Amgen announced that the European Commission has approved the use of IMLYGICTM (talimogene laherparepvec) for the treatment of adults with unresectable melanoma that is regionally or distantly metastatic (Stage IIIB, IIIC and IVM1a), with no bone, brain, lung or other visceral disease. IMLYGIC is the first oncolytic immunotherapy to demonstrate therapeutic benefit for patients with metastatic melanoma in a Phase III clinical trial.
IMLYGIC is derived from the herpes simplex type 1 virus (HSV-1), commonly called the cold sore virus. IMLYGIC has been modified to replicate within tumours and to produce the immune stimulatory protein human granulocyte-macrophage colony-stimulating factor (GM-CSF). Administered via intralesional injection, IMLYGIC is designed to cause the death of tumour cells and initiate an anti-tumour immune response.
“As the first oncolytic immunotherapy authorised in the European Union, the approval of IMLYGIC is an important milestone for this new class of drugs, bringing patients with a rare and deadly form of skin cancer a much needed new treatment option,” said Sean E Harper, MD, executive vice president of Research and Development at Amgen. “By igniting the body’s own immune system IMLYGIC can initiate an anti-tumour immune response, providing meaningful and durable response rates in the early stage metastatic melanoma patient.”
Melanoma remains a significant public health concern in the European Union (EU), with an estimated 22,000 deaths from the disease in 2012.1,2 While melanoma is curable when detected in the early stages, metastatic melanoma continues to be one of the most difficult-to-treat cancers because it is highly aggressive and complex.3 Even with recent new options in immune-oncology, a large number of patients with metastatic melanoma still do not respond to treatment.4
The European approval included a review of exploratory subgroup analyses of Study 005/05, referred to as OPTiM. The durable response rate (DRR) in patients with Stage IIIB, IIIC and IVM1a disease was 25.2% compared to 1.2% in those treated with GM-CSF. In the study, patients with Stage IIIB, IIIC and IVM1a disease achieved an overall response rate (ORR) of 40.5% when treated with IMLYGIC compared to 2.3% with GM-CSF. The median overall survival (OS) for IMLYGIC patients with Stage IIIB, IIIC and IVM1a disease was 41.1 months compared to 21.5 months for patients treated with GM-CSF. While the pivotal study was not powered to evaluate efficacy in these individual subgroups, patients with no visceral disease derived greater benefit from IMLYGIC treatment than those with more advanced disease. Due to the exploratory nature of the analysis and based on the current evidence, it has not been established that IMLYGIC is associated with an effect on OS.
The most commonly reported treatment-related adverse events were fatigue, chills, pyrexia, nausea, influenza-like illness and injection-site pain. Overall, 98% of these adverse reactions reported were mild or moderate in severity. The most common grade 3 or higher adverse reaction was cellulitis. No fatal treatment-related adverse events occurred.5
This approval grants a centralized marketing authorization in the 28 countries that are members of the EU. Norway, Iceland and Liechtenstein, as members of the European Economic Area (EEA), will take corresponding decisions on the basis of the decision of the EC.
References
1 Boyle P et al. Cancer of the skin: a forgotten problem in Europe. Ann Oncol 2004;15(1):5–6.
2 Ferlay J et al. Cancer incidence and mortality patterns in Europe: Estimates for 40 countries in 2012. Eur J Cancer 2013;49(6):1374–403.
3 American Cancer Society. Melanoma Skin Cancer. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003120-pdf.pdf. Accessed 23 November 2015.
4 Garbe C al. Diagnosis and treatment of melanoma. European consensus-based interdisciplinary guideline – Update 2012. Eur J Cancer 2012;48:2375–90.
5 Andtbacka RHI et al. Talimogene Laherparepvec Improves Durable Response Rate in Patients With Advanced Melanoma. J Clin Oncol 2015;33(25):2780–8.
