Can we stop can­cer cells from evolv­ing and de­vel­op­ing drug re­sis­tance? British sci­en­tists take a leaf out of the HIV play­book

British sci­en­tists want to counter can­cer by us­ing an ap­proach that worked for HIV and tu­ber­cu­lo­sis: by cre­at­ing treat­ments to pre­clude can­cer’s abil­i­ty to be­come re­sis­tant to ex­ist­ing drugs and re­cur.

The drug dis­cov­ery pro­gram, or­ches­trat­ed by the In­sti­tute of Can­cer Re­search (ICR) in Lon­don, will be launched at a fa­cil­i­ty in the British cap­i­tal with an ini­tial £75 mil­lion (rough­ly $85 mil­lion) in­jec­tion.

De­spite the ad­vent of im­munother­a­pies in the can­cer ther­a­peu­tic ar­se­nal, the is­sue of re­sis­tance to can­cer drugs — in­clud­ing chemother­a­pies and mol­e­c­u­lar-tar­get­ed ther­a­pies — is ram­pant. For ex­am­ple, the clas­sic ap­proach of em­ploy­ing ag­gres­sive ‘shock and awe’ chemother­a­py can fal­ter be­cause too of­ten it helps fu­el an ‘sur­vival of the nas­ti­est’ evo­lu­tion among can­cer cells, ICR sci­en­tists con­tend.

ICR in­tends to ad­dress the chal­lenge on two fronts. First, is an ap­proach called ‘evo­lu­tion­ary herd­ing’. Us­ing ar­ti­fi­cial in­tel­li­gence, re­searchers at ICR can fore­cast how can­cer cells tend to re­act when treat­ed with a par­tic­u­lar drug. There­fore by se­lect­ing an ini­tial drug treat­ment — can­cer cells can be com­pelled to adapt in a fash­ion that makes them sus­cep­ti­ble to a sec­ondary treat­ment, or thrusts them in­to an “evo­lu­tion­ary dead end”.

The sec­ond strat­e­gy is to de­vel­op a fam­i­ly of drugs that thwart the abil­i­ty of can­cer cells to evolve and re­sist treat­ment. This fresh class of drugs are be­ing con­struct­ed to tar­get a pro­tein called APOBEC in a bid to di­min­ish the rate of mu­ta­tion in can­cer cells, slow down evo­lu­tion and de­lay re­sis­tance. Al­though the en­zyme is cru­cial for the im­mune sys­tem to adapt to dif­fer­ent in­fec­tious dis­eases, it has been im­pli­cat­ed in can­cer mu­ta­tions re­cent­ly, af­ter be­ing the fo­cus of vi­rol­o­gy re­search for over a decade.

Olivia Rossanese

Once de­vel­oped, these APOBEC in­hibitors could be ad­min­is­tered in tan­dem with ex­ist­ing tar­get­ed on­col­o­gy ther­a­pies to keep the can­cer at bay for longer pe­ri­ods, or in­deed el­e­vate it to the po­si­tion of a chron­ic dis­ease from an of­ten in­cur­able di­ag­no­sis.

“We be­lieve this will be the first treat­ment in the world that rather than deal­ing with the con­se­quences of can­cer’s evo­lu­tion and re­sis­tance, aims to di­rect­ly con­front the dis­ease’s abil­i­ty to adapt and evolve in the first place,” said Olivia Rossanese, who will serve as head of bi­ol­o­gy at the new ICR fa­cil­i­ty, in a state­ment.

An­oth­er ap­proach tout­ed by ICR is com­bin­ing can­cer drugs to com­bat drug re­sis­tance. In the lab, ICR re­searchers have ob­served that bow­el can­cer cells evolved to re­sist two tar­get­ed treat­ments, but suc­cumbed to the third, they said on Wednes­day.

2019 Trin­i­ty Drug In­dex Eval­u­ates Ac­tu­al Com­mer­cial Per­for­mance of Nov­el Drugs Ap­proved in 2016

Fewer Approvals, but Neurology Rivals Oncology and Sees Major Innovations

This report, the fourth in our Trinity Drug Index series, outlines key themes and emerging trends in the industry as we progress towards a new world of targeted and innovative products. It provides a comprehensive evaluation of the performance of novel drugs approved by the FDA in 2016, scoring each on its commercial performance, therapeutic value, and R&D investment (Table 1: Drug ranking – Ratings on a 1-5 scale).

How to cap­i­talise on a lean launch

For start-up biotechnology companies and resource stretched pharmaceutical organisations, launching a novel product can be challenging. Lean teams can make setting a launch strategy and achieving your commercial goals seem like a colossal undertaking, but can these barriers be transformed into opportunities that work to your brand’s advantage?
We spoke to Managing Consultant Frances Hendry to find out how Blue Latitude Health partnered with a fledgling subsidiary of a pharmaceutical organisation to launch an innovative product in a
complex market.
What does the launch environment look like for this product?
FH: We started working on the product at Phase II and now we’re going into Phase III trials. There is a significant unmet need in this disease area, and everyone is excited about the launch. However, the organisation is still evolving and the team is quite small – naturally this causes a little turbulence.

Aymeric Le Chatelier, Ipsen

A $1B-plus drug stum­bles in­to an­oth­er big PhI­II set­back -- this time flunk­ing fu­til­i­ty test -- as FDA hold re­mains in ef­fect for Ipsen

David Meek

At the time Ipsen stepped up last year with more than a billion dollars in cash to buy Clementia and a late-stage program for a rare bone disease that afflicts children, then CEO David Meek was confident that he had put the French biotech on a short path to a mid-2020 launch.

Instead of prepping a launch, though, the company was hit with a hold on the FDA’s concerns that a therapy designed to prevent overgrowth of bone for cases of fibrodysplasia ossificans progressiva might actually stunt children’s growth. So they ordered a halt to any treatments for kids 14 and under. Meek left soon after to run a startup in Boston. And today the Paris-based biotech is grappling with the independent monitoring committee’s decision that their Phase III had failed a futility test.

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UP­DAT­ED: FDA’s golodirsen CRL: Sarep­ta’s Duchenne drugs are dan­ger­ous to pa­tients, of­fer­ing on­ly a small ben­e­fit. And where's that con­fir­ma­to­ry tri­al?

Back last summer, Sarepta CEO Doug Ingram told Duchenne MD families and investors that the FDA’s shock rejection of their second Duchenne MD drug golodirsen was due to some concerns regulators raised about the risk of infection and the possibility of kidney toxicity. But when pressed to release the letter for all to see, he declined, according to a report from BioPharmaDive, saying that kind of move “might not look like we’re being as respectful as we’d like to be.”

He went on to assure everyone that he hadn’t misrepresented the CRL.

But Ingram’s public remarks didn’t include everything in the letter, which — following the FDA’s surprise about-face and unexplained approval — has now been posted on the FDA’s website and broadly circulated on Twitter early Wednesday.

The CRL raises plenty of fresh questions about why the FDA abruptly decided to reverse itself and hand out an OK for a drug a senior regulator at the FDA believed — 5 months ago, when he wrote the letter — is dangerous to patients. It also puts the spotlight back on Sarepta $SRPT, which failed to launch a confirmatory study of eteplirsen, which was only approved after a heated internal controversy at the FDA. Ellis Unger, director of CDER’s Office of Drug Evaluation I, notes that study could have clarified quite a lot about the benefit and risks associated with their drugs — which can cost as much as a million dollars per patient per year, depending on weight.

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Roche's check­point play­er Tecen­triq flops in an­oth­er blad­der can­cer sub­set

Just weeks after Merck’s star checkpoint inhibitor Keytruda secured FDA approval for a subset of bladder cancer patients, Swiss competitor Roche’s Tecentriq has failed in a pivotal bladder cancer study.

The 809-patient trial — IMvigor010 — tested the PD-L1 drug in patients with muscle-invasive urothelial cancer (MIUC) who had undergone surgery, and were at high risk for recurrence.

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Stephen Hahn, AP

The FDA has de­val­ued the gold stan­dard on R&D. And that threat­ens every­one in drug de­vel­op­ment

Bioregnum Opinion Column by John Carroll

A few weeks ago, when Stephen Hahn was being lightly queried by Senators in his confirmation hearing as the new commissioner of the FDA, he made the usual vow to maintain the gold standard in drug development.

Neatly summarized, that standard requires the agency to sign off on clinical data — usually from two, well-controlled human studies — that prove a drug’s benefit outweighs any risks.

Over the last few years, biopharma has enjoyed an unprecedented loosening over just what it takes to clear that bar. Regulators are more willing to drop the second trial requirement ahead of an accelerated approval — particularly if they have an unmet medical need where patients are clamoring for a therapy.

That confirmatory trial the FDA demands can wait a few years. And most everyone in biopharma would tell you that’s the right thing for patients. They know its a tonic for everyone in the industry faced with pushing a drug through clinical development. And it’s helped inspire a global biotech boom.

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Gilead claims Tru­va­da patents in HHS’ com­plaint are in­valid

Back in November, the Department of Health and Human Services took the rare step of filing a complaint against Gilead for infringing on government-owned patents related to the HIV drug Truvada (emtricitabine/tenofovir disoproxil fumarate) for pre-exposure prophylaxis (PrEP).

But on Thursday, Gilead filed its own retort, making clear that it does not believe it has infringed on the Centers for Disease Control and Prevention’s (CDC) Truvada patents because they are invalid.

Gilead dusts off a failed Ebo­la drug as coro­n­avirus spreads; Ex­elix­is boasts pos­i­tive Ph I/II da­ta

→ Less than a year ago Gilead’s antiviral remdesivir failed to make the cut as investigators considered a raft of potential drugs that could be used against an Ebola outbreak. But it may gain a new mission with the outbreak of the coronavirus in China, which is popping up now around the world.

Gilead put out a statement saying that they’re now in discussions with health officials in the US and China about testing their NUC against the virus. It’s the latest in a growing lineup of biopharma companies that are marshaling R&D forces to see if they can come up with a vaccine or therapy to blunt the spread of the virus, which has now sickened hundreds, killed at least 17 people and led the Chinese government to start quarantining cities.

Alex Karnal (Deerfield)

Deer­field vaults to the top of cell and gene ther­a­py CD­MO game with $1.1B fa­cil­i­ty at Philadel­phi­a's newest bio­phar­ma hub

Back at the beginning of 2015, Deerfield Management co-led a $10 million Series C for a private gene therapy startup, reshaping the company and bringing in new leaders to pave way for an IPO just a year later.

Fast forward four more years and the startup, AveXis, is now a subsidiary of Novartis marketing the second-ever gene therapy to be approved in the US.

For its part, Deerfield has also grown more comfortable and ambitious about the nascent field. And the investment firm is now putting down its biggest bet yet: a $1.1 billion contract development and manufacturing facility to produce everything one needs for cell and gene therapy — faster and better than how it’s currently done.