Ex­elix­is pulls a sur­prise win in thy­roid can­cer just days ahead of fi­nal Cabome­tyx read­out

Ex­elix­is added a thy­roid can­cer in­di­ca­tion to its su­per-sell­er Cabome­tyx’s la­bel on Fri­day — months be­fore the FDA was ex­pect­ed to make a de­ci­sion, and days be­fore the com­pa­ny was set to un­veil the fi­nal da­ta at #ES­MO21.

At a me­di­an fol­low-up of 10.1 months, dif­fer­en­ti­at­ed thy­roid can­cer pa­tients treat­ed with Cabome­tyx (cabozan­ti­nib) lived a me­di­an of 11 months with­out their dis­ease wors­en­ing, com­pared to just 1.9 months for pa­tients giv­en a place­bo, Ex­elix­is said on Mon­day.

Michael Mor­ris­sey

The piv­otal tri­al, dubbed COS­MIC-311, en­rolled 258 pa­tients from a small but des­per­ate pa­tient pop­u­la­tion: those whose dis­ease pro­gressed fol­low­ing treat­ment with vas­cu­lar en­dothe­lial growth fac­tor re­cep­tor (VEG­FR)-tar­get­ed ther­a­py, and who are re­frac­to­ry to or in­el­i­gi­ble for ra­dioac­tive io­dine.

On­ly about 5% to 15% of thy­roid can­cer pa­tients are re­sis­tant to ra­dioio­dine treat­ment, but with a lack of avail­able treat­ments, they are on­ly ex­pect­ed to live three to five years af­ter di­ag­no­sis.

“Be­fore to­day, pa­tients with ra­dioac­tive io­dine-re­frac­to­ry dif­fer­en­ti­at­ed thy­roid can­cer who have pro­gressed fol­low­ing pri­or VEG­FR-tar­get­ed ther­a­py were fac­ing ag­gres­sive dis­ease and no stan­dard treat­ment op­tion,” prin­ci­pal in­ves­ti­ga­tor Mar­cia Brose said in a state­ment.

The fi­nal COS­MIC-311 analy­sis comes three months af­ter Ex­elix­is un­corked the in­ter­im da­ta, which sug­gest­ed Cabome­tyx re­duced pa­tients’ risk of dis­ease pro­gres­sion or death by 78% com­pared to place­bo af­ter about six months. But de­spite hit­ting the mark on pro­gres­sion-free sur­vival, the drug failed a co-pri­ma­ry end­point of ob­jec­tive re­sponse rate in the first 100 ran­dom­ized pa­tients at 6 months, com­ing in at just 15%. Across the whole in­tent-to-treat pop­u­la­tion, that fig­ure is low­er at just 11%, Ex­elix­is an­nounced on Mon­day.

Ex­elix­is didn’t say much about that end­point in its news re­lease, and CEO Michael Mor­ris­sey was not avail­able for an in­ter­view be­fore press time.

The com­pa­ny’s stock $EX­EL was down about 5% on Mon­day, pric­ing in at $19.67 apiece.

Cabome­tyx was first ap­proved for sec­ond-line kid­ney can­cer in 2016, two years af­ter a prostate can­cer fail­ure forced Ex­elix­is to lay off 70% of its staff. The com­pa­ny’s re­cent strat­e­gy has been push­ing com­bi­na­tion treat­ments and reg­u­la­to­ry fil­ings to ex­pand its list of ap­proved in­di­ca­tions. Last year, Cabome­tyx raked in $718.7 mil­lion in the US.

Reg­u­la­tors grant­ed the drug break­through ther­a­py des­ig­na­tion back in Feb­ru­ary, and as­signed a PDU­FA date of Dec. 4. But the agency un­ex­pect­ed­ly came for­ward with an OK a whole three months ear­ly. The la­bel in­cludes pa­tients 12 years and old­er.

Among the most com­mon Grade 3 or 4 side ef­fects seen in COS­MIC-311 was pal­mar-plan­tar ery­throdyses­the­sia, a con­di­tion that caus­es red­ness, swelling and pain in the hands and feet. Oth­er side ef­fects in­clud­ed hy­per­ten­sion, fa­tigue, di­ar­rhea, and hypocal­cemia. No treat­ment-re­lat­ed deaths were re­port­ed.

“We would like to thank the clin­i­cal tri­al par­tic­i­pants, the physi­cians and their staff who par­tic­i­pat­ed in the COS­MIC-311 tri­al and to ac­knowl­edge the team at the FDA for their col­lab­o­ra­tion dur­ing the quick re­view of our ap­pli­ca­tion,” Mor­ris­sey said in a state­ment.

In 2016, Ipsen struck a deal with Ex­elix­is for ex­clu­sive de­vel­op­ment and com­mer­cial­iza­tion rights to Cabome­tyx out­side of the US and Japan. Take­da has the rights in Japan, which it snapped up in 2017.

This ar­ti­cle has been up­dat­ed to clar­i­fy points made about the de­sign of the study.

Biotech Half­time Re­port: Af­ter a bumpy year, is biotech ready to re­bound?

The biotech sector has come down firmly from the highs of February as negative sentiment takes hold. The sector had a major boost of optimism from the success of the COVID-19 vaccines, making investors keenly aware of the potential of biopharma R&D engines. But from early this year, clinical trial, regulatory and access setbacks have reminded investors of the sector’s inherent risks.

RBC Capital Markets recently surveyed investors to take the temperature of the market, a mix of specialists/generalists and long-only/ long-short investment strategies. Heading into the second half of the year, investors mostly see the sector as undervalued (49%), a large change from the first half of the year when only 20% rated it as undervalued. Around 41% of investors now believe that biotech will underperform the S&P500 in the second half of 2021. Despite that view, 54% plan to maintain their position in the market and 41% still plan to increase their holdings.

So — that pig-to-hu­man trans­plant; Po­ten­tial di­a­betes cure reach­es pa­tient; Ac­cused MIT sci­en­tist lash­es back; and more

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We’re incredibly excited to welcome Beth Bulik, seasoned pharma marketing reporter, to the team. You can find much of her work in our new Marketing channel — and in her weekly newsletter, Endpoints PharmaRx, which will launch in early November. Add it to your subscriptions here.

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NYU surgeon transplants an engineered pig kidney into the outside of a brain-dead patient (Joe Carrotta/NYU Langone Health)

No, sci­en­tists are not any clos­er to pig-to-hu­man trans­plants than they were last week

Steve Holtzman was awoken by a 1 a.m. call from a doctor at Duke University asking if he could put some pigs on a plane and fly them from Ohio to North Carolina that day. A motorcyclist had gotten into a horrific crash, the doctor explained. He believed the pigs’ livers, sutured onto the patient’s skin like an external filter, might be able to tide the young man over until a donor liver became available.

UP­DAT­ED: Agenus calls out FDA for play­ing fa­vorites with Mer­ck, pulls cer­vi­cal can­cer BLA at agen­cy's re­quest

While criticizing the FDA for what may be some favoritism towards Merck, Agenus on Friday officially pulled its accelerated BLA for its anti-PD-1 inhibitor balstilimab as a potential second-line treatment for cervical cancer because of the recent full approval for Merck’s Keytruda in the same indication.

The company said the BLA, which was due for an FDA decision by Dec. 16, was withdrawn “when the window for accelerated approval of balstilimab closed,” thanks to the conversion of Keytruda’s accelerated approval to a full approval four months prior to its PDUFA date.

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How to col­lect and sub­mit RWD to win ap­proval for a new drug in­di­ca­tion: FDA spells it out in a long-await­ed guid­ance

Real-world data are messy. There can be differences in the standards used to collect different types of data, differences in terminologies and curation strategies, and even in the way data are exchanged.

While acknowledging this somewhat controlled chaos, the FDA is now explaining how biopharma companies can submit study data derived from real-world data (RWD) sources in applicable regulatory submissions, including new drug indications.

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No­vo CEO Lars Fruer­gaard Jør­gensen on R&D risk, the deal strat­e­gy and tar­gets for gen­der di­ver­si­ty


I kicked off our European R&D summit last week with a conversation involving Novo Nordisk CEO Lars Fruergaard Jørgensen. Novo is aiming to launch a new era of obesity management with a new approval for semaglutide. And Jørgensen had a lot to say about what comes next in R&D, how they manage risk and gender diversity targets at the trendsetting European pharma giant.

John Carroll: I’m here with Lars Jørgensen, the CEO of Novo Nordisk. Lars, it’s been a really interesting year so far with Novo Nordisk, right? You’ve projected a new era of growing sales. You’ve been able to expand on the GLP-1 franchise that was already well established in diabetes now going into obesity. And I think a tremendous number of people are really interested in how that’s working out. You have forecast a growing amount of sales. We don’t know specifically how that might play out. I know a lot of the analysts have different ideas, how those numbers might play out, but that we are in fact embarking on a new era for Novo Nordisk in terms of what the company’s capable of doing and what it’s able to do and what it wants to do. And I wanted to start off by asking you about obesity in particular. Semaglutide has been approved in the United States for obesity. It’s an area of R&D that’s been very troubled for decades. There have been weight loss drugs that have come along. They’ve attracted a lot of attention, but they haven’t actually ever gained traction in the market. My first question is what’s different this time about obesity? What is different about this drug and why do you expect it to work now whereas previous drugs haven’t?

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David Livingston (Credit: Michael Sazel for CeMM)

Renowned Dana-Far­ber sci­en­tist, men­tor and bio­phar­ma ad­vi­sor David Liv­ingston has died

David Livingston, the Dana-Farber/Harvard Med scientist who helped shine a light on some of the key molecular drivers of breast and ovarian cancer, died unexpectedly last Sunday.

One of the senior leaders at Dana-Farber during his nearly half century of work there, Livingston was credited with shedding light on the genes that regulate cell growth, with insights into inherited BRCA1 and BRCA2 mutations that helped lay the scientific foundation for targeted therapies and earlier detection that have transformed the field.

Marty Duvall, Oncopeptides CEO

On­copep­tides stock craters as it pulls can­cer drug Pepax­to from the mar­ket

Shares of Oncopeptides crashed more than 70% in early Friday trading after the company said it’s pulling its multiple myeloma drug Pepaxto (melphalan flufenamide) from the US market after failing a confirmatory trial. The move will force the company to close its US and EU business units and enact significant layoffs.

The FDA had scheduled an adcomm meeting next Thursday to discuss Pepaxto, which first won accelerated approval in February and costs about $19,000 per course of treatment. The committee was to weigh in on whether the confirmatory trial demonstrated a worse overall survival in the treatment arm compared to the control arm.

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Pfiz­er pitch­es its Covid-19 vac­cine for younger chil­dren ahead of ad­comm next week

Pfizer will present its case to the FDA’s vaccine adcomm next week, seeking authorization for a lower-dose version of its Covid-19 vaccine for kids ages 5 through 12, which the Biden administration said will likely begin rolling out early next month.

Two primary doses of the 10 µg vaccine (the dose for those ages 12 and up is 30 μg) given 3 weeks apart in this group of children “have shown a favorable safety and tolerability profile, robust immune responses against all variants of concern including Delta, and vaccine efficacy of 90.7% against laboratory-confirmed symptomatic COVID-19,” the company said in briefing documents ahead of next Tuesday’s meeting of the FDA’s Vaccines and Related Biological Products Advisory Committee.