Reno, Nevada (UroToday.com) -- AstraZeneca and Merck, known as MSD outside of the United States and Canada, announced that LYNPARZA has been approved in the European Union (EU) in combination with abiraterone and prednisone or prednisolone for the treatment of adult patients with metastatic castration-resistant prostate cancer (mCRPC) in whom chemotherapy is not clinically indicated.
This approval by the European Commission follows the positive recommendation from the Committee for Medicinal Products for Human Use received in November this year and was based on the Phase 3 PROpel trial, results of which were published in NEJM Evidence in June 2022.
In PROpel, LYNPARZA in combination with abiraterone and prednisone or prednisolone reduced the risk of disease progression or death by 34% (HR=0.66 [95% CI, 0.54-0.81]; p<0.0001) versus placebo plus abiraterone and prednisone or prednisolone, based on investigator assessment. Median radiographic progression-free survival (rPFS) was 24.8 months for the LYNPARZA plus abiraterone arm (95% CI, 20.5, 27.6) versus 16.6 months for the placebo plus abiraterone arm (95% CI, 13.9, 19.2). A planned sensitivity analysis by blinded independent central review was consistent with the investigator-based analysis, with a median rPFS of 27.6 months for the LYNPARZA plus abiraterone arm compared to 16.4 months for the placebo plus abiraterone arm.
Interim results for the key secondary efficacy endpoint of overall survival (OS) did not reach statistical significance, with an event rate of 37.1% in the LYNPARZA plus abiraterone arm versus 43.1% in the placebo plus abiraterone arm at the time of the analysis (HR=0.83 [95% CI, 0.66-1.03]).
The safety and tolerability of LYNPARZA in combination with abiraterone and prednisone or prednisolone was generally consistent with that of the individual medicines. Approximately 16% of patients who received LYNPARZA in combination with abiraterone and prednisone or prednisolone discontinued treatment due to an adverse event (AE). As previously reported, based on an analysis from the PROpel trial presented earlier this year at the American Society of Clinical Oncology Genitourinary Cancers Symposium, the most common AEs (≥20%) were anemia (46%), fatigue (37%) and nausea (28%). Grade ≥3 AEs were anemia (15%), hypertension (4%), urinary tract infection (2%), fatigue (2%), decreased appetite (1%), vomiting (1%), back pain (1%), diarrhea (1%) and nausea (0.3%).
Prostate cancer is the most commonly diagnosed cancer in men in Europe, with an estimated 473,000 cases and 108,000 deaths in 2020. Approximately 10-20% of patients with prostate cancer are estimated to develop castration-resistant prostate cancer (CRPC) within five years, with at least 84% of these patients presenting with metastases at the time of CRPC diagnosis. Patients diagnosed with advanced prostate cancer have a particularly poor prognosis, with a five-year relative survival rate of about 30%, compared to patients diagnosed with earlier stages of the disease, with a five-year relative survival rate of more than 99%.
Noel Clarke, urological surgeon and professor of urological oncology at Manchester’s Christie/Salford Royal Hospitals and Manchester University, a senior investigator of the PROpel trial, said, “The results of the PROpel Phase 3 trial of olaparib in combination with abiraterone as a first-line treatment show that this therapeutic combination can provide significant clinical benefit to patients with mCRPC. Patients with this condition in the EU will now, for the first time, have the opportunity to benefit from this new treatment combination.”Dave Fredrickson, executive vice president, oncology business unit, AstraZeneca, said, “Many patients with mCRPC are only able to receive one line of active therapy, as the disease can progress quickly. LYNPARZA in combination with abiraterone has been shown to reduce the risk of disease progression by 34% versus the standard of care treatment in the PROpel trial. Moreover, the combination of LYNPARZA with abiraterone as a first-line treatment expands the use of LYNPARZA to a broader group of mCRPC patients than those treated with LYNPARZA alone in the second-line setting in the PROfound trial. Today’s approval marks a significant advance toward addressing the unmet need of patients with mCRPC in the EU.”
Dr. Eliav Barr, senior vice president, head of global clinical development and chief medical officer, Merck Research Laboratories, said, “Merck is committed to developing new treatment options for patients with mCRPC, a complex disease that urgently needs more therapies. This approval by the European Commission marks another step toward delivering on that commitment, and we look forward to extending the benefits of LYNPARZA to more patients with mCRPC in the EU.”
Use of LYNPARZAin combination with abiraterone and prednisone or prednisolone is currently under review by the U.S. FDA for the treatment of adult patients with mCRPC. LYNPARZA is approved in the U.S. as monotherapy for patients with homologous recombination repair (HRR) gene-mutated mCRPC (BRCA-mutated and other HRR gene mutations) who have progressed following prior treatment with enzalutamide or abiraterone and in the EU, Japan and China for patients with BRCA-mutated mCRPC who have progressed following prior therapy that included a new hormonal agent (NHA). These approvals were based on the data from the Phase 3 PROfound trial.
Source: “Lynparza® (OLAPARIB) in Combination with Abiraterone and Prednisone or Prednisolone Approved in the EU as Treatment for Certain Patients with Metastatic Castration-Resistant Prostate Cancer.” Merck.com, December 21, 2022.