REG - AstraZeneca PLC - Imfinzi approved in US for limited-stage SCLC

AstraZenecaAnnouncement

05/12/2024 07:00

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RNS Number : 8984O  AstraZeneca PLC  05 December 2024

5 December 2024

 

Imfinzi approved in the US as first and only immunotherapy

regimen for patients with limited-stage small cell lung cancer

 

 Based on ADRIATIC Phase III trial results which showed a 27% reduction in
the risk of death versus placebo

 

AstraZeneca's Imfinzi (durvalumab) has been approved in the US for the
treatment of adult patients with limited-stage small cell lung cancer
(LS-SCLC) whose disease has not progressed following concurrent platinum-based
chemotherapy and radiation therapy.

 

The approval was granted by the Food and Drug Administration (FDA) after
securing Priority Review
(https://www.astrazeneca.com/media-centre/press-releases/2024/imfinzi-granted-priority-review-and-breakthrough-therapy-designation-for-patients-with-limited-stage-small-cell-lung-cancer-in-the-us.html)
and Breakthrough Therapy Designation. It was based on results from the
ADRIATIC Phase III trial which were presented during the Plenary Session of
the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting and
subsequently published in the New England Journal of Medicine
(https://www.nejm.org) .

 

SCLC is a highly aggressive form of lung cancer.(1) LS-SCLC typically recurs
and progresses rapidly, despite initial response to standard-of-care
chemotherapy and radiotherapy.(2-3) The prognosis for LS-SCLC is particularly
poor, as only 15-30% of patients will be alive five years after diagnosis.(4)

 

Suresh Senan, PhD, Professor of Clinical Experimental Radiotherapy at the
Amsterdam University Medical Centers, The Netherlands, and international
coordinating investigator in the trial, said: "Durvalumab is the first and
only systemic treatment following curative-intent, platinum-based
chemoradiotherapy to show improved survival for patients with this aggressive
form of lung cancer. This finding represents the first advance for this
disease in four decades. The ADRIATIC trial showed 57 percent of patients were
still alive at three years after being treated with durvalumab, which
underscores the practice-changing potential of this medicine in this setting."

 

Dave Fredrickson, Executive Vice President, Oncology Business Unit,
AstraZeneca, said: "This approval for Imfinzi marks a breakthrough for
patients with limited-stage small cell lung cancer, allowing them to receive
immunotherapy for the first time. The ADRIATIC trial showed an improvement in
median overall survival of 22.5 months, setting a new benchmark. Imfinzi is
now the only immunotherapy approved for both limited- and extensive-stage
small cell lung cancer, underscoring our commitment to improving survival
rates."

 

Dusty Donaldson, Founder and Executive Director of LiveLung, said: "This new
treatment option is a game changer for patients with limited-stage small cell
lung cancer, a disease known for its high rate of recurrence. Historically,
more often than not, clinical trials to identify new treatment options for
this type of cancer have failed to show benefit. We are therefore so excited
that many more people will now have the opportunity to access this
immunotherapy treatment that holds the potential to significantly improve
outcomes."

 

In the trial, Imfinzi reduced the risk of death by 27% versus placebo (based
on an overall survival  OS  hazard ratio  HR  of 0.73; 95% confidence interval
 CI  0.57-0.93; p=0.0104). Estimated median OS was 55.9 months for Imfinzi
versus 33.4 months for placebo. An estimated 57% of patients treated with
Imfinzi were alive at three years compared to 48% for placebo.

 

Imfinzi also reduced the risk of disease progression or death by 24% (based on
a progression-free survival  PFS  HR of 0.76; 95% CI 0.61-0.95; p=0.0161)
versus placebo. Median PFS was 16.6 months for Imfinzi versus 9.2 months for
placebo. An estimated 46% of patients treated with Imfinzi had not experienced
disease progression at two years compared to 34% for placebo.

 

The safety profile for Imfinzi was generally manageable and consistent with
the known profile of this medicine. No new safety signals were observed.

 

Imfinzi is also approved in Switzerland in this setting based on the ADRIATIC
results. Regulatory applications are currently under review in the EU, Japan
and several other countries in this indication.

 

Notes

 

Small cell lung cancer

Lung cancer is the leading cause of cancer death among both men and women,
accounting for about one-fifth of all cancer deaths.(5-6) Lung cancer is
broadly split into non-small cell lung cancer (NSCLC) and SCLC, with about 15%
of cases classified as SCLC.(7)

 

LS-SCLC (Stage I-III) is classified as SCLC that is generally only in one lung
or one side of the chest.(8) LS-SCLC accounts for approximately 30% of SCLC
diagnoses and the prognosis remains poor despite curative-intent treatment
with standard-of-care cCRT.(9)

 

ADRIATIC

The ADRIATIC trial is a randomised, double-blind, placebo-controlled,
multi-centre global Phase III trial evaluating Imfinzi monotherapy and Imfinzi
plus Imjudo (tremelimumab) versus placebo in the treatment of 730 patients
with LS-SCLC who had not progressed following cCRT. In the experimental arms,
patients were randomised to receive a 1500mg fixed dose of Imfinzi with or
without Imjudo 75mg every four weeks for up to four doses/cycles each,
followed by Imfinzi every four weeks for up to 24 months.

 

The dual primary endpoints were PFS and OS for Imfinzi monotherapy versus
placebo. Key secondary endpoints included OS and PFS for Imfinzi plus Imjudo
versus placebo, safety and quality of life measures. The trial included 164
centres in 19 countries across North and South America, Europe and Asia.

 

Imfinzi

Imfinzi (durvalumab) is a human monoclonal antibody that binds to the PD-L1
protein and blocks the interaction of PD-L1 with the PD-1 and CD80 proteins,
countering the tumour's immune-evading tactics and releasing the inhibition of
immune responses.

 

In addition to its indication in LS-SCLC, Imfinzi is the only approved
immunotherapy and the global standard of care in the curative-intent setting
of unresectable, Stage III NSCLC in patients whose disease has not progressed
after CRT. Additionally, Imfinzi is approved as a perioperative treatment in
combination with neoadjuvant chemotherapy in resectable NSCLC, in combination
with chemotherapy (etoposide and either carboplatin or cisplatin) for the
treatment of extensive-stage SCLC, and in combination with a short course of
Imjudo and chemotherapy for the treatment of metastatic NSCLC.

 

Imfinzi is also approved in combination with chemotherapy (gemcitabine plus
cisplatin) in locally advanced or metastatic biliary tract cancer and in
combination with Imjudo in unresectable hepatocellular carcinoma (HCC).
Imfinzi is also approved as a monotherapy in unresectable HCC in Japan and the
EU.

 

Imfinzi is also approved in combination with chemotherapy (carboplatin and
paclitaxel) followed by Imfinzi monotherapy in primary advanced or recurrent
endometrial cancer that is mismatch repair deficient (dMMR) in the US. In the
EU, Imfinzi plus chemotherapy followed by Lynparza (olaparib) and Imfinzi is
approved for patients with mismatch repair proficient (pMMR) advanced or
recurrent endometrial cancer, and Imfinzi plus chemotherapy followed by
Imfinzi alone is approved for patients with dMMR disease. In Japan, Imfinzi
plus chemotherapy followed by Imfinzi monotherapy has also been approved as
1st-line treatment in primary advanced or recurrent endometrial cancer, and
Imfinzi plus chemotherapy followed by Imfinzi and Lynparza has been approved
for patients with pMMR disease.

 

Imfinzi is also under review by global regulatory authorities as perioperative
treatment in combination with neoadjuvant chemotherapy based on the results of
the NIAGARA Phase III trial, which demonstrated a statistically significant
and clinically meaningful improvement in the primary endpoint of event-free
survival and the key secondary endpoint of OS versus neoadjuvant chemotherapy.

 

Since the first approval in May 2017, more than 374,000 patients have been
treated with Imfinzi. As part of a broad development programme, Imfinzi is
being tested as a single treatment and in combinations with other anti-cancer
treatments for patients with SCLC, NSCLC, breast cancer, bladder cancer,
several gastrointestinal and gynaecologic cancers, and other solid tumours.

 

AstraZeneca in lung cancer

AstraZeneca is working to bring patients with lung cancer closer to cure
through the detection and treatment of early-stage disease, while also pushing
the boundaries of science to improve outcomes in the resistant and advanced
settings. By defining new therapeutic targets and investigating innovative
approaches, the Company aims to match medicines to the patients who can
benefit most.

 

The Company's comprehensive portfolio includes leading lung cancer medicines
and the next wave of innovations, including Tagrisso (osimertinib) and Iressa
(gefitinib); Imfinzi and Imjudo; Enhertu (trastuzumab deruxtecan) and
datopotamab deruxtecan in collaboration with Daiichi Sankyo; Orpathys
(savolitinib) in collaboration with HUTCHMED; as well as a pipeline of
potential new medicines and combinations across diverse mechanisms of action.

 

AstraZeneca is a founding member of the Lung Ambition Alliance, a global
coalition working to accelerate innovation and deliver meaningful improvements
for people with lung cancer, including and beyond treatment.

 

AstraZeneca in immuno-oncology (IO)

AstraZeneca is a pioneer in introducing the concept of immunotherapy into
dedicated clinical areas of high unmet medical need. The Company has a
comprehensive and diverse IO portfolio and pipeline anchored in
immunotherapies designed to overcome evasion of the anti-tumour immune
response and stimulate the body's immune system to attack tumours.

 

AstraZeneca strives to redefine cancer care and help transform outcomes for
patients with Imfinzi as a monotherapy and in combination with Imjudo as well
as other novel immunotherapies and modalities. The Company is also
investigating next-generation immunotherapies like bispecific antibodies and
therapeutics that harness different aspects of immunity to target cancer,
including cell therapy and T-cell engagers.

 

AstraZeneca is pursuing an innovative clinical strategy to bring IO-based
therapies that deliver long-term survival to new settings across a wide range
of cancer types. The Company is focused on exploring novel combination
approaches to help prevent treatment resistance and drive longer immune
responses. With an extensive clinical programme, the Company also champions
the use of IO treatment in earlier disease stages, where there is the greatest
potential for cure.

 

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's innovative medicines are
sold in more than 125 countries and used by millions of patients worldwide.
Please visit astrazeneca.com (http://www.astrazeneca.com/) and follow the
Company on social media @AstraZeneca
(https://www.linkedin.com/company/astrazeneca/) .

 

Contacts

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.

 

References

1.   National Cancer Institute. NCI Dictionary - Small Cell Lung Cancer.
Available at:
https://www.cancer.gov/publications/dictionaries/cancer-terms/def/small-cell-lung-cancer.
(https://www.cancer.gov/publications/dictionaries/cancer-terms/def/small-cell-lung-cancer)
Accessed December 2024.

2.   Qin A, Kalemkerian GP. Treatment Options for Relapsed Small-Cell Lung
Cancer: What Progress Have We Made? J Oncol Pract. 2018;14(6):369-370.

3.   Cheng Y, et al. Durvalumab after Chemoradiotherapy in Limited-Stage
Small-Cell Lung Cancer. N Engl J Med. 2024;391(14):1313-1327.

4.   Bebb DG, et al. Symptoms and Experiences with Small Cell Lung Cancer: A
Mixed Methods Study of Patients and Caregivers. Pulm Ther. 2023;9:435-450.

5.   World Health Organization. International Agency for Research on Cancer.
Lung Fact Sheet. Available at:
https://gco.iarc.who.int/today/en/fact-sheets-cancers
(https://gco.iarc.who.int/today/en/fact-sheets-cancers) . Accessed December
2024.

6.   World Health Organization. International Agency for Research on Cancer.
World Fact Sheet. Available at:
https://gco.iarc.who.int/media/globocan/factsheets/populations/900-world-fact-sheet.pdf
(https://gco.iarc.who.int/media/globocan/factsheets/populations/900-world-fact-sheet.pdf)
.  Accessed December 2024.

7.   LUNGevity Foundation. Types of Lung Cancer. Available at:
https://www.lungevity.org/for-patients-caregivers/lung-cancer-101/types-of-lung-cancer.
(https://www.lungevity.org/for-patients-caregivers/lung-cancer-101/types-of-lung-cancer)
Accessed December 2024.

8.   American Cancer Society. Small Cell Lung Cancer Stages. Available at:
https://www.cancer.org/cancer/types/lung-cancer/detection-diagnosis-staging/staging-sclc.html
(https://www.cancer.org/cancer/types/lung-cancer/detection-diagnosis-staging/staging-sclc.html)
. Accessed December 2024.

9.   Senan S, et al. ADRIATIC: A phase III trial of durvalumab ±
tremelimumab after concurrent chemoradiation for patients with limited stage
small cell lung cancer. Ann Oncol. 2019;30(suppl. 2):ii25.

 

Adrian Kemp

Company Secretary

AstraZeneca PLC

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