Olaratumab
| Monoclonal antibody | |
|---|---|
| Type | Whole antibody |
| Source | Human |
| Target | PDGF-R α |
| Clinical data | |
| Trade names | Lartruvo |
| Other names | IMC-3G3, LY-3012207 |
| AHFS/Drugs.com | Monograph |
| License data | |
| Routes of administration | Intravenous infusion |
| ATC code | |
| Legal status | |
| Legal status | |
| Pharmacokinetic data | |
| Protein binding | None |
| Metabolism | Proteolytic enzymes |
| Elimination half-life | 11 days |
| Identifiers | |
| CAS Number | |
| DrugBank | |
| ChemSpider |
|
| UNII | |
| KEGG | |
| Chemical and physical data | |
| Formula | C6554H10076N1736O2048S40 |
| Molar mass | 147241.21 g·mol−1 |
  (what is this?) (verify) | |
Olaratumab, sold under the brand name Lartruvo, is a monoclonal antibody medication developed by Eli Lilly and Company for the treatment of solid tumors. It is directed against the platelet-derived growth factor receptor alpha.[2]
It was removed from the United States and European Union markets in 2019, due to insufficient proof of its medical advantage (see below "Medical uses").
Medical uses
[edit]Olaratumab is used in combination with doxorubicin for the treatment of adults with advanced soft-tissue sarcoma (STS) who cannot be cured by cancer surgery or radiation therapy, and who have not been previously treated with doxorubicin.[3][4]
In a randomised controlled trial with 133 STS patients, olaratumab plus doxorubicin improved the median of progression-free survival from 4.1 to 6.6 months as compared to doxorubicin alone (p = 0.0615, narrowly missing statistical significance), and overall survival from 14.7 to 26.5 months (p = 0.0003, highly significant).[3][5] However, the ANNOUNCE phase 3 trial did not find any advantage in adding olaratumab to doxorubicin. Therefore, in January 2019, FDA and EMA decided to recommend against starting olaratumab for soft tissue sarcoma.[6] In April 2019 the European Medicines Agency explicitly requested the marketing authorisation of the medicine to be revoked.[7] Shortly afterwards the German Physician's Medicines Commission reported that olaratumab will be removed from the German market "in a few weeks" and asked doctors not to treat new patients with this drug outside of clinical trials.[8] Lilly subsequently voluntarily withdrew its approval in the United States.[9]
Contraindications
[edit]The drug has no contraindications apart from hypersensitivity reactions.[3]
Side effects
[edit]In studies, the most serious side effects of the combination olaratumab/doxorubicin were neutropenia (low count of neutrophil white blood cells) with a severity of grade 3 or 4 in 55% of patients, and musculoskeletal pain grade 3 or 4 in 8% of patients. Common milder side effects were lymphopenia, headache, diarrhoea, nausea and vomiting, mucositis, and reactions at the infusion site;[3] all typical effects of cancer therapies.
Interactions
[edit]No pharmacokinetic interactions with doxorubicin were observed in studies. Being a monoclonal antibody, olaratumab is neither metabolised by cytochrome P450 liver enzymes nor transported by transmembrane pumps, and is thus not expected to interact relevantly with other drugs.[3]
Pharmacology
[edit]Mechanism of action
[edit]Olaratumab inhibits growth of tumour cells by blocking subunit alpha of the platelet-derived growth factor receptor, a type of tyrosine kinase.[3]
Pharmacokinetics
[edit]After intravenous infusion, olaratumab has a volume of distribution of 7.7 litres in steady state and a biological half-life of 11 days.[3]
History
[edit]Olaratumab was originally developed by ImClone Systems, which was acquired by Eli Lilly in 2008.[10] A Phase I clinical trial was conducted in Japanese patients in September 2010,[11] followed by a Phase II trial in 133 patients, starting in October 2010.[12]
In February 2015, the European Medicines Agency assigned olaratumab orphan drug status for the treatment of soft-tissue sarcoma.[13] The European Commission granted a conditional marketing authorisation, based on the mentioned Phase II study, valid throughout the European Union on 9 November 2016.[14]
Previously considered a promising drug, the FDA granted olaratumab fast track designation, breakthrough therapy designation and priority review status. In October 2016, the US FDA issued an accelerated approval notice for use of olaratumab with doxorubicin to treat adults with certain types of soft-tissue sarcoma, based on the same study.[4][15]
A phase III trial completed in 2019, and unfortunately showed no benefit from the addition of olaratumab to doxorubicin.[15][16] As noted above, these results led to withdrawal of approval in the United States and Europe.
References
[edit]- ^ "Cancer therapies". Health Canada. 8 May 2018. Retrieved 13 April 2024.
- ^ "Statement on a Nonproprietary name adopted by the USAN Council: Olaratumab" (PDF). Archived from the original (PDF) on 15 August 2016. Retrieved 18 March 2010.
- ^ a b c d e f g "EPAR – Product information for Lartruvo" (PDF). European Medicines Agency. 23 November 2016. Archived from the original (PDF) on 17 March 2018. Retrieved 30 December 2016.
- ^ a b "FDA grants accelerated approval to new treatment for advanced soft tissue sarcoma". US FDA. 19 October 2016.
- ^ Tap WD, Jones RL, Van Tine BA, Chmielowski B, Elias AD, Adkins D, et al. (July 2016). "Olaratumab and doxorubicin versus doxorubicin alone for treatment of soft-tissue sarcoma: an open-label phase 1b and randomised phase 2 trial". Lancet. 388 (10043): 488–97. doi:10.1016/S0140-6736(16)30587-6. PMC 5647653. PMID 27291997.
- ^ "FDA, EMA Recommend Against Starting Olaratumab for Soft Tissue Sarcoma". OncLive. 25 January 2019.
- ^ "EMA recommends withdrawal of marketing authorisation for cancer medicine Lartruvo" (PDF).
- ^ "Drug Safety Mail 2019-25 by Arzneimittelkommission der Deutschen Ärzteschaft (in German)". 7 May 2019.
- ^ "FDA Purple Book Data". U.S. Food and Drug Administration. August 2020. Retrieved 23 September 2020.
- ^ "Imclone legacy drug gains green light for Lilly in soft tissue sarcoma". BioWorld. Archived from the original on 1 January 2017. Retrieved 31 December 2016.
- ^ Doi T, Ma Y, Dontabhaktuni A, Nippgen C, Nippgen J, Ohtsu A (July 2014). "Phase I study of olaratumab in Japanese patients with advanced solid tumors". Cancer Science. 105 (7): 862–9. doi:10.1111/cas.12444. PMC 4317910. PMID 24816152.
- ^ Clinical trial number NCT01185964 for "A Study of IMC-3G3 in Soft Tissue Sarcoma" at ClinicalTrials.gov
- ^ "Orphan Designation for olaratumab". European Medicines Agency. 9 April 2015. Archived from the original on 5 May 2016. Retrieved 22 April 2016.
- ^ "EPAR summary for the public for Lartruvo" (PDF). European Medicines Agency. 23 November 2016. Archived from the original (PDF) on 17 March 2018. Retrieved 30 December 2016.
- ^ a b Shirley M (January 2017). "Olaratumab: First Global Approval". Drugs. 77 (1): 107–112. doi:10.1007/s40265-016-0680-2. PMID 27995580. S2CID 3604814.
- ^ Clinical trial number NCT02451943 for "A Study of Doxorubicin Plus Olaratumab (LY3012207) in Participants With Advanced or Metastatic Soft Tissue Sarcoma (ANNOUNCE)" at ClinicalTrials.gov
