On December 22, 2015 Stemline Therapeutics, Inc. (Nasdaq:STML) reported the opening of its SL-801 Investigational New Drug (IND) application and initiation of a broad clinical development program in multiple cancer types (Press release, Stemline Therapeutics, DEC 22, 2015, View Source [SID:1234508628]). SL-801 is an oral, reversible, small molecule inhibitor of Exportin 1 (XPO1), a promising and clinically validated oncology target overexpressed by many solid and hematologic cancers. SL-801 has demonstrated robust anti-cancer activity in animal models of multiple solid and hematologic malignancies.
Ivan Bergstein, M.D., Stemline’s Chief Executive Officer, stated, "We are pleased to have successfully advanced the SL-801 program quickly through IND opening. Our SL-801 development strategy builds upon current knowledge in the XPO1 space and is designed to evaluate the agent’s clinical potential across multiple cancer types early in the program." Dr. Bergstein concluded, "The clinical debut of SL-801 serves to advance our pipeline and greatly strengthen the company’s clinical and commercial potential."
Author: [email protected]
Merck and Pfizer Advance Clinical Development Program with Two Additional Phase III Trials of Avelumab
On December 22, 2015 Merck and Pfizer reported the opening of trial sites for an international Phase III study of avelumab*, an investigational fully human anti-PD-L1 IgG1 monoclonal antibody, in patients with platinum-resistant/refractory ovarian cancer (Press release, Pfizer, DEC 22, 2015, View Source [SID:1234508626]). Schedule your 30 min Free 1stOncology Demo! The JAVELIN Ovarian 200 trial is the first Phase III study of a PD-L1 inhibitor investigated as a treatment for platinum-resistant/refractory ovarian cancer. The alliance also announced that the US Food and Drug Administration has provided approval to move forward with a Phase III study of avelumab as a maintenance treatment, in the first-line setting, in patients with locally advanced or metastatic urothelial cancer. The first trial sites are expected to open shortly.
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"There are limited treatment options for women with ovarian cancer, and the prognosis for women with platinum-resistant ovarian cancer is especially poor," said Chris Boshoff, Vice President and Head of Early Development, Translational and Immuno-Oncology at Pfizer Oncology. "We have observed encouraging signs of early clinical activity of avelumab in patients with platinum-resistant or platinum-refractory ovarian cancer, and we hope to build on these results next year through a planned Phase III study of avelumab in combination with platinum therapy in patients with previously-untreated ovarian cancer."
This Phase III, randomized (1:1:1), open-label, parallel, multicenter, global study (JAVELIN Ovarian 200) is designed to evaluate the superiority of avelumab as a monotherapy or in combination with pegylated liposomal doxorubicin (PLD), compared with PLD alone, in treating patients with platinum-resistant/refractory ovarian cancer. The primary endpoint is overall survival (OS). Study investigators anticipate enrolling approximately 550 patients across more than 190 sites in Asia, Europe and North America.
Merck and Pfizer have also initiated a Phase III study (JAVELIN Bladder 100) investigating avelumab as a maintenance treatment, in the first-line setting, in patients with locally advanced or metastatic urothelial cancer. This is currently the only Phase III trial designed to evaluate an immunotherapy agent as a maintenance treatment, in the first-line setting, in patients with urothelial cancer.
"Locally advanced or metastatic urothelial cancer is another aggressive cancer, with the disease often progressing quickly following first-line treatment," said Dr. Alise Reicin, Head of Global Clinical Development at Merck’s biopharma business. "It’s an exciting time for the Merck-Pfizer Alliance as we continue to accelerate our clinical development program, and now into urothelial cancer. This disease has an exceptionally high unmet need and we believe there is potential for our anti-PD-L1 antibody to be part of future treatment strategies."
This open-label, multicenter, randomized, global, Phase III study is designed to evaluate the safety and efficacy of avelumab plus best supportive care (BSC), compared with BSC alone, in patients with unresectable locally advanced or metastatic urothelial cancer whose disease did not progress on (or following) completion of first-line treatment with a platinum-containing chemotherapy. The primary endpoint of the study is OS which will be assessed in two urothelial cancer patient populations: patients with PD-L1 positivity and all randomized patients.
JAVELIN Bladder 100 is expected to enroll 668 patients across more than 200 sites in 38 countries. PD-L1 expression status will be determined by retrospective analysis of mandatory tumor samples collected from patients enrolled in the trial. It is estimated that at least half of those patients randomized to treatment will be
PD-L1-positive.
The clinical development program for avelumab now includes more than 1,500 patients who have been treated across more than 15 tumor types, including breast cancer, gastric/gastro-esophageal junction cancers, head and neck cancer, melanoma, Merkel cell carcinoma, non-small cell lung cancer, ovarian cancer, renal cell carcinoma and urothelial (e.g. bladder) cancer. The alliance has initiated six pivotal trials, reaching its goal for 2015, with additional trials expected to initiate in 2016.
*Avelumab is the proposed International Non-proprietary 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. Ferlay J, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013. Available from: View Source Accessed December 2015.
2. World Cancer Research Fund International. Ovarian Cancer Statistics. Available from: View Source Accessed November 2015.
3. NICE. Ovarian Cancer: Recognition and Initial Management.
View Source Accessed November 2015.
4. National Cancer Institute. Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer Treatment (PDQ). Available from: View Source Accessed November 2015.
5. Lederman JA, et al. Newly diagnosed and relapsed epithelial ovarian carcinoma: ESMO (Free ESMO Whitepaper) clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24 Suppl 6: vi24-32.
6. Ojavo LS, et al. Emerging immunotherapies in ovarian cancer. Discov Med 2015; 20: 97-109.
7. NCCN Clinical Practice Guidelines in Oncology. Bladder Cancer Version 2. 2015. Available at:´
View Source Accessed December 2015.
8. Malats N, Real FX. Epidemiology of Bladder Cancer. Hematol Oncol Clin North Am 2015; 29(2):177-89.
About Ovarian Cancer
Globally, ovarian cancer is the seventh most common cancer in women.1 Annually, nearly 239,000 cases are diagnosed worldwide.2 Ovarian cancer may be difficult to diagnose, as symptoms may appear only in the later stages, when the disease has spread beyond the ovaries.2 Outcomes for women with ovarian cancer are generally poor due to most patients presenting with advanced disease.3 The 5-year prevalence of women globally living with ovarian cancer is 22.6 per 100,000.2 Current treatment options for epithelial ovarian cancer may include surgery, radiotherapy, chemotherapy and targeted therapies.4 Women who are unable to undergo treatment with platinum-based chemotherapy, due to resistance or refractory disease, currently have very limited treatment options. Platinum-resistant ovarian cancer is defined as ovarian cancer that recurs within six months of completing primary chemotherapy with a platinum-based medication.5 Platinum-refractory ovarian cancer is defined as ovarian cancer that progresses during treatment with a platinum-based chemotherapy regimen.5 There is still a clear unmet need in ovarian cancer in relation to general disease awareness,2 improving initial investigations in primary and secondary care and novel therapies with demonstrable efficacy.6
About Urothelial Cancer
Urothelial cancer includes several tumors originating from the urothelial cells lining the bladder, renal pelvis and urethra.7 Bladder cancer accounts for 90% of urothelial cancers,7 and is the ninth most common cancer globally. Approximately 400,000 new cases of bladder cancer are diagnosed and 150,000 deaths are attributed to this disease each year.8 The incidence and mortality of bladder cancer have remained unchanged over the past 25 years.8
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 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 and Pfizer announced a strategic alliance to co-develop and co-commercialize avelumab.
Loxo Oncology Announces First Patient Enrolled in Phase 1 Trial of LOXO-101 in Pediatric Cancer Patients
On December 22, 2015 Loxo Oncology, Inc. (Nasdaq:LOXO), a biopharmaceutical company innovating the development of highly selective medicines for patients with genetically defined cancers, reported the enrollment of the first patient in its Phase 1 trial of LOXO-101 in pediatric patients with advanced solid or primary central nervous system (CNS) tumors (Press release, Loxo Oncology, DEC 22, 2015, View Source [SID:1234508625]). LOXO-101 is the only selective inhibitor of the tropomyosin receptor kinase (TRK) protein family in clinical development. Schedule your 30 min Free 1stOncology Demo! "Given the promising early efficacy and tolerability results we have seen in adults with TRK fusion cancers, we are excited to explore the potential of LOXO-101 in children and adolescents with cancer," said Josh Bilenker, M.D., chief executive officer of Loxo Oncology. "The TRK pathway has been implicated in many pediatric cancers, and this trial is an important step toward understanding LOXO-101 in these settings."
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The Phase 1 clinical trial is a multicenter, open-label trial in pediatric patients with advanced solid or primary CNS tumors. Loxo Oncology plans to open as many as 15 clinical sites in the U.S. In the dose-escalation phase, LOXO 101 will be administered orally twice daily, with the initial starting dose level intended to match the pharmacokinetic exposures of the 100 mg twice daily dose that is currently being employed in the LOXO-101 Phase 2 basket trial in adult patients. The actual dose for each patient will depend on patient body size and age. The trial will also utilize a liquid formulation of LOXO-101 designed specifically for pediatric patients unable to swallow capsules. The primary endpoint of the trial is to explore the safety of LOXO-101. Secondary endpoints include the characterization of pharmacokinetic properties, the identification of the maximum tolerated dose and/or the Phase 2 dose, a description of antitumor activity, and a description of pain and health related quality of life impact.
In order to meet the criteria for enrollment, patients must be between one year of age and 21 years of age with a locally advanced or metastatic solid tumor or primary CNS tumor that has progressed, or was nonresponsive to available therapies, and for which no standard or available curative therapy exists. Patients at least one month old are eligible for enrollment if they have a diagnosis of infantile/congenital fibrosarcoma, with a documented NTRK fusion that has progressed, or was nonresponsive to available therapies, and for whom no standard or available curative therapy exists.
Additional patient cohorts may be enrolled in an expansion phase of the Phase 1 trial to better characterize safety and efficacy in patients with specific abnormalities in the NTRK genes or proteins.
The TRK pathway plays an important role in many pediatric cancers. TRK gene fusions have been described in pediatric tumor types such as infantile/congenital fibrosarcoma, congenital mesoblastic nephroma, secretory breast carcinoma, pontine glioma, and may occur at increased frequency in younger patients with other tumor types, according to proprietary Loxo Oncology analyses. TRK signaling may also play a role in neuroblastoma.
LOXO-101 has shown objective clinical responses in adult patients with tumors harboring TRK gene fusions in a Phase 1 trial. LOXO-101 is also being evaluated in a global Phase 2 multi-center basket trial in adult patients with solid tumors that harbor TRK gene fusions.
About LOXO-101
LOXO-101 is a potent, oral and selective investigational new drug in clinical development for the treatment of patients with cancers that harbor abnormalities involving the tropomyosin receptor kinases (TRKs). Growing research suggests that the NTRK genes, which encode for TRKs, can become abnormally fused to other genes, resulting in growth signals that can lead to cancer in many sites of the body. In an ongoing Phase 1 clinical trial, LOXO-101 has demonstrated encouraging preliminary efficacy. LOXO-101 is also being evaluated in a global Phase 2 multi-center basket trial in patients with solid tumors that harbor TRK gene fusions, and a Phase 1 dose escalation trial in pediatric cancer patients. For additional information about both the LOXO-101 clinical trials, please refer to www.clinicaltrials.gov. Interested patients and physicians can contact the Loxo Oncology Physician and Patient Clinical Trial Hotline at 1-855-NTRK-123.
OPKO’s GeneDx Study of More Than 10,000 Individuals Tested with Multigene NGS Hereditary Cancer Panel Reveals New Risks
On December 21, 2015 OPKO Health, Inc. (NYSE: OPK) through its subsidiary GeneDx, reported results from the largest published study to date of patients who received hereditary genetic testing with Next Generation Sequencing (NGS) cancer panels (Press release, Opko Health, DEC 21, 2015, View Source [SID:1234508623]). The study, "Pathogenic and Likely Pathogenic Variant Prevalence among the First 10,000 Patients Referred for Next Generation Cancer Panel Testing," was published in the December 2015 issue of Genetics in Medicine. GeneDx’s analysis of the data generated from the first 10,030 patients highlights the clinical utility of testing for multiple cancer genes to identify variants that would not have been identified through previously used testing methods. The patients, who were referred for testing between August, 2013 and October, 2014, underwent genetic testing for panels of genes associated with hereditary cancer.
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While many patients were found to carry pathogenic or likely pathogenic variants in well-established, high-risk cancer genes, approximately half of the pathogenic variants identified were in genes with moderate risk and in recently identified cancer genes. Notably, among women with breast cancer, 50% of positive findings were in genes other than BRCA1 or BRCA2. Additionally, several individuals had pathogenic variants in high-risk genes that were somewhat unexpected, so clinical presentation alone might not have prompted testing for these genes.
"We believe that molecular diagnostic testing for panels containing multiple genes are significantly more accurate in determine the heritable factors which increase the risk of cancer, and may permit more tailored treatment for cancer patients and screening for their family members," said Sherri Bale, PhD, FACMG, Co-Founder and Managing Director of GeneDx. "Our experience, based on a large database of patients, demonstrates that multi-gene panels have the potential to identify pathogenic variants in genes that would not typically have been tested and most likely would have been missed. This study provides important empirical data for clinical decision-making when choosing between single genes and NGS cancer panel testing for a variety of cancers."
Foundation Medicine Announces National Agreement with UnitedHealthcare for FoundationOne® in Metastatic Non-Small Cell Lung Cancer
On December 21, 2015 Foundation Medicine, Inc. (NASDAQ:FMI) reported that it has signed a national agreement for FoundationOne, a comprehensive genomic profiling assay for solid tumors, with UnitedHealthcare, one of the nation’s largest private payers (Press release, Foundation Medicine, DEC 21, 2015, View Source [SID:1234508618]). The Agreement, which became effective December 15, 2015, covers FoundationOne for patients with metastatic stage IV non-small cell lung cancer (NSCLC). In the United States, approximately 50 percent of patients with NSCLC have metastatic disease at the time of diagnosis.1
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FoundationOne is a comprehensive genomic profile that enables physicians to make treatment decisions for patients with cancer by identifying the molecular growth drivers of their cancers and by helping oncologists match the identified drivers with relevant targeted therapeutic options. Requiring only a small amount of tumor tissue, FoundationOne interrogates the entire coding sequence of 315 cancer-related genes plus select introns from 28 genes that are known to be altered in solid tumors.
"UnitedHealthcare’s coverage decision is a critical first step towards ensuring that comprehensive genomic profiling becomes standard-of-care treatment for patients with metastatic disease," said Bonnie J. Addario, lung cancer survivor, and founder of the Bonnie J. Addario Lung Cancer Foundation and the Addario Lung Cancer Medical Institute. "Lack of reimbursement for comprehensive genomic profiling tests, like FoundationOne, continues to be one of the major barriers impeding patient access to potentially life-extending therapies for which the patient is a molecular match."
"This national coverage agreement with UnitedHealthcare is an important step towards broader reimbursement for Foundation Medicine, and importantly, it’s a significant advance for patients with metastatic NSCLC," said Michael Pellini, M.D., chief executive officer for Foundation Medicine. "Studies demonstrate that improved clinical outcomes are achieved by matching patients to targeted therapies based on the unique genomic alterations contributing to the disease. We look forward to building upon our relationship with UnitedHealthcare and other national insurers as we continue to demonstrate clinical and economic evidence supporting coverage and payment for FoundationOne in additional cancer types."