Astellas Pharma, Exhibition booth during ASCO 2019, held May 31 – June 4, 2019 in Chicago, Ill.| Courtsey: Emila Duaerte / Sunvalley Communication
Astellas Pharma, Exhibition booth during ASCO 2019, held May 31 – June 4, 2019 in Chicago, Ill.| Courtsey: Emila Duaerte / Sunvalley Communication

Enfortumab vedotin (also known as ASG-22CE), an investigational antibody-drug conjugates being developed by Seattle Genetics in collaboration with Astellas Pharma, showed a positive, high tumor response in the ongoing single-arm, pivotal phase II single-arm clinical trial known as EV-201 (NCT03219333)

The clinical trial was designed to study the drug patients with locally advanced or metastatic urothelial (bladder) cancer who had received previous treatment with both platinum-containing chemotherapy and a PD-1 or PD-L1 inhibitor.

While there are many new developments in the treatment of patients with metastatic bladder cancer, approximately 80% of people do not respond to PD-1 or PD-L1 inhibitors, which are the standard of care after platinum-containing therapy has failed as an initial treatment for advanced disease. These patients have few treatment options.[1][2][3]

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“There remains a high unmet need for effective treatments upon progression after initial chemotherapy and immunotherapy,” noted Roger Dansey, M.D., Chief Medical Officer at Seattle Genetics.

“After progression on platinum-containing chemotherapy and a PD-1 or PD-L1 inhibitor, patients with locally advanced or metastatic urothelial cancer are left with no approved standard of care treatment options,” added Steven Benner, M.D., Senior Vice President and Global Therapeutic Area Head, Oncology Development at Astellas.

The researchers involved in this clinical trial tried to confirm if enfortumab vedotin is one of the potential drug candidates able to fill this unmet medical need.

“These data are very encouraging, and we look forward to discussing the data with relevant health authorities,” Benner added.

In this trial, a total of 128 patients were enrolled at multiple centers internationally. The primary endpoint is confirmed objective response rate per blinded independent central review. Secondary endpoints include assessments of duration of response, disease control rate, progression-free survival, overall survival, safety and tolerability

Exhibition booth Seattle Genetics - ASCO 2019 | Courtsey: Emila Duaerte / Sunvalley Communication
Exhibition booth Seattle Genetics – ASCO 2019 | Courtsey: Emila Duaerte / Sunvalley Communication

Nectin-4

Enfortumab vedotin is an investigational antibody-drug conjugate composed of an anti-Nectin-4 monoclonal antibody attached to a microtubule-disrupting agent Monomethyl Auristatin E or MMAE, using a proprietary linker technology developped by Seattle Genetics.

The trial drug targets Nectin-4, a cell adhesion molecule identified as an ADC target by Astellas, which is expressed on many solid tumors.

Objective response

Results showed a high objective response rate (ORR) per blinded independent central review. The duration of response was consistent with that recently reported in the previous phase I study (EV-101; NCT02091999) [A]

Updated trial results

Updated results presented today during the annual meeting of the American Society of Clinical Oncology (ASCO), being held May 31 – June 4, 2019 in Chicago, Ill, demonstrated that enfortumab vedotin rapidly shrank tumors in most patients, resulting in an objective response rate (ORR) of 44% (55/125; 95% Confidence Interval (CI): 35.1-53.2). Complete responses (CR) were also observed in 12% of patients (15/125). The median duration of tumor response was 7.6 months (range 0.95-11.3+).

This cohort was open to patients with locally advanced or metastatic urothelial cancer who had received previous treatment with a platinum-containing chemotherapy and a PD-1/L1 checkpoint inhibitor.

Responses were similar in the subgroups of patients analyzed, including those who had the worst prognosis, such as patients who had three or more previous lines of therapy, patients with liver metastases, and those who had not responded to a PD-1/L1 inhibitor.

Adverse events

The most common treatment-related adverse events reported by 40% or more patients included fatigue, alopecia, decreased appetite, taste distortion rash and peripheral neuropathy.

Enfortumab vedotin is an investigational antibody-drug conjugate (ADC) that targets Nectin-4, a therapeutic target that is highly expressed in multiple solid tumors including urothelial cancers. Based on preliminary results from a phase 1 trial (EV-101), enfortumab vedotin was granted Breakthrough Therapy designation by the U.S. Food and Drug Administration (FDA) for patients with locally advanced or metastatic urothelial cancer whose disease has progressed during or following treatment with a PD-1 or PD-L1 inhibitor.

Urothelial cancer

Urothelial cancer is the most common type of bladder cancer (90% of all cases). [4] In 2018, more than 82,000 people were diagnosed with bladder cancer in the United States. [5] Globally, approximately 549,000 people were diagnosed with bladder cancer last year, and there were approximately 200,000 deaths worldwide. [6] Approximately 80% of people do not respond to PD-1 or PD-L1 inhibitors after a platinum-containing therapy has failed as an initial treatment for advanced disease. [2] There are currently no approved therapies for metastatic urothelial cancer once it has progressed after chemotherapy and a PD-1 or PD-L1 inhibitor. [3]

“Outcomes for patients diagnosed with locally advanced or metastatic urothelial cancer are generally poor, and treatment options after initial chemotherapy and immunotherapy are very limited,” said Daniel P. Petrylak, M.D., Professor of Medicine and of Urology, Yale Cancer Center, New Haven.

“These data have the potential to change the treatment course of advanced urothelial cancer, and it is gratifying to see these results for patients.”

What’s Next

The companies plan to submit a Biologics License Application (BLA) to the FDA later this year based on the results from the EV-201 trial. A global, randomized phase III clinical trial (EV-301) is ongoing and intended to support global registration as well as to serve as the confirmatory randomized trial for enfortumab vedotin for patients with locally advanced or metastatic urothelial cancer who have been previously treated with a platinum-containing chemotherapy and a PD-1 or PD-L1 inhibitor.

In addition to the ongoing confirmatory phase III study intended to also support global registration, development of enfortumab vedotin is underway in earlier lines of treatment for locally advanced or metastatic urothelial cancer, including in newly diagnosed patients in combination with pembrolizumab and/or platinum chemotherapy.

The EV-201 phase II trial continues to enroll patients in who have not received a platinum-containing chemotherapy and who are ineligible for cisplatin.

Clinical trials

[A] A Study of Escalating Doses of ASG-22CE Given as Monotherapy in Subjects With Metastatic Urothelial Cancer and Other Malignant Solid Tumors That Express Nectin-4 (EV-101)- NCT02091999

[B] A Study of Enfortumab Vedotin for Patients With Locally Advanced or Metastatic Urothelial Bladder Cancer (EV-201) – NCT03219333

[C] A Study to Evaluate Enfortumab Vedotin Versus (vs) Chemotherapy in Subjects With Previously Treated Locally Advanced or Metastatic Urothelial Cancer (EV-301) – NCT03474107

Reference

[1] Kim HS, Seo HK, Immune checkpoint inhibitors for urothelial carcinoma. Investig Clin Urol 2018 Sep;59(5):285-296

[2] Alhalabi O, Shah AY, Lemke EA, Gao J. Current and Future Landscape of Immune Checkpoint Inhibitors in Urothelial Cancer. Oncology (Williston Park). 2019 Jan 17;33(1):11-8

[3] National Comprehensive Cancer Network (NCCN). Bladder Cancer (Version 3.2019). [Guideline]

[4] American Society of Clinical Oncology. Bladder Cancer: Introduction (10-2017). [Article]

[5] Cancer Today. Online IARC. Last accesses May 31, 2019. [Factsheet]

[6] Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424.


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