Cell Therapeutics, Inc. (CTI), company focused on translating science into novel cancer therapies, has launched Pixuvri in the European Union (EU) to treat adult patients with multiply relapsed or refractory aggressive B-cell non-Hodgkin Lymphoma (NHL), with entry into Sweden, Denmark and Finland in September, to be followed by Austria and Norway in early October 2012 and Germany, United Kingdom and the Netherlands in November 2012. CTI plans to expand availability to France, Italy and Spain as well as other European countries in 2013.

Pixuvri was granted conditional marketing authorization by the European Commission in May 2012 and is the first medicinal product licensed in the EU. In the EU, there are approximately 37,000 new cases of aggressive B-cell NHL every year.

"Patients with late-stage aggressive NHL who are not eligible for, or who have not responded to, second line therapy, have very limited treatment options and a bleak outlook, with average survival of less than a year," commented Dr Ruth Pettengell, consultant Hemato-Oncologist at St George's Hospital, London and principal investigator of the phase III EXTEND study. "The evidence for Pixuvri demonstrates improved efficacy over current treatment options, but without the cardiotoxicity of anthracyclines. By addressing this unmet need, Pixuvri is an important new treatment option for physicians treating this group of patients."

In the EXTEND (Expanding the reach of anthracyclines with piXanTronE in relapsed or refractory aggressive NHL Disease) study for Pixuvri, when compared with other active single-agent  treatments, more patients on Pixuvri achieved a complete response or unconfirmed complete response, and also survived for longer before their disease progressed. Prior to the approval of Pixuvri there was no standard of care for treating patients who failed front line and second line therapy for aggressive B cell NHL. The EXTEND trial is the only randomized controlled clinical study in this patient population establishing the standard of care for this patient population.

"We are pleased to be able to offer the first meaningful treatment option for physicians treating those patients with multiply relapsed and refractory aggressive NHL," stated James A Bianco, MD, president and CEO of CTI. "CTI looks forward to making this innovative product available to healthcare providers across the European Union."

Pixuvri is a novel aza-anthracenedione with unique structural and physio-chemical properties. Unlike related compounds, Pixuvri forms stable DNA adducts and has demonstrated superior anti-lymphoma activity compared to related compounds. Pixuvri was structurally designed so that it cannot bind iron and perpetuate oxygen radical production or form a long-lived hydroxyl metabolite - both of which are the putative mechanisms for anthracycline-induced acute and chronic cardiotoxicity. These novel pharmacologic properties allow Pixuvri to be administered to patients with near maximal lifetime exposure to anthracyclines without unacceptable rates of cardiotoxicity.

In May 2012, Pixuvri received conditional marketing authorization in the EU as monotherapy for the treatment of adult patients with multiply relapsed or refractory aggressive NHL. The benefit of pixantrone treatment has not been established in patients when used as fifth line or greater chemotherapy in patients who are refractory to last therapy.

CTI is currently accruing patients into a phase III trial comparing pixantrone and rituximab with gemcitabine and rituximab in the setting of aggressive B-cell NHL. European sites will be participating in this study later this year.

Pixuvri is available in the EU through Named Patient Programmes in those countries where it is not available commercially. Pixuvri does not have marketing approval in the United States.

Similar to accelerated approval regulations in the United States, conditional marketing authorizations are granted in the EU to medicinal products with a positive benefit/risk assessment that address unmet medical needs and whose availability would result in a significant public health benefit as determined by the assessment conducted by the European Medicines Agency. A conditional marketing authorization is renewable annually. Under the provisions of the conditional marketing authorisation for Pixuvri, CTI will be required to complete a post-marketing study aimed at confirming the clinical benefit previously observed.

The European Medicines Agency's (EMA) Committee for Medicinal Products for Human Use has accepted PIX306, CTI's ongoing randomized controlled phase III clinical trial, which compares Pixuvri-rituximab to gemcitabine-rituximab in patients who have relapsed after one to three prior regimens for aggressive B-cell NHL and who are not eligible for autologous stem cell transplant. As a condition of approval, CTI has agreed to have available the PIX306 clinical trial results by June 2015.

NHL is caused by the abnormal proliferation of lymphocytes, cells key to the functioning of the immune system. It usually originates in lymph nodes and spreads through the lymphatic system. NHL can be broadly classified into two main forms—aggressive and indolent NHL. Aggressive NHL is a rapidly growing form of the disease that moves into advanced stages much faster than indolent NHL, which progresses more slowly.

There are many subtypes of NHL, but aggressive B cell NHL is the most common and accounts for about 50 per cent of NHL cases. After initial therapy for aggressive NHL with anthracycline-based combination therapy, one-third of patients typically develop progressive disease. Approximately half of these patients are likely to be eligible for intensive second-line treatment and stem cell transplantation, although 50 per cent are expected not to respond. For those patients who fail to respond or relapse following second-line treatment, treatment options are limited, and usually palliative only. Pixuvri is the first treatment to receive EU regulatory approval for treatment of patients with multiply relapsed or refractory aggressive B-cell NHL.