FDA Approves Blinatumomab to Treat a Rare Form of Acute Lymphoblastic Leukaemia

First anti-CD19 drug to receive agency approval

The USA Food and Drug Administration (FDA) approved on 3 December, 2014 blinatumomab (Blincyto) to treat patients with Philadelphia chromosome-negative precursor B-cell acute lymphoblastic leukaemia (B-cell ALL), an uncommon form of ALL.

Precursor B-cell ALL is a rapidly growing type of cancer in which the bone marrow makes too many B-cell lymphoblasts, an immature type of white blood cell. The Philadelphia chromosome is an abnormality that sometimes occurs in the bone marrow cells of leukaemia patients.

Blinatumomab is an example of immunotherapy. It is the first approved drug that engages the body’s T-cells, a type of white blood cell or lymphocyte, to destroy leukaemia cells. The drug acts as a connector between a protein called CD19, which is found on the surface of most B-cell lymphoblasts, and CD3, a protein on T-cell lymphocytes. It is intended for patients whose disease relapsed or is refractory to previous treatment.

“Immunotherapies, especially Blincyto with its unique mechanism of action, are particularly promising for patients with leukemia,” said Dr Richard Pazdur, director of the Office of Hematology and Oncology Products in the FDA’s Center for Drug Evaluation and Research. “Recognizing the potential of this novel therapy, the FDA worked proactively with the sponsor under our breakthrough therapy designation program to facilitate the approval of this novel agent.”

The FDA granted blinatumomab breakthrough therapy designation, priority review and orphan product designation because the sponsor demonstrated through preliminary clinical evidence that the drug may offer a substantial improvement over available therapies; the drug had the potential, at the time the application was submitted, to be a significant improvement in safety or effectiveness in the treatment of a serious condition; and the drug is intended to treat a rare disease, respectively. Blinatumomab is being approved more than five months ahead of the prescription drug user fee goal date of May 19, 2015, the date the FDA was scheduled to complete review of the application.

The safety and effectiveness of blinatumomab were evaluated in a clinical study involving 185 adults with Philadelphia chromosome-negative relapsed or refractory precursor B-cell ALL. All participants were treated with blinatumomab for at least four weeks via infusion. Results showed 32% of participants had no evidence of disease (complete remission) for approximately 6.7 months.

Blinatumomab is being approved under the FDA’s accelerated approval programme, which allows approval of a drug to treat a serious or life-threatening disease based on clinical data showing the drug has an effect on a surrogate endpoint reasonably likely to predict clinical benefit to patients. This program provides earlier patient access to promising new drugs while the company conducts confirmatory clinical trials. The FDA is requiring blinatumomab’s manufacturer to conduct a study to verify that the drug improves survival in participants with relapsed or refractory Philadelphia-negative precursor B-cell ALL.

Blinatumomab carries a boxed warning alerting patients and health care professionals that some clinical trial participants had problems with low blood pressure and difficulty breathing (cytokine release syndrome) at the start of the first treatment, encephalopathy or other side effects in the nervous system. The most common side effects seen in blinatumomab-treated participants were pyrexia, headache, peripheral oedema, febrile neutropaenia, nausea, hypokalaemia, fatigue, constipation, diarrhoea and tremor.

The FDA approved blinatumomab with a Risk Evaluation and Mitigation Strategy, which consists of a communication plan to inform health care providers about the serious risks and the potential for preparation and administration errors.

Blincyto is marketed by Thousand Oaks, California-based Amgen Inc.