Biotech Strategy Blog

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Posts tagged ‘Gemcitabine Pancreatic Cancer’

At ASCO 2013 Daniel D. Van Hoff, MD, Physician-In-Chief of the Translational Genomics Research Institute (TGen), presented the data for the phase III pancreatic cancer MPACT trial that compared weekly nab-paclitaxel (Abraxane) plus gemcitabine (Gem) versus gemcitabine alone (ASCO 2013 Abstract 4005).

The results were first presented at the ASCO GI meeting earlier this year, so what’s new here?

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AB Science confirms the filing for the Marketing Authorization Application to the European Medicines Agency of Masitinib in the treatment of Pancreatic Cancer.

AB Science LogoParis based biopharmaceutical company AB Science announced in an October 16 news release that the company has applied to the European Medicines Agency (EMA) for approval of masitinib in pancreatic cancer.

Masitinib is a tyrosine kinase inhibitor of PDGF, PDGFR, FGFR, FAK, c-KIT. A phase 3 clinical trial (NCT00789633) in pancreatic cancer is underway that compares masitinib with gemcitabine to placebo with gemcitabine.  The trial started in November 2008 with an estimated enrollment of 320 patients at 68 study locations. As far as I am aware no data has yet been presented for this trial.

The phase 2 trial results for mastinib in pancreatic cancer were, however, extremely promising.

Alain Moussy, CEO of AB Science in an interview on Pharma Strategy Blog, A leap of faith: AB Science & mastinib in pancreatic cancer, stated that masitinib “is unique its ability to resensitize the pancreatic cell that has become resistant to gemcitabine.

Strangely, the AB Science news release today offers no top line results, and merely states the “communication of results was delayed to allow the filing for patent applications aimed at extending the period of marketing exclusivity.

The presumption from the filing and today’s announcement is that the data for mastinib in pancreatic cancer is positive, which is good news for patients. I look forward to hearing more about the overall survival benefit for masitinib when more data becomes available.

This news also adds to the excitement building in pancreatic cancer, with the Celgene Abraxane data expected before year end.

Update November 1, 2012: Phase 3 Trial Results Announced

In an October 30, 2012 news release, AB Science finally shared the data for their Phase 3 clinical trial (NCT00789633): A Study to Compare Efficacy and Safety of Masitinib in Combination With Gemcitabine, to Placebo in Combination With Gemcitabine, in Treatment of Patients With Advanced/Metastatic Pancreatic Cancer.

I don’t plan to rehash the self-explanatory news release, but the results are mixed. The Principal Investigator, and leading pancreatic cancer experts I contacted (who were not involved with the trial) did not respond to requests for comment. This suggests that we will have to wait till the data is presented at the ASCO GI symposium in San Francisco next year to fully understand the implications for clinical practice.

Bad news: Study failed to meet it’s primary endpoint of showing that masitinib increased overall survival (patients lived longer) when used in combination with gemcitinabine versus gemcitabine alone.

  • Median OS was 7.7 months in the masitinib plus gemcitabine treatment arm versus 7.0 months in the placebo plus gemcitabine treatment arm (p=0.74; hazard ratio=0.90).

The company news release states:

“This finding of a non significant survival improvement in the overall population is explained by the fact that masitinib is not indicated when Gemzar® is highly efficient.”

However, there is some positive news for AB Science, and that is a subset of the 320 patients in the study did significantly live longer with masitinib.

Good news: a subset of pancreatic cancer patients with a novel genetic biomarker for tumor aggressiveness, identified using RNA expression from whole blood samples, lived significantly longer with masitinb.

  • Patients in the subset with this biomarker (65% of the study population) had a median overall survival (OS) of 5 months on gemcitabine alone, while those on masitinib and gemcitabine had an OS of 11.0 months (hazard ratio of 0.29, p=0.000038).

A survival advantage of 6 months with mastinib is a dramatic result!

If mastinib can be used in conjunction with a predictive biomarker that identifies those patients who may likely respond, it is hard not to imagine that some form of regulatory approval would be forthcoming, despite the failure of the trial to meet it’s primary endpoint. However, more clinical data and another clinical trial may be needed to validate the biomarker, if as it appears, the biomarker was identified retrospectively.

There are also many unanswered questions:

  • what is the technology needed to detect the biomarker?
  • is this a test that can be routinely performed?
  • is there a diagnostic kit available?
  • How might such a genetic biomarker be used in clinical practice by non-academic physicians?
  • What is the extent to which the biomarker has been shown to be valid and reproducible?

I look forward to hearing more about the masitinib data at the ASCO GI 2013 meeting.

Update November 6, 2012: Skuldtech identified as diagnostics partner

Another piece of the jigsaw has been provided in a November 3 news release from AB Science that french company, Skuldtech is the company they are working with on a companion diagnostic test for masitinib in pancreatic cancer. As usual, I found the news out first on Twitter:

The AB Science news release states that:

Skuldtech and AB Science plan to exploit these new markers for commercialization of a future companion test associated with masitinib, a molecule developed by AB science for treating pancreatic cancer.

It goes on to say:

“From a simple drop of blood, Skuldtech and AB Science were able to identify specific markers – transcriptomic markers – that can distinguish between the different populations treated during the phase III study and select the predictive markers for pancreatic cancer survival associated with masitinib treatment.”

We await further information on the cost, availability and validation of the companion diagnostic.

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A diagnosis of stage IV pancreatic cancer is pretty much a death sentence.

People are often diagnosed in the advanced stage of the disease – 49.5% are diagnosed in stage IV – and the prognosis is generally not good.  Sadly most don’t live long, even with the latest treatments.

According to the National Cancer Institute (NCI) SEER survival monograph, the relative survival rates are extremely poor. Across all types of pancreatic cancer, only 5% of people live for 5 years, and only 23% survive 1 year.  Three to five months is the median survival time for those with untreated metastatic pancreatic cancer.

In the United States, there were 33,730 new cases of pancreatic cancer in 2006 and 32,300 deaths!  There is, therefore, an unmet need for effective new pancreatic cancer treatments.

Lake Tahoe Pancreatic Cancer ConferencePreclinical data presented by Nicole Teichmann and colleagues at the recent American Association for Cancer Research (AACR) special conference on Pancreatic Cancer in Lake Tahoe, NV suggests that BAY 86-9766 may be an interesting compound to watch as it moves forward in clinical development.

“We showed in our endogenous mouse model that our novel chemotherapeutic agent leads to dramatic tumor shrinkage after only one week of treatment,” said Nicole Teichmann, Ph.D., of the Klinikum rechts der Isar at the Technische Universität München in Munich, Germany in an AACR press release.

Although impressive tumor shrinkage was seen in the preclinical trial of BAY 86-9766, a novel MEK1/2 inhibitor, “in most animals the tumors relapsed typically after 3 weeks of treatment,” according to Teichmann’s abstract.  This suggests that there is an escape pathway that may also need to be targeted for the drug to be more effective.

One of the signaling pathways involved in pancreatic cancer is the Raf-MEK-ERK pathway (75-90% of pancreatic cancers have a K-ras mutation), which is why a MEK inhibitor such as BAY 86-9766 that targets this pathway may be effective.

However, pancreatic cancer represents a challenge for drug development and many drugs have failed in clinical development.

Sorafenib despite being an inhibitor of Raf-1 kinase and EGFR2, failed to show any effect in pancreatic cancer.  Adding sorafenib to gemcitabine did not improve survival significantly.

Recently, Infinity Pharmaceuticals terminated a pancreatic cancer phase 2 trial with their Hedgehog inhibitor, saridegib (IPI-926).

Despite scientific evidence suggesting that hedgehog signaling plays an important role in pancreatic cancer, patients receiving saridegib with gemcitabine did worse (i.e. lived for a shorter period) than they would if they had just received gemcitabine alone.

The Infinity news release noted that “the median survival for patients receiving saridegib plus gemcitabine was less than the historical median survival for single-agent gemcitabine of approximately six months.” Not surprisingly, the trial was terminated.

Other Hedgehog compounds being evaluated in pancreatic cancer include Roche’s vismodegib (Erivedge), which was initially approved in advanced, refractory basal cell carcinoma last year.  The drug is also being tested in trials for pancreatic cancer, including one with gemcitabine and another with gemcitabine plus nab-paclitaxel (Abraxane).

Interestingly, Celgene are waiting for the final data to mature on their phase III trial in pancreatic cancer with nab-paclitaxel and gemcitabine.  The interim results were encouraging, but it is too early to tell if the outcomes will be significantly improved by the combination. You can read more about the scientific rationale for nab-paclitaxel in pancreatic cancer on Pharma Strategy Blog.

The efficacy and safety of BAY 86-977 in combination with gemcitabine is currently being evaluated in a phase 2 trial of patients with non-resectable, locally advanced or metastatic pancreatic cancer.

Caution must, therefore, be expressed as to whether BAY 86-9766 will be effective given that so many promising pancreatic cancer drugs have failed in drug development.

It remains to be seen whether BAY 86-9766 will live up to the promise of the preclinical data presented at the AACR pancreatic meeting in Lake Tahoe.

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It’s been a bad week for vitamins, especially with the publication of data from the SELECT trial that showed healthy men taking 400 IU/day of Vitamin E had a 17% increased risk of prostate cancer.

However, there is some evidence in support of tocotrienols (unsaturated form of Vitamin E) having a potential role to play in anti-cancer therapy.  One paper that caught my attention was the work by Kazim Husain and colleagues from the Moffitt Cancer Center and Research Institute in Tampa.

Published Online First (October 4, 2011) in the American Association for Cancer Research (AACR) journal, “Molecular Cancer Therapeutics” they showed that δ- tocotrienol may have potential to improve the effectiveness of gemcitabine in pancreatic cancer.

In their laboratory and animal based research, the authors showed that δ-Tocotrienol:

  • “augments inhibition of pancreatic cancer cell proliferation by gemcitabine”
  • “augments gemcitabine-induced apoptosis in pancreatic cancer cells”
  • down-regulates constitutively activated NF-κB in gemcitabine-treated pancreatic cancer cells”
  • “enhances the in vivo therapeutic effects of gemcitabine in a pancreatic tumor model in SCID nude mice”

Pancreatic cancer patients have a poor prognosis with less than <5% of patients surviving 5 years.  Current treatment revolves around the chemotherapy gemcitabine, but as the authors note in their Molecular Cancer Therapeutics paper, “tumor resistance is common.”

Various researchers are working on how to improve treatment options for pancreatic cancer.  One company I’m watching is AB Science and their phase 3 trial for masitinib.  You can read more about this on Pharma Strategy Blog and Sally Church’s excellent interview with CEO, Alain Moussy.

The work on the δ-tocotrienol form of Vitamin E shows that it may have a role to play in cancer treatment, notwithstanding the negative data that was published earlier this week in prostate cancer.

Husain and colleagues from Moffitt showed for the first time that δ-tocotrienol inhibited NF-κB activity and the expression of NF-κB regulated gene products. They note that inflammatory transcription factor NF-κB is involved in tumorigenesis, so inhibition of NF-κB may be how tocotrienols exert their anti-cancer effects.

These preclinical results are promising and show that:

“δ-tocotrienol is the most bioactive tocotrienol against human pancreatic cancer cells and provide the rationale for selecting δ-tocotrienol as the lead tocotrienol compound for further studies of the use of tocotrienols for pancreatic cancer prevention and treatment.”

A phase I clinical trial is ongoing (NCT00985777) evaluating the use of δ-tocotrienol in patients with pancreatic tumors.

While Vitamin E supplementation may yet be of benefit to healthy individuals, it could have benefit in patients with pancreatic cancer, so it will be interesting to see how this develops.

ResearchBlogging.orgHusain, K., Francois, R., Yamauchi, T., Perez, M., Sebti, S., & Malafa, M. (2011). Vitamin E  -Tocotrienol Augments the Anti-tumor Activity of Gemcitabine and Suppresses Constitutive NF- B Activation in Pancreatic Cancer Molecular Cancer Therapeutics DOI: 10.1158/1535-7163.MCT-11-0424

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