Janssen-Cilag International NV (“Janssen”) has announced that The Committee for Medical Products for Human Use (CHMP) of The European Medicines Agency (EMA) adopted a positive opinion recommending the granting of a marketing authorisation for siltuximab for the treatment of adult patients with multicentric Castleman’s disease (MCD) who are HIV-negative and human herpes virus-8 (HHV-8)-negative.
If approved, siltuximab would be the first medicine to receive regulatory approval in the EU for treatment of MCD patients.
MCD is a very rare and complex blood disorder with high morbidity. It is a condition in which lymphocytes, a type of white blood cells, are over-produced, leading to enlarged lymph nodes. MCD can also affect lymphoid tissue of internal organs, causing the liver, spleen, or other organs to enlarge. Infections, multisystem organ failure, and malignancies including malignant lymphoma are common causes of death in patients with MCD.[2–4]
The positive opinion of the CHMP is based on a review of data from a multinational, randomised, double-blind, placebo-controlled pivotal study (MCD2001) in 79 patients with MCD, along with data from two non-randomised supportive studies. The MCD 2001 study assessed the safety and efficacy of siltuximab plus best supportive care (BSC) compared with placebo plus BSC in patients with MCD who are HIV-negative and HHV-8-negative. The primary endpoint of the study was durable tumour and symptomatic response, defined as tumour response assessed by independent review and complete resolution or stabilisation of prospectively collected MCD symptoms, for at least 18 weeks without treatment failure. Secondary endpoints included additional predefined efficacy measures and safety.
MCD2001 is the first randomised study in MCD. Results showed that more than one-third of patients in the siltuximab arm had a durable tumour and symptomatic response to treatment plus BSC, compared to none of the patients who received placebo plus BSC (34% versus 0%; p=0.0012; based on central review). The median time to treatment failure was not reached for patients who received siltuximab plus BSC over 48 weeks of treatment; those who received placebo plus BSC experienced treatment failure at a median of 134 days (p=0.0084).
“At Janssen, we are driven by our commitment to patients and to the research and development of innovative products,” said Jane Griffiths, Company Group Chairman of Janssen Europe, the Middle East and Africa (EMEA). “We are therefore very pleased with the CHMP positive opinion and are proud of our work on siltuximab, which has the potential to address an unmet need amongst MCD patients, for whom no approved treatment in the EU currently exists.”
Siltuximab was granted orphan drug status in MCD in both the EU and the US. A final decision for siltuximab is expected from the European Commission within the next three months.
On September 3, 2013, Janssen announced the submission of a Biologic License Application (BLA) to the US Food and Drug Administration (US FDA) for siltuximab for the treatment of patients with MCD who are HIV-negative and HHV-8-negative. The US FDA accepted the submission and granted siltuximab priority review, which is currently ongoing.
Siltuximab is an anti-interleukin-6 (IL-6) chimeric monoclonal antibody that binds to human IL-6. IL-6 is a multifunctional cytokine produced by various cells such as T cells, B cells, monocytes, fibroblasts and endothelial cells. Dysregulated overproduction of IL-6 from activated B cells in affected lymph nodes has been implicated in the pathogenesis of, or mechanism causing, MCD. Information about the ongoing study of siltuximab can be found at http://www.clinicaltrials.gov.
About multicentric Castleman’s disease (MCD)
MCD is a proliferative disease that acts very much like lymphoma (cancer of lymph nodes). It is so rare that it is very difficult to track the number of cases.
MCD signs and symptoms are driven by dysregulated IL-6 production.[2,6] Many common symptoms include enlarged lymph nodes (appear as lumps under the skin), fever, weakness, fatigue, night sweats, weight loss, loss of appetite, nausea, vomiting and nerve damage that leads to numbness and weakness. Some symptoms can be life threatening. Infections, multisystem organ failure, and malignancies including malignant lymphoma are common causes of death in patients with MCD.[2–4] Currently there are no approved treatments in the EU for MCD.
Unlike “unicentric” Castleman’s disease, which is localised and affects only a single area or group of lymph nodes, patients with MCD have more than one group of lymph nodes in different anatomical areas that are affected. Unicentric disease can be treated by surgically removing the diseased lymph node,while multicentric disease is usually much more difficult to treat.[2,6]
- Meeting highlights from the Committee for Medicinal Products for Human Use (CHMP) 17-20 March 2014. Available from: http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2014/03/news_detail_002044.jsp&mid=WC0b01ac058004d5c1
- American Cancer Society. Castleman disease. Available from: http://www.cancer.org/acs/groups/cid/documents/webcontent/003093-pdf.pdf. Accessed February 28, 2014.
- Greiner T, Armitage JO, Gross TG. Atypical lymphoproliferative diseases. Hematology Am Soc Hematol Educ Program 2000:133-46.
- Van Rhee F, Stone K, Szmania S, et al. Castleman Disease in the 21st century: an update on diagnosis, assessment, and therapy. Clin Adv Hematol Oncol 2010;8:486-98.
- Wong RS et al. A Multicenter, Randomized, Double-Blind, Placebo-Controlled Study Of The Efficacy and Safety Of Siltuximab, An Anti-Interleukin-6 Monoclonal Antibody, In Patients With Multicentric Castleman’s Disease. Blood 2013 122:505. (Oral presentation presented at: 55th American Society of Hematology (ASH) Annual Meeting; Dec. 7-11, 2013; New Orleans, LA.)
- El-Osta HE, Kurzrock R. Castleman’s disease: from basic mechanisms to molecular therapeutics. Oncologist 2011;16:497-511.