Novartis has received a positive opinion supporting European Union (EU) approval of Glivec® (imatinib)* as a post-surgery treatment for patients at significant risk of relapse following removal of gastrointestinal stromal tumors (GIST). The Committee for Medicinal Products for Human Use (CHMP) has recommended approval for Glivec based on positive findings from a pivotal Phase III study, which showed that use of Glivec after surgery reduces risk of recurrence by approximately 89%[1]. The European Commission generally follows the recommendations of the CHMP and delivers its final decision within two to three months. The decision will apply in all 27 EU member states plus Iceland and Norway.
"This positive opinion is an important step forward for GIST patients," said David Epstein, President and CEO, Novartis Oncology, Novartis Molecular Diagnostics. "If approved in Europe, Glivec would provide an immediate option for post-surgical protection against the return of this highly aggressive disease."
GIST is a life-threatening cancer of the gastrointestinal tract. After initial removal, it can return in as many as one out of two patients[2] within a median of two years[3]. If approved for this new use, Glivec would be the first and only treatment indicated for use after surgery to delay the return of this highly aggressive cancer. In the EU, Glivec is currently indicated for the first-line treatment of metastatic or unresectable (inoperable) Kit (CD117)-positive GIST, the treatment of all phases of Philadelphia chromosome-positive chronic myeloid leukemia (CML), and other rare cancers[4]. This would be the tenth indication approved for Glivec in the EU. Glivec is already approved for this new indication in the US, Switzerland and several other countries.
Filing data
The CHMP reviewed data from a double-blind, randomized, multicenter study, which was just published in The Lancet. The study was conducted throughout the US and Canada by the American College of Surgeons Oncology Group (ACOSOG) and included 713 GIST patients whose tumors had been surgically removed. The study compared the recurrence-free survival (RFS) of patients taking Glivec 400 mg daily versus placebo for one year immediately following surgery. The results showed that after one year, 97.7% of those receiving Glivec remained recurrence-free, compared with 82.3% of those receiving placebo (P<0.0001). Therefore, risk of recurrence was reduced by approximately 89% with Glivec as compared to placebo[1].
The investigators reported that treatment with Glivec was well tolerated by most patients, with side effects similar to those observed in previous clinical trials with Glivec. These include nausea, diarrhea and swelling (edema)[1].
About gastrointestinal stromal tumors
GIST belong to a group of cancers known as soft tissue sarcomas[3]. The most common sarcomas, they can be found most often in the stomach and small bowel[3]. In the EU, the incidence of GIST is estimated to be more than 5,000 cases per year[5],[6], of which approximately 95% are Kit-positive[3]. Kit is the protein that, when mutated, has been identified as one of the major causes of GIST. Glivec inhibits the activity of several proteins, including Kit[3].
About Glivec
Glivec is approved in more than 90 countries including the US, EU and Japan for the treatment of all phases of Philadelphia chromosome-positive (Ph+) chronic myeloid leukemia (CML). Glivec is also approved in the US, EU and other countries for the treatment of patients with Kit (CD117)-positive GIST which cannot be surgically removed and/or have already spread to other parts of the body (metastasized). In the US, Glivec was recently approved for the post-surgery treatment of adult patients following complete surgical removal of Kit (CD117)-positive GIST. In the EU, Glivec is also approved for the treatment of adult patients with newly diagnosed Ph+ acute lymphoblastic leukemia (Ph+ ALL) in combination with chemotherapy and as a single agent for patients with relapsed or refractory Ph+ ALL. Glivec is also approved for the treatment of adult patients with unresectable, recurrent and/or metastatic dermatofibrosarcoma protuberans (DFSP) who are not eligible for surgery. Glivec is also approved for the treatment of patients with myelodysplastic/myeloproliferative diseases (MDS/MPD). Glivec is also approved for hypereosinophilic syndrome and/or chronic eosinophilic leukemia (HES/CEL).
The effectiveness of Glivec is based on overall hematological and cytogenetic response rates and progression-free survival in CML, on hematological and cytogenetic response rates in Ph+ ALL, MDS/MPD, on hematological response rates in systemic mastocytosis (SM), HES/CEL, on objective response rates and progression-free survival in unresectable and/or metastatic GIST, on recurrence free survival in adjuvant GIST, and on objective response rates in DFSP. Increased survival in controlled trials has been demonstrated only in newly diagnosed chronic phase CML and GIST.
Not all indications are available in every country.
About Novartis
Novartis AG provides healthcare solutions that address the evolving needs of patients and societies. Focused solely on healthcare, Novartis offers a diversified portfolio to best meet these needs: innovative medicines, preventive vaccines, diagnostic tools, cost-saving generic pharmaceuticals and consumer health products. Novartis is the only company with leading positions in these areas. In 2008, the Group's continuing operations achieved net sales of USD 41.5 billion and net income of USD 8.2 billion. Approximately USD 7.2 billion was invested in R&D activities throughout the Group. Headquartered in Basel, Switzerland, Novartis Group companies employ approximately 96,700 full-time-equivalent associates and operate in more than 140 countries around the world. For more information, please visit http://www.novartis.com.
References
1. DeMatteo, R., et al. Adjuvant imatinib mesylate after resection of localised, primary gastrointestinal stromal tumour: a randomised, double-blind, placebo-controlled trial. The Lancet. Published online March 19, 2009. Accessed March 2009. http://www.thelancet.com/
2. Van den Abbeele A., Benjamin R., Blanke C, et al. Clinical Management of GIST. Recurrence patterns and prognostic factors for survival. 2003;1-24.
3. Demetri GD, Benjamin RS, Blanke CD, et al. NCCN task force report: management of patients with gastrointestinal stromal tumor (GIST) - update of NCCN clinical practice guidelines. J Natl Compr Cancer Network, 2007; 2(suppl 1):S1-S26.
4. Glivec® (imatinib) prescribing information. Basel, Switzerland: Novartis International AG; March 2009.
5. Joensuu H. Current perspectives on the epidemiology of gastrointestinal stromal tumors. European Journal of Cancer Supplements. March 2006; Volume 4, Issue 3: 4-9.
6. The World Factbook. European Union Population. CIA.gov; June 2005. Available from: https://www.cia.gov/library/publications/the-world-factbook/print/ee.html. Accessed March 2009.
* Known as Gleevec® (imatinib mesylate) tablets in the US, Canada and Israel.