Non-small cell lung cancer treatment |
Crizotinib is targeted drug for treatment of non-small cell lung cancer cell developed by the American Pfizer Company, with the trade name being SaiKeRui. SaiKeRui is the frontier and groundbreaking drug in the filed of targeted therapy of the lung cancer. It was approved for entering into the United State Market at August 2011 and had been also written into the international guideline for lung cancer treatment by the end of that year. As a first-line treatment drug in patients with ALK-positive, another stuff which was approved together with Crizotinib was the first genetic diagnosis approach-Vysis ALK Break Apart FISH Probe Kit which had used fluorescence in situ hybridization (FISH) for the first time. This is this approach currently used in global clinical trials for detecting the EML4-ALK fusion gene in the NSCLC. This detection will help identify patients that could benefit from the therapy of Crizotinib.
On February 25, 2013, Pfizer announced that the SaiKeRui XALKORI (Crizotinib) capsules had been approved by China State Food and Drug Administration (SFDA) in recent time. This is the first drug determined by the detection method approved by SFDA for being applied to the treatment of locally advanced or metastatic non-small cell lung cancer (NSCLC) patients with positive symptoms of anaplastic lymphoma kinase (ALK).
SaiKeRui has opened a new chapter of individualized treatment of lung cancer so that the doctors can provide the right treatment for the right patient. In the clinical trials of SaikeRui, the test program requires the analysis results of the tumor biomarker ALK fusion gene to be positive, in order to increase the likelihood of responding to treatment. This detection method for the treatment of lung cancer for the first time allows researchers to observe good therapeutic effect in the patient population from pre-screen. In two multi-center single arm clinical trials (Test A and Test B), a study of 255 patients with locally advanced or metastatic non-small cell lung cancer ALK- positive (NSCLC) patients had showed the objective alleviating rates were 51% and 61%, respectively. The preliminary epidemiological studies have shown that in non-small cell lung cancer (NSCLC), the ALK-positive rate is about 3-5%, which means that each year there are about 46,000 to 28,000 ALK-positive non-small cell lung cancer (NSCLC) patients in the world.
From the publication of the result of the ALK fusion gene in the non-small cell lung cancer (NSCLC) to FDA approval, the study and development of SaiKeRui only takes four years. This is a major initiative in the field of oncology. This has once again showed the importance of close cooperation in various parties including academic research, pharmaceutical, diagnostics and drug administration and other regulatory authorities. From the novel drug application in China to the SFDA approval today, due to the inclusion of the fast-track passage of the national Center for Drug Evaluation, the entire process takes only about 11 months.
The resistance to the crizotinib is the major problem in the treatment of the patients of non-small cell lung cancer with positive ALK gene rearrangement. This resistance usually occurs within the first year of treatment with crizotinib. Among them, the drug resistance of 1/3 of the patients is caused by the ALK tyrosine kinase gene mutation or ALK gene amplification caused. Ceritinib is a kind of the second-generation oral ALK tyrosine kinase inhibitors. It is not acting on the MET proto-oncogene, but instead inhibiting the insulin-like growth factor 1 receptor. In the pre-clinical models, the anti-tumor effect via inhibitory of ALK of Ceritinib is 20 times as high as crizotinib. Studies have found that Ceritinib is still effective in the treatment of the crizotinib tolerated central nervous system lesions (NSCLC). The median progression-free survival period was 6.9 months for applying Ceritinib to NSCLC patients who have been subject to crizotinib treatment while this value is 10.4 months for patients free of treatment of crizotinib. The preliminary molecular analysis of some patients has found that no matter whether the ceritinib resistance mechanism is ALK-dependent or non-dependent, it has clinical benefit for the majority of patients. The findings suggest that: ceritinib can effectively inhibit ALK target and may act on an unknown but drug resistance-associated kinase. From this perspective, it is apparent that the crizotinib resistance issue should be able to be overcome.
The above information is edited by the chemicalbook of Dai Xiongfeng. |