Roche’s biologics license application (BLA) for polatuzumab vedotin in combination with bendamustine plus Rituxan® (rituximab) (BR) for the treatment of people with relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL) has been accepted and granted a priority review by the US Food and Drug Administration. A decision on approval of the BLA is expected by August 19, 2019. Developed in collaboration with Seattle Genetics, polatuzumab vedotin is composed of a humanized anti-CD79b IgG1 antibody conjugated to the antimitotic agent monomethyl auristatin E. The antibody’s target is highly expressed on B cells of patients with lymphoma. Polatuzumab vedotin was granted FDA’s Breakthrough Therapy designation, the European Medicines Agency (EMA)’s PRIME designation, and US and EU Orphan Drug designations for DLBCL. A marketing application for polatuzumab vedotin is undergoing review by EMA.
The BLA is based on positive clinical data from a randomized Phase 1/2 study (NCT02257567/GO29365), which evaluated polatuzumab vedotin administered by IV infusion in combination with standard doses of BR or obinutuzumab in patients with R/R follicular lymphoma (FL) or DLBCL. Study results indicated that median overall survival was over one year in people with R/R DLBCL not eligible for a hematopoietic stem cell transplant who received the combination of polatuzumab vedotin and BR, and less than 5 month for those in the BR arm of the study (12.4 vs. 4.7 months, hazard ratio (HR)=0.42; 95% CI 0.24-0.75). In addition, polatuzumab vedotin plus BR increased median progression-free survival (PFS) and led to a 66% reduction in risk of disease worsening or death compared to BR alone (median PFS: 7.6 months vs. 2.0 months; HR=0.34; 95% CI 0.20-0.57), and patients treated with polatuzumab vedotin plus BR showed a longer time between first response to treatment and disease worsening than those receiving BR alone (investigator assessed median duration of response: 10.3 months vs. 4.1 months; HR=0.44).
The combination of polatuzumab vedotin with R-CHP protocol (rituximab, cyclophosphamide, doxorubicin and prednisone) versus R-CHOP (rituximab-cyclophosphamide, doxorubicin, vincristine and prednisone) in DLBCL patients is currently being investigated in the Phase 3 POLARIX (NCT03274492) study. The primary endpoint is PFS. Secondary outcome measures include PFS, compete response and overall survival. The estimated primary completion date of the study is December 2019.
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