REG - AstraZeneca PLC - Enhertu recommended for EU approval in gastric

AstraZenecaAnnouncement

14/11/2022 07:16

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RNS Number : 2237G  AstraZeneca PLC  14 November 2022

14 November 2022 07:10 GMT

 

Enhertu recommended for approval in the EU by CHMP for patients with
previously treated HER2-positive advanced gastric cancer

 

Based on DESTINY-Gastric02 which showed AstraZeneca and Daiichi Sankyo's
Enhertu demonstrated clinically meaningful efficacy and DESTINY-Gastric01
which showed improved overall survival compared to chemotherapy

 

AstraZeneca and Daiichi Sankyo's Enhertu (trastuzumab deruxtecan) has been
recommended for approval in the European Union (EU) as monotherapy for the
treatment of adult patients with advanced HER2-positive gastric or
gastroesophageal junction (GEJ) adenocarcinoma who have received a prior
trastuzumab-based regimen.

 

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 based its positive opinion on results from the
DESTINY-Gastric02 and the DESTINY-Gastric01 Phase II trials.

 

In DESTINY-Gastric02, conducted in patients from North America and Europe,
updated results showed treatment with Enhertu resulted in a confirmed
objective response rate (ORR) of 41.8% as assessed by independent central
review (ICR). Median duration of response (DoR) was 8.1 months and median
overall survival (OS) was 12.1 months. Primary results from the
DESTINY-Gastric02 Phase II trial were presented at the 2021 European Society
for Medical Oncology (ESMO) Congress, with the updated data presented at ESMO
2022.(1)

( )

In DESTINY-Gastric01, conducted in patients from Japan and South Korea,
updated results showed treatment with Enhertu resulted in an ORR of 51.3%
versus 14.3% with chemotherapy (irinotecan or paclitaxel). Patients treated
with Enhertu had a 40% reduction in the risk of death versus patients treated
with chemotherapy (based on a hazard ratio of 0.60; 95% confidence interval:
0.42-0.86, p=0.01) with a median OS of 12.5 months versus 8.9 months.
Additionally, confirmed ORR, a major efficacy outcome, was 42.0% with Enhertu
versus 12.5% with chemotherapy as assessed by ICR. The primary analysis was
published in The New England Journal of Medicine
(https://www.nejm.org/doi/10.1056/NEJMoa2004413) ,(2) with the updated data
presented at the 2021 American Society of Clinical Oncology Annual Meeting.

 

Susan Galbraith, Executive Vice President, Oncology R&D, AstraZeneca,
said: "Gastric cancer is usually diagnosed in the advanced stage in many
European countries and patients face high mortality rates. If approved,
Enhertu would be the first HER2-directed medicine for patients with advanced
gastric cancer in the European Union in more than a decade."

 

Ken Takeshita, Global Head, Oncology R&D, Daiichi Sankyo, Inc, said:
"Enhertu is the first HER2-directed medicine to demonstrate a significant
improvement in overall survival compared to chemotherapy in patients with
gastric cancer following initial treatment with a HER2-directed medicine in
the advanced or metastatic setting. The CHMP opinion recognises the high unmet
need in this patient population and brings us one step closer to bringing this
medicine to patients with gastric cancer in Europe."

 

In both trials, the safety profiles observed in patients treated with Enhertu
were consistent with those seen in other trials of Enhertu with no new safety
signals identified.

 

Enhertu is approved in the US and several other countries for locally advanced
or metastatic HER2-positive gastric cancer.

 

Notes

 

HER2-positive gastric cancer

Gastric (stomach) cancer is the fifth most common cancer worldwide and the
fourth highest leading cause of cancer mortality, with a five-year global
survival rate of 5% to 10% for advanced or metastatic disease.(3-5)
Approximately one million new patients were diagnosed with gastric cancer in
2020, with 768,000 deaths reported globally.(6) In Europe, approximately
136,000 cases of gastric cancer are diagnosed annually, and Eastern Europe has
the second highest incidence of gastric cancer worldwide after Eastern
Asia.(5-6) Gastric cancer is the sixth leading cause of cancer death in Europe
and is typically diagnosed in the advanced stage. Even when diagnosed in
earlier stages of the disease, the survival rate remains modest.(5-7)

 

Approximately one in five gastric cancers are HER2-positive.(8,9) 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.(8) HER2 overexpression may be associated with a specific HER2 gene
alteration known as HER2 amplification.(9)

 

Recommended first-line treatment for HER2-positive advanced or metastatic
gastric cancer is combination chemotherapy plus trastuzumab, an anti-HER2
medicine, which has been shown to improve survival outcomes when added to
chemotherapy.(10) For patients with metastatic gastric cancer that progresses
following initial treatment with a trastuzumab-based regimen, treatment
options are limited, and in many regions in the world there are no additional
HER2 directed medicines available.(2,11,12)

 

DESTINY-Gastric02

DESTINY-Gastric02 is an open-label, single-arm Phase II trial in Western
patients evaluating the efficacy and safety of Enhertu (6.4mg/kg) in patients
with HER2-positive metastatic and/or unresectable gastric or GEJ
adenocarcinoma with disease progression on or after a trastuzumab-containing
regimen.

 

The primary endpoint of DESTINY-Gastric02 is confirmed ORR based on ICR.
Secondary endpoints include progression-free survival (PFS), OS, DoR and
safety.

 

DESTINY-Gastric02 enrolled 79 patients at multiple sites in North America and
Europe. For more information about the trial, visit ClinicalTrials.gov
(https://clinicaltrials.gov/ct2/show/NCT04014075) .

 

DESTINY-Gastric01

DESTINY-Gastric01 is a randomised, open-label Phase II trial evaluating the
efficacy and safety of Enhertu (6.4mg/kg) in patients from Japan and South
Korea with primarily HER2-positive (defined as immunohistochemistry  IHC  3+
or IHC 2+/in-situ hybridisation  ISH +) advanced gastric cancer or GEJ
adenocarcinoma whose tumours have progressed on two or more prior treatment
regimens including fluoropyrimidine (5-FU), platinum chemotherapy and
trastuzumab. Patients were randomised 2:1 to receive Enhertu or physician's
choice of chemotherapy (paclitaxel or irinotecan monotherapy).

 

The primary endpoint of DESTINY-Gastric01 is ORR. Secondary endpoints include
OS, PFS, DoR, disease control rate and time to treatment failure, as well as
pharmacokinetic and safety endpoints.

 

DESTINY-Gastric01 enrolled 187 patients at multiple sites in Japan and South
Korea. For more information about the trial, visit ClinicalTrials.gov
(https://clinicaltrials.gov/ct2/show/NCT03329690) .

 

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 (5.4mg/kg) is approved in more than 35 countries for the treatment of
adult patients with unresectable or metastatic HER2-positive breast cancer who
have received a (or one or more) 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 the results from the DESTINY-Breast03 trial.

Enhertu (5.4mg/kg) is approved in several 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 (5.4mg/kg) is approved in Brazil and the US for the treatment of
adult patients with unresectable or metastatic HER2-low (IHC 1+ or IHC
2+/ISH-) breast cancer who have received a prior chemotherapy 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.

Enhertu (5.4mg/kg) is approved under accelerated approval in the US for the
treatment of adult patients with unresectable or metastatic non-small cell
lung cancer whose tumours have activating HER2 (ERBB2) mutations, as detected
by an FDA-approved test, and who have received a prior systemic therapy, based
on the results of the DESTINY-Lung02 trial. Continued approval for this
indication may be contingent upon verification and description of clinical
benefit in a confirmatory 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
GEJ 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 in breast and gastric cancer are currently
under review in several other countries based on the DESTINY-Breast01,
DESTINY-Breast03, DESTINY-Breast04, DESTINY-Gastric01 and DESTINY-Gastric02
trials, respectively.

 

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
(https://www.astrazeneca.com/media-centre/press-releases/2019/astrazeneca-and-daiichi-sankyo-enter-collaboration-for-novel-her-2-targeting-antibody-drug-conjugate.html#modal-historic-confirmation)
, and datopotamab deruxtecan (DS-1062; a TROP2-directed ADC) in July 2020
(https://www.astrazeneca.com/media-centre/press-releases/2020/astrazeneca-and-daiichi-sankyo-enter-collaboration-to-develop-and-commercialise-new-antibody-drug-conjugate.html#modal-historic-confirmation)
, except in Japan where Daiichi Sankyo maintains exclusive rights. Daiichi
Sankyo is responsible for the manufacturing and supply of Enhertu and
datopotamab deruxtecan.

 

AstraZeneca in gastrointestinal cancers

AstraZeneca has a broad development programme for the treatment of
gastrointestinal (GI) cancers across several medicines and a variety of tumour
types and stages of disease. In 2020, GI cancers collectively represented
approximately 5.1 million new cancer cases leading to approximately 3.6
million deaths.(13)

 

Within this programme, the Company is committed to improving outcomes in
gastric, liver, biliary tract, oesophageal, pancreatic and colorectal cancers.

 

Enhertu, a HER2-directed antibody drug conjugate, is approved in the US and
several other countries for HER2-positive advanced gastric cancer and is being
assessed in colorectal cancer. Enhertu is jointly developed and commercialised
by AstraZeneca and Daiichi Sankyo.

 

Imfinzi (durvalumab) is approved in the US and several other countries in
combination with chemotherapy (gemcitabine plus cisplatin) for advanced
biliary tract cancer and in the US in combination with Imjudo (tremelimumab)
in unresectable hepatocellular carcinoma. Imfinzi is being assessed in
combinations, including with Imjudo, in liver, oesophageal and gastric cancers
in an extensive development programme spanning early to late-stage disease
across settings.

 

Lynparza (olaparib), a first-in-class PARP inhibitor, is approved in the US
and several other countries for the treatment of BRCA-mutated metastatic
pancreatic cancer. Lynparza is developed and commercialised in collaboration
with MSD (Merck & Co., Inc. inside the US and Canada).

 

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.   Updated analysis of DESTINY-Gastric02. Available at:
https://oncologypro.esmo.org/meeting-resources/esmo-congress/updated-analysis-of-destiny-gastric02-a-phase-ii-single-arm-trial-of-trastuzumab-deruxtecan-t-dxd-in-western-patients-pts-with-her2-positive
(https://oncologypro.esmo.org/meeting-resources/esmo-congress/updated-analysis-of-destiny-gastric02-a-phase-ii-single-arm-trial-of-trastuzumab-deruxtecan-t-dxd-in-western-patients-pts-with-her2-positive)
. Accessed November 2022.

2.   Shitara K, et al. Trastuzumab Deruxtecan in Previously Treated
HER2-Positive Gastric Cancer. N Engl J Med 2020; 382:2419-2430.

3.   Casamayor M, et al. Targeted literature review of the global burden of
gastric cancer. Ecancermedicalscience. 2018; 12:883;12:883.

4.   SEER Cancer Stat Facts: Stomach Cancer. Available at:
https://seer.cancer.gov/statfacts/html/stomach.html
(https://seer.cancer.gov/statfacts/html/stomach.html) . Accessed November
2022.

5.   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.

6.   WHO. International Agency of Cancer Research. Cancer Today. Stomach
Incidence. 2020. Available at:
https://gco.iarc.fr/today/data/factsheets/cancers/7-Stomach-fact-sheet.pdf
(https://gco.iarc.fr/today/data/factsheets/cancers/7-Stomach-fact-sheet.pdf) .
Accessed November 2022.

7.   Cancer Research UK. Stomach Cancer Survival Statistics. Available at:
https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/stomach-cancer/survival#heading-Zero
(https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/stomach-cancer/survival#heading-Zero)
. Accessed November 2022.

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

9.   Abrahao-Machado LF, et al. HER2 testing in gastric cancer: An update.
World J Gastroenterol. 2016; 22(19):4619-4625.

10.  Orditura M, et al. "Treatment of gastric cancer." World Journal of
Gastroenterology: WJG 20.7 (2014): 1635.

11.  Thuss-Patience PC, et al. Trastuzumab emtansine versus taxane use for
previously treated HER2-positive locally advanced or metastatic gastric or
gastro-oesophageal junction adenocarcinoma (GATSBY): an international
randomised, open-label, adaptive, phase 2/3 study. Lancet Oncol. 2017;
18(5):640-653.

12.  Satoh T, et al. Lapatinib Plus Paclitaxel Versus Paclitaxel Alone in the
Second-Line Treatment of HER2-Amplified Advanced Gastric Cancer in Asian
Populations: TyTAN-A Randomized, Phase III Study. J Clin Oncol.2014;
32(19):2039‐2049.

13.  WHO. World Cancer Fact Sheet. Available at:
https://gco.iarc.fr/today/data/factsheets/populations/900-world-fact-sheets.pdf.
Accessed November 2022.

 

Adrian Kemp

Company Secretary

AstraZeneca PLC

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