Tag: cancer clinical trials

Nivolumab Receives U.S. FDA Breakthrough Therapy Designation for Hodgkin Lymphoma

Yesterday, investigators announced the U.S. FDA  “Breakthrough Therapy Designation” approval for the investigational PD-1 immune checkpoint inhibitor nivolumab in the treatment of patients with Hodgkin lymphoma after failure of autologous stem cell transplant and brentuximab. The FDA designation was created to expedite the development process of drugs aimed at treating serious and life-threatening conditions. These new  findings for nivolumab are based on an ongoing Phase 1b trial. Nivolumab also known as BMS-936558 or MDX1106 is an,

“…investigational, fully-human PD-1 immune checkpoint inhibitor that binds to the checkpoint receptor PD-1 (programmed death-1) expressed on activated T-cells. We are investigating whether by blocking this pathway, nivolumab would enable the immune system to resume its ability to recognize, attack and destroy cancer cells.”

Look to this blog and our clinical trials page for further developments regarding the use of nivolumab in the treatment of Hodgkin lymphoma.

Obinutuzumab Approved for Patients with Previously Untreated CLL

Last week the FDA announced approval for obinutuzumab (Gazyva) in combination with chlorambucil for the treatment of patients with previously untreated CLL. Obinutuzumab is the first designated “Breakthrough Therapy” to be granted FDA approval, receiving a priority review through its demonstration of “significant improvement” in safety or effectiveness over available therapies.

Obinutuzumab is a 3rd generation type II anti-CD20 antibody. Acting as an immunomodulator, obinutuzumab selectively binds to the extracellular domain of the human CD20 antigen on malignant human B cells.

This “significant improvement” was demonstrated in a phase III study. Patients treated with a combination of obinutuzumab and chlorambucil experienced significant improvement in progression free survival, increasing to an average of 23 months, compared to 11 months for chlorambucil therapy.

The FDA press release can be seen here. Further information regarding CLL clinical trials at Weill Cornell Medical College can be found here.

Ibrutinib is Effective Therapy for Relapsed CLL Patients

Reporting results in the New England Journal of Medicine, Weill Cornell’s Dr. Richard Furman and others recently completed a large phase 1b/2 clinical trial on the effects of ibrutinib in patients with Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL). Recently granted a third breakthrough therapy designation as a monotherapy for CLL and SLL, ibrutinib acts as an oral, irreversible inhibitor of the enzyme, Bruton tyrosine kinase (BTK).  BTK is an essential component of the B-cell receptor signaling pathway and  facilitates interactions between the CLL cells and their micro-environment, promoting the survival of CLL/SLL cells.

In the clinical study, ibrutinib was administered orally to 85 previously treated patients with CLL once daily at doses of 420 mg and 840 mg. Both doses demonstrated an overall response rate of 71%, with an additional 20% and 15% in each group achieving a partial response with lymphocytosis. At a median follow up of 26 months, estimated progression-free and overall survival for the 85 patients overall were 75% and 83% respectively. Side effects were mild and included diarrhea, fatigue, and infections. The study concluded that ibrutinib produces, “a high frequency of durable remissions for relapsed or refractory CLL/SLL, including those patients with high-risk genetic lesions.”

Ibrutinib represents an important improvement in the treatment of patients with CLL/SLL.  Treatment previously consisted of regimens utilizing chemotherapies, including chlorambucil, cyclophosphamide, fludarabine, and bendamustine in various combinations that effectively generated responses in patients, but with significant toxicities.  Ultimately, patients relapsed and became unresponsive to or unable to tolerate chemotherapy.  Additionally, the subset of patients characterized by having del 17p13.1  who respond extremely poorly to chemoimmunotherapy, demonstrated response rates equivalent to the rest of the patient population.

Currently there are ongoing trials of ibrutinib in CLL and other lymphomas at the Weill Cornell CLL Research Center and Lymphoma Program. Additional clinical trials are available here.