New preclinical data show combination of lenvatinib and everolimus yield greater antitumour activity than either agent alone in kidney cancer
A preclinical study of lenvatinib plus everolimus1 demonstrates enhanced inhibition of vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF)-induced angiogenesis than for either agent alone in human endothelial cell models. The combination also showed synergistic enhancement against bFGF- driven angiogenesis, distinguishing this from other VEGFR2 tyrosine kinase inhibitors (TKIs). These data are one of a number of lenvatinib abstracts presented this week at the American Association for Cancer Research (AACR) Annual Meeting 2016, New Orleans, USA.
“Lenvatinib and everolimus appear to be working together to produce significant combination effects, including synergistic antiangiogenic and additive antiproliferative activities against human umbilical vein endothelial cells (HUVEC). This is because the agents together simultaneously inhibit VEGFR-TK/FGFR-TK and mammalian target of rapamycin (mTOR). In preclinical models, this study examined the inhibition of molecular drivers of cancer associated with development of new blood vessels that tumours need for growth and drivers of rapid growth of cancer cells. The study revealed a possible mechanistic basis of the combination of these two drugs, which could explain the observed magnified clinical benefit,” comments Dr Takashi Owa, Chief Medicine Creation Officer Oncology Business Group, Corporate Officer Eisai Co., Ltd.
Lenvatinib is indicated for the treatment of adult patients with progressive locally advanced or metastatic, differentiated (papillary, follicular, Hürthle cell) thyroid carcinoma (DTC) refractory to radioactive iodine (RAI)2. Lenvatinib is an oral multiple receptor tyrosine kinase (RTK) inhibitor that selectively inhibits the kinase activities of vascular endothelial growth factor (VEGF) receptors in addition to other proangiogenic and oncogenic pathway-related RTKs including fibroblast growth factor (FGF) receptors FGFR1, 2, 3, and 4; the platelet-derived growth factor (PDGF) receptor PDGFR?; KIT; and rearranged during transfection (RET) proto-oncogene.
A recent Phase II study found lenvatinib in combination with everolimus significantly extends Progression-Free Survival in unresectable advanced renal cell carcinoma (RCC), when compared to either treatment alone3. People treated with the combination regimen experience a median progression-free survival of 14.6 months compared with 5.5 months for those who receive everolimus alone (HR 0.40; 95% CI: 0.24-0.68; p<0.001).3
The enhanced effect of the combination lenvatinib plus everolimus is also demonstrated in a second study presented at AACR4 in human renal cell carcinoma xenograft models (a graft of tissue or cells from one species to an unlike species). Results indicate that lenvatinib in combination with everolimus causes significant antitumour effects through the potent antiangiogenic activity of lenvatinib and direct antitumour activity of everolimus. Gene expression analysis also supports the mode of action in this model, i.e.,lenvatinib alone upregulates hypoxia-related genes and everolimus decreases proliferation-related genes.
“These preclinical data demonstrate our ongoing search for molecules that go on to be used in clinical practice to help patients living with life-limiting diseases, such as kidney cancer. We are encouraged by these data as they further support our Marketing Authorisation Application (MAA) to bring this combination to patients with kidney cancer,” comments Gary Hendler, Chief Commercial Officer Oncology Business Group, Chairman and CEO EMEA.
In January 2016, Eisai submitted a new Marketing Authorisation Application to the European Medicines Agency (EMA) for the use of lenvatinib in combination with everolimus for advanced renal cell carcinoma in people who have received one prior VEGF-targeted therapy. A similar application has already been submitted to the Food and Drug Administration in the US. Lenvatinib was granted an accelerated assessment for advanced RCC in Europe by the EMA in October 2015.
Eisai is dedicated to discovering, developing and producing innovative oncology therapies that can make a difference and impact the lives of patients and their families. This passion for people is part of Eisai’s human health care (hhc) mission, which strives for better understanding of the needs of patients and their families to increase the benefits health care provides.