Panel Rejects Daiichi-Sankyo NDA for Leukemia

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FDA’s Oncologic Drugs Advisory Committee has voted 3 to 8 not to recommend approval of a Daiichi-Sankyo NDA for quizartinib, indicated for treating adults with relapsed or refractory acute myeloid leukemia (AML) which is FLT3-ITD positive, as detected by an FDA-approved test.

Panel members appeared to agree with FDA reviewers who questioned the robustness of data submitted in the NDA. In a briefing document released in advance of the meeting, FDA reviewers said that data from a single study was positive, but the significance was marginal and the overall survival (OS) results were not robust. They said that the OS treatment effect “appeared to be driven by the stratum of patients preselected for low-intensity chemotherapy and may have been confounded by imbalances in poststudy therapy, and the results of analyses of other efficacy endpoints were either not statistically significant or provided for a magnitude of effect that might not be considered clinically meaningful. These inconsistencies and imbalances undermine the reliability of the trial results.”

Safety issues were also a concern for some panel members. The briefing document noted that quizartinib “causes QT prolongation via a unique mechanism, namely IKs blockade. Blockade of IKs by quizartinib results in the potential for fatal cardiac arrhythmias. In Study AC220-007, 27% of patients experienced at least one event of QT-prolongation. When compared to intensive chemotherapy or LDAC, the risk of cardiac events was substantially higher with quizartinib.”

Panel members recommended that another Phase 3 trial should be conducted before granting approval.

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