On November 30, 2015 Bristol-Myers Squibb Company (NYSE:BMY) and AbbVie (NYSE:ABBV) reported the U.S. Food and Drug Administration (FDA) has approved Empliciti (elotuzumab) for the treatment of multiple myeloma as combination therapy with Revlimid (lenalidomide) and dexamethasone (ERd) in patients who have received one to three prior therapies (Press release, Bristol-Myers Squibb, NOV 30, 2015, View Source [SID:1234508365]).

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The approval of this first and only immunostimulatory antibody for multiple myeloma is based on data from the randomized, open-label, Phase 3, ELOQUENT-2 study, which demonstrated that the ERd regimen resulted in a 30% reduction in the risk of disease progression or death compared to Rd alone (HR 0.70 [95% CI: 0.57, 0.85; p = 0.0004]).

The co-primary endpoints were progression-free survival (PFS), as assessed by hazard ratio, and overall response rate (ORR). With a minimum of two years follow-up, ERd delivered a benefit in PFS that was maintained over time, with PFS rates of 68% versus 57% at one year and 41% versus 27% at two years in the ERd and Rd arms, respectively. The ERd regimen also demonstrated a significant improvement in ORR, achieving an ORR of 78.5% (95% CI: 73.6% to 82.9%) versus 65.5% in the Rd arm (95% CI: 60.1% to 70.7%). The most common adverse reactions in ERd and Rd, respectively (>20%) were fatigue (61.6%, 51.7%), diarrhea (46.9%, 36.0%), pyrexia (37.4%, 24.6%), constipation (35.5%, 27.1%), cough (34.3%, 18.9%), peripheral neuropathy (26.7%, 20.8%), nasopharyngitis (24.5%, 19.2%), upper respiratory tract infection (22.6%, 17.4%), decreased appetite (20.8%, 12.6%), and pneumonia (20.1%, 14.2%).

"At Bristol-Myers Squibb, we are leading a revolution in cancer treatment that is changing expectations for patients with some of the hardest-to-treat cancers. With today’s approval of Empliciti, we are pleased to now bring the promise of our Immuno-Oncology research to patients with multiple myeloma," said Francis Cuss, MB Bchir, FRCP, chief scientific officer, Bristol-Myers Squibb. "Empliciti represents a fundamentally different approach of directly activating the immune system in patients with relapsed or refractory multiple myeloma, delivering improved outcomes for those in need."

Empliciti is available for injection for intravenous use in 300 mg and 400 mg vials. The company expects to begin shipping Empliciti within the next 48 hours. Empliciti is also under review by the European Medicines Agency and has been granted accelerated assessment.

Discontinuation rates due to adverse reactions were similar across the ERd and Rd control arms (6.0% vs. 6.3%). ERd is associated with the following Warnings and Precautions: Infusion Reactions, Infections, Second Primary Malignancies, Hepatotoxicity, Interference with Determination of Complete Response, Pregnancy/Females and Males of Reproductive Potential, and Adverse Reactions. Please see the detailed Important Safety Information and a link to the Prescribing Information below.

"Multiple myeloma remains largely incurable, with only half of patients surviving five years after diagnosis," said Sagar Lonial, M.D., chief medical officer of the Winship Cancer Institute of Emory University. "The approval of elotuzumab (Empliciti) provides renewed hope for the multiple myeloma community who urgently need a treatment option that extends the time patients live without their disease progressing."

"Empliciti in combination with lenalidomide and dexamethasone is an important new option for patients with multiple myeloma and healthcare providers who are treating this cancer," said Michael Severino, M.D., executive vice president of research and development and chief scientific officer, AbbVie. "AbbVie is pleased to have partnered with Bristol-Myers Squibb in making this new treatment available for patients with relapsed or refractory multiple myeloma."

About ELOQUENT-2

ELOQUENT-2 (CA204-004) is a randomized, open-label, Phase 3 study evaluating Empliciti in combination with lenalidomide and dexamethasone (ERd) versus lenalidomide and dexamethasone (Rd) alone in patients with relapsed or refractory multiple myeloma. The trial enrolled 646 patients who had received one to three prior therapies. Patients were randomized 1:1 to receive either Empliciti 10 mg/kg in combination with Rd or Rd alone in 4-week cycles until disease progression or unacceptable toxicity. Baseline patient demographics and disease characteristics were well balanced between treatment arms and included a meaningful portion of patients who were ≥ 65 years old, had high-risk cytogenetics, and/or were refractory to the most recent line of therapy. The minimum follow-up for all study subjects was 24 months. The co-primary endpoints were PFS, as assessed by hazard ratio, and ORR as determined by a blinded Independent Review Committee using the European Group for Blood and Marrow Transplantation response criteria. Results of the ELOQUENT-2 study were published in The New England Journal of Medicine on June 2, 2015.

The study demonstrated that the ERd regimen resulted in a 30% reduction in the risk of disease progression or death compared to Rd alone (HR 0.70 [95% CI: 0.57, 0.85; p = 0.0004]). Additionally, the PFS rates in the ERd arm versus the Rd arm were 68% versus 57% at one year and 41% versus 27% at two years, respectively. The ERd regimen demonstrated a significant improvement in ORR, achieving an ORR of 78.5% (95% CI, 73.6% to 82.9%; p = 0.0002) in the ERd arm versus 65.5% in the Rd arm (95% CI, 60.1% to 70.7%). The median PFS in the ERd group was 19.4 months (95% CI, 16.6 to 22.2) versus 14.9 months (95% CI, 12.1 to 17.2) in the Rd group. At the time of the interim analysis, there were fewer deaths in the ERd versus Rd study arm (94 [29%] versus 116 [36%], respectively).

Serious adverse reactions were reported in 65.4% of patients treated on the ERd arm and 56.5% for patients treated on the Rd arm. The most frequent serious adverse reactions in the ERd arm compared to the Rd arm were: pneumonia (15.4%, 11%), pyrexia (6.9%, 4.7%), respiratory tract infection (3.1%, 1.3%), anemia (2.8%, 1.9%), pulmonary embolism (3.1%, 2.5%), and acute renal failure (2.5%, 1.9%). The most common adverse reactions in ERd and Rd, respectively (>20%) are fatigue (61.6%, 51.7%), diarrhea (46.9%, 36.0%), pyrexia (37.4%, 24.6%), constipation (35.5%, 27.1%), cough (34.3%, 18.9%), peripheral neuropathy (26.7%, 20.8%), nasopharyngitis (24.5%, 19.2%), upper respiratory tract infection (22.6%, 17.4%), decreased appetite (20.8%, 12.6%), and pneumonia (20.1%, 14.2%). Infusion reactions occurred in 10% of patients treated with ERd; these adverse events were Grade 3 or lower (Grade 3, 1%; Grade 4, 0%) and were manageable. In the trial, 1% of patients discontinued due to infusion reactions and 5% of patients required interruption of the administration of Empliciti for a median of 25 minutes. Grade 3/4 laboratory abnormalities that worsened from baseline and had a 10% or higher incidence for ERd patients and a 5% higher incidence than Rd patients were: lymphopenia (76.7%, 48.7%), leukopenia (32.4%, 25.6%), hyperglycemia (17.0%, 10.2%), and hypocalcemia (11.3% and 4.7%). Overall, the proportion of patients who discontinued treatment due to adverse reactions was similar for the ERd and Rd arms (6.0% vs. 6.3%, respectively).

"The approval of Empliciti is an innovative advancement in the treatment of multiple myeloma," said Walter M. Capone, chief executive officer and president, The Multiple Myeloma Research Foundation. "This is an exciting opportunity for patients who experience relapse and may benefit from this new immunotherapy treatment."

About Empliciti

Empliciti is an immunostimulatory antibody that specifically targets Signaling Lymphocyte Activation Molecule Family member 7 (SLAMF7), a cell-surface glycoprotein. SLAMF7 is expressed on myeloma cells independent of cytogenetic abnormalities. SLAMF7 is also expressed on Natural Killer cells, plasma cells, and at lower levels on specific immune cell subsets of differentiated cells within the hematopoietic lineage.

Empliciti has a dual mechanism-of-action. It directly activates the immune system through Natural Killer cells via the SLAMF7 pathway. Empliciti also targets SLAMF7 on myeloma cells, tagging these malignant cells for Natural Killer cell-mediated destruction via antibody-dependent cellular toxicity.

Bristol-Myers Squibb and AbbVie are co-developing Empliciti, with Bristol-Myers Squibb solely responsible for commercial activities. Prior to approval, Empliciti was granted Breakthrough Therapy Designation by the FDA for use in combination with lenalidomide and dexamethasone for the treatment of multiple myeloma in patients who have received one to three prior therapies. According to the FDA, Breakthrough Therapy Designation is intended to expedite the development and review of drugs for serious or life-threatening conditions. The criteria for Breakthrough Therapy Designation requires preliminary clinical evidence that demonstrates the drug may have substantial improvement on at least one clinically significant endpoint over available therapy.

About Bristol-Myers Squib’s Patient Support Programs

Bristol-Myers Squibb is committed to helping patients through treatment with Empliciti. For support and assistance, patients and physicians may call 1-844-EMPLICITI. This number offers one-stop access to a range of support services for patients and healthcare professionals alike.

About Bristol-Myers Squibb’s Access Support

Bristol-Myers Squibb is committed to helping patients access Empliciti and offers numerous programs to support patients and providers in gaining access. BMS Access Support, the Bristol-Myers Squibb Reimbursement Services program, is designed to support access to BMS medicines and expedite time to therapy through reimbursement support including Benefit Investigations, Prior Authorization Facilitation, Appeals Assistance, and assistance for patient out-of-pocket costs. BMS Access Support assists patients and providers throughout the treatment journey―whether it is at initial diagnosis or in support of transition from a clinical trial. More information about our reimbursement support services can be obtained by calling 1-800-861-0048 or by visiting www.bmsaccesssupport.com. For healthcare providers seeking Empliciti specific reimbursement information, please visit the BMS Access Support Product section by visiting www.bmsaccesssupportoncology.com.

About Multiple Myeloma

Multiple myeloma is a hematologic, or blood, cancer that develops in the bone marrow. It occurs when a plasma cell, a type of cell in the soft center of bone marrow, becomes cancerous and multiplies uncontrollably. Common symptoms of multiple myeloma include bone pain, fatigue, kidney impairment, and infections.

Despite advances in multiple myeloma treatment over the last decade, less than half of patients survive for five or more years after diagnosis. A common characteristic for many patients is that they experience a cycle of remission and relapse, in which they stop treatment for a short time, but eventually return to a treatment shortly after. It is estimated that annually, more than 114,200 new cases of multiple myeloma are diagnosed and more than 80,000 people die from the disease globally.

EMPLICITI (elotuzumab) INDICATIONS & IMPORTANT SAFETY INFORMATION

INDICATION

EMPLICITI (elotuzumab), is indicated in combination with lenalidomide and dexamethasone for the treatment of patients with multiple myeloma who have received one to three prior therapies.

IMPORTANT SAFETY INFORMATION

Infusion Reaction

In a clinical trial of patients with multiple myeloma (n=365), EMPLICITI caused infusion reactions. Common symptoms include fever, chills, and hypertension. Bradycardia and hypotension also developed during infusions. In the trial, 5% of patients required interruption of the administration of EMPLICITI for a median of 25 minutes due to infusion reactions, and 1% of patients discontinued due to infusion reactions. Of the patients who experienced an infusion reaction, 70% (23/33) had them during the first dose. If a Grade 2 or higher infusion reaction occurs, interrupt the EMPLICITI infusion and institute appropriate medical and supportive measures. If the infusion reaction recurs, stop the EMPLICITI infusion and do not restart it on that day. Severe infusion reactions may require permanent discontinuation of EMPLICITI therapy and emergency treatment.
Premedicate with dexamethasone, H1 Blocker, H2 Blocker, and acetaminophen prior to infusing with EMPLICITI.

Infections

Infections were reported in 81.4% of patients in the EMPLICITI with lenalidomide/dexamethasone arm (ERd) and 74.4% in the lenalidomide/dexamethasone arm (Rd). Grade 3-4 infections were 28% (ERd) and 24.3% (Rd). Opportunistic infections were reported in 22% (ERd) and 12.9% (Rd). Fungal infections were 9.7% (ERd) and 5.4% (Rd). Herpes zoster was 13.5% (ERd) and 6.9% (Rd). Discontinuations due to infections were 3.5% (ERd) and 4.1% (Rd). Fatal infections were 2.5% (ERd) and 2.2% (Rd). Monitor patients for development of infections and treat promptly.

Second Primary Malignancies

Invasive second primary malignancies (SPM) were 9.1% (ERd) and 5.7% (Rd). The rate of hematologic malignancies were the same between ERd and Rd treatment arms (1.6%). Solid tumors were reported in 3.5% (ERd) and 2.2% (Rd). Skin cancer was reported in 4.4% (ERd) and 2.8% (Rd). Monitor patients for the development of SPMs.

Hepatotoxicity

Elevations in liver enzymes (AST/ALT greater than 3 times the upper limit, total bilirubin greater than 2 times the upper limit, and alkaline phosphatase less than 2 times the upper limit) consistent with hepatotoxicity were 2.5% (ERd) and 0.6% (Rd). Two patients experiencing hepatotoxicity discontinued treatment; however, 6 out of 8 patients had resolution and continued treatment. Monitor liver enzymes periodically. Stop EMPLICITI upon Grade 3 or higher elevation of liver enzymes. After return to baseline values, continuation of treatment may be considered.
Interference with Determination of Complete Response

EMPLICITI is a humanized IgG kappa monoclonal antibody that can be detected on both the serum protein electrophoresis and immunofixation assays used for the clinical monitoring of endogenous M-protein. This interference can impact the determination of complete response and possibly relapse from complete response in patients with IgG kappa myeloma protein.

Pregnancy/Females and Males of Reproductive Potential

There are no studies with EMPLICITI with pregnant women to inform any drug associated risks.
There is a risk of fetal harm, including severe life-threatening human birth defects associated with lenalidomide and it is contraindicated for use in pregnancy. Refer to the lenalidomide full prescribing information for requirements regarding contraception and the prohibitions against blood and/or sperm donation due to presence and transmission in blood and/or semen and for additional information.

Adverse Reactions

Infusion reactions were reported in approximately 10% of patients treated with EMPLICITI with lenalidomide and dexamethasone. All reports of infusion reaction were Grade 3 or lower. Grade 3 infusion reactions occurred in 1% of patients.
Serious adverse reactions were 65.4% (ERd) and 56.5% (Rd). The most frequent serious adverse reactions in the ERd arm compared to the Rd arm were: pneumonia (15.4%, 11%), pyrexia (6.9%, 4.7%), respiratory tract infection (3.1%, 1.3%), anemia (2.8%, 1.9%), pulmonary embolism (3.1%, 2.5%), and acute renal failure (2.5%, 1.9%).
The most common adverse reactions in ERd and Rd, respectively (>20%) are fatigue (61.6%, 51.7%), diarrhea (46.9%, 36.0%), pyrexia (37.4%, 24.6%), constipation (35.5%, 27.1%), cough (34.3%, 18.9%), peripheral neuropathy (26.7%, 20.8%), nasopharyngitis (24.5%, 19.2%), upper respiratory tract infection (22.6%, 17.4%), decreased appetite (20.8%, 12.6%), and pneumonia (20.1%, 14.2%).

On November 30, 2015 Merck KGaA, Darmstadt, Germany, and Pfizer reported that the European Medicines Agency (EMA)’s Committee for Orphan Medicinal Products (COMP) has issued a positive opinion for Orphan Drug designation (ODD) for avelumab*, an investigational fully human anti-PD-L1 IgG1 monoclonal antibody, pending an official decision by the European Commission (EC), expected in December (Press release, Pfizer, NOV 30, 2015, View Source [SID:1234508363]).

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The COMP positive opinion is for the cancer immunotherapy avelumab, for the treatment of Merkel cell carcinoma (MCC), a rare and aggressive type of skin cancer.1,2 Each year, there are approximately 2,500 new cases of MCC diagnosed in the European Union (EU).3 There is currently no therapy approved specifically for the treatment of metastatic MCC.4

"While significant therapeutic advances have been made against other types of skin cancer, similar progress has not been made against Merkel cell carcinoma. There is a great need for effective therapies in this disease," said Dr. Mace Rothenberg, Senior Vice President of Clinical Development and Medical Affairs and Chief Medical Officer for Pfizer Oncology. "Orphan Drug Designation is an important regulatory tool that can help facilitate development of a new treatment option for patients in Europe with this serious and rare condition."

The COMP’s positive opinion follows the US Food and Drug Administration’s ODD for avelumab for the treatment of MCC that was received in September, Fast Track designation for avelumab for the treatment of metastatic MCC that was received in October, and Breakthrough Therapy Designation for avelumab for the treatment of metastatic MCC that was received in November. In order for a drug to be granted ODD by the EMA, it must be intended for the treatment, prevention or diagnosis of a disease that is life-threatening or chronically debilitating; the prevalence of the condition in the EU must not be more than 5 in 10,000 or it must be unlikely that marketing of the medicine would generate sufficient returns to justify the investment needed for its development; and where no satisfactory treatment is currently available.

"We are delighted the EMA’s Committee for Orphan Medicinal Products has considered that avelumab matches the Orphan Drug designation criteria for metastatic Merkel cell carcinoma in the EU," said Dr. Luciano Rossetti, Head of Global Research & Development at Merck KGaA, Darmstadt, Germany’s biopharma business. "We look forward to working closely with the EMA to make this potential treatment available to patients as soon as possible, and we eagerly await the results of our Phase II trial in this rare skin cancer."

Merck KGaA, Darmstadt, Germany, and Pfizer are currently conducting a Phase II study (JAVELIN Merkel 200) to assess the safety and efficacy of avelumab in patients with metastatic MCC whose disease has progressed after at least one prior chemotherapy regimen. JAVELIN Merkel 200 is a multicenter, single-arm, open-label Phase II study with a primary objective of objective response rate.

The clinical development program for avelumab now includes more than 1,400 patients who have been treated across more than 15 tumor types, including breast cancer, gastric/gastro-esophageal junction cancers, head and neck cancer, MCC, mesothelioma, melanoma, non-small cell lung cancer, ovarian cancer, renal cell carcinoma and urothelial (e.g. bladder) cancer.

About the EMA Orphan Drug Designation

An ODD by the EMA allows a pharmaceutical company to benefit from incentives from the EU to develop a medicine for a rare disease. Applications for ODD are examined by the COMP, which adopts an opinion that is forwarded to the EC. The EC then decides whether to grant an orphan designation for the medicine in question within 30 days of receipt of the COMP opinion.

Pharmaceutical companies that obtain ODD benefit from a number of incentives, including protocol assistance, a type of scientific advice specific for designated orphan medicines, and market exclusivity once the medicine is on the market. Fee reductions are also available, depending on the status of the sponsor and the type of service required.

*Avelumab is the proposed International Nonproprietary Name for the anti-PD-L1 monoclonal antibody (MSB0010718C). Avelumab is under clinical investigation and has not been proven to be safe and effective. There is no guarantee any product will be approved in the sought-after indication by any health authority worldwide.

References
1. Hughes MP et al. Merkel cell carcinoma: epidemiology, target, and therapy. Curr Dermatol Rep 2014;3:46–53.
2. Kaae J et al. Merkel cell carcinoma: incidence, mortality, and risk of other cancers. J Natl Cancer Inst 2010;102(11):793–801.
3. IMMOMEC (European Commission). Merkel cell carcinoma. Available at: View Source (link is external) Last accessed November 2015
4. Miller NJ et al. Emerging and mechanism-based therapies for recurrent or metastatic Merkel cell carcinoma. Curr Treat Options Oncol; 2013 14(2): 249–6

About Merkel Cell Carcinoma (MCC)

MCC is a rare and aggressive disease in which cancer cells form in the top layer of the skin, close to nerve endings. MCC, which is also known as neuroendocrine carcinoma of the skin or trabecular cancer, often starts in those areas of skin that are most often exposed to the sun, including the head and neck, arms, legs, and trunk. Risk factors for MCC include sun exposure and having a weak immune system (i.e., solid organ transplant recipients, people with HIV/AIDS and people with other cancers, such as chronic lymphocytic leukemia, are at higher risk). Caucasian males over age 50 are at increased risk. MCC tends to metastasize at an early stage, spreading initially to nearby lymph nodes, and then potentially to more distant areas in the body, including other lymph nodes or areas of skin, lungs, brain, bones or other organs. Current treatment options for MCC include surgery, radiation and chemotherapy. Treatment for metastatic or Stage IV MCC is generally palliative.

About Avelumab

Avelumab (also known as MSB0010718C) is an investigational fully human anti-PD-L1 IgG1 monoclonal antibody. By inhibiting PD-L1 interactions, avelumab is thought to potentially enable the activation of T-cells and the adaptive immune system. By retaining a native Fc-region, avelumab is thought to engage the innate immune system and induce antibody-dependent cell-mediated cytotoxicity (ADCC). In November 2014, Merck KGaA, Darmstadt, Germany, and Pfizer announced a strategic alliance to co-develop and co-commercialize avelumab.

Alliance between Merck KGaA, Darmstadt, Germany, and Pfizer Inc., New York, US

On November 30, 2015 Ignyta, Inc. (Nasdaq: RXDX), a precision oncology biotechnology company, and the European Organisation for Research and Treatment of Cancer (EORTC) reported that they will collaborate via EORTC’s Screening Patients for Efficient Clinical Trial Access (SPECTA) biomarker screening initiative to identify patients who harbor a gene rearrangement to NTRK1, NTRK3, ROS1 or ALK and therefore may be eligible for Ignyta’s global STARTRK-2 Phase 2 clinical study (Press release, Ignyta, NOV 30, 2015, View Source [SID:1234508358]).

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This study is evaluating entrectinib, Ignyta’s novel, orally available, selective tyrosine kinase inhibitor targeting tumors that harbor activating alterations to these genes. Under the collaboration between SPECTA and Ignyta, eligible patients testing positive for a gene rearrangement to NTRK1, NTRK3, ROS1 or ALK are to be exclusively recommended for enrollment in the STARTRK-2 clinical trial.

SPECTA is a pan-European clinical trial site and cancer patient molecular screening network established by EORTC in collaboration with more than 30 leading cancer treatment centers in 11 European countries to provide efficient access for patients to molecularly driven clinical trials. Tissue samples from cancer patients being treated at SPECTA institutions throughout Europe are sent to the SPECTA program central laboratory at 14M Genomics, a spin-out of the Wellcome Trust Sanger Institute, for molecular genetic analysis. The collaboration will focus initially on SPECTA’s currently active programs to screen patients with colorectal cancer (SPECTAcolor) and lung cancer (SPECTAlung) and will expand to include additional tumor types in the future as additional SPECTA cohorts become activated. The collaboration will extend throughout the accrual phase of the STARTRK-2 study.

"Since we first initiated dialog with the leadership of the EORTC SPECTA initiative a year-and-a-half ago, we have shared their vision to conduct efficient biomarker-driven clinical trials of innovative new cancer medicines," said Jonathan Lim, M.D., Chairman and CEO of Ignyta. "We are honored to be selected by EORTC as the first biopharmaceutical partner for the SPECTA initiative and see this collaboration as an opportunity to help cancer patients throughout Europe by matching patients with certain biomarker signatures to a targeted treatment option."

Denis Lacombe, M.D., EORTC Headquarters Director, added, "SPECTA is a unique model of partnership as it connects all stakeholders involved in drug development, enhancing joint expertise to benefit patients. We look forward to working with Ignyta to leverage the SPECTA infrastructure to study entrectinib in patients with potentially relevant molecular alterations."

About Entrectinib

Entrectinib is a novel, orally available, selective tyrosine kinase inhibitor targeting tumors that harbor activating alterations to NTRK1/2/3 (encoding TrkA/ TrkB/TrkC), ROS1 or ALK. Entrectinib is the most potent Trk inhibitor in the clinic, without undesirable off-target activity, and the only Trk inhibitor with clinically demonstrated activity against CNS metastases. This product candidate is in a Phase 2 clinical trial called STARTRK-2, which is the second of the "Studies of Tumor Alterations Responsive to Targeting Receptor Kinases." The trial is a global, multicenter, open label, potentially registration-enabling Phase 2 clinical trial of entrectinib that utilizes a basket design with screening of patient tumor samples for the relevant targets. Such a basket design takes full advantage of entrectinib’s demonstrated preliminary clinical activity across a range of different tumor types and molecular targets.

On November 30, 2015 Kura Oncology, Inc. (NASDAQ:KURA), reported that the first patient has been dosed in an investigator-sponsored Phase 2 trial of its lead drug candidate, tipifarnib, an inhibitor of protein farnesylation, in cancer patients with urothelial carcinoma tumors characterized by HRAS mutations (Press release, Kura Oncology, NOV 30, 2015, View Source [SID:1234508355]). The study is being conducted under the direction of Se Hoon Park, M.D., Ph.D. in the Division of Hematology-Oncology at the Samsung Medical Center in Seoul, South Korea.

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"This study, in combination with our ongoing Phase 2 study in HRAS mutant tumors, should provide further insight into tipifarnib’s activity in HRAS mutant tumors and broaden our understanding of its mechanism of action," said Antonio Gualberto, M.D., Ph.D., Chief Medical Officer of Kura Oncology. "We are pleased to support the efforts of Dr. Park and his colleagues at the Samsung Medical Center."

"The development of new drugs for patients with refractory urothelial cancer is an important unmet medical need," said Dr. Park, lead investigator of the study. "There is a compelling scientific rationale to evaluate the role of HRAS and the activity of tipifarnib in this setting."

The primary objective of the Phase 2 study is to investigate the antitumor activity, in terms of objective response rate, of tipifarnib in patients with locally advanced, unresectable or metastatic, relapsed and/or refractory urothelial cancer tumors that carry HRAS mutations. Secondary objectives include evaluation of progression-free survival, duration of response and safety. It is planned that the study will enroll up to 18 patients.

About HRAS

The HRAS protein is a GTPase involved in regulating cell division in response to growth factor stimulation. Growth factors act by binding cell surface receptors that span the cell’s plasma membrane. Once activated, receptors stimulate signal transduction events in the cytoplasm, a process by which proteins and second messengers relay signals from outside the cell to the cell nucleus and instruct the cell to grow or divide. HRAS is an early player in many signal transduction pathways.

HRAS acts as a molecular on/off switch. Once it is turned on, it recruits and activates proteins necessary for the propagation of the receptor’s signal. In certain tumors, mutations in HRAS or its upstream effectors cause it to be permanently on, resulting in persistent activation of downstream growth and proliferation signals that drive tumor cell growth. Farnesyl transferase inhibitors (FTIs), such as tipifarnib, work to prevent the aberrant growth and proliferation of cells that are dependent on these signaling pathways by switching HRAS off.

Trial Rationale

The development of new drugs for patients with refractory urothelial cancer represents an important unmet medical need. Although the expression of HRAS in bladder tumors has been reported to have an inverse correlation with recurrence and disease progression, no data are yet available on the prognostic value of HRAS mutation in this indication. However, the strong association between Costello syndrome and bladder cancer may implicate HRAS in bladder carcinogenesis.

About Tipifarnib

Kura Oncology’s lead drug candidate, tipifarnib, inhibits farnesylation, a key cell signaling process implicated in cancer initiation and development. In extensive clinical trials, tipifarnib has shown compelling and durable anti-cancer activity in certain patient subsets and a well-established safety profile. Preclinical and clinical data suggest that, in the right genetic context, tipifarnib has the potential to provide significant benefit to cancer patients with limited treatment options. Leveraging advances in next-generation sequencing as well as emerging information about cancer genetics, Kura Oncology will seek to identify patients most likely to benefit from tipifarnib. In addition to the currently ongoing Phase 2 clinical trial of tipifarnib in patients with tumors characterized by HRAS mutations, the company initiated a Phase 2 clinical trial in patients with peripheral T-cell lymphomas in the third quarter of 2015. Kura Oncology holds an exclusive license to develop and commercialize tipifarnib in the field of oncology, under an agreement with Janssen Pharmaceutica NV.