Jaz­z's $1B SCLC drug fails com­bo tri­al, quash­ing hopes of quick full ap­proval. But how much does it mat­ter?

Lur­binecte­din was look­ing like a great turn­around sto­ry for Span­ish biotech Phar­ma­Mar. More than a year af­ter the drug flopped in a Phase III ovar­i­an can­cer study, it hit the mark for over­all re­sponse rate in small cell lung can­cer, at­tract­ed Jazz Phar­ma to gam­ble on a $1 bil­lion pact and land­ed an ac­cel­er­at­ed ap­proval ear­li­er this year.

Un­til it failed the over­all sur­vival end­point in a new Phase III study.

The part­ners said lur­binecte­din, mar­ket­ed as Zepzel­ca, didn’t meet the “pre-spec­i­fied cri­te­ria of sig­nif­i­cance” for OS in the over­all pop­u­la­tion. Pa­tients were giv­en ei­ther a com­bi­na­tion of the drug and the chemother­a­py dox­oru­bicin, or just their physi­cians’ choice of topote­can or cy­clophos­phamide/dox­oru­bicin/vin­cristine.

To be sure, the com­bo reg­i­men isn’t what the FDA ap­proved. Reg­u­la­tors gave their thumbs up to the monother­a­py as a sec­ond-line ther­a­py for pa­tients who re­lapsed fol­low­ing plat­inum-based chemother­a­py. An open-la­bel study showed an ORR of 35.2%, while pro­gres­sion-free sur­vival and OS were 4.6 months and 11.9 months, re­spec­tive­ly.

But the dis­ap­point­ing out­come of the new study, dubbed AT­LANTIS, may not nces­sar­i­ly be a crush­ing blow, said Jack West, a lung can­cer spe­cial­ist at City of Hope.

First, peo­ple HATE topote­can (some­times called “topote­can’t”) and see it as a very weak in­cum­bent that has nev­er clear­ly de­served its ti­tle as stan­dard of care — at best, the re­sults have al­ways damned with faint praise. Sec­ond, the tri­al was with a chemo com­bo that may very well have been too tox­ic to al­low op­ti­mal dos­ing of lur­binecte­din and may have led to ear­ly ter­mi­na­tion of the com­bi­na­tion and/or ag­gres­sive dose re­duc­tions. If the tri­al had been pos­i­tive, I think there would have been very lit­tle in­ter­est in ad­min­is­ter­ing the com­bi­na­tion, so I would con­sid­er lur­binecte­din monother­a­py as a dis­tinct if some­what over­lap­ping ques­tion, and the fact that the phase 2 ex­pe­ri­ence is over 100 pa­tients makes me con­sid­er it clin­i­cal­ly mean­ing­ful vs. a very du­bi­ous cur­rent stan­dard of care. It wouldn’t hold up against a more wor­thy 2nd line stan­dard.

Even though it wasn’t orig­i­nal­ly planned as con­fir­ma­to­ry, Jazz had said that the FDA ap­peared ready to ac­cept its da­ta for that pur­pose.

Robert Ian­none

It will now dis­cuss with reg­u­la­tors what ev­i­dence they need for full ap­proval. The drug was launched in the US in Ju­ly.

“While the com­bi­na­tion of lur­binecte­din and dox­oru­bicin did not achieve the pri­ma­ry end­point in this study, the over­all re­sults sup­port the ac­tiv­i­ty and tol­er­a­bil­i­ty of lur­binecte­din in this line of ther­a­py,” Jazz EVP of R&D Robert Ian­none said in a state­ment. “We look for­ward to the fur­ther de­vel­op­ment of lur­binecte­din in SCLC and oth­er tu­mors, both as monother­a­py and in com­bi­na­tion.”

Small cell lung can­cer has been a dif­fi­cult field for drug de­vel­op­ment, with the PD-(L)1 check­point in­hibitors pro­vid­ing the first op­tions in years.

Al­ber­to Chi­ap­pori, an on­col­o­gist at Mof­fitt Can­cer Cen­ter and an AT­LANTIS in­ves­ti­ga­tor, said he’s still “con­fi­dent” lur­binecte­din is an “ef­fec­tive new op­tion” for this area.

Jazz and Phar­ma­Mar em­pha­sized that no new safe­ty sig­nals were re­port­ed, “there was no ad­verse ef­fect on OS with the ex­per­i­men­tal arm” and that the dose test­ed was low­er than the FDA-ap­proved dose.

At the In­flec­tion Point for the Next Gen­er­a­tion of Can­cer Im­munother­a­py

While oncology researchers have long pursued the potential of cellular immunotherapies for the treatment of cancer, it was unclear whether these therapies would ever reach patients due to the complexity of manufacturing and costs of development. Fortunately, the recent successful development and regulatory approval of chimeric antigen receptor-engineered T (CAR-T) cells have demonstrated the significant benefit of these therapies to patients.

Stéphane Bancel, Moderna CEO

'This is not go­ing to be good': Mod­er­na CEO Ban­cel warns of a 'ma­te­r­i­al drop' in vac­cine ef­fi­ca­cy as Omi­cron spreads

Even as public health officials remain guarded about their comments on the likelihood Omicron will escape the reach of the currently approved Covid-19 vaccines, there’s growing scientific consensus that we’re facing a variant that threatens to overwhelm the vaccine barricades that have been erected.

Stéphane Bancel, the CEO of Moderna, one of the leading mRNA players whose quick vault into the markets with a highly effective vaccine created an instant multibillion-dollar market, added his voice to the rising chorus early Tuesday. According to Bancel, there will be a significant drop in efficacy when the average immune system is confronted by Omicron. The only question now is: How much?

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Philip Dormitzer, new GSK global head of vaccines R&D

Glax­o­SmithK­line poach­es Pfiz­er's vi­ral vac­cines lead in rush to cap­i­tal­ize on fu­ture of mR­NA

GlaxoSmithKline has appointed Philip Dormitzer, formerly chief scientific officer of Pfizer’s viral vaccines unit, as its newest global head of vaccines R&D, looking to leverage one of the leading minds behind Pfizer and BioNTech’s RNA collaboration that led to Covid-19 jab Comirnaty, the British drug giant said Tuesday.

Dormitzer had been with Pfizer for a little more than six years, joining up after a seven-year stint with Novartis, where he reached the role of US head of research and head of global virology for the company’s vaccines and diagnostics unit.

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In­tro­duc­ing End­points Stu­dio, a new way to ad­ver­tise with End­points-craft­ed brand­ing cam­paigns

Since our start in 2016, Endpoints has grown fast while executing our mission to cover biopharma’s most critical developments for industry pros worldwide. As readership has grown, our advertising business has too. Endpoints advertising partners support the mission and engage their desired audiences through announcements on our email and web platforms, brand recognition in our event coverage and sponsorships of Endpoints daily and weekly reports.

Reshma Kewalramani, Vertex CEO (Vertex via YouTube)

Bat­tling a line­up of skep­tics, Ver­tex claims an­oth­er ear­ly clin­i­cal win — this time in kid­ney dis­ease

Vertex claimed its second early-stage win of the fall Wednesday, announcing positive results in a small study on a genetically defined form of kidney disease.

The 16-patient, Phase II trial focused on patients with focal segmental glomerulosclerosis, a rare disease where kidneys are unable to filter blood properly. Over 13 weeks on an experimental pill, the level of protein in the patients’ urine fell by an average of 47.6%.

With on­ly burns to show in gene ther­a­py, Astel­las inks deal with AAV spe­cial­ist Dyno in push for a bet­ter cap­sid

On the hunt for a better AAV capsid for gene therapy, Eric Kelsic’s Dyno Therapeutics has set itself apart with its focus on machine learning to help speed discovery. Now, Japanese drugmaker Astellas — fresh off a slate of gene therapy burns — is taking a bet on Dyno as it looks to the future.

Astellas and Dyno will work together as part of an R&D pact to develop next-gen AAV vectors for gene therapy using Dyno’s CapsidMap platform directed at skeletal and cardiac muscle, the companies said Wednesday. Under the terms of the deal, Dyno will design AAV capsids for gene therapy, while Astellas will be responsible for conducting preclinical, clinical and commercialization activities for gene therapy product candidates using the capsids.

As first Omi­cron case in US crops up, re­searchers won­der: which an­ti­bod­ies, vac­cines will hold up?

As Covid-19 drug and vaccine developers race to figure out which of their products might be hampered by the new variant, the CDC on Wednesday afternoon announced the first confirmed case of the Omicron variant (B.1.1.529) in the US, found in San Francisco.

The unidentified individual was a traveler who returned from South Africa on Nov. 22, 2021, was fully vaccinated, and had mild symptoms that the CDC described as improving. All close contacts have been contacted and have tested negative, the centers said.

As lead drug runs in­to a wall, De­ci­phera slims down its pipeline, puts 140 jobs on the chop­ping block

Barely a month after disappointing data shattered hopes for a major label expansion for the GI tumor drug Qinlock, Deciphera is making a major pivot — scrapping development plans for that drug and discarding another while it hunkers down and focuses on two remaining drugs in the pipeline.

As a result, 140 of its staffers will be laid off.

The restructuring, which claims the equivalent of 35% of its total workforce, will take place across all departments including commercial, R&D as well as general and administrative support functions, Deciphera said, as it looks to streamline Qinlock-related commercial operations in the US while concentrating only on a “select number of key European markets.”

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How to use reg­istry da­ta to sup­port FDA de­ci­sion mak­ing: Agency ex­plains in new guid­ance

Drugmakers looking to design a new registry or use an existing one to support a regulatory decision on a drug’s effectiveness or safety will need to consult with a new draft guidance released Monday by the FDA.

The agency’s reliance on registry data for regulatory decisions dates back more than two decades, at least, as in 1998 Bayer won approval for its anticoagulant Refludan (withdrawn from the market in 2013 for commercial reasons) based in part on a historical control group pulled from a registry.