ZYTIGA® Receives Positive Regulatory Recommendation in the European Union
for Treatment of Metastatic Castration-Resistant Prostate Cancer before
BEERSE, Belgium -- November 19, 2012
Janssen-Cilag International NV (Janssen) announced today that the Committee
for Medical Products for Human Use (CHMP) of the European Medicines Agency
(EMA) has granted a positive opinion recommending approval of the oral,
once-daily medication ZYTIGA^® (abiraterone acetate) for use in combination
with prednisone or prednisolone in the treatment of metastatic
castration-resistant prostate cancer (mCRPC), in adult men who are
asymptomatic or mildly symptomatic after failure of androgen deprivation
therapy and in whom chemotherapy is not yet clinically indicated.^1 If
endorsed by the European Commission, the recommendation would expand the
indication for ZYTIGA^®, which is currently approved for use in combination
with prednisone/prednisolone to treat men with mCRPC whose disease has
progressed on or after a docetaxel-based chemotherapy regimen.
In February 2012 an Independent Data Monitoring Committee (IDMC) unanimously
recommended unblinding the Phase III COU-AA-302 study^2 on which this CHMP
recommendation is based after a pre-specified analysis found statistically
significant differences in radiographic progression-free survival (rPFS) and a
strong trend in overall survival (OS) favouring ZYTIGA^®. Based on these
results, the IDMC also recommended that patients in the control arm be offered
treatment with ZYTIGA^®. Patients in the ZYTIGA arm also demonstrated a
statistically significant difference in all the secondary endpoints compared
to the control arm.
The CHMP is the committee responsible for the scientific assessment of
products seeking centralised marketing authorisation throughout the European
Union. The CHMP’s positive opinion is now referred for approval to the
European Commission. Janssen anticipates receiving the regulatory decision
from the Commission in early 2013.
Jane Griffiths, Company Group Chairman, Janssen Europe, Middle-East, Africa,
commented, “This positive opinion brings us a step closer to being able to
offer ZYTIGA^® to advanced cancer patients earlier in the course of their
disease and fills a previously unmet medical need. If approved, the expanded
indication will provide a welcome new option for patients with
castration-resistant prostate cancer. It could not only give men a chance of
extended survival, but may also delay the need for chemotherapy and help to
improve their quality of life.”
NOTES TO EDITORS
About the COU-AA-302 study^2
Study COU-AA-302 is a Phase III, international, randomised, double-blind,
placebo controlled study which evaluated ZYTIGA^® plus prednisone/prednisolone
compared to placebo plus prednisone/prednisolone in 1,088 asymptomatic or
mildly symptomatic men with mCRPC who had not received prior chemotherapy.
Patients were randomised 1:1 to receive either abiraterone acetate (ZYTIGA^®)
1,000 milligrams (mg) administered orally once daily plus
prednisone/prednisolone 5 mg administered twice daily or placebo plus
prednisone/prednisolone 5 mg administered twice daily. The co-primary
endpoints of the study are radiographic progression-free survival (rPFS) and
overall survival (OS).
This is the first randomised study to demonstrate a rPFS benefit and an OS
trend in this patient population. The COU-AA-302 results were presented at the
48th Annual Meeting of theAmerican Society of Clinical Oncology(ASCO) in
The data demonstrated a statistically significant improvement in rPFS in the
abiraterone acetate plus prednisone/prednisolone arm (ZYTIGA^® arm) of the
study compared to the placebo plus prednisone/prednisolone (control) arm. The
median rPFS in the control arm was 8.3 months but had not yet been reached in
the ZYTIGA^® arm at the time of the final analysis for rPFS (N=251 vs. 150,
respectively). These results reached statistical significance with a p value
<0.0001 and a hazard Ratio (HR) of 0.43, with a 95% confidence interval (CI):
Additionally, treatment with ZYTIGA^® plus prednisone/prednisolone resulted in
a longer overall survival than with placebo; HR=0.752; 95% CI: 0.606; 0.934
(median overall survival in the ZYTIGA^® arm was not reached because
progression events occurred more slowly in the ZYTIGA^® arm compared to the
control arm, in which median overall survival was 27.2 months; HR=0.75; 95%
CI: [0.61, 0.93], p=0.0097). At the time of the interim analysis, statistical
significance was not reached.
Treatment with ZYTIGA^® plus prednisone also demonstrated significant
improvements in secondary study endpoints compared to the control arm,
specifically, longer time until:
*Opiate use for cancer pain: the median time in the ZYTIGA^® arm was not
reached and was 23.7 months in the control arm (HR=0.69; 95% CI: [0.57,
*Initiation of cytotoxic chemotherapy for prostate cancer: 25.2 months for
the ZYTIGA^® arm vs. 16.8 months for the control arm (HR=0.58 [95% CI:
0.49, 0.69]; p<0.0001).
*Deterioration in performance status: 12.3 months for the ZYTIGA^® arm vs.
10.9 months for the control arm (HR=0.82; 95% CI: [0.71, 0.94]; p=0.0053)
for an increase in the Eastern Cooperative Oncology Group (ECOG)
performance score of one point or more. The ECOG performance score is a
standard measure used to assess functional status of a patient and is
often used to determine prognosis and appropriate treatment.
*PSA progression: 11.1 months for the ZYTIGA^® arm vs. 5.6 months for the
control arm (HR=0.49; 95% CI: [0.42, 0.57], p<0.0001), based on The
Prostate Cancer Clinical Trials Working Group (PCWG2) criteria.
Patients in the ZYTIGA^® arm of the study experienced more grade 3 and grade 4
adverse events than those in the control arm, including cardiac disorders (6%
vs. 3%) and hypertension (4% vs. 3%), as well as increases in alanine
aminotransferase (ALT) and aspartate aminotransferase (AST) (5.4% vs. 0.8% and
3.0% vs. 0.9%, respectively). Fatigue was the most common adverse event
observed in the study.
About metastatic castration-resistant prostate cancer
Metastatic castration-resistant prostate cancer occurs when cancer has
metastasised (spread) beyond the prostate to other parts of the body and the
disease progresses despite serum testosterone below castrate levels.^3
The prostate is a gland in men that produces part of the seminal fluid and is
located around the urethra (under the bladder). In some cases, cancer of the
prostate can grow slowly. However, depending on factors including
characteristics specific to the patient and the tumour, prostate cancer also
can grow very quickly and spread widely.^4
In 2008, an estimated 370,000 new cases of prostate cancer were diagnosed in
Europe, and nearly 90,000 men died from the disease.^5
Since its approval in 2011, ZYTIGA^® has been approved in more than 60
countries worldwide, many thousands of men have received treatment with it,
and it is quickly becoming one of the cornerstones of our oncology offerings.
ZYTIGA^® is the only approved therapy that inhibits production of androgen,
which fuels prostate cancer growth, via inhibiting the CYP17 enzyme complex
present at three sources: the testes, adrenals and the tumour itself.
ZYTIGA^® in combination with prednisone/prednisolone was approved by the
European Medicines Agency (EMA) in September 2011, for the treatment of
metastatic castration-resistant prostate cancer (mCRPC) in adult men whose
disease has progressed on or after a docetaxel-based chemotherapy regimen.
ZYTIGA^® in combination with prednisone was approved by the U.S. Food and Drug
Administration (FDA) in April 2011 for the treatment of men with metastatic
castration-resistant prostate cancer who have received prior chemotherapy
In June 2012, Janssen simultaneously submitted a supplemental New Drug
Application (sNDA) to the U.S. Food and Drug Administration (FDA) for ZYTIGA^®
and a type II variation to the European Medicines Agency (EMA). Both
applications are intended to extend the use of ZYTIGA^® administered with
prednisone or prednisolone to include the treatment of adult men with
metastatic castration-resistant prostate cancer who are asymptomatic or mildly
symptomatic after failure of androgen deprivation therapy and in whom
chemotherapy is not yet clinically indicated.
Important Safety Information^6
DOSAGE & ADMINISTRATION:
In adults, the recommended dose of ZYTIGA^® is 1000 mg (4 tablets) single
daily dose. It must not be taken with food as this increases systemic exposure
to abiraterone (take dose at least two hours after eating; no food for at
least one hour post-dose). Tablets should be swallowed whole with water and
taken with the recommended dose of prednisone or prednisolone (10 mg daily).
In the event of a missed daily dose, treatment should be resumed the following
day with the usual daily dose.
Medical castration with LHRH analogue should be continued during treatment in
patients not surgically castrated.
Renal impairment: No dose adjustment is required, however caution is advised
as there is no previous experience in patients with prostate cancer and severe
Hepatotoxicity: If hepatotoxicity develops (serum ALT or AST above five times
the upper limit of normal), stop treatment immediately until liver function
returns to baseline; restart ZYTIGA^® at 500 mg (2 tablets) once daily and
monitor serum transaminases at least every two weeks for three months and
monthly thereafter (see full prescribing information). If hepatotoxicity
recurs at the reduced dose, stop treatment. If severe hepatotoxicity develops
(ALT or AST 20 times the upper limit of normal), discontinue ZYTIGA^® and do
Hepatic impairment: No dose adjustment is required in mild cases (Child-Pugh
Class A). In moderate cases (Child-Pugh Class B) systemic exposure is
increased by approximately four times after a single oral dose of 1,000mg. In
moderate cases (Child-Pugh Class B) there is no clinical data for multiple
doses and treatment with ZYTIGA^® should be cautiously assessed and the
benefit clearly should outweigh the possible risks. It should not be used in
patients with severe hepatic impairment.
ZYTIGA^® is contraindicated in women who are pregnant or may potentially be
pregnant, in people hypersensitive to the active substance or any excipients
and in people with severe hepatic impairment [Child-Pugh Class C].
SPECIAL WARNINGS & PRECAUTIONS:
Mineralocorticoid excess-related: ZYTIGA® may cause hypertension, hypokalaemia
and fluid retention due to mineralocorticoid excess from CYP17 inhibition.
Reduced incidence and severity is associated with corticosteroid
administration. Caution is required in patients whose underlying medical
conditions might be compromised by hypertension, hypokalaemia (those on
cardiac glycosides), or fluid retention (those with heart failure), severe or
unstable angina pectoris, recent myocardial infarction or ventricular
arrhythmia and those with severe renal impairment. Caution is advised in
patients with a history of cardiovascular disease. The phaseIII studies
conducted with ZYTIGA excluded patients with uncontrolled hypertension,
clinically significant heart disease as evidenced by myocardial infarction, or
arterial thrombotic events in the past 6months, severe or unstable angin, or
a left ventricular ejection fraction below50% or NYHA ClassIII or IV heart
failure (study 301) or Class II to IV heart failure (study 302). Control of
hypertension and correction of hypokalaemia should be done in advance of and
during treatment with ZYTIGA^®. Before treating patients with a significant
risk of congestive heart failure (e.g. a history of cardiac failure,
uncontrolled hypertension or cardiac events such as ischaemic heart disease)
consider obtaining an assessment of cardiac function (e.g. echocardiogram).
Before treatment with ZYTIGA, cardiac failure should be treated and cardiac
function optimised. Blood pressure, serum potassium and fluid retention should
be monitored before treatment and at least monthly thereafter; for patients
with significant risk of congestive heart failure, monitor every two weeks for
the first three months.
Hepatotoxicity: Marked increases in liver enzymes leading to treatment
discontinuation or dose modification occurred in controlled clinical studies.
Serum transaminases should be measured before treatment with ZYTIGA^® and
every two weeks for the first three months, and then monthly. If
symptoms/signs suggest hepatotoxicity, serum transaminases should be
immediately measured. At any time if serum ALT or AST is above five times the
upper limit of normal, treatment should be stopped and liver function
monitored. Treatment can be restarted after liver function returns to
baseline; using a reduced dose (see above). There is no clinical data in
patients with active or symptomatic viral hepatitis.
Corticosteroid withdrawal: Adrenocortical insufficiency should be monitored
for if prednisone or prednisolone is withdrawn. An increased dose of
corticosteroids may be indicated before/during and after a stressful
situation. Mineralocorticoid excess should be monitored for if ZYTIGA^® is
continued after corticosteroids withdrawn.
Bone density: Decreased bone density may be accentuated by treatment with
ZYTIGA^® plus glucocorticoid.
Prior use of ketoconazole: Lower response rates to ZYTIGA^® may occur in
patients previously treated with ketoconazole for prostate cancer.
Hyperglycaemia: The use of glucocorticoids could increase hyperglycaemia,
therefore blood sugar should be measured frequently in patients with diabetes.
Use with chemotherapy: The safety and efficacy of concomitant use of ZYTIGA
with cytotoxic chemotherapy has not been established.
Intolerance to excipients: ZYTIGA^® should not be taken by patients with
galactose intolerance, Lapp lactase deficiency or glucose-galactose
malabsorption. Sodium content should be taken into account for those on
controlled sodium diet.
Potential risks: Anaemia and sexual dysfunction may occur in men with
metastatic castration resistant prostate cancer including those undergoing
treatment with ZYTIGA.
Most common: urinary tract infection, hypokalaemia, hypertension, peripheral
Common: hypertriglyceridaemia, cardiac failure (including congestive heart
failure, left ventricular dysfunction and decreased ejection fraction), angina
pectoris, arrhythmia, atrial fibrillation, tachycardia, increased alanine
aminotransferase, fractures (includes all fractures with the exception of
pathological fracture), dyspepsia, haematuria and rash.
Uncommon: adrenal insufficiency.
Refer to SmPC for other side effects.
FERTILITY/ PREGNANCY/ LACTATION: ZYTIGA^® should not be used in women. It is
not known whether abiraterone or its metabolites are present in semen. A
condom is required if the patient is engaged in sexual activity with a
pregnant woman. If the patient is engaged in sexual activity with a woman of
childbearing potential, a condom is required along with another effective
contraceptive method. Abiraterone affected fertility in male and female rats,
but these effects were fully reversible
Use ZYTIGA^® with ^ caution alongside with drugs activated by or metabolised
by CYP2D6 particularly when there is a narrow therapeutic index e.g.
metoprolol, propranolol, desipramine, venlafaxine, haloperidol, risperidone,
propafenone, flecanide, codeine, oxycodone and tramadol. Dose reduction for
those metabolised by CYP2D6 should be considered. ZYTIGA is an inhibitor of
CYP2C8 (in vitro data); Medicinal products metabolised by CYP2C8 include
paclitaxel and repaglinide. There are no clinical data on the use of ZYTIGA^®
with drugs that are substrates of CYP2C8. ZYTIGA is CYP3A4 substrate (in vitro
data); avoid or use with caution with strong CYP3A4 inhibitors (e.g.
ketoconazole, itraconazole, clarithromycin, atazanavir, nefazodone,
saquinavir, telithromycin, ritonavir, indinavir, nelfinavir, voriconazole) or
inducers (e.g. phenytoin, carbamazepine, rifampicin, rifabutin, rifapentine,
phenobarbital). Food increases systemic exposure to abiraterone (see above).
The Janssen Pharmaceutical Companies of Johnson & Johnson are dedicated to
addressing and solving the most important unmet medical needs of our time,
including oncology, immunology, neuroscience, infectious disease, and
cardiovascular and metabolic diseases.
Driven by our commitment to patients, we develop innovative products, services
and healthcare solutions to help people throughout the world.
More information can be found at www.janssen-emea.com
(This press release contains "forward-looking statements" as defined in the
Private Securities Litigation Reform Act of 1995. The reader is cautioned not
to rely on these forward-looking statements. These statements are based on
current expectations of future events. If underlying assumptions prove
inaccurate or unknown risks or uncertainties materialize, actual results could
vary materially from the expectations and projections of Janssen- Cilag
International NV, any of the Janssen Pharmaceutical Companies and/or Johnson &
Johnson. Risks and uncertainties include, but are not limited to, general
industry conditions and competition; economic factors, such as interest rate
and currency exchange rate fluctuations; technological advances, new products
and patents attained by competitors; challenges inherent in new product
development, including obtaining regulatory approvals; challenges to patents;
changes in behaviour and spending patterns or financial distress of purchasers
of health care products and services; changes to governmental laws and
regulations and domestic and foreign health care reforms; trends toward health
care cost containment; and increased scrutiny of the health care industry by
government agencies. A further list and description of these risks,
uncertainties and other factors can be found in Exhibit 99 of Johnson &
Johnson’s Annual Report on Form 10-K for the fiscal year ended January 1,
2012. Copies of this Form 10-K, as well as subsequent filings, are available
online at www.sec.gov, www.jnj.com or on request from Johnson & Johnson. None
of the Janssen Pharmaceutical Companies nor Johnson & Johnson undertake to
update any forward-looking statements as a result of new information or future
events or developments.)
[last accessed November 2012]
^2 Ryan C.J et al. Interim analysis (IA) results of COU-AA-302, a randomized,
phase III study of abiraterone acetate (AA) in chemotherapy-naive patients
(pts) with metastatic castration-resistant prostate cancer (mCRPC). J Clin
Oncol 30, 2012 (suppl; abstr LBA4518)
^3 Hotte SJ, Saad F. Current management of castrate-resistant prostate cancer.
Curr Oncol. 2010 September; 17(Supplement 2): S72–S79.
^4 Mayo Clinic. “Prostate Cancer.”
http://www.mayoclinic.com/health/prostate-cancer/DS00043. [Last accessed
^5 http://globocan.iarc.fr/factsheet.asp [last accessed November 2012]
^6 ZYTIGA^® summary of product characteristics 2012
+32 (0) 14 60 71 72
Press spacebar to pause and continue. Press esc to stop.