the unfavorable impact of foreign exchange rates on revenue. Gross margin as a percent of revenue was 77.8 percent, an increase of 3.0 percentage points compared with the third quarter of 2014. The increase in gross margin percent was due to the favorable impact of foreign exchange rates on international inventories sold.

Operating expenses in the third quarter of 2015 were $2.683 billion, a decline of 7 percent compared with the third quarter of 2014. Research and development expenses decreased 10 percent to $1.143 billion, or 23.0 percent of revenue, driven primarily by a 2014 charge associated with the termination of tabalumab development, and to a lesser extent the favorable impact of foreign exchange rates. Marketing, selling and administrative expenses decreased 5 percent to $1.540 billion, due to the favorable impact of foreign exchange rates, partially offset by expenses related to new product launches.

Other income (expense) was income of $86.5 million in the third quarter of 2015, compared with income of $59.3 million in the third quarter of 2014.

The effective tax rate increased 1.6 percentage points compared to the third quarter of 2014 to 24.9 percent, due to an increased percentage of forecasted earnings in higher taxed jurisdictions.

Net income and earnings per share both increased 22 percent to $949.6 million and $0.89 respectively, compared with $781.2 million and $0.73, respectively, in the third quarter of 2014. The increases in net income and earnings per share were driven by higher operating income.

For further detail, see the reconciliation below as well as the Reconciliation of GAAP Reported to Selected Non-GAAP Adjusted Information table later in this release.

Year-to-Date Results

For the first nine months of 2015, worldwide revenue increased 1 percent compared to the same period in 2014 to $14.583 billion. Reported net income and earnings per share were $1.930 billion and $1.81, respectively. Net income and earnings per share, on a non-GAAP basis, were $2.828 billion and $2.65, respectively.

For further detail, see the reconciliation below as well as the Reconciliation of GAAP Reported to Selected Non-GAAP Adjusted Information table later in this release.

Humalog
For the third quarter of 2015, worldwide Humalog sales remained flat at $705.0 million compared with the third quarter of 2014. Sales in the U.S. increased 6 percent to $440.9 million, driven by higher prices and, to a lesser extent, increased demand. Sales outside the U.S. decreased 9 percent to $264.1 million, driven by the unfavorable impact of foreign exchange rates, partially offset by increased volume.

Alimta
For the third quarter of 2015, Alimta generated sales of $628.5 million, a decline of 13 percent compared with the third quarter of 2014. U.S. sales of Alimta decreased 7 percent to $296.7 million, driven by decreased volume due to increased competitive pressures and customer buying patterns. Sales outside the U.S. decreased 18 percent to $331.8 million, driven by the unfavorable impact of foreign exchange rates and, to a lesser extent, lower prices, partially offset by increased volume.

Cialis
Cialis sales for the third quarter of 2015 remained flat at $566.1 million compared with the third quarter of 2014. U.S. sales of Cialis were $313.3 million, a 25 percent increase compared with the third quarter of 2014, driven by higher prices and, to a lesser extent, increased volume. Sales of Cialis outside the U.S. decreased 21 percent to $252.8 million, driven by the unfavorable impact of foreign exchange rates.

Forteo
Third-quarter 2015 sales of Forteo were $348.9 million, a 5 percent increase compared with the third quarter of 2014. U.S. sales of Forteo increased 26 percent to $160.1 million, driven by higher prices and increased volume. Sales outside the U.S. decreased 8 percent to $188.8 million, due to the unfavorable impact of foreign exchange rates, partially offset by increased volume.

Humulin
Worldwide Humulin sales of $316.7 million for the third quarter of 2015 decreased 6 percent compared with the third quarter of 2014. U.S. sales increased 12 percent to $185.5 million, driven by higher prices. Sales outside the U.S. decreased 23 percent to $131.2 million, driven by decreased volume, primarily due to the loss of a government contract in Brazil, and the unfavorable impact of foreign exchange rates.

Cymbalta
For the third quarter of 2015, Cymbalta generated $242.9 million of sales, a decline of 34 percent compared with the third quarter of 2014. Sales of Cymbalta outside the U.S. were $218.3 million, a decline of 27 percent, driven by the unfavorable impact of foreign exchange rates and the loss of exclusivity in Europe in 2014.

Zyprexa
In the third quarter of 2015, Zyprexa sales totaled $237.9 million, a decline of 8 percent compared with the third quarter of 2014. Zyprexa sales outside the U.S. decreased 20 percent to $191.0 million, due primarily to the unfavorable impact of foreign exchange rates.

Strattera
During the third quarter of 2015, Strattera generated $196.9 million of sales, an increase of 3 percent compared with the third quarter of 2014. U.S. sales increased 7 percent to $128.8 million, driven by higher prices. Sales outside the U.S. decreased 4 percent to $68.1 million, driven by the unfavorable impact of foreign exchange rates, largely offset by increased volume.

Effient
Effient sales remained flat at $132.1 million in the third quarter of 2015 compared with the third quarter of 2014. U.S. Effient sales increased 7 percent to $106.3 million, due to higher prices, partially offset by decreased demand. Sales outside the U.S. decreased 19 percent to $25.8 million, driven primarily by the unfavorable impact of foreign exchange rates.

Evista
Evista sales for the third quarter of 2015 were $58.0 million, a decline of 35 percent compared with the third quarter of 2014. U.S. sales of Evista were $15.5 million as sales of the authorized generic led to increased volume and lower prices. Sales outside the U.S. decreased 22 percent to $42.5 million, driven primarily by the unfavorable impact of foreign exchange rates.

Animal Health
In the third quarter of 2015, worldwide animal health sales totaled $778.8 million, an increase of 33 percent compared with the third quarter of 2014. U.S. animal health sales increased 25 percent to $392.6 million, and animal health sales outside the U.S. increased 42 percent to $386.2 million. The increases were primarily driven by the inclusion of revenue from Novartis Animal Health.

Including the sales of Novartis Animal Health in 2014, worldwide animal health sales decreased 9 percent, U.S. sales increased 1 percent, and sales outside the U.S. decreased 18 percent. The increase in U.S. sales was driven by increased volume in food animal products, partially offset by decreased volume in companion animal products. The decline in sales outside the U.S. was driven by the unfavorable impact of foreign exchange rates and to a lesser extent decreased volume, primarily in companion animal products, partially offset by higher prices. Including the sales of Novartis Animal Health in 2014 and excluding the unfavorable impact of foreign exchange rates, worldwide animal health sales decreased 2 percent.

2015 Financial Guidance

The company has revised certain elements of its 2015 financial guidance on a reported basis and on a non-GAAP basis. Full-year 2015 earnings per share are now expected to be in the range of $2.40 to $2.45 on a reported basis. On a non-GAAP basis, full-year 2015 earnings per share are now expected to be in the range of $3.40 to $3.45.

The company still expects 2015 revenue of between $19.7 billion and $20.0 billion.

The company still expects gross margin as a percent of revenue will be approximately 74.5 percent on a reported basis. On a non-GAAP basis, gross margin as a percent of revenue is still expected to be approximately 78.0 percent, reflecting the exclusion of inventory step-up costs associated with the acquisition of Novartis Animal Health as well as amortization of intangibles.

Marketing, selling and administrative expenses on a reported basis are now expected to be in the range of $6.4 billion to $6.6 billion. On a non-GAAP basis, marketing, selling and administrative expenses are now expected to be in the range of $6.3 billion to $6.5 billion. Research and development expenses are now expected to be in the range of $4.6 billion to $4.8 billion.

Other income (expense) is now expected to be in a range between $50 million and $75 million of income on a reported basis, reflecting net gains on investments realized to date, partially offset by the net charge related to the repurchase of debt. On a non-GAAP basis, other income (expense) is now expected to be in a range between $200 million and $225 million of income, reflecting net gains on investments realized to date.

The 2015 tax rate is now expected to be approximately 16.5 percent on a reported basis and 21.5 percent on a non-GAAP basis, reflecting the impact of an increased percentage of forecasted earnings in higher taxed jurisdictions. Both rates assume a full-year 2015 benefit of the R&D tax credit and other tax provisions up for extension. If these items are not extended, the non-GAAP 2015 tax rate would be approximately 1.5 percentage points higher.

Capital expenditures are now expected to be approximately $1.1 billion.

The company’s 2015 financial guidance, on a reported basis, does not include the potential impact of the recent acquisition of worldwide rights to an intranasal glucagon from Locemia Solutions.