• Somatuline® prolongs progression free survival in the treatment of metastatic gastroenteropancreatic neuroendocrine tumors
• After 96 weeks of investigational treatment with Somatuline®, the risk of disease progression or death was reduced by 53%
Ipsen today announced that the New England Journal of Medicine has published clinical trial results showing that Somatuline® Autogel® / Somatuline® Depot® (lanreotide) Injection 120 mg (referred to as Somatuline®) achieved statistically significant prolongation of progression free survival over placebo in patients with metastatic gastroenteropancreatic neuroendocrine tumors (GEP-NETs). CLARINET®, an investigational phase III randomized, double-blind, placebo-controlled study of the antiproliferative effects of Somatuline® was conducted in 48 centers across 14 countries. The article titled “Lanreotide in Metastatic Enteropancreatic Neuroendocrine Tumors” is available online at NEJM.org and has been published in the July 17th edition (N. Engl. J. Med. 2014; 371: 224-233).
The data gathered from 204 GEP-NET patients over the 96-week study showed that placebotreated patients had a median PFS of 18.0 months and 33.0% had not progressed or died at 96 weeks, whereas the median PFS for Somatuline® treated patients was not reached and 65.1% had not progressed or died at 96 weeks (stratified logrank test, p<0.001). This represented a 53% reduction in risk of disease progression or death based on a hazard ratio of 0.47 (95% CI: 0.30 0.73). These statistically and clinically significant antiproliferative effects of Somatuline® were observed in a large population of patients with grade G1 or G2 (World Health Organization classification) GEP-NETs, and independent of hepatic tumor volume (≤25% or >25%). Quality of life measures were not different between the Somatuline® and placebo groups. Safety data generated from the study are consistent with the known safety profile of Somatuline®.
“The CLARINET® data are compelling, since no similar GEP-NET progression free survival data exist for a somatostatin analog in such a large, multinational study population.” said Pr Martyn Caplin, Professor of Gastroenterology & Gastrointestinal Neuroendocrinology, Royal Free Hospital (London, UK) and lead author and principal investigator of the CLARINET® study.
“The peer-reviewed publication of CLARINET® results in the New England Journal of Medicine highlights the robust data that showed an antiproliferative effect of Somatuline® in the treatment of GEP-NETs.” said Claude Bertrand, Executive Vice President R&D and Chief Scientific Officer. “Based on these significant results, Ipsen has initiated a worldwide registration program and on July 1st 2014, the submission of a Supplemental New Drug Application for Somatuline® for the treatment of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) to the U.S. FDA as well as Marketing Authorization variations in 25 countries of the European Union were announced.”
The data from CLARINET® is considered investigational, as Somatuline® is not indicated for antiproliferative treatment of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) in any market. Somatuline® is approved for treatment of symptoms associated with neuroendocrine tumors, which can include the treatment of GEP-NET patients experiencing symptoms from carcinoid syndrome, in many markets where it is marketed as Somatuline® Autogel®. Somatuline® is not approved in the US to treat GEP-NETs or the symptoms thereof, where it is marketed as Somatuline® Depot® for acromegaly.
CLARINET® is a randomized, double-blind, placebo-Controlled study of Lanreotide Antiproliferative Response in patients with enteropancreatic Neuroendocrine Tumors (ClinicalTrials.gov NCT00353496). This 96-week multinational study was conducted in collaboration with UK & Ireland Neuroendocrine Tumour Society (UKI NETS) and the European Neuroendocrine Tumour Society (ENETS).
A total of 204 patients from 48 centers across 14 countries with well or moderately differentiated nonfunctioning enteropancreatic neuroendocrine tumors and a proliferation index (Ki67) of <10%, were randomized to treatment with Somatuline® Autogel® 120 mg (n=101) or placebo (n=103). At enrollment, primary tumor locations were pancreas (44%), midgut (36%), hindgut (7%) and unknown (13%). Most patients had stable disease (96%) and were treatment-naïve (84%). Thirty percent of patients had a Ki67 of 3% ≤10% (WHO grade 2) and 33% had an hepatic tumor load >25%.
The primary efficacy endpoint was time to either disease progression (centrally assessed using Response Evaluation Criteria In Solid Tumors, RECIST 1.0) or death. Two baseline computed tomography or magnetic resonance imaging scans were performed (the second one done 12 to 24 weeks after the first imaging test), followed by additional scans at 12- week intervals during the first year and 24-week intervals during the second year up to 96 weeks.
Safety data generated from the CLARINET® study were consistent with the known safety profile of Somatuline®. Similar proportions of each treatment group experienced adverse events (lanreotide, 88%; placebo, 90%). Most of these patients experienced mild (17% per group) or moderate events (lanreotide, 44%; placebo, 43%). One-half of the lanreotide group experienced treatment-related adverse events (vs. 28% with placebo), most commonly diarrhea (26% vs. 9%, respectively), followed by abdominal pain and cholelithiasis Six patients experienced adverse events leading to withdrawal, three in each group, with only one considered by the investigator to be treatment-related in the Somatuline® group. Fifty-seven patients experienced 122 serious adverse events; eight were considered treatment-related (lanreotide, seven events; placebo, one event).
About gastroenteropancreatic neuroendocrine tumors
Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are serious rare types of cancer. They constitute a heterogeneous group of tumors most often arising from cells in the gastrointestinal tract or the pancreas; although rare, their incidence has been on the rise (4-6 fold increase in the last 30 years). They have the ability to secrete functional amines and peptides and based on the type and amount of these bioactive substances in circulation, they can or cannot result in an identifiable hormonal clinical syndrome. GEP-NETs can be clinically silent for long periods of time, delaying the diagnosis until late presentation with hormonal related symptoms or with symptoms related to tumor mass effect such as intestinal obstruction or abdominal pain.
The active substance in Somatuline® is lanreotide acetate, a somatostatin analog that inhibits the secretion of several endocrine, exocrine and paracrine functions. It has been shown to be effective in inhibiting the secretion of GH and certain hormones secreted by the digestive system. Somatuline® is marketed as Somatuline® Depot® within the United States and as Somatuline® Autogel® in other countries where it has marketing authorization.
Somatuline® was initially developed and continues to be used for the treatment of acromegaly in many countries, including the United States, where it is indicated for the long-term treatment of patients with acromegaly who have had an inadequate response to or cannot be treated with surgery and/or radiotherapy. Somatuline® is not currently indicated as an antiproliferative agent for the treatment of GEPNETs.
Somatuline® is approved for the treatment of symptoms associated with neuroendocrine tumors in many markets, but is not approved within the United States for this indication.
Important Safety Information about Somatuline®
The most commonly reported adverse drug reactions following treatment with lanreotide are gastrointestinal disorders and cholelithiasis. In addition there have been reports of changes to glucose regulation, levels of liver enzymes, changes to heart rate, injection site and allergic reactions. The product information should be consulted for a complete list of undesirable effects, warnings and precautions and contraindications for use.
Ipsen (ipsen.com) is a global specialty-driven pharmaceutical company with total sales exceeding €1.2 billion in 2013. Ipsen’s ambition is to become a leader in specialty healthcare solutions for targeted debilitating diseases. Its development strategy is supported by 3 franchises: neurology, endocrinology and urology-oncology. Moreover, the Group has an active policy of partnerships. Ipsen's R&D is focused on its innovative and differentiated technological platforms, peptides and toxins. In 2013, R&D expenditure totaled close to €260 million, representing more than 21% of Group sales. Ipsen also has a significant presence in primary care. The Group has close to 4,600 employees worldwide. Ipsen’s shares are traded on segment A of Euronext Paris (stock code: IPN, ISIN code: FR0010259150) and eligible to the “Service de Règlement Différé” (“SRD”). The Group is part of the SBF 120 index. Ipsen has implemented a Sponsored Level I American Depositary Receipt (ADR) program, which trade on the over-the-counter market in the United States under the symbol IPSEY.
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