REG - AstraZeneca PLC - Enhertu recommended for breast cancer EU approval

AstraZenecaAnnouncement

27/06/2022 07:16

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RNS Number : 2102Q  AstraZeneca PLC  27 June 2022

27 June 2022 07:05 BST

 

Enhertu recommended for approval in the EU by CHMP for patients with
HER2-positive metastatic breast cancer treated with a prior anti-HER2-based
regimen

 

Recommendation based on DESTINY-Breast03 trial results showing AstraZeneca and
Daiichi Sankyo's Enhertu reduced the risk of disease progression or death by
72% vs. trastuzumab emtansine (T-DM1)

 

AstraZeneca and Daiichi Sankyo's Enhertu (trastuzumab deruxtecan) has been
recommended for approval in the European Union (EU) as a monotherapy for the
treatment of adult patients with unresectable or metastatic HER2-positive
breast cancer who have received one or more prior anti-HER2-based regimens.

 

Enhertu is a specifically engineered HER2-directed antibody drug conjugate
(ADC) being jointly developed and commercialised by AstraZeneca and Daiichi
Sankyo.

 

The Committee for Medicinal Products for Human Use (CHMP) of the European
Medicines Agency (EMA) based its positive opinion on results from the
DESTINY-Breast03 Phase III trial, which were published in The New England
Journal of Medicine
(https://www.nejm.org/doi/full/10.1056/NEJMoa2115022?query=featured_home) .(1)
In the trial, Enhertu reduced the risk of disease progression or death by 72%
versus trastuzumab emtansine (T-DM1) (hazard ratio  HR  0.28; 95% confidence
interval  CI : 0.22-0.37; p<0.0001) in patients with HER2-positive
unresectable and/or metastatic breast cancer previously treated with
trastuzumab and a taxane.

 

In Europe, more than 530,000 cases of breast cancer are diagnosed annually.(2)
Approximately one in five cases of breast cancer are considered
HER2-positive.(3) Despite initial treatment with trastuzumab, pertuzumab and a
taxane, patients with HER2-positive metastatic breast cancer will often
experience disease progression.(4,5) More treatment options are needed to
further delay progression and extend survival.(4,6,7)

 

Susan Galbraith, Executive Vice President, Oncology R&D, AstraZeneca,
said: "This recommendation reflects the transformative progression-free
survival benefit seen in the DESTINY-Breast03 trial compared to T-DM1,
supporting Enhertu as a potential new standard of care and setting a new
benchmark in the treatment of HER2-positive metastatic breast cancer. If
approved by the European Commission, patients in Europe may be able to benefit
from this important medicine earlier in the treatment of their disease,
improving their chance for better outcomes."

 

Gilles Gallant, Senior Vice President, Global Head, Oncology Development,
Oncology R&D, Daiichi Sankyo, said: "Today's CHMP opinion provides further
validation of the significance of the DESTINY-Breast03 trial results, which
for the first time showed superiority of Enhertu in prolonging
progression-free survival in patients previously treated for HER2-positive
metastatic breast cancer as compared to another HER2-directed ADC. This
positive CHMP opinion is an important step forward in bringing this
potentially practice-changing medicine to patients in Europe to use earlier in
the treatment of HER2-positive metastatic breast cancer and builds on the
recent approval of Enhertu in the US."

 

The recommendation will now be reviewed by the European Commission, which has
the authority to grant marketing authorisations for medicines in the EU.

 

Enhertu is being further assessed in a comprehensive clinical development
programme evaluating efficacy and safety across multiple HER2-targetable
cancers, including breast, gastric, lung and colorectal cancers.

 

Notes

 

HER2-positive breast cancer

Breast cancer is the most common cancer and is one of the leading causes of
cancer-related deaths worldwide.(8) More than two million cases of breast
cancer were diagnosed in 2020, with nearly 685,000 deaths globally.(8) In
Europe, more than 530,000 cases of breast cancer are diagnosed annually.(2)
Approximately one in five cases of breast cancer are considered
HER2-positive.(3)

 

HER2 is a tyrosine kinase receptor, growth-promoting protein expressed on the
surface of many types of tumours including breast, gastric, lung and
colorectal cancers.(9) HER2 protein overexpression may occur as a result of
HER2 gene amplification and is often associated with aggressive disease and
poor prognosis in breast cancer.(10)

 

Despite initial treatment with trastuzumab, pertuzumab and a taxane, patients
with HER2-positive metastatic breast cancer will often experience disease
progression.(4.5) More treatment options are needed to further delay
progression and extend survival.(4,6,7)

 

DESTINY-Breast03

DESTINY-Breast03 is a global, head-to-head, randomised, open-label,
registrational Phase III trial evaluating the efficacy and safety of Enhertu
(5.4 mg/kg) versus T-DM1 in patients with HER2-positive unresectable and/or
metastatic breast cancer previously treated with trastuzumab and a taxane.

 

The primary efficacy endpoint of DESTINY-Breast03 is progression-free survival
(PFS) based on blinded independent central review. Secondary efficacy
endpoints include overall survival, objective response rate, duration of
response, PFS based on investigator assessment and safety.

 

DESTINY-Breast03 enrolled 524 patients at multiple sites in Asia, Europe,
North America, Oceania and South America. Results from DESTINY-Breast03 have
been published in The New England Journal of Medicine
(https://www.nejm.org/doi/full/10.1056/NEJMoa2115022?query=featured_home) .(1)
For more information about the trial, visit ClinicalTrials.gov
(https://clinicaltrials.gov/ct2/show/NCT03529110) .

 

Enhertu

Enhertu is a HER2-directed ADC. Designed using Daiichi Sankyo's proprietary
DXd ADC technology, Enhertu is the lead ADC in the oncology portfolio of
Daiichi Sankyo and the most advanced programme in AstraZeneca's ADC scientific
platform. Enhertu consists of a HER2 monoclonal antibody attached to a
topoisomerase I inhibitor payload, an exatecan derivative, via a stable
tetrapeptide-based cleavable linker.

 

Enhertu (5.4 mg/kg) is approved in Canada, Israel and the US for the treatment
of adult patients with unresectable or metastatic HER2-positive breast cancer
who have received a prior anti-HER2-based regimen either in the metastatic
setting, or in the neoadjuvant or adjuvant setting and have developed disease
recurrence during or within six months of completing therapy, based on results
from the DESTINY-Breast03 trial.

 

Enhertu (5.4mg/kg) is also approved in approximately 40 countries for the
treatment of adult patients with unresectable or metastatic HER2-positive
breast cancer who have received two or more prior anti-HER2-based regimens
based on the results from the DESTINY-Breast01 trial.

 

Enhertu (6.4mg/kg) is approved in several countries for the treatment of adult
patients with locally advanced or metastatic HER2-positive gastric or
gastroesophageal junction (GEJ) adenocarcinoma who have received a prior
trastuzumab-based regimen based on the results from the DESTINY-Gastric01
trial.

 

Enhertu development programme

A comprehensive development programme is underway globally, evaluating the
efficacy and safety of Enhertu monotherapy across multiple HER2-targetable
cancers, including breast, gastric, lung and colorectal cancers. Trials in
combination with other anticancer treatments, such as immunotherapy, are also
underway.

 

Regulatory applications for Enhertu are currently under review in China,
Europe, Japan and several other countries for the treatment of adult patients
with unresectable or metastatic HER2-positive breast cancer who have received
a prior anti-HER2-based regimen based on the results from the DESTINY-Breast03
trial.

 

Enhertu is under review in Europe for the treatment of adult patients with
unresectable or metastatic HER2-low (immunohistochemistry (IHC) 1+ or IHC 2+/
in-situ hybridisation (ISH)-negative) breast cancer who have received a prior
systemic therapy in the metastatic setting or developed disease recurrence
during or within six months of completing adjuvant chemotherapy, based on the
results from the DESTINY-Breast04 trial. Patients with hormone receptor (HR)
positive breast cancer must additionally have received or be ineligible for
endocrine therapy.

 

Enhertu is also currently under review in the US for the treatment of adult
patients with unresectable or metastatic non-small cell lung cancer (NSCLC)
whose tumours have a HER2 (ERBB2) mutation and who have received a prior
systemic therapy based on the results of the DESTINY-Lung01 trial, and in
Europe for the treatment of adult patients with locally advanced or metastatic
HER2-positive gastric or GEJ adenocarcinoma who have received a prior
anti-HER2 based regimen based on the DESTINY-Gastric01 and DESTINY-Gastric02
trials.

 

Enhertu was granted Breakthrough Therapy Designation in the US for the
treatment of adult patients with unresectable or metastatic HER2-low (IHC 1+
or IHC 2+/ISH-negative) breast cancer who have received a prior systemic
therapy in the metastatic setting or developed disease recurrence during or
within six months of completing adjuvant chemotherapy, based on the results of
the DESTINY-Breast04 trial. Patients with HR-positive breast cancer should
additionally have received or be ineligible for endocrine therapy.

Daiichi Sankyo Collaboration

Daiichi Sankyo Company, Limited (TSE:4568) [referred to as Daiichi Sankyo] and
AstraZeneca entered into a global collaboration to jointly develop and
commercialise Enhertu (a HER2-directed ADC) in March 2019, and datopotamab
deruxtecan (DS-1062; a TROP2-directed ADC) in July 2020, except in Japan where
Daiichi Sankyo maintains exclusive rights. Daiichi Sankyo is responsible for
manufacturing and supply of Enhertu and datopotamab deruxtecan.

 

AstraZeneca in breast cancer

Driven by a growing understanding of breast cancer biology, AstraZeneca is
starting to challenge, and redefine, the current clinical paradigm for how
breast cancer is classified and treated to deliver even more effective
treatments to patients in need - with the bold ambition to one day eliminate
breast cancer as a cause of death.

 

AstraZeneca has a comprehensive portfolio of approved and promising compounds
in development that leverage different mechanisms of action to address the
biologically diverse breast cancer tumour environment.

 

AstraZeneca aims to continue to transform outcomes for HR-positive breast
cancer with foundational medicines Faslodex (fulvestrant) and Zoladex
(goserelin) and the next-generation oral selective oestrogen receptor degrader
(SERD) and potential new medicine camizestrant.

 

PARP inhibitor Lynparza (olaparib) is a targeted treatment option that has
been studied in HER2-negative early and metastatic breast cancer patients with
an inherited BRCA mutation. AstraZeneca with MSD (Merck & Co., Inc. in the
US and Canada) continue to research Lynparza in metastatic breast cancer
patients with an inherited BRCA mutation and are exploring new opportunities
to treat these patients earlier in their disease.

 

Building on the initial approvals of Enhertu, a HER2-directed ADC, in
previously treated HER2-positive metastatic breast cancer, AstraZeneca and
Daiichi Sankyo are exploring its potential in earlier lines of treatment and
in new breast cancer settings.

 

To bring much needed treatment options to patients with triple-negative breast
cancer, an aggressive form of breast cancer, AstraZeneca is testing
immunotherapy Imfinzi (durvalumab) in combination with other oncology
medicines, including Lynparza and Enhertu, evaluating the potential of AKT
kinase inhibitor, capivasertib, in combination with chemotherapy, and
collaborating with Daiichi Sankyo to explore the potential of TROP2-directed
ADC, datopotamab deruxtecan.

 

AstraZeneca in oncology

AstraZeneca is leading a revolution in oncology with the ambition to provide
cures for cancer in every form, following the science to understand cancer and
all its complexities to discover, develop and deliver life-changing medicines
to patients.

 

The Company's focus is on some of the most challenging cancers. It is through
persistent innovation that AstraZeneca has built one of the most diverse
portfolios and pipelines in the industry, with the potential to catalyse
changes in the practice of medicine and transform the patient experience.

 

AstraZeneca has the vision to redefine cancer care and, one day, eliminate
cancer as a cause of death.

 

AstraZeneca

AstraZeneca (LSE/STO/Nasdaq: AZN) is a global, science-led biopharmaceutical
company that focuses on the discovery, development, and commercialisation of
prescription medicines in Oncology, Rare Diseases, and BioPharmaceuticals,
including Cardiovascular, Renal & Metabolism, and Respiratory &
Immunology. Based in Cambridge, UK, AstraZeneca operates in over 100 countries
and its innovative medicines are used by millions of patients worldwide.
Please visit astrazeneca.com (http://www.astrazeneca.com/) and follow the
Company on Twitter @AstraZeneca (https://twitter.com/AstraZeneca) .

 

Contacts

For details on how to contact the Investor Relations Team, please click here
(https://www.astrazeneca.com/investor-relations.html#Contacts) . For Media
contacts, click here (https://www.astrazeneca.com/media-centre/contacts.html)
.

 

References

1. Cortes J, et al. Trastuzumab Deruxtecan versus Trastuzumab Emtansine for
Breast Cancer. N Engl J Med 2022; 386:1143-1154.

2. Globocan 2020. Europe Fact Sheets. Available at:
https://gco.iarc.fr/today/data/factsheets/populations/908-europe-fact-sheets.pdf
(https://gco.iarc.fr/today/data/factsheets/populations/908-europe-fact-sheets.pdf)
. Last accessed: June 2022.

3. Ahn S, et al. HER2 status in breast cancer: changes in guidelines and
complicating factors for interpretation. J Pathol Transl Med. 2020; 54(1):
34-44.

4. Barok M, et al. Trastuzumab emtansine: mechanism of action and drug
resistance. Breast Cancer Res. 2014; 16(2):209.

5. Nader-Marta G, et al. How we treat patients with metastatic HER2-positive
breast cancer. ESMO Open. 2022; 7:1.

6. Mounsey L, et al. Changing Natural History of HER2-Positive Breast Cancer
Metastatic to the Brain in the Era of New Targeted Therapies. Clin Breast
Cancer. 2018; 18(1):29-37.

7. Martinez-S Sáez O, et al. Current and Future Management of HER2-Positive
Metastatic Breast Cancer. JCO Oncol Pract. 2021. 10.1200/OP.21.00172.

8. Sung H, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of
Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J
Clin. 2021; 10.3322/caac.21660.

9. Iqbal N, et al. Human Epidermal Growth Factor Receptor 2 (HER2) in Cancers:
Overexpression and Therapeutic Implications. Mol Biol Int. 2014;852748.

10. Pillai R, et al. HER2 mutations in lung adenocarcinomas: A report from the
Lung Cancer Mutation Consortium. Cancer. 2017;1;123(21):4099-4105.

 

Adrian Kemp

Company Secretary

AstraZeneca PLC

 

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