On September 9, 2017 Amgen (NASDAQ:AMGN) and Allergan plc. (NYSE:AGN) reported data from a Phase 3 study evaluating the efficacy and safety of ABP 980, a Herceptin (trastuzumab) biosimilar, compared with the originator product in patients with human epidermal growth factor receptor 2-positive (HER2-positive) early breast cancer (Press release, Amgen, SEP 9, 2017, View Source [SID1234520439]). Results from the neoadjuvant efficacy phase of the study, including pathologic complete response assessed both by local investigators and also by independent pathology review, were presented today during a poster discussion at the European Society for Medical Oncology (ESMO) (Free ESMO Whitepaper) 2017 Congress. Efficacy, safety and immunogenicity data support ABP 980 as a trastuzumab biosimilar and add to the totality of evidence currently under review by the European Medicines Agency (EMA) and the U.S. Food and Drug Administration (FDA).

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"Biosimilars have the potential to provide more patients access to high-quality therapies with proven safety and efficacy profiles," said Serafin Morales, M.D., medical oncologist, University Hospital Arnau de Vilanova, Lleida, Spain. "The results presented today add to the data package demonstrating similarity between ABP 980 and trastuzumab."

The co-primary endpoints of the study were risk difference (RD) and risk ratio (RR) of pathologic complete response in breast tissue and axillary lymph nodes, and the prespecified equivalence margins were +/-13 percent for RD and 0.759 to 1.318 for RR. According to local review, 48 percent and 40.5 percent of patients in the ABP 980 arm and trastuzumab arm, respectively, achieved pathologic complete response. RD and RR of pathologic complete response were 7.3 percent (90 percent CI: 1.2, 13.4) and 1.19 (90 percent CI: 1.033, 1.366) respectively. Based on central independent review, which was conducted as part of a sensitivity analysis, 47.8 percent and 41.8 percent in the ABP 980 arm and trastuzumab arm, respectively, achieved pathologic complete response. RD and RR of pathologic complete response respectively were 5.8 percent (90 percent CI: -0.5, 12.0) and 1.14 (90 percent CI: 0.993, 1.312).

Frequency, type and severity of adverse events were similar between ABP 980 and trastuzumab. No new safety signals compared to the known safety profile of trastuzumab were detected.

"At the heart of Amgen’s commitment to biosimilars is our mission to serve patients. We are leveraging our more than 35 years of biotechnology experience and using the same personnel, services and manufacturing expertise from the company’s innovative business to produce high-quality, reliably supplied biosimilars for some of the most complex diseases," said Sean E. Harper, M.D., executive vice president of Research and Development at Amgen. "The results presented today reinforce the potential of ABP 980 for breast cancer patients, and we look forward to continued discussions with regulatory authorities."

"Allergan is proud to be collaborating with Amgen on the development of several oncology biosimilars that require significant expertise, infrastructure and investment to ensure safe therapies for patients," said David Nicholson, Ph.D., chief research and development officer, Allergan. "We are excited about the progress of ABP 980 and are committed to its development in hopes of providing patients with an effective alternative option."

Amgen and Allergan are collaborating on the development and commercialization of four oncology biosimilars. Amgen has a total of 10 biosimilars in its portfolio, one of which has been approved by the FDA and European authorities.

ABP 980 Phase 3 Study Design
The ABP 980 Phase 3 LILAC study was a randomized, multicenter, double-blinded, active-controlled study (study number 20120283) that evaluated safety and efficacy of ABP 980 compared to trastuzumab in adult female patients with HER2-positive early breast cancer. There were 725 patients randomized, with 364 patients in the ABP 980 group and 361 patients in the trastuzumab group.

In the neoadjuvant phase, enrolled patients received run-in chemotherapy consisting of epirubicin and cyclophosphamide (EC) every three weeks (Q3W) for four cycles. Once run-in chemotherapy was completed, patients with adequate cardiac function were randomized 1:1 to receive ABP 980 or trastuzumab, plus paclitaxel, Q3W for four cycles. Surgery (breast and sentinel node or axillary lymph node resection) was complete three to seven weeks after the last dose of either ABP 980 or trastuzumab in the neoadjuvant phase, and pathologic complete response was analyzed.

In the adjuvant phase, following surgery, patients received ABP 980 or trastuzumab Q3W for up to one year from the first day either product was administered in the neoadjuvant phase. Patients who received ABP 980 during the neoadjuvant phase continued to receive ABP 980 Q3W for the adjuvant phase. Patients who received trastuzumab during the neoadjuvant phase either underwent a single switch to ABP 980 or continued on trastuzumab Q3W for the adjuvant phase. The allocation to a treatment group during the neoadjuvant or adjuvant phase occurred by randomization, as did the single switch from trastuzumab to ABP 980 after the neoadjuvant phase.

The primary analysis was conducted when the last patient completed the surgery following the neoadjuvant therapy. Statistical equivalence was assessed by comparing the confidence interval of the RD and RR of the pathologic complete response in breast tissue and axillary lymph nodes with the prespecified equivalence margins.

About HER2-Positive Early Breast Cancer
HER2-positive early breast cancer is a breast cancer that tests positive for a protein called human epidermal growth factor receptor 2 (HER2), which promotes the growth of cancer cells.1 Approximately 20 percent of all breast cancers are HER2-positive.2 Breast cancer is the most common cancer in Europe for females, and the most common cancer overall, with more than 464,000 new cases diagnosed each year.3 HER2-positive breast cancers tend to grow and spread more aggressively than HER2-negative breast cancers.1

About ABP 980
ABP 980 is being developed as a biosimilar to trastuzumab, a recombinant DNA-derived humanized monoclonal immunoglobulin G1 kappa antibody approved in many regions for the treatment of HER2-overexpressing early breast cancer, adjuvant breast cancer, metastatic breast cancer and metastatic gastric cancer. The active ingredient of ABP 980 is a humanized monoclonal antibody that has the same amino acid sequence as trastuzumab. ABP 980 has the same pharmaceutical dosage form and strength as trastuzumab. In March and July of 2017 respectively, Amgen and Allergan submitted a Marketing Authorization Application to the EMA and a Biologics License Application to the FDA for ABP 980.

On September 9, 2017 Array BioPharma (Nasdaq: ARRY) and Pierre Fabre reported results from Part 2 of the Phase 3 COLUMBUS study evaluating binimetinib, a MEK inhibitor, and encorafenib, a BRAF inhibitor, in patients with BRAF-mutant advanced, unresectable or metastatic melanoma (Press release, Array BioPharma, SEP 9, 2017, View Source [SID1234520436]). The primary analysis of Part 2 compared progression free survival (PFS) in patients treated with binimetinib 45 mg twice daily plus encorafenib 300 mg daily (COMBO300) to patients treated with encorafenib 300 mg daily as a single agent. Part 2 of the study was designed specifically to measure the contribution of binimetinib to the combination by holding the dose of encorafenib at 300 mg in both arms.

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The median PFS for patients treated with COMBO300 was 12.9 months compared to 9.2 months for patients treated with single agent encorafenib, with HR of 0.77 [95% CI 0.61-0.97, p=0.029]. As part of the trial design, the analysis was based on a Blinded Independent Central Review (BICR) of patient scans, while results by local review at the investigative site were also analyzed. COMBO300 was generally well-tolerated and reported dose intensity and adverse events were consistent with binimetinib 45 mg twice daily plus encorafenib 450 mg daily (COMBO450) results in COLUMBUS Part 1. Grade 3/4 adverse events (AEs) that occurred in 5% or more of patients receiving COMBO300 were increased gamma-glutamyltransferase (GGT) (5%), increased blood creatine phosphokinase (CK) (5%) and increased alanine aminotransferase (ALT) (5%). The incidence of selected any grade AEs of special interest, defined based on toxicities commonly associated with commercially available MEK+BRAF-inhibitor treatments for patients receiving COMBO300 included: pyrexia (17%), rash (15%), retinal pigment epithelial detachment (9%) and photosensitivity (2%). Full safety results of COLUMBUS Part 2 were presented at the 2017 ESMO (Free ESMO Whitepaper) Congress.

"The totality of the COLUMBUS results, across Part 1 and 2, including median PFS, objective response rate, dose intensity and tolerability of the combination, provide a strong and consistent theme across multiple endpoints, underscoring the promise of binimetinib plus encorafenib as an attractive treatment option for patients diagnosed with BRAF-mutant melanoma," said Keith T. Flaherty, M.D., Director of the Termeer Center for Targeted Therapy, Massachusetts General Hospital and Professor of Medicine, Harvard Medical School.

Reinhard Dummer, M.D., investigator, University Hospital Zurich, noted: "Results from COLUMBUS Part 2 clearly demonstrated the contribution of MEK to the combination and suggest that the robust activity seen with COMBO450 in COLUMBUS Part 1 may be related to the ability to increase the dose of encorafenib."

On July 5, 2017, Array announced that it submitted two NDAs to the FDA to support use of the combination of binimetinib 45 mg twice daily and encorafenib 450 mg once daily (COMBO450) for the treatment of patients with BRAF-mutant advanced, unresectable or metastatic melanoma. Array completed its NDA submissions based on findings from the pivotal Phase 3 COLUMBUS trial. In addition, Array’s European partner, Pierre Fabre, announced on August 28, 2017, that the European Medicines Agency has validated the review of the MAAs for binimetinib and encorafenib.

COLUMBUS Results
As presented at the 2016 Society for Melanoma Research Annual Congress, results from Part 1 of the COLUMBUS study showed that COMBO450 significantly extended PFS in patients with advanced BRAF-mutant melanoma, with a PFS of 14.9 months compared with 7.3 months observed with vemurafenib [hazard ratio (HR) 0.54, (95% CI 0.41-0.71, P<0.001)]. As part of the trial design, the primary analysis was based on a BICR of patient scans, while results by local review at the investigative site were also analyzed. The table below outlines the median PFS (mPFS) results, as determined by both assessments, for COMBO450 versus vemurafenib, COMBO450 versus encorafenib, and encorafenib versus vemurafenib:

mPFS BICR

mPFS Local Review
COMBO450
vs.
Vemurafenib

COMBO450
Vemurafenib

COMBO450
Vemurafenib

14.9 months
7.3 months

14.8 months
7.3 months

HR (95% CI): 0.54 (0.41-0.71); P<0.001

HR (95% CI): 0.49 (0.37-0.64); P<0.001

COMBO450
vs.
Encorafenib

COMBO450
Encorafenib

COMBO450
Encorafenib

14.9 months
9.6 months

14.8 months
9.2 months

HR (95% CI): 0.75 (0.56-1.00); P=0.051

HR (95% CI): 0.68 (0.52-0.90); P=0.006

Encorafenib
vs.
Vemurafenib

Encorafenib
Vemurafenib

Encorafenib
Vemurafenib

9.6 months
7.3 months

9.2 months
7.3 months

HR (95% CI): 0.68 (0.52-0.90); P=0.007

HR (95% CI): 0.70 (0.54-0.91); P=0.008
In this study, COMBO450 was generally well-tolerated, with a median duration of treatment of 51 weeks and median relative dose intensity for encorafenib and binimetinib of 100% and 99.6%, respectively. Grade 3/4 AEs that occurred in more than 5% of patients receiving COMBO450 were increased GGT (9%), increased blood CK (7%) and hypertension (6%). The incidence of selected any grade AEs of special interest, defined based on toxicities commonly associated with commercially available MEK+BRAF-inhibitor treatments for patients receiving COMBO450 included: rash (23%), pyrexia (18%), retinal pigment epithelial detachment (13%) and photosensitivity (5%). Full safety results of COLUMBUS Part 1 were presented at the 2016 Society for Melanoma Research Annual Congress.

COLUMBUS Part 2 was designed specifically to assess the contribution of binimetinib to the combination of binimetinib and encorafenib by reducing the dose of encorafenib to 300 mg in the combination arm to allow for a comparison of equal doses across arms. In COLUMBUS Part 2, the primary analysis compared PFS in patients treated with COMBO300 to patients treated with encorafenib 300 mg daily as a single agent.

About the Phase 3 COLUMBUS Study
The COLUMBUS trial, (NCT01909453), is a two-part, international, randomized, open label Phase 3 study evaluating the efficacy and safety of the combination of binimetinib plus encorafenib to vemurafenib and to encorafenib monotherapy in 921 patients with locally advanced, unresectable or metastatic melanoma with BRAFV600 mutation. Prior immunotherapy treatment was allowed. Over 200 sites across North America, Europe, South America, Africa, Asia and Australia participated in the study. Patients were randomized into two parts:

In Part 1, 577 patients were randomized 1:1:1 to receive COMBO450, 300 mg encorafenib alone, or 960 mg vemurafenib alone. The dose of encorafenib in the combination arm is 50% higher than the single agent maximum tolerated dose of 300 mg. A higher dose of encorafenib was possible due to improved tolerability when combined with binimetinib. The primary endpoint for the COLUMBUS trial was a PFS comparison of COMBO450 versus vemurafenib. PFS is determined based on tumor assessment (RECIST version 1.1 criteria) by a BICR. Secondary endpoints include a comparison of the PFS of encorafenib monotherapy to that of COMBO450 and a comparison of overall survival (OS) for COMBO450 to that of vemurafenib alone.
In Part 2, 344 patients were randomized 3:1 to receive COMBO300 or 300 mg encorafenib alone. Part 2 was designed to provide additional data to help evaluate the contribution of binimetinib to the combination of binimetinib and encorafenib. As the comparison of COMBO450 to encorafenib in Part 1 did not achieve statistical significance, analyses of other endpoints including the statistical analysis conducted in Part 2 is descriptive.
About Melanoma
Metastatic melanoma is the most serious and life-threatening type of skin cancer and is associated with low survival rates[1],[2]. There are about 200,000 new cases of melanoma diagnosed worldwide each year, approximately half of which have BRAF mutations, a key target in the treatment of metastatic melanoma[1],[3],[4].

About Binimetinib and Encorafenib
MEK and BRAF are key protein kinases in the MAPK signaling pathway (RAS-RAF-MEK-ERK). Research has shown this pathway regulates several key cellular activities including proliferation, differentiation, survival and angiogenesis. Inappropriate activation of proteins in this pathway has been shown to occur in many cancers, such as melanoma, colorectal and thyroid cancers. Binimetinib is a late-stage small molecule MEK inhibitor and encorafenib is a late-stage small molecule BRAF inhibitor, both of which target key enzymes in this pathway. Binimetinib and encorafenib are being studied in clinical trials in advanced cancer patients, including the Phase 3 BEACON CRC trial with encorafenib in combination with cetuximab with or without binimetinib in patients with BRAFV600E-mutant colorectal cancer.

Binimetinib and encorafenib are investigational medicines and are not currently approved in any country.

Array BioPharma retains exclusive rights to binimetinib and encorafenib in key markets including the U.S., Canada and Israel. Array has granted Ono Pharmaceutical exclusive rights to commercialize both products in Japan and South Korea and Pierre Fabre exclusive rights to commercialize both products in all other countries, including Europe, Asia and Latin America.