Imetelstat

随着医学科技的迅猛发展和创新药物研发的不断深入，2024年再次见证了FDA在药物审批方面的重大进展。这一年，FDA批准了多种新药上市，这些药物不仅为患者带来了全新的治疗方案，更在疾病治疗领域取得了突破性进展。 作者｜momo 相关阅读：2024年FDA批准的重磅小分子药物 表1. FDA批准的17种大分子药物 截至2024年12月16日，FDA已经批准44款新药上市，其中包括17款生物大分子药物（图1），在获批的生物大分子药物中，单抗药物依旧是创新主力，以59%（10款）的占比遥遥领先；其次是双抗，有3款（占比17%）；蛋白类药物2款（占比12%）；小核酸药物和甲状旁腺激素类似物各1款（分别占比6%）。 图1. 2024 年 FDA 批准生物大分子药物类型 本文将对2024年FDA批准上市的生物大分子药物进行详细介绍，探讨其在各自疾病领域的重要性及潜在影响。 1.Letybo（letibotulinumtoxinA-wlbg） 适应症：中度至重度眉间纹的外观改善 靶点：BoNT/A 批准日期：2024年2月29日 企业：Hugel Inc. Letybo是一种乙酰胆碱释放抑制剂和神经肌肉阻滞剂，通过肌肉内注射，用于暂时改善成年患者与皱眉肌和/或降眉肌活动相关的中度至重度眉间纹外观。Letybo获得FDA的批准得到了三项已完成的3期试验的积极结果支持，这些试验在美国和欧洲招募了1000多名受试者。Letybo的临床试验结果证明了其在治疗眉间纹方面的有效性和安全性。 2.Tevimbra （tislelizumab-JSGR） 适应症：不可切除、局部晚期或转移性食管鳞状细胞癌 靶点：PD-1 批准日期：2024年3月13日 企业：百济神州 Tevimbra是一款人源化IgG4抗PD-1单克隆抗体，设计目的旨在最大限度地减少与巨噬细胞中的Fcγ受体结合，帮助人体免疫细胞检测和对抗肿瘤细胞。用于治疗既往接受过全身化疗（不包括PD-1或PD-L1类疗法），患有不可切除或转移性食管鳞状细胞癌（ESCC）的成年患者。这是Tevimbra首次在美国获批。Tevimbra于2023年获得欧盟委员会批准用于治疗既往曾接受过化疗的晚期或转移性ESCC患者，并于2024年2月获得欧洲药品管理局（EMA）人用药品委员会的推荐，用于治疗非小细胞肺癌。在中国，该疗法已有12个适应症获得批准。 3.Winrevair （sotatercept-CSRK） 适应症：肺动脉高压 靶点：INHBA 批准日期：2024年3月26日 企业：默克 Winrevair是一款“first-in-class”的IIA型激活素受体（ActRIIA）融合蛋白。它将ActRIIA经过改造的细胞外域与抗体的Fc端融合在一起。它可以阻断激活素与细胞膜上的受体结合，从而降低激活素介导的信号传导。用于治疗肺动脉高压（PAH）患者。Winrevair是默沙东于2021年以约115亿美元收购Acceleron Pharma公司获得的关键疗法。值得一提的是，这款疗法被行业媒体Evaluate评为2024年有望获批的潜在重磅疗法之一。 4.Anktiva （nogapendekin alfa inbakicept-pmln） 适应症：膀胱癌 靶点：IL-15R 批准日期：2024年4月22日 企业：Altor Bioscience Corp. Anktiva是一款IL-15超级激动剂。IL-15通过影响自然杀伤（NK）细胞和免疫T细胞的发育、维持和功能，在免疫系统中发挥着至关重要的作用。Anktiva由与IL-15受体α/IgG1 Fc融合蛋白结合的IL-15突变体（IL-15N72D）组成。用于治疗对BCG无应答且伴有原位癌（CIS）的非肌层浸润性膀胱癌（NMIBC）成年患者。Anktiva在2019年获FDA授予突破性疗法认定，用于与BCG联合治疗此前对BCG应答不佳的非肌层浸润性原位膀胱癌患者。此外，行业媒体Evaluate在今年初将这款疗法列为今年有望获批的10款潜在重磅疗法之一。 5.Imdelltra （tarlatamab-dlle） 适应症：广泛期小细胞肺癌 靶点：CD3E、DLL3 批准日期：2024年5月16日 企业：安进 Imdelltra是一款“first-in-class”双特异性抗体（bsAbs），通过结合肿瘤细胞上的 DLL3 蛋白和 T 细胞上的 CD3 抗原，激活人体的免疫细胞并诱导表达 DLL3 的癌细胞被破坏。用于治疗铂类化疗期间或之后疾病进展的广泛期小肺癌（SCLC）患者。Imdelltra在今年5月获FDA加速批准用于治疗ES-SCLC成人患者，他们在接受化疗时或之后出现疾病进展。值得一提的是，Imdelltra是首款用于治疗实体瘤的获批BiTE疗法。 6.Rytelo （imetelstat） 适应症：低危骨髓增生异常综合征伴输血依赖性贫血 靶点：Telomerase 批准日期：2024年6月6日 企业：Geron Corp. Rytelo是一款“first-in-class”的寡核苷酸端粒酶抑制剂，通过抑制端粒酶活性，抑制癌变干细胞和祖细胞不可控制的增殖，导致癌变细胞的凋亡。用于治疗患有低风险至中等-1风险的骨髓增生异常综合征（MDS）成年患者。Rytelo是40年来首个获美国FDA批准的端粒酶靶向疗法。Rytelo被行业媒体Evaluate列为今年10大潜在重磅疗法之一。 7.Piasky （crovalimab-akkz） 适应症：阵发性睡眠性血红蛋白尿症 靶点：C5 批准日期：2024年6月20日 企业：Sino-Foreign Pharmaceutical Co., Ltd. Piasky是一款靶向补体蛋白C5的可循环使用人源化单克隆抗体，能够阻止C5裂解为C5a和C5b，阻止终末补体通路，从而防止红细胞在阵发性睡眠性血红蛋白尿症（PNH）等疾病中的破坏。用以治疗阵发性睡眠性血红蛋白尿症（PNH）患者。Piasky是PNH的首个每月皮下注射治疗药物，且患者可以选择在受监督的医疗机构之外进行自我给药。 8.Kisunla（Donanemab-azbt） 适应症：阿尔茨海默病 靶点：pGlu3Aβ 批准日期：2024年7月2日 企业：礼来 Kisunla是一款靶向β淀粉样蛋白（Aβ）的单克隆抗体，它能与N3pG的淀粉样蛋白亚型特异性结合，从而促进淀粉样斑块的清除。用于治疗出现早期症状的阿尔茨海默病（AD）的成年人。Kisunla是首个有证据表明在淀粉样斑块清除后可停止治疗的淀粉样斑块靶向疗法。2021年6月，Donanemab被FDA授予突破性疗法认定。 9.Yorvipath（palopegteriparatide） 适应症：甲状旁腺功能亢进 靶点：PTH1R 批准日期：2024年8月9日 企业：Ascendis Pharma. Yorvipath是一种长效甲状旁腺激素（PTH）前药，旨在将甲状旁腺功能减退（HP）患者的PTH恢复至生理水平，以解决HP导致的血钙含量降低、血液磷酸盐水平升高等问题。用于治疗成人慢性甲状旁腺功能减退。该产品为甲状旁腺功能减退的首款激素替代疗法。 10.Nemluvio（nemolizumab-ilto） 适应症：结节性痒疹 靶点：IL-31 批准日期：2024年8月12日 企业：Galderma Pharma. Nemluvio是一种”first-in-class”单克隆抗体，它通过与IL-31受体α相结合，可以阻断IL-31的信号通路，用于治疗成人结节性痒疹（prurigo nodularis）患者。Nemluvio是首款获得FDA批准用以抑制IL-31信号的单克隆抗体，它曾在2019年获得美国FDA授予突破性疗法认定，并在今年2月获得治疗结节性痒疹的优先审评资格。 11.Niktimvo（axatilimab-csfr） 适应症：慢性移植物抗宿主病 靶点：CSF-1R 批准日期：2024年8月14日 企业：Incyte/Syndax制药 Niktimvo是一种靶向集落刺激因子-1受体（CSF-1R）的单克隆抗体，用于治疗慢性移植物抗宿主病（cGVHD）成人和体重40公斤以上的儿科患者。Niktimvo是全球首个获得批准用于治疗慢性移植物抗宿主病（GVHD）的CSF-1R单克隆抗体疗法。 12.Ebglyss（lebrikizumab-lbkz） 适应症：中度至重度特应性皮炎 靶点：IL-13 批准日期：2024年9月13日 企业：礼来 Ebglyss是一种单克隆抗体，能高亲和力结合IL-13，有效阻止IL-13Rα1/IL-4Rα异二聚体复合物的形成及其后续信号传导。用于治疗中度至重度特应性皮炎（AD）成年和青少年患者。Ebglyss于2023年获得欧盟委员会批准，并于2024年1月在日本获得批准。 13.Hympavsi（marstacimab-hncq） 适应症：预防或减少与血友病A或B相关的出血事件 靶点：BCMA 批准日期：2024年10月11日 企业：辉瑞 Hympavsi是一种靶向TFPI的人源IgG1单克隆抗体，通过靶向TFPI的Kunitz-2结构域，重新建立出血和凝血之间的平衡；用于预防或减少患有 A 型血友病（先天性第 VIII 因子缺乏症）和B 型血友病（先天性第 IX 因子缺乏症）成人和 12 岁及以上儿童患者的出血发作频率。Hympavzi是FDA批准治首款只需每周一次皮下注射的血友病B疗法。 14.Vyloy（Zolbetuximab-clzb） 适应症：胃或胃食管结合部腺癌 靶点：Claudin 18.2 批准日期：2024年10月18日 企业：安斯泰来 Vyloy是一种“first-in-class”的靶向CLDN18.2的单克隆抗体，被美国FDA批准与氟尿嘧啶和铂类化疗联合用于一线治疗HER2阴性、其肿瘤经FDA批准的检测确定为Claudin18.2阳性的局部晚期不可切除或转移性胃或胃食管交界处（GEJ）腺癌。Vyloy是全球首个获批的靶向Claudin 18.2的治疗药物。 15.Ziihera（zanidatamab） 适应症：HER2阳性（IHC 3+）的经治无法切除或转移性胆道癌 靶点：HER2 批准日期：2024年11月20日 企业：Jazz Pharmaceuticals Ziihera是一种具有新作用机制的HER2靶向双特异性抗体，可靶向HER2蛋白上两个不重复的抗原表位，用于治疗经FDA批准检测确诊为HER2阳性（IHC 3+）的经治无法切除或转移性胆道癌（BTC）成人患者。FDA曾授予Ziihera突破性疗法认定，快速通道资格、孤儿药资格。 16.Bizengri（zenocutuzumab） 适应症：胰腺导管腺癌或非小细胞肺癌 靶点：HER2、HER3 批准日期：2024年12月4日 企业：Merus Bizengri是一种双特异性抗体，能结合表达在细胞（包括肿瘤细胞）表面的HER2和HER3的细胞外结构域，抑制HER2与HER3形成二聚体并阻止NRG1与HER3的结合，用于治疗携带NRG1基因融合（NRG1+）的晚期不可切除或转移性胰腺导管腺癌或非小细胞肺癌（NSCLC）成年患者。Bizengri是FDA批准的首款治疗这一患者群体的靶向疗法，FDA也曾授予Bizengri突破性疗法认定。 17.Unloxcyt（cosibelimab） 适应症：皮肤鳞状细胞癌 靶点：PD-L1 批准日期：2024年12月14日 企业：Checkpoint Therapeutics Unloxcyt是一种完全人源化、具有高亲和力的单克隆抗体，可直接与PD-L1结合，从而阻断其与PD-1以及B7.1受体的相互作用，进而除去PD-L1对CD8阳性T细胞的抑制效果，恢复其毒杀性T细胞反应。用于治疗转移性皮肤鳞状细胞癌（cSCC）或不适合治愈性手术或放疗的局部晚期cSCC成年患者。Unloxcyt是首个获批用于治疗晚期cSCC患者的PD-L1靶向抗体。 参考资料 [1] https://www.fda.gov/ [2]各种公开资料 共建Biomedical创新生态圈！ 如何加入BiG会员？

FOSTER CITY, Calif.--( BUSINESS WIRE )--Geron Corporation (Nasdaq: GERN), a commercial-stage biopharmaceutical company aiming to change lives by changing the course of blood cancer, today announced that the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) has adopted a positive opinion recommending the approval of RYTELO (imetelstat) for the treatment of adult patients with transfusion-dependent (TD) anemia due to very low, low or intermediate risk myelodysplastic syndromes (LR-MDS) without an isolated deletion 5q cytogenetic (non-del 5q) abnormality and who had an unsatisfactory response to or are ineligible for erythropoietin-based therapy. The European Commission (EC), which has the authority to approve medicines in the European Union (EU), will review the CHMP’s recommendation and is expected to make a final decision on the marketing authorization application (MAA) in the following months. “ The positive CHMP opinion is an important step towards our goal to optimize value and patient access to RYTELO in the European Union, where we look forward to the opportunity to make this important new treatment option for LR-MDS patients available in select markets. If approved, RYTELO would be the first and only telomerase inhibitor available in Europe,” said John A. Scarlett, M.D., Geron’s Chairman and Chief Executive Officer. “ We are deeply appreciative to the patients, caregivers, advocates and investigators across the EU who contributed to the clinical development of RYTELO.” As part of its review of the marketing authorization application (MAA), the CHMP looked at the results from the IMerge Phase 3 clinical trial and assessed that the benefit of RYTELO in patients with transfusion-dependent anemia due to very low, low or intermediate risk MDS is a reduction in the need for red blood cell transfusions in the first 24 weeks of treatment compared to placebo, as observed in the double-blind controlled study. The most common side effects were thrombocytopenia, leukopenia, neutropenia, increased aspartate aminotransferase (AST), increased alanine aminotransferase (ALT), increased alkaline phosphatase (ALP), asthenia and headache. If approved by the EC, RYTELO will be available as 47 mg and 188 mg lyophilized powder for reconstitution in a solution that is administered as an intravenous infusion. Treatment with RYTELO should be administered and monitored under the supervision of physicians and healthcare professionals who are experienced in hematologic diseases and their treatment. About Lower-Risk Myelodysplastic Syndromes (LR-MDS) Lower-risk myelodysplastic syndromes (LR-MDS) is a blood cancer that often progresses to require increasingly intensified management of key symptoms such as anemia and resulting fatigue 1 . These symptomatic LR-MDS patients frequently become red blood cell transfusion dependent, which has been shown to be associated with short- and long-term clinical consequences that reduce quality of life and shorten survival 2,3 . There is a high unmet need for many LR-MDS patients, particularly those with characteristics having poorer prognosis. Current treatment options for those failing ESA are limited to select sub-populations and there is an unmet need for treatments that can provide extended and continuous red blood cell transfusion independence. About RYTELO™ (imetelstat) A marketing authorization application for RYTELO™ (imetelstat) is under review by the European Commission as a monotherapy treatment for adult patients with transfusion-dependent anemia due to very low, low or intermediate risk myelodysplastic syndromes (MDS) without an isolated deletion 5q cytogenetic (non-del 5q) abnormality and who had an unsatisfactory response to or are ineligible for erythropoietin-based therapy. RYTELO is an FDA-approved oligonucleotide telomerase inhibitor for the treatment of adult patients with low-to-intermediate-1 risk myelodysplastic syndromes (LR-MDS) with transfusion-dependent anemia requiring four or more red blood cell units over eight weeks who have not responded to or have lost response to or are ineligible for erythropoiesis-stimulating agents (ESAs). It is indicated to be administered as an intravenous infusion over two hours every four weeks. RYTELO is a first-in-class treatment that works by inhibiting telomerase enzymatic activity. Telomeres are protective caps at the end of chromosomes that naturally shorten each time a cell divides. In LR-MDS, abnormal bone marrow cells often express the enzyme telomerase, which rebuilds those telomeres, allowing for uncontrolled cell division. Developed and exclusively owned by Geron, RYTELO is the first and only telomerase inhibitor approved by the U.S. Food and Drug Administration. U.S. IMPORTANT SAFETY INFORMATION WARNINGS AND PRECAUTIONS Thrombocytopenia RYTELO can cause thrombocytopenia based on laboratory values. In the clinical trial, new or worsening Grade 3 or 4 decreased platelets occurred in 65% of patients with MDS treated with RYTELO. Monitor patients with thrombocytopenia for bleeding. Monitor complete blood cell counts prior to initiation of RYTELO, weekly for the first two cycles, prior to each cycle thereafter, and as clinically indicated. Administer platelet transfusions as appropriate. Delay the next cycle and resume at the same or reduced dose, or discontinue as recommended. Neutropenia RYTELO can cause neutropenia based on laboratory values. In the clinical trial, new or worsening Grade 3 or 4 decreased neutrophils occurred in 72% of patients with MDS treated with RYTELO. Monitor patients with Grade 3 or 4 neutropenia for infections, including sepsis. Monitor complete blood cell counts prior to initiation of RYTELO, weekly for the first two cycles, prior to each cycle thereafter, and as clinically indicated. Administer growth factors and anti-infective therapies for treatment or prophylaxis as appropriate. Delay the next cycle and resume at the same or reduced dose, or discontinue as recommended. Infusion-Related Reactions RYTELO can cause infusion-related reactions. In the clinical trial, infusion-related reactions occurred in 8% of patients with MDS treated with RYTELO; Grade 3 or 4 infusion-related reactions occurred in 1.7%, including hypertensive crisis (0.8%). The most common infusion-related reaction was headache (4.2%). Infusion-related reactions usually occur during or shortly after the end of the infusion. Premedicate patients at least 30 minutes prior to infusion with diphenhydramine and hydrocortisone as recommended and monitor patients for one hour following the infusion as recommended. Manage symptoms of infusion-related reactions with supportive care and infusion interruptions, decrease infusion rate, or permanently discontinue as recommended. Embryo-Fetal Toxicity RYTELO can cause embryo-fetal harm when administered to a pregnant woman. Advise pregnant women of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with RYTELO and for 1 week after the last dose. ADVERSE REACTIONS Serious adverse reactions occurred in 32% of patients who received RYTELO. Serious adverse reactions in >2% of patients included sepsis (4.2%) and fracture (3.4%), cardiac failure (2.5%), and hemorrhage (2.5%). Fatal adverse reactions occurred in 0.8% of patients who received RYTELO, including sepsis (0.8%). Most common adverse reactions (≥10% with a difference between arms of >5% compared to placebo), including laboratory abnormalities, were decreased platelets, decreased white blood cells, decreased neutrophils, increased AST, increased alkaline phosphatase, increased ALT, fatigue, prolonged partial thromboplastin time, arthralgia/myalgia, COVID-19 infections, and headache. Please see RYTELO (imetelstat) full Prescribing Information, including Medication Guide, available at https://pi.geron.com/products/US/pi/rytelo_pi.pdf . About Geron Geron is a commercial-stage biopharmaceutical company aiming to change lives by changing the course of blood cancer. Our first-in-class telomerase inhibitor RYTELO™ (imetelstat) is approved in the United States for the treatment of certain adult patients with lower-risk myelodysplastic syndromes (LR-MDS) with transfusion-dependent anemia. We are also conducting a pivotal Phase 3 clinical trial of imetelstat in JAK-inhibitor relapsed/refractory myelofibrosis (R/R MF), as well as studies in other hematologic malignancies. Inhibiting telomerase activity, which is increased in malignant stem and progenitor cells in the bone marrow, aims to potentially reduce proliferation and induce death of malignant cells. To learn more, visit www.geron.com or follow us on LinkedIn . Use of Forward-Looking Statements Except for the historical information contained herein, this press release contains forward-looking statements made pursuant to the “safe harbor” provisions of the Private Securities Litigation Reform Act of 1995. Investors are cautioned that such statements, include, without limitation, those regarding: (i) the EC’s review of the CHMP’s recommendation and expected timing of its decision on the MAA for RYTELO; (ii) Geron’s goal to optimize value and patient access to RYTELO in the European Union and its plans to make RYTELO available in select markets, subject to regulatory approval; and (iii) other statements that are not historical facts, constitute forward-looking statements. These forward-looking statements involve risks and uncertainties that can cause actual results to differ materially from those in such forward-looking statements. These risks and uncertainties, include, without limitation, risks and uncertainties related to: (a) whether Geron is successful in commercializing RYTELO (imetelstat) for the treatment of certain patients with LR-MDS with transfusion dependent anemia; (b) whether Geron overcomes potential delays and other adverse impacts caused by enrollment, clinical, safety, efficacy, technical, scientific, intellectual property, manufacturing and regulatory challenges in order to have the financial resources for and meet expected timelines and planned milestones; (c) whether regulatory authorities permit the further development of imetelstat on a timely basis, or at all, without any clinical holds; (d) whether any future safety or efficacy results of imetelstat treatment cause the benefit-risk profile of imetelstat to become unacceptable; (e) whether imetelstat actually demonstrates disease-modifying activity in patients and the ability to target the malignant stem and progenitor cells of the underlying disease; (f) that Geron may seek to raise substantial additional capital in order to continue the development and commercialization of imetelstat; (g) whether Geron meets its post-marketing requirements and commitments in the U.S. for RYTELO for the treatment of certain patients with LR-MDS with transfusion dependent anemia; (h) whether there are failures or delays in manufacturing or supplying sufficient quantities of imetelstat or other clinical trial materials that impact commercialization of RYTELO for the treatment of certain patients with LR-MDS with transfusion dependent anemia or the continuation of the IMpactMF trial; (i) that the projected timing for the interim and final analyses of the IMpactMF trial may vary depending on actual enrollment and death rates in the trial; (j) whether Geron stays in compliance with and satisfies its obligations under its debt and royalty financing agreements; and (k) whether the European Commission will approve RYTELO for the treatment of patients with LR-MDS with transfusion dependent anemia and whether the FDA and EMA will approve imetelstat for other indications on the timelines expected, or at all. Additional information on the above risks and uncertainties and additional risks, uncertainties and factors that could cause actual results to differ materially from those in the forward-looking statements are contained in Geron’s filings and periodic reports filed with the Securities and Exchange Commission under the heading “Risk Factors” and elsewhere in such filings and reports, including Geron’s quarterly report on Form 10-Q for the quarter ended September 30, 2024, and subsequent filings and reports by Geron. Undue reliance should not be placed on forward-looking statements, which speak only as of the date they are made, and the facts and assumptions underlying the forward-looking statements may change. Except as required by law, Geron disclaims any obligation to update these forward-looking statements to reflect future information, events, or circumstances. 1 Lewis R, Bewersdorf JP, Zeidan AM. Clinical Management of Anemia in Patients with Myelodysplastic Syndromes: An Update on Emerging Therapeutic Options. Cancer Manag Res. 2021 Jan 25;13:645-657. doi: 10.2147/CMAR.S240600. PMID: 33531837; PMCID: PMC7846829. 2 Cogle CR, Reddy SR, Chang E, et al. Early treatment initiation in lower-risk myelodysplastic syndromes produces an earlier and higher rate of transfusion independence. Leuk Res. 2017;60:123-128. 3 Balducci, L. (2006), Transfusion independence in patients with myelodysplastic syndromes. Cancer, 106: 2087-2094. https://doi-org.libproxy1.nus.edu.sg/10.1002/cncr.21860