The field of oncology has always been the focus of new drug research and development, and domestic and international anti-cancer new drugs have been launched. In the first half of the year alone, 16 new anti-cancer therapies and new indications were approved by the US Food and Drug Administration (FDA), and some cancer types even broke the treatment deadlock and ushered in the first targeted drugs, bringing hope to thousands of patients.
So what are the new anti-cancer drugs approved in the first half of the year? As can be seen from the table below, the new drugs approved by the FDA in the first half of the year covered a variety of solid tumors and blood tumor types. Below we briefly introduce these drugs.
1. Drug name: Tucatinib (brand name: Tukysa)
Company name: Seagen
Indication: Colorectal cancer
On January 19, 2023, the FDA approved Tucatinib (TUKYSA) in combination with trastuzumab for previously treated RAS wild-type HER2-positive metastatic colorectal cancer. This is the first FDA-approved treatment for HER2-positive metastatic colorectal cancer.
Tucatinib, an oral small molecule HER2 inhibitor, was approved in 2020 for the treatment of HER2-positive metastatic breast cancer. HER2 is an important therapeutic target for metastatic colorectal cancer, and it is statistically found to be amplified or overexpressed in 3% to 5% of patients with advanced or metastatic colorectal cancer, more likely to appear in the left or right side of the tumor. In the phase II trial code-named MOUNTAINEER (NCT03043313), 84 patients received Tucatinib combined with trastuzumab, and the confirmed objective response rate (ORR) was 38.1%, which means that nearly 40% of patients had tumors that shrank significantly by more than 30% or even disappeared after receiving the new combination regimen. In addition, patients had a median overall survival (OS) of 24.1 months, which is more than 2 years.
2. Drug name: Zanubrutinib (brand name: Brukinsa)
Company Name: Beigene
Indications: chronic lymphocytic leukemia and small lymphocytic lymphoma
On January 19, 2023,the FDA approved zanubrutinib (Brukinsa) for chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL). As the first Chinese local anti-cancer drug to go abroad, Zanubrutinib is a small molecule BTK inhibitor, which is characterized by maximizing the specific binding to BTK targets, thereby minimizing the toxic and side effects caused by off-target effects.
In the phase II Chinese clinical trial BGB-3111-206 (NCT03206970), 86 adult patients with relapsed/refractory (R/R) MCL received 160 mg Zanubrutinib twice daily until disease progression or toxicity became intolerable. The results showed an objective response rate (ORR) of 84% (95% CI, 74% to 91%), with a complete response (CR) rate of 59% and a partial response (PR) rate of 24%. Median follow-up was 18.8 months, and median duration of response (DOR) was 19.5 months (95% CI, 16.6-NE).
In the international phase I/II BGB-3111-AU-003 (NCT02343120) trial, 32 patients with previously treated MCL received zanubrutinib at a total daily dose of 320 mg. The results showed that the ORR was 84% (95% CI, 67%-95%), of which the CR rate was 22% and the PR rate was 62%. At a median follow-up of 18.8 months, the median DOR was 18.5 months (95% CI, 12.6–NE).
3. Drug name: Pembrolizumab (brand name: Keytruda)
Company name: Merck Sharp & Dohme, MSD
Indication: Non-small cell lung cancer
On January 26, 2023, the FDA approved a new indication for the PD-1 inhibitor pembrolizumab for the adjuvant treatment of stage Ib, II or IIIa non-small cell lung cancer after surgical resection and platinum-based chemotherapy. Approved clinical data show that compared with the placebo control group, adjuvant pembrolizumab can significantly prolong the disease-free survival of patients with completely resected non-small cell lung cancer. The median disease-free survival period reached 58.7 months, close to 5 years. The placebo group had only 34.9 months.
4. Drug name: Elacestrant (brand name: Orserdu)
Company name: Stemline
Indication: Breast cancer
On January 27, 2023, the FDA approved Elacestrant for advanced or metastatic breast cancer in postmenopausal women or adult men with ER+, HER2-, ESR1 mutations whose disease has progressed after prior first-line endocrine therapy. Elacestrant is a selective estrogen receptor degrader (SERD), which is also the first oral SERD approved by the FDA. Prior to this, AstraZeneca's Fulvestrant was the only SERD-targeted drug approved for marketing, but it could only be injected intramuscularly.
Elacestrant can dose-dependent degrade estrogen receptor α, and inhibit estradiol-dependent ER-directed gene transcription and tumor growth. Phase III clinical trial EMERALD recruited 478 patients with ER-positive, HER2-negative advanced or metastatic postmenopausal women and men, 228 of whom had ESR1 mutations. The trial required patients with disease progression after prior first-line or second-line endocrine therapy, including first-line therapy containing a CDK4/6 inhibitor. Among 228 patients with ESR1 mutations, median progression-free survival (PFS) was 3.8 months in the elacestrant group and 1.9 months in the fulvestrant/aromatase inhibitor group. In addition, elacestrant reduced the risk of progression by 45%.
5. Drug name: Pirtobrutinib (brand name: LOXO-305)
Company Name: Eli Lilly
On January 27, 2023, the FDA approved Eli Lilly's pirtobrutinib (LOXO-305) for the treatment of relapsed or refractory mantle cell lymphoma (MCL) after receiving at least 2 lines of systemic therapy, including BTK inhibitors. The drug is the first and only non-official (reversible) BTK inhibitor approved by the FDA. BTK plays a key role in the B-cell antigen receptor signaling pathway and is required for the development, activation, and survival of normal leukocytes (B cells) and malignant B cells, and thus serves as an effective molecular target for disease control, including chronic lymphocytic leukemia (CLL), Waldenstrom's macroglobulinemia, mantle cell lymphoma (MCL) and marginal zone lymphoma (MZL).
The global multi-center phase I/II clinical data of LOXO-305 showed that among 139 CLL/SLL patients who could be evaluated for efficacy, the objective response rate (ORR) was 63% (95% CI: 55-71). Among the 121 evaluable patients with previous BTK inhibitor treatment failure, the ORR was 62% (95%CI: 53-71), and the ORR rose to 84% after 10 months or more of follow-up. The degree of remission increased over time.
Observation of the efficacy of LOXO-305 in the treatment of mantle cell lymphoma (MCL).
(Source: 2020 ASH)
6. Drug name: Sacituzumab govitecan-hziy (brand name: Trodelvy)
Company Name: Gilead
Indications: breast cancer
Triple-negative breast cancer (TNBC) accounts for approximately 15% of all breast cancers and is more common in women under the age of 50 than other types of breast cancer. Trop-2 is a cell surface protein that is frequently expressed in many epithelial tumors, including TNBC, and is expressed in more than 90% of TNBC. Trodelvy is a new, first-in-class antibody-drug conjugate targeting Trop-2.
On February 3, 2023, the FDA approved the world's first Trop2 ADC drug Sacituzumab govitecan-hziy (Trodelvy, SG) for unresectable locally advanced or metastatic hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative (IHC 0, IHC 1+ or IHC 2+/ISH-) breast cancer who have received endocrine therapy in the metastatic setting and at least two additional systemic treatments.
In the Phase III ASCENT study (NCT02574455), Trodelvy significantly extended progression-free survival (PFS) compared to chemotherapy (median PFS: 4.8 months vs1.7 months), significantly reduced patients' risk of disease progression or death by 57% (HR=0.43, p < 0.0001), significantly extended overall survival (OS) (median OS: 11.8 months vs 6.9 months), and significantly reduced patients' risk of death by 49% (HR=0.51, p < 0.0001).
7. Drug name: Dostarlimab-gxly (brand name: Jemperli)
Company Name: GlaxoSmithKline
Indications: endometrial cancer
On February 9, 2023,the FDA approved dostarlimab-gxly (Jemperli, dostarimab) for adult patients with deficient mismatch repair (dMMR) recurrent or advanced endometrial cancer whose disease has progressed on or after any type of prior platinum-based regimen and who are not candidates for definitive surgery or radiation. Jemperli is the first anti-PD-1 therapy for the treatment of endometrial cancer in the European and American markets.
GARNET is a multicenter, nonrandomized, multiparallel cohort, open-label study. Most patients (n=81) had received 2 or more kinds of systemic therapies. In the study, patients received Jemperli at a dose of 500 mg every 3 weeks for 4 times, followed by Jemperli at a dose of 1000 mg every 6 weeks until 2 years or until disease progression or drug withdrawal. The primary objective of the study was to assess objective response rate (ORR) and duration of response (DOR) according to RECIST V1.1 by blinded independent central review.
The results showed that among all deficient mismatch repair (dMMR) solid tumors (n=209), the ORR was 41.6% (95% CI: 34.9-48.6), the complete response rate (CR) was 9.1%, and the partial response rate (PR) was 32.5%. The median DOR was 34.7 months (range 2.6-35.8+), and 95.4% of patients had a DOR of 6 months or longer.
8. Drug name: Abemaciclib (brand name: Verzenio)
Company Name: Eli Lilly
Indications: Breast cancer
On March 3, 2023, Eli Lilly announced that the FDA has approved the expansion of indications for abemaciclib (Verzenio)in combination with endocrine therapy (tamoxifen or an aromatase inhibitor) for the adjuvant treatment of adult patients with hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2-), positive lymph nodes, and high risk of early breast cancer. Currently, abemaciclib is still the only CDK4/6 inhibitor approved for adjuvant therapy.
The approval is primarily based on 4-year data from the phase III monarchE study. MonarchE is a global randomized phase 3 trial designed to study the effect of abemaciclib combined with endocrine therapy in patients with HR+/HER2- node-positive, high-risk, early-stage breast cancer.
The latest results showed that after a median follow-up of 42 months, neither group reached the median IDFS, and the addition of abemaciclib to endocrine therapy could significantly reduce the risk of IDFS events by 33.6% (HR 0.664, nominal p<0.0001).
The IDFS benefit of abemaciclib combined with endocrine therapy continued to expand: the estimated 4-year IDFS rate was 85.8% in the abemaciclib combined with endocrine therapy group, compared with 79.4% in the endocrine therapy group alone, with an absolute difference of 6.4%, while the difference at 2 years was 2.8% (92.7% vs 89.9%), and the difference at 3 years was 4.8% (89.2% vs 84.4%).
Abecelixirib combined with endocrine therapy reduced the risk of DRFS by 34% (HR 0.659, nominal p<0.0001). The estimated 4-year DRFS rate was 88.4% in the abemaciclib combined with endocrine therapy group versus 82.5% in the endocrine therapy alone group, an absolute difference of 5.9% compared to a 2.5% difference at 2 years (94.0% vs 91.6%) and a 4.1% difference at 3 years (90.8% vs 86.8%).
9. Drug name: Dabrafenib (brand name: Tafinlar) and trametinib (brand name: Mekinist)
Company Name: Novartis
Indications: Glioma in children
On March 16, 2023, the FDA approved dabrafenib (Tafinlar, Novartis) and trametinib (Mekinist, Novartis) for the treatment of BRAF V600E-mutated pediatric patients 1 year of age and older with low-grade glioma (LGG) who require systemic therapy. The FDA also approved new oral formulations of the two drugs for patients who cannot swallow pills.
The approval is based on positive results from the TADPOLE trial (NCT02684058).
The trial enrolled pediatric cancer patients between the ages of 12 months and 17 years who had low-grade gliomas genetically tested for BRAF V600 mutations, who were inoperable or whose disease progressed after surgical resection and first required systemic therapy. The children were randomized to receive either a new-drug regimen of dabrafenib plus trametinib or a conventional regimen of carboplatin plus vincristine.
Results showed that the objective response rate (ORR) was 46.6% (95% CI, 34.8% - 58.6%) for the 73 patients who received dabrafenib plus trametinib, compared to 10.8% (95% CI, 3.0% - 25.4%) for the 37 patients who received carboplatin plus vincristine (n = 37; P < 0.001). In addition, median progression-free survival (PFS) was 20.1 months with dabrafenib/trametinib compared with 7.4 months with carboplatin/vincristine.
10. Drug name: Retifanlimab-dlwr (brand name: Zynyz)
Company Name: Incyte
Indications: Merkel cell carcinoma
Merkel cell carcinoma is a rare, aggressive skin cancer that tends to appear in adults over the age of 65. Typically presenting as a single painless reddish-purple skin nodule on the sun-exposed head, neck, and arms, this malignant tumor grows rapidly and metastasizes easily, with a poor prognosis. Once metastases appear, the 5-year overall survival (OS) rate is only 14%.
On March 23, 2023, the FDA approved the listing of the fifth PD-1 inhibitor, retifanlimab-dlwr (Zynyz), for the treatment of adults with metastatic or recurrent locally advanced Merkel cell carcinoma.
The approval is based on excellent data from the Phase 2 trial code-named POD1UM-201 (NCT03599713). As of June 16, 2021, 65 patients who are not eligible for radiotherapy or surgery and have not received chemotherapy are evaluable after receiving retifanlimab-dlwr. The results showed that the overall objective response rate (ORR) was as high as 52%, with 18% achieving a complete response (CR), meaning that imaging showed complete disappearance of the target lesion. Duration of response (DOR) ranged from 1.1 months to over 24.9 months. Notably, 76% of patients had sustained responses for at least 6 months, and 62% had responses for 12 months or longer.
11. Drug name: Enfortumab vedotin-ejfv (brand name: Padcev)
Company Name: Astellas
Indications: Urothelial carcinoma
On April 3, 2023, the FDA accelerated approval of enfortumab vedotin-ejfv (Padcev) in combination with Keytruda for the treatment of locally advanced or metastatic urothelial cancer in patients who are not eligible for cisplatin-containing chemotherapy. Padcev is a first-in-class ADC targeting a cell surface protein (Nectin-4) highly expressed in bladder cancer.
The Padcev monotherapy (EV-201 study [NCT03219333] cohort 2) trial is the first study to report objective response data in patients with advanced urothelial carcinoma (UC) whose disease progressed after anti-PD-L1 immunotherapy. Patients were unable to receive cisplatin chemotherapy due to physical conditions. After a median follow-up of 16 months, among patients receiving Padcev treatment, the objective response rate (ORR) was 51% (95%CI: 39.8-61.3), and the complete response rate (CR) was 22%. The median duration of response (DOR) was 13.8 months (95% CI: 6.4-not reached). The median progression-free survival (PFS) was 6.7 months (95%CI: 5.0-8.3), and the median overall survival (OS) was 16.1 months (95%CI: 11.3-24.1).
12. Drug name: Polatuzumab vedotin-piiq (brand name: Polivy)
Company Name: Genentech
Indications: Diffuse large B-cell lymphoma (DLBCL)
On April 19, 2023, the FDA approved Polivy (polatuzumab vedotin), an antibody-drug conjugate targeting CD79b, combined with the R-CHP regimen (rituximab + cyclophosphamide + doxorubicin + prednisone) for the first-line treatment of patients with diffuse large B-cell lymphoma (DLBCL).
The approval is based on data from a randomized, double-blind Phase III POLARIX trial. A total of 879 subjects were included in the study, with 440 subjects in the Polivy+R-CHP group and 439 subjects in the R-CHOP group.
The results showed a statistically significant and clinically meaningful improvement in progression-free survival with Polivy+R-CHP in the first-line treatment of DLBCL compared to R-CHOP therapy. Polivy+R-CHP reduced the risk of disease progression, recurrence or death in patients by 27% (HR=0.73; 95% CI, 0.57-0.95; p<0.02). In terms of safety, the safety of Polivy+R-CHP was comparable to that of R-CHOP. The incidence of grade 3-4 adverse events was about 57%. For the incidence of serious adverse events, the Polivy+R-CHP group was 34%, and the R-CHOP group was 30.6%.
To further improve treatment outcomes in DLBCL, Roche is combining Polivy with its CD20xCD3 bispecific antibody Lunsumio in the phase III SUNMO study in the previously treated disease.
13. Drug name: Epcoritamab (brand name: Epkinly)
Company Name: Genmab US, Inc.
EPKINLY, an IgG1 bispecific antibody drug, can induce T cells in human immune cells to attack cancerous B cells. It targets both CD3 on T cells and CD20 on B cells. On May 19, 2023, the FDA granted accelerated approval to epcoritamab-bysp (Epkinly) for the treatment of relapsed or refractory diffuse large B-cell lymphoma (DLBCL) not otherwise specified, including DLBCL caused by indolent lymphoma and high-grade B-cell lymphoma after two or more systemic therapies. Data on the drug's treatment of follicular lymphoma have also been published, showing that 82% of such patients had tumors that shrank substantially or disappeared.
Approval for this indication is primarily based on data from the EPCORE NHL-1 (NCT03625037) study. The results showed that the objective response rate (ORR) was 61% (95% CI: 53, 69), and the complete response (CR) was 38%. Among responding patients, with a median follow-up of 9.8 months, the estimated median duration of response (DOR) was 15.6 months (95% CI 9.7, not reached).
14. Drug name: Olaparib (brand name: Lynparza)
Company Name: AstraZeneca
Indications: Prostate Cancer
On May 31, 2023, the FDA approved the PARP inhibitor olaparib in combination with abiraterone and prednisone (or prednisolone) for the treatment of adult patients with germline BRCA-mutated (BRCAm) metastatic castration-resistant prostate cancer (mCRPC).
The approval of this indication is based on the efficacy evaluation of clinical research PROpel. The results showed a statistically significant improvement in radiographic progression-free survival (rPFS) with olaparib + abiraterone compared to placebo + abiraterone in the intention-to-treat (ITT) population.
Positive results from the Phase III PROpel study
In an exploratory subgroup analysis of 85 patients with BRCAm mutations, the median rPFS of the olaparib + abiraterone group and the placebo + abiraterone group were not reached vs 8 months, respectively. The OS HR for these patients was 0.30.
Among 711 patients without BRCAm mutations, the rPFS HR was 0.77 and the OS HR was 0.92, suggesting that the rPFS improvement observed in the ITT population was mainly attributable to BRCAm patients.
15. Drug name: Glofitamab-gxbm (brand name: Columvi)
Company Name: Genentech
On June 15, 2023, the FDA accelerated approval of the CD3/CD20 bispecific antibody glofitamab-gxbm (Columvi) for the treatment of adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) or large B-cell lymphoma (LBCL) caused by follicular lymphoma who have received at least two lines of systemic therapy.
Columvi is currently the first and only bispecific antibody for a fixed course of treatment in patients with relapsed or refractory diffuse large B-cell lymphoma. Columvi is the third bispecific antibody approved by the FDA for lymphoma and the second bispecific antibody specifically for DLBCL.
In May of this year, the FDA approved Epkinly (epcoritamab-bysp), the first T cell-binding bispecific antibody for the treatment of DLBCL patients. Both Epkinly and Columvi target CD3 on the surface of T cells and CD20 on the surface of B cells. This dual targeting brings the T cells closer to the B cells, activating the T cells to release cancer-killing proteins. But Columvi differs from Epkinly in that Columvi is a fixed-duration intravenous infusion therapy, while Epkinly is a monthly subcutaneous injection.
The FDA's approval is mainly based on the positive data of the phase I/II study of NP30179. The results showed that 43.0% (57/132) of the patients treated with glofitamab achieved CR, and 56.0% (74/132) of the patients achieved objective response (OR, including CR and partial response). The median duration of response was 1.5 years (18.4 months).
16. Drug name: Talazoparib (brand name: Talzenna)
Company Name: Pfizer
Indications: Prostate Cancer
On June 20, 2023, the FDA approved the PARP inhibitor talazoparib (Talzenna) in combination with enzalutamide for metastatic castration-resistant prostate cancer (mCRPC) with mutations in the homologous recombination repair (HRR) gene.
The approval is based on significantly improved radiographic progression-free survival (rPFS) data from the Phase 3 TALAPRO-2 trial. Statistically and clinically significant radiographic progression-free survival (rPFS) data were observed in the trial. In mCRPC patients with HRR gene mutations (ATM, ATR, BRCA1, BRCA2, CDK12, CHEK2, FANCA, MLH1, MRE11A, NBN, PALB2, or RAD51C), treatment with Talzenna plus enzalutamide reduced the risk of disease progres.
It is believed that with the continuous deepening of medical research, more and more new anti-cancer drugs will be developed and listed. As a professional pharmaceutical intermediates supplier, Huateng Pharma is dedicated to manufacturing and supplying a wide range of anti-cancer API intermediates to serve customers in the world, such as Ribociclib intermediates & Palbociclib intermediates for the treatment of breast cancer, Enzalutamide intermediates for the treatment of prostate cancer, Pralatrexate intermediates for the treatment of lymphoma, non-small-cell lung cancer, breast cancer, and bladder cancer.