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Atezolizumab, an anti-PD-L1 drug, for advanced bladder cancer, FDA has granted priority review


The FDA ( Food and Drug Administration ) has granted Priority Review for Atezolizumab ( anti-PD-L1; MPDL3280A ) for the treatment of people with locally advanced or metastatic urothelial carcinoma ( mUC ) who had disease progression during or following Platinum-based chemotherapy in the metastatic setting, or whose disease worsened within 12 months of receiving Platinum-based chemotherapy before surgery ( neoadjuvant ) or after surgery ( adjuvant ).
Urothelial carcinoma accounts for 90% of all bladder cancers and can also be found in the renal pelvis, ureter and urethra.

A Priority Review designation is granted to medicines that the FDA has determined to have the potential to provide significant improvements in the safety and effectiveness of the treatment, prevention or diagnosis of a serious disease.
Atezolizumab was granted Breakthrough Therapy designation by the FDA in May 2014 for the treatment of people whose metastatic bladder cancer expresses the protein PD-L1 ( programmed death ligand-1 ).
Breakthrough Therapy designation is designed to expedite the development and review of medicines intended to treat serious or life-threatening diseases and to help ensure that people have access to them through FDA approval as soon as possible.

The BLA ( Biologics License Application ) submission for Atezolizumab is based on results of the IMvigor 210 phase II study.

IMvigor 210 is an open-label, multicenter, single-arm phase II study that evaluated the safety and efficacy of Atezolizumab in people with locally advanced or mUC, regardless of PD-L1 expression.
People in the study whose disease had progressed during or following previous treatment with a Platinum-based chemotherapy regimen ( n=311 ) received a 1200-mg intravenous dose of Atezolizumab on day one of 21-day cycles until loss of clinical benefit.
The primary endpoint of the study was objective response rate ( ORR ) as assessed by an independent review facility ( IRF ) using Response Evaluation Criteria in Solid Tumors ( RECIST ) v1.1.
Secondary endpoints included duration of response ( DOR ), overall survival, progression-free survival and safety.
In an updated analysis based on 11.7 months of median follow up, Atezolizumab shrank tumors ( ORR ) in 15% ( 95% CI: 11, 19 ) of people evaluable for efficacy and safety ( n=310 ) whose disease progressed after Platinum-based chemotherapy.
Atezolizumab shrank tumors in 26% ( 95% CI: 18, 36 ) of people whose disease had medium and high levels of PD-L1 expression ( n=100 ). Median DOR was not reached at the time of analysis; with a median duration of follow up of 11.7 months, 84% ( 38/45 ) of people had an ongoing response.
The most common grade 3 to 4 treatment-related adverse events included: fatigue ( 2% ), decreased appetite, fever ( pyrexia ), anemia, enzymes in the blood ( ALT and AST increase ), joint pain ( arthralgia ), difficulty breathing ( dyspnea ), inflammation of the lung wall ( pneumonitis ), inflammation of the lining of the colon ( colitis ), hypertension and hypotension ( all 1% ). There were no treatment-related grade 5 adverse events.

Atezolizumab is an investigational monoclonal antibody designed to bind with a protein called programmed death ligand-1 ( PD-L1 ). Atezolizumab is designed to directly bind to PD-L1 expressed on tumor cells and tumor-infiltrating immune cells, blocking its interactions with PD-1 and B7.1 receptors. By inhibiting PD-L1, Atezolizumab may enable the activation of T cells. Atezolizumab may also affect normal cells.

According to the American Cancer Society ( ACS ), it is estimated that more than 76,000 Americans will be diagnosed with bladder cancer in 2016, and about 11% of new diagnoses are made when bladder cancer is in advanced stages.
There is a dramatic difference in survival rates between early and advanced bladder cancer.
The ACS estimates that approximately 96% of people will live five or more years when diagnosed with the earliest stage of the disease, compared to 39% when diagnosed in advanced stages ( stage III-IV ) of the disease.
Men are about three to four times more likely to get bladder cancer during their lifetime than women. ( Xagena )

Source: Roche, 2016

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