ARIAD Pharmaceuticals today announced that the European Commission (EC) has granted a marketing authorization for ponatinib as an orphan medicinal product for two indications:

1. The treatment of adult patients with chronic phase, accelerated phase or blast phase chronic myeloid leukaemia (CML) who are resistant to dasatinib or nilotinib; who are intolerant to dasatinib or nilotinib and for whom subsequent treatment with imatinib is not clinically appropriate; or who have the T315I mutation, and
2. The treatment of adult patients with Philadelphia-chromosome positive acute lymphoblastic leukaemia (Ph ALL) who are resistant to dasatinib; who are intolerant to dasatinib and for whom subsequent treatment with imatinib is not clinically appropriate; or who have the T315I mutation.

“We are delighted by the rapid approval of ponatinib in Europe and will now work closely with the national health authorities to make ponatinib available to Philadelphia-positive leukaemia patients as quickly as possible,” stated Harvey J. Berger, M.D., chairman and chief executive officer of ARIAD. “The clinical development of ponatinib involved many leukaemia experts throughout Europe, and we want to recognize their critical roles in bringing ponatinib to patients with resistant or intolerant CML and Ph ALL in the EU.”

The most common (>1%) serious adverse reactions for ponatinib were pancreatitis, abdominal pain, pyrexia, anaemia, febrile neutropenia, decrease in platelet count and neutrophil count, pancytopenia, myocardial infarction, diarrhea, and increased lipase.

The most common (≥20%) adverse reactions of any severity were decrease in platelet count, rash, dry skin, and abdominal pain. There were no new safety signals observed with ponatinib when compared to the other approved products from the same class (BCR-ABL inhibitors).

ARIAD was granted accelerated assessment by the Committee for Medicinal Products for Human Use for the ponatinib marketing authorization application. The aim of accelerated assessment is to expedite the review process for new medicines that address a major public-health interest. Accelerated assessment is reserved for innovative products that respond to an unmet medical need and that are expected to have a major impact on medical practice.

“ponatinib’s approval in Europe will offer CML patients, some of whom have run out of other treatment options, a new opportunity to improve their clinical outcome,” said Stephen G. O’Brien, M.D., Ph.D., Professor of Haematology at the Northern Institute for Cancer Research at Newcastle University, United Kingdom. “We have seen deep, durable responses from this once daily, oral treatment, and it would appear that ponatinib is a very useful new medicine for CML and Ph ALL patients who have become resistant to, or intolerant of, other TKIs.”

The EC decision was based on results from the pivotal Phase 2 PACE (Ponatinib Ph ALL and CML Evaluation) trial in patients with CML or Ph ALL who were resistant or intolerant to prior tyrosine kinase inhibitor (TKI) therapy, or who had the T315I mutation of BCR-ABL. ponatinib had robust anti-leukemic activity achieving a major cytogenetic response (MCyR) in 54 percent of chronic-phase CML patients and in 70 percent of patients with the T315I mutation. MCyR was the primary endpoint of the PACE trial for chronic-phase patients.

In patients with advanced disease, 58 percent of accelerated-phase CML patients, 31 percent of blast-phase CML patients and 41 percent of Ph ALL patients achieved a major hematologic response (MaHR) with ponatinib. MaHR was the primary endpoint in the trial for patients with advanced disease.

CML is a cancer of the white blood cells that is diagnosed in approximately 7,000 patients each year in Europe[1]. CML and Ph ALL patients treated with TKIs can develop resistance or intolerance over time to these therapies. ponatinib is a targeted cancer medicine discovered and developed at ARIAD. It was designed by ARIAD scientists using ARIAD’s platform of computational chemistry and structure-based drug design to inhibit BCR-ABL, including drug-resistant mutants that arise during treatment. ponatinib is the only TKI that has received an approval in Europe for an indication that includes CML and Ph ALL patients with the T315I mutation.

“For European patients with CML and Philadelphia-positive ALL who have been failed by prior therapy, the accelerated approval of ponatinib is very positive news and underscores the need for new medicines,” said Sandy Craine, director of The CML Support Group in the United Kingdom. “This approval is a significant step in giving hope to patients coping with CML and Philadelphia-positive ALL.”

Source: ARIAD

Reference:

1. Rohrbacher M, Hasford J. Epidemiology of chronic myeloid leukaemia (CML). Best Pract Res Clin Haematol. 2009 Sep;22(3):295-302. Based on current estimate of population of Europe (738,199,000 in 2010).

Notes:

Ponatinib (trade name Iclusig) is a kinase inhibitor. The primary target for ponatinib is BCR-ABL, an abnormal tyrosine kinase that is expressed in chronic myeloid leukaemia (CML) and Philadelphia-chromosome positive acute lymphoblastic leukaemia (Ph ALL). Ponatinib was designed using ARIAD’s computational and structure-based drug design platform specifically to inhibit the activity of BCR-ABL. It targets both native BCR-ABL and isoforms that carry mutations that confer resistance to treatment, including the T315I mutation, which is a common mutation among resistant patients.