FDA Approves Eli Lilly's Gemzar To Treat Ovarian Cancer; Contraceptive Implanon Also Approved
Main Category: Ovarian CancerAlso Included In: Cancer / Oncology; Regulatory Affairs / Drug Approvals
Article Date: 20 Jul 2006 - 9:00 PDT
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FDA has approved Eli Lilly's drug Gemzar for use in combination with FDA-approved carboplatin -- a chemotherapy drug -- for treatment of advanced, recurrent ovarian cancer, the company announced Monday, Reuters reports. The approval comes despite the recommendation earlier this year of an FDA panel to reject the approval (Pierson, Reuters, 7/17). The panel in March voted 9-2 to recommend the agency reject an application to market the drug. The agency in 1996 had approved Gemzar, which is considered a chemotherapy drug, to treat pancreatic cancer, and since then it has been approved as a treatment for lung and breast cancers. FDA's Oncologic Drugs Advisory Committee found that data provided by Lilly on the use of Gemzar, known generically as gemcitabine, for advanced ovarian cancer were not strong enough to merit approval (Kaiser Daily Women's Health Policy Report, 3/14). Lilly spokesperson Gregory Clarke said the agency approved Gemzar for ovarian cancer because the company filed additional information that highlighted the benefits of the drug. Gemzar does not increase survival time, but it increases the time women can go without treatment, thereby freeing them from the side effects of chemotherapy, Clarke said. He added that the approval marked the first time FDA has approved an ovarian cancer drug because it helps women to prolong periods between treatments, rather than for its survival benefit (Reuters, 7/17). Lilly said it is testing other treatments for ovarian cancer (Dow Jones, 7/17).
FDA Approves Implanon
In related news, FDA has approved Dutch pharmaceutical company Akzo Nobel's contraceptive implant Implanon, the company announced Tuesday (AFX/Forbes, 7/18). Implanon, a one-inch plastic rod inserted by a doctor into a woman's upper arm, releases progesterone, inhibiting pregnancy for up to three years or until the device is surgically removed. FDA in November 2004 granted approval status to the contraceptive (Kaiser Daily Women's Health Policy Report, 11/4/04). Akzo Nobel's human health care division Organon USA later this year plans to train health care providers on how to insert and remove the device, so that the use of Implanon can be expanded in 2007 (Akzo Nobel release, 7/18).
"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
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Gemzar Combination Assay-Verified
posted by Gregory D. Pawelski on 22 Jul 2006 at 12:45 amClinical Oncologists for Individualized Treatment of cancer patients had found out years ago that the combination of (Gemzar) gemcitabine + platinum (either cisplatin, carboplatin or oxaliplatin) was the most important drug combination introduced for the treatment of solid tumors in the past 18 years. Clinical responses with this regimen were unprecedented.
Individualized testing of the gemcitabine + platinum combination began in the mid-1990s by Dr. Robert Nagourney, Director of Rational Therapeutics, Inc. Many patients received treatment with this regimen because of individualized testing long before any clinical trials in their particular disease types had ever been published.
The contribution of Dr. Nagourney in terms of recognizing the synergistic effects of this combination had been very important in getting clinical trials with this regimen started in a broad spectrum of cancers. Think of all the many cancer patients that were helped by this, long before these clinical trials ever started?
According to a study published in Gynecologic Oncology, the most probable mechanism for the synergy between gemcitabine + platinum is gemcitabine inhibition of repair of platinum/DNA adducts. What this means is that platinum-resistant tumor cells "cut out" the damaged DNA (to which the platinum is attached) in the same way that the railroad company repairs damaged sections of rail track. Then the railroad company lays down new track. Platinum-resistant tumor cells do the same thing, and gemcitabine interferes with this process. (Belpomme, et al. Gynecol. Oncol. 91:32-38, 2003)
Thus, you want to administer first gemcitabine (to have gemcitabine on board to inhibit the repair process). Then, you want to administer platinum shortly thereafter. In addition, you don't want to give either gemcitabine or platinum by itself on any days of the cycle; this doesn't take advantage of the synergy between the drugs and, in many cases, will just increase toxicity.
It is possible that clinical investigators did not design their treatment schedule to take advantage of the gemcitabine + platinum synergy which exists when platinum is administered in the presence of gemcitabine. An example in the Belpomme, et al study: patients received a platin on Day 1 and gemcitabine on Days 1 (after a platin) and Day 8 (without the platin) of a 21 day treatment cycle. The results were about the same that would be expected with a single agent platinum alone. Overall response rate of 65% and median survival of 24 months.
So it may have been more a problem with synergistic scheduling of the drugs rather than the drugs themselves. It may be one example of how clinical oncologists may get it wrong.
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