Lilly Cancer Treatment Reaches Primary Endpoint

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A potential cancer treatment being developed by Indianapolis-based Eli Lilly and Co. (NYSE: LLY) continues to move forward. The pharmaceutical maker reports a late-stage trial shows patients taking Cyramza in combination with another drug had a "statistically significant improvement" in survival rate. September 18, 2014

News Release

INDIANAPOLIS, Ind. - Eli Lilly and Company (NYSE: LLY) today announced that results of the global Phase III trial of ramucirumab (CYRAMZA) in combination with paclitaxel in patients with advanced gastric (stomach) cancer or gastroesophageal junction (GEJ) adenocarcinoma were published in the online version of The Lancet Oncology.

In the trial, known as RAINBOW, the addition of ramucirumab to paclitaxel showed a statistically significant improvement in median overall survival, meeting its primary endpoint; it also met secondary endpoints of progression-free survival and objective response rate. RAINBOW is the largest trial in second-line gastric cancer to date and the first Phase III study to demonstrate a survival benefit with a biologic used in combination with chemotherapy in this setting. Data from the RAINBOW trial were first presented at the Gastrointestinal Cancers Symposium (ASCO GI) in January 2014.

Ramucirumab has now been the focus of two positive Phase III gastric cancer trials that have demonstrated statistically significant improvements in both overall survival and progression-free survival. The first trial, REGARD, examined ramucirumab as a single-agent treatment for patients with advanced or metastatic gastric or GEJ adenocarcinoma with disease progression on or after prior fluoropyrimidine- or platinum-containing chemotherapy. These study results were published in 2013.

"As the third leading cause of cancer death worldwide, stomach cancer is a major global health issue," said Richard Gaynor, M.D., senior vice president, product development and medical affairs for Lilly Oncology. "We are encouraged by the RAINBOW study results and are pleased that we now have a second Phase III trial of ramucirumab which has demonstrated improved survival in advanced gastric cancer patients."

RAINBOW was a global, randomized, double-blinded Phase III study of ramucirumab and paclitaxel compared to placebo and paclitaxel as treatment in patients with advanced (locally advanced, unresectable or metastatic) gastric cancer or GEJ adenocarcinoma that was refractory to or progressive after initial platinum- and fluoropyrimidine-containing chemotherapy.

"I am very pleased that this trial demonstrated a significant and clinically meaningful benefit for patients with advanced stomach cancer," said Hansjochen Wilke, M.D., department of medical oncology, hematology with the Center for Palliative Care at Kliniken Essen-Mitte in Germany, and principal investigator of the RAINBOW trial. "Currently, there is a significant need for effective therapies to help combat this deadly disease and ramucirumab in this combination could provide a valuable second-line treatment option."

Patients randomized to the ramucirumab-plus-paclitaxel arm had a median survival benefit of 9.6 months, compared to 7.4 months for patients on the placebo-plus-paclitaxel arm (stratified hazard ratio 0.807 [95% confidence interval (CI), 0.678-0.962; p=0.0169]). Treatment with ramucirumab plus paclitaxel significantly reduced the risk of disease progression or death (by 37 percent), with a 52 percent increase in median progression-free survival compared with placebo plus paclitaxel (4.4 months vs. 2.9 months; stratified hazard ratio 0.635 [95% CI, 0.536-0.752; p < 0.0001]).="" there="" was="" a="" statistically="" significant="" increase="" in="" objective="" response="" rate,="" from="" 16="" to="" 28="" percent,="" with="" the="" addition="" of="" ramucirumab="" (p="">

The following adverse events (grade 3 or higher) occurred at a higher rate and for more than 10 percent of patients on the ramucirumab-plus-paclitaxel arm: neutropenia, or a decrease in a specific type of white blood cell (neutrophils) (41% vs. 19%); leukopenia, or decreased white blood cell count (all white blood cells) (17% vs. 7%); hypertension, or high blood pressure (15% vs. 3%); and fatigue/asthenia (12% vs. 5%). The incidence of febrile neutropenia, or a fever combined with decreased neutrophils, was low in both trial arms (3% vs. 2%, respectively).

Data from the RAINBOW trial are the basis for regulatory submissions in the U.S. and EU; plans for a submission to Japanese regulatory authorities in the second half of 2014 are on track.

About the RAINBOW Trial

RAINBOW was a global, randomized, double-blinded, placebo-controlled Phase III study of ramucirumab and paclitaxel compared to placebo and paclitaxel in patients with advanced (locally advanced, unresectable or metastatic) gastric cancer (including adenocarcinomas of the gastroesophageal junction) refractory to or progressive after initial platinum- and fluoropyrimidine-containing chemotherapy. Initiated in 2010, the global study randomized a total of 665 patients across 27 countries in North America, South America, Europe, Australia and Asia.

About Gastric Cancer

Gastric (stomach) cancer is a major health problem. It is the fifth most common cancer in the world and is the third-leading cause of cancer death. There were nearly one million new cases worldwide in 2012 (631,000 men, 320,000 women) with approximately 723,000 deaths (469,000 men, 254,000 women).i Stomach cancer is more prevalent in countries outside the U.S. and EU.ii In the U.S., it is estimated that approximately 22,000 people will be diagnosed with gastric cancer in 2014.iii

Gastric cancer is a disease in which cancer cells form in the stomach. It develops slowly, usually over many years, and often goes undetected.iv As stomach cancer advances, it can travel through the bloodstream and spread to organs such as the liver, lungs and bones.v

The most common type of stomach cancer is called adenocarcinoma, which starts from one of the common cell types found in the lining of the stomach.vi

About Angiogenesis

Angiogenesis is the process of making new blood vessels. This process involves the migration, growth, and differentiation of endothelial cells, which line the inside wall of blood vessels. Chemical signals in the body stimulate the repair of damaged blood vessels and formation of new blood vessels during this process.

In a person with cancer, angiogenesis creates new blood vessels that give a tumor its own blood supply, allowing it to grow and spread.

Some tumors create proteins called VEGF. These proteins attach to the VEGF receptors of blood vessel cells causing new blood vessels to form around the tumors, enabling growth. Blocking the VEGF protein from linking to the blood vessels helps to inhibit tumor growth by slowing angiogenesis and the blood supply that feeds tumors.

Of the three known VEGF receptors, VEGF Receptor 2 is linked most closely to VEGF-induced tumor angiogenesis.vii

About Ramucirumab (CYRAMZA)

Ramucirumab, marketed as CYRAMZA, is approved for use as a single agent in the U.S. for patients with advanced gastric or gastroesophageal junction (GEJ) adenocarcinoma who have progressed after prior fluoropyrimidine- or platinum-containing chemotherapy. CYRAMZA inhibited angiogenesis in an in vivo animal model. CYRAMZA is a VEGF Receptor 2 antagonist that specifically binds and blocks activation of VEGF Receptor 2 and blocks binding of VEGF receptor ligands VEGF-A, VEGF-C, and VEGF-D.

There are several studies underway or planned to investigate CYRAMZA as a single agent and in combination with other anti-cancer therapies for the treatment of multiple tumor types.

Source: Eli Lilly and Co.