A fa­ther's plea: The FDA needs to make sure that Juno's lethal dis­as­ter is­n't re­peat­ed

The FDA nev­er has pub­licly ex­plained just why it de­cid­ed to lift a clin­i­cal hold on Juno’s lead CAR-T drug JCAR015 just days af­ter the stun­ning news that the tri­al was be­ing halt­ed af­ter three pa­tients tak­ing the cell ther­a­py died of a cere­bral ede­ma. But then, it nev­er does, cit­ing se­cre­cy rules that fre­quent­ly keep reg­u­la­tors silent.

Now the fa­ther of one of those vic­tims has joined in a pe­ti­tion from the Cen­ter for Re­spon­si­ble Sci­ence seek­ing some re­al trans­paren­cy at the FDA on the way it han­dles pa­tient deaths — with ma­jor im­pli­ca­tions for the peo­ple who par­tic­i­pate in clin­i­cal tri­als.

Al­most a year af­ter Michael Vokhgelt’s 24-year-old son Max died in Juno’s ROCK­ET study, and five months af­ter telling STAT that “he died for greed,” Vokhgelt is still look­ing for an­swers. Max didn’t die from leukemia, says his fa­ther. He was killed by the drug, which has since been scrapped by Juno.

Not on­ly did Juno not an­nounce Max Vokhgelt’s death, a week lat­er it put out a re­lease cit­ing the “en­cour­ag­ing” and “im­pres­sive” re­sults it was see­ing.

In the fa­ther’s words:

It wasn’t un­til two more tri­al vol­un­teers died and FDA is­sued a clin­i­cal hold that on Ju­ly 7, 2016, Juno an­nounced the deaths. Juno blamed the deaths on flu­dara­bine, a chemother­a­py pre­con­di­tion­ing treat­ment in con­junc­tion with the CAR-T ther­a­py. FDA ac­cept­ed Juno’s ex­pla­na­tion and al­lowed Juno to re­sume the tri­al with­out Flu­dara­bine. I was dev­as­tat­ed when I learned that two more tri­al par­tic­i­pants died in No­vem­ber from cere­bral ede­ma. How can this hap­pen? I don’t even know the ra­tio­nale be­hind FDA’s de­ci­sion to lift the clin­i­cal hold af­ter my son and two oth­ers died, be­cause that is con­sid­ered “pro­pri­etary”.

I have read the Cit­i­zen Pe­ti­tion from the Cen­ter for Re­spon­si­ble Sci­ence and sup­port the re­quest­ed reg­u­la­to­ry amend­ments to al­low for the use of the pre­clin­i­cal test that is best to pre­dict what will hap­pen to clin­i­cal tri­al par­tic­i­pants. If tra­di­tion­al tests don’t al­ways pre­dict dead­ly tox­i­c­i­ties, drug spon­sors must be al­lowed to use more pre­dic­tive tests that bet­ter pre­dict what hap­pens in hu­mans.

It is FDA’s re­spon­si­bil­i­ty to pro­tect hu­man health and pro­tect the pub­lic from dan­ger­ous drugs. To achieve that man­date, all avail­able tools to pre­dict safe­ty must be used. I don’t want an­oth­er fam­i­ly to go through what my fam­i­ly went through.

In a let­ter sent last April, and first re­port­ed by RAPS’ Zachary Bren­nan, the Cen­ter for Re­spon­si­ble Sci­ence not­ed 19 treat­ment-re­lat­ed deaths in clin­i­cal tri­als from Ju­ly 2016 through April 2017.  Three of those were in a study of a ri­val CAR-T by Kite, which re­cent­ly was hit with the death of its first pa­tient from a case of cere­bral ede­ma.

The CRS wants things to change be­fore more pa­tients die.

“We ar­gue that every­thing that can be done to pro­tect clin­i­cal tri­al vol­un­teers must be done. Rather than re­sume a tri­al with­out know­ing the ac­tu­al cause of the dead­ly tox­i­c­i­ty, spon­sors should have made the drug avail­able so that it could be test­ed in a hu­man-rel­e­vant plat­form.”

The FDA says it’s still un­der re­view. Let’s hope they do bet­ter by tri­al vol­un­teers.

Com­mu­ni­cat­ing the val­ue of pre­ci­sion med­i­cine

By Natasha Cowan, Content Marketing Manager at Blue Latitude Health.
Many stakeholders are confused by novel precision medicines, including patients and healthcare professionals. So, how can industry help them to navigate this complexity?

Precision medicine represents a new paradigm in healthcare. It embodies the shift from treating many patients with the same therapy, to having the tools to identify the best treatment for every patient.

Spe­cial re­port: Twen­ty ex­tra­or­di­nary women in bio­phar­ma R&D who worked their way to the top

What differentiates a woman leader in biopharma R&D from a man?

Not much, except there are fewer of them in senior posts. Data suggest women are not more risk-averse, family-oriented or less confident than their male counterparts — indeed the differences between the two sexes are negligible. But a glance at the top R&D positions in Big Pharma leaves little doubt that upward migration in the executive ranks of biopharma R&D is tough.

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The lat­est Cin­derel­la sto­ry in on­col­o­gy ends with a sud­den rout as up­dat­ed da­ta dis­play spooks in­vestors

NextCure’s turn as the Cinderella of cancer-focused biotechs was short-lived.
Just a few days after its shares $NXTC zoomed up more than 250% on some very early stage results in a SITC abstract, a more complete analysis over the weekend spiked the hype and left investors in high dudgeon as the stock price collapsed back towards earth Monday.
The focus at NextCure is centered on NC318, an antibody that is intended to shut down the immunosuppressive Siglec-15 — or S-15 — target. After adding a small group of patients to the readout, investigators circled 2 clinical responses, a complete and partial response, along with 4 stable disease cases in non-small cell lung cancer.

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Te­va spin­out rais­es $85M in IPO; No­var­tis beefs up gener­ics unit with $440M deal

→ After Teva spinout 89bio recently announced that its IPO was being held up, the company is back in the game offering 5,304,687 shares at a price of $16 per share. The company has raised $84.9 million IPO in gross proceeds and will be listed under the ticker symbol $ETNB. BofA Securities, SVB Leerink and RBC Capital Markets are the joint book-running managers for the offering. Oppenheimer & Co is the co-manager for the offering.
→ Looking to amp up its presence in Japan’s hospitals, Novartis has struck a deal to buy out Aspen’s portfolio of generics in the world’s third largest healthcare market. The pharma giant is paying $440 million for Aspen’s Japanese subsidiary.
→ Novartis said tropifexor, a non-bile acid FXR agonist, has scored on several key biomarkers of NASH in a Phase IIb trial, including reductions in hepatic fat, alanine aminotransferase and body weight compared to a placebo at 12 weeks.

Break­through sta­tus and promise of a speedy re­view ar­rives for Op­di­vo/Yer­voy com­bi­na­tion as Bris­tol-My­ers bites at Bay­er

Its frontline and single-agent aspirations have been set back, but Bristol-Myers Squibb just took a big step forward in its efforts to apply its checkpoint inhibitor Opdivo to liver cancer. The FDA has granted breakthrough status and priority review to a combination, second-line treatment.

The designation is for Opdivo (nivolumab) in combination with Yervoy (ipilimumab),  for treating advanced hepatocellular carcinoma (HCC), the most common form of liver cancer. The PD-L1 drug was already approved as a single-agent, second-line treatment for HCC. A PDUFA date was set for March 10, 2020 — just 4 months from now.

Third time un­lucky: Lipocine's lat­est quest to mar­ket their oral testos­terone drug snubbed again by FDA

Lipocine’s latest attempt at securing approval for its oral testosterone drug has fizzled yet again.

The Utah-based drug developer on Monday said the FDA has spurned its marketing application, indicating that some efficacy data on the drug, Tlando, was not up to scratch to treat male hypogonadism, a condition characterized by low production of the hormone testosterone, which is responsible for maintaining muscle bulk, bone growth, and sexual function.

UP­DAT­ED: De­cry­ing 'ar­bi­trary and capri­cious' ac­tion, Re­genxBio sues FDA over clin­i­cal holds on gene ther­a­py

When RegenxBio disclosed that the FDA had placed a partial clinical hold on one of its lead gene therapies, execs outlined several customary next steps: continuing assessment and monitoring, delaying a related IND filing, and working with the FDA to address the matter.

As it turned out, they were planning something much less mundane. Two days after announcing the hold in its Q3 update, RegenxBio filed a lawsuit seeking to set it aside, the FDA Law Blog noted.

Roche's SMA chal­lenge to Bio­gen's Spin­raza fran­chise looms larg­er with piv­otal win

Roche has just landed a crucial advance in scoring a come-from-behind win on the spinal muscular atrophy field, giving Novartis and Biogen a run for their money.

The update was brief, but Roche said risdiplam hit the primary endpoint in the placebo-controlled pivotal SUNFISH trial, meeting the threshold for change from baseline in the Motor Function Measure 32 (MFM-32) scale after one year of treatment. The results, which is the second, confirmatory portion of a two-part study, involved 180 patients with type 2 or 3 spinal muscular atrophy between 2 and 25 years old.

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Roche steers Gazy­va in­to a new PhI­II pro­gram af­ter com­bo shows promise in lu­pus nephri­tis study

Roche is working on putting together a late-stage study for its monoclonal antibody Gazyva in patients with severe kidney disease associated with lupus after a combination approach helped patients in a mid-stage study.

The 125-patient NOBILITY trial evaluated Gazyva, combined with standard-of-care treatment mycophenolate mofetil or mycophenolic acid and corticosteroids, versus standard treatment alone. The combo met the main goal of inducing a statistically superior complete renal response (CRR) of 40% at week 76, versus 18% in patients given standard treatment, Roche said.