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Treatment of advanced kidney cancer: Nexavar approved in Europe


European Commission has granted marketing authorization to Nexavar ( Sorafenib ) tablets for the treatment of patients with advanced renal cell carcinoma who have failed prior Interferon-alpha or Interleukin-2 based therapy or are considered unsuitable for such therapy.
The decision by the European Commission to grant marketing authorization to Nexavar followed a positive opinion issued by the European Medicines Agency's Committee on Medicinal Products for Human Use ( CHMP ) in April this year.
Nexavar was approved by the U.S. Food and Drug Administration (FDA) in December 2005.

Nexavar EMEA approval was based on phase III data from the largest randomized, placebo-controlled trial ever conducted in patients with advanced renal cell carcinoma.
In the phase III study, Nexavar doubled progression-free survival in previously treated patients when compared to placebo. Progression-free survival measures the time that a patient lives without evident tumor growth.
In this study, PFS was doubled to a median value of six months in patients receiving Nexavar as compared to three months for patients receiving placebo ( p-value < 0.000001 ).
All subgroups examined, including patients who had not received conventional treatment with biologics, such as Interleukin-2 or Interferon-alpha, appeared to benefit as well.

In April 2005, Bayer and Onyx discussed the clinical and statistical significance of this analysis with the principal investigators, an independent data monitoring committee ( DMC ), and with regulatory authorities and decided that it would not be ethical to continue the study with a placebo-control arm. The companies immediately recommended that all patients in the trial be offered access to Nexavar. In parallel, an interim analysis of overall survival was conducted. The median overall survival for placebo was 14.7 months, while the median overall survival for Nexavar had not been reached ( p=0.018, hazard ratio, HR=0.72 ).

In June 2006, a further interim analysis of overall survival was presented, based on 367 deaths and after 48 percent of the placebo patients ( N=217 ) had crossed over to Nexavar. Median overall survival for this analysis was 19.3 months for Nexavar patients versus 15.9 months for placebo patients ( p=0.015, HR=0.77 ). Although these data did not reach the pre-specified result required for statistical significance and to stop the overall survival analysis early, they suggest a favorable survival trend for patients who received Nexavar.
The final analysis of overall survival is planned when 540 events are observed.

Nexavar is an oral multi-kinase inhibitor that targets both the tumor cell and tumor vasculature. In preclinical models, Nexavar targeted members of two classes of kinases known to be involved in both cell proliferation and angiogenesis, two important processes that enable cancer growth. These kinases included RAF kinase, VEGFR-1, VEGFR-2, VEGFR-3, PDGFR- B, KIT, and FLT-3.

Every year, more than 200,000 people around the world are diagnosed with kidney cancer and more than 102,000 die from the disease. In Europe, there are more than 46,000 new cases of kidney cancer annually. At the time of diagnosis, the cancer has already metastasized in about one-third of people with kidney cancer.

Source: EMEA, 2006

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