14 septiembre 2017

Pascal Besman, COO de PharmaMar en EEUU , en la Morgan Stanley Global Healthcare Conference en (Nueva York) .





PM01183 ( Zepsyre ) + Doxo = PFS de 6 Meses y una ORR del 50 % en SCLC. Esmo 2017 – Pharmamar and Abbvie fight it out in small-cell lung cancer .

Esmo 2017 – Pharmamar and Abbvie fight it out in small-cell lung cancer .

Source : EP Vantage
Company : PharmaMar, AbbVie
Tags
Free Content, Comment, Phase III, Monoclonal Antibody, Oncology, Trial Results
Date : September 12, 2017


Despite progress made in oncology small-cell lung cancer remains a highly intractable disease, with second-line topotecan being the last drug to get US approval – 21 years ago. Presentations at Esmo this weekend from Pharmamar and Abbvie showed that industry has not given up just yet.

The most important readout for Abbvie ’s Rova-T is still awaited, but Esmo saw an update of a phase I trial that backs use in DLL3-high patients but also shows that safety needs to be watched. Pharmamar ’s focus is on Zepsyre , which could supersede its ageing marketed cell cycle inhibitor Yondelis , and its early data hint at a possible window of opportunity, though the march of immuno-oncology complicates matters.

The threat of immuno-oncology is important. Though data are very limited IO drugs have been recommended for SCLC in US National Comprehensive Cancer Network guidelines. If their use becomes routine it could affect the design of some ongoing studies.
Awaiting Atlantis

Pharmamar wants to await results of a randomised phase III study before filing Zepsyre ; SCLC is one of two late-stage shots on goal, the other being ovarian cancer. While according to EvaluatePharma sellside consensus Yondelis , which has been on the market for 10 years, is expected to generate revenues of $138m in 2022, Zepsyre is seen hitting $362m.

The group’s Esmo data concerned an update of uncontrolled studies in the second and third-line SCLC setting. This encompassed several dosing regimens – combinations with doxorubicin or taxotere , and a single-agent phase II basket trial.

Across these cohorts Zepsyre showed overall remissions of 36-71%, with progression-free survival in platinum-sensitive subjects of up to 6 months.

Of course, these being early data, the only comparison is across trials: topotecan ’s registrational study showed around three months of PFS, while Rova-T worryingly gave even less, at 2.8 months, though based on its mechanism – Rova-T is an anti-DLL3 antibody-drug conjugate – Abbvie is relying on efficacy in DLL3-high patients, where PFS was 4.3 months.

It is important to bear in mind that there are different settings here; most of the subjects in Pharmamar ’s trial were second line, meaning that they had largely not received topotecan . Pharmamar says when it designed this phase II study there was no immuno-oncology or Rova-T to consider.

Combined uncontrolled data from 3 phase I/II studies  
Patients ORR in all-comers PFS in platinum-sensitives 
Zepsyre  +  doxorubicin  48 50% 6.0 mth 
Zepsyre  +  taxotere  71% 3.9 mth 
Zepsyre  single agent 36 36% 4.6 mth 






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Zepsyre . Resultados Obtenidos y Espectativas en Cáncer de Pulmón de Células Pequeñas según el Oncologo Martín Foster .


Estamos muy expectantes con PM1183 o lurbinectedina. Los datos de la combinación con doxorubicina son realmente impresionantes y los que se acaban de presentar como agente único son muy esperanzadores.

En este caso concreto de PM1183, ¿podría explicarnos qué tipo de compuesto es, qué actividad tiene, qué posibles indicaciones tendría y en qué fase de investigación se encuentra actualmente?

Supongo que describiría a lurbinectedina como una quimioterapia novedosa. Aunque gran parte de la atención actual está puesta en las terapias dirigidas y en la inmunoterapia, se siguen desarrollando nuevos quimioterapéuticos. Yo creo que los nuevos tratamientos quimioterapéuticos con un mecanismo de acción novedoso todavía tienen un papel muy importante que desempeñar. Cuando se trata de la terapia sistémica, la quimioterapia sigue siendo la columna vertebral de la mayoría de nuestros éxitos terapéuticos.

El compuesto aporta otras muchas actividades, como el proceso de transcripción, por lo tanto, tiene un número de mecanismos diferentes que es parte de lo que lo hace a una terapia interesante. Llevo involucrado con lurbinectedina más de cinco años en un amplio número de estudios diferentes, tanto como agente único como en combinación con varias quimioterapias diferentes.

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