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You are here: Home / Archives for Clinical pipeline

Antibodies to watch in 2016: Mid-year update

August 18, 2016 by Janice Reichert

mabs-coverSince 2010, the “Antibodies to watch” article series has documented annually the number and identities of commercially sponsored antibody therapeutics in Phase 3 studies, regulatory review and those recently approved in the US and EU. Taken together, the articles have captured the extraordinary doubling of the number of antibody therapeutics in Phase 3 studies from 26 to 53, as identified in the “Antibodies to watch in 2010” and “Antibodies to watch in 2016” articles, respectively. Due to the highly dynamic nature of antibody therapeutics development, numerous transitions have occurred during 2016, and the Society offers here a mid-year update to data reported in the “Antibodies to watch in 2016” article.

As described in our previous posts, 4 antibody therapeutics (atezolizumab, reslizumab, ixekizumab, obiltoxaximab) were granted first marketing authorizations in either the US or EU during January to June 2016. As of mid-2016, marketing applications for 8 antibody therapeutics are being considered for first approvals in the US or EU. Of these, 5 applications (olaratuzumab, bezlotoxumab, sarilumab, brodalumab, ocrelizumab) have Food and Drug Administration action dates during September -December 2016. Recommendations by the European Medicines Agency on applications for Xilonix and inotuzumab ozogamicin could be made in 2016, but additional time would be needed for the European Commission’s decision regarding whether to grant the marketing authorization. It thus remains to be seen whether the number of antibody therapeutics approved in the US or EU during 2016 will match or exceed the record of 9 approvals granted in a single year set in 2015.

As of mid-2016, 53 unique antibody therapeutics were in Phase 3 studies. This is the same total number noted in the “Antibodies to watch in 2016” article, but the antibodies included in the totals are not all the same. The tables included in this mid-year update result from the addition of antibodies that started a first Phase 3 study in late 2015 to mid-2016, and deletion of antibodies that transitioned to regulatory review, reverted to an earlier clinical phase or had their development suspended or terminated. Compared to the totals included in the “Antibodies to watch in 2016” article, the number of antibodies in Phase 3 studies for cancer indications as of mid-2016 decreased slightly (from 17 to 15, respectively), while those for non-cancer indications increased slightly (from 36 to 38, respectively).

Antibodies for cancer represent only 28% of the current commercial Phase 3 pipeline, although they are ~55% of the overall clinical pipeline of therapeutic antibodies. The 15 antibody therapeutics in Phase 3 studies for cancer indications are notable for the diversity in their composition. Of the 15, 6 (40%) are non-canonical antibodies (1 radiolabeled antibody, 1 scFv-containing liposome, 2 immunotoxins, 2 antibody-drug conjugates (ADCs)), and a majority of the canonical antibodies (i.e., full-length IgG1, 2 or 4) are Fc- or glyco-engineered to enhance functionality. The 2 ADCs now in Phase 3 studies represent a vanguard, as this type of antibody therapeutic has entered clinical studies in large numbers only recently. Of the ADCs currently in clinical studies, most (44/56, 79%) are in either Phase 1 or Phase 1/2 studies, and most (55/56) are for cancer indications. ADCs now comprise ~20% of the clinical pipeline of antibodies for cancer, but ~11% of all antibodies in clinical development. There is substantial diversity of the targets, drugs, linkers, and drug-to-antibody ratios of the ADCs in the clinic. For example, of the ADCs in the clinic, targets for 51 have been disclosed, and 39 of these 51 targets are unique, i.e., only one ADC in clinical studies is known to target that particular antigen. Antigens known to be the target of more than one ADC in clinical studies include CD19, CD37, EGFR, HER2 and mesothelin. The diversity of the molecules may initially serve as a hindrance, but knowledge gained by the development of this class of molecules should increase overall as more ADCs enter clinical studies, transition through the phases and join the two ADCs currently on the market, brentuximab vedotin (Adcetris®) and ado-trastuzumab vedotin (Kadcyla®).

Antibodies for non-cancer indications dominate the current commercial Phase 3 pipeline. Unlike the antibodies for cancer, the 38 antibodies in Phase 3 studies for non-cancer indications are mostly canonical full-length IgG1, 2 or 4 molecules. Only 4 of the 38 (~11%) are non-canonical molecules: 1 bispecific antibody and 3 antibody ‘fragments’ (scFv, Fab, nanobody). Like ADCs, bispecific antibodies are expected to comprise a larger percentage of the Phase 3 pipeline in the next ~6-8 years. Bispecific antibodies now comprise ~9% of the entire commercial pipeline of antibody therapeutics, but most (32/45, 71%) of those are currently in early clinical studies (either Phase 1 or Phase 1/2). Compared to ADCs, bispecific antibodies are undergoing evaluation in a broader range of indications, although the majority of bispecifics (30/45, 67%) are for cancer and they comprise ~11% of the clinical pipeline of antibodies for cancer. The two bispecific antibodies now on the market, catumaxomab (Removab®) and blinatumomab (BLINCYTO®), are both for cancer. Nevertheless, the one bispecific antibody now in Phase 3 studies, emicizumab, is for a non-cancer indication (hemophilia A).

The clinical pipeline of antibody therapeutics, including at Phase 3, is highly dynamic. The Antibody Society will continue to track antibodies in the clinic, and report progress to its members.

Acknowledgements: The Antibody Society thanks Hanson Wade for access to the Beacon ADC database.

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Filed Under: Clinical pipeline, Development metrics, European Medicines Agency, Food and Drug Administration, Phase 3 pipeline Tagged With: ADC, Antibody drug conjugates, antibody therapeutics, bispecific, clinical pipeline

Antibody Drug Conjugates – News

July 10, 2016 by Joost Melis

square logo ADCImmunomedics announced the issuance of a novel patent (U.S. Patent 9,375,489) related to the company’s lead cancer therapeutic, sacituzumab govitecan, also known as IMMU-132. This antibody-drug conjugate (ADC) comprises a humanized antibody to the cancer target Trop-2 and is conjugated with SN-38, an active metabolite of the anti-cancer drug irinotecan. The patent entitled “Antibody-SN-38 Immunoconjugates with a CL2A Linker.” is the 28th issued U.S. patent covering the uses and composition of sacituzumab govitecan.

The ADC is in development for the treatment of patients with many diverse solid cancers. The most advanced indication in development is triple-negative breast cancer (TNBC). Phase II are also studies ongoing in patients with metastatic non-small-cell lung cancer (NSCLC), small-cell lung cancer (SCLC) and in patients with metastatic urothelial cancers. According to Immunomedics’ updated clinical development plan for sacituzumab govitecan, in Q3 of 2016 the company plans to complete enrollment of additional patients into the ongoing single-arm Phase II study for patients with relapsed/refractory metastatic TNBC who received at least 2 prior therapies, including taxane. Immunomedics is collaborating with the FDA for completion of the ongoing Phase II trial and for submitting an Accelerated Approval registration application. Also discussions with the European Medicine Agency (EMA) have been initialized, and EMA has provided the company with advice on the scheduled Phase III trial.

 

In other news, AbbVie announced safety and preliminary efficacy data from a Phase I study of ABT-414. ABT-414 is an investigational ADC for treatment of epidermal growth factor receptor (EGFR) amplified, recurrent glioblastoma (GBM). Glioblastoma is the most common and most aggressive type of malignant primary brain tumor and in most cases a fatal disease. Amplified EGFR is the most common genetic mutation associated (~50% are EGFR mutations) with malignant GBM. With standard of care therapy, patients with GBM have a median survival of 15 months after diagnosis and two-year survival is 30%, demonstrating the urgent unmet need for new treatment options.

Published data showed no dose-limiting toxicities and frequent, reversible ocular toxicities. Furthermore, an estimated 30% (n=44) of patients treated with ABT-414 as monotherapy were progression free at six months [95% CI=17, 44] (secondary endpoint). Best Response Assessment in Neuro-Oncology (RANO) Criteria identified two partial responses, 18 patients with stable disease, and 24 with progressive disease for a total of 44 patients with complete data.

The most common serious adverse event (>1 patient) (n=48) was seizure (8%) as of January 7, 2016. Grade 3/4 treatment emergent adverse events (TEAEs) (>1 patient) were keratitis (15%), corneal epithelial microcysts (8%), hemiparesis (6%), hyperglycemia (6%), muscular weakness (6%), seizure (6%), blurred vision (4%) and ulcerative keratitis (4%).The most common TEAEs (≥25% patients) in this study arm were blurred vision (60%), headache (29%), photophobia (29%), dry eye (27%), eye pain (27%), and fatigue (27%).

 

Filed Under: Ab news, ADC, Clinical pipeline Tagged With: ADC, Antibody drug conjugates, antibody therapeutics, cancer, clinical pipeline, GBM, NSCLC, SCLC, TNBC

European Medicines Agency’s antibody PRIority MEdicines

June 6, 2016 by Janice Reichert

mabs-coverOn June 1, the European Medicines Agency (EMA) announced that four medicines in development were accepted under their new PRIority MEdicines (PRIME) scheme, which focuses on medicines that may offer a major therapeutic advantage over existing treatments, or benefit patients without treatment options. In this voluntary scheme, EMA offers early, proactive and enhanced support to developers to optimize the generation of robust data on a medicine’s benefits and risks, and enable accelerated assessment of medicine applications. Early clinical data that shows a medicine has the potential to benefit patients with unmet medical needs must be provided for it to be accepted for PRIME access.

Of the four medicines given PRIME access to date, two, aducanumab and NI-0501, are antibody therapeutics. Aducanumab, which targets amyloid beta, has PRIME access as a treatment of Alzheimer’s disease. The antibody is currently being evaluated in two Phase 3 studies of patients with early Alzheimer’s disease. The primary objective of the studies is to evaluate the efficacy of monthly doses of aducanumab in slowing cognitive and functional impairment. An estimated 1350 patients will be enrolled in each study. Both studies were initiated in 2015, and have primary completion dates in February 2020.

NI-0501, a human mAb targeting interferon gamma, has PRIME access as a treatment of primary hemophagocytic lymphohistiocytosis (PHL). A Phase 2, open-label, single arm study to explore the safety, tolerability, pharmacokinetics and efficacy of intravenous multiple administrations of NI-0501 in children with PHL is currently recruiting patients. The study was initiated in 2013 and has an estimated enrollment of 10 patients. The primary completion date of the study is December 2016. NI-0501 has orphan drug designations in the European Union and United States. It also has the US Food and Drug Administration’s Breakthrough Therapy Designation, which, like the PRIME scheme, is intended to expedite the development and review of new therapies for serious or life threatening conditions that have shown encouraging early clinical results over available therapies.

Find information about the four medicines accepted under the PRIME scheme here.

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Filed Under: Clinical pipeline, European Medicines Agency, Food and Drug Administration, Orphan drug Tagged With: antibody therapeutics, clinical pipeline, European Medicines Agency, priority medicines

Antibody Drug Conjugates – Clinical Progress

June 1, 2016 by Joost Melis

square logo ADCIn the second half of May several companies reported important progress on their therapeutic ADC products. The Dutch pharmaceutical company Synthon initiated the second phase of the ongoing phase I clinical trial with its investigational anti-HER2 ADC SYD985. During the first part patients with solid tumors of any origin were enrolled. Promising results were obtained in this dose-finding part of the trial in 33 cancer patients who were dosed with between 0.3 and 2.4 mg/kg of SYD985 every three weeks. Very high response rates and durable responses were observed  at doses from 1.2 mg/kg onwards in patients whose cancers were refractory to HER2-targeted agents, including Herceptin® and Kadcyla®. The second part will see 48 additional heavily pre-treated patients with HER2-positive breast cancer enrolled into the Phase I trial. This marked a significant next step in the development of SYD985, the frontrunner of the company’s duocarmycin-based ADC platform.

Additionally, Seattle Genetics announced initiation of a pivotal phase III clinical trial, CASCADE, evaluating vadastuximab talirine (SGN-CD33A) in combination with azacitidine (Vidaza) or decitabine (Dacogen) in older patients with newly diagnosed acute myeloid leukemia (AML). SGN-CD33A is an ADC targeting CD33 comprising an engineered cysteine antibody (EC-mAb) stably linked to a pyrrolobenzodiazepine (PBD) dimer. CD33 is expressed on leukemic blasts in nearly all AML patients and expression is generally consistent regardless of age, cytogenetic abnormalities or underlying mutations. Azacitidine and decitabine are hypomethylating agents (HMAs) commonly used in the treatment of older AML patients. The phase III CASCADE study is a randomized, double-blinded, placebo-controlled, global clinical trial. Patients will be randomized on a 1:1 ratio to be treated with an HMA plus SGN-CD33A or an HMA plus placebo. The secondary endpoints include the comparison of composite complete remission rate, event-free and leukemia-free survival, duration of response, safety, and 30- and 60-day mortality rates. This phase III trial will enroll approximately 500 patients globally.

Filed Under: Ab news, ADC, Clinical pipeline, Phase 3 pipeline

Antibody immune checkpoint modulators in the clinic

May 5, 2016 by Janice Reichert

Antibody impressionThe possibility of using antibody therapeutics to modulate immune checkpoint pathways has captured the attention of many organizations involved in the research and development of cancer drugs. As of early May 2016, three antibody checkpoint inhibitors (ipilimumab / Yervoy®, pembrolizumab / Keytruda® and nivolumab / Opdivo®) have been approved for marketing, and one (atezolizumab) is undergoing regulatory review. In 2011, ipilimumab, which targets CTLA-4, became the first antibody of this class to be approved. Pembrolizumab and nivolumab, which target PD1, were subsequently granted first approvals in 2014. These drugs are currently marketed as treatments for melanoma and non-small cell lung cancer (NSCLC), but they have also undergone evaluation as treatments for other cancers, e.g., head and neck squamous cell carcinoma. A marketing application for the use of anti-PD-L1 atezolizumab as a treatment for urothelial carcinoma is undergoing a priority review by the Food and Drug Administration (FDA), and a regulatory action is expected in September 2016. An FDA action on a second application for use of atezolizumab as a treatment for NSCLC is expected in October 2016.

The biology of immune checkpoint pathways is complicated, and the use of antibodies to modulate numerous immune checkpoint targets is being explored. At least 45 antibody checkpoint modulators are currently undergoing evaluation in clinical studies of patients with a variety of cancers. In addition to CTLA-4, PD1 and PD-L1, other targets for antibodies in the clinic include B7-H3, CD70, CD40, CD137, GITR, OX40, KIR, LAG-3 and TIM3. Antibodies that modulate immune checkpoints are now ~16% of the entire clinical pipeline of antibodies for cancer, but most (~80%) are in early stage (i.e., Phase 1 or 1/2) clinical studies. First-in-human studies for over 20 antibody checkpoint modulators were initiated in 2015, and given the intense interest in the topic, many more are expected to enter clinical studies in the near future. Much work remains to be done, however, to demonstrate the relevance of some targets, and to determine suitable treatment regimens, especially when the antibody is administered as part of combination therapy.  If the potential of this class of molecules is realized, unmet medical need could be reduced, and patients’ choice of antibody therapeutics could substantially increase, in the next 5-10 years.

Filed Under: Clinical pipeline, Development metrics

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