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FDA Approves Mitomycin for Low Grade Upper Tract Urothelial Cancer

Efficacy of mitomycin for pyelocaliceal use is determined in an ongoing OLYMPUS trial
17 Apr 2020
Anticancer agents & Biologic therapy;  Genitourinary cancers

On 15 April 2020, the US Food and Drug Administration (FDA) approved mitomycin (JELMYTO, UroGen Pharma) for adult patients with low grade upper tract urothelial cancer (LG UTUC).

Efficacy determination was based on OLYMPUS (NCT02793128), an ongoing, single-arm, multicentre trial enrolling 71 patients with treatment-naïve or recurrent low grade non-invasive UTUC with at least one measurable papillary tumour located above the ureteropelvic junction. Patients who had larger tumours could have had prior tumour debulking.

Patients received weekly JELMYTO 4 mg per mL instillations via ureteral catheter or nephrostomy tube for 6 weeks. For patients with a complete response (CR) at 3 months, instillations were to be administered monthly for a maximum of 11 additional instillations.

The major efficacy outcome measures were CR and CR durability. The CR was defined as complete absence of tumour lesions 3 months after JELMYTO initiation and was assessed by urine cytology and ureteroscopy. If warranted, a biopsy was performed. In total, 41 patients (58%) achieved a CR three months following treatment initiation and were continued in follow-up; 29 patients received at least one dose of maintenance therapy.

Durability of response in those with CRs was evaluated at 3, 6, 9 and 12 months, following the CR determination. Seven patients had documented recurrences and 19 patients remained in CR at 12-months following CR determination. The median response duration had not been reached (range: 0, 18.8+ months). 

The most common adverse reactions (≥ 20%) in patients who received JELMYTO were ureteric obstruction, flank pain, urinary tract infection, haematuria, renal dysfunction, fatigue, nausea, abdominal pain, dysuria, and vomiting. Ureteric obstruction occurred in 58% of those receiving JELMYTO and required ureteral stent placement in 88% of these patients.

The recommended JELMYTO dose is 4 mg per mL instilled via ureteral catheter or nephrostomy tube, with total instillation volume based on volumetric measurements using pyelography, not exceeding 15 mL (60 mg mitomycin).

Full prescribing information for JELMYTO is available here.

This review used the Assessment Aid, a voluntary submission from the applicant to facilitate the FDA’s assessment.

FDA granted this application priority review, fast track and breakthrough therapy designation.

Healthcare professionals should report all serious adverse events suspected to be associated with the use of any medicine and device to FDA’s MedWatch Reporting System.

For assistance with single-patient INDs for investigational oncology products, healthcare professionals may contact FDA’s Oncology Center of Excellence Project Facilitate.

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