On August 2, 2017 Genentech, a member of the Roche Group (SIX: RO, ROG; OTCQX: RHHBY), reported that the U.S. Food and Drug Administration (FDA) has accepted the company’s supplemental New Drug Application (sNDA) and granted Priority Review for Alecensa (alectinib) as an initial (first-line) treatment for people with anaplastic lymphoma kinase (ALK)-positive, locally advanced or metastatic non-small cell lung cancer (NSCLC) as detected by an FDA-approved test (Press release, Genentech, AUG 2, 2017, View Source [SID1234520051]). The FDA will make a decision on approval by November 30, 2017.
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"Phase III results showed Alecensa reduced the risk of disease worsening by more than half compared to the current standard of care and lowered the risk of tumors spreading to or growing in the brain by more than 80 percent," said Sandra Horning, M.D., chief medical officer and head of Global Product Development. "We are working closely with the FDA to bring this medicine as an initial treatment for people with ALK-positive NSCLC as soon as possible."
This sNDA submission for Alecensa is based on results from the Phase III ALEX and Phase III J-ALEX studies. A Priority Review designation is granted to proposed medicines that, if approved, the FDA has determined to have the potential to provide a significant improvement in the safety or effectiveness of the treatment, prevention or diagnosis of a serious disease.
Alecensa received Breakthrough Therapy Designation from the FDA in September 2016 for the treatment of adults with advanced ALK-positive NSCLC who have not received prior treatment with an ALK inhibitor. Breakthrough Therapy Designation is designed to expedite the development and review of medicines intended to treat serious or life-threatening diseases and to help ensure people have access to them through FDA approval as soon as possible. Breakthrough Therapy Designation was granted on the basis of the Phase III J-ALEX trial.
Alecensa was granted accelerated approval by the FDA in December 2015 for the treatment of people with ALK-positive metastatic NSCLC who have progressed on or are intolerant to crizotinib. The ALEX study is part of the company’s commitment in the U.S. to convert the current accelerated approval of Alecensa in people with ALK-positive, metastatic NSCLC who have progressed on or are intolerant to crizotinib to a full approval as an initial treatment.
About the ALEX and J-ALEX Studies
Results from the Phase III ALEX study and updated results from the Phase III J-ALEX study were recently presented at the 2017 Annual Meeting of the American Society of Clinical Oncology (ASCO) (Free ASCO Whitepaper).
ALEX (NCT02075840/B028984) is a randomized, multicenter, open-label Phase III study evaluating the efficacy and safety of Alecensa versus crizotinib in treatment-naïve people with ALK-positive NSCLC whose tumors were characterized as ALK-positive by the VENTANA ALK (D5F3) CDx Assay, a companion immunohistochemistry (IHC) test developed by Roche Tissue Diagnostics. People were randomized (one-to-one ratio) to receive either Alecensa or crizotinib. The multicenter study was conducted in 303 people across 161 sites in 31 countries. Results include:
Alecensa reduced the risk of disease worsening or death (progression-free survival, PFS) by 53 percent compared to crizotinib (hazard ratio [HR]=0.47, 95 percent CI: 0.34-0.65, p<0.0001).
Investigator-reported median PFS (the primary endpoint) was not yet reached in the Alecensa arm (95 percent CI: 17.7-not reached) versus 11.1 months (95 percent CI: 9.1-13.1 months) in the crizotinib arm.
Independent Review Committee (IRC)-reported median PFS (a secondary endpoint) was 25.7 months (95 percent CI: 19.9-not reached) in the Alecensa arm versus 10.4 months (95 percent CI: 7.7-14.6 months) in the crizotinib arm (HR=0.50, 95 percent CI: 0.36-0.70, p<0.0001).
Alecensa reduced the risk of progression in the central nervous system (CNS) by 84 percent (HR=0.16, 95 percent CI: 0.10-0.28, p<0.0001) versus crizotinib.
The 12-month cumulative rate of CNS progression for people with or without existing CNS metastases at baseline was 9.4 percent (95 percent CI: 5.4-14.7 percent) for people treated with Alecensa and 41.4 percent (95 percent CI: 33.2-49.4 percent) for people treated with crizotinib.
Overall survival (OS) data are currently considered immature with only about a quarter of events being reported.
Grade 3-5 adverse events (AEs) were less frequent in the Alecensa arm (41 percent) compared to the crizotinib arm (50 percent). In the Alecensa arm, the most common Grade 3-5 AEs (≥5 percent) were increased liver enzymes (alanine transferase and aspartate transferase; 5 percent) and decreased red blood cells (anemia; 5 percent). AEs leading to discontinuation (11 percent vs. 13 percent), dose reduction (16 percent vs. 21 percent) and dose interruption (19 percent vs. 25 percent) were all lower in the Alecensa arm compared to the crizotinib arm.
The J-ALEX study is an open-label, randomized Phase III study conducted by Chugai that compared the efficacy and safety of Alecensa with crizotinib in Japanese people. J-ALEX enrolled 207 people with ALK-positive, advanced or recurrent NSCLC who had not been treated with an ALK inhibitor. People were randomized to the Alecensa group or the crizotinib group on a one-to-one ratio. Results include:
Alecensa reduced the risk of disease worsening or death (PFS) by 62 percent compared to crizotinib (HR=0.38, 95 percent CI: 0.26-0.55, p<0.0001).
The median PFS was 25.9 months in the Alecensa arm (95 percent CI: 20.3-not reached) versus 10.2 months (95 percent CI: 8.3-12.0 months) in the crizotinib arm.
Alecensa reduced the risk of progression in the CNS by 81 percent (HR=0.19, 95 percent CI: 0.07-0.53) in people without brain metastases at baseline, and reduced the risk of CNS progression by 49 percent (HR=0.51, 95 percent CI: 0.16-1.64) in people with brain metastases at baseline.
Grade 3-4 adverse events (AEs) were less frequent in the Alecensa arm (32 percent) compared to the crizotinib arm (57 percent). In the Alecensa arm, the most common Grade 3-4 AEs (≥5 percent) were an increase in muscle enzymes (blood creatine phosphokinase increase; 5 percent) and interstitial lung disease (5 percent). AEs leading to discontinuation (11 percent vs. 23 percent) and dose interruption (29 percent vs. 64 percent) were lower in the Alecensa arm compared to the crizotinib arm.
About Lung Cancer
According to the American Cancer Society, it is estimated that more than 222,000 Americans will be diagnosed with lung cancer in 2017, and NSCLC accounts for 85 percent of all lung cancers. It is estimated that approximately 60 percent of lung cancer diagnoses in the United States are made when the disease is in the advanced stages.
About Alecensa
Alecensa is a kinase inhibitor approved for the treatment of people with anaplastic lymphoma kinase (ALK)-positive, metastatic non-small cell lung cancer (NSCLC) who have progressed on or are intolerant to crizotinib. This indication is approved under accelerated approval based on tumor response rate and duration of response (DOR). Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trials.
Important Safety Information
Everyone reacts differently to treatment with Alecensa. It’s important to know the most serious and most common side effects with Alecensa.
A doctor may lower the dose or stop treatment with Alecensa if any serious side effects occur. Patients taking Alecensa should contact their doctor right away if they have any of the following side effects.
Alecensa may cause serious side effects, including:
Liver problems (hepatotoxicity). Alecensa may cause liver injury. A doctor will do blood tests at least every 2 weeks for the first 3 months and as needed during treatment with Alecensa. Patients taking Alecensa should tell their doctor right away if they experience any of the following signs and symptoms:
Feeling tired
Feeling less hungry than usual
Yellowing of the skin or whites of the eyes
Dark urine
Itchy skin
Nausea or vomiting
Pain on the right side of stomach area
Bleeding or bruising more easily than normal
Lung problems. Alecensa may cause severe or life-threatening swelling (inflammation) of the lungs during treatment.
Symptoms may be similar to those symptoms from lung cancer. Patients taking Alecensa should tell their doctor right away if they have any new or worsening symptoms, including:
Trouble breathing
Shortness of breath
Fever
Cough
Slow heartbeat (bradycardia). Alecensa may cause very slow heartbeats that can be severe. A doctor will check a patient’s heart rate and blood pressure during treatment with Alecensa. Patients taking Alecensa should tell their doctor right away if they feel dizzy, lightheaded, or faint during treatment with Alecensa. Patients taking Alecensa should tell their doctor if they take any heart or blood pressure medicines.
Muscle pain, tenderness, and weakness (myalgia). Muscle problems are common with Alecensa and can be severe. A doctor will do blood tests at least every 2 weeks for the first month and as needed during treatment with Alecensa. Patients taking Alecensa should tell their doctor right away if they have any new or worsening signs and symptoms of muscle problems, including unexplained muscle pain or muscle pain that does not go away, tenderness, or weakness.
Before taking Alecensa, patients should tell their doctor about all medical conditions, including if they:
Have liver problems
Have lung or breathing problems
Have a slow heartbeat
Are pregnant or plan to become pregnant. Alecensa can harm an unborn baby. Patients taking Alecensa should tell their doctor right away if they become pregnant during treatment with Alecensa or think they may be pregnant
Women who are able to become pregnant should use effective birth control during treatment with Alecensa and for one week after the final dose of Alecensa
Men who have female partners that are able to become pregnant should use effective birth control during treatment with Alecensa and for three months after the final dose of Alecensa
Are breastfeeding or plan to breastfeed. It is not known if Alecensa passes into breast milk. A patient should not breastfeed during treatment with Alecensa and for one week after the final dose of Alecensa. Patients should talk with their doctor about the best way to feed their baby during this time.
Patients taking Alecensa should tell their doctor about all the medicines they take, including prescription medicines, over-the-counter medicines, vitamins, and herbal supplements.
Patients taking Alecensa should avoid spending time in the sunlight during treatment with Alecensa and for seven days after the final dose of Alecensa. Patients taking Alecensa may burn more easily and get severe sunburns. Patients taking Alecensa should use sunscreen and lip balm with a SPF 50 or greater to help protect against sunburn.
The most common side effects of Alecensa include:
Tiredness
Constipation
Swelling in hands, feet, ankles, and eyelids
These are not all of the possible side effects of Alecensa. For more information, patients should ask their doctor or pharmacist. Patients should call their doctor for medical advice about side effects.