On August 25, 2016 Mylan N.V. (NASDAQ, TASE: MYL) and Biocon Ltd. (BSE code: 532523, NSE: BIOCON) reported that the European Medicines Agency (EMA) has accepted for review Mylan’s Marketing Authorization Application (MAA) for a proposed biosimilar Trastuzumab, which is used to treat certain HER2-positive breast and gastric cancers (Press release, Mylan, AUG 25, 2016, View Source [SID:1234514729]). This is the second biosimilar submission developed by the partnership that has been accepted for review in Europe. Last month, Mylan’s MAA for the proposed biosimilar Pegfilgrastim was accepted for review by EMA. Schedule your 30 min Free 1stOncology Demo! Mylan
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Mylan and Biocon, which have co-developed this proposed biosimilar, anticipate that this may be the first MAA for a Trastuzumab biosimilar accepted by the EMA for review.
This filing includes analytical, functional and pre-clinical data, as well as results from the pharmacokinetics (PK) and confirmatory efficacy/safety global clinical trials for Trastuzumab. The PK study had demonstrated measured bioequivalence of Mylan’s and Biocon’s proposed Trastuzumab biosimilar relative to that of the reference drug. The second study, the ‘HERITAGE Study’, evaluated the efficacy, safety and immunogenicity of the proposed biosimilar Trastuzumab in comparison to branded Trastuzumab.
Mylan President Rajiv Malik commented: "The acceptance of our regulatory submission of our proposed biosimilar Trastuzumab in Europe is another example of the strong progress we continue to make across our broad biosimilars portfolio. Following our successful commercialization in India and emerging markets, we look forward to our pending launch in Europe. Europe represents a key market for more affordable versions of these important products, as governments across the region strive to reduce healthcare costs. We look forward to continuing to work to bring this product to patients upon approval."
Arun Chandavarkar, CEO and Joint Managing Director, Biocon, said: "The regulatory submission for proposed biosimilar Trastuzumab in Europe takes us a step closer towards enabling affordable access to this critical biologic therapy for the treatment of HER2-positive breast cancer. We remain committed to bring a diversified portfolio of high-quality, life-enhancing biosimilars to patients globally."
At the annual American Society of Clinical Oncology (ASCO) (Free ASCO Whitepaper) event held in June this year, 24 week data for the ‘HERITAGE’ study was presented. The results of the 48 week extension data of the ‘HERITAGE’ study are expected to be presented at the upcoming European Society for Medical Oncology Congress (ESMO) (Free ESMO Whitepaper) in October.
About Biocon and Mylan Partnership
Biocon and Mylan are exclusive partners on a broad portfolio of biosimilars and insulin analogs. The proposed biosimilar Trastuzumab is one of the six biologic products co-developed by Mylan and Biocon for the global marketplace. Mylan has exclusive commercialization rights for the proposed biosimilar Trastuzumab in the U.S., Canada, Japan, Australia, New Zealand, the European Union and European Free Trade Association countries. Biocon has co-exclusive commercialization rights with Mylan for the product in the rest of the world.
About HER2-Positive Breast Cancer and Trastuzumab
Worldwide, nearly 2 million women are diagnosed with breast cancer each year, making it the second most common cancer in the world. HER2-positive breast cancer is an aggressive form of breast cancer that tests positive for the human epidermal growth factor receptor 2 (HER2), which promotes cancer cell growth. Approximately 20% to 30% of primary breast cancers are HER2-positive. Trastuzumab is indicated for the treatment of certain HER2-positive early stage and metastatic breast cancer as well as HER2-positive metastatic gastric cancer.
About the Heritage Study
The Phase III study, HERITAGE, is a double-blind, randomized clinical trial designed to evaluate comparative efficacy and safety of the proposed trastuzumab biosimilar, MYL-1401O, versus branded trastuzumab. Eligible patients had centrally confirmed, measurable HER2-positive metastatic breast cancer without prior chemotherapy or trastuzumab for metastatic disease. Patients were randomized to receive either MYL-1401O or branded trastuzumab with docetaxel or paclitaxel for a minimum of eight cycles. Trastuzumab was continued until progression. The primary endpoint is overall response at week 24 by blinded central evaluation using RECIST 1.1. Secondary endpoints include progression free survival, overall survival, and safety. A sample size of 456 patients was calculated to demonstrate equivalence in overall response at week 24 for MYL-1401O versus branded trastuzumab, defined as a 90% confidence interval for the ratio of best overall response rate within the equivalence margin (0.81, 1.24). This study successfully met the predefined equivalence criteria. The response rates at 24 weeks were 69.6% with MYL-1401O combined with taxane chemotherapy versus 64% with branded trastuzumab combined with taxane chemotherapy. The incidence of adverse events was similar in the patients who received MYL-1401O and those who received reference trastuzumab.
About Biosimilars
A biosimilar medicine is a biological medicine that is developed to be similar to an existing biological medicine and has demonstrated no clinically meaningful differences in safety, purity, and potency compared to that of the reference biologic. A biosimilar product and its reference biologic product are expected to have the same safety and efficacy profile and are generally used to treat the same conditions. Biosimilars may offer a less-costly alternative to existing biological medicinal products that have lost their exclusivity rights.
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Data from Phase III CASTOR Study of Daratumumab Published in The New England Journal of Medicine
On August 25, 2016 Genmab A/S (Nasdaq Copenhagen: GEN) reported The New England Journal of Medicine has published data from the Phase III CASTOR (MMY3004) study of daratumumab (Press release, Genmab, AUG 25, 2016, View Source [SID:1234514714]). The CASTOR data were presented at the 2016 American Society of Clinical Oncology (ASCO) (Free ASCO Whitepaper) Annual Meeting and the 21st Congress of the European Hematology Association (EHA) (Free EHA Whitepaper). Daratumumab was granted a Breakthrough Therapy Designation (BTD) from the U.S. Food and Drug Administration (FDA) based on these data in July 2016. Schedule your 30 min Free 1stOncology Demo! The Phase III CASTOR study included 498 patients who had relapsed or refractory multiple myeloma. Patients were randomized to receive either daratumumab combined with subcutaneous bortezomib (a type of chemotherapy, called a proteasome inhibitor) and dexamethasone (a corticosteroid), or bortezomib and dexamethasone alone. The study met the primary endpoint of improving progression free survival (PFS); Hazard Ratio (HR) = 0.39, p<0.001. The median PFS for patients treated with daratumumab has not been reached, compared to median PFS of 7.2 months for patients who did not receive daratumumab. The overall response rate was 82.9% for patients treated with daratumumab versus an overall response rate of 63.2% in the group that did not receive daratumumab. The rate of very good partial response or better was also higher for the group treated with daratumumab (59.2% vs 29.1%). The most common grade 3 or 4 adverse events in patients treated with daratumumab in combination with bortezomib and dexamethasone compared to those who only received bortezomib and dexamethasone were thrombocytopenia (45.3% vs 32.9%), anemia (14.4% vs 16.0%) and neutropenia (12.8% vs 4.2%). Daratumumab-associated infusion-related reactions were reported in 45.3% of patients, were mostly grade 1/2, and occurred predominantly during the first infusion. This is consistent with the reported safety profile of daratumumab monotherapy and background bortezomib/dexamethasone therapy.
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"We are pleased that the positive data from the Phase III CASTOR study of daratumumab, which was presented earlier this year at the ASCO (Free ASCO Whitepaper) and EHA (Free EHA Whitepaper) meetings, has now been published in the prestigious New England Journal of Medicine," said Jan van de Winkel, Ph.D., Chief Executive Officer of Genmab. "The data from this study formed part of the basis of this month’s submission of the supplemental Biologics License Application to the U.S. Food and Drug Administration and the submission of the variation to the Marketing Authorization to the European Medicines Agency."
About multiple myeloma
Multiple myeloma is an incurable blood cancer that starts in the bone marrow and is characterized by an excess proliferation of plasma cells.1 Multiple myeloma is the third most common blood cancer in the U.S., after leukemia and lymphoma.2 Approximately 30,330 new patients are expected to be diagnosed with multiple myeloma and approximately 12,650 people are expected to die from the disease in the U.S. in 2016.3 Globally, it was estimated that 124,225 people would be diagnosed and 87,084 would die from the disease in 2015.4 While some patients with multiple myeloma have no symptoms at all, most patients are diagnosed due to symptoms which can include bone problems, low blood counts, calcium elevation, kidney problems or infections.5 Patients who relapse after treatment with standard therapies, including proteasome inhibitors or immunomodulatory agents, have poor prognoses and few treatment options.6
About DARZALEX (daratumumab)
DARZALEX (daratumumab) injection for intravenous infusion is indicated in the United States for the treatment of patients with multiple myeloma who have received at least three prior lines of therapy, including a proteasome inhibitor (PI) and an immunomodulatory agent, or who are double-refractory to a PI and an immunomodulatory agent.7 DARZALEX is the first monoclonal antibody (mAb) to receive U.S. Food and Drug Administration (FDA) approval to treat multiple myeloma. DARZALEX is indicated in Europe for use as monotherapy for the treatment of adult patients with relapsed and refractory multiple myeloma, whose prior therapy included a PI and an immunomodulatory agent and who have demonstrated disease progression on the last therapy. For more information, visit www.DARZALEX.com.
Daratumumab is a human IgG1k monoclonal antibody (mAb) that binds with high affinity to the CD38 molecule, which is highly expressed on the surface of multiple myeloma cells. It is believed to induce rapid tumor cell death through programmed cell death, or apoptosis,7,8 and multiple immune-mediated mechanisms, including complement-dependent cytotoxicity,7,8 antibody-dependent cellular phagocytosis9,10 and antibody-dependent cellular cytotoxicity.7,8 In addition, daratumumab therapy results in a reduction of immune-suppressive myeloid derived suppressor cells (MDSCs) and subsets of regulatory T cells (Tregs) and B cells (Bregs), all of which express CD38. These reductions in MDSCs, Tregs and Bregs were accompanied by increases in CD4+ and CD8+ T cell numbers in both the peripheral blood and bone marrow.7,11
Daratumumab is being developed by Janssen Biotech, Inc. under an exclusive worldwide license to develop, manufacture and commercialize daratumumab from Genmab. Five Phase III clinical studies with daratumumab in relapsed and frontline settings are currently ongoing, and additional studies are ongoing or planned to assess its potential in other malignant and pre-malignant diseases on which CD38 is expressed, such as smoldering myeloma, non-Hodgkin’s lymphoma and a solid tumor.
Biothera Pharmaceuticals Expands Relationship with Merck, Enters Collaboration for Combination Cancer
On August 24, 2016 Biothera Pharmaceuticals, Inc. reported a collaboration with Merck, known as MSD outside the United States and Canada, to expand the companies’ ongoing clinical program evaluating KEYTRUDA (pembrolizumab), Merck’s anti-PD-1 inhibitor, in combination with Biothera’s Imprime PGG, a Pathogen Associated Molecular Patterning molecule, or PAMP (Press release, Biothera Pharmaceuticals, AUG 24, 2016, View Source [SID1234562109]). Imprime PGG acts as an immunological "ignition switch" enlisting the innate immune system to enhance the therapeutic efficacy of tumor targeting, anti-angiogenic, and immune checkpoint inhibitor antibodies.
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Under this new collaboration, a Phase 2 clinical trial is anticipated to enroll up to 95 patients who have either advanced melanoma no longer responding to initial treatment with a checkpoint inhibitor therapy or TNBC whose disease has progressed following treatment with one or more lines of therapy for metastatic disease. Biothera will be the sponsor of the study, which is planned to begin in the fourth quarter of 2016. Merck will provide clinical supplies of KEYTRUDA for the planned studies. Other terms of the collaboration were not disclosed.
Biothera previously announced an agreement in December 2015 for Merck to supply KEYTRUDA for a Phase 1b/2 clinical study testing combination therapy with Imprime PGG in NSCLC patients. The Big Ten Cancer Research Consortium will conduct the multi-center trial, which is expected to commence this fall.
Barry Labinger, Chief Executive Officer of Biothera, stated, "Combination therapies with breakthrough medicines such as KEYTRUDA are potentially the next major advance in the treatment of cancer. We believe that Imprime PGG is uniquely suited to complement immune checkpoint inhibitor therapy and meaningfully enhance patient outcomes. The trial will assess safety and efficacy, as well as provide biomarker and pharmacodynamic data that will inform the design of potential Phase 3 pivotal studies."
Eric Rubin, M.D., Vice President and Therapeutic Area Head, Oncology Early-stage Development, Merck Research Laboratories, commented, "As a leading innovator in the field of immuno-oncology, Merck is dedicated to advancing breakthrough science by continuing to identify novel combinations with potential to improve the care for people with cancer. We are pleased to expand our partnership with Biothera as we explore the potential for combining KEYTRUDA with their lead candidate."
BeiGene Appoints Amy Peterson, M.D. as Chief Medical Officer, Immuno-oncology
On August 24, 2016 BeiGene, Ltd. (NASDAQ:BGNE), a clinical-stage biopharmaceutical company focused on developing innovative molecularly-targeted and immuno-oncology drugs for the treatment of cancer, reported the appointment of Amy C. Peterson, M.D. as Chief Medical Officer, Immuno-oncology (Press release, BeiGene, AUG 24, 2016, View Source;ut=1472118472&p=RssLanding&cat=news&id=2197224 [SID:1234514748]). Dr. Peterson will lead the global clinical development of BGB-A317, BeiGene’s PD-1 inhibitor; BGB-290, BeiGene’s PARP inhibitor; and the expanding pipeline of other immuno-oncology agents expected to enter clinical development. Dr. Eric Hedrick, currently serving as the Interim Chief Medical Officer, will continue to oversee global clinical hematology development including the program for BGB-3111, BeiGene’s BTK inhibitor, and will remain serving as an advisor as BeiGene continues to expand its global clinical development capabilities.
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"We are delighted to have Dr. Peterson join our team," said John V. Oyler, Founder, Chief Executive Officer, and Chairman of BeiGene. "BeiGene continues to expand its senior medical leadership in response to emerging global development opportunities, particularly in immuno-oncology. Amy’s broad experience in oncology drug development and her academic background in immuno-oncology research are well-suited to our expanding clinical development efforts. We very much look forward to her contribution in the continued growth and development of our existing and future pipeline and the company as a whole."
"BeiGene has a robust pipeline of clinical stage, internally discovered molecules against validated targets as well as an expanding roster of candidates in the preclinical pipeline," said Dr. Peterson. "I look forward to leveraging my past experiences to successfully build an organization that can bring these assets to market while continuing to expand the clinical pipeline."
Prior to joining BeiGene, Dr. Peterson was Vice President of Clinical Development at Medivation, where she was primarily responsible for the development of enzalutamide and talazoparib in breast cancer and of pidilizumab in diffuse large b-cell lymphoma. Previously, she served as Associate Group Medical Director at Genentech, where she was responsible for the development of early stage molecules targeting multiple major pathways in oncology. Prior to joining Genentech, Dr. Peterson was an Instructor of Medicine in Oncology at the University of Chicago, where she conducted translational research in tumor immunology in conjunction with Dr. Thomas F. Gajewski.
Dr. Peterson received her M.D. from Thomas Jefferson University in Philadelphia, PA, and she completed her residency in Internal Medicine at Northwestern Memorial Hospital and Fellowship in Hematology and Oncology at the University of Chicago. She holds a Bachelor of Arts degree from Wesleyan University in Middletown, CT.
New England Journal of Medicine Publishes MINDACT Trial Results Proving the Clinical Utility of MammaPrint® in Assisting Physicians to Identify Early-Stage Breast Cancer Patients who can Safely Forgo Chemotherapy
On August 24, 2016 Agendia, Inc., a world leader in personalized medicine and molecular cancer diagnostics, reported the peer-reviewed publication of the primary outcome results of the Microarray In Node-negative and 1 to 3 positive lymph node Disease may Avoid ChemoTherapy (MINDACT) clinical trial in the prestigious New England Journal of Medicine (NEJM) (Press release, Agendia, AUG 24, 2016, View Source [SID:1234514712]). [i, iii, iv] The publication demonstrates that 46% of breast cancer patients considered for chemotherapy, whose tumors are classified MammaPrint Low Risk, have excellent survival without chemotherapy, and can thus be candidates to avoid this toxic therapy. [i, pg. 717]
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MINDACT is a collaboration between Agendia, the European Organization for Research and Treatment of Cancer (EORTC) and the Breast International Group (BIG). A unique phase III prospective, randomized, controlled study of 6,693 patients across 112 European cancer centers, MINDACT provides the highest level of clinical evidence (Level 1A) and confirms the clinical utility of using Agendia’s MammaPrint 70-gene breast cancer recurrence assay to help predict clinical outcome in women with early-stage breast cancer.
"When we developed MammaPrint, we knew we wanted to achieve the same level of evidence required for a typical pharmaceutical drug. That is why we are one of only a few diagnostic tests with FDA clearance and why we rigorously evaluated MammaPrint in the context of clinical-pathological factors in the randomized MINDACT trial," said Prof. Laura van ’t Veer, Chief Research Officer at Agendia, and Leader, Breast Oncology Program, and Director, Applied Genomics at UCSF Helen Diller Family Comprehensive Cancer Center. "Now indeed, we have the only genomic assay with Level 1A evidence to help physicians more accurately predict risk of distant metastasis in patients with early-stage breast cancer."
MINDACT is the first prospective translational clinical study of this magnitude in early-stage breast cancer to report the results of its primary objective and publish them in a peer-reviewed journal. At 5 years, patients who did not receive adjuvant chemotherapy but were classified as being at high risk for breast cancer recurrence based on clinical-pathological factors and as being at Low Risk based on MammaPrint, had similar rates of disease free survival. [i, pg. 717]
"The design of the MINDACT trial proves the clinical utility of the MammaPrint assay," said Dr. Gabriel Hortobagyi, MD, FACP, FASCO Professor and Chair Emeritus of the Department of Breast Medical Oncology at the MD Anderson Cancer Center (MDACC) and Chair of the Agendia Inc. Medical Advisory Board. "The reporting of these conclusive results of the trial will now give physicians increased confidence that in using MammaPrint, their treatment decisions will be based on the highest level of clinical evidence and will minimize the incidence of over- or under-treatment."
"We understand that a risk–benefit assessment and decisions with respect to the use of adjuvant chemotherapy are highly variable and personalized among physicians and individual patients. However, these findings provide clinical utility by demonstrating that MammaPrint’s accuracy in helping to detect patients with a low risk of distant recurrence could be safely used in the management of over one hundred thousand[ii] women and potentially spare them from unnecessary chemotherapy," said Dr. William Audeh, Chief Medical Officer at Agendia. "The toxicities and side effects of chemotherapy may outweigh the potentially small and non-statistically significant benefit (1.5% 95% CI, 0.50 to 1.21; p = 0.27) of chemotherapy in women at high risk based on clinical factors but at Low Risk per MammaPrint. Thus, physicians and breast cancer patients may on an individual basis decide to avoid it."
In MINDACT, when the authors looked at the patients with the most common type of breast cancer, hormone receptor positive, human epidermal growth factor receptor 2 negative, and lymph node negative (HR+/HER2-/LN0) disease, 75% were identified as having a Low Risk of recurrence using MammaPrint. The Distant Metastasis Free Interval (DMFI) for these patients (which according to the researchers is the optimal endpoint to evaluate a genomic assay that looks at prognosis and benefit of chemotherapy treatment) was 97.8% without chemotherapy. [i, supplement pg. 12-13]
In MINDACT, this MammaPrint Low Risk group of breast cancer patients who may be candidates to forgo chemotherapy is over four times larger than the proportion identified with a low-Recurrence Score (RS) in both TAILORx.[v] and Plan B.[vi]. The TAILORx trial, which is the trial that would validate the appropriate cut-offs for the Oncotype DX 21-gene breast cancer recurrence assay, has only reported data on the low risk arm of the study that included 15% of the patients who are in the non-randomized arm of patients with RS 10 and under. The TAILORx trial, has not presented results of its primary objective of the outcome of patients with RS between 11-25.
"MINDACT provides us with the highest level of evidence to support what we at Agendia have always believed, that MammaPrint is a definitive, accurate and clinically relevant breast cancer recurrence assay. The quality of life and cost efficiency implications of helping physicians choose the appropriate management for women with breast cancer is the reason we do what we do every day," commented Mark Straley, Chief Executive Officer, Agendia. "We understand that ultimately, the decision to receive or forgo chemotherapy lies with each patient and physician who is properly informed about the potential side effects and benefits of such treatment. Nonetheless, MammaPrint could potentially change the standard of care and we look forward to its recommendation for inclusion in all early-stage breast cancer management guidelines. This will ensure that even more patients, physicians and healthcare systems are aware of the benefits of MammaPrint-based management decisions."
Breast cancer is the most frequently diagnosed cancer in women worldwide.[vii] In 2012, there were nearly 1.7 million new breast cancer cases among women worldwide, accounting for 25% of all new cancer cases in women.[viii] MINDACT initial results were selected for a prestigious breakthrough presentation at the AACR (Free AACR Whitepaper) Annual Meeting 2016, 16-20 April.
For more information on the MINDACT trial publication, please visit the Agendia newsroom: View Source
[i] Cardosa F, van’t Veer LJ, Bogaerts J et al. 70-Gene Signature as an Aid to Treatment Decisions in Early-Stage Breast Cancer. N Engl J Med 2016; 375: 717-29.
[ii] Based on applying MINDACT risk data to: American Cancer Society. Global Cancer Facts & Figures 3rd Edition. Atlanta: American Cancer Society; 2015. (online) and American Cancer Society. Breast Cancer Facts & Figures 2015-2016. Atlanta: American Cancer Society, Inc. 2015.
[iii] Hudis CA, Dickler, M. Increasing Precision in Adjuvant Therapy for Breast Cancer. N Engl J Med 2016; 375: 790-91.
[iv] For disclosures regarding involvement in trial, see page 728 of publication (Cardosa F. NEJM 2016) mentioned above.
[v] Sparano JA, Gray RJ, Makower DF, et al. Prospective validation of a 21-gene expression assay in breast cancer. N Engl J Med 2015; 373: 2005-14.
[vi] Gluz O, Nitz, U. A., Matthias, C, et al. West German Study Group Phase III Plan B Trial: First Prospective Outcome Data for the 21-Gene Recurrence Score Assay and Concordance of Prognostic Markers by Central and Local Pathology Assessment. J Clin Oncol 2016; 34(20):2341-9
[vii] World Health Organization. Breast cancer: prevention and control. Website. View Source Accessed March 2016.
[viii] American Cancer Society. Global Cancer Facts & Figures 3rd Edition. Atlanta: American Cancer Society; 2015. (online)
About MINDACT
MINDACT is a prospective, randomized, phase III, controlled clinical trial that investigates the clinical utility of MammaPrint, when used in conjunction with standard clinical pathological criteria, for the selection of patients unlikely to benefit from adjuvant chemotherapy. From 2007 to 2011, 6,693 women who had undergone surgery for early-stage breast cancer enrolled in the trial, across 112 centers in nine countries. Patients were categorized as low or high risk for tumor recurrence in two ways: first, through analysis of tumor tissue using MammaPrint; and second, using Adjuvant! Online, a tool that calculates risk of breast cancer recurrence based on common clinical pathological factors. Patients characterized in both clinical and genomic assessments as low risk are spared chemotherapy, while patients characterized as high risk are advised chemotherapy. Those with discordant results were randomized to use either clinical or genomic risk (MammaPrint) evaluation for chemotherapy treatment.
MINDACT is a population based trial. A risk–benefit assessment and decisions with respect to the use of chemotherapy are highly variable among physicians and patients, and even national and international guidelines differ in their recommendations. Ultimately, the decision to receive or forgo chemotherapy (or any other treatment) lies with each patient who is properly informed about the potential side effects and the potential benefits of such treatment. For the same risk–benefit scenario, different patients may make different decisions. [i, pg. 727-28]
About MammaPrint
MammaPrint is a FDA-cleared in vitro diagnostic test, performed in a single laboratory, using the gene expression profile of breast cancer tissue samples to assess a patients’ risk for distant metastasis. The MammaPrint result is indicated for use by physicians as a prognostic marker only, along with other clinical-pathological factors. MammaPrint is not intended for diagnosis, or to predict or detect response to therapy, or to help select the optimal therapy for patients. Results should be taken in the context of other relevant clinical-pathological factors and standard practice of medicine.