Pharma Strategy Blog

Commentary on Pharma & Biotech Oncology / Hematology New Product Development

Posts by MaverickNY

At the recent American Association of Clinical Research special conference on the PI3K-mTOR pathway, it was very clear that this area of research is becoming a hot topic. At the annual meeting starting tomorrow, there are over 330 abstracts on PI3K alone – a huge increase over the last couple of years. This is one area where a systems biology approach to understanding the disease is bearing fruit.

We’ll be posting some highlights of each day during the meeting along with some video interviews with some experts on different topics.

In the meantime, we put together a short trailer for the AACR meeting – check it out:

http://www.youtube.com/watch?v=tubv0Mw4rgs

Every year I attend a numerous annual meetings associated with oncology and hematology, but the American Association of Cancer Research (AACR) event in April is one of my personal favourites.

It may be April Fool’s Day today, but this meeting is no joke – it’s for serious cancer researchers and a lot of fun to boot!

I’m looking forward to meeting a lot of people and catching up on the latest research advances. Last year, there was a credible number of us tweeting different sessions, around 130 of us in fact, from the CoverItLive statistics I collated from last year’s meeting.   This year the hashtag continues to be #aacr so you can follow along remotely, join in with questions and thoughts or tweet from some of the sessions. The sentiments are collated in the widget below for easy reading, so do check back periodically if you want to get a feel of what’s going on in Orlando this year:

You can also follow the sessions more easily from the online schedule that AACR have made available. In addition, they have also got an awesome lineup of podcasts and webcasts for those who cannot attend to follow remotely – check out the tools and services here.

Check back tomorrow, as I’ll be posting about the daily highlights from the meeting.

In the meantime, if you wish to receive the blog delivered daily by email (and only the blog) and don’t want to miss the updates, just enter your preferred email address in the box below:

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Way back in November 2009 at the American Association of Cancer Research (AACR) Molecular Targets meeting in Boston, there was a fascinating poster on the early promise for nanotechnology as a new form of efficient drug delivery for cancer therapeutics (see the blog post here).

Fast forward 18 months and my attention was drawn to a new article published in Cancer Research about how nanotechnology has been used preclinically to deliver therapy for breast cancer into the cancer cells rather than to the cells.  This is a subtle, but important, difference.

For those of your wondering what nanotechnology is, my colleague Pieter Droppert reviewed some basics earlier this month in a blog post:

“Nanotechnology is the application of science and engineering to materials that are between 1 and 100 nanometers (nm) in size.”

He went on to put this in layman terms:

“1nm is one-billionth of a meter.   To put this in context, 1nm is one seven-thousandth of the width of a red blood cell or one eighty-thousandth of the width of a human hair.  These are unimaginably small materials that are engineered to operate at the molecular and atomic level.”

The approach in the latest preclinical research (see references below) is to take trastuzumab (Herceptin) and combine it with biodegradable polymers to form nanoconjugates that are small enough to enter cancer cells because they are more water soluble rather than attack the outside of the cells, thereby potentially reducing toxicities associated with the therapy.

The same group also tried this technique with brain cancer (see references below), allowing the nanocells to cross the usually impenetratable blood-brain barrier, which:

“resulted in a marked inhibition of tumor angiogenesis and growth.”

In the breast cancer research, the group compared the results of their polymer-trastuzumab conjugate with trastuzumab alone in mice:

“Our experiments confirmed that a proper design of the lead nanobiopolymer was possible for efficient blocking of HER2/neu-positive breast tumor growth through dual inhibition of HER2/neu and Akt phosphorylation, and as a result, promoting enhanced tumor cell apoptosis.

The nanobiopolymer’s unique combination of features resulted in highly specific drug accumulation in the tumor tissue and inside tumor cells.”

It will be most interesting to see if this idea is developed clinically in human trials and whether the results will be reproducible or not.

Significance of the findings:

The nanoconjugate concept has promise, not just in allowing a novel drug delivery system to cross impenetrable barriers, but also in reducing the toxicities associated with systemic targeted therapy.  Randomised clinical trials in patients with cancer are required to determine if there is viability in humans.

References:

ResearchBlogging.orgInoue, S., Ding, H., Portilla-Arias, J., Hu, J., Konda, B., Fujita, M., Espinoza, A., Suhane, S., Riley, M., Gates, M., Patil, R., Penichet, M., Ljubimov, A., Black, K., Holler, E., & Ljubimova, J. (2011). Polymalic Acid-Based Nanobiopolymer Provides Efficient Systemic Breast Cancer Treatment by Inhibiting both HER2/neu Receptor Synthesis and Activity Cancer Research, 71 (4), 1454-1464 DOI: 10.1158/0008-5472.CAN-10-3093

Ljubimova, J., Fujita, M., Ljubimov, A., Torchilin, V., Black, K., & Holler, E. (2008). Poly(malic acid) nanoconjugates containing various antibodies and oligonucleotides for multitargeting drug delivery Nanomedicine, 3 (2), 247-265 DOI: 10.2217/17435889.3.2.247

Ding, H., Inoue, S., Ljubimov, A., Patil, R., Portilla-Arias, J., Hu, J., Konda, B., Wawrowsky, K., Fujita, M., Karabalin, N., Sasaki, T., Black, K., Holler, E., & Ljubimova, J. (2010). Inhibition of brain tumor growth by intravenous poly( -L-malic acid) nanobioconjugate with pH-dependent drug release Proceedings of the National Academy of Sciences, 107 (42), 18143-18148 DOI: 10.1073/pnas.1003919107

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This week’s Nature is chock full of interesting articles on various cancer related topics so it was quite hard to pick just one to discuss in a blog post.   Nevertheless, two on Zebrafish was very striking, since the Letters discusses how models have revealed oncogenes and potential new drug targets in a particularly difficult to treat tumour type, i.e. melanoma.

Zebrafish, source: wikipedia

We now know that in melanoma, the BRAF V600E mutation drives signaling and proliferation of the MAPK pathway and that resistance also develops to treatment with targeted therapies such as PLX4032 and other inhibitors after six months or so.  The question then is what factors are driving the resistance and are other (druggable) oncogenes involved?

A multinational group of researchers from Boston, Rome and Paris used Zebrafish melanoma models to explore events in a:

“Recurrently amplified region of chromosome 1 for the ability to cooperate with BRAF(V600E) and accelerate melanoma.”

In doing so, they discovered something very interesting:

“SETDB1, an enzyme that methylates histone H3 on lysine 9 (H3K9), was found to accelerate melanoma formation significantly in Zebrafish.”

Chromatin was also found to be involved in tumorigenesis associated with SETDB1.

Histone methylation has been mooted as a promotor of cancer in other tumour types such as renal cell carcinoma and others, thus this study lends support to that theory.

In the second letter, White et al., (2011) report that DHODH inhibition with either leflunomide and NSC210627 led to a marked decrease in melanoma growth, both in vivo and in a xenograft model.  They used the Zebrafish to successfully identify:

“Small molecule suppressors of neural crest progenitors that give rise to melanoma.”

What do these findings mean?

SETDB1 is focally amplified in a number of malignancies, which means that it would be interesting to see if it also promotes histone methyltransferase activity in other cancers too.

The results from the Letters to Nature suggest that both DHODH and SETBD1 could be valid new targets for therapeutic intervention if drugs could be designed and developed to shut down the activity and prevent acceleration of the disease.  Future new logical combinations or sequencing of therapies in melanoma could therefore emerge from these important research findings.

In addition…

If you haven’t taken a look yet, this weeks Nature magazine is well worth reading for several other useful articles on cancer that are related to research including vaccines, biomarkers, liver cancer, genome sequencing in multiple myeloma, FAS and NF-kB signalling in lung cancer.  There is also a whole Outlook section (open access) on Cancer Prevention that is relatively easy to read, even for the layman that is worth checking out.

References:

ResearchBlogging.orgCeol, C., Houvras, Y., Jane-Valbuena, J., Bilodeau, S., Orlando, D., Battisti, V., Fritsch, L., Lin, W., Hollmann, T., Ferré, F., Bourque, C., Burke, C., Turner, L., Uong, A., Johnson, L., Beroukhim, R., Mermel, C., Loda, M., Ait-Si-Ali, S., Garraway, L., Young, R., & Zon, L. (2011).  The histone methyltransferase SETDB1 is recurrently amplified in melanoma and accelerates its onset.  Nature, 471 (7339), 513-517  DOI: 10.1038/nature09806

White, R., Cech, J., Ratanasirintrawoot, S., Lin, C., Rahl, P., Burke, C., Langdon, E., Tomlinson, M., Mosher, J., Kaufman, C., Chen, F., Long, H., Kramer, M., Datta, S., Neuberg, D., Granter, S., Young, R., Morrison, S., Wheeler, G., & Zon, L. (2011).  DHODH modulates transcriptional elongation in the neural crest and melanoma Nature, 471 (7339), 518-522  DOI: 10.1038/nature09882

Many regular readers will remember the interview with Dr Sue Desmond-Hellmann, the Chancellor of UCSF, on the I-SPY2 trial, a large neoadjuvant study that seeks to accelerate the pace of identifying effective novel agents for early breast cancer by incorporating biomarkers from the beginning and an adaptive conjoint design. Biomarkers is definitely something that is very much to the fore these days.

A great resource for scientists involved with research in the biomarker field is Biomarker Commons, curated by my friend Walter Jessen, who describes himself as,

“a computational biologist focused on biomarker discovery and prioritization”

Now that sounds like a fun job to me!

Walter has put a very nice site together in his spare time (he also runs Highlight Health a site dedicated to biomedical research as well as having a day job).  Biomarker Commons collates news, research and journal articles about biomarkers – it’s well worth checking out of you are interested in this field:

Biomarker Commons

I subscribe to the RSS feed for news items myself and find it very useful indeed, as well as loving the clean easy to use interface.

Another useful resource is the Biomarkers Consortium, which describes itself as:

“The Biomarkers Consortium is a major public-private biomedical research partnership managed by the Foundation for the National Institutes of Health with broad participation from stakeholders across the health field, including government, industry, academia and patient advocacy and other non-profit private sector organizations.

In addition to the Foundation for NIH, founding members include the National Institutes of Health, Food and Drug Administration and the Pharmaceutical Research and Manufacturers of America.”

The link above takes you to their active projects, which includes ISPY2, but if you are involved in cancer research, they welcome new project ideas and submissions too.

Related to biomarkers is companion diagnostics and this is something big Pharma and Biotech are both active in.  At least in high tech areas such as oncology.  As we identify and validate more biomarkers associated with disease, so the need for tests to measure them will increase.

In the long run, insurers in the US will also be happier because biomarkers will ultimately lead to fewer patients being treated with higher priced new therapeutics ie those most likely to benefit, rather than exposing thousands of patients to the systemic effects of a targeted therapy.

What was interesting though, was learning at European Association Urology meeting that in Germany, for example, bone mineral density measurements using DXA are not covered and patients must pay for them out of pocket.  These measurements are often required to determine the degree of bone loss.  For therapies that treat cancer-associated bone loss such as zoledronic acid (Zometa), which is currently approved and denosumab (Xgeva), which is pending approval in Europe, this may limit uptake of the drug.

This weekend I will be attending the annual American American of Cancer Research (AACR) meeting in Orlando and look forward to catching up on the various new developments not just in basic research, but also biomarkers and companion diagnostics. It promises to be an interesting meeting!

 

From an oncology perspective, the big drama played out in advanced high risk prostate cancer at this meeting. There were three new approvals in US last year and approval of some of them in Europe is immiment, including sanofi-aventis’s cabazitazel (Jevtana), which was approved by the EMEA at the EAU conference.

2010 and 2011 are therefore promising to be great years for increased patient and physician choice.

We took a quick look at the new data and what new therapies will likely impact the landscape for this disease in the near term, including abiraterone:

http://www.youtube.com/watch?v=rWsb3yoRi9c

This is my first videoblog but more will be coming, including a snapshot later this week of what’s hot at the AACR meeting next weekend. Do feel free to add any comments below.

Watch this space for more!

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Today is Friday and I try to post something lighthearted and fun at the end of a busy week.  With that in mind, someone sent me this great link to Kids Kicking Cancer.  As someone who experienced a childhood cancer, I can identify with this awesome concept – help the kids feel victors not victims:

Kids Kicking Cancer

They have some great use of social media tools to spread their message and provide links to inspiring stories about the Kids.  There is a Facebook Page and a YouTube channel, for example.  After watching one of their their videos, I simply couldn’t resist sharing a genuine feel-good story about what their vision is:

“Kids Kicking Cancer uses martial arts breathing, meditation and imagery techniques to ease the pain of very sick children while empowering them to heal physically, spiritually and emotionally.

Our mantra of “Power Peace Purpose” allows the children to know that they are victors not victims. In turn they teach adults, corporations and other children how to control stress, pain, fear and anger.

When they hear from the Hollywood superstars that “you boys and girls are the real heroes” it helps them to recognize that they really do have the enormous power to bring themselves to an inner healing peace.”

Check out this short inspiring video and spread a little happiness…

Many of us live busy stressful lives and forget to nurture the spirit and mindfulness to decompress from the hurly burly of life.  I was therefore really pleased to see that there is also a an iPhone app and Blackberry app that are worth checking out for breathing exercises to manage stress for everyone, not just kids, as well.  Do check them out and share them with your family and friends!

There is a provocative article in this week’s New England Journal of Medicine asking whether the accelerated approval process should be used for more cancer drugs:

“The striking results of recent phase 1 trials of targeted cancer drugs have provoked serious discussion about shortening the road to drug approval.”

The main thrust of the argument was that it takes on average seven years from entering human trials to approval if phase III trials are included in the oncology drug development process.

“Of the 23 oncologic drugs given accelerated approval between 1993 and 2008, two were ultimately withdrawn from the U.S. market — gemtuzumab because of toxicity and gefitinib because of lack of efficacy.”

The author argues that:

“Phase 3 trials are expensive and time-consuming, usually taking at least 2 to 3 years to reach survival end points. The news of a highly successful new compound in phase 1 or 2 rapidly reaches physicians and patients, creating demand for early access.”

While we have seen some successes with the Accelerated Review process with imatinib (Gleevec), erlotinib (Tarceva), cetuximab (Erbitux), bevacizumab (Avastin) and others, there has also been a flood of promising phase II agents that duly flopped in randomised phase III trials, with Pfizer’s figitumumab, Novartis/Antisoma’s ASA404 and sanofi-aventis’ iniparib to name a few off the top of my head.

One of the challenges here is that companies often take a targeted therapy but strangely test it in an unselected patient population, which will increase the chances of failure in a more rigorous randomised phase III trial.  In an ideal world, several carefully designed adaptive phase II trials would help develop logical combinations and markers of response, thus increasing the chances of success in phase III studies.

The big problem as I see it then, is that while we have exciting new agents likely to be approved in 2011 such as:

  • crizotinib in lung cancer
  • ipilimumab (Yervoy) and PLX4032 (vemurafenib) in metastatic melanoma
  • brentuximab vedotin in Hodgkin Lymphoma
  • abiraterone acetate (Zytiga) in prostate cancer

we don’t always know how to carefully select patients to enable treatment based on the underlying molecular basis of the disease.

Of those mentioned above, with crizotinib (ALK), vemurafenib (V600E BRAF) and brentuximab (CD30) we clearly do, but with abiraterone and ipilimumab the issue of patient selection seems less clear at the moment.  Sadly there are not any biomarkers available to tell us which patients are most likely to benefit from treatment in targeted therapies already approved such as bevacizumab.

The fate of bevacizumab in breast cancer has yet to be determined.  It was approved under the FDA Accelerated Review process based on the initial phase II data, with the assumption that the phase III trials would show an improvement in overall survival.  The AVADO and RIBBON1 trials showed a benefit in progression free survival or PFS (ie a surrogate marker of event free survival), but unfortunately were not positive for overall survival, which is the ultimate measure of disease progression and the condition required to be met under the fast track process.

The FDA are therefore recommending withdrawal based on the lack of overall survival as per the accelerated agreement and Roche offering the counter argument that there was evidence of patient benefit.  That issue will no doubt continue to be debated for much of 2011 until the public hearing later this year.  There is an excellent analysis of the impact of the FDA recommendation on bevacizumab uptake in the US in Oncology Business Review for anyone interested in trends.

Ultimately, we need have a better understanding of the molecular basis of the cancer types and drugs developed to target that aberration in a more carefully selected patient population.  The arguments for and against accelerated review will run and run – probably for longer than the debate about how to pronounce some of the new names!

My position on the accelerated review process?

When it works, it works well.  However, problems can arise when you get phase III trials that do not support the full approval due to a lack of a proven overall survival advantage in the population evaluated.  The FDA can find themselves in an impossible position especially given the high emotions that run in breast cancer, for example.  The onus should be on the company to do further research or trials better defining the patients who are most likely to respond rather than risk exposing thousands of patients to the systemic effects of a drug that may not offer meaningful benefit to the majority.

References:

ResearchBlogging.orgChabner, B. (2011). Early Accelerated Approval for Highly Targeted Cancer Drugs New England Journal of Medicine, 364 (12), 1087-1089 DOI: 10.1056/NEJMp1100548

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Whew, this has been one very busy European Association of Urology (EAU) meeting here in Vienna this weekend! By that, I mean the medical sessions, as I’ve been too busy attending multiple presentations and symposia to sightsee.

Yesterday, Drs Johann De Bono and Bertrand Tombal did an excellent job in the plenary session discussing issues and emerging new treatments around high risk prostate cancer.

Dr De Bono provided an update on the anti-androgen inhibitor abiraterone after treatment with docetaxel.  This novel agent was filed in December in the US, EU and Canada and fast track approval is expected soon in the US, perhaps in time for the sister meeting, the American Urology Association (AUA), which takes place in Washington DC in May.  Interestingly, he was the first person at this meeting to talk about patients and how they deserve better treatments than we have now.

Dr Tombal took a broader perspective, discussing how the focus in Europe is gradually turning to multidisciplinary teams of surgeons, urologists, radiation oncologists and medical oncologists to coordinate the care of prostate cancer patients.  He was particularly vehement about the silo mentality that has evolved:

“Claiming that abiraterone is a drug for urologists because it is orally available and cabazitaxel is a drug for medical oncologists because it is chemotherapy is wrong.  This will send us back in time, into the dark age of cancer treatment.  The only wise choice is in a multidisciplinary setting.”

I agree with this concept in general, but the reality is that turf wars are rife in urology and it will take time for a multidisciplinary approach to evolve and catch up with other cancers.  This also means that ultimately, a more rigorous approach is needed, both in the science and biology of the diseases and in rigourous randomised clinical trials to evaluate the benefits of new surgical techniques, therapies and technologies.

Change is happening, but it will likely be an evolution rather than a revolution.

Yesterday was a busy day for prostate cancer in general with sanofi aventis also announcing that cabazitaxel (Jevtana) is now approved in Europe for castrate resistant prostate cancer after treatment with Taxotere.

The EAU conference organisers have done a very nice job gathering the recordings of the sessions for anyone interested in following remotely.  I heartily encourage any of you interested in castrate resistant prostate cancer (CRPC) to check out Dr De Bono and Tombal’s talks, which you can access here – just select Day 3 and scroll down about 3/4 of the way and click on the play button to see the slides and hear the accompanying audio.

I’m planning on catching up on several other scientific and translational sessions that clashed with ones I attended myself, but to see the talks up the next morning is excellent.

Nice job from @uroweb!  You can follow the tweets from the meeting via Twitter using the hashtag #EAU11 or read them in the aggregator here.

 

This weekend I’m at the annual meeting of the European Association of Urology (EAU), which takes place here in Vienna, Austria.  It promises to be an interesting meeting, with new developments in the areas of bladder/urothelial, prostate and renal cancers being discussed.

For those of you interested in following remotely, here are the links to the scientific programme and the podcasts.  You can also browse the abstracts online.

According to the EAU:

“For the 2011 edition, more than 3,700 abstracts were submitted and reviewed by the EAU Scientific Congress Office. As a result, 1,111 abstracts and 50 video abstracts were accepted, and will be presented at 92 poster sessions and 8 video sessions.”

While not as big as it’s American cousin, the AUA, that’s still an impressive number of abstracts submitted for the meeting.  They have an active presence on Twitter, you follow them via @uroweb.

I’m going to try and aggregate my thoughts and tweets from the sessions, depending upon the availability of wifi access.  Most of the sessions I’m interested in will be from Saturday to Monday.  Unfortunately, my iPad didn’t arrive in time so the iPhone and wifi will sadly have to suffice, although coverage may be spotty with thousands of people also trying to access the network.

Check back over the weekend for any live tweeting for the hashtag #EAU11 (#EAU is unfortunately used for other things, including water tweets), but you can follow the #EAU11 coverage in the widget below:

If any one has any questions or observations, please do add them in the comments below.

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