Phase 2 Study Suggests That Extended Dosing of Aranesp is as Efficacious as Weekly Dosing
Additionally, results from two combined patient level analyses suggest that patients treated with Aranesp experienced a decrease in blood transfusions and improvement in hematologic response. These analyses do not suggest a negative impact on overall survival or progression-free survival between patients receiving chemotherapy treatment with Aranesp and those that did not receive Aranesp treatment. These data were presented at the 14th European Cancer Conference (ECCO) in Barcelona, Spain (Abstract # 1.141, 1.120, 1.104).
About the Phase 2 Study
This Phase 2 study is the first prospective trial illustrating how various Aranesp dosing regimens can be paired with chemotherapy administered across a range of dosing schedules.
"Flexibility in dosing is important for physicians to optimize anemia management and meet patient needs," said Timothy Rearden, M.D., Hematology Oncology Consultant, Inc. "In this study, Aranesp was consistently effective regardless of dosing frequency, providing healthcare professionals with the ability to adapt Aranesp treatment as required."
The mean change in Hb from baseline to week 13 was comparable between extended dosing (every two or every three weeks depending on chemotherapy regimen) and weekly dosing. The percentage of patients who achieved a Hb greater than or equal to 11 g/dL by Kaplan-Meier estimates was also similar (76 percent for weekly dosing and 71 percent for extended dosing).
The trial was a Phase 2, 25-week open-label study to evaluate non-inferiority of Aranesp in patients with anemia as a result of chemotherapy treatment who were randomized 1:1 to either an extended dosing schedule (n=378) or a weekly schedule (n=374).
Patients in the arm receiving an extended dose schedule of Aranesp received 300 mcg Q2W if chemotherapy treatment (CTX) was QW, Q2W, or Q4W or 500 mcg Q3W if CTX was Q3W. Patients in the arm receiving a weekly schedule of Aranesp (DA-QW) received 150 mcg QW regardless of CTX schedule. The QW and Q2W fixed dosing schedules utilized in this study are not approved dosing options. Q3W 500 mcg fixed dosing is the recommended initial dose with alternate weight based dosing options available at QW and Q3W.
Stratification factors were chemotherapy cycle length, screening Hb (less than 10 g/dL versus greater than or equal to 10 g/dL) and type of cancer (lung/gynecological versus other cancers). The primary endpoint was change in Hb from baseline to week 13. Demographics between the two groups were broadly similar.
Aranesp Combined Patient Level Analyses Results
Two combined analyses reported patient level data from six Amgen-sponsored, placebo-controlled, randomized trials of Aranesp to treat anemia as a result of chemotherapy in patients with screening Hb less than or equal to 11 - 13 g/dL, nonmyeloid malignancies, greater than or equal to one prior chemotherapy cycle, and additional planned chemotherapy cycles. Amgen presented the results of these combined patient level analyses at the U.S. Food and Drug Administration's Oncologic Drugs Advisory Committee meeting in May 2007.
While preserving initial randomization, patient level data from 2,112 patients was analyzed to determine differences between Aranesp (n=1,200) treatment and placebo (n=912). The results suggest that patients treated with Aranesp experienced a decrease in blood transfusions, improvement in hematologic response, and an expected increased risk of thromboembolic events (TE). No differences in risks of death, disease progression or progression-free survival were observed between the two groups.
"The results of these combined patient level analyses further add to the large scientific body of evidence that ESAs are safe and effective when used according to their approved label. The increased risk of TEs has long been observed and appropriately represented for in class labeling for ESAs," said Heinz Ludwig, M.D., Center for Oncology and Haematology, Wilhelminen Hospital, Vienna, Austria.
The Aranesp group had an approximate 54 percent relative risk reduction for transfusions (HR: 0.46, 95 percent CI: 0.39, 0.55) and also were approximately more than twice as likely to achieve a hematopoietic response (HR: 2.40, 95 percent CI: 2.10, 2.75). The relative risk for TEs was approximately 50 percent higher in the Aranesp group (HR: 1.57, 95 percent CI: 1.10, 2.26). The rates of TEs were eight percent in patients treated with Aranesp and five percent in placebo patients. These rates are similar to what has been reported in current product labeling.
A second combined analysis evaluated the association between achieved Hb levels or rates of Hb increase and safety outcomes in anemic cancer patients undergoing chemotherapy. The analysis included 1,200 patients treated with Aranesp. Achieving a Hb greater than 12 or 13 g/dL or a Hb increase of greater than 1 g/dL in 14 days or greater than 2 g in 28 days did not appear to be associated with an increased risk of death or disease progression. Risk of TEs was not clearly related to achieving Hb of greater than 12 or greater than 13, although rates of rise greater than 1g in 14 days and greater than 2 g in 28 days were associated with a trend towards increased risk. These risks of TEs are consistent with those already noted in ESA product labels.
A similar pattern was seen when deaths were identified during a study's follow-up period. No increased risk of disease progression and progression-free survival was seen in patients who achieved a Hb greater than 12 g/dL, Hb greater than 13 g/dL, a Hb increase of greater than 1 g/dL in 14 days or greater than 2 g in 28 days. It should be recognized that in this combined analysis, the patients ability to respond is an important potential confounder.
The results of the combined analyses presented at ECCO appear to suggest that patients receiving chemotherapy who are able to reach a Hb level of above 12 g/dL do not experience an increased risk of on-study death and disease progression. A higher rate of TEs was associated with increased rates of Hb increase, which is a recognized risk in this patient population treated with ESAs. These data provide further information regarding the relationship of achieved Hb and safety outcomes for Aranesp.
Aranesp is a recombinant erythropoiesis-stimulating protein (a protein that stimulates production of red blood cells, which carry oxygen). Amgen revolutionised the treatment of anaemia with the development of recombinant erythropoietin, Epoetin alfa. Building on this heritage, Amgen developed Aranesp, a unique erythropoiesis stimulating protein, which contains two additional sialic acid-containing carbohydrate chains compared to the epoetin alfa and epoetin beta molecule and remains in the bloodstream longer than epoetin alfa and epoetin beta as demonstrated by its longer half-life.
Aranesp was granted marketing authorisation by the European Commission in 2001 for the treatment of anaemia associated with chronic renal failure (CRF), also known as chronic kidney disease (CKD), in adults and paediatric subjects 11 years of age or older. In 2002, the European Commission approved Aranesp for the treatment of anemia in adult cancer patients receiving chemotherapy with solid tumors. This patient population was subsequently expanded in 2003 to include treatment of symptomatic anaemia in adult cancer patients with non-myeloid malignancies receiving chemotherapy. Approval was granted in 2004 for extended dosing intervals of once-every-three-weeks in the treatment of anemia in adult cancer patients with non-myeloid malignancies who are receiving chemotherapy and up to once-per-month Aranesp administration in the treatment of anemia in CKD patients not on dialysis. In 2006, the Aranesp label was updated to allow CKD patients on dialysis to switch from rHuEPO one to three times a week to Aranesp every two weeks. In 2007, the Aranesp label was updated to allow for treatment of anaemia associated with CRF, in all European paediatric patients on dialysis or not on dialysis.
Aranesp was approved by the U.S. Food and Drug Administration (FDA) in September 2001 for the treatment of anemia associated with CRF for patients on dialysis and patients not on dialysis. In July 2002, the FDA approved weekly dosing of Aranesp for the treatment of anemia caused by concomitantly administered chemotherapy in patients with nonmyeloid malignancies and in March 2006, the FDA approved every-three-week dosing in these patients.
Important EU Aranesp Safety Information
Aranesp is contraindicated in patients with uncontrolled hypertension. Erythropoietic therapies may increase the risk of thrombotic and other serious events; regional guidelines should be referred to for target and maximum hemoglobin levels, and dose adjustment rules should be performed in line with regional prescribing information.
The most commonly reported side effects in clinical trials were arthralgia, edema, injection site pain and thromembolic event reactions. Prescribers are recommended to consult regional prescribing information before prescribing Aranesp, including side-effects, precautions and contra-indications.
Important U.S. Aranesp Safety Information
Use the lowest dose of Aranesp(R) that will gradually increase the hemoglobin concentration to the lowest level sufficient to avoid the need for red blood cell transfusion.
Aranesp(R) and other erythropoiesis-stimulating agents (ESAs) increased the risk for death and for serious cardiovascular events when administered to target a hemoglobin of greater than 12 g/dL
Cancer Patients: Use of ESAs
-- Shortened the time to tumor progression in patients with advanced head and neck cancer receiving radiation therapy when administered to target a hemoglobin of greater than 12 g/dL,
-- Shortened overall survival and increased deaths attributed to disease progression at 4 months in patients with metastatic breast cancer receiving chemotherapy when administered to target a hemoglobin of greater than 12 g/dL,
-- Increased the risk of death when administered to target a hemoglobin of 12 g/dL in patients with active malignant disease receiving neither chemotherapy or radiation therapy. ESAs are not indicated for this population.
Patients receiving ESAs pre-operatively for reduction of allogeneic red blood cell transfusions: A higher incidence of deep venous thrombosis was documented in patients receiving Epoetin alfa who were not receiving prophylactic anticoagulation. Aranesp(R) is not approved for this indication.
Aranesp is contraindicated in patients with uncontrolled hypertension.
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Posted: September 2007