白血病新药!第一三共第2代FLT3抑制剂Vanflyta欧盟监管传不利消息,已在日本上市!-

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白血病新药!第一三共第2代FLT3抑制剂Vanflyta欧盟监管传不利消息,已在日本上市!

阅读量：3712128 2019-10-23

日本药企第一三共制药（Daiichi Sankyo）近日宣布，欧洲药品管理局（EMA）人用医药产品委员会（CHMP）已针对口服靶向抗癌药Vanflyta（quizartinib）治疗复发性/难治性FLT3-ITD急性髓性白血病（AML）成人患者的营销授权申请（MAA）发布了不推荐批准的意见。
在美国监管方面，FDA在今年4月将Vanflyta的新药申请（NDA）审查时间延长了3个月，至2019年8月25日。根据当时发布的声明，FDA需要时间来审查第一三共提交的与FDA要求相关的额外数据。但在今年6月，FDA发布了一封完整回应函（CRL），拒绝批准Vanflyta。
Vanflyta于今年6月获得日本卫生劳动福利部（MHLW）批准，这也是该药在全球范围内的首个监管批准。本月初，Vanflyta已在日本上市销售。此次日本批准，基于全球性关键III期临床研究QuANTUM-R以及一项在日本复发性/难治性FLT3-ITD AML患者中开展的II期临床研究的数据。

值得一提的是，QuANTUM-R研究是评估一种FLT3抑制剂作为口服单药疗法相对化疗治疗复发性/难治性FLT3-ITD AML患者显著延长总生存期的首个随机III期研究。在该研究中，与挽救性化疗相比，Vanflyta口服单药疗法使死亡风险显著降低24%（HR=0.76，p=0.0177，95%CI:0.58-0.98）、总生存期显著延长（中位OS：6.2个月[双边检验95%CI:5.3-7.2] vs 4.7个月[双边检验95%CI:4.0-5.5]）；Vanflyta治疗组估计的1年生存率为27%，挽救性化疗组为20%。安全性方面，接受Vanflyta治疗的患者最常见的药物不良反应是恶心（33.2%，80/241例）、心电图QT延长（24.9%，60/241例）、贫血（24.9%，60/241例）和血小板减少（21.2%，51/241例）。来自日本II期研究的数据显示，在中期分析时，已经达到了预先指定的符合完全缓解率的主要终点。该研究中Vanflyta的疗效和安全性与QuANTUM-R研究中一致。
第一三共肿瘤研发执行副总裁兼全球负责人Antoine Yver医学博士表示：“虽然我们对CHMP的意见感到失望，但我们将评估从CHMP收到的反馈，以确定Vanflyta治疗欧洲复发/难治性FLT3-ITD AML患者的下一步措施。尽管面临这一挫折，我们仍然相信Vanflyta对FLT3-ITD AML患者的潜在益处，我们期待着全球关键性III期QuANTUM-First研究的结果，该研究正在评估Vanflyta联合化疗治疗新诊断的FLT3-ITD AML患者。我们仍然致力于将Vanflyta作为一种潜在的治疗选择，用于美国、欧洲和世界其他地区这种侵略性的、难以治疗的AML亚型。”

Vanflyta的活性药物成分quizartinib属于第二代FLT3抑制剂，该药是一种口服小分子受体酪氨酸激酶抑制剂，选择性靶向抑制FLT3。在美国，quizartinib已获FDA授予治疗复发性/难治性FLT3-ITD AML成人患者的突破性药物资格、治疗复发性/难治性AML的快速通道地位。此外，quizartinib在美国、欧盟均被授予了治疗AML的孤儿药资格，在日本被授予了治疗FLT3突变AML的孤儿药资格。
AML是一种侵袭性血液和骨髓癌症，导致患者体内功能失常的癌变白细胞不受控制地增生和积累，并影响正常血细胞的生成。FLT3基因突变是AML最常见的基因异常改变之一，其中FLT3-ITD是最常见的FLT3突变，影响约1/4的AML患者。
FLT3-ITD是白血病高负担、预后差并对AML患者疾病管理有显著影响的一种驱动突变。与未携带FLT3-ITD突变的AML患者相比，FLT3-ITD AML患者总体预后更差，包括复发率增加、复发后死亡风险增加、造血干细胞移植后复发的可能性更高。
Tokyo and Munich – (October 18, 2019) – Daiichi Sankyo Company, Limited (hereafter, Daiichi Sankyo) today announced the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) has adopted a negative opinion on the Marketing Authorization Application (MAA) for quizartinib for the treatment of adults with relapsed/refractory FLT3-ITD acute myeloid leukemia (AML). The CHMP opinion is based on the MAA submission of data from the global pivotal QuANTUM-R study of quizartinib. Results from QuANTUM-R were published in The Lancet Oncology. “While we are disappointed by this opinion, we will evaluate feedback received from the CHMP in order to determine next steps for quizartinib for the treatment of patients with relapsed/refractory FLT3-ITD AML in Europe,” said Antoine Yver, MD, MSc, Executive Vice President and Global Head, Oncology Research and Development, Daiichi Sankyo. “Despite this setback, we continue to believe in the potential benefit of quizartinib for patients with FLT3-ITD AML and we look forward to the results of the global, pivotal phase 3 QuANTUM-First study evaluating quizartinib in combination with chemotherapy for patients with newly-diagnosed FLT3-ITD AML. We remain committed to bringing quizartinib forward as a potential treatment option for this aggressive and difficult-to-treat subtype of AML in the U.S., Europe and other parts of the world.” About Quizartinib
Quizartinib, an oral FLT3 inhibitor, is the lead product in the AML Franchise of Daiichi Sankyo.
Quizartinib currently is approved for use in Japan under the brand name VANFLYTA? for the treatment of adult patients with relapsed/refractory FLT3-ITD AML, as detected by an approved test. It was launched in Japan on October 10, 2019. Enrollment into QuANTUM-First, a global, pivotal phase 3 study evaluating quizartinib in combination with standard chemotherapy in newly diagnosed FLT3-ITD AML, was recently completed. Other ongoing studies include phase 1/2 development for pediatric and young adult relapsed/refractory FLT3-ITD AML in North America and Europe; and phase 1 development in combination with milademetan, an investigational MDM2 inhibitor, for relapsed/refractory FLT3-ITD AML and newly-diagnosed FLT3-ITD AML unfit for intensive chemotherapy in the U.S. Milademetan is an investigational agent that has not been approved for any indication in any country. Safety and efficacy have not been established. About FLT3-ITD AML
AML is an aggressive blood and bone marrow cancer that causes uncontrolled growth and accumulation of malignant white blood cells that fail to function normally and interfere with the production of normal blood cells. In the EU, there are approximately 18,000 new cases of AML each year, and their five-year survival rate is less than 30 percent. FLT3 gene mutations are one of the most common genetic abnormalities in AML. FLT3-ITD is the most common FLT3 mutation, affecting approximately one in four patients with AML.FLT3-ITD is a driver mutation that presents with high leukemic burden, a poor prognosis and a significant impact on disease management for patients with AML. Patients with FLT3-ITD AML have a worse overall prognosis, including an increased incidence of relapse, an increased risk of death following relapse and a higher likelihood of relapse following hematopoietic stem cell transplantation, as compared to those without this mutation.

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