People With Thyroid Cancer in Switzerland Now Able to Benefit From New Advanced Thyroid Cancer Treatment Lenvima® (Lenvatinib)

HATFIELD, England, November 2, 2015 /PRNewswire/ --

FOR EMEA MEDIA ONLY - NOT FOR AUSTRIAN JOURNALISTS  

Launch of a new treatment option for advanced thyroid cancer   

Lenvima^® (lenvatinib) was launched in Switzerland on October 1^st, a treatment for people with radioactive iodine refractory differentiated thyroid cancer (RAI refractory DTC).^[1]  Advanced thyroid cancer is a difficult to treat condition with a poor prognosis and lenvatinib represents a significant advance for patients in Switzerland.

Lenvatinib is indicated for the treatment of adult patients with locally advanced or metastatic, progressive differentiated (papillary, follicular, Hürthle cell) thyroid carcinoma (DTC) refractory to radioactive iodine (RAI).^[2]

In the pivotal phase III study, SELECT, Lenvatinib demonstrated a statistically significant median 18.3 months progression free survival versus 3.6 months for placebo (hazard ratio [HR] 0.21; 99% confidence interval 0.14-0.31, p<0.001). The response rate was 64.8% in the lenvatinib group (4 complete responses, 1.5%) and 1.5% in the placebo (P, 0.001). Lenvatinib was associated with a median time to objective response of 2 months (95% CI, 1.9-3.5). Median duration of treatment was 16.1 months with lenvatinib versus 3.9 months for placebo.^[3] First dose reduction occurred with a median of 3 months (95% CI, 2.7-3.7), the mean lenvatinib dose was 17.2mg per day. SELECT is a randomised, double-blind, multicentre trial for people with progressive RAI DTC (n=392).^[4] For lenvatinib, the most common treatment related adverse events were hypertension, diarrhoea, fatigue, decreased appetite, decreased weight, and nausea.

"For patients who no longer respond to radioactive iodine new treatments options are needed. Lenvatinib has demonstrated efficacy in this population and is a new treatment option now available for these patients. The guidelines of the National Comprehensive Cancer Network (NCCN) highlight lenvatinib as a first-line treatment option. We can now offer our patients an effective treatment option," comments Dr. Marco Siano, Senior Consultant, Kantonsspital St. Gallen.

Lenvatinib, discovered and developed by Eisai, is an oral therapy that possesses a potent selectivity and a binding mode different to other tyrosine kinase inhibitors (TKI). Lenvatinib simultaneously inhibits the activities of several different molecules including vascular endothelial growth factor receptors (VEGFR), fibroblast growth factor receptors (FGFR), RET, KIT and platelet-derived growth factor receptors (PDGFR). This potentially makes lenvatinib the first TKI that simultaneously inhibits the kinase activities of FGFR 1-4 as well as VEGFR 1-3.^[5],[6] In addition, lenvatinib was found to have a new Type V binding mode of kinase inhibition that is distinct from existing compounds.^[7],[8]

While thyroid cancer is relatively rare, over the past few decades the incidence of the disease has risen rapidly across the whole of Europe.^[9],[10] Approximately 480 people in Switzerland are diagnosed with thyroid cancer each year.^[11] More prevalent in women than men, at a ratio of 2 to 1, thyroid cancer is the most common endocrine malignancy.^[12]  

Lenvatinib has been approved for the treatment of refractory thyroid cancer in the United States, Europe Japan and Switzerland, and has been submitted for regulatory approval in South Korea, Canada, Singapore, Russia, Australia and Brazil. Lenvatinib was granted Orphan Drug Designation in Japan for thyroid cancer, in the United States for treatment of follicular, medullary, anaplastic, and metastatic or locally advanced papillary thyroid cancer and in Europe and Switzerland for follicular and papillary thyroid cancer.

The development of lenvatinib underscores Eisai's human health care (hhc) mission, the company's commitment to innovative solutions in disease prevention, cure and care for the health and well-being of people worldwide. Eisai is committed to the therapeutic area of oncology and to address the unmet medical needs of patients and their families.

Notes to Editors   

About Lenvatinib's Novel Binding Mode (Type V)^[6]

Kinase inhibitors are categorized into several types (Type I to Type V) depending on the binding site and the conformation of the targeted kinase in complex with them. Most of the currently approved tyrosine kinase inhibitors are either Type I or Type II, however according to X-ray crystal structural analysis, lenvatinib was found to possess a new Type V binding mode of kinase inhibition that is distinct from existing compounds. In addition, lenvatinib was confirmed via kinetic analysis to exhibit rapid and potent inhibition of kinase activity, and it is suggested that this may be attributed to its novel binding mode.

About SELECT^[4]

The SELECT (Study of (E7080) LEnvatinib in Differentiated Cancer of the Thyroid) study was a multicentre, randomised, double-blind, placebo-controlled Phase III study to compare the PFS of patients with RR- radioiodine-refractory differentiated thyroid cancer and radiographic evidence of disease progression within the prior 13 months, treated with once-daily, oral lenvatinib (24mg) versus placebo. The study enrolled 392 patients in over 100 sites in Europe, North and South America and Asia and was conducted by Eisai in collaboration with the SFJ Pharmaceuticals Group.

Participants were stratified by age (≤65, >65 years), region and ≤1 prior VEGFR-targeted therapies and randomised 2:1 to either lenvatinib or placebo therapy (24mg/d, 28-d cycle). The primary endpoint was PFS assessed by independent radiologic review. The secondary endpoints of the study included overall response rate (ORR), overall survival (OS) and safety. Rates of complete response were 1.5% (4 patients) for the lenvatinib group and zero in the placebo group. The results for partial response were 63.2% (165 patients) in the lenvatinib group and 1.5% (2 patients) in the placebo arm. The median exposure duration was 16.1 months for lenvatinib and 3.9 months for placebo and the median time to response for lenvatinib was 2.0 months. Median OS has not yet been reached.

The six most common lenvatinib treatment-related adverse events (TRAEs) of any grade were hypertension (67.8%), diarrhoea (59.4%), fatigue (59.0%), decreased appetite (50.2%), weight loss (46.4%) and nausea (41.0%). TRAEs of Grade 3 or higher (Common Terminology Criteria for Adverse Events) included hypertension (41.8%), proteinuria (10.0%), weight loss (9.6%), diarrhoea (8.0%), and decreased appetite (5.4%).

Subgroup analyses presented at the European Thyroid Association Annual Meeting in September 2014 showed that lenvatinib maintained a PFS benefit in all pre-defined subgroups of people with progressive radioiodine-refractory differentiated thyroid cancer. In particular, the PFS benefit observed in 195 people with progressive radioiodine-refractory differentiated thyroid cancer in Europe (lenvatinib n=131 and placebo n=64) was similar to the PFS of overall study population (HR=0.24, [95% CI, 0.16-0.35]).^[13] The median PFS with lenvatinib and placebo were 18.7 months and 3.7 months respectively.  

Two recent subanalyses from the SELECT study have been presented at the Endocrine Society Congress 2015 (ENDO). The first reports the results of the open-label extension phase of SELECT and aims to assess the crossover of patients in the placebo arm to the optional open-label lenvatinib treatment period. The results highlight that patients who crossed over from the placebo arm achieved a median PFS of 12.4 months with open-label lenvatinib treatment. Although toxicities were substantial, these were generally managed with medications, dose interruption, and dose reductions.

The second abstract examines the relationship between thyroid abnormalities and their effect on the safety and efficacy outcomes in SELECT. The analysis shows that although an increase in thyroid-stimulating hormone (TSH) levels was a frequent complication, its direct relationship to lenvatinib therapy has not been established and there is no evidence TSH levels affect tumour responses to lenvatinib treatment.

About Thyroid Cancer  

Thyroid cancer refers to cancer that forms in the tissues of the thyroid gland, located at the base of the throat near the trachea.^[14] It is more common in women than in men and most are in their 40s or 50s at time of diagnosis.^[15]

Thyroid cancer affects more than 52,000 people in Europe each year.^[7] The incidence of thyroid cancer has increased significantly in the last decade by 69% and 65% in men and women, respectively.^[16] The most common types of thyroid cancer, papillary and follicular (including Hurthle cell), are classified as differentiated thyroid cancer (DTC) and account for approximately 85-90% of all cases.^[17],^[18],^[19] The remaining cases are classified as either medullary (3-4% of cases)^[20] or anaplastic (1-2% of cases).^[15],[16]

About Eisai Co., Ltd.  

Eisai Co., Ltd. is a leading global research and development-based pharmaceutical company headquartered in Japan. We define our corporate mission as "giving first thought to patients and their families and to increasing the benefits health care provides," which we call our human health care (hhc) philosophy. With over 10,000 employees working across our global network of R&D facilities, manufacturing sites and marketing subsidiaries, we strive to realise our hhc philosophy by delivering innovative products in multiple therapeutic areas with high unmet medical needs, including Oncology and Neurology. 

As a global pharmaceutical company, our mission extends to patients around the world through our investment and participation in partnership-based initiatives to improve access to medicines in developing and emerging countries.

For more information about Eisai Co., Ltd., please visit http://www.eisai.com.  

References   

1. European Commission Decision. Data on file. 2015

2. SPC Lenvima (august 2015) http://www.swissmedicinfo.ch

3. European Medicines Agency, EMAR - Lenvima http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Public_assessment_report/human/003727/WC500188676.pdf Accessed: October 2015

4. Schlumberger M et al. Lenvatinib versus placebo in radioiodine refractory differentiated thyroid cancer. NEJM 2015; 372: 621-630. Available at http://www.nejm.org/doi/full/10.1056/NEJMoa1406470 Accessed: October 2015

5. Matsui J, et al. Multi-Kinase Inhibitor E7080 Suppresses Lymph Node and Lung Clin Cancer Res 2008;14:5459-65

6. Matsui J, et al. E7080, a novel inhibitor that targets multiple kinases, has potent antitumor activities against stem cell factor producing human small cell lung cancer H146, based on angiogenesis inhibition. Int J Cancer 2008;122:664-71

7. Okamoto K, et al. Distinct Binding Mode of Multikinase Inhibitor Lenvatinib Revealed by Biochemical Characterization. ACS Med. Chem. Lett 2015;6:89-94

8. Wu P. Small-molecule kinase inhibitors: an analysis of FDA-approved drugs. Drug Discovery Today, July 2015; 1-6

9. EUCAN 2015.  http://eu-cancer.iarc.fr/EUCAN/Cancer.aspx?Cancer=35. Accessed: October 2015

10. Kilfoy BA et al. Cancer Causes Control. 2009 Jul;20(5):525-31

11. EUCAN, Thyroid Cancer Estimated incidence, mortality & prevalence for both sexes, 2012, Available at:  http://eco.iarc.fr/eucan/Cancer.aspx?Cancer=35 Accessed: October 2015

12. Butterfly Thyroid Cancer Trust. About Thyroid Cancer. Available at : http://www.butterfly.org.uk/about.htm Accessed: October 2015

13. Newbold K et al. Phase 3 study of (E7080) Lenvatinib in Differentiated Cancer of the Thyroid (SELECT): Results and subgroup analysis of patients from Europe. Presented as a digital poster at ETA 2014.  

14. National Cancer Institute at the National Institute of Health. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/thyroid/Patient/page1/AllPages#1 . Accessed: October 2015

15. Brito J et al. BMJ 2013; 347

16. Cancer Research UK. Thyroid cancer incidence statistics. Available at:

http://www.cancerresearchuk.org/cancer-info/cancerstats/types/thyroid/incidence/uk-thyroid-cancer-incidence-statistics.  Accessed: October 2015

17. Pacini F et al. ESMO Guidelines Working Group. Ann Oncol. 2012;23(suppl 7):vii110-vii119

18. Thyroid Cancer Basics. 2011, 2012, at: http://www.thyca.org. Accessed: October 2015

19. Cooper DS et al; Thyroid. 2009;19:1167-1214

20. National Cancer Institute. Medullary Thyroid Cancer. http://www.cancer.gov/cancertopics/pdq/treatment/thyroid/HealthProfessional/page7. Accessed: October 2015