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EMA 审查柔红霉素和阿糖胞苷包封在脂质体中(Vyxeos,CPX-351)用于治疗新诊断的成人、治疗相关的急性髓系白血病或伴骨髓增生异常相关改变的急性髓系白血病。

EMA Review of Daunorubicin and Cytarabine Encapsulated in Liposomes (Vyxeos, CPX-351) for the Treatment of Adults with Newly Diagnosed, Therapy-Related Acute Myeloid Leukemia or Acute Myeloid Leukemia with Myelodysplasia-Related Changes.

机构信息

European Medicines Agency, Amsterdam, The Netherlands.

Committee for Medicinal Products for Human Use (CHMP), Amsterdam, The Netherlands.

出版信息

Oncologist. 2020 Sep;25(9):e1414-e1420. doi: 10.1634/theoncologist.2019-0785. Epub 2020 Apr 13.


DOI:10.1634/theoncologist.2019-0785
PMID:32282100
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7485353/
Abstract

On June 28, 2018, the Committee for Medicinal Products for Human Use adopted a positive opinion, recommending the granting of a marketing authorization for the medicinal product Vyxeos, intended for the treatment of acute myeloid leukemia (AML). Vyxeos was designated as an orphan medicinal product on January 11, 2012. The applicant for this medicinal product was Jazz Pharmaceuticals Ireland Limited. Vyxeos is a liposomal formulation of a fixed combination of daunorubicin and cytarabine, antineoplastic agents that inhibit topoisomerase II activity and also cause DNA damage. The strength of Vyxeos is 5 units/mL, where 1 unit equals 1.0 mg cytarabine plus 0.44 mg daunorubicin. The marketing authorization holder Jazz Pharmaceuticals had found that this was an optimal ratio for the efficacy of the product. Study CLTR0310-301, a phase III, multicenter, randomized, trial of Vyxeos (daunorubicin-cytarabine) liposome injection versus standard 3+7 daunorubicin and cytarabine in patients aged 60-75 years with untreated high-risk (secondary) AML, showed a statistically significant difference between the two groups in overall survival (OS) with a median OS of 9.56 months in the daunorubicin-cytarabine arm compared with 5.95 months for standard chemotherapy (hazard ratio, 0.69; 95% confidence interval, 0.52-0.90; one-sided p = .003). The most common side effects were hypersensitivity including rash, febrile neutropenia, edema, diarrhea/colitis, mucositis, fatigue, musculoskeletal pain, abdominal pain, decreased appetite, cough, headache, chills, arrhythmia, pyrexia, sleep disorders, and hypotension. IMPLICATIONS FOR PRACTICE: Vyxeos has demonstrated a clinically significant improvement in overall survival compared with the standard of care 7+3 in the proposed population of patients with newly diagnosed acute myeloid leukemia (AML) with myelodysplasia-related changes and therapy-related AML. This is remarkable given the very poor prognosis of these patients and their unmet medical need. Secondary endpoints support the primary outcome, in particular an increased rate of hematopoietic stem cell transplantation, which is potentially the only curative treatment in AML.

摘要

2018 年 6 月 28 日,人用药品委员会发表积极意见,建议批准用于治疗急性髓细胞白血病(AML)的药物 Vyxeos 的营销授权。Vyxeos 于 2012 年 1 月 11 日被指定为孤儿药。该药物的申请人是 Jazz Pharmaceuticals Ireland Limited。Vyxeos 是一种多柔比星和阿糖胞苷固定组合的脂质体制剂,属于抑制拓扑异构酶 II 活性并导致 DNA 损伤的抗肿瘤药物。Vyxeos 的强度为 5 单位/毫升,其中 1 单位等于 1.0 毫克阿糖胞苷加 0.44 毫克多柔比星。营销授权持有人 Jazz Pharmaceuticals 发现,这是产品疗效的最佳比例。CLTR0310-301 是一项 III 期、多中心、随机、试验,比较了 Vyxeos(多柔比星-阿糖胞苷)脂质体注射与标准的 3+7 多柔比星和阿糖胞苷在未经治疗的高危(继发性)AML 且年龄在 60-75 岁的患者中的疗效,结果显示在总生存期(OS)方面,两组之间存在统计学差异,多柔比星-阿糖胞苷组的中位 OS 为 9.56 个月,而标准化疗组为 5.95 个月(风险比,0.69;95%置信区间,0.52-0.90;单侧 p =.003)。最常见的副作用是过敏反应,包括皮疹、发热性中性粒细胞减少症、水肿、腹泻/结肠炎、黏膜炎、疲劳、肌肉骨骼疼痛、腹痛、食欲下降、咳嗽、头痛、寒战、心律失常、发热、睡眠障碍和低血压。实践意义:Vyxeos 与标准的 7+3 相比,在新诊断的伴 MDS 相关改变和治疗相关 AML 的急性髓细胞白血病(AML)患者的目标人群中,在总生存期方面具有显著的临床改善,这是值得注意的,因为这些患者的预后非常差,且存在未满足的医疗需求。次要终点支持主要结果,特别是造血干细胞移植率的增加,这可能是 AML 唯一的治愈性治疗。

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EMA Review of Daunorubicin and Cytarabine Encapsulated in Liposomes (Vyxeos, CPX-351) for the Treatment of Adults with Newly Diagnosed, Therapy-Related Acute Myeloid Leukemia or Acute Myeloid Leukemia with Myelodysplasia-Related Changes.

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