FDA批准ZALTRAP® (ziv-aflibercept) 治疗转移性CRC !!

新型抗血管生成药物获准治疗部分转移性结直肠癌 发布时间：2012-8-7 来源：爱唯医学 2012年8月3日，赛诺菲公司和Regeneron制药公司宣布，美国食品药品管理局(FDA)已经批准注射用Zaltrap(ziv-aflibercept)与5-氟尿嘧啶、亚叶酸及伊立替康(FOLFIRI)联用，治疗对含奥沙利铂治疗方案耐药或在完成该方案治疗后病情进展的转移性结直肠癌(mCRC)患者。Zaltrap是一种血管生成抑制剂。FDA批准Zaltrap是基于一项3期、随机、国际、双盲临床试验的数据，该试验在mCRC患者中将FOLFIRI+Zaltrap治疗与FOLFIRI+安慰剂进行了比较，受试群体为1,226例先前曾接受含奥沙利铂方案治疗的mCRC患者，这些患者在研究中接受了随机化分组，其中有28%的患者之前曾接受贝伐珠单抗治疗。在FOLFIRI治疗的基础上又接受Zaltrap治疗的患者生存期显著延长，从12.06个月延长至13.5个月，相对风险降低18%；另外，无进展生存期也显著延长，从4.67个月延长至6.9个月；Zaltrap+FOLFIRI治疗组的总应答率为19.8%，而FOLFIRI+安慰剂组为11.1%(P=0.0001)。Zaltrap+FOLFIRI治疗组最常见的不良反应(发生率均≥20%)按发生率从高到低的顺序依次为白细胞减少、腹泻、中性粒细胞减少、蛋白尿、天冬氨酸氨基转移酶水平升高、胃炎、疲乏、血小板减少、丙氨酸氨基转移酶水平升高、高血压、体重减少、食欲下降、鼻衄、腹痛、发声困难、血清肌酐水平升高及头痛。

U.S. FDA Approves ZALTRAP® (ziv-aflibercept) After Priority Review for Previously Treated Metastatic Colorectal Cancer   PARIS and TARRYTOWN, N.Y., Aug. 3, 2012 /PRNewswire/ -- Sanofi (EURONEXT: SAN and NYSE: SNY) and Regeneron Pharmaceuticals, Inc. (NASDAQ: REGN) today announced that the U.S. Food and Drug Administration (FDA) approved ZALTRAP® (ziv-aflibercept) Injection for Intravenous Infusion, in combination with 5-fluorouracil, leucovorin, irinotecan (FOLFIRI), for patients with metastatic colorectal cancer (mCRC) that is resistant to or has progressed following an oxaliplatin-containing regimen. "There are limited treatment options for metastatic colorectal cancer patients who are resistant to or whose disease has progressed after an oxaliplatin-containing regimen," said Edith Mitchell, M.D., Clinical Professor of Medicine and Medical Oncology at Jefferson Medical College of Thomas Jefferson University and an investigator of the VELOUR pivotal study. "The approval of ZALTRAP in combination with a FOLFIRI chemotherapy regimen offers another treatment option and is welcome news for metastatic colorectal patients and their physicians." ZALTRAP was approved following a Priority Review by the FDA. A priority review is a designation given to therapies that offer major advances in treatment or provide a treatment where no adequate therapy exists. Marketing authorization applications for ZALTRAP are also under review by the European Medicines Agency (EMA) and other regulatory agencies worldwide. "Colorectal cancer is one of the deadliest cancers and is responsible for more than half a million deaths globally each year," said Debasish Roychowdhury, M.D., Senior Vice President and Head, Sanofi Oncology. "Sanofi looks forward to making ZALTRAP available as soon as possible to patients with metastatic colorectal cancer previously treated with an oxaliplatin-containing regimen." The ZALTRAP approval was based on data from the pivotal Phase III VELOUR trial, a multinational, randomized, double-blind trial comparing FOLFIRI in combination with either ZALTRAP or placebo in the treatment of patients with mCRC. The study randomized 1,226 patients with mCRC who previously had been treated with an oxaliplatin-containing regimen. Twenty-eight percent of patients in the study received prior bevacizumab therapy. The primary endpoint was overall survival. Secondary endpoints included progression-free survival, overall response rate, and safety."The approval of the novel angiogenesis inhibitor ZALTRAP provides a new option to address the unmet medical need in this patient population," said George D. Yancopoulos, M.D., Ph.D., Chief Scientific Officer of Regeneron and President of Regeneron Research Laboratories. "However, there continues to be a need to develop new cancer therapies. Regeneron and Sanofi continue to devote resources to finding novel investigational treatments and combinations."

VELOUR Trial Results The VELOUR trial showed that in patients previously treated with an oxaliplatin containing regimen, adding ZALTRAP to FOLFIRI significantly improved median survival from 12.06 months to 13.50 months (HR=0.817 (95% CI 0.714 to 0.935; p=0.0032), an 18 percent relative risk reduction. A significant improvement in progression-free survival from 4.67 months to 6.90 months (HR=0.758 95% CI 0.661 to 0.869; p=0.00007), a 24% relative risk reduction, was also observed. The overall response rate in the ZALTRAP plus FOLFIRI arm was 19.8% vs. 11.1% for FOLFIRI (p=0.0001).The most common adverse reactions (all grades, ≥20% incidence) reported at a higher incidence (2% or greater between-arm difference) in the ZALTRAP/FOLFIRI arm, in order of decreasing frequency, were leukopenia, diarrhea, neutropenia, proteinuria, AST increased, stomatitis, fatigue, thrombocytopenia, ALT increased, hypertension, weight decreased, decreased appetite, epistaxis, abdominal pain, dysphonia, serum creatinine increased, and headache. The most common Grade 3-4 adverse reactions (≥5%) reported at a higher incidence (2% or greater between-arm difference) in the ZALTRAP/FOLFIRI arm, in order of decreasing frequency, were neutropenia, diarrhea, hypertension, leukopenia, stomatitis, fatigue, proteinuria, and asthenia.

About ZALTRAP® (ziv-aflibercept) Injection for Intravenous Infusion ZALTRAP is a recombinant fusion protein, which acts as a soluble receptor that binds to Vascular Endothelial Growth Factor-A (VEGF-A), VEGF-B and placental growth factor (PIGF). Inhibition of these factors can result in decreased neovascularization and decreased vascular permeability. Sanofi plans to make ZALTRAP available in the U.S. in the third quarter of 2012. Under the terms of their collaboration agreement, Sanofi and Regeneron share equally the global profits of ZALTRAP after Regeneron's obligation to repay its share of development expenses. In the U.S., ZALTRAP is a registered trademark of Regeneron Pharmaceuticals, Inc.

Important Safety Information for ZALTRAP®

WARNING: HEMORRHAGE, GASTROINTESTINAL PERFORATION, COMPROMISED WOUND HEALING Severe and sometimes fatal hemorrhage, including gastrointestinal (GI) hemorrhage, has been reported in the patients who have received ZALTRAP in combination with FOLFIRI. Monitor patients for signs and symptoms of GI bleeding and other severe bleeding. Do not administer ZALTRAP to patients with severe hemorrhage. GI perforation including fatal GI perforation can occur in patients receiving ZALTRAP. Discontinue ZALTRAP therapy in patients who experience GI perforation. Severe compromised wound healing can occur in patients receiving ZALTRAP/FOLFIRI. Discontinue ZALTRAP in patients with compromised wound healing. Suspend ZALTRAP for at least 4 weeks prior to elective surgery, and do not resume ZALTRAP for at least 4 weeks following major surgery and until the surgical wound is fully healed.

WARNINGS AND PRECAUTIONS Patients treated with ZALTRAP have an increased risk of hemorrhage, including severe and sometimes fatal hemorrhagic events. Monitor patients for signs and symptoms of bleeding. Do not initiate ZALTRAP to patients with severe hemorrhage. Discontinue ZALTRAP in patients who develop severe hemorrhage. GI perforation including fatal GI perforation can occur in patients receiving ZALTRAP. Monitor patients for signs and symptoms of GI perforation. Discontinue ZALTRAP in patients who experience GI perforation. Discontinue ZALTRAP in patients with compromised wound healing. Suspend ZALTRAP for at least 4 weeks prior to elective surgery Do not initiate/resume ZALTRAP until at least 4 weeks after surgery and surgical wound is fully healed. Fistula formation involving GI and non-GI sites occurs at a higher incidence in patients treated with ZALTRAP. Discontinue ZALTRAP therapy in patients who develop fistula. An increased risk of Grade 3-4 hypertension has been observed in patients receiving ZALTRAP. Monitor blood pressure every two weeks or more frequently and treat with appropriate anti-hypertensive therapy during treatment with ZALTRAP. Temporarily suspend ZALTRAP until hypertension is controlled, and reduce ZALTRAP dose to 2 mg/kg for subsequent cycles. Discontinue ZALTRAP in patients with hypertensive crisis. Arterial thromboembolic events (ATE), including transient ischemic attack, cerebrovascular accident, and angina pectoris, occurred more frequently in patients who have received ZALTRAP. Discontinue ZALTRAP in patients who experience an ATE. Severe proteinuria, nephrotic syndrome, and thrombotic microangiopathy (TMA) occurred more frequently in patients treated with ZALTRAP. Suspend ZALTRAP when proteinuria ≥2 grams/24 hours and resume ZALTRAP when proteinuria < 2 grams/24 hours. If recurrent, suspend until proteinuria < 2 grams/24hours and then reduce ZALTRAP dose to 2 mg/kg. Discontinue ZALTRAP if nephrotic syndrome or TMA develops. A higher incidence of neutropenic complications (febrile neutropenia and neutropenic infection) occurred in patients receiving ZALTRAP. Delay administration of ZALTRAP/FOLFIRI until neutrophil count is ≥1.5 x 109/L. Incidence of severe diarrhea and dehydration is increased in patients treated with ZALTRAP/FOLFIRI. The incidence of diarrhea is increased in patients ≥65 years of age. Monitor closely. Discontinue ZALTRAP in patients who develop reversible posterior leukoencephalopathy syndrome.

ADVERSE REACTIONS The most common adverse reactions (all grades, ≥20% incidence) reported at a higher incidence (2% or greater between-arm difference) in the ZALTRAP/FOLFIRI arm, in order of decreasing frequency, were leukopenia, diarrhea, neutropenia, proteinuria, AST increased, stomatitis, fatigue, thrombocytopenia, ALT increased, hypertension, weight decreased, decreased appetite, epistaxis, abdominal pain, dysphonia, serum creatinine increased, and headache. The most common Grade 3-4 adverse reactions (≥5%) reported at a higher incidence (2% or greater between-arm difference) in the ZALTRAP/FOLFIRI arm, in order of decreasing frequency, were neutropenia, diarrhea, hypertension, leukopenia, stomatitis, fatigue, proteinuria, and asthenia. Infections occurred at a higher frequency in patients receiving ZALTRAP/FOLFIRI (46%, all grades; 12%, Grade 3-4) than in patients receiving placebo/FOLFIRI (33%, all grades; 7%, Grade 3-4), including urinary tract infection, nasopharyngitis, upper respiratory tract infection, pneumonia, catheter site infection, and tooth infection. In patients with mCRC, venous thromboembolic events (VTE), consisting primarily of deep venous thrombosis and pulmonary embolism, occurred in 9% of patients treated with ZALTRAP/FOLFIRI and 7% of patients treated with placebo/FOLFIRI. Please click here for full Prescribing Information for ZALTRAP (ziv-aflibercept) Injection for Intravenous Infusion, including Boxed WARNING, and visit: www.ZALTRAP.com

About Colorectal Cancer According to the American Cancer Society, it is estimated that more than 143,000 new cases of colorectal cancer will be diagnosed in 2012, and more than 51,000 people will die from it. Approximately 60 percent of colorectal cancer cases are diagnosed at the locally advanced or metastatic stage. Although survival for early stage disease is relatively high, once colorectal cancer metastasizes to distant organs, five-year survival is estimated to be 12 percent.Worldwide, colorectal cancer is the third most commonly diagnosed cancer in males and the second most in females, with more than 1.2 million new cases diagnosed in 2008. One of the deadliest cancers, colorectal cancer was responsible for more than 600,000 deaths globally in 2008 alone.

About Sanofi Oncology Based in Cambridge, Massachusetts, USA and Vitry, France, Sanofi Oncology is dedicated to translating science into effective therapeutics that address unmet medical needs for cancer and organ transplant patients. Starting with a deep understanding of the disease and the patient, Sanofi Oncology employs innovative approaches to drug discovery and clinical development, with the ultimate goal of bringing the right medicines to the right patients to help them live healthier and longer lives. We believe in the value of partnerships that combine our internal scientific expertise with that of industry and academic experts. Our portfolio includes 10 marketed products and more than 15 investigational compounds in clinical development, including small molecules and biological agents.

About Regeneron Pharmaceuticals, Inc. Regeneron is a fully integrated biopharmaceutical company that discovers, invents, develops, manufactures, and commercializes medicines for the treatment of serious medical conditions. Regeneron markets three products in the United States, EYLEA® (aflibercept) Injection, ZALTRAP® (ziv-aflibercept) Injection for Intravenous Infusion, and ARCALYST® (rilonacept) Injection for Subcutaneous Use. Regeneron has filed a regulatory application with the U.S. Food and Drug Administration (FDA) for a second indication for EYLEA. Phase 3 studies are in progress with EYLEA in two additional indications and with product candidates sarilumab and REGN727. Regeneron has active research and development programs in many disease areas, including ophthalmology, inflammation, cancer, and hypercholesterolemia. Additional information and recent news releases are available on the Regeneron web site at www.regeneron.com.