Puma wins big FDA OK for ner­a­tinib af­ter run­ning the gamut with in­vestors

Short in­vestors loved to hate Puma Biotech­nol­o­gy, tak­ing the com­pa­ny $PBYI to task for the side ef­fects that ham­pered its lead can­cer drug ner­a­tinib. But the FDA had no trou­ble sanc­tion­ing the prod­uct for breast can­cer, ap­prov­ing it to­day for use in pre­vent­ing re­cur­rence of the dis­ease af­ter the biotech gained a lop­sided vote in its fa­vor among out­side agency ex­perts.

The FDA ap­proved ner­a­tinib — to be sold as Ner­l­ynx — for pre­vent­ing the re­turn of breast can­cer af­ter ther­a­py in­clud­ing trastuzum­ab. And the em­pha­sis in the OK was on adding op­tions for doc­tors and pa­tients.

“HER2-pos­i­tive breast can­cers are ag­gres­sive tu­mors and can spread to oth­er parts of the body, mak­ing ad­ju­vant ther­a­py an im­por­tant part of the treat­ment plan,” said Richard Paz­dur, M.D., di­rec­tor of the FDA’s On­col­o­gy Cen­ter of Ex­cel­lence and act­ing di­rec­tor of the Of­fice of Hema­tol­ogy and On­col­o­gy Prod­ucts in the FDA’s Cen­ter for Drug Eval­u­a­tion and Re­search. “Now, these pa­tients have an op­tion af­ter ini­tial treat­ment that may help keep the can­cer from com­ing back.”

There are some caveats in the la­bel. Con­cerned about the high rate of Grade 2 and Grade 3 di­ar­rhea in the clin­i­cal stud­ies, reg­u­la­tors are telling physi­cians to stop us­ing the drug if their pa­tient ex­pe­ri­ences Grade 4 di­ar­rhea or Grade 2 af­ter a max­i­mum dose re­duc­tion. But Michael Schmidt at Leerink sees the plus­es as well in a broad la­bel:

The prod­uct la­bel looks broad, not re­strict­ing use to spe­cif­ic pa­tient pop­u­la­tions (e.g., hor­mone-re­cep­tor [HR] pos­i­tive pa­tients) and there is no black box warn­ing. The pre­scrib­ing in­for­ma­tion con­tains fair­ly de­tailed in­for­ma­tion about the use of an­tidiar­rheal pro­phy­lax­is mea­sures, pro­vid­ing spe­cif­ic in­for­ma­tion on how to man­age the drug’s main side ef­fect.

Puma says it isn’t re­leas­ing the price yet and has no time­line on that. Its stock price still had some up­side left af­ter the OK, though, with shares surg­ing 7.5% on a com­pa­ny with a $3.2 bil­lion mar­ket cap. Now that the ap­proval has come through, look for lots more chat­ter about Puma as a po­ten­tial takeover tar­get — even though M&A has large­ly been MIA this year in biotech.

Alan Auer­bach

The FDA ex­perts raised a va­ri­ety of con­cerns in their re­view of ner­a­tinib, mak­ing some points that could hin­der the drug’s mar­ket po­ten­tial now that Puma CEO Alan Auer­bach has a green light to sell it. Crit­i­cal to its suc­cess is a bet­ter un­der­stand­ing of its prop­er role in treat­ing breast can­cer, and the lim­its of its ef­fec­tive­ness.

To get here, Puma had to over­come reg­u­la­tors’ ob­jec­tions in the spring of 2016 to fil­ing the drug with the da­ta that were avail­able, cit­ing a prob­lem­at­ic ap­proach to de­ci­pher­ing the re­sults. The shorts were al­so fix­at­ed on a high rate of grade 3 di­ar­rhea in the tri­als, but ex­perts hard­ly paid any at­ten­tion to that, hap­py to trade off the po­ten­tial for man­age­able side ef­fects for a chance of adding a new ar­row to their quiver of ther­a­pies.

“There’s no ex­cla­ma­tion point af­ter my ‘yes’,” said An­drew Sei­d­man, an on­col­o­gist at Memo­r­i­al Sloan Ket­ter­ing af­ter the FDA vote. “It’s just a yes.” He added that he was hap­py that the drug looks durable and the sta­tis­ti­cal analy­ses ap­plied to the da­ta giv­en the sig­nif­i­cant changes to the study de­sign. “I do think that physi­cians will se­lect pa­tients very se­lec­tive­ly for us­ing this,” he not­ed, echo­ing a con­cern that the ap­proval the com­pa­ny was seek­ing was too broad giv­en the da­ta avail­able.

Puma’s po­si­tion has been height­ened af­ter an­a­lysts fa­vor­ably com­pared ner­a­tinib’s 34% re­duc­tion in the risk of re­cur­rence or death against a mar­gin­al im­prove­ment seen in a Roche com­bi­na­tion study of Per­je­ta and Her­ceptin. It takes a leap to do these kinds of cross-tri­al analy­ses that dri­ve drug de­vel­op­ers a tad crazy now and then, but Wall Street an­a­lysts were quick to give Puma a thumbs up, par­tic­u­lar­ly af­ter it had just hand­i­ly won the FDA pan­el vote.

Eval­u­atePhar­ma pegged 2022 sales at $1.25 bil­lion, mak­ing it one of the top 15 drugs in the in­dus­try pipeline at the be­gin­ning of this year.

The DCT-OS: A Tech­nol­o­gy-first Op­er­at­ing Sys­tem - En­abling Clin­i­cal Tri­als

As technology-enabled clinical research becomes the new normal, an integrated decentralized clinical trial operating system can ensure quality, deliver consistency and improve the patient experience.

The increasing availability of COVID-19 vaccines has many of us looking forward to a time when everyday things return to a state of normal. Schools and teachers are returning to classrooms, offices and small businesses are reopening, and there’s a palpable sense of optimism that the often-awkward adjustments we’ve all made personally and professionally in the last year are behind us, never to return. In the world of clinical research, however, some pandemic-necessitated adjustments are proving to be more than emergency stopgap measures to ensure trial continuity — and numerous decentralized clinical trial (DCT) tools and methodologies employed within the last year are likely here to stay as part of biopharma’s new normal.

'Chang­ing the whole game of drug dis­cov­ery': Leg­endary R&D vet Roger Perl­mut­ter leaps back in­to work as a biotech CEO

Roger Perlmutter needs no introduction to anyone remotely involved in biopharma. As the R&D chief first at Amgen and then Merck, he’s built a stellar reputation and a prolific career steering new drugs toward the market for everything from cancer to infectious diseases.

But for years, he’s also held a less known title: science partner at The Column Group, where he’s regularly consulted about the various ideas the VCs had for new startups.

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FDA ex­tends re­search agree­ment with MIT-li­censed or­gan-on-chip sys­tems

The FDA on Wednesday extended its four-year agreement with CN Bio, a developer of single- and multi-organ-on-chip systems used for drug discovery, for another three years.

CN Bio said the scope of the research performed by the FDA’s Center for Drug Evaluation and Research has expanded to include the exploration of the company’s lung-on-a-chip system to help with the agency’s evaluation of inhaled drugs, in addition to the agency’s work on its liver model.

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In quest to meet user fee goals, FDA’s per­for­mance con­tin­ues down­ward trend

A recent update to the FDA’s running tally of how it’s meeting its user fee-related performance goals during the pandemic shows an agency that is not out of the woods yet.

The latest numbers reveal that for a second straight quarter in 2021, the FDA has met its user fee goal dates for 93% of original new drug applications, which compares with 94% and 98% for the previous two quarters in 2020, respectively.

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UP­DAT­ED: Pfiz­er hits the brakes on their piv­otal tri­al for a BC­MA/CD3 bis­pe­cif­ic on safe­ty con­cerns while FDA road­block is hold­ing up Duchenne MD PhI­II

Pfizer’s ambitious plan to take a Phase II study of its BCMA CD3-targeted bispecific antibody elranatamab (PF-06863135) and run it through to an accelerated approval has derailed.

The pharma giant said in a release this morning that they have halted enrollment for their MagnetisMM-3 study after researchers tracked three cases of peripheral neuropathy in the ongoing Phase I. They are now sharing info with the FDA as they explore the red safety flag.

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Thomas Schall, ChemoCentryx CEO (file photo)

Chemo­Cen­tryx plunges as FDA rais­es ques­tions about rare dis­ease drug ahead of ad­comm

ChemoCentryx’s stock price on Wednesday was cut in half by the release of FDA briefing documents ahead of a Thursday adcomm, raising questions on the company’s clinical data to support avacopan as a treatment for adults with a rare and serious disease known as anti-neutrophil cytoplasmic autoantibody (ANCA)-vasculitis.

ANCA-associated vasculitides (AAV) affect small to medium-size blood vessels that can be fatal in less than a year if left untreated, according to FDA. Only Roche’s Rituxan is currently FDA-approved for the treatment of AAV, while glucocorticoids are approved for the broader indication of vasculitis.

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Re­gen­eron’s gold­en goose Eylea may stave off biosim­i­lar com­pe­ti­tion un­til 2024 or be­yond

Almost 10 years have passed since its first FDA approval and Regeneron’s macular degeneration injection Eylea continues to pile up sales to the tune of about $5 billion per year, or more than half of Regeneron’s annual revenues.

Those billions are not expected to go anywhere anytime soon thanks to competition, even as Novartis subsidiary Sandoz announced Monday that it’s beginning a Phase III trial for an Eylea biosimilar in 460 patients across 20 countries.

Cynthia Butitta (L) and Joe Jimenez

Is that an­oth­er IPO in the mak­ing? Ex-No­var­tis CEO Joe Jimenez and a lead Kite play­er take up new posts at an off-the-shelf ri­val to 2 pi­o­neer­ing drugs

Right on the heels of taking on a $160 million crossover round in a likely leap to Nasdaq, Century Therapeutics CEO Lalo Flores is now pushing ahead with the high-profile ex-Novartis chief Joe Jimenez as chairman.

Jimenez’s greatest fame at Novartis was earned for one of its weakest products, as their pioneering personalized CAR-T Kymriah won the honors for the first such drug to make it to the market. Now a host of players, including Century, are barreling in behind the frontrunners with allogeneic rivals that can be created for off-the-shelf use.

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An em­ploy­ee com­plaint at Eli Lil­ly's Branch­burg plant al­leges al­tered qual­i­ty con­trol docs amid FDA probe — re­port

Eli Lilly was one of the earliest players in the race for a Covid-19 antibody, but a series of setbacks at a New Jersey manufacturing site have set back its efforts. Now, an internal complaint reportedly claims that a director at that site knowingly fudged quality control docs right under the FDA’s nose.

An employee complaint from Eli Lilly’s manufacturing plant in Branchburg, NJ, alleged that a director altered documents handed over to FDA regulators as part of an effort to downplay serious quality control issues amid the agency’s probe at the site, Reuters reported.