On March 2, 2021 Herantis Pharma Plc ("Herantis"), an innovative clinical stage biotech company pioneering new disease modifying and regenerative biologic and gene therapies, reported that clinical trial results from its Phase II study investigating Herantis’ patented gene therapy Lymfactin, for the treatment of Breast Cancer Related Lymphedema (BCRL), were inconclusive (Press release, Herantis Pharma, MAR 2, 2021, View Source,c3298919 [SID1234577482]). Lymfactin is a unique gene therapy that induces expression of VEGF-C, an endogenous protein that is responsible for driving the growth and regeneration of lymphatic vessels. The primary purpose of the trial was to determine whether there was an additional benefit of Lymfactin treatment in combination with lymph node transfer surgery, compared to surgery alone. While both treatment groups experienced clear clinical benefits, the trial did not establish additional treatment benefit for Lymfactin in combination with surgery, compared to surgery alone.
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The results unexpectedly showed differences between the treatment groups at the start of the study (baseline), in terms of arm volume and quality of life, making it unfeasible to draw conclusions on the treatment effect of Lymfactin in combination with surgery, compared to surgery alone. In addition, the outcome measures used for the study were inconsistent which was surprising and made it difficult to accurately assess treatment response. These factors reflect the pioneering nature of the study in a novel indication where there will be inevitable learnings with regard to study design and suitable outcome measures to assess treatment effect.
Dr Anne Saarikko, Coordinating Principal Investigator of the study, commented "Herantis is at the forefront of finding a treatment for BCRL. This has been a ground-breaking study for the treatment of BCRL, and I commend the Herantis team for pushing the boundaries of science in an effort to help patients suffering from this debilitating condition. The overall results of the treatment appear promising for the majority of patients; however, we need to ascertain and assess the effect of Lymfactin specifically, which has not been possible in this challenging study."
The key findings of the analysis at 12 months post treatment indicate that approximately half of the patients obtained a clinically meaningful response, over 25% reduction in the affected arm volume compared with the normal arm in both Lymfactin and placebo treatment groups. Improvement in quality of life of most patients in the study was also seen across both treatment groups. However, for a meaningful statistical analysis to be conducted, it is essential that the two groups – placebo and active treatment groups – are comparable at baseline in terms of the primary outcome measures and other disease characteristics, which was not the case in this trial at the study start. The imprecision of the outcome measures further complicated demonstration of a therapeutic effect of Lymfactin. The company will continue to analyse and review the data to gain additional insight from the study including the baseline differences, adequacy of dosing, outcome measures, measurement tools, other signals in the data, and other potentially applicable target indications. The company expects to be able to announce any further findings and decisions on the program in Q2 2021.
From a safety perspective, Lymfactin was generally safe and well tolerated. Adverse events were mild and transient. The incidence of adverse events reported in patients treated with Lymfactin was comparable to the incidence for patients in the placebo group.
Craig Cook CEO commented "We are very grateful to the patients who participated in this pioneering study of our innovative gene therapy Lymfactin for the treatment of BCRL. While the efficacy of the overall treatment regime i.e. lymph node transfer surgery plus Lymfactin – is encouraging, we are disappointed that the study design did not allow for meaningful conclusions to be drawn about Lymfactin specifically. The novel nature of the Lymfactin program generally, and this study specifically, means there have been a number of clear and important learnings, and we will now continue our analysis of the data and review of the strategic options for the program moving forward. In parallel, the company’s CDNF and xCDNF programs continue at pace, with the dedicated funds raised in recent fundraise December 2020 enabling planned development activities for these programs."
The study is a randomized, double-blinded, placebo-controlled, Phase II clinical trial conducted in 39 patients across 5 sites in Finland and Sweden. Patients selected according to strict inclusion criteria were enrolled into the study and randomized to receive either one dose of placebo or Lymfactin, together with lymph node transfer surgery. The study was unblinded after all patients were monitored for 12 months post-surgery. Primary endpoints were volume reduction in the affected arm, changes in quality of life (QoL) and changes in lymphatic flow assessed by quantitative lymphoscintigraphy. The patients will continue to be monitored for efficacy and safety endpoints for 36 months and 60 months post-operation, respectively.
About Lymfactin
Lymfactin is the world’s first and only clinical stage gene therapy that repairs damages of the lymphatic system. It expresses the human growth factor VEGF-C, which is naturally associated with the development of lymphatic vessels. Based on preclinical studies, Lymfactin triggers the growth of new functional lymphatic vasculature in the injured area and thus repairs the underlying cause of secondary lymphedema. The first target indication for Lymfactin is Breast Cancer Associated Lymphedema; Herantis believes that Lymfactin may also be suitable for the treatment of other forms of secondary lymphedema if its safety and efficacy are established in the first indication.
Lymfactin, patented by Herantis, is based on the internationally renowned scientific research of academy professor Kari Alitalo and his research group, a national center of excellence at the University of Helsinki.
About Breast Cancer Associated Lymphedema
Approximately 20% of breast cancer patients who undergo axillary lymph node dissection develop secondary lymphedema: a progressive, disabling, and disfiguring disease that severely affects the quality of life. Symptoms include a chronic swelling of an upper limb, thickening and hardening of skin, loss of mobility and flexibility, pain, and susceptibility to secondary infections. Secondary lymphedema is currently treated with compression garments, special massage, and exercises. While these therapies may relief the symptoms in some patients, they do not address the underlying cause of lymphedema, which results from damage to the lymphatic system. There are currently no approved medicines for the treatment of secondary lymphedema.